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Benefits of Physical Therapy for Patients with SclerodermaJessica Mandac PT, DPTRehabilitation Institute of ChicagoCenter for Pain Management

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What Physical Therapists Know About Scleroderma

• Systemic autoimmune disorder• Rheumatic disease• Fibrosis of organs• Chronic• Progressive• 2 types:

• Diffuse Cutaneous Involvement• Skin thickening proximal to elbows and knees

• Limited Cutaneous Involvement• Either no skin thickening or thickness limited to

distal extremities

+ Common Symptoms Reported

Increased fatigue Pain Difficulty opening mouth/eating Joint Stiffness Ulcers Poor circulation to fingers/toes Weakness

Hand, grip, legs, trunk

Depression Anxiety Anger Frustration

Physical: Emotional/Psychological

+Body Systems Involved that are Addressed in Therapy

Myositis Soft tissue restrictions Contractures

Hands, wrists, hips/knees

Joint restrictions Wrists, fingers, shoulders, hips, knees, ankles Spine

Musculoskeletal:

+Body Systems continued…

Pulmonary hypertension Vasculitis Dyspnea Anemia Chest wall restriction Interstitial Lung Disease Poor Circulation

Raynaud’s

Pulmonary/Cardiac Systems:

+Body Systems completed…

Skin thickening Swelling

Nervous System: Peripheral Nerve

Entrapment Median nerve (carpal

tunnel) Ulnar nerve Trigeminal nerve

Integumentary & Lymphatic Systems:

GI system: Stomach pain Constipation Diarrhea

+ Outcomes Assessed

Activities of Daily Living Recreational activities Work activities Sleep Fatigue Depression/Anxiety/Mood Overall Health Pain Fear

Outcome Assessment Tools: Health Assessment Questionnaire Short Form-36 Tampa Scale for Kinesiophobia Lower Extremity Functional Scale Visual Analog Scale

HealthAssessmentQuestionnaire

Tampa Scale for Kinesiophobia

Lower ExtremityFunctional Scale

Visual Analog Scale

Strengthening/Stability:

• Core/trunk

• Axioscap/shoulders

How to Treat the Symptoms: Musculoskeletal

Mobility:

• Gentle movement

• Active and Active Assisted Range of Motion

• Stretching

• Hips/gluteals

• Ankles

• Joint mobilization/Passive Range of Motion

• Soft Tissue Massage

• Modalities: Ultrasound, Heat/Heating pad

Core/TrunkHip/Gluteals: Lying position

Core/TrunkHip/Gluteals: Seated Position

Axioscap/Shoulder Exercises

Ankle Stability Exercises

Stretching (Active):Lying position

Stretching (Active):Seated position

Oral/Facial Exercises (Active):

Chair Yoga

Chair Yoga cont.

+How to Treat the Symptoms: Pulmonary/Cardiovascular Appropriate cardiovascular activity:

Walking (treadmill or overground) Cyling (stationary or outside) Elliptical Nustep Upper Extremity Ergometer (Arm Bike)

Maintaining 60-80% of maximum heart rate Allows endorphin release for natural pain relief Strengthens heart tissue Increases blood flow allowing increased oxygenation to tissues

+How to Find Target Heart Rate Zone• 20-30 minutes within age adjusted target heart

rate zone1. [Age] x 0.67 = ________

2. 206.9 - ___________ = _______ (number found (MAX HR) in step 1)

3 . [MAX HR] x 0.6 = ______

4. [MAX HR] x 0.8 = ______

Your target HR zone= [number found in Step 3] to [number found in Step 4]

____ bpm to _____ bpm

+How to Treat the Symptoms:Integumentary/Lymphatic/Nervous/GI

Integumentary/Lymphatic Systems: Manual lymph drainage

techniques (LANA certified) Soft tissue massage Gentle range of motion

Nervous System: Neural

mobilization/flossing for specific structures involved

Primarily median, ulnar, and trigeminal nerves

Gastrointestinal System: Regular cardiovascular

activity will assist with intestinal motility

+ Neural Mobilization/Flossing

Median Nerve Ulnar Nerve

+ Neural Mobilization/Flossing cont. Trigeminal Nerve

+Aquatic Exercise

Aquatic Exercise 98.6° Waist, chest, or shoulder level Water dumbbells Kickboard Pool noodles Ankle weights

Benefits:• Decrease

swelling• Decrease

stiffness/Increase mobility

• Increase muscle strength

• Increase cardiovascular fitness

• Decrease pain• Increase overall

physical function

Aquatic Exercise

Aquatic Exercise Cont.

Activity Pyramid

+ Multidisciplinary Treatment

Promotes ACTIVE role in management: FUNCTIONAL RESTORATION

Medication management/pharmacological interventions

Learning emotional coping skills Relaxation techniques to decrease

tension/stress Improving strength, mobility, endurance Improving physical activity tolerance Improving body mechanics, energy

conservation, and work-related physical capacities

Increasing education Assistance with returning to work

Physicians Physical Therapists Occupational Therapists Psychologists Biofeedback Therapists Vocational Therapists

Benefits Disciplines

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Questions??

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Thank You!!!

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