Physiotherapy can help to manage many of the symptoms of Rett syndrome, a rare neurodevelopmental disorder that affects and delays physical and cognitive development. It almost exclusively affects girls.
Disease symptoms can include growth defects, motor and gait problems, communication issues, an inability to perform learned movements, atypical and abnormal hand and eye movements, and bone deformities, as well as cognitive disabilities, breathing problems, seizures, an irregular heartbeat, abnormalities in spine curvature (scoliosis), and problems with the gastrointestinal tract.
Many are of a neuromuscular nature, raising the possibility that they might be better managed with tailored physiotherapy regimens. Physiotherapy is reported to be especially useful in addressing problems related to motor functions, muscle tone, hand movements, learning disabilities, breathing issues, bone deformities, and cardiovascular irregularities.
The goal of physiotherapy is to gradually improve mobility, coordination, and balance, so as to assist the patient in gaining greater control over movement and greater independence. Since day-to-day and patient-to-patient variability in symptoms are common, physiotherapists often need to tailor the regimen for each patient, and possibly adjust it on a daily basis to meet the mood swings that Rett’s patients may experience.
Physiotherapists have to be mindful of the patient’s progress and individually adapt physiotherapy goals accordingly.
Because symptom onset begins at an early age, physiotherapy ideally should be started as soon as possible after a diagnosis.
Types of physiotherapy
Different physiotherapy interventions that can be used to address specific problems in Rett syndrome include:
Movement, balance, and coordination
Apraxia, or the inability to perform learned motor movements despite understanding the command, is common in Rett patients. Physiotherapy regimens for this likely stress repetitive functional movements and activities.
Specific physical exercises can also be included in the regimen to gradually improve cardiovascular fitness, muscle tone, and balance. Treadmills and stair climbing machines to facilitate physical movement is encouraged by physical therapists. Many will advise the use of braces or casts to manage symptoms arising due to bone deformities and scoliosis.
Physiotherapy here may also focus on stimulating use of the hand use, and proper positioning of the fingers and the wrist, to lessen abnormal hand movements. Splints or similar devices are often incorporated into these exercises to help with hand movement and use.
A physiotherapy regimen may include proprioceptive training exercises — exercises that aim to improve a patient’s sense of spatial orientation, so as to help with balance and coordination.
Hydrotherapy is a special form of physiotherapy, and often included in programs for Rett’s patients to alleviate pain and facilitate movement. It makes use of particular properties of water, such as buoyancy and pressure, to improve blood circulation and to tone and relax muscles. Often, hydrotherapy is recommended for neurological disorders that affect a person’s sense of balance and proprioceptive input.
Hippotherapy uses the movements of a horse as a therapeutic tool. It requires a trained physiotherapist, a professional horse handler, and a horse specifically trained for this purpose. Hippotherapy is reported to help with the muscle coordination and strength, and the sensory processing that go into walking, talking, and using the fine motor skills that are part of daily life activities.
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