Aging and muscular dystrophy – why you should consider physiatry
A physiatrist is a physical medicine and rehabilitation specialist, who treats conditions involving muscle and nerves, with a goal of helping to maintain and restore abilities and function, says Dr. Rajiv Reebye, a physiatrist and staff physician with G.F. Strong Rehabilitation Centre in Vancouver. Dr Reebye was one of the presenters at Muscular Dystrophy Canada’s Empowerment in Action (EIA) Conference, held recently in Richmond BC.
According to Dr. Reebye, a physiatrist can be a very important part of your healthcare team — especially as you age — along with other types of specialists such as occupational therapists, dieticians, social workers and pharmacists.
A physiatrist can help you with a targeted exercise program, designed to strengthen, increase flexibility, reduce pain, and decrease muscle atrophy. Dr. Reebye says that high-resistance training is not usually recommended because of the risk of muscle fibre injuries, but aerobic and light-resistance training can be very helpful. Beneficial exercises include swimming, walking and cycling, depending on your abilities – and proper stretching is also very important.
Of the aerobic exercises listed above, swimming is most highly recommended. It can be done right from early ambulatory to early non-ambulatory phases, and can be continued as long as it is deemed medically safe. It is particularly beneficial because it can be considered both aerobic conditioning and respiratory exercise, he says.
A proper exercise plan can help with so many things, including bone health, respiratory conditioning, prevention of contractures, increased general wellbeing, and decreased disuse atrophy of muscles. A physiatrist can help ensure you are doing the right form of exercises that will benefit you specifically, and can teach you how to modify activities if you experience pain or other difficulties.
For example, significant muscle pain/cramping/breathing difficulties up to 24 hours after a specific activity is a sign of overexertion and contraction-induced injury. If this occurs, the activity should be modified, Dr. Reebye says. Pain often results from positioning problems in wheelchair/contractures, and can often be managed conservatively, such as with enhancing seating, topical creams or aqua-therapy.
Proper stretching is also an important part of any ongoing program. Stretching should be performed at least 4-6 times a week as part of family’s daily routine, and effective stretching may require a range of techniques including stretching, splinting and standing devices.
Regular ankle, knee and hip stretching are particularly important early on, Dr. Reebye says. Later, regular stretching at the arms becomes necessary – especially fingers, wrist, elbow and shoulder. Additional adaptations in late ambulatory and non-ambulatory stages may be needed to help with getting upstairs, transferring, eating/drinking, turning in bed, and bathing, he says.
In order to have the best quality of life possible, Dr. Reebye stresses, it’s important to know your team, understand your body, keep exploring equipment options that may help you, and don’t be afraid to ask for help early.