Sclerosi sistemica,riabilitazione english

Progressive Systemic Sclerosis is a systemic disease, in which there is an immune-inflammatory involvement of connective tissue, and organs. Rehabilitation is an integral part of a patient therapy.

Following some essential information that the patient should better know before undergoing a treatment program of physical therapy and physiotherapy written by:

Tiziana Nava Doctor of Physical TherapyVicepresident Italia Health Professional ,National contact for Specialist Interest Group on Rehabilitation on Rheumatic Diseases Associazione Italiana Fisioterapisti.

e mail: [email protected];

www.sclerosistemica.info

1. Rehabilitation must be carried out only by certified physical therapist.

2. Each rehabilitation is targeted to each single person: there are no equal rehabilitation programmes among the patients with the same disease.

3. We remind the patient that the correct treatment does not ever bring pain, it is not aggressive and traumatizing but it is gradual and relaxing.

4. The therapist should always explain to the patient the methods he intends to pursue by explaining to him his reasons.w

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5. The patient has the right to ask for explanation if the procedure is not clear enough to him.

6. After the treatment, the patient should feel wellbeing, which may be accompanied by a muscle strain, that it is very different from feeling pain.

7. Always at the end of treatment the patient should not have inflammatory manifestations such as swelling, bruising, difficulty in moving, local or diffuse pain.

8. It may happen that the patient is surprised that the therapist is working in a body part other than the one in which he complains for pain: it is a practice sometimes necessary, on which the physical therapist must be prepared to provide explanations.


The mission

The aim of physiotherapy is to :

recreate a muscular-skeletal situation by taking into dueconsideration the damage caused by the disease,

restoring a body posture with appropriate schemes andsupports to solve the secondary damage,

create conditions for a possible prevention of bad posture

educate the patient to correct gestures and healthylifestyle in the management of his condition.


The Programme

The physical therapy program should always be plannedand developed together with the patient, by consideringhis limits and potential capabilities.

Along with the intervention to relief the pain, areappropriate techniques that seek to recovery jointmobility, muscle and tissue at different body districts.

Part of the physiotherapy programs are breathingexercises, which aims to improve the pulmonaryventilation


The area cranio-cervical-mandibular and facial

The specific evaluation of the face investigates on which and how many disabilities the patient is performing on the normal activities of daily living, such as relationship difficulties and limitations on self caring (brushing teeth, facial care , make-up operation, dental care etc).

Treatment aims to recover the expressiveness, the improvement on appearance, gaining facial features and limbs.


The trunk

In the diffuse forms of systemic sclerosis fibrotic process affects not only the chest with sclerosis of the skin, but also internal organs causing myocardial fibrosis and pulmonary fibrosis.

The skin of the trunk is hard, inextensible, adherent to the subcutaneous tissue so that the patient reports the sensation of being caught in a "rigid sheath”.

This condition hinders the movement of flexion, extension and lateralization of the trunk and limits the elevation of the arms due to the particular skin tension that is created under the armpit.

The rehabilitative techniques aims to spread initially the tissue, afterwards to recover articular ability.


The upper limb

In progressive systemic sclerosis the hands are particularly important since the disease has different manifestations that make it difficult to maintain the use of them:

sclerosis of skin, subcutaneous tissue and tendons;thickening of the skin;inelastic skin;Raynaud's phenomenon;ulceration of soft parts;edema;joint deformities

The rehabilitative intervention is complex and is depending on the evaluation on the stage of disease, therefore the programme may use many techniques and aids.


Lower limbs

In progressive systemic sclerosis, the function of physiotherapy is that to maintain the function of joints, particularly those of foot, ankle, knee, hip, that might be affected by any arthritis and tendinitis


The foot

The involvement of the foot causes a double trouble, while it is experienced a damage caused by vascular lesions,

cutaneous and subcutaneous,

Muscle and tendon

and headbands bone,

the more complex are the consequences at a global level.

The foot, compared to the hand, is subject to an aggravating factor, the load, which involves continuous stresses in pressure, caused by an uneven distribution of body weight, and that seriously affects the severity of the deformity.


The Methodology

In the acute stages of the disease it is recommended to rest in bed with frequent changes of decubitus , relaxation and passive mobilization, proper breathing exercises.

In sub-acute phase, according to the improvement of the clinical status, it is suggested:

Relaxation techniques like autogenous training of Schultz, Jacobson's progressive relaxation and biofeedback;gymnastics, the eutonia of Alexander, the method Feldenkreis, Bertherat of the anti-gymnastic;District manual therapies such as pumping, the passive mobilizations and active against resistance the neuromuscular facilitation, isometric exercises, technique Mulligan, the Maitland concept ;global techniques such as global postural re-education,

massage techniques (lymphatic drainage, manipulation of the fascia, connective tissue massage);rehabilitation in water;exercises to strengthen the bone, as listed in the chapter on osteoporosis.


Sclerosi sistemica,riabilitazione english

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