THE ROLE OF PHYSICAL THERAPISTS
THE ROLE OF PHYSICAL THERAPISTS
Multiple System Atrophy( MSA)
Patients will benefit from ongoing exercise, physical activity and social engagement throughout the course of the disease, including appropriate group exercise classes. While the literature on rehabilitation for MSA is limited, it suggests that PT plays a role in managing balance and gait. PT is likely to be needed at various times throughout the course of the disease.
Treatment Strategies
• Patient and caregiver education about disease
For bradykinesia and rigidity:
• Levodopa and dopamine agonists may help initially
• Aerobic and flexibility exercises; large movements
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For orthostatic hypotension:
• Fludrocortisone, midodrine
• Increase salt in diet
• Rising slowly and resting after position changes
• Support stockings
• Elevate head of bed
• Smaller, more frequent meals
• Avoid increased time in motionless positions
• Avoid warmer temperatures
• Avoid valsalva-provoking maneuvers
For meal time:
• SLP and OT consultations
• Upright posture in chair
• Alternate food and liquid swallows
• Softer foods
• Adaptive devices to help make self-feeding easier and safer
For antecollis:
• Stretching and positioning / bracing
• Tilt wheelchair
• Botox not often used due to possibility of further speech and swallow problems occurring
For parkinsonian-type gait:
• Focus on large steps and heel strike
• Teach safe turns, i. e., U-turns in open spaces, avoiding pivot turns or crossing one foot over the other to turn
• Appropriate assistive devices; generally swivel-wheeled rollators with brakes work well; wheelchairs or scooters will eventually be needed