What is physiotherapy?

Physiotherapists (physios) are university-trained allied health professionals who are experts in the way your body moves and functions. They work with children and adults to help you:

• Understand your neuromuscular condition and how it affects your body, both now and into the future
• Find solutions for the activities or tasks that are making your daily life difficult
• Manage pain, muscle tightness, fatigue and other symptoms you might be experiencing
• Mobilise safely both at home and in the community
• Set goals for living with your condition

When would I need to see a physiotherapist?

Depending on your condition and how it affects your daily life, you might see a physiotherapist for any of the following:

Assessments, review and monitoring

• Soon after diagnosis for a baseline assessment. This will include an assessment of gross motor skills, range of movement, muscle strength, gait, balance and coordination, pain, fatigue, respiratory function, posture and spinal alignment.
• Assessment and recommendations on suitable assistive technology/ equipment (eg. walkers, manual wheelchairs, motorised scooters, power wheelchairs) so that you can continue to move around safely and independently at home and in the community.
• Assessment of complex, customised seating to assist with maintaining good spinal alignment, optimal respiratory function and minimising the development of pressure areas.
• Assessment and monitoring of your respiratory (breathing) function and advice about ways to manage your respiratory health, such as the use of a cough assist machine and other airway clearance techniques.
• Regular times throughout the year. This might be as part of a regular review with your neuromuscular healthcare team, or to monitor how you’re going with new activities or equipment. Your physiotherapist may visit you at home, work or school and give advice about mobility, safety, access and ways to manage moving around your environment.

Change in condition

• If you notice any new symptoms, such as increasing muscle tightness or pain.
• When you notice any changes in your abilities such as difficulty walking, changing position, increasing falls, reduced balance and coordination.

Specific management

• For a program of stretches or exercises to do every day to keep your body moving as well as possible.
• Helping you manage secondary symptoms that may develop, such as joint contractures (stiffness) and muscle tightness, and develop strategies to minimise these effects such as regular stretches, advice regarding positioning and/or referral for orthotics or splints.
• Helping you manage your pain and fatigue on a daily basis.
• To start hydrotherapy or exercising in a warm water pool, or are looking for advice about keeping active or joining sport/recreational activities.
• Helping you recover from an injury, acute illness or post-surgery.

Training of carers and disability support workers

• Training disability support workers or carers to carry out your home exercise program.
• Advice on manual handling and to train carers and support workers in manual handling techniques.

What treatments do physiotherapists use?

Treatment and interventions depend on a number of factors including in-depth knowledge of each condition, the clinical presentation, rate of progress and the anticipated development of secondary complications. Regular assessment and prescribed timely intervention are crucial. It is best to seek services from a physiotherapist who has specialist knowledge in the treatment of neuromuscular conditions.

For children, age-appropriate interventions and treatments are recommended through play-based activities and frequent surveillance is essential, as things may change quickly as children grow.

A physiotherapist will complete a detailed assessment, including medical history, presenting symptoms, and safety issues around transfers and mobility. They will assess your movement, muscle strength and joint range with a range of different tests. They will keep records and track changes over time.

Physiotherapists use many different types of treatments which will be individually tailored to your needs and individual goals. Physiotherapy treatments include:

Interventions to manage symptoms

• Exercise programs to improve or maximise your mobility and maintain or maximise muscle strength. The role of active exercise differs depending on your neuromuscular condition. As a general guideline, “to prevent disuse atrophy, it is important to continue with some active exercise, but not to the point of fatigue. Recreational activities appropriate to age are recommended” (Reference: Montrose Access: Duchenne Muscular Dystrophy: A Team Approach to Management. 2011. Funded by NSO (Specialists: Disability Support in Schools)). Endurance can be built up over time. It is important to always find the balance between the amount and type of exercise, and overdoing it. Please note, care needs to be taken with strengthening exercises, as these may be detrimental for some conditions especially those that affect the muscle membrane. You and your physio might find it useful to consult condition-specific physiotherapy guides.
• Mobilisation of joints and soft tissues to reduce pain and stiffness.
• Targeted massage to relax muscles and improve circulation.
• Strategies and interventions to manage pain and fatigue (eg pacing, positioning).

Interventions to minimise the development of secondary complications

• Stretching programs and passive/ assisted active movements to maintain joint range of movement and delay the development of contractures (joint stiffness). The stretch should never cause pain, however, a stretching feeling should be felt.
• Referral to orthotist for night splints (AFOs Ankle Foot Orthoses), usually made of polypropylene, to maintain range of movement at the ankle. This is important to do early, prior to the development of ankle contractures.
• Education on seating and positioning, particularly in wheelchairs, to ensure a supportive seating position is achieved to maintain alignment of the spine, trunk, pelvis and lower limbs, optimise upper limb function, and minimise the development of pressure areas.
  

General health, surveillance and support

• Respiratory care including breathing exercises and airway clearance techniques. This includes spirometry assessment of respiratory function and peak cough flow. Physiotherapists may use an Ambu bag/resuscitator bag to ensure that the lungs expand fully and teach breathing techniques such as breath stacking to get more air into the lungs.
• Treatment and training of support workers/ carers in the use of assistive technology such as the cough assist machine to aid airway clearance and generate an effective cough.
• Hydrotherapy and aquatic physiotherapy.
• Play-based activities for children to develop gross motor skills and maintain range of movement (depending on their type of neuromuscular condition).
• Monitor changes of function with growth in children.
• Advice regarding safe transfers and training of support workers and family members in manual handling.
• Scoliosis monitoring and management, including providing adequate support in sitting and the use of tilt function in power wheelchairs to minimise the effect of gravity through the spine.
• For children, support in their educational setting including specific condition information provision to education staff, advice on accessing the curriculum specific to the diagnosis such as modified activities for physical education, access and movement around the school, fatigue and pain management and their effect on behaviour.
  

Gait and balance training

• Balance and gait (walking) re-training, including the prescription of mobility aids.
• Education regarding safe mobility and falls prevention.
• Referral to orthotist for orthotics and splints to manage foot drop and/or support the structures of the foot during gait.
• Home programs.
• Falls can be dangerous for people with neuromuscular conditions as broken bones take longer to heal and inactivity while recovering from a fall may worsen muscle weakness. Good shoes, clearing any trip hazards from your home and taking care when walking, particularly on uneven ground, can all help to avoid falls. Seek advice from a physiotherapist (or occupational therapist) to learn how you can reduce your risk of falling at home and in the community. Fatigue can also make you more prone to falls. Strategies to manage fatigue including self-pacing, frequent rests and using a wheelchair or motorised device for distances can minimise the risk of falling. When helping someone with a neuromuscular condition to get up from the ground following a fall, it is important not to pull on their upper limbs as they do not have the shoulder stability to ‘brace’. Instead, a through arm hold on the upper limbs, and trunk support to assist them to stand is recommended.

Assistive technology/ mobility aids

• Assistance and education with the use of aids, splints, crutches, walking sticks, manual wheelchairs and scooters.
• Trial and prescription of assistive technology specifically for children including standers, modified bikes and tricycles, strollers and seating systems.
• Your physiotherapist will work with you and equipment suppliers to assess and trial complex mobility aids such as power wheelchairs, manual wheelchairs, power assist add-ons, and complex seating. The process includes trial and selection of equipment, completion and submission of an application to the relevant funding body, delivery and fitting to ensure correct fit, function and safe usage. Visit our page on Equipment for more information.
• Monitor and advice regarding modifications and accessories to existing assistive technology due to growth, decline or changes in function.
  

Post-injury, surgery or illness

• There are times when more intensive interventions are required such as post-surgery (eg spinal rodding), post-injury (eg fracture) or post-illness (eg respiratory infection).
• Blocks of treatment (eg hydrotherapy, stretches or targeted exercise) are often necessary at this time where there is an intense focus on returning to prior levels of function. This may not always be achieved, depending on the condition and the level and type of injury/ event.
  

Please note this list is not comprehensive and there is no one protocol that will fit all neuromuscular conditions.

Where to find a physiotherapist

1. Contact your state or territory neuromuscular organisation for information on where to find a physiotherapist. Some of these organisations have specialised allied health professional teams or may be able to advise on allied health professionals who have an interest in treating people with neuromuscular conditions.
2. Physiotherapists work in both the public and the private healthcare system. There are dedicated neuromuscular teams, linked to public hospitals in some capital cities in Australia which have physiotherapists, or who may be able to link you with a local physiotherapist. Some public hospitals and community health centres have physiotherapy clinics, but there is usually a long wait. You will need a referral from your doctor.
   Physiotherapy appointments may be centre-based, home visits or take place at community centres such as the local pool. They may be individual or group sessions, and this will have an effect on the cost. Travel costs may be added to home visits.
3. You can choose to see a private physiotherapist and pay through
   • Your NDIS plan
   • Private health insurance
   • Medicare, through a Chronic Disease Management Plan prepared by your GP
   • My Aged Care-Home Care Package
   • Private funds