Physical and Occupational Therapy for Spinal Muscular Atrophy

Muscle weakness is the most obvious symptom of spinal muscular atrophy (SMA). It varies for every person, depending on disease severity. How it affects motor functioning and daily activities also varies for every person. Managing muscle weakness can help people with SMA achieve the highest possible level of function and independence.

Usually, physical and occupational therapists will lead part of SMA management. These are experts who can evaluate motor functioning and recommend exercises and tools to help. In most cases, the goal of physical therapy is to improve physical functioning and prevent complications.

What are physical therapy and occupational therapy?

Physical therapy (PT) is focused on improving movement. A physical therapist can design a personalized exercise program. In most cases, PT focuses on improving posture and joint mobility, and slowing down muscle weakness. Physical therapists can also suggest mobility devices and assistive equipment.^1,2

Occupational therapy (OT) is focused on increasing independence in daily activities. For example, an occupational therapist can help people with writing, using a computer, feeding, and dressing. Occupational therapists can also:^1,2

• Suggest devices and modifications to improve accessibility at home, work, and in school, such as mechanical lifts, ramps, shower chairs, and resizing doors for wheelchair access
• Work with schools to provide modifications, such as elevator access, specific seating, and wheelchair accessibility
• Suggest ways to conserve energy

What does research say about physical therapy in SMA?

A proactive PT program can improve health outcomes in SMA. Joint contractures and scoliosis are linked to a greater loss in motor function. Preventing or delaying these joint complications is a main focus of PT.^3,4

Experts are currently researching how to best use exercise as a treatment for SMA. Two early studies have tested different exercise programs in SMA. The first study showed that strength training can improve motor function in people with type 2 or 3 SMA. The second study showed that a bike exercise program can improve exercise capacity for people with SMA.^5,6

An ongoing clinical trial is testing the benefits of PT for children with type 2 or 3 SMA. The trial is testing if a swimming exercise program can improve motor functioning.⁷

How is PT used to manage SMA?

As soon as possible after an SMA diagnosis, families should meet with a team of doctors to determine treatment plans. This team will include a physical therapist and an occupational therapist.⁸

The goals of PT are different for every person. Everyone responds to exercise differently. This is why exercise programs should always be personalized and guided by a physical therapist.

For children with type 1 SMA, PT aims to improve motor function, reduce impairments, and improve tolerance to different postures. This includes:³

• Daily use of seating systems, posture supports, and upper back bracing
• Daily use of arm and leg braces (orthoses) to promote function and range of motion
• Stretching and range-of-motion exercises 3 to 5 times per week
• Assistive technology and adaptive equipment, such as bath equipment, adapted beds, and lifts

For people with type 2 SMA, PT aims to prevent contractures and scoliosis. It also aims to improve function and mobility. This includes:³

• Bracing to improve posture, head support, and physical function
• Stretching and range-of-motion exercises 5 to 7 times per week. These exercises focus on joints at risk for contractures, such as the hip, knee, ankle, and wrist.
• Supported standing for 1 hour per day, at least 3 to 5 days per week
• Braces for arms and legs
• Assistive technology and adaptive equipment, such as gait training devices and custom wheelchairs

For people with type 3 or 4 SMA, the main goal of physical therapy is to maintain mobility, joint range, and balance. This usually includes:³

• Activity programs that include aerobic and conditioning exercises
• Stretching and range-of-motion exercises at least 2 to 3 times per week
• Balance exercises and gait training to prevent falls
• Leg braces to improve posture and function at the ankle and knee