wcpt congress: event of a lifetime - World Confederation for Physical ...

PROFESSIONAL ISSUES
ARTHRITIS: THE PHYSIOTHERAPISTS
WHO TREAT IT
Fun with fitness
For fourteen years she’s been taking
an exercise class aimed at people
with arthritis – and many of the same
people are still coming! It’s a class of
36, with usually about 20 at any one
time, and includes a lot of husband
and wife teams but no single men.
The youngest participant is 50.
“My goal is to keep them fit, not make
money, says Sandy Juergens “– but I’m
also getting my exercise.”
All types of arthritis are represented:
“Joint replacements, general OA,
specific joints – a conglomeration. And
it’s not limited to arthritis; a few others
come along.”
Twice a week Sandy runs this one-hour
class in the Gospel Hall in Rangiora,
charging $3 per class or $5 for two
classes in the week.
• 20 minutes: warm-up with stretches
– more than for a regular class, more
range of motion
• 20 minutes: toning exercises – more
balance and core exercises than in
most exercise classes – many do
them on the floor, some standing,
some do the entire class sitting. “It
doesn’t matter what stage they are
at, they can benefit from the class.”
• 20 minutes: cardio workout – low impact
aerobic dancing, ending with a
minute of posture exercises (low back
extensions, backward shoulder rolls,
chin tucks). As a former dancer, Sandy
choreographs all the dances herself.
• Sandy allows a few moments for
instructions and questions, or stays
on a little longer.
Anyone joining the class completes
a medical information form, and is
given a handout. Sandy ensures that
each participant takes their pulse twice
during every class.
The number one rule of the class is to have fun, Sandy tells her group. “That’s why
they keep coming back. If it’s just hard work, people probably won’t keep it up.”
Physiotherapy for haemophilia
Physiotherapy management of
haemophilia has changed considerably
in recent times. A more proactive
focus on this group of patients with a
high-cost, chronic condition has been
successful in the Auckland region.
Once haemophilia’s vicious
cycle of bleeding and adaptive
musculoskeletal changes starts,
it can be difficult to stop the
accelerated arthritis which
characterises this condition
A Changing Population
Young men growing up today are
fortunate to have far less chronic
joint damage than their older peers.
Older men with haemophilia who
did not have access to factor concentrates
or prompt physiotherapy rehabilitation
as children are characterised
by severe, multiple-joint arthropathy
and significant disability.
A vicious cycle: historical
management
Once haemophilia’s vicious cycle of
bleeding and adaptive musculoskeletal
changes starts, it can be difficult to
stop the accelerated arthritis which
characterises this condition, explains
Ian d’Young, who is employed by
Auckland DHB as Haemophilia Physiotherapy
Practitioner.
Historically, once blood entered the
joint cavity, a patient was sent to bed
for a few weeks to rest and recover.
Unfortunately this meant that muscle
proteins were metabolised, flexion
contractures would develop, and
coordination and aerobic capacity
would deteriorate. A vicious cycle of
repeated bleeding, muscle shortening,
weakness, proprioceptive and
biomechanical changes then occurred
while the patient was immobile and
awaited physiotherapy management.
Most young men with haemophilia
had therefore developed severe joint
damage by their early teens, resulting
in life-long disability.
New model of care
The weaker, stiffer, less co-ordinated a
patient, the higher the risk of bleeding.
We know that while joint damage is
proportional to the number of bleeds
that have occurred, it is also proportional
to the speed of rehabilitation.
08 | PHYSIO MATTERS AUGUST 2011