AUTHOR: J. Moreno Sanjuán.
Bachelor in Physiotherapy
Physiotherapist of Avilés  “San Agustín” Hospital
email:javivimosan@telecable.es

RESUMEN

Los casos de Esclerodermia que llegan a las manos del fisioterapeuta son muy escasos, ya que la gran mayoría son tratados mediante farmacos por el clínico.

Al llegar a nuestras manos un paciente de Esclerodermia quisimos aprovechar la ocasión para demostrar que el tratamiento fisioterápico es efectivo para paliar los efectos de esta enfermedad; este consistio en : hidroterápia, baños de parafina, ejercicios respiratorios, cinesiterápia y estiramientos musculares; consiguiendo con ello un aumento de los arcos articulares y un aumento de la función respiratoria redundando todo ello en una mejor calidad de vida del paciente.

KEY WORDS

Esclerodermia; Fisioterapia; Cinesiterapia; Ejercicios respiratorios; Termoterapia; Hidroterapia.

Abstract

Very few sclerodermia cases come into physiotherapist hands since most of them are treated with drugs by clinical.
Having come a sclerodermia patient into our hands, we wanted to make the most of it in order to prove that physiotherapeutical treatement is effective to relieve the effects of this illnes. This treatment lied in: hydroterapy, paraffin baths, breathing exercises, kinesitherapy and stretching. We obtained with it an increase in the articulate arches, as well as an increase in the breathing function. All this improvements are to the advantage of a better quality of life of the patient.

KEY WORDS

Sclerodermia; Physiotherapy; Kinesitherapy; Breathing exercises; Thermotherapy; Hydrotherapy.

INTRODUCTION

Sclerodermia produces an articular and muscle invalidating clinical picture with several breathing and visceral signs.
 
Physiotherapy must treat the patient attending a musculoarticular and respiratory point of view. 

In the case we are concerned about, we find a male patient who presents poikiloderma, Raynaud syndrome which affects the fingers in both hands, a generalised epidermal waxy appearance; the patient´s age is 48 and he is done a spirometry due to his respiratory function deficit in the beginning of the treatment in order to compare it with a later result:
 
C.V.
Theorethical 3940 Found 2150 % 55
VEMS
Theorethical 3100 Found 1350 % 44
I. Tifeneau
Theorethical 79% Found 63%

Regarding the articular and muscle problem of the patient, we will focus on hands, wrists, shoulders and ankles since these are the most affected joints. He shows a lack of extension in both wrists of 45º with metacarpophalangeal flexion, abduction of the right shoulder of 110º, slighty deficiency in shoulder flexion (- 25º), bilateral pes equinus that impedes normal walk; he also presents a 20º metacarpophalangeal flexion with inability for extension without previous flexion of the wrist.

We start physioterapy treatment in order to improve ordinary life activities of the patient because of everything which has been previously detailled. Throgh this essay, we want to highlight how important it is to treat these type of patients multidisciplinarly and stablishing physiotherapy protocols. 

INSTRUMENTS AND METHOD

For the sclerodermia treatment, this spedific case, we use:
-Hydrotherapy
- Paraffin wax baths
-Kinesiotherapy
- Directed respiratory exercises
- Assisted mobilizations
- Massage
- Stretchings
- Active exercises
- Self-stretchings
- Bicycle

Hydrotherapy consisted on subaquatic spurts  and general exercises in swimming pool at 36,5º C during 15 minutes.

Paraffin wax baths have been applied during 10 minutes before mobilisation and stretching.

Regarding kinesiotherapy, respiratory exercises have been practised, specially on costal expansion, diafragmatic exercises and auxiliary respiratory muscles workout. Assisted mobilisations and stretchings have been done in shoulders, elbows, wrists and fingers. Active exercises were stablished looking forward to increase flexibility of cervical column and trunk. Massages consisted on kneadings of both triceps before self-stretchings done using the Freeman table for elongation of both muscles. And bicycle in order to achieve a general tonification of the lower limbs.

Treatment lasted 4 months and daily sessions were done (5 days a week).

A Espiro-Flow III has also been used for stimulating inspiration after the respiratory exercises.

RESULTS

Some days before deciding the patient discharge, he was done a spirometry to compare his stage before and after the treatment. The results were the following:

C.V. Found 2650 % 65
V.E.M.S. Found 1850 % 59
I. TIFFE 69,8%

These data compared to the ones obtained during the previous spirometry done at the beginning of the therapy show an increase in the vital capacity and in the  maximum expiratory volume per second.

Since the first days of treatment, the patient expresses an subjective improvement (“he feels lighter”); the exercises he has to perform are easier every day after hydrotherapy than whenever he does them at home. He also states an improvement in his respiratory function which is corroborated by the use of Espiro-Flow III. This machine is used both for achieving an approximate control of the respiratory function and for exerting a patient stimulus and self-control. 

By the time the patient is discharged, he states:
- 140º abduction of both shoulders
- complete shoulder flexion
- 15º ankle dorsal flexion (removal of pes equinus), what allows the patient to walk normally even though the dorsal flexion of the ankle is not complete.

Regarding the wrist and the fingers, results were worse. A complete extension of wrists was not achieved. Nevertherless, a physiological posture of wrist and fingers is achieved, by which the patient obtains a significative improvement in the function of  both hands.

At discharge, the patient is advised to continue exercises and stretchings of the muscle groups he used to workout in the gym, costal expansion respiratory exercises, and the use of the inspiration stimulator.

CONCLUSIONS

Due to the reduced number of sclerodermia cases that physiotherapists may find, it is essential to open a treatment protocol through physical therapy, without underestimating other ways to alleviate this illness. 

This physiotherapy treatment must focus in respiratory disorders in most of the cases. The muscle and joint disorder claims for heat in any of its ways and for the stretching of the group of muscles affected after this heat application.

It is important that the patient becomes conscious of his illness and that the therapy doesn´t end when he leaves the gym. We must educate and train him whatever may be beneficial in order to endure the results obtained. We must also show him how to identify any worsening in the functions achieved so that he can prevent this from happening. This is the reason why the following up of these patients is specially important. The last objective of physiotherapy for these patients is improve ordinary life activities.

BIBLIOGRAPHY
Gregorio Marañon. Manual de Diagnóstico Etiológico. Espasa Calpe 1974 p. 147, 882.

Farreras, Rozman. Medicina Interna. Ediciones Doyma 1988 p. 1042 a 1045.

Antonio Luigi Maccagno. Kinesiología Respiratoria. Editorial Jims 1973. p. 84, 85.

H. O. Kendall, F. P. Kendall, G. E. Wadsworth. Músculos Pruebas y Funciones. Editorial Jims Barcelona 1979. p. 23, 24, 26, 160 a 162.

V. Sanchis Olmos, F. León Vazquez. La Mecánica del Aparato Locomotor y su Exploración Funcional. Publicaciones del Servicio de Traumatología del Hospital Provincial de Madrid 1959. p. 25 a 31, 77 a 122, 207 a 209.

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