Musculoskeletal Rehabilitation in the Person with Scleroderma

Janet L. Poole


Curr Opin Rheumatol. 2010;22(2):205 

In This Article

Range of Motion Exercises

Two studies examined the effectiveness of range of motion exercises without the paraffin (Table 2).[19,20] One single case study[19] compared continuous passive motion machine and three other interventions in a 42-year woman with scleroderma (disease duration of 3 years). Each phase lasted 6 weeks except baseline, which was 2 weeks. An ABCD design was used for each hand over a period of 20 weeks. The phases for each hand were as follows: for the right hand, A was baseline, B was use of a continuous passive motion machine (CPM) 30-45 min daily, C was hands on physical therapy consisting of active (AROM) and passive range of motion (PROM) and stretching exercises for each finger joint, and D was a resting splint worn at night. For the left hand phase A was baseline, B was a warm wrap for 25 min (while the right hand received the CPM), C was CPM for the left hand, and D was the hands on physical therapy consisting of the AROM and PROM and stretching. There was no significant improvement in hand range of motion, strength, or swelling at the end of the 20 weeks.

Mugii et al.[20] evaluated the effectiveness of a self-administered stretching program for individual fingers. Each exercise was held for 10 s and repeated 3-10 times. The three exercises were MCP flexion, interphalangeal extension, and interphalangeal flexion. Total passive motion, or the sum of the extension/flexion measures in each finger joint, significantly improved in each finger 1 month after intervention as did hand function (Health Assessment Questionnaire; HAQ). These improvements were maintained or improved during the year after the first visit.

The contractures in the hand are the most visual musculoskeletal impairment; however, scleroderma also results in a mechanical inability to open the mouth because of skin tightening due to subcutaneous and ligamentous collagen deposits.[21] Small mouth opening or microstomia, along with other symptoms such as dry mouth, can lead to difficulties with teeth and mouth care and eating. Several studies (Table 3) have shown that range of motion and stretching exercises are effective in increasing mouth opening[22,23,24•] with subsequent improvements in speaking and eating ability[23] and oral hygiene.[24•] The exercises consisted of exaggerated facial movements, manual stretching of the mouth with the thumbs, and oral augmentation exercises using tongue depressors.[22,23,24•]


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