Сlinico-biomechanical foundation of necessity of rehabilitation in adult patients with hereditary limb-girdle muscular dystrophy, type I: clinical case

Abstract

Modern approach to rehabilitation of patients with limb girdle muscular dystrophy of type I are discussed in this article. Authors thoroughly investigated the clinical picture of limb-girdle muscular dystrophy, pathogenesis of this disease and the main principles of its treatment. On the example of the concrete patient authors considered the clinical picture of the limb-girdle muscle dystrophy and also the biomechanical and energetic parameters of walking. Authors demonstrated, that essential disturbance of the locomotor function is seen in this patient, what is revealed in remarkable diminution of the mean walking velocity, in severe transformation of the temporal structure of walking, in reduction of amplitude of movements at some joints of the lower extremities and increase of amplitude at the other joints, in displacement of all extreme values to the right along the temporal axis, in remarkable weakening of the support and push functions of the lower extremities, in change of the form of the vertical component Rz of ground reaction force from two-peaked to the triangular, in expressed diminution of moments of muscle forces at the joints of the lower extremities. Authors also point out, that it is necessary to carry out regular courses of rehabilitation in such patients with the purpose to improve the locomotor function. Besides, it is very expedient to retrace systematically changes of the biomechanical and innervative structure of walking. On the grounds of investigation of structure of walking of patient with limb girdle muscular dystrophy authors revealed necessity of ortheses and the subsequent application of functional electrical stimulation of muscles during walking. On the basis of realization of the trial sessions authors for the first time determined the main correctional influences, necessary for these patients and also peculiarities of the amplitude and, especially, temporal programs of functional electrical stimulation of muscles in such patients. Patient herself notes greater stability during walking, possibility of walking greater distance without fatigability. The received results give foundation for the further planning of the course of rehabilitation in such patients.