a. Increase proximal muscle strength.
b. Improve function.
c. Decrease pain.
2. Exercises. See Fig 56-10, Fig 56-11, Fig 56-12, Fig 56-13, Fig 56-14, Fig 56-15, Fig 56-16, Fig 56-17 and Fig.,56-23, Fig 56-24, Fig 56-25, Fig
56-26, Fig 56-2.7, Fig 5.6-2.8, Fig 5.6-29, Fig 5.6.-3.0, Fig ,5.6.-3.1..., Fig 56-32 for appropriate exercises used in the treatment of patients with polymyositis and dermatomyositis.
FIG. 56-10. Neck flexion. Sitting or standing with your back straight, bend your head forward and tuck your chin in toward your chest.
FIG. 56-11. Neck rotation. Sitting or standing with your back straight, tuck your chin in toward your chest. Look over your right shoulder, then over your left shoulder.
FIG. 56-12. Neck lateral flexion. Sitting or standing with your back straight, tuck your chin in. Bend your head so that your ear is moving toward your shoulder.
FIG. 56-13. Shoulder flexion. Lie on your back while holding a rod, with one hand at the top and the other near the bottom. Pull the rod back toward your head until your arm holding onto the top is straight. Return to starting position. Switch hands and repeat. (Reprinted from the Saunders Group, Inc. © 1996.)
FIG. 56-14. Diagonal shoulder flexion. Keeping your elbow straight, bring your left arm down across your body with your thumb pointing toward your right hip. (Reprinted from the Saunders Group, Inc. © 1996.)
FIG. 56-15. Pendulum exercises. Stand holding onto a sturdy chair with your uninvolved arm. Bend forward at the waist and bend your knees to help protect your back. Let your involved arm hang limp. Keep your shoulder relaxed, and use your body motion to swing your arm in a circle. (Reprinted from the Saunders Group, Inc. © 1996.)
FIG. 56-16. Shoulder rotation exercise. While standing, hold a stick or towel as illustrated, with the uninvolved arm over your shoulder and holding the top and the involved arm holding the bottom. Slowly pull the top of the stick or towel with your uninvolved arm as shown. (Reprinted from the Saunders Group, Inc. © 1996.)
FIG. 56-17. Stand with your arm at your side and palm facing forward. (This can also be done while lying on your back with palm up.) Raise your weak arm out to the side and up toward your ear. Keep your elbow straight and palm facing forward.
FIG. 56-23. Leg lifts while lying on side. Lie on your side, weak leg on top. The lower leg should be bent to help balance. Keep the top leg straight and in line with your body. Stay on your side and lift your leg up toward the ceiling. Do not bring your leg forward. Slowly lower it.
FIG. 56-24. Hip external rotation. Lying on your back with entire leg straight, roll entire leg outward.
FIG. 56-25. Hip internal rotation. Lying on your back with your leg straight, roll entire leg inward.
FIG. 56-26. Prone hip extension. Lie on your stomach with both legs straight. Lift one leg up toward the ceiling, keeping your knee straight. Slowly lower it. (Reprinted from the Saunders Group, Inc. © 1996.)
FIG. 56-27. Hip flexion. Sitting on stairs or a chair with both feet flat on the floor, raise one knee up toward your chest as high as possible. Slowly lower it. (Reprinted from the Saunders Group, Inc. © 1996.)
FIG. 56-28. Bridging exercise. Lie on back with knees bent and arms straight. Pull toes up toward the ceiling and push heels into the floor. Tighten buttocks and slowly lift up until hips are fully extended. Return to the starting position and repeat. (Reprinted from the Saunders Group, Inc. © 1996.)
FIG. 56-29. Gluteal contraction. Lying prone, with pillow under abdomen, bend one knee and lift toward ceiling. Slowly lower to starting position and repeat. (Reprinted from the Saunders Group, Inc. © 1996.)
FIG. 56-30. Lie on your back with your weak leg as straight as possible. Bend the other leg as illustrated to protect your back. Tighten your thigh muscle. Raise your leg while keeping it straight. Keep your thigh muscles tight and leg straight as you slowly lower it.
FIG. 56-31. Quad set. Half sitting with your involved leg straight, bend your other leg as illustrated. Tighten the muscles on the top of your thigh. This will make your knee cap move toward your hip. (Reprinted from the Saunders Group, Inc. © 1996.)
FIG. 56-32. Terminal knee extension. Lying on your back with a firm pillow under your involved knee, slowly lift your foot up. Your knee should remain on the pillow. Try to keep your leg as straight as possible. (Reprinted from the Saunders Group, Inc. © 1996.)
E. Scleroderma (progressive systemic sclerosis). Prevention of joint contractures is the primary goal in the physical therapy management of patients with progressive systemic sclerosis. An ROM program designed to stretch soft-tissue contractures should be instituted immediately. Passive stretching of all joints, soft-tissue mobilization, and massage are highly recommended. In addition, paraffin is used on the hands in an effort to decrease pain and increase finger ROM. Skin tightness around the jaw is extremely common. A series of temporomandibular joint exercises are routinely performed to increase jaw excursion. Deep breathing, use of incentive inspirometer, and mobilization of the chest wall to increase chest expansion should be incorporated into the physical therapy program. To assist with feeding and chewing activities, speech therapy is often instituted.
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