Potential benefits and considerations
of surgery and bracing


Limb contractures are common in neuromuscular diseases such as SMA5

Contractures may occur in patients who have lost, or never achieved, the ability to ambulate. They contribute to reduced functional range of motion, loss of function for activities of daily living, and increased pain. One study found reductions in range of motion by >20° among 22% to 50% of patients with later-onset (consistent with Type II) SMA. Hip, knee, and wrist contractures were most common. Orthopaedic treatment often consists of range-of-motion exercises in order to prevent fixed joint contractures.6


Mobility-assistive technology

Power-assistive mobility devices may be considered for individuals with severe or progressive disease who suffer from fatigue and lack of endurance, allowing them to conserve energy and focus more on activities of daily living. Children with SMA who are as young as 20 months of age have demonstrated safe, independent use of powered wheelchairs.6

  1. Spinal Muscular Atrophy Clinical Research Center. Physical/occupational therapy. Available at: http://columbiasma.org/pt-ot.html. Accessed November 2017.
  2. Wang CH et al. J Child Neurol 2007; 22: 1027–49.
  3. Mullender M et al. Scoliosis 2008; 3: 14.
  4. Tangsrud SE et al. Arch Dis Child 2001; 84: 521–24.
  5. Skalsky AJ and McDonald CM. Phys Med Rehabil Clin N Am 2012; 23: 675–87.
  6. Tsirikos AI and Baker ADL. Curr Orthoped 2006; 20: 430–45.
  7. Lin W et al. Phys Med Rehabil Clin N Am 2012; 23: 885–94.
  8. Jones MA et al. Phys Ther 2003; 83: 253–62.
  9. Arva J et al. Assist Technol 2009; 21: 161–8.
  10. Hilliard K. Special Effect’s controllers enable every gamer to enjoy video games. Available at: http://www.gameinformer.com/b/features/archive/2014/06/25/creating-controllers-for-all-disabilities-special-effect-enables-every-gamer-to-enjoy-video-games.aspx. Game Informer website. Accessed November 2017.