Patients with SMA often spend the majority of their time either in their wheelchair or in their bed. Since they can be fairly limited to these two places, it is important to increase their independence within those areas. Although my patient with SMA, Michael, will most likely not be able to roll onto his side independently from supine, we have been successfully working on his assistance and strength within this motion. This will help him with pressure relief and being able to reposition more comfortably while in his own in bed.
While Michael is lying supine on a therapy table, we began this exercise by strapping his hands to a PVC pipe in front of him and assist in extending his arms in front of him. We then roll him partially on his side and apply our hands on the PVC pipe, back shoulder, and both knees. This is our beginning position. We then practice rolling onto his side by rolling him using the pipe, back shoulder, and both legs. On the third roll, Michael pulls back towards neutral by pushing and pulling against our hands. He pushes back on his back shoulder, pull with his arms back to neutral, and then pushes back with abductors of the top leg and adductors of the bottom leg.
We practice rolling onto both sides and back so that Michael can practice getting in and out of his bed on either side, although he has more control rolling onto his right side due to his increased strength of his left adductor as compared to his right, and his right abductors as compared to his left. We then perform the opposite and have him push into the roll to assist in rolling onto his side as compared to assisting in rolling back to neutral. This way he can assist in getting onto and off his back while lying in bed.
To advance this exercise, we will roll him less onto his side before we begin the exercise and work in a larger range of motion as he gains strength and control. Although will most likely not be able to fully roll onto his side from lying supine independently, the goal is for Michael to be able to assist in rolling himself from side to side in the bed and lying down after sitting on the side of the bed. Also, to be able to roll independently in small ranges of motions to pressure relief and make himself more comfortable.
======================== Patient Perspective ========================
I lost the ability to roll from side to side while laying in bed around the age of 15. Before my spinal fusion surgery in 1980, I was extremely flexible, and could reposition myself by not only rolling from side to side, I also had the ability to go from my stomach to my side, and then to my back. It wasn’t until after my spinal fusion surgery, that I lost this ability. After losing this ability, I became more dependent on others, such as my parents. Now that my parents are gone, I rely on my caregivers to help me if I need to roll, or reposition while in bed. I know that I will probably never be able to roll from one side to the other, but working on the abductor and adductor muscles in my legs, has given me greater mobility, and even though I may not be able to roll from side to side, I can now shift some of my body weight from one side to the other, which has greatly reduced the amount of discomfort I experience while in bed.
My physical therapist, Emily, and her assistant, Vikki, have been working over the past couple of months to increase not only my flexibility and range of motion in my hips and legs, they have also been using resistance type exercises to increase the amount of strength in my abductor and adductor muscles. We first started working on the abductor and adductor muscles, and quickly realized that I had more strength than we first thought. After noticing that I had enough muscle tone and strength to at least bring my knees together, and separate my knees, Emily focused much of her attention on not only using the abductor and adductor muscles, we also focused on using the core muscles, such as my abdominals, along with my back and shoulder muscles. Working with me to roll from one side to the other, forces me to not only use the abductor and adductor muscles, it also forces me to use these other muscle groups.