Physical Therapists Need to Be Proactive Regarding Their SMA Patients
Long before Scholar Rock began its Phase 3 pivotal trial of apitegromab, the FDA had awarded Scholar Rock with Priority Review Status. Soon, there could be a shift in what physical therapists should be focusing on with SMA patients. With this status being granted, this means that if the Phase 3 trial ends in April 2024, which is the scheduled conclusion date for this trial, Scholar Rock will probably seek FDA approval around May or June 2024. My patient with SMA, Michael, has made an educated assumption that if this is true, then Scholar Rock could receive FDA approval for their combination therapy around September or October 2024. Again, the FDA approval and the date of release for this combination therapy are purely speculative at this time.
If this assumption holds true, this would mean that we as physical therapists, can now start to gear our activities more towards core control and sitting balance with our SMA patients. Before this combination therapy becomes available, we want to work towards improving strength and balance in preparation. These activities will include core strengthening with resistance bands with Michael. With the resistance bands, we will perform isometric contractions of his trunk and neck in all directions. These directions will include forward neck and trunk flexion, trunk extension, as well as side bending bilaterally. Isometric contractions means that there will be no notable movement from Michael, but he will be working to match the resistance applied with the resistance bands, so he doesn’t move from his given position.
We will also perform eccentric and concentric contractions in the same directions. With the concentric contractions, Michael will be working to move the resistance bands in the direction we are working as his muscles are elongated during the contraction. During the eccentric contractions, he will be working to control the shortening of the muscle or returning to neutral from each direction. All of these contractions will also help to improve his balance as he will be stronger in each direction and able to hold himself in a neutral position when moved off balance.
When Michael is transferred to the therapy table every other week, we work on sitting balance by having him sit with his feet unsupported on the edge of the table and work perturbations in different directions. This is done on different levels of supportive surfaces to challenge Michael. These balance activities are important because he must have good balance to ensure safety during his daily activities. He needs to be able to navigate ramps on other unsteady or uneven surfaces without fearing that he will lose his balance and fall out of his chair.
Over the next two years, as we wait for this combination therapy to become available, we will work towards improving Michael’s core strength as well as balance in preparation for building strength in other areas. Michael and two of his coworkers, Kevin Schaefer and DeAnn Runge, put out a podcast with more information on the new FDA announcements of the conclusion date of the Phase 3 trial. Please click on the play button to listen to this podcast, which is located at the top of the article.