Spinal Muscular Atrophy (SMA)

Spinal muscular atrophy (SMA) is a multisystem disorder affecting many aspects of a patient’s life.¹ Apart from pharmacologic and surgical interventions, patients may also benefit from therapy approaches such as physical therapy, occupational therapy, and speech therapy.²

Physical Therapy for SMA

The consensus for standard of care in SMA recommends a multidisciplinary treatment approach that includes physical therapy.³ Physical therapy can help manage many aspects of the disease, including developmental skills, respiratory complications, contracture, and skeletal deformities such as scoliosis.⁴

Physical therapy aims to ensure the patient can maintain their mobility and independence for as long as possible and delay or prevent the development of complications. Physical therapists use approaches such as therapeutic exercises and strength training, standing programs, and aquatic therapy to improve muscle strength and independence.

The first step before the start of physical therapy is a thorough review of the patient’s medical history and a physical examination to assess the patient’s posture, muscle strength, and motor activities, such as walking, joint motion, and respiratory function. A physical therapist can develop strengthening exercises to delay the deterioration of muscle strength and the development of contracture and prevent respiratory failure. Depending on the age of the patient, these could include sports or aerobic exercises. 

Read more about pharmacologic therapies for spinal muscular atrophy.

Strengthening exercises can help improve head and trunk control and floor mobility, as well as sitting, standing, and walking. Standing programs generally focus on maintaining muscle flexibility and length, preventing contracture, and promoting musculoskeletal development.

Aquatic therapy is a specialty of physical therapy that uses the physical properties of water to provide support. It includes strength training, walking and balance exercises, and aerobic training. Aquatic therapy can improve gross motor function and gait in patients with SMA.⁵

Physical therapists can also teach the patient’s parents or caregivers ways to help them perform exercises at home. While sometimes under the purview of respiratory therapists, physical therapists can also teach them chest drainage techniques to help with breathing and healthy positioning to help reduce scoliosis and skeletal deformities.

Occupational Therapy for SMA

Occupational therapy can help teach the patient to improve his or her independence for daily living.⁶ 

An occupational therapist can help with body positioning, seating, and gross and fine motor skills.⁷ This type of therapist can also provide assistive technology evaluation and prescribe aids to improve a patient’s quality of life. These may include mobility devices, such as walkers, splints, braces, wheelchairs, and communication aids, including voice command and dictation typing systems and bathing, dressing, and feeding equipment. 

An occupational therapist can also suggest home adaptations to increase the patient’s mobility and independence, such as ramps, grab bars for the bathroom, and stairlifts. Finally, they can teach the patient to master life skills, including bathing, dressing, grooming, and feeding.

Speech Therapy for SMA

Spinal muscular atrophy can affect the muscles of the tongue, jaw, and throat.⁸ This can impair patients’ ability to chew, swallow, clear their throat, and speak. 

Speech therapy can help patients with SMA communicate more efficiently. Speech therapists can design a therapy program to strengthen jaw and throat muscles. They can also recommend aids and devices to help patients communicate more effectively. 

Like other types of therapy, speech therapy should be tailored for each patient, taking into account the difficulties that they may be experiencing. A speech therapist first evaluates the patient’s needs. A common assessment is a “swallowing study,” which is a fluoroscopy study of the patient’s ability to chew and swallow that identifies muscles that are not functioning properly.9 A speech therapist then develops an individualized plan for the person with SMA, including food viscosity recommendations to prevent aspiration.

Complementary and Alternative Therapies

Some complementary and alternative therapies may alleviate some symptoms of SMA, such as muscle pain, contracture, and fatigue. These include acupuncture, massage therapy, and osteopathy.¹⁰ 

Some of these therapies may provide temporary relief from symptoms. Still, there is little scientific evidence supporting their benefits.

It is very important that if a patient with SMA undergoes any complementary and alternative therapy, the practitioner understands how the disease affects the patient and the medications they are taking. They should also speak with the patient’s primary care physician, if possible, before they begin. 

It also should be noted that certain therapies, such as massage therapy and osteopathy, pose a potential risk to patients with SMA because of lowered bone density and should be conducted with great care.

Reviewed by Michael Sapko, MD on 7/1/2021

References 

1. Shababi M, Lorson CL, Rudnik-Schöneborn SS. Spinal muscular atrophy: a motor neuron disorder or a multi-organ disease? J Anat. 2014;224(1):15-28. doi:10.1111/joa.12083

2. Foead AI, Yeo WWY, Vishnumukkala T, et al. Rehabilitation in spinal muscular atrophy. J Int Soc Phys Rehabil Med. 2019;2(1):62-70. doi:10.4103/jisprm.jisprm_4_19

3. Wang CH, Finkel RS, Bertini ES, et al. Consensus statement for standard of care in spinal muscular atrophy. J Child Neurol. 2007;22(8):1027-1049. doi:10.1177/0883073807305788

4. Living with SMA. Spinal Muscular Atrophy Clinical Research Center. Accessed May 31, 2021.

5. Salem Y, Gropack SJ. Aquatic therapy for a child with type III spinal muscular atrophy: a case report. Phys Occup Ther Pediatr. 2010;30(4):313-324. doi:10.3109/01942638.2010.493097

6. OTPT: Activities of daily living (ADL). Cincinnati Children’s^®. Accessed May 31, 2021. 

7.  Diagnosis: Spinal muscular atrophy (SMA). Muscular Dystrophy Association (MDA). Accessed May 31, 2021. 

8. Spinal muscular atrophy. Nationwide Children’s Hospital. Accessed May 31, 2021.

9. Wahl M. Sorting out speech services. Muscular Dystrophy Association (MDA). Published January 31, 2001. Accessed May 31, 2021. 10. Complementary and alternative therapies in SMA. Spinal Muscular Atrophy UK. Published December 2016. Accessed May 31, 2021.

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Ozge Ozkaya, MSc, PhD

Özge’s background is in research; she holds a MSc. in Molecular Genetics from the University of Leicester and a PhD. in Developmental Biology from the University of London. Özge worked as a bench scientist for six years in the field of neuroscience before embarking on a career in science communication. She worked as the research communication officer at MDUK, a UK-based charity that supports people living with muscle-wasting conditions, and then a research columnist and the managing editor of resource pages at BioNews Services before joining Rare Disease Advisor.