Advanced physiotherapy for LIS is a crucial component of a multidisciplinary rehabilitation team (including neurologists, speech therapists, occupational therapists, respiratory therapists, nurses, and psychologists).

Techniques

• Early Intervention and Respiratory Management:
  • Airway Management and Chest Physiotherapy: This is paramount from the outset. Techniques like percussion, vibration, postural drainage, and suctioning are used to clear secretions and prevent pneumonia.
  • Breathing Exercises: While voluntary breathing may be severely impaired, the physiotherapist works on strengthening any residual respiratory muscle function and improving lung expansion.
  • Ventilator Weaning: For patients on mechanical ventilation, physiotherapy, in collaboration with the respiratory team, works towards strengthening respiratory muscles to facilitate weaning and potential decannulation of the tracheostomy tube.
• Maintaining Range of Motion and Preventing Contractures:
  • Daily Passive Range of Motion (PROM) Exercises: Performed by the therapist or caregiver for all joints to prevent stiffness, maintain joint integrity, and improve circulation.
  • Serial Casting or Splinting: Applied proactively or reactively to joints at high risk of contracture (e.g., ankles, wrists, elbows) to maintain length and prevent deformity.
  • Proper Positioning: Regular repositioning schedules (e.g., every 2 hours) to prevent pressure injuries and maintain optimal alignment of limbs and trunk. Specialized pressure-relieving mattresses and cushions are essential.
• Spasticity Management:
  • Stretching and Positioning: To reduce muscle hypertonia.
  • Modalities: Therapeutic modalities like cold therapy or electrical stimulation (used cautiously) may help manage spasticity.
• Circulatory Management and Prevention of DVT:
  • Compression Stockings/Devices: To promote venous return.
  • Regular Passive Movements: To stimulate blood flow.
  • Monitoring: Vigilant observation for signs of DVT.
  • Tilt Table Training: Gradually bringing the patient to an upright position using a tilt table. This helps the cardiovascular system adapt to gravity, improves alertness, reduces orthostatic hypotension (sudden drop in blood pressure upon standing), and can facilitate respiratory function.
  • Gradual Sitting Progression: As tolerance improves, progressing to sitting in a specialized wheelchair with appropriate support.
• Early Mobilization and Neuromuscular Re-education (if any recovery occurs):
  • Repetitive Sensorimotor Training (RST): If even minimal voluntary movement returns, the physiotherapist employs highly repetitive, targeted exercises to try and re-educate affected motor pathways.
  • Functional Electrical Stimulation (FES): May be used to stimulate weak muscles and promote re-innervation or maintain muscle bulk if some neural connections remain or recover.
  • Treadmill Therapy with Body Weight Support: In rare cases of very partial recovery, this may be considered to facilitate stepping patterns.