| The
musculoskeletal issues that may be encountered are many and diverse. Scoliosis is common and may be severe
enough to have a significant effect on lung function or to complicate
positioning issues to the extent that skin breakdown occurs. If the individual is wheelchair bound,
finding a skilled durable medical equipment provider with experience in
wheelchair seating systems will be important to provide patient comfort and
optimal mobility as well as to prevent worsening of contractures or skin
breakdown. The same is true for
extremity contractures. Physical and
occupational therapy may be sufficient to prevent decline and/or restore
function. However surgical evaluation
should be sought if contractures, for example, are interfering with good skin
care or ADLs or where repeated dislocations are occurring. |
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| Immobility
increases the risk for osteopenia.
Anticonvulsants and other drugs (e.g. prednisone) also contribute to
bone loss as may untreated hypogonadism.
As a result, osteopenia is common in some persons with DD. Metabolic bone screening is therefore
recommended. Treatment for osteopenia
is multifactorial. First, the
underlying cause should be addressed.
Second, exercise should be encouraged (including weight bearing such
as using walkers for those otherwise non-ambulatory individuals). Finally, drug treatment (calcitonin,
alendronate) are options to consider especially when fractures have
occurred. As always, ensuring
adequate calcium intake starting in childhood is key. |
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| The likelihood
of trauma occuring is due to a number of contributing factors. The individual may have sensory deficits
that reduce self protection. There
may be problems with gait or judgement.
There may be lowered bodily resistance to injury (e.g. osteopenia).
Environmental assessment and careful monitoring can reduce the risk of harm. |
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