Neuromuscular and Skeletal Disorders

Neuromuscular and Skeletal Disorders

Promote physical activity

Promote mobility and regular physical activity (see Physical Inactivity and Obesity).198, 199

Empirical Expert

Neuromuscular and skeletal disorders (eg, scoliosis, contractures, spasticity, and ligamentous laxity) are possible sources of unrecognized pain and occur frequently among people with IDD, especially those with cerebral palsy. This can result in reduced mobility and physical activity with associated adverse health outcomes.195-197

Consult physical or occupational therapy

Consult a physical or occupational therapist regarding adaptations to promote mobility and physical activity (eg, wheelchair, walker, modified seating, splints, orthotics, and safety devices such as handrails).198

Empirical Expert

Neuromuscular and skeletal disorders (eg, scoliosis, contractures, spasticity and ligamentous laxity) are possible sources of unrecognized pain and occur frequently among people with IDD, especially those with Cerebral Palsy. This can result in reduced mobility and physical activity with associated adverse health outcomes.195-197

Monitor foot health

Actively monitor foot health and ensure properly fitting footwear in consultation with a podiatrist or orthotist.200

  Recommended

Empirical Expert

Neuromuscular and skeletal disorders (eg, scoliosis, contractures, spasticity, and ligamentous laxity) are possible sources of unrecognized pain and occur frequently among people with IDD, especially those with cerebral palsy. This can result in reduced mobility and physical activity with associated adverse health outcomes.195-197

Screen for osteoporosis

Screen both male and female patients for osteoporosis starting in early adulthood.201, 203

  Strongly Recommended

Empirical Ecosystem Expert

Osteoporosis and osteoporotic fractures are more prevalent and occur at a younger age among people with IDD than those in the general population.201, 202

Seek advice from a radiologist

Seek advice from a radiologist regarding alternative methods to assess risk of fragility fractures if the patient cannot be assessed using the usual nuclear bone mineral density (BMD) test, such as by assessing the patient’s forearm only.204

  Strongly Recommended

Ecosystem Expert

Osteoporosis and osteoporotic fractures are more prevalent and occur at a younger age among people with IDD than those in the general population.201, 202

Recommend vitamin D

Recommend early and adequate intake or supplementation of calcium and vitamin D unless contraindicated (eg, among people with Williams syndrome).202, 204

  Recommended

Risk factors for osteoporosis specific to people with IDD include increased severity of IDD; long-term use of certain medications such as anticonvulsants, glucocorticoids, injectable long-acting progesterone in women; vitamin D deficiency; prolactinemia; immobility; and presence of certain genetic syndromes.202, 204, 205

Be aware of medical conditions and medications

Be aware of concurrent medical conditions and medications in patients with IDD when considering osteoporotic treatment options, eg, renal insufficiency or swallowing difficulty, and seek advice (eg, from an endocrinologist or pharmacist).202, 204

  Recommended

Risk factors for osteoporosis specific to people with IDD include increased severity of IDD; long-term use of certain medications such as anticonvulsants, glucocorticoids, injectable long-acting progesterone in women; vitamin D deficiency; prolactinemia; immobility; and presence of certain genetic syndromes.202, 204, 205

Some specific genetic syndromes are a risk factor for osteoporosis. Check the Health Watch Tables, developed by the Developmental Disabilities Primary Care Initiative at Surrey Place (Toronto, 2011), for syndrome specific preventive care.

195. Haveman M, Heller T, Lee L, Maaskant M, Shooshtari S, Strydom A. Major health risks in aging persons with intellectual disabilities: An overview of recent studies. Journal of Policy and Practice in Intellectual Disabilities. 2010;7(1):59-69.

196. Pfister AA, Roberts AG, Taylor HM, Noel-Spaudling S, Damian MM, Charles PD. Spasticity in adults living in a developmental center. Arch Phys Med Rehabil. 2003;84(12):1808-12.

197. Jenkins DW, Cooper K, Heigh EG. Prevalence of podiatric conditions seen in special olympics athletes: A comparison of USA data to an international population. Foot (Edinb). 2015;25(1):5-11.

198. Marks B, Sisirak J, Heller T. Health matters : The exercise, nutrition, and health education curriculum for people with developmental disabilities. CD-ROM with instructor references and participant handouts ed. Baltimore: Paul H. Brookes Pub. Co.; 2010.

199. Courtenay K, Murray A. Foot health and mobility in people with intellectual disabilities. Journal of Policy and Practice in Intellectual Disabilities. 2015;12(1):42-6.

200. Jenkins DW, Cooper K, O’Connor R, Watanabe L. Foot-to-shoe mismatch and rates of referral in special olympics athletes. J Am Podiatr Med Assoc. 2012;102(3):187-97.

201. Balogh R, Wood J, Dobranowski K, Lin E, Wilton A, Jaglal SB, et al. Low-trauma fractures and bone mineral density testing in adults with and without intellectual and developmental disabilities: A population study. Osteoporosis Int. 2016:1-6.

202. Petrone LR. Osteoporosis in adults with intellectual disabilities. South Med J. 2012;105(2):87-92.

203. Dreyfus D, Lauer E, Wilkinson J. Characteristics associated with bone mineral density screening in adults with intellectual disabilities. J Am Board Fam Med. 2014;27(1):104-14.

204. Jasien J, Daimon CM, Maudsley S, Shapiro BK, Martin B. Aging and bone health in individuals with developmental disabilities. International Journal of Endocrinology. 2012;2012.

205. Jaffe JS, Timell AM, Elolia R, Thatcher SS. Risk factors for low bone mineral density in individuals residing in a facility for the people with intellectual disability. J Intellect Disabil Res. 2005;49(6):457-62.

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