Charcot-Marie-Tooth (CMT) is a disorder of the peripheral nerves (the motor and sensory nerves outside of the brain and spinal cord) and is one of the most common hereditary and progressive neurological disorders. The degenerative nature of this condition means that individuals experience increasing muscle weakness, altered sensation and pain, which in turn cause a gradual reduction in overall limb control and function. Initially symptoms can be very mild, and may only be detected once a parent seeks medical advice after noticing that their child is repeatedly tripping and stumbling when walking. Though this may seem a minor issue to begin with, it can be an early indication of reduced lower limb muscle control and changes to a child’s sensations in their feet. Gradually, other functional activities may become more difficult for an individual with CMT to perform, such as unscrewing bottle tops, grasping a toothbrush tightly, or squeezing an object.
Individuals with CMT may also experience secondary musculoskeletal problems due to the progressive reduction in muscle strength and control of their joints. As joints begin to lose some of their muscular stability they may become painful, and tend to develop muscle imbalances that can lead to deformities occurring around their feet and ankles. Ankle supports, knee braces and tailor-made foot orthoses (insoles) may be required in order to address these structural changes and to help to support the lower limbs when standing and walking. Wrist supports may be necessary as fine motor skills can become increasingly difficult to perform such as using a knife and fork, and writing. Braces and splints can be extremely helpful not just in assisting with functional movements, but also can help with pain control by providing much needed stability around the joints that no longer have adequate muscle support.
Ideally, an individual should begin physiotherapy and occupational therapy from the outset once diagnosed with CMT. This allows rehabilitation to focus on muscle conditioning when degeneration of the nerve fibres is only mild and the disease process is in its early stages. Depending upon the difficulties and needs of the individual at any one time, and the stage at which their disease process has reached, physiotherapy rehabilitation for CMT may involve soft tissue manipulation and stretching, postural re-education and core muscle training, general muscle strengthening and balance work, and a specific functional rehabilitation programme to help to maintain exercise tolerance and to address the individual goals of each person.
Hydrotherapy may be of benefit to some individuals who struggle with painful joints as a result of CMT, providing a relaxing and supportive medium in which to move. Acupuncture may also be helpful in providing pain relief for those with CMT.
Our Specialist Paediatric Physiotherapy Team will work closely with an individual with CMT and their family / carers to meet their specific needs and personal aims of rehabilitation, and to prolong the functional independence of that individual for as long as possible.
Please get in touch if you would like to know more about the Physiotherapy Service that we can provide for individuals with neurological disorders.