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3.1 – What are the rehabilitation interventions that address impairments common among people living with HIV?

3.1.7: Neuromuscular and movement related structures

People living with HIV commonly experience neuromuscular and movement-related impairments. These impairments include (but are not limited to) difficulties related to joint mobility, muscle power and involuntary movements.

These impairments may be caused by pathology in the central nervous system, spinal cord or peripheral nervous system. Neuromuscular rehabilitation techniques include massage therapy, passive movements, proprioceptive neuromuscular facilitation (PNF) and Bobath techniques, and exercise prescription. Potential causes of these impairments and rehabilitation interventions are shown in the table below.

Table 3.1.7: Clinical Aspects of Neuromuscular and Movement related Impairments

Impairments Possible Etiologies Rehabilitation Interventions8
(for details, see Section 3.3)

Reduced joint mobility



Fluid retention

Muscle tone
(increased or decreased tone including flaccidity, spasticity and rigidity)


Central nervous system lesions (including stroke, malignancy or infection)

Spinal cord pathology (including myelitis, TB)

Lower motor neuron lesions

Reduced muscle strength, power and endurance

Inactivity or deconditioning due to prolonged bed rest or illness

Central nervous system lesions (including stroke, malignancy or infection)

Spinal cord pathology (including myelitis, TB spine)

Acute inflammatory demyelinating polyneuropathy

Inadequate nutritional intake


Electrolyte abnormalities

Involuntary movements (including dystonia and ataxia)

Central nervous system lesions

Side effects of medication

Electrolyte abnormalities

Decreased bone density (including osteoporosis and osteopenia)

Inactivity or deconditioning

Severe weight loss


Hormonal imbalances

Osteonecrosis (avascular necrosis)

Etiology unknown but associated with HIV infection

8Choice of rehabilitation interventions will depend on patient assessment and available resources.