Physical Therapy for Multiple Sclerosis

The original version of this post can be found at https://www.ourcarecommunity.com/Html/CareResourceCenter/Articlesdesc/can-physical-therapy-help-control-symptoms-of-multiple-sclerosis/CatDesc/30/149/rehabilitation.

Approximately 350,000 people in the United States have a diagnosis of Multiple Sclerosis.  Celebrities with a diagnosis of Multiple Sclerosis include talk show host Montel Williams, actress Annette Funicello, actress Teri Garr, journalist Neil Cavuto, former first lady of Massachusetts Ann Romney, singer/actress Lena Horne, and comedian Richard Pryor.

Annette Funicello with Frankie Avalon

Lena Horne

Richard Pryor (photo by Alan Light)

What is Multiple Sclerosis?

Multiple Sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system.  MS is usually diagnosed between 20 and 40 years of age and is more common in women than in men.  Inflammation from MS causes damage to the outer layer of nerve cells, which slows down or stops nerve signals. The cause of MS is not known, though it is believed that it may be the result of genetics, a virus, or environmental factors.

Symptoms of Multiple Sclerosis

MS has a multitude of symptoms, which include:

• Fatigue
• Weakness
• Impaired balance
• Muscle spasms
• Tremor
• Abnormal sensations (including numbness, tingling, or a crawling sensation)
• Difficulty with gross motor movements, such as walking
• Difficulty with fine movements, such as writing, eating, and manipulating clothing fasteners
• Bowel problems (including constipation and/or leakage of stool)
• Problems with urination
• Double vision
• Gradual vision loss
• Hearing loss
• Difficulty swallowing
• Difficulty speaking clearly
• Decreased attention, memory, and decision-making ability
• Depression

Since there is such a wide range of symptoms, the abilities of people with MS can vary greatly.  Symptoms usually come in episodes, which come and go over the course of several days, weeks, or months.   Heat, fatigue, and stress often exacerbate symptoms. 

Physical Therapy for Multiple Sclerosis

While Physical Therapy cannot help all symptoms, it can help to build up endurance, increase strength, improve balance, assistance with moving more normally, to learn energy conservation techniques, and to provide caregiver training.  These PT sessions can take place in a home health care setting, as part of an adult day care program, at an assisted living facility, in skilled nursing facilities, and in outpatient clinics.

During the initial evaluation, the physical therapist will record a thorough history, including other medical diagnoses, medications that the patient is taking, and difficulties that the patient is experiencing. The PT will then assess a patient's range of motion, strength, sensation, balance, and functional mobility, paying close attention to the quality of movement and any compensatory patterns.

Direct PT treatments will include endurance training to help patients increase their physical endurance.  This training may make use of a stationary bike, a pool, a treadmill, or while performing everyday activities.  PT will also incorporate strengthening activities , which may help patients avoid compensatory movements, enhance joint stability, and allow them to perform activities of daily living more easily and efficiently.  Balance training also will be a major part of PT treatment to help patients decrease their risk of falls, allowing them to move throughout their homes and in the community safely.  Finally, transfer and gait training are vital parts of PT treatment, as a physical therapist will help patients learn to perform common movements such a moving in bed, standing from a chair, and walking in the safest and most efficient way possible.

A physical therapist may recommend varying types of adaptive equipment to aid MS patients with mobility, safety, and energy conservation.  The physical therapist may want to schedule a home visit to perform an assessment of the home’s safety and accessibility.  A cane or walker will help people with balance difficulties to walk with more stability.  A commode helps to make toileting easier since the seat is elevated and it includes armrests that a person can push off from to facilitate standing up.   A shower chair allows people to sit while they bathe to ensure safety and to help them conserve energy as they perform hygiene tasks.  Grab bars, particularly in the bathroom help to give support when a person with MS tries to move in a confined and possibly slippery room.  Finally, a wheelchair or electric scooter may be recommended for those who are unable to walk safely or who are unable to walk in the community for long distances due to deficits in balance, decreased strength, or impaired endurance.  

During the course of PT treatment, patients with MS will learn to make lifestyle changes to help avoid exacerbation of symptoms and to help conserve energy.  Lifestyle changes often include eating a balanced diet, avoiding heat, stress, and fatigue, and modifying one’s home to make it safer and more accessible.  

Conclusion

While there is no cure for Multiple Sclerosis, Physical Therapy treatment can help slow a person’s functional decline and allow a person to live independently for as long as possible.  In the case of functional decline, a Physical Therapist can help patients adapt to their changing abilities and recommend the best equipment and lifestyle changes to accommodate them.  Hopefully, with the help of a Physical Therapist, people with Multiple Sclerosis will be able to postpone having to move to an assisted living facility or skilled nursing facility.

 

Diabetic Foot Ulcers

In the United States, nearly 19 million people have been diagnosed with Diabetes.  Diabetes is a chronic disease in which the body's glucose levels are higher than normal, resulting from the body's inability to produce and/or use insulin properly.  There are several different types of Diabetes, including Type I Diabetes, Type II Diabetes, and Gestational Diabetes.

Symptoms of Type I Diabetes include:

• frequent urination
• excessive hunger or thirst
• unusual weight loss
• fatigue
• irritability

Complications of Diabetes include heart disease, stroke, high blood pressure, peripheral neuropathy, blindness, kidney dysfunction, Diabetic ulcers, charcot foot and amputations.

What is a Diabetic Foot Ulcer?

While nonhealing wounds, or ulcers are commonplace in hospitals and nursing homes, people living in the community are also at risk and frequently will develop a diabetic foot ulcer.  A diabetic foot ulcer is a wound that is located on the ball of the foot, the side of the foot, or beneath the big toe.  They form as the result of decreased sensation caused by neuropathy, skin changes (dry, peeling, cracking), improper footwear, and decreased circulation to the leg and foot.  Because of the underlying Diabetes, diabetic foot ulcers are often slow to heal and may go undetected for some time due to decreased sensation.

Accessed from http://trialx.com/curebyte/2011/06/17/clinical-trials-and-related-photos-for-diabetes-foot-ulcers/

 At first, you may notice a reddened area that will not blanch (turn white) when you apply pressure to it with your finger.  This is a Stage I ulcer.  Stage II ulcers appear like blisters.  A Stage III ulcer is open and crater-like.

Preventing Diabetic Foot Ulcers

There are several ways to help prevent Diabetic foot ulcers:

• Keep your skin clean and dry
• Do not apply lotion or moisturizers between your toes, as this may encourage infection
• Wear proper footwear that is not too tight, does not rub, and does not have complicated straps and buckles which create pressure areas
• Perform daily skin checks, looking for areas of redness, blisters, or open areas
• See your doctor regularly

If you notice an ulcer developing on your foot, please see your doctor immediately!  The sooner treatment begins, the less complicated the wound will get, decreasing your risk of a hospital stay, IV antibiotics, intense wound care, and/or an amputation.

Treatment of Diabetic Foot Ulcers

There are many treatment options for Diabetic foot ulcers, depending on the severity of the condition.  These options include:

• keeping the wound clean and moist (new cells will not grow in a dry environment)
• using appropriate bandages and/or wound dressings
• antibiotics (topical solutions, silver nitrate, oral antibiotics, or IV antibiotics) to fight infection
• wound debridement by a Physical Therapist or other wound care specialist.  This can be non-selective (i.e. pulsed lavage) or selective/sharp debridement using scissors, scalpels, tweezers, etc.
• negative pressure wound therapy (AKA wound vac) 
• surgical debridement

Suture set used for sharp debridement

Pulsed Lavage

KCI Wound Vac

Homeschooling and IEP's - An Impossible Combination?

When my husband and I were newlyweds, he stated that he wanted his children to be homeschooled.  I was a bit dubious, mostly because I doubted my abilities to educate my own children.  What if I wasn't good at it and my kids underachieved???  But my teacher husband promised to support me and when my oldest son turned 4, we dove into homeschooling.  After all, how hard is it to teach preschool?

My son thoroughly enjoyed his homeschool preschool curriculum and we had so many opportunities to go on fun outings/field trips.  However, I noticed that he was having difficulty with his fine motor skills, particularly writing and drawing, and he seemed to have some sensory processing issues.  The district recommended that we place him in a Kindergarten readiness class 2 days a week so that a member of their staff could observe him and report on his progress.  Upon the advice from his Pre-K teacher, I requested an IEP from our school district, but since he did not have a formal diagnosis, they could not proceed. 

When he turned 5, he was "old enough" to be formally diagnosed with ADHD, which we knew all along.   He started a homeschool Kindergarten program through the county and was thriving academically, though he continued to struggle with his writing skills.  As the school year progressed, the expectation for written work increased and he became more frustrated, more oppositional, and more unwilling to do his schoolwork.  We revisited the IEP process and thanks to an incredible RSP teacher who took the time to look at my son's work samples, we were on our way!

My son's IEP recommended 40 minutes of RSP per day and 45 minutes of OT per week.  He was to be mainstreamed the rest of the time, since he was doing well academically.  We enrolled him in the public school for the last 2 months of the school year, but were undecided as to continue there or resume homeschooling for first grade.

I contacted several homeschool programs, including charter schools and not a single one of them would accept my son's IEP as written.  Some schools felt that since I would be his primary teacher, I should provide those services (since when am I a Special Ed teacher or Occupational Therapist?).  Others said that our family would have to seek those service privately and pay for them on our own.  Yet others insisted on holding their own IEP meeting so that they could decide what services he should receive.  Frankly, this last group of schools frustrated me the most -- we had already dragged my poor son through the assessment process and he had to go through it again?  What was wrong with his current IEP?  Why wouldn't they answer my questions about all this?  Who is on their IEP team?  No answer.  How do these schools provide services, and by whom?  No answer.  Why did the emailed letter from one school say he has "exceptional needs" when he is mainstreamed and performs well academically?  No answer, except re-sending the email.

I find it sad that families of children with special needs have no options other than traditional public schools.  We pay our taxes.  We should get the services we pay for.  Many families (including ours) cannot afford hundreds of dollars per month on therapy services.  Many families cannot afford private school, either.  And it seems that homeschool programs are less than willing to accommodate IEPs from a school district as they are written and provide services as recommended.  Last I checked, charter schools are public schools that receive public funds, so they should honor IEPs as written.  Interestingly, section 51745(c) of California Ed Code states "No individual with exceptional needs may participate in Independent Study, unless his or her individualized educational plan (IEP) specifically provides for that participation."  (Interestingly, there is an official difference between homeschooling and independent study, but I can't get a straight answer without legalese as to what exactly the difference is)  Here is the "official" definition of "exceptional needs" in the state of California:

56026.  "Individuals with exceptional needs" means those persons who
satisfy all the following:
   (a) Identified by an individualized education program team as a
child with a disability, as that phrase is defined in subparagraph
(A) of paragraph (3) of Section 1401 of Title 20 of the United StatesCode.
   (b) Their impairment, as described by subdivision (a), requires
instruction, services, or both, which cannot be provided with
modification of the regular school program.
   (c) Come within one of the following age categories:
   (1) Younger than three years of age and identified by the
district, the special education local plan area, or the county office
as requiring intensive special education and services, as defined by
the State Board of Education.
   (2) Between the ages of three to five years, inclusive, and
identified by the district, the special education local plan area, or
the county office pursuant to Section 56441.11.
   (3) Between the ages of five and 18 years, inclusive.
   (4) Between the ages of 19 and 21 years, inclusive; enrolled in or
eligible for a program under this part or other special education
program prior to his or her 19th birthday; and has not yet completed
his or her prescribed course of study or who has not met proficiency
standards  or has not graduated from high school with a regular high
school diploma.
   (A) Any person who becomes 22 years of age during the months of
January to June, inclusive, while participating in a program under
this part may continue his or her participation in the program for
the remainder of the current fiscal year, including any extended
school year program for individuals with exceptional needs
established pursuant to regulations adopted by the State Board of
Education, pursuant to Article 1 (commencing with Section 56100) of
Chapter 2.
   (B) Any person otherwise eligible to participate in a program
under this part shall not be allowed to begin a new fiscal year in a
program if he or she becomes 22 years of age in July, August, or
September of that new fiscal year.  However, if a person is in a
year-round school program and is completing his or her individualized
education program in a term that extends into the new fiscal year,
then the person may complete that term.
   (C) Any person who becomes 22 years of age during the months of
October, November, or December while participating in a program under
this act shall be terminated from the program on December 31 of the
current fiscal year, unless the person would otherwise complete his
or her individualized education program at the end of the current
fiscal year.
   (D) No school district, special education local plan area, or
county office of education may develop an individualized education
program that extends these eligibility dates, and in no event may a
pupil be required or allowed to attend school under the provisions of
this part beyond these eligibility dates solely on the basis that
the individual has not met his or her goals or objectives.
   (d) Meet eligibility criteria set forth in regulations adopted by
the board, including, but not limited to, those adopted pursuant to
Article 2.5 (commencing with Section 56333) of Chapter 4.
   (e) Unless disabled within the meaning of subdivisions (a) to (d),
inclusive, pupils whose educational needs are due primarily to
limited English proficiency; a lack of instruction in reading or
mathematics; temporary physical disabilities; social maladjustment;
or environmental, cultural, or economic factors are not individuals
with exceptional needs.

So let this be a warning to those of you who are hoping on homeschooling your children with special needs:  It will not be an easy decision-making process.  You and your child may have to revisit the assessment process yet another time.  Your child may not receive the services he or she requires.  You may have to make a large financial sacrifice to obtain these services for your child.  You may have to jump through hoops just to get answers.  You will most likely be asked to send your child's IEP paperwork to the school before they will consider enrollment.  You may have to make the difficult decision whether to homeschool, or whether to enroll in public school to obtain necessary services paid for with your tax dollars.

My advice:  Do your research.  Advocate for your child.  Do not sign anything without being 100% confident in what you are agreeing to.  If you are completely committed to homeschooling, recognize that you may need to do so without the assistance and support of an IEP.  Do what is best for your child.

I wish you the best of luck!  

Please feel free to share your experiences in the comments.  I'd love to hear how different families have dealt with this. 

Benefits of Standing

When a person experiences an accident, a prolonged illness, or a chronic medical condition, they often spend a much of their time in bed or sitting in a chair.  My previous post regarding the Hazards of Inactivity addresses the risks involved with prolonged immobility and now I'd like to discuss the benefits of standing.

Benefits of Standing:

• Increased bone density: A guided standing program maximizes weight bearing through the long bones and assists in skeletal development, which may prevent or stabilize osteoporosis.  
• Improved cardiovascular functioning:   People who stand can build cardiovascular endurance and reduce swelling and pooling of blood in the lower extremities. Ongoing standing has also been shown to increase circulation and reduce orthostatic hypotension.
• Improved digestion and bowel function
• Increased integrity of the hip joint
• Prevention of contractures: A guided standing program helps to prevent contractures of the lower extremity.
• Increased strength
• Improved respiratory function: A guided standing program may help increase oxygen intake by allowing lungs to completely expand, which in turn can reduce the incidence of upper respiratory infections such as pneumonia.
• Preventing skin breakdown: Frequent positional changes, including standing, can reduce the risk of pressure sores and other forms of skin breakdown.  
• Reducing spasticity
• Benefits people with diagnoses of Multiple Sclerosis, stroke, traumatic brain injury, cerebral palsy, spina bifida, etc.

What does a standing program entail?
A guided standing program is tailored to each individual.  Usually, a person's rehab and medical team will collaborate to develop the most appropriate standing program which includes the type of stander, the ideal positioning to accommodate the patient's unique needs, the amount of time spent in the stander, and where this program will take place (home, school, PT clinic, etc.).

What is a standing frame?
A standing frame is a piece of medical equipment that allows those with physical limitations to stand with support, while ensuring proper alignment and positioning.  There are several types of standers such as prone standers, sit-to-stand standers, and mobile standers.

Prone Stander (image from www.theradapt.com)

Sit-to-Stand Stander (image from www.easystand.com)

MobileStander (image from www.rifton.com)

Contraindications:
People should consult a physician before initiating a standing program if they have the following medical conditions, because prolonged standing may have an adverse effect:

• orthostatic intolerance
• severe contractures
• weakened skeletal structure such as Osteogenesis Imperfecta, or severe Osteoporosis
• hip subluxation

Physical Therapy Following a Stroke

This is another version of an article I had written for Our Care Community:

Experiencing a stroke can be a life-changing event for both patients and their families.  Sometimes, a stroke can leave very few aftereffects, but other times, the resulting disability can be severe.  Fortunately, people who experience strokes are surrounded by a qualified medical team which may include physicians, nurses, physical therapists, occupational therapists, speech-language pathologists, respiratory therapists, recreational therapists and social workers.

Effects of a Stroke

A stroke can occur in any area of the brain and the extent of injury can vary greatly.  Depending on the location, size, and type of stroke, patients may experience paralysis on one side of the body, abnormal muscle tone, difficulty controlling one’s movements, difficulty understanding or producing language, impaired balance and body awareness, and difficulty swallowing.   These will cause deficits in a person’s mobility, self-care, communication, eating, and bowel and/or bladder control.  Physical Therapy addresses a patient’s difficulties in moving in bed, transferring to and from bed, balance, walking, and moving about one’s home and community.  The goal of PT after a stroke is to help patients regain as much independence as possible.

Acute Care

People who are hospitalized following a stroke are often surprised to see a Physical Therapist so soon.  Depending on the type and severity of the stroke, Physical Therapy (PT) during an acute care hospital stay can range from activities as simple as tolerating positional changes while maintaining stable vital signs to walking throughout the halls.  Acute care PT may include bed mobility training, stretching, active and passive range of motion, simple therapeutic exercises, training in how to transfer into and out of bed, wheelchair mobility training, and learning to walk (gait training).

Acute Rehabilitation

After the acute hospital stay, patients may be transferred to acute rehab.  During acute rehab, patients will have the opportunity to participate in therapy for approximately 3 hours per day, 6 days per week.  The specialized care that patients receive in acute rehab include exercise programs, PT to improve functional mobility, OT to improve self-care, Speech Therapy to address communication and swallowing issues, Recreational Therapy, and bowel/bladder retraining.  During PT sessions, treatment will focus on regaining as much functional mobility as possible while using the most appropriate assistive device, be it a cane, walker, or wheelchair.

Transitional Care/Skilled Nursing

The PT treatments that occur in a hospital’s transitional care unit (TCU) or in a skilled nursing facility (SNF) are similar to those in acute rehab.  However, the amount of therapy a patient receives may vary, depending on the areas of greatest need.  PT sessions may include stretching, therapeutic exercise, balance training, transfer training, wheelchair mobility training, gait training, and car transfer training.  Upon discharge from the TCU or SNF, patients usually return home or to an assisted living facility, so caregiver training is an important part of PT in these settings.  Durable medical equipment such as a 3-in-1 commode, walker, or wheelchair are also ordered for the patient before discharge so that patients can have all the necessary equipment to use in the home setting.

Home Health PT

When a patient returns home or moves into an assisted living facility, they will often participate in home health PT.  The aim of home health PT is to help a person to function and move safely and as independently as possible in the patient’s home environment.  Treatment sessions may entail a home safety evaluation, re-enacting common daily tasks (such as moving about the home, getting into and out of the shower, carrying laundry, or preparing meals), continuing caregiver training, and prescribing a home exercise program.

Outpatient Physical Therapy

After “graduating” from home health PT, patients may need to participate in outpatient physical therapy to fine-tune their skills.  Outpatient PT occurs in a hospital-based or private clinic and often includes therapeutic exercise, stretching, strengthening, balance training, advanced gait training (often out in the community), and home program prescription.  Upon discharge from outpatient PT, patients are often encouraged to participate in a community-based exercise program such as a guided aquatic exercise class, a balance class at the local senior center, or a daily walking program.

Though having a stroke can be a devastating experience for the patient and family members alike, Physical Therapy helps to return patients to the greatest amount of functional independence as possible.  

Diastasis Recti (part 5) - Frequently Asked Questions

Does it hurt?
No, it does not hurt.  On a 0-10 pain scale, I would have to say that it's a 1 at its worst.  Before I was diagnosed, I would mention to my husband that my abs felt odd and that I wanted to take it easy.  But that has been the extent of it. 

 
If it doesn't hurt, then what does it feel like?
Other than feeling "odd" at times, I occasionally feel a stretching sensation in my abdominal region.  This sensation is similar to the stretching I felt during my first pregnancy, though it is more localized to my upper abdominal region. 

Does it look funny?
At this point, you can't really tell that I have diastasis recti by looking at me.  The only time someone can see anything unusual is when I move in a way that increases my intraabdominal pressure, such as coughing, laughing or performing a sit-up (which is not recommended -- it's just how my OB assessed me).  I will say that I can feel a gap between the two side of my rectus abdominus muscle, especially at the upper aspect.

I have seen photos online of more severe cases and though they can be a bit scary-looking (especially photos of the severe herniations), cases like those are rare.  If you receive proper care and support, that isn't likely to occur.  Of course, I have 14 more weeks of pregnancy to go, so I'm trying to stay calm during all this.  Doing my exercises and wearing my splint help boost my confidence.

I also will add that though I am measuring large for my gestation, the baby measured normal on ultrasound.

Diastasis Recti (part 4) - Research

Research Articles regarding Diastasis Recti

Here is a list of research articles about Diastasis Recti so that you can learn more about the condition and the various treatment options.  I am not endorsing any one treatment option and am just including the studies so that my readers can make informed decisions regarding their medical treatment.  Remember, everyone is different and everyone's Diastasis Recti can present differently.  Always consult your doctor first! 

from www.bodyalignpt.com

Diastasis Recti and Pregnancy

Ranney B (1990 Oct). Diastasis recti and umbilical hernia causes, recognition, and repair. S D J Med, 43(10): 5-8.
This article discusses how to recognize diastasis recti in post-partum women.  These women expressed a desire for post-operative improvements in firmness and function of the lower abdominal wall.  The article also discusses methods of recognition and repair of diastasis recti of varying severities.

Boissonnault JS, Blaschak MJ (1988 Jul). Incidence of diastasis recti abdominis during the childbearing year. Phys Ther, 68(7): 1082-6.
This study determined that diastasis recti occurred most often at the umbilicus (belly button).  There was a significant relationship between the timing during a woman's pregnancy and the presence or absence of a diastasis recti.  It was initially noted during the second trimester, but incidence peaked in the third trimester.  The researchers concluded that it is important to assess for diastasis recti above, below, and at the umbilicus throughout pregnancy.

Bursch SG (1987 Jul). Interrater reliability of diastasis recti abdominis measurement. Phys Ther, 67(7): 1077-9.
This study's goal was to provide data regarding the incidence and degree of diastasis recti, to describe the measurement system used, and to determine the interrater reliability of the measurements.  Forty women who were immediately post-partum were tested via palpation by four raters.  This measurement system was found to be unreliable among raters.  All 40 subjects had some degree of diastasis recti and the authors conclude that the incidence and severity of diastasis recti may be underdiagnosed and that a reliable method of measuring the amount of separation is needed.

Mota P, Pascoal AG, Sancho F, Bo K (1988 Jul). Test-retest and intrarater reliability of 2D ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther, [Epub ahead of print]
This research study found that ultrasound imaging is a reliable method for measuring the inter-rectus distance at rest and during abdominal crunch and drawing-in exercises

Diastasis Recti Treatment

 Chiarello CM, Falzone LA, McCaslin KE, Patel MN, Ulery KR (2005 Spring). The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women. Journal of Women's Health Physical Therapy, 29(1): 11-16.
This research study used the Tupler Technique and found that the occurrence and size of Diastasis Recti is much greater in non‐exercising pregnant women than in exercising pregnant women. 

Tadiparthi S, Shokrollahi K, Doyle GS, Fahmy FS (2011 Oct 20). Rectus sheath plication in abdominoplasty: assessment of its longevity and a review of the literature. J Plast Reconstr Aesthet Surg, 65(3): 328-32.  

The article concludes that plication (folding over and tucking loose tissue, then suturing it together) with non-absorbable sutures is long-lasting and durable.

Hickey F, Finch, JG, Khanna A (2009 Jun). A systematic review on the outcomes of correction of diastasis of the recti. Hernia, 13(3): 287-92.
Though it is primarily cosmetic, except in the case of herniation, there is high patient satisfaction after surgical correction of diastasis recti.

Palanivelu C, Rangarajan M, Jateaonkar PA, Amar V, Gokul KS, Srikanth B (2004 Jul-Aug). Laparoscopic repair of diastasis recti using the 'Venetian blinds' technique of plication with prosthetic reinforcement: a retrospective study. Aesthetic Plast Surg, 28(4): 189-96. 

 This was written by plastic surgeons, so they advocate surgical repair of diastasis recti for cosmetic reasons and to restore abdominal muscle function.  The authors state that use of a prosthesis is necessary to prevent recurrence.

Nahas FX, Ferreira LM, Mendes Jde A (2004 Jul-Aug). An efficient way to correct recurrent rectus diastasis. Aesthetic Plast Surg. 28(4). 189-96.

I need to get my hands on the full text of this study for all the details, but basically they conclude that the procedure of advancement of the recti muscles seems to be a reliable method for correcting recurrent rectus diastasis in patients with surgically repaired rectus abdominus muscles that were inserted laterally, near the ribs.

Nahas FX, Augusto SM, Ghelford C (1994 Jan). Should diastasis recti be corrected?.Aesthetic Plast Surg. 21(4): 285-9.
The researchers performed CT scans on patients who had surgical repair of their diastasis recti.  After 6 months, they had complete correction.

Asaadi M, Haramis HT (1994 Jan). A simple technique for repair of rectus sheath defects. Ann Plast Surg. 32(1): 107-9.

This study describes one particular surgical method that has shown no recurrence or herniation.

General articles regarding Diastasis Recti

Brauman D (2008 Nov). Diastasis recti: clinical anatomy.  Plast Reconstr Surg.  122(5): 1564-9.
92 abdominoplasty patients were studied and the researcher found that: the linea alba only stretches 1-2 inches, abdominal wall protrusions can be caused by distension of the entire abdominal wall, significant protrusions can occur without diastasis, and those with flat abdomens may still have a diastasis.

Repta R, Hunstad JP (2009 Jun). Diastasis recti: clinical anatomy. Plast Reconstr Surg. 123(6): 1885; author reply 1885-6. 
This is a comment regarding the article mentioned above.  I hope to find the full text soon because I'd love to know what everyone has to say about this!

Braekken IH, Majida M, Ellstrom Engh M, Holme IM, Bo K (2009 Dec). Pelvic floor function is independently associated with pelvic organ prolapse. BJOG. 116(13): 1706-14.

Diastasis recti may be a factor in pelvic organ prolapse.