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I am a physical therapist just starting out. My first job is on a reservation in Utah working for Indian Health Services. Yesterday was a clinic for children with special needs. There were two children there with a problem I've never heard of: Navajo Familial Neurogenic Arthropathy. Can you give me some information about this condition?

Navajo familial neurogenic arthropathy is a rare problem but one that can have serious consequences for the affected child. Obviously, it is found among people of the Navajo Native American group. This tribe lives in the southwest area of the United States in Arizona, New Mexico, and Utah. The term familial tells us the problem is inherited but the exact gene or genetic problem is still unknown. The symptoms are similar from case to case. That's what the name neurogenic arthropathy is all about -- the classic symptoms seen in each of these cases. Neurogenic refers to the loss of sensation to deep pain. Without that protective response, the child can develop joint deformities and problems with limb alignment (especially in the legs). Arthropathy is another term to mean joint disease. Bone fractures, joint swelling called effusion, joint destruction, and infections are added problems and complications that can develop. Surgical treatment often fails and the problem recurs (comes back) and/or gets worse. Although the focus is often on the orthopedic (bone and joint) problems faced by these children, there are other problems. Anhidrosis (inability to sweat) is one of those problems. These children can't tolerate high temperatures. And this heat intolerance is made worse by the fact that they live in a hot, dry desert climate. Management is the key and good management includes physical and occupational therapy to educate, support, and aid function for these individuals. Assistive devices (e.g., braces, orthotics, walkers, wheelchairs) are an important part of preventing things from getting worse while helping these children stay independent as long as possible.

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