Physiotherapy For DMD

Duchene’s muscular Dystrophy (DMD)

Duchene’s muscular Dystrophy (DMD) is a deficiency of muscular dystrophic level.  Dystrophin is a large protein present on short arm of X chromosome.

·         Muscles become fragile which leads to contracture formation, in most cases patients become bed ridden

Diagnosis:

·         Dystrophin level assessment by
          * muscle biopsy

·                 *   Cretinine level

Management:

Steroidal use:

·         Most medical treatment includes use of steroids; it helps to increase the potential to do some task or activity

Physiotherapy plan:  

·         Physiotherapy enables DMD patients to reach to their potential or atleast to do their ADL activities independently

Strengthening exercises:

·         Has not much role but is necessary to prevent atrophy, but they should be done to some extend too much vigorous ex leads to muscular destruction, that is why eccentric exercises are usually not recommended

·         Examples: cycling, fun activities, running etc

o   Trampolines are contraindicated, as it’s an example of eccentric ex. Can also lead to mayoglobinurea

Hydrotherapy:

·         Water exercises like swimming are much appreciated because weaker children which cannot do much exercise normally can do better in water as water provides tendency

Stretching exercises:

·         Contractures are most common in ankle and hip

·         For compensation in walking pt starts walking on toes which leads to TA’s tightness, for remedy TA’s stretching can be done

·         So stretching should be done to prevent contractures, to enable easy and continued walking, to avoid amputation

·         Muscular weakness may also causes asymmetry and leads to development of scoliosis, however use of steroids can slow down the process

Orthotics:

·       *  Devices which can assist in movement can be use for extreme conditions in DMD

·        * Night splints: Use to maintain the dorsiflexion of foot

·         *Stretching of TA is the best way to prevent contracture, if they are uncomfortable then contracture correction devices are also available

·        * KFOS / swivel walkers are used in patients for which walking is impossible thus this orthotics is used for weight transference and enable a child to stand up

·      *   DAY splints can be used for maintaining stability, Posture, Prevent deformity

·       *  Standing wheelchairs are also available.

·         *Proper seating and lumber support are considered while designing

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