Duchenne muscular dystrophy (DMD) is an inherited condition causing muscle weakness. The muscle weakness is not usually noticeable at birth but symptoms may become noticeable between the ages of 2 and 4. As a child gets older the muscle weakness gets progressively worse, making it increasingly difficult for them to continue walking.
What are the Early Symptoms?
- Mild delay in reaching their gross motor milestones e.g. walking late
- Children may start walking on their toes and develop a slight waddle.
- You may notice your child’s calf muscles become bulky.
- Your child may find it difficult to stand up from the floor and use his hands on his legs to help him – this is called “Gower’s sign”.
- Difficulty going up and down stairs
- Difficulty in jumping and clearing both feet off the ground
- Some children will be delayed in their speech
How Can Physiotherapy Help?
Each child is treated according to their symptoms and disease progression but the priorities of treatment are the same:
- Maintain Muscle Length and Joint Range of Movement: A tailored stretching and strengthening programme will be designed that can be fitted into the child’s daily routine.
- Maintaining Fitness Level: A gentle exercise plan including games and activities will be discussed with the child and their parents.
- Prolongation of Walking: This helps to maximise the physical potential of each child, promote functional independence and minimise the adverse effects of conditions e.g. scoliosis.
- Postural Management: Ensuring good spinal alignment in standing, sitting and sleeping.
How can Orthotic Intervention Help People with DMD:
There is no “cure” for MD however, treatment can help symptom management, prolong ambulatory ability & prevent major health complications. Orthosis design depends on the joint that needs supporting & the current muscular ability.
Contractures: As muscles deteriorate, kids with MD develop fixations of the joint. If not treated, these can cause pain, discomfort & restrict mobility & independence. Range of motion exercises performed on a regular basis & wearing an orthoses to stretch the tendons delays the development of contracture.
Spinal Curvatures: As trunk muscles deteriorate the spine can be gradually pulled into a curved shape (side-to-side: scoliosis, front-to-back: kyphosis). Spine strengthening exercises & a back brace can help slow the progression of the spinal deformity.
Joint Stability: Ankle foot orthoses & knee immobilizers may be prescribed for joint stability & stabilization, stretching & positioning.
Standing Ability: Standing frames & standing walkers assist children with MD to stand &/or ambulate efficiently. Standing for a few hours/day with minimal weight bearing promotes better circulation, healthier bones & a straight spine.