Duchennes muscular dystrophy (DMD) having child develop a typical postureal abnormalities as the condition progresses. Typical signs seen in DMD is Gower's sign. Prominant proximal muscle weekness leads to postural abnormalities

1. z
Kinetics and
Kinematics of
Posture in DMD
Dr. Manasi Kulkarni
MPT-Neurophysiotherapy
Guide: Dr. Suvarna Ganvir
D.V.V.P.F’s College of Physiotherapy, Ahmednagar

2. z
Objectives
 At the end of seminar , one should know about
 Brief Idea of DMD
 Abnormal muscle work
 Postures adapted by DMD child
 Kinetics and kinematics of DMD postures

3. z INTRODUCTION
 DMD, also known as pseudo-hypertrophic muscular dystrophy or
progressive muscular dystrophy.
 Incidence- 1 in 3500 male
 X-linked inheritance pattern
 Defect to be a mutation at Xp21 in the gene coding for the protein
dystrophin.

4. z
 Diagnostic tools- Serum Creatine Kinase (CK) level
- EMG
 Onset- insidious in age 2-5 years
 Common Musculoskeletal Symptoms
- Pseudohypertrophy of Gastrocnemius
- Weakness of hip and knee Extensors
- Iliotibial band contracture
- Loss of ambulation
- upper extremity contractures begin to develop in the
elbows, shoulders and long finger flexors in later stages

5. z

6. z
• As walking and other abilities deteriorate,
compensatory spinal deformities such as
scoliosis and hyper-lordosis start developing
and finally culminate in complete functional
dependence.

7. z

8. z

9. z

10. z
Kinetics and kinematics of Optimal Vs DMD
posture

11. z

12. z

13. z
 A study was done by Baptista C. et al on postural alignment in children
with DMD and its relation to balance
 Sample size -29 (6-11 yr) – 10-DMD, 10- eutrophic children, 9-obese
children
 Outcome measures- MFM, PBS
 Conclusion: the distinction between the DMD children and the non-
affected children is based on horizontal pelvic alignment and sagittal-
plane asymmetry. Boys with DMD presented excessive forward
projection of the CoM, exacerbated pelvic anteversion, and the worst
balance scores. The excessive pelvic anteversion of the DMD seems to
aid balance, however this strategy did not guarantee a similar
performance as that achieved by the eutrophic or obese children

14. z
 A study was conducted by Barrette R. et al on changes in COG in boys with DMD.
 Sample size- 37 –normal children, 61- DMD boys
 Analysis of COG- with Force platform
 Conclusion :
38- independently walking
23-orthotic use walking
There was a reduction of the
anteroposterior range of sway with
orthotic use, but the lateral range of
sway remained significantly greater (P
< 0.01) as did the frequency of sway in
both the antero-posterior and lateral
directions (NP P < 0.001, Lat P <
0.001) in DMD children.

15. z
References
 Tecklin J.S. Pediatric Physical Therapy. 5th edition.
 Darcy U.A., Burton G. U., Lazaro R.T., Roller M. L. Umphred’s Neurological
rehabilitation. 6th edition