5. Duchenne Muscular Dystrophy
• The most common form of muscular
dystrophy
• X linked recessive disorder
• Defect is localized to the short arm of X
chromosome at Xp21
• Incidence: 1 per 3500 live male births
• Mutation rate: 1 per 10000 gametes
• 30% cases have no family history
6. • Rare female cases
• Pseudo hypertrophy of calf, deltoid muscle
• Serum CPK elevated between 20 to 100
times
• Absence of dystropin
7. Duchenne Muscular Dystrophy
First problems:
– Delayed motor development: muscle weakness
from 3-4 yrs
– Inability to run
– Difficulties in climbing stairs
– Gower’s Manoeuvre
– Muscle fibrosis – pseudohypertrophy
– Elevated muscle enzymes in serum (creatine
kinase)
13. Becker Muscular Dystrophy
• 10 time less frequent than DMD
• Slower progress in nature
• Patient survives till 40-50 years
• Mental retardation and heart failure can
occur
• serum CPK, EMG similar to DMD
• Reduced amount of distrophin
16. Functional Grades (UL)
1-Sdanding with arms at the sides the patient can
abduct the arms in a full circle until they touch
above the head
2-the patient can raise the arms above the head
only by flexing the elbow or by using accessory
muscle.
3-The patient cannot raise hands above the head
,but can raise an 8-oz glass of water to mouth
17. 4-the patient can raise hands to the mouth but
cannot raise 8-oz glass of water to the mouth
5-The patient cannot raise hands to the mouth but
can use the hands to hold a pen or to pick up
pennies from a table .
6-The patient cannot raise hands to the mouth and
has no useful function of the hands.
18. Functional Grades (LL)
1-walk and climbs stairs without assistance
2-walk and climbs stairs with aid of railing
3-walk and climbs stairs slowly (elapsed
time of more than 12 seconds for four
standards stairs) With the aid of a railing
19. 4-Walks unassisted and raise from a chair
but cannot climbs stairs
5-Walks unassisted but cannot raise from a
chair or climb stairs
6-Walks only with assistance or
independently with long leg braces
20. Physical Therapy Intervention
Area of concern
• Weakness
• Decreased activity and passive ROM
• Loss of ambulation
• Decreased functional ability
• Decreased pulmonary function
• Emotional trauma-individual and family
• Progressive scoliosis
21. • Prevent deformity
• Prolong functional capacity
• Facilitate the development and assistance
of family support and support of others
• Control pain if necessary
22. Facilitate the development and
assistance of family support
• Counseling family and patient
• Developing skills for support therapy
24. Active Exercise
• Several studies have indicated that
submaximal exercise has limited value in
increasing strength or changing function in
DMD- P.Vignos et.al
• Scott et.al have suggested a possible
beneficial effect of chronic low –
frequency electrical stimulation in DMD
25. Prolongation of Ambulation
• Wait control
• Endurance training
• Use of orthotic appliances
• Energy conservation if fatigue occur
