1
|
Vandekerckhove I, Papageorgiou E, Hanssen B, De Beukelaer N, Van den Hauwe M, Goemans N, Van Campenhout A, De Waele L, De Groote F, Desloovere K. Gait classification for growing children with Duchenne muscular dystrophy. Sci Rep 2024; 14:10828. [PMID: 38734731 PMCID: PMC11088636 DOI: 10.1038/s41598-024-61231-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
Classifying gait patterns into homogeneous groups could enhance communication among healthcare providers, clinical decision making and clinical trial designs in boys with Duchenne muscular dystrophy (DMD). Sutherland's classification has been developed 40 years ago. Ever since, the state-of-the-art medical care has improved and boys with DMD are now longer ambulatory. Therefore, the gait classification requires an update. The overall aim was to develop an up-to-date, valid DMD gait classification. A total of 137 three-dimensional gait analysis sessions were collected in 30 boys with DMD, aged 4.6-17 years. Three classes were distinguished, which only partly aligned with increasing severity of gait deviations. Apart from the mildly affected pattern, two more severely affected gait patterns were found, namely the tiptoeing pattern and the flexion pattern with distinct anterior pelvic tilt and posterior trunk leaning, which showed most severe deviations at the ankle or at the proximal segments/joints, respectively. The agreement between Sutherland's and the current classification was low, suggesting that gait pathology with the current state-of-the-art medical care has changed. However, overlap between classes, especially between the two more affected classes, highlights the complexity of the continuous gait changes. Therefore, caution is required when classifying individual boys with DMD into classes.
Collapse
Affiliation(s)
| | | | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Nathalie De Beukelaer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Surgery, University of Geneva, Geneva, Switzerland
| | - Marleen Van den Hauwe
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Child Neurology, University Hospital Leuven, Leuven, Belgium
| | - Nathalie Goemans
- Department of Child Neurology, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Orthopedics, University Hospital Leuven, Leuven, Belgium
| | - Liesbeth De Waele
- Department of Child Neurology, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Pellenberg, Belgium
| |
Collapse
|
2
|
Deng J, Liu F, Feng Z, Liu Z. Population longitudinal analysis of Gait Profile Score and North Star Ambulatory Assessment in children with Duchenne muscular dystrophy. CPT Pharmacometrics Syst Pharmacol 2024; 13:891-903. [PMID: 38539027 PMCID: PMC11098163 DOI: 10.1002/psp4.13126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 05/18/2024] Open
Abstract
Duchenne muscular dystrophy (DMD) is a rare X-linked recessive disorder characterized by loss-of-function mutations in the gene encoding dystrophin. These mutations lead to progressive functional deterioration including muscle weakness, respiratory insufficiency, and musculoskeletal deformities. Three-dimensional gait analysis (3DGA) has been used as a tool to analyze gait pathology through the quantification of altered joint kinematics, kinetics, and muscle activity patterns. Among 3DGA indices, the Gait Profile Score (GPS), has been used as a sensitive overall measure to detect clinically relevant changes in gait patterns in children with DMD. To enhance our understanding of the clinical translation of 3DGA, we report here the development of a population nonlinear mixed-effect model that jointly describes the disease progression of the 3DGA index, GPS, and the functional endpoint, North Star Ambulatory Assessment (NSAA). The final model consists of a quadratic structure for GPS progression and a linear structure for GPS-NSAA correlation. Our model was able to capture the improvement in function in GPS and NSAA in younger subjects, as well as the decline of function in older subjects. Furthermore, the model predicted NSAA (CFB) at 1 year reasonably well for DMD subjects ≤7 years old at baseline. The model tended to slightly underpredict the decline in NSAA after 1 year for those >7 years old at baseline, but the prediction summary statistics were well maintained within the standard deviation of observed data. Quantitative models such as this may help answer clinically relevant questions to facilitate the development of novel therapies in DMD.
Collapse
Affiliation(s)
- Jiexin Deng
- School of Nursing and HealthHenan UniversityKaifengChina
| | - Fangli Liu
- School of Nursing and HealthHenan UniversityKaifengChina
| | - Zhifen Feng
- School of Nursing and HealthHenan UniversityKaifengChina
| | - Zhigang Liu
- Department of OrthopedicsFirst Affiliated Hospital of Henan UniversityKaifengChina
| |
Collapse
|
3
|
Ramli AA, Liu X, Berndt K, Goude E, Hou J, Kaethler LB, Liu R, Lopez A, Nicorici A, Owens C, Rodriguez D, Wang J, Zhang H, Aranki D, McDonald CM, Henricson EK. Gait Characterization in Duchenne Muscular Dystrophy (DMD) Using a Single-Sensor Accelerometer: Classical Machine Learning and Deep Learning Approaches. SENSORS (BASEL, SWITZERLAND) 2024; 24:1123. [PMID: 38400281 PMCID: PMC10892016 DOI: 10.3390/s24041123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Differences in gait patterns of children with Duchenne muscular dystrophy (DMD) and typically developing (TD) peers are visible to the eye, but quantifications of those differences outside of the gait laboratory have been elusive. In this work, we measured vertical, mediolateral, and anteroposterior acceleration using a waist-worn iPhone accelerometer during ambulation across a typical range of velocities. Fifteen TD and fifteen DMD children from 3 to 16 years of age underwent eight walking/running activities, including five 25 m walk/run speed-calibration tests at a slow walk to running speeds (SC-L1 to SC-L5), a 6-min walk test (6MWT), a 100 m fast walk/jog/run (100MRW), and a free walk (FW). For clinical anchoring purposes, participants completed a Northstar Ambulatory Assessment (NSAA). We extracted temporospatial gait clinical features (CFs) and applied multiple machine learning (ML) approaches to differentiate between DMD and TD children using extracted temporospatial gait CFs and raw data. Extracted temporospatial gait CFs showed reduced step length and a greater mediolateral component of total power (TP) consistent with shorter strides and Trendelenberg-like gait commonly observed in DMD. ML approaches using temporospatial gait CFs and raw data varied in effectiveness at differentiating between DMD and TD controls at different speeds, with an accuracy of up to 100%. We demonstrate that by using ML with accelerometer data from a consumer-grade smartphone, we can capture DMD-associated gait characteristics in toddlers to teens.
Collapse
Affiliation(s)
- Albara Ah Ramli
- Department of Computer Science, School of Engineering, University of California, Davis, CA 95616, USA; (A.A.R.); (X.L.); (R.L.)
| | - Xin Liu
- Department of Computer Science, School of Engineering, University of California, Davis, CA 95616, USA; (A.A.R.); (X.L.); (R.L.)
| | - Kelly Berndt
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, CA 95616, USA; (K.B.); (E.G.); (L.B.K.); (A.L.); (A.N.); (D.R.); (J.W.); (H.Z.); (C.M.M.)
| | - Erica Goude
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, CA 95616, USA; (K.B.); (E.G.); (L.B.K.); (A.L.); (A.N.); (D.R.); (J.W.); (H.Z.); (C.M.M.)
| | - Jiahui Hou
- Department of Electrical and Computer Engineering, School of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Lynea B. Kaethler
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, CA 95616, USA; (K.B.); (E.G.); (L.B.K.); (A.L.); (A.N.); (D.R.); (J.W.); (H.Z.); (C.M.M.)
| | - Rex Liu
- Department of Computer Science, School of Engineering, University of California, Davis, CA 95616, USA; (A.A.R.); (X.L.); (R.L.)
| | - Amanda Lopez
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, CA 95616, USA; (K.B.); (E.G.); (L.B.K.); (A.L.); (A.N.); (D.R.); (J.W.); (H.Z.); (C.M.M.)
| | - Alina Nicorici
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, CA 95616, USA; (K.B.); (E.G.); (L.B.K.); (A.L.); (A.N.); (D.R.); (J.W.); (H.Z.); (C.M.M.)
| | - Corey Owens
- UC Davis Center for Health and Technology, University of California, Davis, CA 95616, USA;
| | - David Rodriguez
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, CA 95616, USA; (K.B.); (E.G.); (L.B.K.); (A.L.); (A.N.); (D.R.); (J.W.); (H.Z.); (C.M.M.)
| | - Jane Wang
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, CA 95616, USA; (K.B.); (E.G.); (L.B.K.); (A.L.); (A.N.); (D.R.); (J.W.); (H.Z.); (C.M.M.)
| | - Huanle Zhang
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, CA 95616, USA; (K.B.); (E.G.); (L.B.K.); (A.L.); (A.N.); (D.R.); (J.W.); (H.Z.); (C.M.M.)
| | - Daniel Aranki
- Berkeley School of Information, University of California Berkeley, Berkeley, CA 94720, USA;
| | - Craig M. McDonald
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, CA 95616, USA; (K.B.); (E.G.); (L.B.K.); (A.L.); (A.N.); (D.R.); (J.W.); (H.Z.); (C.M.M.)
| | - Erik K. Henricson
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, CA 95616, USA; (K.B.); (E.G.); (L.B.K.); (A.L.); (A.N.); (D.R.); (J.W.); (H.Z.); (C.M.M.)
- Graduate Group in Computer Science (GGCS), University of California, Davis, CA 95616, USA
| |
Collapse
|
4
|
McDonald C, Camino E, Escandon R, Finkel RS, Fischer R, Flanigan K, Furlong P, Juhasz R, Martin AS, Villa C, Sweeney HL. Draft Guidance for Industry Duchenne Muscular Dystrophy, Becker Muscular Dystrophy, and Related Dystrophinopathies - Developing Potential Treatments for the Entire Spectrum of Disease. J Neuromuscul Dis 2024; 11:499-523. [PMID: 38363616 DOI: 10.3233/jnd-230219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background Duchenne muscular dystrophy (DMD) and related dystrophinopathies are neuromuscular conditions with great unmet medical needs that require the development of effective medical treatments. Objective To aid sponsors in clinical development of drugs and therapeutic biological products for treating DMD across the disease spectrum by integrating advancements, patient registries, natural history studies, and more into a comprehensive guidance. Methods This guidance emerged from collaboration between the FDA, the Duchenne community, and industry stakeholders. It entailed a structured approach, involving multiple committees and boards. From its inception in 2014, the guidance underwent revisions incorporating insights from gene therapy studies, cardiac function research, and innovative clinical trial designs. Results The guidance provides a deeper understanding of DMD and its variants, focusing on patient engagement, diagnostic criteria, natural history, biomarkers, and clinical trials. It underscores patient-focused drug development, the significance of dystrophin as a biomarker, and the pivotal role of magnetic resonance imaging in assessing disease progression. Additionally, the guidance addresses cardiomyopathy's prominence in DMD and the burgeoning field of gene therapy. Conclusions The updated guidance offers a comprehensive understanding of DMD, emphasizing patient-centric approaches, innovative trial designs, and the importance of biomarkers. The focus on cardiomyopathy and gene therapy signifies the evolving realm of DMD research. It acts as a crucial roadmap for sponsors, potentially leading to improved treatments for DMD.
Collapse
Affiliation(s)
| | - Eric Camino
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Rafael Escandon
- DGBI Consulting, LLC, Bainbridge Island, Washington, DC, USA
| | | | - Ryan Fischer
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Kevin Flanigan
- Center for Experimental Neurotherapeutics, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pat Furlong
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Rose Juhasz
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Ann S Martin
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Chet Villa
- Trinity Health Michigan, Grand Rapids, MI, USA
| | - H Lee Sweeney
- Cincinnati Children's Hospital Medical Center within the UC Department of Pediatrics, Cincinnati, OH, USA
| |
Collapse
|
5
|
Poleur M, Markati T, Servais L. The use of digital outcome measures in clinical trials in rare neurological diseases: a systematic literature review. Orphanet J Rare Dis 2023; 18:224. [PMID: 37533072 PMCID: PMC10398976 DOI: 10.1186/s13023-023-02813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
Developing drugs for rare diseases is challenging, and the precision and objectivity of outcome measures is critical to this process. In recent years, a number of technologies have increasingly been used for remote monitoring of patient health. We report a systematic literature review that aims to summarize the current state of progress with regard to the use of digital outcome measures for real-life motor function assessment of patients with rare neurological diseases. Our search of published literature identified 3826 records, of which 139 were included across 27 different diseases. This review shows that use of digital outcome measures for motor function outside a clinical setting is feasible and employed in a broad range of diseases, although we found few outcome measures that have been robustly validated and adopted as endpoints in clinical trials. Future research should focus on validation of devices, variables, and algorithms to allow for regulatory qualification and widespread adoption.
Collapse
Affiliation(s)
- Margaux Poleur
- Department of Neurology, Liege University Hospital Center, Liège, Belgium.
- Neuromuscular Reference Center, Division of Paediatrics University, Hospital University of Liège, Liège, Belgium.
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium.
| | - Theodora Markati
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Neuromuscular Reference Center, Division of Paediatrics University, Hospital University of Liège, Liège, Belgium
| |
Collapse
|
6
|
Kinematic changes in gait in boys with Duchenne Muscular Dystrophy: Utility of the Gait Deviation Index, the Gait Profile Score and the Gait Variable Scores. Gait Posture 2023; 100:157-164. [PMID: 36529026 DOI: 10.1016/j.gaitpost.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/08/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Duchenne Muscular Dystrophy (DMD) is an X-linked muscle disorder caused by a mutation or deletion in the dystrophin gene. In boys with DMD, muscle weakness progresses in a proximal to distal pattern, leading to gait abnormalities at all joints, in all planes of motion. Longitudinal studies are imperative to quantify changes in gait function due to DMD and are of particular importance when examining the efficacy of treatment interventions. RESEARCH QUESTION The purpose of this study was to examine the sensitivity of the Gait Deviation Index (GDI) and Movement Analysis Profile (Gait Profile Score (GPS) and Gait Variable Score (GVS)) to quantify the longitudinal ambulatory decline in boys with DMD. A secondary aim was to quantify the effect of corticosteroid (CS) treatment. METHODS The gait patterns of 75 boys were assessed longitudinally, 11 were steroid naïve (SN), and 64 received CS treatment. Joint kinematics were collected using either a VICON 612 or a Motion Analysis Corporation 3-D system. Representative trials were used to compute the GDI, GPS and the nine GVS for each boy for each visit. RESULTS At baseline, GVS for the boys with DMD revealed abnormalities in all lower extremity joints and in all planes of movement compared to TD peers. GDI and GPS indices verified that the overall quality of gait in boys with DMD decreases at a significant rate with age. Boys who were steroid naïve changed at a rate 3 times greater than boys on CS in coronal plane hip motion. SIGNIFICANCE The gait indices of GDI and GPS are able to identify changes in the quality of gait patterns in boys with DMD. Although boys on steroids had greater gait deviations than boys who were SN at baseline, the rate of decline in gait quality was slower in boys on CS.
Collapse
|
7
|
Aldirmaz E, Uğur F, Yilmaz Ö, Karaduman A, Alemdaroğlu-Gürbüz İ. A New Instrument to Assess Dynamic Balance in Children with Duchenne Muscular Dystrophy: Four Square Step Test and Its Validity, Reliability and Feasibility. Dev Neurorehabil 2023; 26:27-36. [PMID: 36367327 DOI: 10.1080/17518423.2022.2143924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this study was to investigate validity, reliability and feasibility of the Four Square Step Test (FSST) in children with Duchenne Muscular Dystrophy (DMD). METHODS The study included 44 children with DMD aged 5-12 years. The functional level of the children was determined by using the Brooke Lower Extremity Functional Classification (BLEFC). The concurrent validity of the FSST, a dynamic balance assessment, was investigated by analyzing the association between FSST and Timed Up and Go Test (TUG), North Star Ambulatory Assessment (NSAA) and Six-Minute Walk Test (6MWT) distance. The intra- and inter-rater reliability of the FSST was determined by using the Intra Class Correlation Coefficient (ICC) while the feasibility of the test was determined by calculating the percentage of children who successfully completed the test in accordance with the test instructions. RESULTS The FSST score of the children (mean age 9.25 ± 2.14 years) was 11.91 ± 3.43 and the BLEFC level ranged from Level 1 (65.9%) to Level 3 (9.1%). FSST had positive, moderate relation with BLEFC (r = 0.447; p = .002); positive, strong relation with TUG (rs = 0.623), and negative, moderate correlations with NSAA (rs = -0.529) and 6MWT distance (rs = -0.592) (p < .001). Intra-rater (ICC: 0.965) and inter-rater (ICC: 0.991) reliability was "excellent," and the test was feasible with successful performance of 88% children. DISCUSSION The FSST is a valid, reliable and feasible instrument to assess dynamic balance as well as having the ability to reflect falling risk and different functional levels of children with DMD.
Collapse
Affiliation(s)
- Esra Aldirmaz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Turkey
| | - Fatma Uğur
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Turkey
| | - Öznur Yilmaz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Turkey
| | - Ayşe Karaduman
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Lokman Hekim University, Çankaya, Turkey
| | | |
Collapse
|
8
|
Ricotti V, Kadirvelu B, Selby V, Festenstein R, Mercuri E, Voit T, Faisal AA. Wearable full-body motion tracking of activities of daily living predicts disease trajectory in Duchenne muscular dystrophy. Nat Med 2023; 29:95-103. [PMID: 36658421 PMCID: PMC9873561 DOI: 10.1038/s41591-022-02045-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/14/2022] [Indexed: 01/21/2023]
Abstract
Artificial intelligence has the potential to revolutionize healthcare, yet clinical trials in neurological diseases continue to rely on subjective, semiquantitative and motivation-dependent endpoints for drug development. To overcome this limitation, we collected a digital readout of whole-body movement behavior of patients with Duchenne muscular dystrophy (DMD) (n = 21) and age-matched controls (n = 17). Movement behavior was assessed while the participant engaged in everyday activities using a 17-sensor bodysuit during three clinical visits over the course of 12 months. We first defined new movement behavioral fingerprints capable of distinguishing DMD from controls. Then, we used machine learning algorithms that combined the behavioral fingerprints to make cross-sectional and longitudinal disease course predictions, which outperformed predictions derived from currently used clinical assessments. Finally, using Bayesian optimization, we constructed a behavioral biomarker, termed the KineDMD ethomic biomarker, which is derived from daily-life behavioral data and whose value progresses with age in an S-shaped sigmoid curve form. The biomarker developed in this study, derived from digital readouts of daily-life movement behavior, can predict disease progression in patients with muscular dystrophy and can potentially track the response to therapy.
Collapse
Affiliation(s)
- Valeria Ricotti
- National Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre/University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Balasundaram Kadirvelu
- Brain & Behaviour Lab, Department of Bioengineering, Imperial College London, London, UK
- Brain & Behaviour Lab, Department of Computing, Imperial College London, London, UK
- Behaviour Analytics Lab, Data Science Institute, Imperial College London, London, UK
| | - Victoria Selby
- National Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre/University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Festenstein
- Gene Control Mechanisms & Disease Group Department of Brain Sciences, Imperial College London, London, UK
- Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery (University College London Hospitals), London, UK
- Medical Research Council London Institute of Medical Sciences, London, UK
| | - Eugenio Mercuri
- Università Cattolica del Sacro Cuore, Rome, Italy
- Policlinico Universitario Agostino Gemelli University Hospital, Rome, Italy
| | - Thomas Voit
- National Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre/University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Aldo Faisal
- Brain & Behaviour Lab, Department of Bioengineering, Imperial College London, London, UK.
- Brain & Behaviour Lab, Department of Computing, Imperial College London, London, UK.
- Behaviour Analytics Lab, Data Science Institute, Imperial College London, London, UK.
- Medical Research Council London Institute of Medical Sciences, London, UK.
- Chair in Digital Health, Faculty of Life Sciences, University of Bayreuth, Bayreuth, Germany.
- Brain & Behaviour Lab, Institute of Artificial & Human Intelligence, University of Bayreuth, Bayreuth, Germany.
| |
Collapse
|
9
|
Vandekerckhove I, Van den Hauwe M, De Beukelaer N, Stoop E, Goudriaan M, Delporte M, Molenberghs G, Van Campenhout A, De Waele L, Goemans N, De Groote F, Desloovere K. Longitudinal Alterations in Gait Features in Growing Children With Duchenne Muscular Dystrophy. Front Hum Neurosci 2022; 16:861136. [PMID: 35721358 PMCID: PMC9201072 DOI: 10.3389/fnhum.2022.861136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/12/2022] [Indexed: 11/22/2022] Open
Abstract
Prolonging ambulation is an important treatment goal in children with Duchenne muscular dystrophy (DMD). Three-dimensional gait analysis (3DGA) could provide sensitive parameters to study the efficacy of clinical trials aiming to preserve ambulation. However, quantitative descriptions of the natural history of gait features in DMD are first required. The overall goal was to provide a full delineation of the progressive gait pathology in children with DMD, covering the entire period of ambulation, by performing a so-called mixed cross-sectional longitudinal study. Firstly, to make our results comparable with previous literature, we aimed to cross-sectionally compare 31 predefined gait features between children with DMD and a typically developing (TD) database (1). Secondly, we aimed to explore the longitudinal changes in the 31 predefined gait features in growing boys with DMD using follow-up 3DGA sessions (2). 3DGA-sessions (n = 124) at self-selected speed were collected in 27 boys with DMD (baseline age: 4.6-15 years). They were repeatedly measured over a varying follow-up period (range: 6 months-5 years). The TD group consisted of 27 children (age: 5.4-15.6 years). Per measurement session, the spatiotemporal parameters, and the kinematic and kinetic waveforms were averaged over the selected gait cycles. From the averaged waveforms, discrete gait features (e.g., maxima and minima) were extracted. Mann-Whitney U tests were performed to cross-sectionally analyze the differences between DMD at baseline and TD (1). Linear mixed effect models were performed to assess the changes in gait features in the same group of children with DMD from both a longitudinal (i.e., increasing time) as well as a cross-sectional perspective (i.e., increasing baseline age) (2). At baseline, the boys with DMD differed from the TD children in 17 gait features. Additionally, 21 gait features evolved longitudinally when following-up the same boys with DMD and 25 gait features presented a significant cross-sectional baseline age-effect. The current study quantitatively described the longitudinal alterations in gait features in boys with DMD, thereby providing detailed insight into how DMD gait deteriorates. Additionally, our results highlight that gait features extracted from 3DGA are promising outcome measures for future clinical trials to quantify the efficacy of novel therapeutic strategies.
Collapse
Affiliation(s)
| | - Marleen Van den Hauwe
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | - Elze Stoop
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Marije Goudriaan
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Margaux Delporte
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), KU Leuven, Leuven, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), KU Leuven, Leuven, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Anja Van Campenhout
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth De Waele
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Nathalie Goemans
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
10
|
Taboada Díaz JE, Carreño Juan D, Dunn García E, Díaz Novo C, Rodríguez Moliner T. [Essential features for obtaining the biomechanical pattern of gait in healthy children. A systematic review]. Rehabilitacion (Madr) 2022; 56:195-203. [PMID: 35305836 DOI: 10.1016/j.rh.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 10/18/2022]
Abstract
The gait patter in childhood is constantly changing as a result of the neuro-anatomical maturation due to growth, for this reason we propose to identify from published studies and the motion capture method, the essential features for obtaining the biomechanical pattern of gait in children. A search for scientific articles was carried out in Scopus, SciELO, PudMed and PEDro where gait is evaluated in subjects under 18 years old, based on motion capture methods and biomechanical parameters. The results showed that from 7 to 9 years old the child acquires the definitive gait pattern, the most used motion capture method was Vicon, with the use of video, force platform and electromyography and the parameters used were the spatial, temporal, spatial-temporal, kinematic, kinetic and electromyographic.
Collapse
Affiliation(s)
- J E Taboada Díaz
- Universidad Tecnológica de La Habana José Antonio Echeverría, La Habana, Cuba.
| | - D Carreño Juan
- Universidad Tecnológica de La Habana José Antonio Echeverría, La Habana, Cuba
| | - E Dunn García
- Centro Nacional de Rehabilitación Hospital Julio Díaz, La Habana, Cuba
| | - C Díaz Novo
- Universidad Tecnológica Suroeste ITR UTEC, Fray Bentos, Río Negro, Uruguay
| | - T Rodríguez Moliner
- Universidad Tecnológica de La Habana José Antonio Echeverría, La Habana, Cuba
| |
Collapse
|
11
|
Buckon CE, Sienko SE, Fowler EG, Bagley AM, Staudt LA, Sison-Williamson M, Heberer KR, McDonald CM, Sussman MD. A Longitudinal Study of Quantitative Muscle Strength and Functional Motor Ability in Ambulatory Boys with Duchenne Muscular Dystrophy. J Neuromuscul Dis 2021; 9:321-334. [PMID: 34924398 DOI: 10.3233/jnd-210704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is an X-linked recessive genetic disorder, that is characterized by progressive muscle degeneration and loss of ambulation between 7-13 years of age. Novel pharmacological agents targeting the genetic defects and disease mechanisms are becoming available; however, corticosteroid (CS) therapy remains the standard of care. OBJECTIVE The purpose of this longitudinal study was to elucidate the effect of CS therapy on the rate of muscle strength and gross motor skill decline in boys with DMD and assess the sensitivity of selected outcome measures. METHODS Eighty-four ambulatory boys with DMD (49-180 months), 70 on CS, 14 corticosteroid naïve (NCS), participated in this 8-year multi-site study. Outcomes included; isokinetic dynamometry, the Standing (STD) and Walking/Running/jumping (WRJ) dimensions of the Gross Motor Function Measure (GMFM), and Timed Function Tests (TFTs). Nonlinear mixed modeling procedures determined the rate of change with age and the influence of steroids. RESULTS Despite CS therapy the rate of decline in strength with age was significant in all muscle groups assessed. CS therapy significantly slowed decline in knee extensor strength, as the NCS group declined at 3x the rate of the CS group. Concurrently, WRJ skills declined in the NCS group at twice the rate of the CS group. 4-stair climb and 10 meter walk/run performance was superior in the boys on CS therapy. CONCLUSION CS therapy slowed the rate of muscle strength decline and afforded longer retention of select gross motor skills in boys on CS compared to boys who were NCS. Isokinetic dynamometry, Walk/Run/Jump skills, and select TFTs may prove informative in assessing the efficacy of new therapeutics in ambulatory boys with DMD.
Collapse
Affiliation(s)
| | | | - Eileen G Fowler
- Department of Orthopaedics, University of California, Los Angeles, CA, California
| | - Anita M Bagley
- Shriners Hospitals for Children, Northern California, CA, California
| | - Loretta A Staudt
- Department of Orthopaedics, University of California, Los Angeles, CA, California
| | | | - Kent R Heberer
- Department of Orthopaedics, University of California, Los Angeles, CA, California
| | - Craig M McDonald
- Department of Physical Medicine, University of California Davis Medical Center, Sacramento, CA, California
| | | |
Collapse
|
12
|
Servais L, Camino E, Clement A, McDonald CM, Lukawy J, Lowes LP, Eggenspieler D, Cerreta F, Strijbos P. First Regulatory Qualification of a Novel Digital Endpoint in Duchenne Muscular Dystrophy: A Multi-Stakeholder Perspective on the Impact for Patients and for Drug Development in Neuromuscular Diseases. Digit Biomark 2021; 5:183-190. [PMID: 34723071 DOI: 10.1159/000517411] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Functional outcome measures used to assess efficacy in clinical trials of investigational treatments for rare neuromuscular diseases like Duchenne muscular dystrophy (DMD) are performance-based tasks completed by the patient during hospital visits. These are prone to bias and may not reflect motor abilities in real-world settings. Digital tools, such as wearable devices and other remote sensors, provide the opportunity for continuous, objective, and sensitive measurements of functional ability during daily life. Maintaining ambulation is of key importance to individuals with DMD. Stride velocity 95th centile (SV95C) is the first wearable acquired digital endpoint to receive qualification from the European Medicines Agency (EMA) to quantify the ambulation ability of ambulant DMD patients aged ≥5 years in drug therapeutic studies; it is also currently under review for the US Food and Drug Administration (FDA) qualification. Summary Focusing on SV95C as a key example, we describe perspectives of multiple stakeholders on the promise of novel digital endpoints in neuromuscular disease drug development.
Collapse
Affiliation(s)
- Laurent Servais
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Division of Child Neurology, Centre de Référence des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège and University of Liège, Liege, Belgium
| | - Eric Camino
- Parent Project Muscular Dystrophy, Hackensack, New Jersey, USA
| | | | - Craig M McDonald
- University of California Davis Health, Sacramento, California, USA
| | | | - Linda P Lowes
- Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | | | | |
Collapse
|
13
|
Youn BY, Ko Y, Moon S, Lee J, Ko SG, Kim JY. Digital Biomarkers for Neuromuscular Disorders: A Systematic Scoping Review. Diagnostics (Basel) 2021; 11:diagnostics11071275. [PMID: 34359358 PMCID: PMC8307187 DOI: 10.3390/diagnostics11071275] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Biomarkers play a vital role in clinical care. They enable early diagnosis and treatment by identifying a patient's condition and disease course and act as an outcome measure that accurately evaluates the efficacy of a new treatment or drug. Due to the rapid development of digital technologies, digital biomarkers are expected to grow tremendously. In the era of change, this scoping review was conducted to see which digital biomarkers are progressing in neuromuscular disorders, a diverse and broad-range disease group among the neurological diseases, to discover available evidence for their feasibility and reliability. Thus, a total of 10 studies were examined: 9 observational studies and 1 animal study. Of the observational studies, studies were conducted with amyotrophic lateral sclerosis (ALS), Duchenne muscular dystrophy (DMD), and spinal muscular atrophy (SMA) patients. Non-peer reviewed poster presentations were not considered, as the articles may lead to erroneous results. The only animal study included in the present review investigated the mice model of ALS for detecting rest disturbances using a non-invasive digital biomarker.
Collapse
Affiliation(s)
- Bo-Young Youn
- Department of Global Public Health and Korean Medicine Management, Graduate School, Kyung Hee University, Seoul 02447, Korea; (B.-Y.Y.); (S.M.)
| | - Youme Ko
- Department of Preventive Medicine, Kyung Hee University, Seoul 02447, Korea; (Y.K.); (S.-G.K.)
| | - Seunghwan Moon
- Department of Global Public Health and Korean Medicine Management, Graduate School, Kyung Hee University, Seoul 02447, Korea; (B.-Y.Y.); (S.M.)
| | - Jinhee Lee
- Department of Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Seung-Gyu Ko
- Department of Preventive Medicine, Kyung Hee University, Seoul 02447, Korea; (Y.K.); (S.-G.K.)
| | - Jee-Young Kim
- Department of Neurology, Cheongna Best Rehabilitation Hospital, Incheon 22883, Korea
- Correspondence:
| |
Collapse
|
14
|
An J, Xie Z, Jia F, Wang Z, Yuan Y, Zhang J, Fang J. Quantitative coordination evaluation for screening children with Duchenne muscular dystrophy. CHAOS (WOODBURY, N.Y.) 2020; 30:023116. [PMID: 32113230 DOI: 10.1063/1.5126116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
As the potential for a treatment of Duchenne muscular dystrophy (DMD) grows, the need for methods for the early diagnosis of DMD becomes more and more important. Clinical experiences suggest that children with DMD will show some lack of motor ability in the early stage when compared with children at the same age, especially in balance and coordination abilities. Is it possible to quantify the coordination differences between DMD and typically developing (TD) children to achieve the goal of screening for DMD diseases? In this study, we introduced a Local Manifold Structure Mapping approach in phase space and extracted a novel index, relative coupling coefficient (RCC), from gait pattern signals, which were acquired by wearable accelerometers to evaluate the coordination of children with DMD during a walking task. Furthermore, we compared the RCC of 100 children with DMD and 100 TD children in four different age groups and verified the feasibility and reliability of the proposed indices to distinguish children with TD from DMD. T-test results show that, for all age groups, children of the same age with DMD and TD show significant differences in RCC (p < 0.001). Moreover, RCC comprehensively reflects that the coordination ability of DMD patients under walking tasks gradually decreases with age, which is consistent with clinical experience. As a functional biomarker extracted in the phase space of the gait data, the proposed coupling degree index RCC could sensitively distinguish between DMD and TD children at the same age and provide alternative insights and potentially valuable tools for the screening of DMD.
Collapse
Affiliation(s)
- Jian An
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Zhiying Xie
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Fan Jia
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Jue Zhang
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Jing Fang
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| |
Collapse
|
15
|
Straub V, Mercuri E. Report on the workshop: Meaningful outcome measures for Duchenne muscular dystrophy, London, UK, 30-31 January 2017. Neuromuscul Disord 2018; 28:690-701. [PMID: 30033203 DOI: 10.1016/j.nmd.2018.05.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Volker Straub
- Institute of Genetic Medicine, Newcastle University John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | |
Collapse
|
16
|
Ambulatory capacity in Japanese patients with Duchenne muscular dystrophy. Brain Dev 2018; 40:465-472. [PMID: 29551259 DOI: 10.1016/j.braindev.2018.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/13/2018] [Accepted: 02/17/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Few long-term cohort studies have addressed changes in the ambulatory capacity of patients with Duchenne muscular dystrophy (DMD), and no reports have evaluated the factors associated with ambulatory capacity in Japanese. METHODS The longitudinal changes in 10-meter run/walk ability and associated factors were retrospectively investigated using general practice data. The factors associated with loss of this ability before the age of 10 years were explored by logistic regression analysis using parameters of genetic mutations, corticosteroid use, the manual muscle test (MMT), and the joint range of motion (ROM). Explanatory variables of MMT grade included hip flexors, knee flexors, and knee extensors; ROM included hip extension, knee extension, and ankle dorsiflexion. RESULTS Among 418 patients diagnosed with DMD, 145 patients underwent the 10-meter run/walk test between March 1999 and July 2015. The median age at loss of 10-meter walking ability was 10.4 (interquartile range: 9.2-11.3) years. The 10-meter run/walk speed began to decline 3 years before the loss of 10-meter walking ability, and the median was <1 m/s 1 year before the loss of 10-meter walking ability. MMT grade for knee flexors and ROM for hip and knee extension were identified as independent predictors. Based on the change over time of these three items, limitation of the hip extension ROM preceded knee flexor weakness and limitation of the knee extension ROM. CONCLUSIONS This knowledge can be used in optimizing rehabilitation programs and evaluating effect of treatment for DMD patients.
Collapse
|
17
|
Goudriaan M, Van den Hauwe M, Dekeerle J, Verhelst L, Molenaers G, Goemans N, Desloovere K. Gait deviations in Duchenne muscular dystrophy-Part 1. A systematic review. Gait Posture 2018; 62:247-261. [PMID: 29579701 DOI: 10.1016/j.gaitpost.2018.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/13/2018] [Accepted: 03/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although prolonged ambulation is considered important in children with Duchenne muscular dystrophy (DMD), articles describing gait deviations in DMD are scarce. RESEARCH QUESTION Therefore, our research questions were the following: 1) what are the most consistently reported spatiotemporal-, kinematic-, kinetic-, and muscle activity deviations in children with DMD in literature, 2) what is the quality of the studies describing these deviations, and 3) is there need for further research? METHODS We conducted a systematic literature search for studies published before the end of June 2017 in six online databases. We created a data extraction form to define information on materials and methods and on the analyzed gait parameters for each paper included in the review. If enough information was available, we calculated standardized mean differences (SMDs). RESULTS The search yielded nine articles, but generalizability was poor. Seventy-nine parameters were analyzed by seven research groups, but they only agreed on a decrease in walking speed (minimal SMD: 1.26), stride length (1.83), step length (1.80), dorsiflexion during swing (1.43), maximal power generation at the hip (0.92), maximal knee extension torque (0.99), maximal dorsiflexion torque (-1.30), and maximal power generation at the ankle (0.92), and an increased knee range of motion (-0.82) in DMD. SIGNIFICANCE In order to keep children with DMD ambulant as long as possible, a clear understanding of their pathological gait pattern is necessary. However, gait deviations in DMD appear not well defined. Previous studies appear to be of an exploratory nature while using predefined gait parameters to assess an undirected null hypothesis. This made them prone to regional focus bias, thereby increasing the chance of a type I error. Therefore, further research is required to define the altered gait pattern in children with DMD.
Collapse
Affiliation(s)
- Marije Goudriaan
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium.
| | - Marleen Van den Hauwe
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Department of Child Neurology, Leuven, Belgium
| | - Joyce Dekeerle
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Louise Verhelst
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Guy Molenaers
- University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium; KU Leuven - Department of Development and Regeneration, University of Leuven, Leuven, Belgium; University Hospitals Leuven, Department of Orthopedics, Pellenberg, Belgium
| | - Nathalie Goemans
- University Hospitals Leuven, Department of Child Neurology, Leuven, Belgium; KU Leuven - Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Kaat Desloovere
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium
| |
Collapse
|
18
|
Birnkrant DJ, Bushby K, Bann CM, Apkon SD, Blackwell A, Brumbaugh D, Case LE, Clemens PR, Hadjiyannakis S, Pandya S, Street N, Tomezsko J, Wagner KR, Ward LM, Weber DR. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management. Lancet Neurol 2018; 17:251-267. [PMID: 29395989 PMCID: PMC5869704 DOI: 10.1016/s1474-4422(18)30024-3] [Citation(s) in RCA: 689] [Impact Index Per Article: 114.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 10/03/2017] [Accepted: 11/20/2017] [Indexed: 12/12/2022]
Abstract
Since the publication of the Duchenne muscular dystrophy (DMD) care considerations in 2010, multidisciplinary care of this severe, progressive neuromuscular disease has evolved. In conjunction with improved patient survival, a shift to more anticipatory diagnostic and therapeutic strategies has occurred, with a renewed focus on patient quality of life. In 2014, a steering committee of experts from a wide range of disciplines was established to update the 2010 DMD care considerations, with the goal of improving patient care. The new care considerations aim to address the needs of patients with prolonged survival, to provide guidance on advances in assessments and interventions, and to consider the implications of emerging genetic and molecular therapies for DMD. The committee identified 11 topics to be included in the update, eight of which were addressed in the original care considerations. The three new topics are primary care and emergency management, endocrine management, and transitions of care across the lifespan. In part 1 of this three-part update, we present care considerations for diagnosis of DMD and neuromuscular, rehabilitation, endocrine (growth, puberty, and adrenal insufficiency), and gastrointestinal (including nutrition and dysphagia) management.
Collapse
Affiliation(s)
- David J Birnkrant
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Katharine Bushby
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Carla M Bann
- RTI International, Research Triangle Park, NC, USA
| | - Susan D Apkon
- Department of Rehabilitation Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | | | - David Brumbaugh
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Colorado, Aurora, CO, USA
| | - Laura E Case
- Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University School of Medicine, Durham, NC, USA
| | - Paula R Clemens
- Department of Neurology, University of Pittsburgh School of Medicine, and Neurology Service, Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
| | - Stasia Hadjiyannakis
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, and University of Ottawa, Ottawa, ON, Canada
| | - Shree Pandya
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Natalie Street
- Rare Disorders and Health Outcomes Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean Tomezsko
- Medical Nutrition Consulting of Media LLC, and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathryn R Wagner
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, and Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Leanne M Ward
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, and University of Ottawa, Ottawa, ON, Canada
| | - David R Weber
- Division of Endocrinology and Diabetes, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|