Trunk Control and Upper Limb Function of Walking and Non-walking Duchenne Muscular Dystrophy Individuals

The relationship between lower urinary system symptoms and the level of independence and quality of life in children with Duchenne muscular dystrophy

BACKGROUND

The purpose was to investigate the frequency of lower urinary tract symptoms (LUTS) and lower urinary tract dysfunction (LUTD) in Duchenne muscular dystrophy (DMD) and the relationship between these symptoms and independence and quality of life (QoL).

METHODS

The cross-sectional study included children aged 5-18 years and diagnosed with DMD and their families. Data were collected using the Dysfunctional Voiding and Incontinence Scoring System (DVISS), the Barthel Index, and the Pediatric Quality of Life™ 3.0 Neuromuscular Module (PedsQL-NMM).

RESULTS

The study was completed with 45 children with DMD. LUTS was found in 86.66% and LUTD was found in 44.44%. The most common symptom was holding maneuvers (62.22%). Other common symptoms were urinary urgency (55.55%), daytime urinary incontinence (46.66%), and enuresis (31.11%). There was a significant correlation of the DVISS with the level of independence and QoL (p < 0.05). Moreover, higher LUTS score was associated with lower Barthel and PedsQL-NMM scores.

CONCLUSION

LUTS is a neglected condition, although it is frequently seen in children with DMD.

CLINICAL TRIAL REGISTRATION

NCT05464446.

Comparison of energy expenditure of individuals with Duchenne muscular dystrophy in the sitting posture on the ground and in water

Duchenne Muscular Dystrophy (DMD) is one of the most frequent childhood dystrophies, affecting cardiopulmonary functions and walking ability. One of the main symptoms is fatigue, which is caused by altered muscle metabolism related to energy expenditure (EE). Aquatic physiotherapy is a therapeutic modality that facilitates the maintenance of this posture because of immersion on the body. This cross-sectional observational study aimed to compare the EE on the ground and water of individuals with DMD through oxygen consumption in the maintenance of sitting posture. The individuals were in a sitting position on the ground and in the water for 20 min for the assessments. The variables peripheral oxygen saturation, heart rate, maximum expiratory pressure, maximum inspiratory pressure, forced vital capacity, respiratory quotient (RQ), and oxygen consumption per kilogram of body weight (VO2 /kg) were compared, adopting a significance of 5 %. No difference was found between medians and quartiles of RQ when comparing the two environments. The same was observed for VO2 /Kg values on the ground and in water. The data from this study demonstrate that the EE of individuals with DMD did not change when maintaining a sitting posture on the ground and in water.

Update of the Brazilian consensus recommendations on Duchenne muscular dystrophy

In the last few decades, there have been considerable improvements in the diagnosis and care of Duchenne muscular dystrophy (DMD), the most common childhood muscular dystrophy. International guidelines have been published and recently reviewed. A group of Brazilian experts has developed a standard of care based on a literature review with evidence-based graded recommendations in a two-part publication. Implementing best practice management has helped change the natural history of this chronic progressive disorder, in which the life expectancy for children of the male sex in the past used to be very limited. Since the previous publication, diagnosis, steroid treatment, rehabilitation, and systemic care have gained more significant insights with new original work in certain fields. Furthermore, the development of new drugs is ongoing, and some interventions have been approved for use in certain countries. Therefore, we have identified the need to review the previous care recommendations for Brazilian patients with DMD. Our objective was to create an evidence-based document that is an update on our previous consensus on those topics.

Seated Outcome Measures in Children With Duchenne Muscular Dystrophy

PURPOSE

Quantifiable motor strength measures to assess disease severity throughout the continuum of Duchenne muscular dystrophy (DMD) are needed. To study the feasibility of seated trunk strength using hand-held dynamometry (HHD) and caregiver-reported subjective functional independence measures in boys with DMD.

METHODS

Prospective, cross-sectional, observational study of 18 participants with DMD enrolled from pediatric muscular dystrophy clinic during routine clinical assessment. Hand-held dynamometry, seated reach distance test and Pediatric Evaluation of Disability Inventory (PEDI) were administered.

RESULTS

All study participants regardless of the walking status were able to complete the seated function tests demonstrating feasibility. The age of the participants correlated negatively with PEDI mobility and positively with HHD extension scores. The seated measures did not statistically correlate with PEDI mobility scores.

CONCLUSIONS

Seated motor strength measures and PEDI mobility scores are feasible. The PEDI mobility and HHD extension scores correlate with age. Study limitations included single-center experience and cross-sectional data.

VIDEO ABSTRACT LINK

https://www.dropbox.com/s/s4r0k7o6s0tfbkb/PT-Seated-Measures-And-DMD-2022.mp4?dl=0.

Evaluation of a Chair-Mounted Passive Trunk Orthosis: A Pilot Study on Able-Bodied Subjects

Trunk stability is important for adequate arm function due to their kinematic linkage. People with Duchenne muscular dystrophy (DMD) can benefit from trunk-assistive devices for seated daily activities, but existing devices limit trunk movement to forward bending. We developed a new trunk orthosis that has spring and pulley design. This study evaluated orthosis performance with 40 able-bodied subjects under with and without orthosis condition in 20 seated tasks for trunk rotation, forward bending, and side bending movements. Subjects adopted static posture in specific trunk orientation while their muscle activity was recorded. They also rated the subjective scales of perceived exertion and usability. A percent change in muscle activity for each task, due to orthosis use, is reported. Significant muscle activity reductions up to 31% and 65% were observed in lumbar and thoracic erector spinae muscles, respectively. Using three-way ANOVA, we found these reductions to be specific to the task direction and the choice of upper limb that is used to perform the asymmetric tasks. A total of 70% participants reported acceptable usability and ~1-point increase in exertion was found for maximum voluntary reaching with the orthosis. The outcomes of this study are promising, though tested on able-bodied subjects. Hence, orthosis mounted on wheelchairs should be further evaluated on DMD patients.