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Erden Güner A, Öztürk D, Sarı M, Çelik Hİ, Tunç AR, Ünver B, Kılınç HE, Korkmaz N, Turanoğlu M, Gürsoy S, Karaduman AA. Maintaining Physical Health in Individuals with Duchenne Muscular Dystrophy Through Telerehabilitation. Phys Occup Ther Pediatr 2024:1-17. [PMID: 39014867 DOI: 10.1080/01942638.2024.2376055] [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: 10/31/2023] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
AIMS To investigate the effects of a telerehabilitation program on walking performance, lower and upper extremity function, fall frequency, respiratory function, and satisfaction in individuals with Duchenne muscular dystrophy (DMD). METHODS Thirty children (mean age 8.8 ± 4.2 years) were ambulant (Group 1), and 12 youth (18.5 ± 4.7 years) were non-ambulant (Group 2). The telerehabilitation program was applied by physiotherapists for 24 sessions (3 days/week). The 10-meter walking test, stand up from the supine position test, the modified upper extremity performance test, repetition of Lower and upper extremity movements, and the single breath count (SBC) test were administered. Fall frequency and satisfaction level were also recorded. RESULTS Significant improvement was found after telerehabilitation in upper extremity performance, repetition of lower and upper extremity movements, fall frequency, and SBC scores in Group 1. Changes in the 10-minute Walk and Stand Up from the Supine Position tests were not significant. There was a significant improvement in SBC scores in Group 2. Satisfaction with the service was 88%. CONCLUSIONS The 8-week telerehabilitation program was effective in improving aspects of upper and lower extremity function, fall frequency, pulmonary function, and satisfaction levels in individuals with DMD.
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Affiliation(s)
- Arzu Erden Güner
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey
| | - Demet Öztürk
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Lokman Hekim University, Ankara, Turkey
| | - Mustafa Sarı
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Lokman Hekim University, Ankara, Turkey
| | | | - Azize Reda Tunç
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Lokman Hekim University, Ankara, Turkey
| | - Banu Ünver
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Lokman Hekim University, Ankara, Turkey
| | - Hasan Erkan Kılınç
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Nurhayat Korkmaz
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey
| | - Mehtap Turanoğlu
- Turkish Republic Health Ministry Tepecik Educational and Research Hospital, İzmir, Turkey
| | - Selda Gürsoy
- Arsin Yeşilce Special Education Occupation School, Trabzon, Turkey
| | - Aynur Ayşe Karaduman
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey
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Nangliya R, Sasun AR, Samal S. Pragmatic Neurorehabilitation Approach for Improving Quality of Life in Duchenne Muscular Dystrophy: A Case Report. Cureus 2024; 16:e56315. [PMID: 38629006 PMCID: PMC11020631 DOI: 10.7759/cureus.56315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
This case report provides insights into the physiotherapy management of a 12-year-old male with Duchenne muscular dystrophy (DMD). DMD is a devastating genetic disorder characterized by progressive muscle degeneration and weakness. Skeletal muscle degeneration is induced by a genetic disorder. It is a common X-linked condition that causes hypertrophy of the calves and proximal muscular weakness in children. It frequently results in early mortality, wheelchair confinement, and delays in motor development. Physiotherapy interventions aim to optimize functional abilities and quality of life in individuals with DMD. This case report highlights the effectiveness of physiotherapy in managing DMD progression. This study presents a case exhibiting notable clinical symptoms, highlighting the urgency for advanced treatments to combat this debilitating disease. Outcome measures such as body mass index, spirometry, manual muscle testing, and the World Health Organization Quality-of-Life scale are used to report patient progress. The treatment plan was carried out for six weeks, five times a week. Physiotherapy strategies include diet management, stretching and splinting techniques, and pulmonary training. While current treatments focus on symptom management, ongoing research holds promise for the development of more effective therapies to improve outcomes and quality of life for affected individuals. Multidisciplinary care, including neurophysiotherapy rehabilitation, plays a crucial role in managing the symptoms and complications of DMD, emphasizing the importance of comprehensive support for patients and their families. At the end of our rehabilitation, the patient showed significant improvement in the outcome measures.
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Affiliation(s)
- Radha Nangliya
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anam R Sasun
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Snehal Samal
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Manzano M, Guegan S, Le Breton R, Devigne L, Babel M. Model-Based Upper-Limb Gravity Compensation Strategies for Active Dynamic Arm Supports. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941294 DOI: 10.1109/icorr58425.2023.10304711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
NeuroMuscular Disorders (NMDs) may induce difficulties to perform daily life activities in autonomy. For people with NMDs affecting the upper-limb mobility, Dynamic Arm Supports (DASs) turn out to be relevant assistive devices. In particular, active DASs benefit from an external power source to support severely impaired people. However, commercially available active devices are controlled with push buttons, which add cognitive load and discomfort. To alleviate this issue, we propose a new force-based assistive control framework. In this preliminary work, we focus on the computation of a feedforward force to compensate upper-limb gravity. Four strategies based on a biomechanical model of the upper limb, tuned using anthropometric measurements, are proposed and evaluated. The first one is based on the potential energy of the upper-limb, the second one makes a compromise between the shoulder and elbow torques, the third one minimizes the sum of the squared user joint torques and the last one uses a probabilistic approach to minimize the expected torque norm in the presence of model uncertainties. These strategies have been evaluated quantitatively through an experiment including nine participants with an active DAS prototype. The activity of six muscles was measured and used to compute the Mean Effort Index (MEI) which represents the global effort required to maintain the pose. A statistical analysis shows that the four strategies significantly lower the MEI (p-value < 0.001).
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Savaş D, Şimşek TT. Functional level and its relationship to upper extremity function, pain, and muscle stiffness in children with Duchenne muscular dystrophy. Ir J Med Sci 2023; 192:1867-1873. [PMID: 36112314 DOI: 10.1007/s11845-022-03162-z] [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: 08/26/2022] [Accepted: 09/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The progressive symptoms of Duchenne muscular dystrophy (DMD) negatively affect upper extremity skills, and this may have an effect that reduces the independence of daily life. AIMS The purpose of this study is to investigate the relationship between functional level and upper extremity function, pain, and stiffness in children with DMD. METHODS A total of 38 children with DMD were participated. The functional level of the upper and lower extremities was assessed using Brooke scale and Vignos scale. Upper extremity function, pain and stiffness were assessed using Upper Limb Short Questionnaire (ULSQ). The correlation between ULSQ and Brooke and Vignos scales was calculated. RESULTS A moderate positive correlation was calculated between ULSQ total scores and Vignos scale (r = 0.52, p < 0.001) and Brooke scale (r = 0.65, p < 0.001). There was a moderate positive correlation between Vignos scale scores and ULSQ subscores of function (r = 0.42, p < 0.05) and stiffness (r = 0.56, p < 0.001); no significant correlation was found between pain scores and Vignos scale (p = 0.053). There was a moderate positive correlation between the function (r = 0.54, p < 0.001), pain (r = 0.40, p < 0.05), and stiffness (r = 0.62, p < 0.001) subscores of the ULSQ with the Brooke scale. CONCLUSION In our study, there was a significant relationship between the functional level of patients with DMD and upper extremity function, pain, and muscle stiffness.
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Affiliation(s)
- Dilan Savaş
- Institute of Health Sciences, Dokuz Eylul University, Mithatpasa Street No:1606, TR-35340, Balcova, Izmir, Turkey.
| | - Tülay Tarsuslu Şimşek
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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Savaş D, Tarsuslu T. Reliability and validity of the Turkish version of the Upper Limb Short Questionnaire in Duchenne muscular dystrophy. Somatosens Mot Res 2022; 40:56-61. [PMID: 36538388 DOI: 10.1080/08990220.2022.2157391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to evaluate the construct validity and reliability of the Turkish version of the Upper Limb Short Questionnaire in Duchenne muscular dystrophy. MATERIALS AND METHODS A total of 41 children with Duchenne muscular dystrophy have participated in the study. Upper and lower extremities functional levels were assessed with Vignos Scale and Brooke Upper Extremity Functional Rating Scale, respectively. The construct validity of the questionnaire was determined using the correlation between the Upper Limb Short Questionnaire and ABILHAND-Kids. The Cronbach alpha value was calculated to determine internal consistency. To determine test-retest reliability, 17 randomly selected children were evaluated seven days after the first evaluation, and the 'Intraclass Correlation Coefficient' value was calculated. RESULTS There was a moderate level of positive correlation between the Upper Limb Short Questionnaire scores and the Vignos Scale (r = 0.52, p < 0.001) and the Brooke Upper Extremity Functional Rating Scale (r = 0.65, p < 0.001). There was a strong correlation between the Upper Limb Short Questionnaire and ABILHAND-Kids in the negative direction (r= -0.80, p < 0.001). Internal consistency of the ULSQ was fairly high (Cronbach's alpha = 0.785) and test-retest reliability was good (ICC = 0.86). CONCLUSION The Turkish version of Upper Limb Short Questionnaire is a valid and reliable scale for children with Duchenne muscular dystrophy. It can be a useful tool in the UE clinical evaluation of children with Duchenne muscular dystrophy.
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Affiliation(s)
- Dilan Savaş
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Tülay Tarsuslu
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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Bulut N, Karaduman A, Alemdaroğlu-Gürbüz İ, Yılmaz Ö, Topaloğlu H, Özçakar L. The effect of aerobic training on motor function and muscle architecture in children with Duchenne muscular dystrophy: A randomized controlled study. Clin Rehabil 2022; 36:1062-1071. [PMID: 35443813 DOI: 10.1177/02692155221095491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the effects of aerobic training adding to home-based exercise program on motor function and muscle architectural properties in children with Duchenne muscular dystrophy. DESIGN This is a prospective randomized controlled study. SETTING Pediatric neuromuscular clinic in a tertiary care center. SUBJECTS Children with Duchenne muscular dystrophy. INTERVENTIONS Children were randomly divided into two groups whereby 12-weeks aerobic training was additionally given in treatment group in contrast to the control group which received only home-based exercise program. MAIN MEASURES Motor Function Measure and Six Minute Walk Test were used for clinical evaluation, and muscle architectural properties (thickness, pennation angle and fascicle length) were measured by ultrasound imaging. Both groups were assessed at baseline and after 12-weeks of training. RESULTS Median age of children was 7.9 years in the treatment group and 8.6 years in the control group (p > 0.05). Significant improvements were obtained for Motor Function Measure and Six Minute Walk Test from baseline to 12-weeks in the treatment group; Motor Function Measure total score changed from 83.2 (6.1) to 86.9 (4.0) vs. 82.3 (10.2) to 80.4 (9.4) points in the control group (p = 0.006); 6 Minute Walk Test distance changed from 395.3 (46.6) to 413.0 (52.3) vs. 421.7 (64.4) to 393.8 (68.2) meters in the control group (p < 0.001). However, muscle architectural parameters did not change during study period (p > 0.05). CONCLUSION Aerobic training may be of additional value in improving motor function and performance with no remarkable effect on muscle architectural properties.
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Affiliation(s)
- Numan Bulut
- Faculty of Physical Therapy and Rehabilitation, 37515Hacettepe University, Ankara, Turkey
| | - Ayşe Karaduman
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Lokman Hekim University, Ankara, Turkey
| | | | - Öznur Yılmaz
- Faculty of Physical Therapy and Rehabilitation, 37515Hacettepe University, Ankara, Turkey
| | - Haluk Topaloğlu
- Department of Pediatrics, Division of Pediatric Neurology, Yeditepe University Hospital, İstanbul, Turkey
| | - Levent Özçakar
- Department of Physical Medicine and Rehabilitation, 37515Hacettepe University Medical School, Ankara, Turkey
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Gonzalez A, Garcia L, Kilby J, McNair P. Robotic devices for paediatric rehabilitation: a review of design features. Biomed Eng Online 2021; 20:89. [PMID: 34488777 PMCID: PMC8420060 DOI: 10.1186/s12938-021-00920-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/06/2021] [Indexed: 01/11/2023] Open
Abstract
Children with physical disabilities often have limited performance in daily activities, hindering their physical development, social development and mental health. Therefore, rehabilitation is essential to mitigate the adverse effects of the different causes of physical disabilities and improve independence and quality of life. In the last decade, robotic rehabilitation has shown the potential to augment traditional physical rehabilitation. However, to date, most robotic rehabilitation devices are designed for adult patients who differ in their needs compared to paediatric patients, limiting the devices' potential because the paediatric patients' needs are not adequately considered. With this in mind, the current work reviews the existing literature on robotic rehabilitation for children with physical disabilities, intending to summarise how the rehabilitation robots could fulfil children's needs and inspire researchers to develop new devices. A literature search was conducted utilising the Web of Science, PubMed and Scopus databases. Based on the inclusion-exclusion criteria, 206 publications were included, and 58 robotic devices used by children with a physical disability were identified. Different design factors and the treated conditions using robotic technology were compared. Through the analyses, it was identified that weight, safety, operability and motivation were crucial factors to the successful design of devices for children. The majority of the current devices were used for lower limb rehabilitation. Neurological disorders, in particular cerebral palsy, were the most common conditions for which devices were designed. By far, the most common actuator was the electric motor. Usually, the devices present more than one training strategy being the assistive strategy the most used. The admittance/impedance method is the most popular to interface the robot with the children. Currently, there is a trend on developing exoskeletons, as they can assist children with daily life activities outside of the rehabilitation setting, propitiating a wider adoption of the technology. With this shift in focus, it appears likely that new technologies to actuate the system (e.g. serial elastic actuators) and to detect the intention (e.g. physiological signals) of children as they go about their daily activities will be required.
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Affiliation(s)
- Alberto Gonzalez
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Lorenzo Garcia
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Jeff Kilby
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Sobierajska-Rek A, Mański Ł, Jabłońska-Brudło J, Śledzińska K, Ucińska A, Wierzba J. Establishing a telerehabilitation program for patients with Duchenne muscular dystrophy in the COVID-19 pandemic. Wien Klin Wochenschr 2020; 133:344-350. [PMID: 33346889 PMCID: PMC7750780 DOI: 10.1007/s00508-020-01786-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/21/2020] [Indexed: 12/13/2022]
Abstract
Background Duchenne muscular dystrophy is a genetic disease characterized by gradual loss of motor function, respiratory failure and cardiomyopathy. During the time of the global coronavirus pandemic, maintenance of social distancing and self-isolation might complicate regular multidisciplinary care of patients with Duchenne muscular dystrophy but on the other hand may lead to new medical care telehealth solutions. The aim of the study was to investigate patients’ situation regarding rehabilitation in the pandemic, to establish an online rehabilitation program and motor assessment and to determine the needs of telerehabilitation in this group. Methods The project involved 69 boys with Duchenne muscular dystrophy. The rehabilitation program was presented during online workshops for patients and caregivers. The same program was recorded on video and published in the internet. The online motor assessment tool consisted of six motor tests, caregivers were asked to perform the tasks and share a photograph of the patient’s posture using a designed app. Results In the nonambulant group the emphasis was placed on chest physiotherapy, stretching of upper extremities, positioning and wheelchair ergonomics. The program for the ambulant group focused on lower extremities stretching and full body exercises. Response rate for the workshops for ambulant patients was 29.7%, and only 9.0% for nonambulant patients. Videos showing exercises were displayed 132 times within a month. Conclusion With the physiotherapist guidance (online communication or video) patients with caregivers’ help can continue home based rehabilitation. Online videos/instructions/video guidelines are more acceptable by parents/caregivers of patients with Duchenne muscular dystrophy than live workshops.
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Affiliation(s)
- Agnieszka Sobierajska-Rek
- Department of Rehabilitation Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Al.Zwyciestwa 30, 80-210, Gdansk, Poland.
| | - Łukasz Mański
- Department of Rehabilitation Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Al.Zwyciestwa 30, 80-210, Gdansk, Poland
| | - Joanna Jabłońska-Brudło
- Department of Rehabilitation Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Al.Zwyciestwa 30, 80-210, Gdansk, Poland
| | - Karolina Śledzińska
- Department of Internal and Pediatric Nursing, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Aleksandra Ucińska
- Clinic of Paediatrics, Haematology and Oncology, University Clinical Centre, Gdansk, Poland
| | - Jolanta Wierzba
- Department of Internal and Pediatric Nursing, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdansk, Poland
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Retrospective Analysis of Fractures and Factors Causing Ambulation Loss After Lower Limb Fractures in Duchenne Muscular Dystrophy. Am J Phys Med Rehabil 2020; 99:789-794. [PMID: 32195737 DOI: 10.1097/phm.0000000000001423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Prevalence and characteristics of fractures and factors related to loss of ambulation after lower limb fractures were investigated. DESIGN Chart review included height, weight, dual-energy x-ray absorptiometry, corticosteroid use, vitamin D, fracture history, muscle strength, range of motion, and timed performance tests (10 meter walk/run, Gowers, and four steps). Patients were grouped by fracture location and ambulation loss after fracture. RESULTS Two hundred eighty-seven patients with Duchenne muscular dystrophy were identified, 53 of these had experienced fracture. Eighty-one percent were older than 9 yrs at first fracture and 36.4% became nonambulatory after fracture. Dorsiflexion range of motion (fracture side, P = 0.021), quadriceps strength (right side, P = 0.025), and shoulder abduction strength (right, left, and fracture side; P = 0.028, P = 0.027, and P = 0.016) were significantly different within the groups. Patients who became nonambulatory after fracture initially had less dorsiflexion (right, left, fracture side; 2.25 vs. -7.29, P = 0.004; 2.67 vs. -12, P = 0.001; and 2.41 vs. -7.42, P = 0.002) and slower 10-meter walk/run times (7.43 secs vs. 14.7 secs, P = 0.005). CONCLUSIONS Fracture represents a significant risk in patients with Duchenne muscular dystrophy; both slower walking speed and ankle contracture confer an increased risk of ambulation loss after fracture. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Identify the main factors that are associated with ambulation loss after fracture in patients with Duchenne muscular dystrophy; (2) Identify the risk of fracture in the Duchenne muscular dystrophy population; and (3) Articulate the characteristics associated with fracture in patients with Duchenne muscular dystrophy. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Verros S, Peeters L, Bergsma A, Hekman EEG, Verkerke GJ, Koopman BFJM. Exploring physiological signals on people with Duchenne muscular dystrophy for an active trunk support: a case study. BMC Biomed Eng 2020; 1:31. [PMID: 32903311 PMCID: PMC7422594 DOI: 10.1186/s42490-019-0032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Arm support devices are available to support people with Duchenne muscular dystrophy (DMD), but active trunk support devices are lacking. An active trunk support device can potentially extend the reach of the arm and stabilize the unstable trunk of people with DMD. In a previous study, we showed that healthy people were able to control an active trunk support using four different control interfaces (based on joystick, force on feet, force on sternum and surface electromyography). All four control interfaces had different advantages and disadvantages. The aim of this study was to explore which of the four inputs is detectably used by people with DMD to control an active trunk support. Results The results were subject-dependent in both experiments. In the active experiment, the joystick was the most promising control interface. Regarding the static experiment, surface electromyography and force on feet worked for two out of the three subjects. Conclusions To our knowledge, this is the first time that people with DMD have engaged in a control task using signals other than those related to their arm muscles. According to our findings, the control interfaces have to be customised to every DMD subject.
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Affiliation(s)
- Stergios Verros
- Department Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands
| | - Laura Peeters
- Department of Rehabilitation, Radboud University Medical Center, Reiner Postlaan 4, 6500 HB Nijmegen, the Netherlands
| | - Arjen Bergsma
- Department Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands
| | - Edsko E G Hekman
- Department Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands
| | - Gijsbertus J Verkerke
- Department Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands.,University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Bart F J M Koopman
- Department Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands
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Siciliano G, Chico L, Lo Gerfo A, Simoncini C, Schirinzi E, Ricci G. Exercise-Related Oxidative Stress as Mechanism to Fight Physical Dysfunction in Neuromuscular Disorders. Front Physiol 2020; 11:451. [PMID: 32508674 PMCID: PMC7251329 DOI: 10.3389/fphys.2020.00451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022] Open
Abstract
Neuromuscular diseases (NMDs) are a group of often severely disabling disorders characterized by dysfunction in one of the main constituents of the motor unit, the cardinal anatomic-functional structure behind force and movement production. Irrespective of the different pathogenic mechanisms specifically underlying these disease conditions genetically determined or acquired, and the related molecular pathways involved in doing that, oxidative stress has often been shown to play a relevant role within the chain of events that induce or at least modulate the clinical manifestations of these disorders. Due to such a putative relevance of the imbalance of redox status occurring in contractile machinery and/or its neural drive in NMDs, physical exercise appears as one of the most important conditions able to positively interfere along an ideal axis, going from a deranged metabolic cell homeostasis in motor unit components to the reduced motor performance profile exhibited by the patient in everyday life. If so, it comes out that it would be important to identify a proper training program, suitable for load and type of exercise that is able to improve motor performance in adaptation and response to such a homeostatic imbalance. This review therefore analyzes the role of different exercise trainings on oxidative stress mechanisms, both in healthy and in NMDs, also including preclinical studies, to elucidate at which extent these can be useful to counteract muscle impairment associated to the disease, with the final aim of improving physical functions and quality of life of NMD patients.
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Affiliation(s)
- Gabriele Siciliano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Lucia Chico
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Annalisa Lo Gerfo
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Costanza Simoncini
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Erika Schirinzi
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
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Corrigan MC, Foulds RA. Evaluation of admittance control as an alternative to passive arm supports to increase upper extremity function for individuals with Duchenne muscular dystrophy. Muscle Nerve 2020; 61:692-701. [PMID: 32128840 DOI: 10.1002/mus.26848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 02/04/2023]
Abstract
The degree of upper extremity active range of motion provided by an admittance control robot compared with a commercially available passive arm support for individuals with DMD who have limited arm function was investigated in this study. The reachable workspace evaluation was used to assess active range of motion provided by both devices. A visual analog scale was also used to secure participant-reported outcome measures. The admittance control robot significantly increased reachable surface area scores compared with the passive arm support for the dominant arm (Wilcoxon T = 5, P = .022, r2 = 0.263) and for the nondominant arm (paired-samples t test, t(9) = 4.66, P = .001, r2 = 0.71). The admittance control robot also significantly decreased participant-reported exertion compared with the passive arm support. Results of this study substantiated the benefits of admittance control for individuals with DMD compared with a commercially available passive arm support.
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Affiliation(s)
- Madeline C Corrigan
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Richard A Foulds
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
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Monje C, Jannas‐Vela S, Baar K, Zbinden‐Foncea H. Case report of an exercise training and nutritional intervention plan in a patient with A350P mutation in DES gene. Clin Case Rep 2020; 8:283-288. [PMID: 32128174 PMCID: PMC7044380 DOI: 10.1002/ccr3.2607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/05/2019] [Accepted: 11/12/2019] [Indexed: 12/02/2022] Open
Abstract
Performing a supplementation intervention with creatine and protein, in conjunction with low-intensity endurance and resistance exercise is safe and has a positive effect on the quality of life in a patient with desminopathy.
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Affiliation(s)
- Camila Monje
- Universidad Finis TerraeRegión MetropolitanaChile
| | | | - Keith Baar
- University of California DavisDavisCalifornia
| | - Hermann Zbinden‐Foncea
- Universidad Finis TerraeRegión MetropolitanaChile
- Clinica Santa MariaCentro Salud DeportivaSantiagoChile
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Nizamis K, Schutte W, Grutters JJ, Goseling J, Rijken NHM, Koopman BFJM. Evaluation of the cognitive-motor performance of adults with Duchenne Muscular Dystrophy in a hand-related task. PLoS One 2020; 15:e0228128. [PMID: 32004329 PMCID: PMC6993979 DOI: 10.1371/journal.pone.0228128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/08/2020] [Indexed: 11/19/2022] Open
Abstract
Duchenne muscular Dystrophy (DMD) is a progressive degenerative muscle disease, affecting, among others, the upper extremities. Effective hand rehabilitation can improve the hand function of people with DMD. To reach this goal, we first need to gain more insight into the hand cognitive-motor performance of people with DMD. This is the first study employing a systematic analysis on multi-finger, cognitive-motor performance of people with DMD. For this purpose, we propose an active dynamic visuo-motor task. The task employed six visual stimuli, a subset of which was activated at each trial. The stimuli were activated with a frequency of 1, 2, 3 and 4 Hz. Eight healthy participants and three participants with DMD performed the task. Additionally, the healthy participants performed seven sessions, and we assessed the training effects. Task-related cognitive-motor performance was evaluated using information transfer rate (ITR) and perceived workload. Regarding ITR, healthy participants performed significantly better than DMD participants; however, this was more evident for trials involving more than three fingers. Workload showed no difference between the healthy and the DMD groups. Healthy participants significantly improved their performance during training. Our results suggest that hand rehabilitation of people with DMD should consider multi-finger dynamic training. However, additional research with more people with DMD is needed for further generalization of our conclusions.
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Affiliation(s)
- Kostas Nizamis
- Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Wouter Schutte
- Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jan J. Grutters
- Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jasper Goseling
- Stochastic Operations Group and the Data Science Group, University of Twente, Enschede, The Netherlands
| | - Noortje H. M. Rijken
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, GC Nijmegen, The Netherlands
| | - Bart F. J. M. Koopman
- Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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15
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Voet NBM, van der Kooi EL, van Engelen BGM, Geurts ACH. Strength training and aerobic exercise training for muscle disease. Cochrane Database Syst Rev 2019; 12:CD003907. [PMID: 31808555 PMCID: PMC6953420 DOI: 10.1002/14651858.cd003907.pub5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Strength training or aerobic exercise programmes, or both, might optimise muscle and cardiorespiratory function and prevent additional disuse atrophy and deconditioning in people with a muscle disease. This is an update of a review first published in 2004 and last updated in 2013. We undertook an update to incorporate new evidence in this active area of research. OBJECTIVES To assess the effects (benefits and harms) of strength training and aerobic exercise training in people with a muscle disease. SEARCH METHODS We searched Cochrane Neuromuscular's Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL in November 2018 and clinical trials registries in December 2018. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-RCTs or cross-over RCTs comparing strength or aerobic exercise training, or both lasting at least six weeks, to no training in people with a well-described muscle disease diagnosis. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 14 trials of aerobic exercise, strength training, or both, with an exercise duration of eight to 52 weeks, which included 428 participants with facioscapulohumeral muscular dystrophy (FSHD), dermatomyositis, polymyositis, mitochondrial myopathy, Duchenne muscular dystrophy (DMD), or myotonic dystrophy. Risk of bias was variable, as blinding of participants was not possible, some trials did not blind outcome assessors, and some did not use an intention-to-treat analysis. Strength training compared to no training (3 trials) For participants with FSHD (35 participants), there was low-certainty evidence of little or no effect on dynamic strength of elbow flexors (MD 1.2 kgF, 95% CI -0.2 to 2.6), on isometric strength of elbow flexors (MD 0.5 kgF, 95% CI -0.7 to 1.8), and ankle dorsiflexors (MD 0.4 kgF, 95% CI -2.4 to 3.2), and on dynamic strength of ankle dorsiflexors (MD -0.4 kgF, 95% CI -2.3 to 1.4). For participants with myotonic dystrophy type 1 (35 participants), there was very low-certainty evidence of a slight improvement in isometric wrist extensor strength (MD 8.0 N, 95% CI 0.7 to 15.3) and of little or no effect on hand grip force (MD 6.0 N, 95% CI -6.7 to 18.7), pinch grip force (MD 1.0 N, 95% CI -3.3 to 5.3) and isometric wrist flexor force (MD 7.0 N, 95% CI -3.4 to 17.4). Aerobic exercise training compared to no training (5 trials) For participants with DMD there was very low-certainty evidence regarding the number of leg revolutions (MD 14.0, 95% CI -89.0 to 117.0; 23 participants) or arm revolutions (MD 34.8, 95% CI -68.2 to 137.8; 23 participants), during an assisted six-minute cycle test, and very low-certainty evidence regarding muscle strength (MD 1.7, 95% CI -1.9 to 5.3; 15 participants). For participants with FSHD, there was low-certainty evidence of improvement in aerobic capacity (MD 1.1 L/min, 95% CI 0.4 to 1.8, 38 participants) and of little or no effect on knee extension strength (MD 0.1 kg, 95% CI -0.7 to 0.9, 52 participants). For participants with dermatomyositis and polymyositis (14 participants), there was very low-certainty evidence regarding aerobic capacity (MD 14.6, 95% CI -1.0 to 30.2). Combined aerobic exercise and strength training compared to no training (6 trials) For participants with juvenile dermatomyositis (26 participants) there was low-certainty evidence of an improvement in knee extensor strength on the right (MD 36.0 N, 95% CI 25.0 to 47.1) and left (MD 17 N 95% CI 0.5 to 33.5), but low-certainty evidence of little or no effect on maximum force of hip flexors on the right (MD -9.0 N, 95% CI -22.4 to 4.4) or left (MD 6.0 N, 95% CI -6.6 to 18.6). This trial also provided low-certainty evidence of a slight decrease of aerobic capacity (MD -1.2 min, 95% CI -1.6 to 0.9). For participants with dermatomyositis and polymyositis (21 participants), we found very low-certainty evidence for slight increases in muscle strength as measured by dynamic strength of knee extensors on the right (MD 2.5 kg, 95% CI 1.8 to 3.3) and on the left (MD 2.7 kg, 95% CI 2.0 to 3.4) and no clear effect in isometric muscle strength of eight different muscles (MD 1.0, 95% CI -1.1 to 3.1). There was very low-certainty evidence that there may be an increase in aerobic capacity, as measured with time to exhaustion in an incremental cycle test (17.5 min, 95% CI 8.0 to 27.0) and power performed at VO2 max (maximal oxygen uptake) (18 W, 95% CI 15.0 to 21.0). For participants with mitochondrial myopathy (18 participants), we found very low-certainty evidence regarding shoulder muscle (MD -5.0 kg, 95% CI -14.7 to 4.7), pectoralis major muscle (MD 6.4 kg, 95% CI -2.9 to 15.7), and anterior arm muscle strength (MD 7.3 kg, 95% CI -2.9 to 17.5). We found very low-certainty evidence regarding aerobic capacity, as measured with mean time cycled (MD 23.7 min, 95% CI 2.6 to 44.8) and mean distance cycled until exhaustion (MD 9.7 km, 95% CI 1.5 to 17.9). One trial in myotonic dystrophy type 1 (35 participants) did not provide data on muscle strength or aerobic capacity following combined training. In this trial, muscle strength deteriorated in one person and one person had worse daytime sleepiness (very low-certainty evidence). For participants with FSHD (16 participants), we found very low-certainty evidence regarding muscle strength, aerobic capacity and VO2 peak; the results were very imprecise. Most trials reported no adverse events other than muscle soreness or joint complaints (low- to very low-certainty evidence). AUTHORS' CONCLUSIONS The evidence regarding strength training and aerobic exercise interventions remains uncertain. Evidence suggests that strength training alone may have little or no effect, and that aerobic exercise training alone may lead to a possible improvement in aerobic capacity, but only for participants with FSHD. For combined aerobic exercise and strength training, there may be slight increases in muscle strength and aerobic capacity for people with dermatomyositis and polymyositis, and a slight decrease in aerobic capacity and increase in muscle strength for people with juvenile dermatomyositis. More research with robust methodology and greater numbers of participants is still required.
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Affiliation(s)
- Nicoline BM Voet
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourPO Box 9101NijmegenNetherlands6500 HB
- Rehabilitation Centre KlimmendaalArnhemNetherlands
| | | | - Baziel GM van Engelen
- Radboud University Medical CentreDepartment of Neurology, Donders Institute for Brain, Behaviour and CognitionNijmegenNetherlands
| | - Alexander CH Geurts
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourPO Box 9101NijmegenNetherlands6500 HB
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16
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Iolascon G, Paoletta M, Liguori S, Curci C, Moretti A. Neuromuscular Diseases and Bone. Front Endocrinol (Lausanne) 2019; 10:794. [PMID: 31824418 PMCID: PMC6886381 DOI: 10.3389/fendo.2019.00794] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/30/2019] [Indexed: 02/05/2023] Open
Abstract
Neuromuscular diseases (NMDs) are inherited or acquired conditions affecting skeletal muscles, motor nerves, or neuromuscular junctions. Most of them are characterized by a progressive damage of muscle fibers with reduced muscle strength, disability, and poor health-related quality of life of affected patients. In this scenario, skeletal health is usually compromised as a consequence of modified bone-muscle cross-talk including biomechanical and bio-humoral issues, resulting in increased risk of bone fragility and fractures. In addition, NMD patients frequently face nutritional issues, including malnutrition due to feeding disorders and swallowing problems that might affect bone health. Moreover, in these patients, low levels of physical activity or immobility are common and might lead to overweight or obesity that can also interfere with bone strength features. Also, vitamin D deficiency could play a critical role both in the pathogenesis and in the clinical scenario of many NMDs, suggesting that its correction could be useful in maintaining or enhancing bone health, especially in the early phases of NMDs. Last but not least, specific disease-modifying drugs, available for some NMDs, are frequently burdened with adverse effects on bone tissue. For example, glucocorticoid therapy, standard of care for many muscular dystrophies, prolongs long-term survival in treated patients; nevertheless, high dose and/or chronic use of these drugs are a common cause of secondary osteoporosis. This review addresses the current state of knowledge about the factors that play a role in determining bone alterations reported in NMDs, how these factors can modify the biological pathways underlying bone health, and which are the available interventions to manage bone involvement in patients affected by NMDs. Considering the complexity of care of these patients, an interdisciplinary and multimodal management strategy based on both pharmacological and non-pharmacological interventions is recommended, particularly targeting musculoskeletal issues that are closely related to functional independence as well as social implications.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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17
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Kern V, Wicklund M, Haulman A, McDermott MP, Martens WB, Griggs RC, Kumar A. Ankle bracing practices in ambulatory, corticosteroid-naive boys with Duchenne muscular dystrophy. Muscle Nerve 2019; 61:52-57. [PMID: 31588574 DOI: 10.1002/mus.26727] [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: 01/16/2019] [Revised: 09/19/2019] [Accepted: 09/21/2019] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Loss of ambulation in Duchenne muscular dystrophy presages scoliosis, respiratory failure, and death. Strategies to maintain ankle range of motion are employed, but little evidence exists to support these approaches and limited information is available concerning current practice. METHODS In this study we assessed baseline bracing data from 187 boys participating in a multicenter, international clinical trial. RESULTS Ankle-foot orthoses (AFOs) were recommended for 54% of the boys, with nighttime static AFOs and nighttime dynamic AFOs utilized in 94% and 6% of these boys, respectively. Daytime static AFOs were recommended for 3 boys. Compliance with bracing recommendations was 54% for nighttime static braces and 67% for nighttime dynamic braces. DISCUSSION The basis for the variation in recommended AFO use is unknown and requires further study. Long-term follow-up of boys may permit assessment of the effects of AFO use.
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Affiliation(s)
- Victoria Kern
- Rehabilitative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew Wicklund
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Anne Haulman
- Department of Neurology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York.,Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - William B Martens
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Robert C Griggs
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Ashutosh Kumar
- Division of Pediatric Neurology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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18
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Martins EJ, Gastaldi AC, Davoli GBQ, Leonardi-Figueiredo MM, Mattiello-Sverzut AC. Decreased respiratory performance of children and adolescents with myelomeningocele who use a wheelchair - preliminary data. ACTA ACUST UNITED AC 2019; 52:e8671. [PMID: 31389492 PMCID: PMC6686271 DOI: 10.1590/1414-431x20198671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 06/06/2019] [Indexed: 11/21/2022]
Abstract
Myelomeningocele (MMC) is a neural tube defect that often causes spinal cord injury at the thoracolumbar region, as well as sensory and motor paralysis in the lower limbs. This leads to continuous use of a wheelchair and, consequently, a sedentary lifestyle, predisposition to muscle weakness, cardiovascular and respiratory disorders, obesity, and structural alterations in the spine. We assessed the respiratory function and shoulder strength of MMC participants who were wheelchair-users and had no respiratory complaints and compared them to healthy children and adolescents. MMC (n=10) and healthy (n=25) participants of both genders with a mean age of 12.45 years (SD=2.1) were assessed for weight, height, respiratory performance, and isometric peak for shoulder flexors, extensors, abductors, and adductors, using an isokinetic dynamometer. Medullary lesion, functional levels, and abnormal curvatures of the spine were assessed for MMC participants. The level of spinal cord injury for the majority of the MMC participants was high lumbar and they had scoliosis. MMC showed lower values for forced vital capacity, forced expiratory volume at the first second, forced expiratory flow (25-75%), maximal voluntary ventilation, and isometric peak for shoulder flexors and adductors compared to healthy participants. This indicated a decreased vital capacity, respiratory muscle endurance, and shoulder muscle strength.
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Affiliation(s)
- E J Martins
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A C Gastaldi
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - G B Q Davoli
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M M Leonardi-Figueiredo
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A C Mattiello-Sverzut
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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19
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Bouchard M, Vogel LF, Apkon SD. Restoration of Walking After Surgical Management of Equinus in a Non-ambulatory Child With Duchenne Muscular Dystrophy: A Case Presentation. PM R 2019; 11:1240-1243. [PMID: 30859710 DOI: 10.1002/pmrj.12151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/22/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Maryse Bouchard
- Department of Orthopedics, Seattle Children's Hospital, Seattle, Washington
| | - Leslie F Vogel
- Department of Rehabilitation, Seattle Children's Hospital, Seattle, Washington
| | - Susan D Apkon
- Department of Rehabilitation, Seattle Children's Hospital, Seattle, Washington
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20
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Atamturk H, Atamturk A. Therapeutic effects of aquatic exercises on a boy with Duchenne muscular dystrophy. J Exerc Rehabil 2018; 14:877-882. [PMID: 30443536 PMCID: PMC6222151 DOI: 10.12965/jer.1836408.204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/16/2018] [Indexed: 12/19/2022] Open
Abstract
Participation in physical activities benefits individuals with disabilities in terms of addressing their social and psychological needs in order for the purposes of quality living. This study reports the findings from a case study conducted with a boy who has Duchenne muscular dystrophy (DMD) in a swimming pool located in the campus of a private university in North Cyprus. The current study reports the adjustments made in the swimming pool in accordance with the needs of the participant, how service quality was increased to cater for these needs and in what ways the participant benefited from the aquatic program. This qualitative investigation aims to shed light onto how aquatic therapy has affected the boy with DMD physically, psychologically, and socially from the parents’ perspectives. The results revealed that aquatic therapy had beneficial effects on the participant with DMD in terms of socialization, relaxation, quality of life and self-perception.
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Affiliation(s)
- Hakan Atamturk
- Department of Physical Education, Faculty of Sports Sciences, Near East University, North Nicosia, Northern Cyprus
| | - Arda Atamturk
- Faculty of Medicine, Near East University, North Nicosia, Northern Cyprus
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21
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Houang EM, Sham YY, Bates FS, Metzger JM. Muscle membrane integrity in Duchenne muscular dystrophy: recent advances in copolymer-based muscle membrane stabilizers. Skelet Muscle 2018; 8:31. [PMID: 30305165 PMCID: PMC6180502 DOI: 10.1186/s13395-018-0177-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/13/2018] [Indexed: 02/07/2023] Open
Abstract
The scientific premise, design, and structure-function analysis of chemical-based muscle membrane stabilizing block copolymers are reviewed here for applications in striated muscle membrane injury. Synthetic block copolymers have a rich history and wide array of applications from industry to biology. Potential for discovery is enabled by a large chemical space for block copolymers, including modifications in block copolymer mass, composition, and molecular architecture. Collectively, this presents an impressive chemical landscape to leverage distinct structure-function outcomes. Of particular relevance to biology and medicine, stabilization of damaged phospholipid membranes using amphiphilic block copolymers, classified as poloxamers or pluronics, has been the subject of increasing scientific inquiry. This review focuses on implementing block copolymers to protect fragile muscle membranes against mechanical stress. The review highlights interventions in Duchenne muscular dystrophy, a fatal disease of progressive muscle deterioration owing to marked instability of the striated muscle membrane. Biophysical and chemical engineering advances are presented that delineate and expand upon current understanding of copolymer-lipid membrane interactions and the mechanism of stabilization. The studies presented here serve to underscore the utility of copolymer discovery leading toward the therapeutic application of block copolymers in Duchenne muscular dystrophy and potentially other biomedical applications in which membrane integrity is compromised.
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Affiliation(s)
- Evelyne M Houang
- Department of Integrative Biology and Physiology, University of Minnesota Medical School, 6-125 Jackson Hall, 321 Church Street SE, Minneapolis, MN, 55455, USA
| | - Yuk Y Sham
- Department of Integrative Biology and Physiology, University of Minnesota Medical School, 6-125 Jackson Hall, 321 Church Street SE, Minneapolis, MN, 55455, USA.,University of Minnesota Informatics Institute, MN, USA.,Bioinformatics and Computational Biology Program, University of Minnesota, MN, USA
| | - Frank S Bates
- Department of Chemical Engineering and Materials Science, University of Minnesota, MN, USA
| | - Joseph M Metzger
- Department of Integrative Biology and Physiology, University of Minnesota Medical School, 6-125 Jackson Hall, 321 Church Street SE, Minneapolis, MN, 55455, USA.
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22
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Massetti T, Fávero FM, Menezes LDCD, Alvarez MPB, Crocetta TB, Guarnieri R, Nunes FLS, Monteiro CBDM, Silva TDD. Achievement of Virtual and Real Objects Using a Short-Term Motor Learning Protocol in People with Duchenne Muscular Dystrophy: A Crossover Randomized Controlled Trial. Games Health J 2018; 7:107-115. [PMID: 29608336 DOI: 10.1089/g4h.2016.0088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate whether people with Duchenne muscular dystrophy (DMD) practicing a task in a virtual environment could improve performance given a similar task in a real environment, as well as distinguishing whether there is transference between performing the practice in virtual environment and then a real environment and vice versa. METHODS Twenty-two people with DMD were evaluated and divided into two groups. The goal was to reach out and touch a red cube. Group A began with the real task and had to touch a real object, and Group B began with the virtual task and had to reach a virtual object using the Kinect system. RESULTS ANOVA showed that all participants decreased the movement time from the first (M = 973 ms) to the last block of acquisition (M = 783 ms) in both virtual and real tasks and motor learning could be inferred by the short-term retention and transfer task (with increasing distance of the target). However, the evaluation of task performance demonstrated that the virtual task provided an inferior performance when compared to the real task in all phases of the study, and there was no effect for sequence. CONCLUSIONS Both virtual and real tasks promoted improvement of performance in the acquisition phase, short-term retention, and transfer. However, there was no transference of learning between environments. In conclusion, it is recommended that the use of virtual environments for individuals with DMD needs to be considered carefully.
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Affiliation(s)
- Thais Massetti
- 1 Faculty of Medicine, University of São Paulo , São Paulo, Brazil
| | - Francis Meire Fávero
- 2 Paulista School of Medicine, Federal University of São Paulo , UNIFESP, São Paulo, Brazil
| | | | | | | | | | - Fátima L S Nunes
- 4 School of Arts, Sciences and Humanities, University of São Paulo , EACH-USP, São Paulo, Brazil
| | | | - Talita Dias da Silva
- 2 Paulista School of Medicine, Federal University of São Paulo , UNIFESP, São Paulo, Brazil
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23
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A systematic review on fatigue analysis in triceps brachii using surface electromyography. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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McPherson AC, McAdam L, Keenan S, Schwellnus H, Biddiss E, DeFinney A, English K. A feasibility study using solution-focused coaching for health promotion in children and young people with Duchenne muscular dystrophy. Dev Neurorehabil 2018; 21:121-130. [PMID: 28272972 DOI: 10.1080/17518423.2017.1289271] [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] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the feasibility and acceptability of a coaching intervention (Solution-Focused Coaching in pediatric rehabilitation [SFC-Peds]) related to physical activity and diet in males with Duchenne muscular dystrophy. METHODS A pre-post design was employed. Participants had five coaching sessions over 8 weeks. The first session was face-to-face, followed by four virtual sessions. Feasibility criteria included recruitment rates, attrition, and intervention fidelity. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were employed to look at outcome trends. The acceptability was assessed using a survey. RESULTS Five males (11-19 years) participated. All feasibility criteria were met. Clinically significant increases were observed for GAS and COPM scores. Participants reported SFC-Peds to be acceptable. Broad barriers and facilitators to coaching success were identified. CONCLUSIONS A SFC-Peds intervention for health promotion is feasible and acceptable in children with DMD and their families. A rigorous efficacy study assessing SFC-Peds intervention is warranted.
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Affiliation(s)
- Amy C McPherson
- a Bloorview Research Institute , Toronto , Ontario , Canada.,b Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada
| | - Laura McAdam
- a Bloorview Research Institute , Toronto , Ontario , Canada.,c Department of Paediatrics , University of Toronto , Toronto, Ontario , Canada
| | - Sarah Keenan
- a Bloorview Research Institute , Toronto , Ontario , Canada.,d Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Heidi Schwellnus
- a Bloorview Research Institute , Toronto , Ontario , Canada.,d Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Elaine Biddiss
- a Bloorview Research Institute , Toronto , Ontario , Canada.,e The Institute of Biomaterials & Biomedical Engineering and Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada
| | - Andrea DeFinney
- d Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Kirsten English
- d Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
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25
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Elboim-Gabyzon M, Atun-Einy O, Khoury-assaf I. RETRACTED ARTICLE: Early Use of Power Wheelchair for Children with Duchenne Muscular Dystrophy: A Narrative Review. Disabil Rehabil 2017. [DOI: 10.1080/09638288.2016.1194902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michal Elboim-Gabyzon
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Osnat Atun-Einy
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Insaf Khoury-assaf
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Sanchez B, Iyer SR, Li J, Kapur K, Xu S, Rutkove SB, Lovering RM. Non-invasive assessment of muscle injury in healthy and dystrophic animals with electrical impedance myography. Muscle Nerve 2017; 56:E85-E94. [PMID: 28056487 DOI: 10.1002/mus.25559] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Dystrophic muscle is particularly susceptible to eccentric contraction-induced injury. We tested the hypothesis that electrical impedance myography (EIM) can detect injury induced by maximal-force lengthening contractions. METHODS We induced injury in the quadriceps of wild-type (WT) and dystrophic (mdx) mice with eccentric contractions using an established model. RESULTS mdx quadriceps had significantly greater losses in peak twitch and tetany compared with losses in WT quadriceps. Injured muscle showed a significant increase in EIM characteristic frequency in both WT (177 ± 7.7%) and mdx (167 ± 7.8%) quadriceps. EIM also revealed decreased extracellular resistance for both WT and mdx quadriceps after injury. DISCUSSION Our results show overall agreement between muscle function and EIM measurements of injured muscle, indicating that EIM is a viable tool to assess injury in dystrophic muscle. Muscle Nerve 56: E85-E94, 2017.
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Affiliation(s)
- Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Shama R Iyer
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Room 540, 100 Penn Street, Baltimore, Maryland, 21201, USA
| | - Jia Li
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kush Kapur
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - Su Xu
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard M Lovering
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Room 540, 100 Penn Street, Baltimore, Maryland, 21201, USA
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Bell JM, Shields MD, Watters J, Hamilton A, Beringer T, Elliott M, Quinlivan R, Tirupathi S, Blackwood B. Interventions to prevent and treat corticosteroid-induced osteoporosis and prevent osteoporotic fractures in Duchenne muscular dystrophy. Cochrane Database Syst Rev 2017; 1:CD010899. [PMID: 28117876 PMCID: PMC6464928 DOI: 10.1002/14651858.cd010899.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Corticosteroid treatment is considered the 'gold standard' for Duchenne muscular dystrophy (DMD); however, it is also known to induce osteoporosis and thus increase the risk of vertebral fragility fractures. Good practice in the care of those with DMD requires prevention of these adverse effects. Treatments to increase bone mineral density include bisphosphonates and vitamin D and calcium supplements, and in adolescents with pubertal delay, testosterone. Bone health management is an important part of lifelong care for patients with DMD. OBJECTIVES To assess the effects of interventions to prevent or treat osteoporosis in children and adults with DMD taking long-term corticosteroids; to assess the effects of these interventions on the frequency of vertebral fragility fractures and long-bone fractures, and on quality of life; and to assess adverse events. SEARCH METHODS On 12 September 2016, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus to identify potentially eligible trials. We also searched the Web of Science ISI Proceedings (2001 to September 2016) and three clinical trials registries to identify unpublished studies and ongoing trials. We contacted correspondence authors of the included studies in the review to obtain information on unpublished studies or work in progress. SELECTION CRITERIA We considered for inclusion in the review randomised controlled trials (RCTs) and quasi-RCTs involving any bone health intervention for corticosteroid-induced osteoporosis and fragility fractures in children, adolescents, and adults with a confirmed diagnosis of DMD. The interventions might have included oral and intravenous bisphosphonates, vitamin D supplements, calcium supplements, dietary calcium, testosterone, and weight-bearing activity. DATA COLLECTION AND ANALYSIS Two review authors independently assessed reports and selected potential studies for inclusion, following standard Cochrane methodology. We contacted study authors to obtain further information for clarification on published work, unpublished studies, and work in progress. MAIN RESULTS We identified 18 potential studies, of which two, currently reported only as abstracts, met the inclusion criteria for this review. Too little information was available for us to present full results or adequately assess risk of bias. The participants were children aged five to 15 years with DMD, ambulant and non-ambulant. The interventions were risedronate versus no treatment in one trial (13 participants) and whole-body vibration versus a placebo device in the second (21 participants). Both studies reported improved bone mineral density with the active treatments, with no improvement in the control groups, but the abstracts did not compare treatment and control conditions. All children tolerated whole-body vibration treatment. No study provided information on adverse events. Two studies are ongoing: one investigating whole-body vibration, the other investigating zoledronic acid. AUTHORS' CONCLUSIONS We know of no high-quality evidence from RCTs to guide use of treatments to prevent or treat corticosteroid-induced osteoporosis and reduce the risk of fragility fractures in children and adults with DMD; only limited results from two trials reported in abstracts were available. We await formal trial reports. Findings from two ongoing relevant studies and two trials, for which only abstracts are available, will be important in future updates of this review.
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Affiliation(s)
- Jennifer M Bell
- Queen's University BelfastCentre for Experimental Medicine, School of Medicine, Dentistry and Biomedical SciencesRoom 02.041, 2nd FloorMulhouse, Grosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Michael D Shields
- Queen's University BelfastCentre for Experimental Medicine, School of Medicine, Dentistry and Biomedical SciencesRoom 02.041, 2nd FloorMulhouse, Grosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Janet Watters
- Belfast Health and Social Care TrustGP Out of Hours ServiceBelfastNorthern IrelandUK
| | - Alistair Hamilton
- Belfast Health and Social Care TrustWithers Orthopaedic CentreMusgrave Park Hospital, Royal Group of Hospitals,Stockman's LaneBelfastNorthern IrelandUK
| | - Timothy Beringer
- Belfast Health and Social Care TrustDepartment of Care for the ElderyFlorence Elliot CentreRoyal Victoria HospitalBelfastNorthern IrelandUKBT12 6BA
| | - Mark Elliott
- Musgrave Park Hospital, Belfast Health and Social Care TrustBelfastUK
| | - Rosaline Quinlivan
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery and Great Ormond StreetMRC Centre for Neuromuscular Diseases and Dubowitz Neuromuscular CentrePO Box 114LondonUKWC1B 3BN
| | - Sandya Tirupathi
- Royal Belfast Hospital for Sick ChildrenPaediatric Neurology180 Falls RoadBelfastUKBT12 6BE
| | - Bronagh Blackwood
- Queen's University BelfastCentre for Experimental Medicine, School of Medicine, Dentistry and Biomedical SciencesRoom 02.041, 2nd FloorMulhouse, Grosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
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Capelini CM, da Silva TD, Tonks J, Watson S, Alvarez MPB, de Menezes LDC, Favero FM, Caromano FA, Massetti T, de Mello Monteiro CB. Improvements in motor tasks through the use of smartphone technology for individuals with Duchenne muscular dystrophy. Neuropsychiatr Dis Treat 2017; 13:2209-2217. [PMID: 28860778 PMCID: PMC5571857 DOI: 10.2147/ndt.s125466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In individuals severely affected with Duchenne muscular dystrophy (DMD), virtual reality has recently been used as a tool to enhance community interaction. Smartphones offer the exciting potential to improve communication, access, and participation, and present the unique opportunity to directly deliver functionality to people with disabilities. OBJECTIVE To verify whether individuals with DMD improve their motor performance when undertaking a visual motor task using a smartphone game. PATIENTS AND METHODS Fifty individuals with DMD and 50 healthy, typically developing (TD) controls, aged 10-34 years participated in the study. The functional characterization of the sample was determined through Vignos, Egen Klassifikation, and the Motor Function Measure scales. To complete the task, individuals moved a virtual ball around a virtual maze and the time in seconds was measured after every attempt in order to analyze improvement of performance after the practice trials. Motor performance (time to finish each maze) was measured in phases of acquisition, short-term retention, and transfer. RESULTS Use of the smartphone maze game promoted improvement in performance during acquisition in both groups, which remained in the retention phase. At the transfer phases, with alternative maze tasks, the performance in DMD group was similar to the performance of TD group, with the exception of the transfer to the contralateral hand (nondominant). However, the group with DMD demonstrated longer movement time at all stages of learning, compared with the TD group. CONCLUSION The practice of a visual motor task delivered via smartphone game promoted an improvement in performance with similar patterns of learning in both groups. Performance can be influenced by task difficulty, and for people with DMD, motor deficits are responsible for the lower speed of execution. This study indicates that individuals with DMD showed improved performance in a short-term motor learning protocol using a smartphone. We advocate that this technology could be used to promote function in this population.
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Affiliation(s)
| | - Talita Dias da Silva
- Department of Medicine, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | - James Tonks
- University of Exeter Medical School, Exeter.,University of Lincoln, Lincoln.,Haven Clinical Psychology Practice, Cornwall
| | - Suzanna Watson
- The Cambridge Centre for Paediatric Neuropsychologicial Rehabilitation, Cambridge, UK
| | | | | | - Francis Meire Favero
- Department of Medicine, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Thais Massetti
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo
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Abstract
Muscular dystrophies are a clinically and heterogeneous group of disorders that all share clinical characteristics of progressive muscular weakness. Duchenne muscular dystrophy (DMD) is the most common X-linked disorder muscular dystrophy in children, presenting in early childhood and characterized by proximal muscle weakness and calf hypertrophy in affected boys. There is usually delay in motor development and eventually wheelchair confinement followed by premature death from cardiac or respiratory complications. Treatment modalities such as corticosteroid therapy and use of intermittent positive pressure ventilation have provided improvements in function, ambulation, quality of life, and life expectancy, although novel therapies still aim to provide a cure for this devastating disorder. Here, we present a case of DMD in a 12-year-old male with remarkable clinical and oral manifestations.
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Affiliation(s)
- Rupam Sinha
- Department of Oral Medicine and Radiology, Haldia Institute of Dental Sciences and Research, Haldia, West Bengal, India
| | - Soumyabrata Sarkar
- Department of Oral Medicine and Radiology, Haldia Institute of Dental Sciences and Research, Haldia, West Bengal, India
| | - Tanya Khaitan
- Department of Oral Medicine and Radiology, Haldia Institute of Dental Sciences and Research, Haldia, West Bengal, India
| | - Soumyajit Dutta
- Department of Oral Medicine and Radiology, Haldia Institute of Dental Sciences and Research, Haldia, West Bengal, India
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Dirks I, Koene S, Verbruggen R, Smeitink JA, Jansen M, Groot IJD. Assisted 6-minute cycling test: An exploratory study in children. Muscle Nerve 2016; 54:232-8. [DOI: 10.1002/mus.25021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 12/10/2015] [Accepted: 12/22/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Ilse Dirks
- Nijmegen Centre for Mitochondrial Disorders at the Department of Paediatrics; Radboudumc Nijmegen The Netherlands
| | - Saskia Koene
- Nijmegen Centre for Mitochondrial Disorders at the Department of Paediatrics; Radboudumc Nijmegen The Netherlands
| | - Renee Verbruggen
- Donders Centre for Neuroscience, Department of Rehabilitation; Radboudumc Nijmegen The Netherlands
| | - Jan A.M. Smeitink
- Nijmegen Centre for Mitochondrial Disorders at the Department of Paediatrics; Radboudumc Nijmegen The Netherlands
| | - Merel Jansen
- Donders Centre for Neuroscience, Department of Rehabilitation; Radboudumc Nijmegen The Netherlands
| | - Imelda J.M. De Groot
- Nijmegen Centre for Mitochondrial Disorders at the Department of Paediatrics; Radboudumc Nijmegen The Netherlands
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Bergsma A, Lobo-Prat J, Vroom E, Furlong P, Herder JL. 1st Workshop on Upper-Extremity Assistive Technology for People with Duchenne: State of the art, emerging avenues, and challenges: April 27th 2015, London, United Kingdom. Neuromuscul Disord 2016; 26:386-93. [PMID: 27133663 DOI: 10.1016/j.nmd.2016.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/05/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Arjen Bergsma
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, The Netherlands; Department of Biomechanical Engineering, University of Twente, The Netherlands; Flextension Foundation, The Netherlands.
| | - Joan Lobo-Prat
- Department of Biomechanical Engineering, University of Twente, The Netherlands
| | - Elizabeth Vroom
- Duchenne Parent Project, The Netherlands; United Parent Project Muscular Dystrophy
| | - Pat Furlong
- United Parent Project Muscular Dystrophy; Parent Project Muscular Dystrophy, USA
| | - Just L Herder
- Department of Biomechanical Engineering, University of Twente, The Netherlands; Flextension Foundation, The Netherlands; Department of Precision and Microsystems Engineering, Delft University of Technology, The Netherlands
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Malheiros SRP, da Silva TD, Favero FM, de Abreu LC, Fregni F, Ribeiro DC, de Mello Monteiro CB. Computer task performance by subjects with Duchenne muscular dystrophy. Neuropsychiatr Dis Treat 2016; 12:41-8. [PMID: 26766911 PMCID: PMC4699593 DOI: 10.2147/ndt.s87735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
AIMS Two specific objectives were established to quantify computer task performance among people with Duchenne muscular dystrophy (DMD). First, we compared simple computational task performance between subjects with DMD and age-matched typically developing (TD) subjects. Second, we examined correlations between the ability of subjects with DMD to learn the computational task and their motor functionality, age, and initial task performance. METHOD The study included 84 individuals (42 with DMD, mean age of 18±5.5 years, and 42 age-matched controls). They executed a computer maze task; all participants performed the acquisition (20 attempts) and retention (five attempts) phases, repeating the same maze. A different maze was used to verify transfer performance (five attempts). The Motor Function Measure Scale was applied, and the results were compared with maze task performance. RESULTS In the acquisition phase, a significant decrease was found in movement time (MT) between the first and last acquisition block, but only for the DMD group. For the DMD group, MT during transfer was shorter than during the first acquisition block, indicating improvement from the first acquisition block to transfer. In addition, the TD group showed shorter MT than the DMD group across the study. CONCLUSION DMD participants improved their performance after practicing a computational task; however, the difference in MT was present in all attempts among DMD and control subjects. Computational task improvement was positively influenced by the initial performance of individuals with DMD. In turn, the initial performance was influenced by their distal functionality but not their age or overall functionality.
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Affiliation(s)
| | - Talita Dias da Silva
- Department of Medicine, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Francis Meire Favero
- Department of Medicine, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | - Felipe Fregni
- Center for Neurosciences, University of São Paulo, São Paulo, Brazil
| | - Denise Cardoso Ribeiro
- Post-graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carlos Bandeira de Mello Monteiro
- School of Medicine of ABC, Santo Andre, Brazil; Post-graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
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van Bruggen HW, van den Engel-Hoek L, Steenks MH, van der Bilt A, Bronkhorst EM, Creugers NHJ, de Groot IJM, Kalaykova SI. Fighting Against Disuse of the Masticatory System in Duchenne Muscular Dystrophy: A Pilot Study Using Chewing Gum. J Child Neurol 2015; 30:1625-32. [PMID: 25792431 DOI: 10.1177/0883073815575575] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/20/2015] [Indexed: 11/15/2022]
Abstract
Duchenne muscular dystrophy patients report masticatory problems. The aim was to determine the efficacy of mastication training in Duchenne muscular dystrophy using chewing gum for 4 weeks. In all, 17 patients and 17 healthy age-matched males participated. The masticatory performance was assessed using a mixing ability test and measuring anterior bite force before, shortly after and 1 month after the training. In the patient group the masticatory performance improved and remained after 1-month follow-up, no significant changes in anterior maximum bite force was observed after mastication training. In the healthy subject the bite force increased and remained at the 1-month follow-up; no significant differences in masticatory performance were observed. Mastication training by using sugar-free chewing gum in Duchenne muscular dystrophy patients improved their masticatory performance. Since bite force did not improve, the working mechanism of the improvement in chewing may relate to changes of the neuromuscular function and coordination, resulting in improvement of skills in performing mastication.
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Affiliation(s)
- H Willemijn van Bruggen
- Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Medical Center, Nijmegen, Netherlands Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Netherlands
| | | | - Michel H Steenks
- Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Netherlands
| | - Andries van der Bilt
- Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Netherlands
| | - Ewald M Bronkhorst
- Department of Preventive and Restorative Dentistry, College of Dental Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nico H J Creugers
- Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Stanimira I Kalaykova
- Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Medical Center, Nijmegen, Netherlands
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Huijben J, Jansen M, Ginjaar IB, Lammens M, van Putten M, van Alfen N, de Groot IJM. What can we learn from assisted bicycle training in a girl with dystrophinopathy? A case study. J Child Neurol 2015; 30:659-63. [PMID: 24832398 DOI: 10.1177/0883073814534316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this case study, a 9-year-old ambulatory girl with dystrophinopathy due to a mosaic translocation mutation participated in dynamic training. Because the role of exercise is unclear in both boys and girls with dystrophinopathy, a recently developed assisted bicycle training regimen was evaluated for its feasibility and effectiveness in this girl. The girl trained at home, first 15 minutes with her legs and then 15 minutes with her arms, 5 times a week, for 24 weeks. This case study showed that the training was feasible and safe. In addition, we found that no physical deterioration occurred during the training period: the Motor Function Measure and the Assisted 6-Minute Cycling Test results remained stable. Slight improvements in quantitative muscle ultrasound intensity were found, indicating less fatty infiltration in the muscles. These results suggest that physical training could be beneficial in females with dystrophinopathy who express low levels of dystrophin.
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Affiliation(s)
- Jilske Huijben
- Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Merel Jansen
- Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Ieke B Ginjaar
- Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin Lammens
- Department of Pathology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Maaike van Putten
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Nens van Alfen
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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Alemdaroğlu I, Karaduman A, Yilmaz ÖT, Topaloğlu H. Different types of upper extremity exercise training in Duchenne muscular dystrophy: Effects on functional performance, strength, endurance, and ambulation. Muscle Nerve 2015; 51:697-705. [DOI: 10.1002/mus.24451] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 01/30/2023]
Affiliation(s)
- Ipek Alemdaroğlu
- Faculty of Health Sciences; Physiotherapy and Rehabilitation Department; Bezmialem Vakıf University; Fatih Istanbul Turkey
| | - Ayşe Karaduman
- Faculty of Health Sciences; Physiotherapy and Rehabilitation Department; Hacettepe University; Ankara Turkey
| | - Öznur Tunca Yilmaz
- Faculty of Health Sciences; Physiotherapy and Rehabilitation Department; Hacettepe University; Ankara Turkey
| | - Haluk Topaloğlu
- İhsan Doğramacı Children Hospital; Pediatric Neurology Department; Hacettepe University; Ankara Turkey
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van Bruggen HW, Van Den Engel-Hoek L, Steenks MH, Bronkhorst EM, Creugers NHJ, de Groot IJM, Kalaykova SI. Reduced mandibular range of motion in Duchenne Muscular Dystrophy: predictive factors. J Oral Rehabil 2015; 42:430-8. [PMID: 25600935 DOI: 10.1111/joor.12274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 11/26/2022]
Abstract
Patients with Duchenne muscular dystrophy (DMD) experience negative effects upon feeding and oral health. We aimed to determine whether the mandibular range of motion in DMD is impaired and to explore predictive factors for the active maximum mouth opening (aMMO). 23 patients with DMD (mean age 16.7 ± 7.7 years) and 23 controls were assessed using a questionnaire about mandibular function and impairments. All participants underwent a clinical examination of the masticatory system, including measurement of mandibular range of motion and variables related to mandibular movements. In all patients, quantitative ultrasound of the digastric muscle and the geniohyoid muscle and the motor function measure (MFM) scale were performed. The patients were divided into early and late ambulatory stage (AS), early non-ambulatory stage (ENAS) and late non-ambulatory stage (LNAS). All mandibular movements were reduced in the patient group (P < 0.001) compared to the controls. Reduction in the aMMO (<40 mm) was found in 26% of the total patient group. LNAS patients had significantly smaller mandibular movements compared to AS and ENAS (P < 0.05). Multiple linear regression analysis for aMMO revealed a positive correlation with the body height and disease progression, with MFM total score as the strongest independent risk factor (R(2) = 0.71). Mandibular movements in DMD are significantly reduced and become more hampered with loss of motor function, including the sitting position, arm function, and neck and head control. We suggest that measurement of the aMMO becomes a part of routine care of patients with DMD.
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Affiliation(s)
- H W van Bruggen
- Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center, Utrecht, The Netherlands
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Abstract
PURPOSE To determine exercise response during cardiopulmonary exercise testing in children and adolescents with dystrophinopathies. METHODS Exercise response on the cardiopulmonary exercise test (CPET) was compared with a standard care test protocol. RESULTS Nine boys (aged 10.8 ± 4.7 years) with Becker muscular dystrophy (n = 6) and Duchenne muscular dystrophy (n = 3) were included. The feasibility of the CPET was similar to a standard care test protocol, and no serious adverse events occurred. In 67% of the subjects with normal or only mildly impaired functional capacity, the CPET could be used to detect moderate to severe cardiopulmonary exercise limitations. CONCLUSIONS The CPET seems to be a promising outcome measure for cardiopulmonary exercise limitations in youth with mild functional limitations. Further research with larger samples is warranted to confirm current findings and investigate the additional value of the CPET to longitudinal follow-up of cardiomyopathy and the development of safe exercise programs for youth with dystrophinopathies.
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Houwen-van Opstal SLS, Jansen M, van Alfen N, de Groot IJM. Health-related quality of life and its relation to disease severity in boys with Duchenne muscular dystrophy: satisfied boys, worrying parents--a case-control study. J Child Neurol 2014; 29:1486-95. [PMID: 24141275 DOI: 10.1177/0883073813506490] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The progression of Duchenne muscular dystrophy is expected to negatively influence the patients' health-related quality of life, but knowledge of the relationship with disease severity is limited. We investigated the relationship between health-related quality of life (KIDSCREEN-52 questionnaire) and disease severity (clinical assessments of body functions and activities) in 40 boys with Duchenne muscular dystrophy (19 ambulant, 21 wheelchair dependent) who were in different phases of the disease and underwent life-limiting events such as the loss of the ability to ambulate and the ability to lift the arms. In addition, we compared boys' health-related quality of life perceptions with that of their parents. The participants' health-related quality of life was similar to healthy peers' and not influenced by disease severity, except for the physical domain. Parents scored much lower than the boys on the KIDSCREEN-52 domains Self Perception, Moods and Emotions, and Bullying. The latter finding needs attention in the management of Duchenne muscular dystrophy.
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Affiliation(s)
| | - M Jansen
- Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands
| | - N van Alfen
- Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Department of Neurology and Clinical Neurophysiology, Nijmegen, The Netherlands
| | - I J M de Groot
- Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands
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Van der Heide LA, van Ninhuijs B, Bergsma A, Gelderblom GJ, van der Pijl DJ, de Witte LP. An overview and categorization of dynamic arm supports for people with decreased arm function. Prosthet Orthot Int 2014; 38:287-302. [PMID: 23950551 DOI: 10.1177/0309364613498538] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 06/21/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Assistive devices that augment arm function were already introduced during the polio era. Devices are still being developed, but a review has not been performed thus far. OBJECTIVE To create an overview and categorize assistive devices facilitating arm function in activities of daily living for people with decreased arm function. STUDY DESIGN Literature review. METHODS A systematic review in three scientific literature databases. Conference proceedings, assistive technology databases, and references were searched and experts consulted. This resulted in a database of dynamic arm supports. Product information was added, and the devices were categorized. RESULTS A total of 104 dynamic arm supports were found. These could be categorized as nonactuated devices (N = 39), passively actuated devices (N = 24), actively actuated devices (N = 34), or devices using the functional electrical stimulation principle (N = 7). Functionality analysis resulted in second-level categorization: tremor suppression, facilitation of anti-gravity movement, and assistance of specific joint motion. CONCLUSION All devices could be ordered in a categorization of low complexity. Many have been developed; most have disappeared and have been succeeded by similar devices. Limitations of the devices found mainly concern interfacing and the range of motion facilitated. Future devices could make use of whatever residual strength is available in the users' arm for control. CLINICAL RELEVANCE The provided overview of devices in this article and the classification developed is relevant for practitioners seeking assistive solutions for their clients as it makes the range of developed solutions both accessible and comprehensible.
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Affiliation(s)
- Loek A Van der Heide
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Bob van Ninhuijs
- Department of Electrical Engineering, Electromechanics and Power Electronics Group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Arjen Bergsma
- Nijmegen Centre of Evidence Based Practice, Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gert Jan Gelderblom
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | | | - Luc P de Witte
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Bell JM, Blackwood B, Shields MD, Watters J, Hamilton A, Beringer T, Elliott M, Quinlivan R, Tirupathi S. Interventions to prevent steroid-induced osteoporosis and osteoporotic fractures in Duchenne muscular dystrophy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ljubicic V, Burt M, Jasmin BJ. The therapeutic potential of skeletal muscle plasticity in Duchenne muscular dystrophy: phenotypic modifiers as pharmacologic targets. FASEB J 2013; 28:548-68. [PMID: 24249639 DOI: 10.1096/fj.13-238071] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a life-limiting, neuromuscular disorder that causes progressive, severe muscle wasting in boys and young men. Although there is no cure, scientists and clinicians can leverage the fact that slower, more oxidative skeletal muscle fibers possess an enhanced degree of resistance to the dystrophic pathology relative to their faster, more glycolytic counterparts, and can thus use this knowledge when investigating novel therapeutic avenues. Several factors have been identified as powerful regulators of muscle plasticity. Some proteins, such as calcineurin, peroxisome proliferator-activated receptor (PPAR) γ coactivator 1α (PGC-1α), PPARβ/δ, and AMP-activated protein kinase (AMPK), when chronically stimulated in animal models, remodel skeletal muscle toward the slow, oxidative myogenic program, whereas others, such as receptor-interacting protein 140 (RIP140) and E2F transcription factor 1 (E2F1), repress this phenotype. Recent studies demonstrating that pharmacologic and physiological activation of targets that shift dystrophic muscle toward the slow, oxidative myogenic program provide appreciable molecular and functional benefits. This review surveys the rationale behind, and evidence for, the study of skeletal muscle plasticity in preclinical models of DMD and highlights the potential therapeutic opportunities in advancing a strategy focused on remodeling skeletal muscle in patients with DMD toward the slow, oxidative phenotype.
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Affiliation(s)
- Vladimir Ljubicic
- 1Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
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Farjadian AB, Kong Q, Gade VK, Deutsch JE, Mavroidis C. VRACK: measuring pedal kinematics during stationary bike cycling. IEEE Int Conf Rehabil Robot 2013; 2013:6650453. [PMID: 24187270 DOI: 10.1109/icorr.2013.6650453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ankle impairment and lower limb asymmetries in strength and coordination are common symptoms for individuals with selected musculoskeletal and neurological impairments. The virtual reality augmented cycling kit (VRACK) was designed as a compact mechatronics system for lower limb and mobility rehabilitation. The system measures interaction forces and cardiac activity during cycling in a virtual environment. The kinematics measurement was added to the system. Due to the constrained problem definition, the combination of inertial measurement unit (IMU) and Kalman filtering was recruited to compute the optimal pedal angular displacement during dynamic cycling exercise. Using a novel benchmarking method the accuracy of IMU-based kinematics measurement was evaluated. Relatively accurate angular measurements were achieved. The enhanced VRACK system can serve as a rehabilitation device to monitor biomechanical and physiological variables during cycling on a stationary bike.
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Jansen M, van Alfen N, Geurts ACH, de Groot IJM. Assisted bicycle training delays functional deterioration in boys with Duchenne muscular dystrophy: the randomized controlled trial "no use is disuse". Neurorehabil Neural Repair 2013; 27:816-27. [PMID: 23884013 DOI: 10.1177/1545968313496326] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Physical training might delay the functional deterioration caused by disuse in boys with Duchenne muscular dystrophy (DMD). The "No Use Is Disuse" study is the first explorative, randomized controlled trial in boys with DMD to examine whether assisted bicycle training is feasible, safe, and beneficial. METHODS Ambulatory and recently wheelchair-dependent boys with DMD were allocated to the intervention or control group. The intervention group received assisted bicycle training of the legs and arms during 24 weeks. The control group received the same training after a waiting period of 24 weeks. The primary study outcomes were the Motor Function Measure (MFM) and the Assisted 6-Minute Cycling Test (A6MCT). Group differences were examined by an analysis of covariance. RESULTS Thirty boys (mean age 10.5 ± 2.6 years, 18 ambulant and 12 wheelchair-dependent) were allocated to the intervention (n = 17) or the control (n = 13) group. All boys in the intervention group (except one) completed the training. After 24 weeks, the total MFM score remained stable in the intervention group, whereas it had significantly decreased in the control group (Δ = 4.9, 95% confidence interval = 2.2-7.6). No significant group differences were found for the A6MCT. No serious adverse events were observed. CONCLUSIONS Our results suggest that assisted bicycle training of the legs and arms is feasible and safe for both ambulant and wheelchair-dependent children and may decline the deterioration due to disuse. Progressive deterioration, however, may compromise the design of trials for DMD.
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Affiliation(s)
- Merel Jansen
- 1Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Voet NBM, van der Kooi EL, Riphagen II, Lindeman E, van Engelen BGM, Geurts ACH. Strength training and aerobic exercise training for muscle disease. Cochrane Database Syst Rev 2013:CD003907. [PMID: 23835682 DOI: 10.1002/14651858.cd003907.pub4] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Strength training or aerobic exercise programmes might optimise muscle and cardiorespiratory function and prevent additional disuse atrophy and deconditioning in people with a muscle disease. This is an update of a review first published in 2004. OBJECTIVES To examine the safety and efficacy of strength training and aerobic exercise training in people with a muscle disease. SEARCH METHODS We searched the Cochrane Neuromuscular Disease Group Specialized Register (July 2012), CENTRAL (2012 Issue 3 of 4), MEDLINE (January 1946 to July 2012), EMBASE (January 1974 to July 2012), EMBASE Classic (1947 to 1973) and CINAHL (January 1982 to July 2012). SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing strength training or aerobic exercise programmes, or both, to no training, and lasting at least six weeks, in people with a well-described diagnosis of a muscle disease.We did not use the reporting of specific outcomes as a study selection criterion. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted the data obtained from the full text-articles and from the original investigators. We collected adverse event data from included studies. MAIN RESULTS We included five trials (170 participants). The first trial compared the effect of strength training versus no training in 36 people with myotonic dystrophy. The second trial compared aerobic exercise training versus no training in 14 people with polymyositis and dermatomyositis. The third trial compared strength training versus no training in a factorial trial that also compared albuterol with placebo, in 65 people with facioscapulohumeral muscular dystrophy (FSHD). The fourth trial compared combined strength training and aerobic exercise versus no training in 18 people with mitochondrial myopathy. The fifth trial compared combined strength training and aerobic exercise versus no training in 35 people with myotonic dystrophy type 1.In both myotonic dystrophy trials and the dermatomyositis and polymyositis trial there were no significant differences between training and non-training groups for primary and secondary outcome measures. The risk of bias of the strength training trial in myotonic dystrophy and the aerobic exercise trial in polymyositis and dermatomyositis was judged as uncertain, and for the combined strength training and aerobic exercise trial, the risk of bias was judged as adequate. In the FSHD trial, for which the risk of bias was judged as adequate, a +1.17 kg difference (95% confidence interval (CI) 0.18 to 2.16) in dynamic strength of elbow flexors in favour of the training group reached statistical significance. In the mitochondrial myopathy trial, there were no significant differences in dynamic strength measures between training and non-training groups. Exercise duration and distance cycled in a submaximal endurance test increased significantly in the training group compared to the control group. The differences in mean time and mean distance cycled till exhaustion between groups were 23.70 min (95% CI 2.63 to 44.77) and 9.70 km (95% CI 1.51 to 17.89), respectively. The risk of bias was judged as uncertain. In all trials, no adverse events were reported. AUTHORS' CONCLUSIONS Moderate-intensity strength training in myotonic dystrophy and FSHD and aerobic exercise training in dermatomyositis and polymyositis and myotonic dystrophy type I appear to do no harm, but there is insufficient evidence to conclude that they offer benefit. In mitochondrial myopathy, aerobic exercise combined with strength training appears to be safe and may be effective in increasing submaximal endurance capacity. Limitations in the design of studies in other muscle diseases prevent more general conclusions in these disorders.
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Affiliation(s)
- Nicoline B M Voet
- Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Medical Centre, Nijmegen, Netherlands.
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Gianola S, Pecoraro V, Lambiase S, Gatti R, Banfi G, Moja L. Efficacy of muscle exercise in patients with muscular dystrophy: a systematic review showing a missed opportunity to improve outcomes. PLoS One 2013; 8:e65414. [PMID: 23894268 PMCID: PMC3680476 DOI: 10.1371/journal.pone.0065414] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/25/2013] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Although muscular dystrophy causes muscle weakness and muscle loss, the role of exercise in the management of this disease remains controversial. OBJECTIVE The purpose of this systematic review is to evaluate the role of exercise interventions on muscle strength in patients with muscular dystrophy. METHODS We performed systematic electronic searches in Medline, Embase, Web of Science, Scopus and Pedro as well as a list of reference literature. We included trials assessing muscle exercise in patients with muscular dystrophy. Two reviewers independently abstracted data and appraised risk of bias. RESULTS We identified five small (two controlled and three randomized clinical) trials comprising 242 patients and two ongoing randomized controlled trials. We were able to perform two meta-analyses. We found an absence of evidence for a difference in muscle strength (MD 4.18, 95% CIs - 2.03 to 10.39; p = 0.91) and in endurance (MD -0.53, 95% CIs -1.11 to 0.05; p = 0.26). In both, the direction of effects favored muscle exercise. CONCLUSIONS The first included trial about the efficacy of muscular exercise was published in 1978. Even though some benefits of muscle exercise were consistently reported across studies, the benefits might be due to the small size of studies and other biases. Detrimental effects are still possible. After several decades of research, doctors cannot give advice and patients are, thus, denied basic information. A multi-center randomized trial investigating the strength of muscles, fatigue, and functional limitations is needed.
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Affiliation(s)
- Silvia Gianola
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy.
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Baltgalvis KA, Call JA, Cochrane GD, Laker RC, Yan Z, Lowe DA. Exercise training improves plantar flexor muscle function in mdx mice. Med Sci Sports Exerc 2013; 44:1671-9. [PMID: 22460476 DOI: 10.1249/mss.0b013e31825703f0] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE We tested the hypothesis that low-intensity exercise in mdx mice improves plantar flexor muscle contractile function, resistance to fatigue, and mitochondrial adaptations without exacerbating muscular dystrophy. METHODS We subjected mdx mice to 12 wk of voluntary low-resistance wheel running (Run, n = 17) or normal cage activities (sedentary (Sed), n = 16) followed by in vivo analyses for plantar flexor torque generation and fatigue resistance or running capacity on a treadmill. Gastrocnemius muscles were further evaluated for exercise-induced mitochondrial adaptations and fiber type distribution and central nuclei. t-tests were used to determine differences between the Sed and Run groups. RESULTS Plantar flexor submaximal isometric torques and maximal isometric torque at multiple ankle joint angles and resistance to fatigue were greater in Run compared with Sed mdx mice (P G 0.05). Citrate synthase and A-hydroxyacyl-CoA dehydrogenase enzyme activities and cytochrome c oxidase IV protein expression in gastrocnemius muscles were greater in Run than in Sed mdx mice(P e 0.04), along with a trend of fiber type transformation from Type IIb to Type IIx fibers. Exercise training in mdx mice did not elevate serum creatine kinase levels but led to a significant reduction of centrally nucleated myofibers. CONCLUSIONS Voluntary low-resistance wheel running in mdx mice can result in skeletal muscle adaptation, leading to improved contractile function and reduced fatigability,with no indication that exercise was detrimental. This study supports the need for further investigation of low-intensity exercise as an early therapeutic intervention in ambulatory boys with Duchenne muscular dystrophy.
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Abstract
In this review, we present an overview of the role of exercise in neuromuscular disease (NMD). We demonstrate that despite the different pathologies in NMDs, exercise is beneficial, whether aerobic/endurance or strength/resistive training, and we explore whether this benefit has a similar mechanism to that of healthy subjects. We discuss further areas for study, incorporating imaginative and novel approaches to training and its assessment in NMD. We conclude by suggesting ways to improve future trials by avoiding previous methodological flaws and drawbacks in this field.
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Affiliation(s)
- Yaacov Anziska
- Department of Neurology, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, New York, 11203, USA.
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Lowes LP, Alfano LN, Yetter BA, Worthen-Chaudhari L, Hinchman W, Savage J, Samona P, Flanigan KM, Mendell JR. Proof of concept of the ability of the kinect to quantify upper extremity function in dystrophinopathy. PLOS CURRENTS 2013; 5. [PMID: 23516667 PMCID: PMC3600356 DOI: 10.1371/currents.md.9ab5d872bbb944c6035c9f9bfd314ee2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Individuals with dystrophinopathy lose upper extremity strength in proximal muscles followed by those more distal. Current upper extremity evaluation tools fail to fully capture changes in upper extremity strength and function across the disease spectrum as they tend to focus solely on distal ability. The Kinect by Microsoft is a gaming interface that can gather positional information about an individual's upper extremity movement which can be used to determine functional reaching volume, velocity of movement, and rate of fatigue while playing an engaging video game. The purpose of this study was to determine the feasibility of using the Kinect platform to assess upper extremity function in individuals with dystrophinopathy across the spectrum of abilities. METHODS Investigators developed a proof-of-concept device, ACTIVE (Abilities Captured Through Interactive Video Evaluation), to measure functional reaching volume, movement velocity, and rate of fatigue. Five subjects with dystrophinopathy and 5 normal controls were tested using ACTIVE during one testing session. A single subject with dystrophinopathy was simultaneously tested with ACTIVE and a marker-based motion analysis system to establish preliminary validity of measurements. RESULTS ACTIVE proof-of-concept ranked the upper extremity abilities of subjects with dystrophinopathy by Brooke score, and also differentiated them from performance of normal controls for the functional reaching volume and velocity tests. Preliminary test-retest reliability of the ACTIVE for 2 sequential trials was excellent for functional reaching volume (ICC=0.986, p<0.001) and velocity trials (ICC=0.963, p<0.001). DISCUSSION The data from our pilot study with ACTIVE proof-of-concept demonstrates that newly available gaming technology has potential to be used to create a low-cost, widely-accessible and functional upper extremity outcome measure for use with children and adults with dystrophinopathy.
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Affiliation(s)
- Linda P Lowes
- Nationwide Children's Hospital, Columbus, Ohio, United States
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Lovering RM, Brooks SV. Eccentric exercise in aging and diseased skeletal muscle: good or bad? J Appl Physiol (1985) 2013; 116:1439-45. [PMID: 23471953 DOI: 10.1152/japplphysiol.00174.2013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Evidence is accumulating regarding the benefits of exercise in people who are more susceptible to injury, such as the elderly, or those with a neuromuscular disease, for example Duchenne muscular dystrophy (DMD). There appears to be a consensus that exercise can be safely performed in aging and diseased muscles, but the role of eccentric exercise is not as clear. Eccentric (lengthening) contractions have risks and benefits. Eccentric contractions are commonly performed on a daily basis, and high-force voluntary eccentric contractions are often employed in strength training paradigms with excellent results; however, high-force eccentric contractions are also linked to muscle damage. This minireview examines the benefits and safety issues of using eccentric exercise in at-risk populations. A common recommendation for all individuals is difficult to achieve, and guidelines are still being established. Some form of exercise is generally recommended with aging and even with diseased muscles, but the prescription (frequency, intensity, and duration) and type (resistance vs. aerobic) of exercise requires personal attention, as there is great diversity in the functional level and comorbidities in the elderly and those with neuromuscular disease.
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Affiliation(s)
- Richard M Lovering
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland; and
| | - Susan V Brooks
- Department of Molecular and Integrative Physiology, University of Michigan School of Medicine, Ann Arbor, Michigan
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Oral muscles are progressively affected in Duchenne muscular dystrophy: implications for dysphagia treatment. J Neurol 2012; 260:1295-303. [DOI: 10.1007/s00415-012-6793-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/06/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
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