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Objective and subjective measures of sleep in men with Muscular Dystrophy. PLoS One 2022; 17:e0274970. [PMID: 36137167 PMCID: PMC9499246 DOI: 10.1371/journal.pone.0274970] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Despite poor sleep quality being recognised in Duchenne Muscular Dystrophy, reports from milder forms of Muscular Dystrophy (MD), and accompanied associations with quality of life (QoL), pain and fatigue, remain limited however. Methods Adult males (n = 15 Beckers MD (BMD), n = 12 Limb-Girdle MD (LGMD), n = 12 Fascioscapulohumeral (FSHD), n = 14 non-MD (CTRL)) completed assessments of body composition (Bio-electrical impedance), sleep (7-day 24-hour tri-axial accelerometer, Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index, QoL (SF36-v2), pain (Visual analogue scale), fatigue (Modified Fatigue Index Scale) and functional assessments (Brookes and Vignos). Results FSHD and BMD reported worse sleep than CTRL on the PSQI. FSHD scored worse than CTRL on the Insomnia Severity Index (P<0.05). 25–63% and 50–81% of adults with MD reported poor sleep quality using the Insomnia Severity Index and PSQI, respectively. Accelerometery identified no difference in sleep quality between groups. Associations were identified between sleep measures (PSQI global and insomnia severity) with mental or physical QoL in LGMD, BMD and FSHD. Multiple regression identified associations between sleep impairment and fatigue severity (all MDs), body composition (BMD & LGMD), upper and lower limb function (LGMD, FSHD) and age (FSHD). Conclusions 25–81% of men with MD, depending on classification, experience sleep impairment, using self-report sleep measures. Whilst BMD and FSHD showed worse sleep outcomes than CTRL, no group difference was observed between LGMD and CTRL, however all groups showed associations with sleep impairment and higher levels of fatigue. These findings, and associations with measures of health and wellbeing, highlight an area for further research which could impact QoL in adults with MD.
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Jacques MF, Onambele-Pearson GL, Reeves ND, Stebbings GK, Dawson EA, Stockley RC, Edwards B, Morse CI. 12-Month changes of muscle strength, body composition and physical activity in adults with dystrophinopathies. Disabil Rehabil 2020; 44:1847-1854. [PMID: 32853037 DOI: 10.1080/09638288.2020.1808087] [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] [Indexed: 01/10/2023]
Abstract
PURPOSE Muscular dystrophy (MD) is an umbrella term for muscle wasting conditions, for which longitudinal changes in function and body composition are well established in children with Duchenne (DMD), however, changes in adults with DMD and Beckers (BMD), respectively, remain poorly reported. This study aims to assess 12-month changes in lower-limb strength, muscle size, body composition and physical activity in adults with Muscular Dystrophy (MD). METHODS Adult males with Duchenne MD (DMD; N = 15) and Beckers MD (BMD; N = 12) were assessed at baseline and 12-months for body composition (Body fat and lean body mass (LBM)), Isometric maximal voluntary contraction (Knee-Extension (KEMVC) and Plantar-Flexion (PFMVC)) and physical activity (tri-axial accelerometry). RESULTS 12-Month change in strength was found as -19% (PFMVC) and -14% (KEMVC) in DMD. 12-Month change in strength in BMD, although non-significant, was explained by physical activity (R2=0.532-0.585). Changes in LBM (DMD) and body fat (BMD) were both masked by non-significant changes in body mass. DISCUSSION 12-Month changes in adults with DMD appear consistent with paediatric populations. Physical activity appears important for muscle function maintenance. Specific monitoring of body composition, and potential co-morbidities, within adults with MD is highlighted.Implications for rehabilitationQuantitative muscle strength assessment shows progressive muscle weakness in adults with Duchenne Muscular Dystrophy is comparable to paediatric reports (-14 to -19%).Physical activity should be encouraged in adults with Beckers Muscular Dystrophy, anything appears better than nothing.Body composition, rather than body mass, should be monitored closely to identify any increase in body fat.
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Affiliation(s)
- Matthew F Jacques
- Faculty of Science and Engineering, School of Healthcare Science, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - Gladys L Onambele-Pearson
- Faculty of Science and Engineering, School of Healthcare Science, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - Neil D Reeves
- Faculty of Science and Engineering, School of Healthcare Science, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - Georgina K Stebbings
- Faculty of Science and Engineering, School of Healthcare Science, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - Ellen A Dawson
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rachel C Stockley
- School of Nursing, University of Central Lancashire, Preston, United Kingdom
| | - Bryn Edwards
- The Neuromuscular Centre, Winsford, Cheshire, United Kingdom
| | - Christopher I Morse
- Faculty of Science and Engineering, School of Healthcare Science, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom
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Nuckolls GH, Kinnett K, Dayanidhi S, Domenighetti AA, Duong T, Hathout Y, Lawlor MW, Lee SSM, Magnusson SP, McDonald CM, McNally EM, Miller NF, Olwin BB, Raghavan P, Roberts TJ, Rutkove SB, Sarwark JF, Senesac CR, Vogel LF, Walter GA, Willcocks RJ, Rymer WZ, Lieber RL. Conference report on contractures in musculoskeletal and neurological conditions. Muscle Nerve 2020; 61:740-744. [PMID: 32108365 DOI: 10.1002/mus.26845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/03/2020] [Accepted: 02/23/2020] [Indexed: 12/18/2022]
Abstract
Limb contractures are debilitating complications associated with various muscle and nervous system disorders. This report summarizes presentations at a conference at the Shirley Ryan AbilityLab in Chicago, Illinois, on April 19-20, 2018, involving researchers and physicians from diverse disciplines who convened to discuss current clinical and preclinical understanding of contractures in Duchenne muscular dystrophy, stroke, cerebral palsy, and other conditions. Presenters described changes in muscle architecture, activation, extracellular matrix, satellite cells, and muscle fiber sarcomeric structure that accompany or predispose muscles to contracture. Participants identified ongoing and future research directions that may lead to understanding of the intersecting factors that trigger contractures. These include additional studies of changes in muscle, tendon, joint, and neuronal tissues during contracture development with imaging, molecular, and physiologic approaches. Participants identified the requirement for improved biomarkers and outcome measures to identify patients likely to develop contractures and to accurately measure efficacy of treatments currently available and under development.
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Affiliation(s)
- Glen H Nuckolls
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack, New Jersey
| | | | | | - Tina Duong
- Department of Neurology, Stanford University, Palo Alto, California
| | - Yetrib Hathout
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York
| | - Michael W Lawlor
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sabrina S M Lee
- Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Craig M McDonald
- Department of Physical Medicine & Rehabilitation, University of California Davis School of Medicine, Sacramento, California.,Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California
| | - Elizabeth M McNally
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Natalie F Miller
- Center for Gene Therapy, Nationwide Children's Hospital, Columbus, Ohio
| | - Bradley B Olwin
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado at Boulder, Colorado
| | - Preeti Raghavan
- Rusk Rehabilitation, New York University School of Medicine, New York, New York
| | - Thomas J Roberts
- Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John F Sarwark
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Claudia R Senesac
- Physical Therapy Department, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Leslie F Vogel
- Department of Rehabilitation, Seattle Children's Hospital, Seattle, Washington
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
| | - Rebecca J Willcocks
- Physical Therapy Department, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
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de Souza MA, Figueiredo MML, de Baptista CRDJA, Aldaves RD, Mattiello-Sverzut AC. Beneficial effects of ankle-foot orthosis daytime use on the gait of Duchenne muscular dystrophy patients. Clin Biomech (Bristol, Avon) 2016; 35:102-10. [PMID: 27139255 DOI: 10.1016/j.clinbiomech.2016.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Orthosis use prevents muscle contracture and prolongs ambulation in patients with Duchenne muscular dystrophy (DMD). However, its biomechanical effects on gait are unclear. This study assessed the effects of daytime and night-time use of Articulated Ankle Foot Orthosis (AFO) on kinematic, kinetic and spatial/temporal gait parameters of DMD patients. METHODS Twenty ambulatory patients (4-12years of age) were assigned to one of three groups: no orthosis (NoO; n=7), night-time orthosis (NiO; n=7), day-time orthosis (DO; n=6). All subjects were evaluated once (Ev1) and five of them were re-evaluated between five and seven months after Ev1 (Ev2). FINDINGS Cross-sectional analysis with linear mixed-effects models (ANOVA) showed increased peak dorsiflexion angle and dorsiflexor moment and decreased plantar flexion angle and ankle joint power generation for the DOwith group when compared to the NoO group (P<0.05). The DOwith group also showed decreased peak hip flexion angle, hip power absorption, plantar flexion angle and increased peak dorsiflexion moment when compared to the NoO group (P<0.05). Analysis of gait cycle curves showed significant and clinically relevant changes in kinematic and kinetic parameters for the DOwith group when compared to the other experimental groups. Longitudinal analysis suggest that night-time use of Articulated AFO can promote positive changes in gait parameters of DMD patients, when used before the functional deficit is too advanced. INTERPRETATION Early daytime and night-time use of Articulated AFO changed gait and minimized typical compensations seen in DMD patients, thus it is recommended in order to prolong gait ability.
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Affiliation(s)
- Mariana Angélica de Souza
- Ribeirao Preto Medical School, University of Sao Paulo, Bandeirantes Av., 3500, 14049-900 Ribeirao Preto, Sao Paulo, Brazil
| | | | | | - Robson Devanir Aldaves
- Rehabilitation Center of the Hospital of Clinics, Ribeirão Preto Medical School, University of Sao Paulo, Bandeirantes Av., 3500, 14048-900 Ribeirao Preto, Sao Paulo, Brazil
| | - Ana Claudia Mattiello-Sverzut
- Ribeirao Preto Medical School, University of Sao Paulo, Bandeirantes Av., 3500, 14049-900 Ribeirao Preto, Sao Paulo, Brazil.
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Skalsky AJ, McDonald CM. Prevention and management of limb contractures in neuromuscular diseases. Phys Med Rehabil Clin N Am 2013; 23:675-87. [PMID: 22938881 DOI: 10.1016/j.pmr.2012.06.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Limb contractures are a common impairment in neuromuscular diseases. They contribute to increased disability from decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living, and increased pain. The pathogenesis of contractures is multifactorial. Myopathic conditions are associated with more severe limb contractures compared with neuropathic disorders. Although the evidence supporting the efficacy of multiple interventions to improve range of motion in neuromuscular diseases in a sustained manner is lacking, there are generally accepted principles with regard to splinting, bracing, stretching, and surgery that help minimize the impact or disability from contractures.
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Affiliation(s)
- Andrew J Skalsky
- Rady Children's Hospital, Division of Pediatric Rehabilitation, MC 5096, 3020 Children's Way, University of California San Diego School of Medicine, San Diego, CA 92123, USA
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Leitch KK, Raza N, Biggar D, Stephen D, Wright JG, Alman B. Should foot surgery be performed for children with Duchenne muscular dystrophy? J Pediatr Orthop 2005; 25:95-7. [PMID: 15614068 DOI: 10.1097/00004694-200501000-00021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The authors conducted a retrospective study to determine the outcome of foot surgery in full-time wheelchair users with Duchenne muscular dystrophy. Medical records on all 88 teenaged boys with Duchenne muscular dystrophy treated at the authors' institution were obtained and reviewed. Patients completed questions about shoe wear, pain, hypersensitivity, and cosmesis, and a foot examination was performed. There were no significant differences between patients who did and did not receive foot surgery with respect to shoe wear (P > 0.05), pain (P > 0.05), hypersensitivity (P > 0.05), or cosmesis (P > 0.05). Hindfoot motion was significantly better (P > 0.05) but equinus contracture was significantly worse (P > 0.05) in patients who had not had surgery.
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Affiliation(s)
- Khristinn Kellie Leitch
- Hospital for Sick Children and the Bloorview-Hugh MacMillan Rehabilitation Centre, Toronto, Canada.
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Bakker JP, de Groot IJ, Beckerman H, de Jong BA, Lankhorst GJ. The effects of knee-ankle-foot orthoses in the treatment of Duchenne muscular dystrophy: review of the literature. Clin Rehabil 2000; 14:343-59. [PMID: 10945419 DOI: 10.1191/0269215500cr319oa] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE A systematic review of the available literature on the effectiveness of knee-ankle-foot orthoses in the treatment of Duchenne muscular dystrophy. DESIGN A computer search was carried out (MEDLINE 1966-97, CINAHL 1982-97) using the key words muscular dystrophy, rehabilitation, locomotion, braces or orthotic devices. References in relevant publications and nonindexed journals were also examined. Criteria to include and exclude articles were formulated. We used a systematic review procedure to evaluate the literature. Seven methodological criteria were formulated. RESULTS Thirty articles describing 35 studies met the inclusion criteria for our review, nine studies were selected based on completeness of information on study population, treatment and quantitative presentation of the effect outcome. Operations on the lower limbs were performed on most patients. A concomitant programme of rehabilitation was not described thoroughly. A percentage success of treatment was calculated for eight studies. Median percentage after one year was 75.1, after two years 47.9 and after three years 24.3. The median for the means of independent walking was 24 months, the median for the means of assisted walking was 36.2 months and the median for the means of standing ability was 50.5 months duration. CONCLUSION The scientific strength of the studies reviewed is poor. It seems that the use of knee-ankle foot orthoses can prolong assisted walking and standing, but it is uncertain whether it can prolong functional walking. The boys that benefit most have a relatively low rate of deterioration, are capable of enduring an operation and are well motivated.
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Affiliation(s)
- J P Bakker
- Academic Medical Center, University of Amsterdam, Department of Rehabilitation, The Netherlands
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Limb Contractures in Progressive Neuromuscular Disease and the Role of Stretching, Orthotics, and Surgery. Phys Med Rehabil Clin N Am 1998. [DOI: 10.1016/s1047-9651(18)30286-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vignos PJ, Wagner MB, Karlinchak B, Katirji B. Evaluation of a program for long-term treatment of Duchenne muscular dystrophy. Experience at the University Hospitals of Cleveland. J Bone Joint Surg Am 1996; 78:1844-52. [PMID: 8986661 DOI: 10.2106/00004623-199612000-00007] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
One hundred and forty-four boys who had Duchenne muscular dystrophy were managed at a single center between 1953 and 1994 and were followed for a mean of 8.9 years. The long duration of follow-up provided an opportunity to examine the effects of physical therapy and orthopaedic treatment on contractures of the lower extremities and on the duration of the ability to walk. Contractures of the lower extremities were controlled best when patients were managed with a combination of daily passive stretching exercises, prescribed periods of standing and walking, tenotomy of the Achilles tendon, posterior tibial-tendon transfer, and application of knee-ankle-foot orthoses. Approximately two years after bracing, the severity of the contracture of the heel cords was similar in the patients who had had an operation and those who had not. By the fourth year after bracing, however, the patients who had had an operation had less severe contractures than those who had had bracing alone. Five to seven years after the operation and bracing, control of contractures was still good, especially for the patients who had had posterior tibial-tendon transfer. Contracture of the knee was well controlled five to seven years after bracing in all patients who had had bracing, with or without an operation. The program enabled the patients who had been managed with bracing to walk until a mean age of 13.6 years. After loss of the ability to walk with bracing, the ability to stand continued for an additional two years with use of orthoses. The findings of the present study demonstrate the value of traditional methods of operative treatment and bracing for controlling contractures of the lower extremities in patients who have Duchenne muscular dystrophy and for prolonging their ability to walk.
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Affiliation(s)
- P J Vignos
- University Hospitals of Cleveland, Ohio 44106, USA
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Abstract
Duchenne muscular dystrophy is the second most common lethal genetic disorder in humans. With the advent of molecular genetic technology, the definition of this disease has been modified to include an abnormality of dystrophin in muscle--a dystrophinopathy. Accurate genetic counseling is possible using methods of deletion detection and linkage analysis. Treatment of this type of muscular dystrophy may soon mean the routine use of steroids and later include direct injection of an artificial gene for dystrophin.
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Abstract
The gait of 7 boys with Duchenne muscular dystrophy (DMD) who could walk unaided and 21 normal boys was analysed by means of a video recording technique linked to a Kistler force plate. An electronic device was used to superimpose the patient's ground reaction vector on the video recording of their walking. This recording was analysed to obtain sequential values for the moments developed around the knee during the walking cycle. The equinus gait of boys with DMD is shown to be a necessary adaptation to keep the forces about proximal joints, particularly the knee, within limits controllable by weakened muscles. These findings explain the observation that elongation of the Achilles tendon to correct contracture at the ankle can have irrevocably damaging effects on gait.
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