Physiotherapy enables people to improve and remain at their maximum functional potential within the constraints of their medical condition. A Physiotherapist (PT) is an important partner on the child’s healthcare team and works with the child and their family, caregivers and school to advise them on appropriate treatment and exercise plan for the child to move forward.

Physiotherapy ideally begins as soon as a diagnosis is made for Muscular Dystrophy and before joint or muscle tightness has developed.  The Physiotherapist will perform an assessment of the child’s developmental history, overall health and specific tests to determine motor development, sensory, cognitive, balance assessments, as well as for posture and gait. It is important to check that the following areas have been covered in the child’s physiotherapy plan:

1. Manage muscle extensibility and Joint contractures: There are many factors that contribute to the contracture of joints, which is why stretching exercises will be required to open up these joints and retain the normal muscle length on a daily basis. By maintaining good range of motion and symmetry at different joints helps maintain best possible function and prevents the development of deformities.
2. Improve Strength: Parents are encouraged to seek physiotherapy early in order to identify the best strengthening exercises for the child.  High resistance strength training is not recommended as this can cause excessive overload and can cause injury to the child’s muscle fibers due to overexertion.
3. Maintain a good fitness level: The physiotherapist will determine specific and tailor made exercises, diet and social community involvement to promote overall good health. Hydrotherapy or aquatic exercises are a distinctive part of physiotherapy rehabilitation for Muscular Dystrophy.
4. Postural Management and seating: The physiotherapy treatment for the child should include education on proper posture and positioning to ensure good spinal alignment. The child may naturally adopt unusual postures to compensate for muscle weakness, low mobility and contractures.  It is vital to correct these postures which could otherwise lead to further complications.
5. Balance and gait training: A physiotherapist will supervise balance and gait training for ambulatory children in order to function better independently.  The rehabilitation plan will also include development of motor skills such as sitting, crawling, running and jumping that are appropriate of the child’s level and needs. As a child becomes wheelchair bound, the focus of training will be to perform activities of daily living.
6. Respiratory Care: Chest and cardiac congestion is seen in patients with Muscular Dystrophy as the muscles of the heart and respiratory system weaken.  The physiotherapist will work with a respiratory therapist to design a program to maintain good respiratory strength.  Treatment plan can include passive chest manipulation techniques to maintain clear airway and manual assisted coughing in order to spit out chest secretions.  Deep breathing exercises will also be included to condition the cardiorespiratory performance and endurance.
7. Wheelchairs and Standing Frames: Due to the large differences of symptoms and functional deficits, no single wheelchair would adequately serve the needs of all children with Muscular Dystrophy. Along with a seating and positioning specialist, the physiotherapist will help choose the right wheelchair for the child.  Choosing the right wheelchair should be done with great care and fitted appropriately for frame and seat size, cushions, head rest, lumbar support, tilt facility and position of power controls.  Without proper postural support and seating, deformation may occur. Standing upright with the use of standing frames is recommended in order to promote better circulation, healthier bones and prevent scoliosis.
8. Brace/ Orthosis:   Ankle weakness can lead to foot drop where children with MD find it difficult to lift the toes causing to drag the foot on the ground.  Ankle-Foot Orthosis (AFO) and Knee-Ankle Foot orthosis (KAFO) are prescribed for the child to be worn while sleeping to keep the foot from pointing downwards and to hold it in a normal position.  The physiotherapist will check for the right fit and comfort.
9. Adaptive Equipment: A physiotherapist can recommend devices to make the life of a child much easier and teach them how to be independent from a young age.  Some examples of such assistive devices are shower chairs, mechanical patient hoists, electrical beds, adapted utensils and kitchenware.

The physiotherapist counsels the family about various aspects of the child’s condition including how the child is progressing or expected to progress.  This forms a vital part of the treatment plan.  Physiotherapy can be provided at a clinic, community center, school or even at the child’s home.

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Sources:

PT Haven

Iamd

Muscular Dystrophy UK

Myotonic org

Parent Project MD