Impact of Duchenne Muscular Dystrophy
Duchenne Muscular Dystrophy Stages
1. Early Stage (Diagnosis to Age 6)
Duchenne is typically diagnosed between the ages of two and six. The first noticeable symptom is delay of motor milestones, including sitting and standing independently. Speech delays are also very common in boys with DMD ("Learning about DMD," 2014).
A child diagnosed with DMD in early childhood will...
-Typically move slower or with more difficulty than other boys his age
-Appear clumsy and fall frequently, and have difficulty climbing, jumping, or running
-Become tired more easily, or will have low energy because of muscle weakness
-Tend to ask to be carried frequently, or need the use of a stroller for longer distances
-Have some muscles that appear enlarged or overdeveloped (most common: calves muscles)
-Have decreased flexibility and loss of elasticity in the joints, which leads to contractors
("Stages of Duchenne," 2014)
2. Transitional Stage (Ages 6 to 10)
During this time, a boy with Duchenne will have more and more difficulty walking as muscles in the thighs grow weaker. This causes the child to be off-balance as he shifts weight while walking. Walking on the toes or balls of the feet to help achieve balance is very common. (Solomon & O'Brien, 2011)
A child with DMD experiences major weakness in the trunk. In order to compensate for weak trunks, a child with DMD may stick out his belly and push his shoulders back while walking. When asked to stand up, the child will usually carry out the Gowers' or Gower Maneuver or when a child puts his bottom up in the air first and uses his arms for support by "walking" the arms up to the legs with hands until standing is reached. *See picture below
Muscle weakness around the spine can also cause scoliosis or a curvature of the spine in boys diagnosed with DMD.
("Stages of Duchenne," 2014)
("Facts About Duchenne," 2014)
Cardiovascular (heart) problems typically occur during this stage of DMD. This is because the heart is also a muscle in the body that is affected by the disorder. Leg muscle fatigue commonly impacts boys with DMD during this stage. Some boys may use a walker to assist them in getting around places. Typically around age 10, a motorized wheelchair or scooter is necessary to further assist the boy in transporting himself. ("Stages of Duchenne," 2014) *Refer to chart below
3. Loss of Ambulation Stage (Ages 10 to 14)
4. Adult Stage (Ages 15+)
1. Early Stage (Diagnosis to Age 6)
Duchenne is typically diagnosed between the ages of two and six. The first noticeable symptom is delay of motor milestones, including sitting and standing independently. Speech delays are also very common in boys with DMD ("Learning about DMD," 2014).
A child diagnosed with DMD in early childhood will...
-Typically move slower or with more difficulty than other boys his age
-Appear clumsy and fall frequently, and have difficulty climbing, jumping, or running
-Become tired more easily, or will have low energy because of muscle weakness
-Tend to ask to be carried frequently, or need the use of a stroller for longer distances
-Have some muscles that appear enlarged or overdeveloped (most common: calves muscles)
-Have decreased flexibility and loss of elasticity in the joints, which leads to contractors
("Stages of Duchenne," 2014)
2. Transitional Stage (Ages 6 to 10)
During this time, a boy with Duchenne will have more and more difficulty walking as muscles in the thighs grow weaker. This causes the child to be off-balance as he shifts weight while walking. Walking on the toes or balls of the feet to help achieve balance is very common. (Solomon & O'Brien, 2011)
A child with DMD experiences major weakness in the trunk. In order to compensate for weak trunks, a child with DMD may stick out his belly and push his shoulders back while walking. When asked to stand up, the child will usually carry out the Gowers' or Gower Maneuver or when a child puts his bottom up in the air first and uses his arms for support by "walking" the arms up to the legs with hands until standing is reached. *See picture below
Muscle weakness around the spine can also cause scoliosis or a curvature of the spine in boys diagnosed with DMD.
("Stages of Duchenne," 2014)
("Facts About Duchenne," 2014)
Cardiovascular (heart) problems typically occur during this stage of DMD. This is because the heart is also a muscle in the body that is affected by the disorder. Leg muscle fatigue commonly impacts boys with DMD during this stage. Some boys may use a walker to assist them in getting around places. Typically around age 10, a motorized wheelchair or scooter is necessary to further assist the boy in transporting himself. ("Stages of Duchenne," 2014) *Refer to chart below
3. Loss of Ambulation Stage (Ages 10 to 14)
4. Adult Stage (Ages 15+)
Areas of Occupation Impacted by DMD
Occupations are defined as various kinds of life activities in which individuals engage (AOTA, 2014).
A child with DMD will require assistance in all areas of occupation, particularly with ADLs.
Some ADL categories that are affected include:
-Bathing/Showering due to a decreased muscle strength, lack of muscle endurance, poor balance, and lack of range of motion
-Dressing due to decreased gross and fine muscle strength, lack of range of motion, and poor trunk control
-Feeding self due to lack of motor control, postural control, and difficulty raising hand against gravity
-Toileting due to decreased mobility, lack of strength, and lack of range of motion in upper extremities
-Functional mobility because a child with DMD will not be able to ambulate properly from place to place or transferring from chair to bed, in and out of bathtub
(AOTA, 2014)
*The use of adaptive devices and remedial activities can help promote a child's independence and ability to carry out ADLs.
A child with DMD will also experience difficulties in other occupations of their life including:
-IADLs because it is difficult to experience the symptoms of DMD and caring for others proves to be challenging
-Community Participation because the child with DMD may require a wheelchair and not all places are wheelchair accessible
-Education due to a decrease in ambulation, poor speech and language skills. These deficits can cause learning to be challenging for the child.
-Play is a child's main occupation and when a child had DMD it is difficult to carry out this role. This is because there is a lack of ambulation, upper extremity strength, lack of endurance, and postural stability. Compensatory devices and remedial activities must be introduced at a young age to try to assist the child in play.
-Social participation also lacks because of all the deficits that are present in a child with DMD. Creative activities need to be utilized by the parent/caregiver or occupational therapist to promote interaction between the child and his peers.
(AOTA, 2014)
Occupations are defined as various kinds of life activities in which individuals engage (AOTA, 2014).
A child with DMD will require assistance in all areas of occupation, particularly with ADLs.
Some ADL categories that are affected include:
-Bathing/Showering due to a decreased muscle strength, lack of muscle endurance, poor balance, and lack of range of motion
-Dressing due to decreased gross and fine muscle strength, lack of range of motion, and poor trunk control
-Feeding self due to lack of motor control, postural control, and difficulty raising hand against gravity
-Toileting due to decreased mobility, lack of strength, and lack of range of motion in upper extremities
-Functional mobility because a child with DMD will not be able to ambulate properly from place to place or transferring from chair to bed, in and out of bathtub
(AOTA, 2014)
*The use of adaptive devices and remedial activities can help promote a child's independence and ability to carry out ADLs.
A child with DMD will also experience difficulties in other occupations of their life including:
-IADLs because it is difficult to experience the symptoms of DMD and caring for others proves to be challenging
-Community Participation because the child with DMD may require a wheelchair and not all places are wheelchair accessible
-Education due to a decrease in ambulation, poor speech and language skills. These deficits can cause learning to be challenging for the child.
-Play is a child's main occupation and when a child had DMD it is difficult to carry out this role. This is because there is a lack of ambulation, upper extremity strength, lack of endurance, and postural stability. Compensatory devices and remedial activities must be introduced at a young age to try to assist the child in play.
-Social participation also lacks because of all the deficits that are present in a child with DMD. Creative activities need to be utilized by the parent/caregiver or occupational therapist to promote interaction between the child and his peers.
(AOTA, 2014)
Client Factors Impacted by DMD
Factors that reside within the client that influence the client's performance in occupations (AOTA, 2014).
The child's factors which are greatly affected by DMD include:
-Values due to the outlook of a child with DMD. This child will place unique importance on everyday tasks that a "typical" child performs. Even the simplest things as getting dressed or taking a walk by himself will be meaningful and important to the child.
Body functions:
Sensory functions:
A child diagnosed with DMD will experience challenges with:
-Vestibular Function- problems with balance
-Proprioceptive Function- determining where his body is in space
-Pain- certain joints and muscle contractors can cause pain (AOTA, 2014)
Neuromusculoskeletal and Movement-Related Functions:
A child diagnosed with DMD will experience challenges with:
-Joint Mobility and Stability- the range of motion in limbs will be limited; muscles around joints do not provide stability
-Muscle Power/Muscle Tone/Muscle Endurance- there will be a decrease in all of these aspects due to the DMD; a child will fatigue fast and easily even when just completing simple tasks (AOTA, 2014)
Movement Functions:
Unfortunately, a child diagnosed with DMD will experience delays and impairments in all of the following categories:
-Involuntary Movement Reactions- postural reactions, body adjustment reactions
-Control of Voluntary Movement- eye-hand, bilateral integration, gross motor control
-Gait Patterns- walking patterns
(AOTA, 2014)
Cardiovascular and Respiratory Functions:
-Cardiovascular Funcation- Because all muscles in DMD are affected the heart is also affected; children must be monitored and pulse rate taken frequently
-Respiratory Functions - a child with DMD will experience problems with breathing and eventually may rely on respirator. (AOTA, 2014)
Voice and Speech Functions:
-Voice and Speech- there are deficits and delays that are noticeable in the beginning stages of DMD (AOTA, 2014)
Factors that reside within the client that influence the client's performance in occupations (AOTA, 2014).
The child's factors which are greatly affected by DMD include:
-Values due to the outlook of a child with DMD. This child will place unique importance on everyday tasks that a "typical" child performs. Even the simplest things as getting dressed or taking a walk by himself will be meaningful and important to the child.
Body functions:
Sensory functions:
A child diagnosed with DMD will experience challenges with:
-Vestibular Function- problems with balance
-Proprioceptive Function- determining where his body is in space
-Pain- certain joints and muscle contractors can cause pain (AOTA, 2014)
Neuromusculoskeletal and Movement-Related Functions:
A child diagnosed with DMD will experience challenges with:
-Joint Mobility and Stability- the range of motion in limbs will be limited; muscles around joints do not provide stability
-Muscle Power/Muscle Tone/Muscle Endurance- there will be a decrease in all of these aspects due to the DMD; a child will fatigue fast and easily even when just completing simple tasks (AOTA, 2014)
Movement Functions:
Unfortunately, a child diagnosed with DMD will experience delays and impairments in all of the following categories:
-Involuntary Movement Reactions- postural reactions, body adjustment reactions
-Control of Voluntary Movement- eye-hand, bilateral integration, gross motor control
-Gait Patterns- walking patterns
(AOTA, 2014)
Cardiovascular and Respiratory Functions:
-Cardiovascular Funcation- Because all muscles in DMD are affected the heart is also affected; children must be monitored and pulse rate taken frequently
-Respiratory Functions - a child with DMD will experience problems with breathing and eventually may rely on respirator. (AOTA, 2014)
Voice and Speech Functions:
-Voice and Speech- there are deficits and delays that are noticeable in the beginning stages of DMD (AOTA, 2014)
Performance Skills Impacted by DMD
Skills that are observable elements of action that have an implicit functional purpose (AOTA, 2014). It is important to understand that performance skills deteriorate as muscles continue to weaken. Motor skills that are impacted by DMD: -Aligns -Stabilizes -Positions -Reaches -Bends -Grips -Manipulates -Coordinates -Moves -Lifts -Walks -Transports -Endures (AOTA, 2014) Performance Patterns Impacted by DMD: Aspects that are used in the process of engaging in occupations or activities (AOTA, 2014). Person: Habits, Routines, Roles- Daily routines are affected due to the need for hands on assistance for most ADLs. Additionally, more time should be allowed for simple tasks to be completed. Children's roles of student, son, playmate are all impacted because of DMD. These individuals cannot efficiently carry out the tasks that make up the role without experiencing issues. (AOTA, 2014) |
Process skills that are affected by DMD:
-Attends -Chooses -Uses -Handles -Sequences -Organizes -Navigates -Adjusts -Accommodates (A0TA, 2014) Social interaction skills that have difficulty developing in children with DMD: -Approaches/Starts -Speaks fluently -Turns toward (AOTA, 2014) |
Take a look at this video to watch the progression of Duchenne Muscular Dystrophy