Assessment

PT diagnosis: Duchenne Muscular Dystrophy further defined by diff. in bed mobility, transfers and ambu-
lation.

PT impression: MD Dx Duchenne Muscular Dustrophy c pt. informants stated that the child was no
longer rise from chair/toilet seat, stand up and walk, Difficulty in overhead activities, Crawling is the pri-
mary mobility to move inside the house and edema on LE, LOM on UE and contracture on LE, mm
weakness of all major mm Of UE, LE and diaphragm, minimal difficulty in breathing and difficulty in
ADLs involving Modified independence on eating, grooming and dressing UE, complete dependence on
transfer from bed to W/C, min. Diff in bed mobility from supine to sidelying to sitting c dangling, modi-
fied dependence on dressing LE and complete dependence on sit to stand 2* mm dystrophy.

Rehab potential :
• Pt. has poor prognosis d/t the ff reasons :
• pt’s condition is a progressive disease
• the condition itself is irreversible
• pt is financially unstable

Problem list:
• LOM on UE in all planes and contracture on LE
• Mm weakness of the major mm of UE, LE and diaphragm
• Decrease chest expansion : Upper chest breather
• Difficulty in ADLs involving Modified independence on eating, grooming and dressing
UE, complete dependence on transfer from bed to W/C, min. Diff in bed mobility from supine to side-
lying to sitting c dangling, modified dependence on dressing LE and complete dependence on sit to stand
• Postural deviations

LTG: pt. will be able to regain ROM and mm function of all planes on UE and LE and. Also perform
ADLs c less limitation and difficulty p 16wks

STG:
• pt will demonstrate inc. in ROM towards all plane on UE and LE p 6wks
• Pt will demonstrate inc mm strength of: sh flexors, extensors, abductors, adductors from
3/5 to 4/5. ELBOW flexors, extensors, wrist flexion, extension from 3/5 to 5/5. HIP flexors, adductors,
abductors, extensors from 1/5 to 3/5. KNEE flexors, extensors from 1/5 to 3/5. ANKLE dorsiflexion and
extension from 1/5 to 3/5 and the diaphragm mm from 4/5 to 5/5.
• Pt will demonstrate improvement in performance of ADLs on:
a) eating from FIM score 6/7 to 7/7 p 6 wks
b) grooming from FIM score 6/7 to 7/7 p 6wks
c) bathing from FIM score 6/7 to 7/7 p 6wks
d) dressing UE from FIM score 6/7 to 7/7 p 6wks
e) dressing LE from FIM 4/7to 6/7 p 6wks
f) toileting from FIM
g) transfers from bed to W/C from FIM 1/7 to 4/7 p
h) bed mobility from supine to (bilat) sidelying to sitting c dangling from performance time of
45 seconds to less performance time p 6wks
i) sit to stand from maximum difficulty to moderate difficulty p 6wks
PLAN :

PRECAUTION :
Exercises should be :
• non fatiguing
• low in repititions
• submaximal
• avoiding eccentric exercises

1. HMP on (B) UE and LE x 20 mins to increase tissue extensibility

2. Low frequency ES on large affected mm x 20 ‘ the ff parameters : (35pps; 200us; 1:5 on:off time ra-
tio c 6 secs on time , 40 secs off time ; ramp time of 2 secs) to increase mm strength
3. PROMEs and AAROMEs on (B) UE and LE towards all planes x 5 reps x 2 sets to maintain joint
integrity
4. Isometric exercises for affected mm groups on (B) UE and LE x 6 SH x 6 reps x 1 sets to increase
muscular strength
5. Manual stretching on (B) UE and LE x 15 sh x 3 sets to increase soft tissue extensibility
6. Proper body mechanics
7. Postural exercise
8. Deep breathing exercise

HEP :

• Educate the pt’s family

• Deep breathing exercises
• Observe proper posture during sitting to avoid further complications

Recommendation :
1. application of LE splint c ankle in neutral position during sleep to prevent progression of contractures