Part 2: Exercise Treatment for Duchenne MD

Transcription

1 Part 2: Exercise Treatment for Duchenne MD

2 Duchenne MD A progressive loss of muscle function Females are carriers of the disease and only males are affected X-linked Affects 1 in 3600 boys Symptoms appear before age 6 and sometimes even in infancy - usually lose the ability to walk by age Worsens quickly Average life expectancy = age 25-30

3 Barriers and Precautions Cardiomyopathy (deterioration of the myocardium or the heart muscle ) Difficulty walking Muscle Weakness Breathing difficulties (later stages) Dehydration Lordosis (weakened hip extensors) Scoliosis Difficulty swallowing Overweight or Underweight Gastrointestinal Problems Psychological problems (unmotivated, depression etc ) Muscle fibers are abnormally vulnerable to contraction-induced injuries Always avoid EECENTRIC contractions when exercising with resistance

4 Objectives of Exercise Keep the client strong, flexible and as symmetric as possible Improve ability to perform daily activities Increase muscular strength and endurance Improve/maintain ROM Improve cardiovascular function Better breathing Decrease risk of future injury Delay the loss of physical abilities as a result of DMD Increase energy / Decrease fatigue Decrease psychological problems

5 General Guidelines for Exercise Resistance Mixed reviews Moderate to low resistance (light weights, no weights or resistance bands) 3 sets, reps each exercise 48 hours in between resistance sessions using the same muscle groups 3x per week Flexibility Primary focus of exercise program Performed at least once daily held for seconds, 3 sets No ballistic stretching Cardiovascular Swimming is best (but also cycling, walking, rowing if able) At least 20 minutes, 4-6x per week Low-moderate intensity

6 Early Development Stages of DMD Approx. ages 3-7 Regular stretching (Active Self) Prevents/slows the progression of contractures tightening of the tendon and muscle Concentrate on tendo-achilles, hamstrings and IT band Swimming, hydrotherapy Wear splints at night to slow down contractures in ankles Games/Fitness for young boys increase cardiovascular fitness These boys are usually still mobile but have decreased strength Example: capture the flag

7 Later Development Stages of DMD Approx. ages 7-10 Beginning to have difficulty walking and keeping up with other boys their age Regular passive stretches Tendo-Achilles, hamstrings, hip flexor and IT band Prone lying Splints at night Games/activities with deep breathing Blowing bubbles or playing a wind instrument Muscular Dystrophy vs. Normal

8 Wheelchair Stage of DMD Approx. ages 10+ Cannot walk Some may even have difficulty bringing their hand to their mouth Regular passive stretches Maintain ROM and flexibility as much as possible Pulley exercises and Hand erg/bicycle Use of ankle splints when sitting in wheelchair Chest clearance and assisted cough Standing frame Swimming/Hydrotherapy Standing Frame

9 Examples of Active/Self Stretches Self-stretch for the calf Knee flexed = soleus Leg fully extended = gastrocs Gastrocs/soleus, Achilles are one of the first to being to tighten in DMD Self-stretch for the hamstrings Back/Hips against the wall Spine as straight as possible Sitting in this position will stretch the hams but leaning forward can increase the stretch

10 Examples of Active/Self Stretches Self-stretch Lie on back in a doorway Place leg on doorframe Bottom leg is straight on the floor Knee is slightly bent and the bottom is close to the wall Increase the stretch by straightening the knee

11 Examples of Passive Stretches Passive stretch for the hip Lie on back and the leg not being stretched is bent up towards the chest and held in that position by the caregiver Stretch: Place your hand just above the knee of the leg to be stretched and exert a downward pressure.

12 Examples of Passive Stretches Stretch for elbow, wrist, and fingers Use one hand to support the child s elbow Place the palm of your hand on the child s palm Stretch move wrist backwards keeping fingers straight

13 Examples of Passive Stretches Stretch for the IT band Child lays on their side Leg to be stretched = uppermost Knee straight Lower leg is bent Use hand to stabilize the pelvis Gently move the uppermost leg as far back as possible Apply downward pressure at the knee

14 Posture / Sitting Techniques Feet should be at a90º angle to the legs when the child is sitting Seat of the chair should be firm and not too wide Back of the chair needs to be firm and either upright or slight slanting backwards (10º ) Seat should be as deep as the thigh is long to use back of chair so they don t slump Armrests right height and not too far apart So elbows can be supported without causing hunched shoulders or leaning

15 Prone Lying posture Good for resting, or for when reading or watching TV Prevents contractures developing in the hips and knees Place a pillow below hips encourages hip extension Keep feet free (hanging off of bed)

16 Examples of Resistance Exercises* Early & Later Stages of DMD With light weights, resistance bands or no weights at all Examples: Shoulder press Seated row Leg extensions Hamstring curls Calf raises Hip adduction/abduction Wrist flexion and extension Wheelchair stage Pulley system Just the movements with very little or no weights

17 Examples of Cardiovascular Exercise Early & Later Stages of DMD Games for young boys Swimming with a noodle/life jacket Walking If they are able Wheelchair Stage Hand erg/bicycle Swimming/Hydrotherapy

18 Nutritional Considerations Supplements for calcium and vitamin D. Foods that are high in Omega-3 fatty acids, (fish, or fish oil) Foods rich in antioxidants such as berries, tomatoes, spinach and bell pepper. Lean meats instead of red meat. (fish, chicken; which contain less fat and cholesterol) Limit intake of chips, cookies etc 6-8 cups per day of fluid per day (of which about 3-4 cups should be water) Avoid stimulants such as caffeine (coffee, tea, cola beverages)

19 Exam Questions 1. What should be the primary focus of any exercise program for a child with DMD? 2. What type of muscle contraction should boys with DMD avoid with resistance training? 3. What is the most common symptom of muscular dystrophy? 4. Why can resistance training sometimes be detrimental to MD patients?