Physical Medicine Interventions for Duchenne Muscular Dystrophy, the Including Avoiding Invasive Airway Tubes

9 lengthening of the heel cords and hamstrings muscles at the knees, wide resection of the iliotibial bands and fascia lata at the thighs, and often resection of the tensor fascia lata at the hip to better balance strength and increase ROM at the hips. Early surgical intervention is also safer and better tolerated with less post-op physical therapy needed. It is performed when patients have difficulty in rising from a seated position on the floor when contractures begin and can decrease a vicious cycle of weakness, muscle tightness, contracture, and abstinence from walking that leads to deconditioning and further weakness and falls. With early intervention, free walking is permitted by the second post-op day in ankle casts, and only brief outpatient or home physiotherapy is required. Continued ambulation is free of bracing. 4-6 E. Upper Extremity Arm and hand contractures begin to develop early with finger deformities beginning by age 8. Ultimately, when shoulder and elbow contractures become greater than 25°, most people perceive them as hampering function, detracting from appearance, and being associated with pain and discomfort. 7 However, there has been little interest in studying the effects of ROM, stretching, positioning, bracing, and surgery on arm and hand contractures. At this time, it may be most appropriate to recommend arm and hand ROM and stretching several times a day to slow contracture development. Effective surgical and other treatment strategies may be possible for upper limb contractures like they are for the lower limbs. F. Splinting and Casting Splinting can be used to maximize joint function and hamper contracture development. Resting hand splints can also be used at night to impede finger and wrist contractures and during the daytime for patients without functional hand movements. Resting splints provide a sustained stretch to the joint while holding it in a neutral position. They are also used after surgical releases of contractures. Dynamic finger extension assist “banjo” splints can also increase hand function for finger flexor dominating hands. 1) Tensor fasciae latae tendon, 2) resection of iliotibial band and fasciae latae, 3) hamstrings lengthening, 4) heel cord len- gthening, 5) bil – tightness of the iliotibial bands causing abduction of the thighs and a wide-based gait.