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

3 TABLE OF CONTENTS I. INTRODUCTION. II. STAGE 1: AMBULATORY. • Interventions to Optimize Habilitation A. Prevention of Joint Contractures B. Lower Extremities C. Late Surgery D. Early Surgery E. Upper Extremity F. Splinting and Casting G. Extremity Exercise H. Respiratory Muscle Exercises III. STAGE 2: WHEELCHAIR USE. • Prevention of Spinal Deformity and Preparation of Surgery • Patients are Evaluated for use of Physical Medicine Respiratory Muscle Aids. • Evaluation • Interventions in Stage 2: A. Air Stacking B. Mechanical Insufflation-Exsufflation IV. STAGE 3: PROLONGATION OF LIFE WITH QUALITY ANDWITHOUT AIRWAY TUBES. • Continuously Maintain Normal Pulmonary Ventilation • Inspiratory Muscle Aids A. Noninvasive Positive Pressure Ventilatory Support (NVS) B. Intermittent Abdominal Pressure Ventilation (IAPV) C. Complications of NVS D. Glossopharyngeal Breathing (GPB) E. Oximetry Monitoring and Feedback Protocol • Extubation and Decannulation to Definitively Avoid Tracheostomies • Quality of Life V. KEY POINTS. VI. REFERENCES.