Definition
Muscular Dystrophy is a group of genetic disorders characterized by progressive muscle
weakness and degeneration due to absence or defect of muscle proteins (like dystrophin).
Common Types
Duchenne Muscular Dystrophy (DMD) – most common, severe, early childhood
Becker Muscular Dystrophy (BMD) – milder, slower progression
Limb-girdle MD
Facioscapulohumeral MD
Clinical Features
Progressive muscle weakness (proximal > distal)
Difficulty in walking, running, climbing stairs
Gowers’ sign (using hands to stand up)
Calf pseudohypertrophy
Frequent falls
Loss of ambulation (usually in DMD by 10–12 years)
Respiratory and cardiac involvement (later stages)
Goals of Physiotherapy Management
Maintain muscle strength
Prevent contractures and deformities
Preserve functional independence
Delay disease progression
Improve respiratory function
Enhance quality of life
Physiotherapy Management
- Exercise Therapy
a. Strengthening Exercises
Mild to moderate intensity only
Avoid overexertion (can damage muscles)
Focus on submaximal exercises
Example: active-assisted movements, light resistance
b. Stretching Exercises
Prevent contractures (very important)
Target muscles:
Gastrocnemius–soleus
Hamstrings
Hip flexors
Daily passive stretching recommended
- Range of Motion (ROM) Exercises
Maintain joint mobility
Passive and active ROM exercises
Perform regularly (daily routine)
- Proper sitting and standing posture
Use of positioning aids
Prevent scoliosis and deformities
- Gait Training
Encourage walking as long as possible
Use assistive devices when needed:
Walkers
Crutches
- Orthotic Management
Ankle-Foot Orthosis (AFO) to prevent equinus deformity
Night splints to maintain muscle length
Wheelchair in later stages
- Respiratory Physiotherapy
Deep breathing exercises
Chest expansion exercises
Incentive spirometry
Assisted coughing techniques
Prevent respiratory infections
- Functional Training
Activities of daily living (ADLs)
Energy conservation techniques
Task modification
- Hydrotherapy
Water exercises reduce stress on muscles
Improve mobility and relaxation
- Prevention of Complications
Contractures
Pressure sores
Respiratory infections
Scoliosis
- Patient & Family Education
Avoid fatigue and overexertion
Importance of regular therapy
Home exercise program
Psychological support
Medical Management (Brief)
Corticosteroids (e.g., deflazacort)
Cardiac monitoring
Respiratory support (ventilation in later stages)
Neuroplasticity & Task-Oriented Training
Focus on functional, goal-directed activities (e.g., sit-to-stand, stair climbing).
Uses motor learning principles to optimize remaining muscle strength.
Encourages repetitive, meaningful movement to maintain independence.
Advanced Physiotherapy Interventions in Muscular Dystrophy
Neuromuscular Electrical Stimulation (NMES)
Applies electrical impulses to stimulate weak muscles.
Helps:
Prevent muscle atrophy
Improve muscle activation
Maintain circulation
Used carefully to avoid fatigue in dystrophic muscles.
Robotics & Assistive Technology
Robotic devices and exoskeletons assist movement:
Gait trainers
Robotic-assisted walking devices
Examples include powered orthoses and mobility aids from companies like Ekso Bionics
Improves mobility and reduces caregiver burden.
Aquatic Therapy (Hydrotherapy)
Water reduces joint load and supports weak muscles.
Benefits:
Improves endurance
Enhances flexibility
Reduces fatigue
Ideal for patients with reduced weight-bearing capacity.
Stages & PT Focus
Early Stage
Maintain strength and mobility
Encourage play and activity
Middle Stage
Prevent contractures
Introduce orthoses
Assisted mobility
Late Stage
Wheelchair mobility
Respiratory care
Positioning and comfort
Precautions
Avoid heavy resistance exercises
Avoid fatigue and muscle damage
Monitor for pain and weakness after exercise
