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Brachial Plexus Birth Palsy, Thoracic Outlet Syndrome, Arthrogryposis Multiplex Congenital Muscular Dystrophy

Terms in this set (98)

BRACHIAL PLEXUS NERVE COMPLEX
• Network of peripheral nerves that provides movement & sensation to shoulder, arm, & hand
• Nerves that support the arm exit spinal cord high in neck
• Nerves that support the hand exit spinal cord
lower in neck
BRACHIAL PLEXUS NERVE COMPLEX formed from
● Ventral rami of 4 cervical nerves (C5-C8) &
1st thoracic nerve (T1)
Rami combine to form 3 trunks
• C5-C6 form upper/superior trunk
• C7 middle trunk
• C8-T1 lower/inferior trunk
● Each trunk splits into a division
- Half of divisions supply flexor muscles to lift & bend arm
- Other half supply extensor muscle that straighten & bring arm down
• C5, 6, 7, 8, T1 Nerves and go above
• T1 goes above and so on with the rest
of the nerves
BRACHIAL PLEXUS INJURIES (risk factors)
• Shoulder dystocia
• Difficult delivery, needing external assistance
• Other possible risk factors:
● Maternal diabetes
● Maternal obesity
● Advanced maternal age
● Large gestational size
● Prolonged labor
● Breech presentation at birth
● Siblings with obstetric palsy
• *Please note literature results are mixed on what are risk factors. Ex: birth weight as well as breech position may not necessarily be factors.
Shoulder dystocia
shoulder dystocia
(which is the separate during birth)
TYPES OF INJURIES
Nerves being injured when BP
Avulsion
Rupture
Neuroma
Neurapraxia
Avulsion
● Nerve is torn from its attachment to spinal cord
Rupture
● Nerve is torn, but not where it attaches to spinal cord
Rup: more distal
Neuroma
● Nerve has tried to heal itself by forming a neuroma, but scar tissue limits nerve function
• Hard tissues form
Neurapraxia
● Nerve has been stretched & damaged but not torn
DIAGNOSIS
PROM is okay but not active
• Symptoms of BP injury are usually noticed soon after injury
• More precise diagnosis can be made 48 hours following birth
• Evaluation should occur as soon as possible (by 3 months) early
● Medical hx & physical exam
● X-rays
● MRI
● Myelogram
● Electromyogram (EMG)
ETIOLOGY
• Most BP injuries are unilateral and occur at birth
• Occurs in up to 3 in 1,000 births
● Only about 10% of those babies need tx, most heal on own
• not always reported so numbers vary
• -many heal on on
Two ways to get a BP injuries
Obstetrical BP injury
Traumatic BP injury
Obstetrical BP injury plexus
Occurs if baby's shoulders become impacted,
causing the nerves to stretch or tear
Traumatic BP injury
Caused by damage to nerve roots
• Life not birth is traumatic: car accident (self belt), gun shot wounds, twirling kids, sports accident, surgeries
TYPES OF BRACHIAL PLEXUS INJURIES
• Erb's Palsy
• Klumpke's Palsy
• Total Plexus Palsy
ERB'S PALSY
• Lesions to upper trunk of brachial plexus
• Most common typee* of brachial plexus injury
• C5, C6 and sometimes C7
• Typically muscles of the shoulder and elbow are affected
• Hand movement is retained
• Functional movement of UE is extremely limited
ERB'S PALSY Presentation
● Arm hangs limp in internal rotation and adduction
● Elbow is extended, forearm pronated, wrist flexed- resulting in "waiter's tip position"
● Weak biceps & triceps
KLUMPKE'S PALSY
• Results from compression or traction to lower trunk of brachial plexus (C8 and T1)
● caused by strong upward pull on UE when in an abducted position
• Less common/rare injury
• Involved nerves innervate muscles that are involved in wrist and finger flexion & finger abduction and adduction
KLUMPKE'S PALSY Presentation:
● paralysis to distal musculature of wrist flexors and intrinsic muscles of hand
● results in "claw-hand deformity" aka intrinsic minus hand deformity
TOTAL PLEXUS PALSY OR GLOBAL PALSY
• Most devastating injury to brachial plexus
• Arm is completely flail
• Hand rests in "claw" position, tone is within normal limits
• Arm is anesthetic
● No reaction to pinching
PROGNOSIS for BP
All depends on what nerve is effected
C5/C6 have high rate of recovery
C8, T1 is less rate of resolving
Prognosis depends on severity of lesion
PROGNOSIS for BP: Indicator of probable recovery:
● Ability to bend elbow (bicep function) by 3rd month
● The longer bicep muscle recovery takes & the more extensive the level of injury, the poorer the prognosis for final shoulder function
PROGNOSIS for BP: Strong indicator of spontaneous improvement:
● Active movement of wrist, thumb & finger extension (in addition to bicep function)
PROGNOSIS for BP: Avulsions & ruptures
● no potential for full recovery unless surgery is donee* in timely manner
PROGNOSIS for BP: Neuroma & neuropraxia injuries
● potential for improvement varies
● most neuropraxia injuries have fair prognosis of recovering spontaneously with 90-100% return of function
EVALUATION - ACTIVE MOVEMENT SCALE (AMS)
This is evaluation but observed
● Used to assess motor function in infants with obstetrical brachial plexus palsy
● 8 grade scale to measure changes in arm movement for infants & young children
● Does not require children to perform tasks on command
● Evaluation performed with UE exposed, child on flat/firm surface with room to move, & variety of toys should be available to stimulate movement
● Gravity eliminate positions are observed first
EVALUATION - MALLET
● Assesses AROM in upper plexus movement
● Best with children over 3-4 years old
● Grades I (no function) through V (normal)
-older kids
rating 1-5
TREATMENT for BP
• Depends on type & severity of injury
• Infants with milder injuries often fully recover
● PT/OT & exercise are prescribed to ensure full recovery
• Infants with mild injuries who do not heal by 3-4 months or those with more severe injuries (avulsions or ruptures) need surgeryy* to improve or correct nerve function
● Ideally should occur between 3-6months
● PT/OT prescribed post surgery
-If not improve 3-4 than surgery and need to do it early as possible for more success rate
SURGERY for BP
• Microsurgery to improve nerve growth & UE function may be recommended if improvement is not seen within a few months
● Neurolysis
● Neuroma Excision
● Nerve graft
● Nerve transfer
● Neurotization
These all just help nerve function
SECONDARY SURGERY for BP
• Other conditions may develop in neighboring joints of arm if recovery is not full
● May result in muscle imbalance or contractures
● Secondary procedures can be done to address the issues when child is older (2-10 years of age)
• Free muscle transfer
• Capsule release
• Tendon transfer
• Muscle transfer
• Corrections of arm (osteotomy)
• Joint fusion
• Shoulder & elbow reconstruction
• Botox- for muscle spasticity or contractures
INTERVENTION for BP
OT INVENTION ASAP EARLY!
• OT intervention initially involves partial immobilization & positioning
• Passive ROM is critical for maintaining joint flexibility: stabilize the scapula
• Strengthening
• Retrograde massage for edema in hand or arm
• Variety of tactile & proprioceptive sensory input to increase sensory awareness
• Aquatic therapy
• Electrical stimulation as prescribed by physician
• Kinesio taping
• Slings
• Splints
• CIMT
Eating, crawling, muscle tone effecting strength: dressing, education, play
Only immobilization if fractures are
present
Messages are uses for Edna
-we want activity that elimate gravity
KEY POINTS FOR INTERVENTION for BP
-Preventing contractures is critical to functional outcome
• Provide occupations that are appropriate to developmental ages & stages, meaningful to client, and encourage bilateral activities
Maintaining ROM
Encourage Muscle Strengthening
Prevent compensatory movement patterns
Prevent fractures
We need to give the kids appropriate occupational
Normal childhood developments
Don't want them to hang on monkey bars
Crawling
Never pull child by arms
Don't be bp on effeected side
No needles on effected side, maybe do on leg to keep unaffected side good
THORACIC OUTLET
• Group of disorders that occur when blood vessels or nerves in the thoracic outlet become compressed
● Leads to pain in shoulders & neck & arms and numbness in fingers
● Can be very debilitating
Thoracic Outlet is the area located between the clavicle and first rib.
It is a narrow area containing important blood vessels, nerves, and muscles.
BP
Subclavian nerve and artery
3 entrapment point
Middle and anterior scalene
Over the first rib
Pectoral minor
TOS Common causes:
● Physical trauma
● Repetitive injuries
● Congenital
Clavicle has different shapes
Extra rib
Posture
Tumor
Fibrous Bands
-more common in women's
3 TYPES OF TOS
Neurogenic TOS
Vascular TOS
Nonspecific TOS
Neurogenic TOS
● Compression of the brachial plexus
● Majority of TOS cases are neurogenic
Common: subclavian muscles are compressed
Vascular TOS
● One or more subclavian vesselss* are compressed
● Occurs less frequently
● Can lead to life threatening complications
Can lead to clots
Nonspecific TOS
● Chronic pain in the area of the thoracic outlet,
however specific cause of pain can not be determined
No real reason why just chronic pain
SIGNS & SYMPTOMS for TOS
• Vary depending on what structures in the thoracic outlet are compressed
• May be unilateral or bilateral
• General Symptoms: pain, paresthesia, weakness, & psychological factors
Neurologic TOS SIGNS & SYMPTOMS
• Numbness or tingling along ulnar distribution (sensory)
• Atrophy of ulnar muscles (motor)
• Pain in neck, shoulder, arm, &/or hand
Vascular TOS SIGNS & SYMPTOMS
Compression of vein:
• UE edema
• Blueness (cyanosis)
Compression of artery:
• Paleness
• coolness
• Decreased pulse/BP
SIGNS & SYMPTOMS Non-specific TOS
Dull, aching pain in neck & UE that gets worse with activity
ETIOLOGY for TOS
• General cause of TOS is compression of nerves & blood vessels in the thoracic outlet
• Any condition resulting in enlargement or movement of tissues of or near the thoracic outlet may cause TOS
• Compression may be positional or static
Causes of compression vary:
● Tumors
● Anatomical defects
● Poor posture
● Trauma
● Repetitive activity
● Pressure on joints
● Pregnancy
DIAGNOSIS for TOS
• Diagnosis is difficultt* as symptoms vary greatly
1. Evaluation/physical exam
● Looking at posture, limited ROM, muscle guarding, skin color & temperature, sensory & motor testing, etc
● Review occupation, medical history & symptoms
● Ergonomic evaluation
2. Confirm diagnosis via further testing
● X-ray
● MRI (magnetic resonance imaging scan)
● EMG (electromyography)
● Nerve conduction study
Perform special tests for TOS
• Adson's manuever
• Wright Test
• Roos Stress Test (Compression on structures BP and subclavin)
TREATMENT TOS
● Occupational & Physical Therapy
• Educationn* (posture, overhead activists, sleep position)
Strengthen/stretching
• Posture & positioning
• Activity modification & modification of other contributing factors
• Gentle ROM
• Nerve gliding
• Exercise to strengthen shoulder muscles in order to open thoracic outlet, improve ROM, & improve posture
• Ice/Heat
• Overall therapy goal: take pressure off blood vessels & nerves in the thoracic outlet
• Important to monitor pain throughout therapy!
● Relaxation, Massage Therapy, Acupuncture
● Medications
• Pain meds, muscle relaxants, & anti-inflammatory
INVASIVE TREATMENT for BP
• Cortisone injections
• Botox injections
• Surgery
● Surgery to repair compressed blood vessels
● Resection of first rib to relieve compression
● Surgery to remove an extra rib
● Removal of anterior &/or middle scalene muscles
● Neurolysis (removal of fibrous tissues from brachial plexus)
Complications:
● TOS can cause permanent nerve damage if left untreated
● Surgery is considered risky
• Damage to nerves or blood vessels may occur during surgery
PREVENTION for TOS
• Avoid unnecessary stress on shoulders & muscles surrounding the thoracic outlet
● Maintain good posture
● Take frequent breaks at work
● Practice relaxation techniques
● Avoid repetitive movements
● Avoid lifting heavy objects
● Avoid prolonged positions with arms held out or
overhead
● If overweight, lose weight in order to prevent or relieve symptoms
● Avoid carrying heavy bags over shoulder
● Stretch daily
● Exercise to keep shoulder muscles strong
PROGNOSIS for TOS
• Varies according to type
● Majority of people with TOS improve with exercise & therapy
● Some require surgery (which varies in success rates)
ARTHROGRYPOSIS MULTIPLEX CONGENITA
• "curved or hooked joints"
• Musculoskeletal disorder involving multiple joint contractures present at birth
• Description vs diagnosis
• Often accompanied by fibrous ankylosis
-more description and not officially diagnosed
AMC IS RARE!
fibrous ankylosis
Decrease of mobility of many joints due to excessive fibrous tissues growth
Contracture:
limitation of limited range of motion at a joint and can be various reasons (fixed stuck, and lost ROM)
-These kids have multi ones with arthrogryposis
Two diagnosis of AMC
Classic AMC
Severe AMC
• Frequently contractures are accompanied by muscle weakness
Classic AMC
● hands, wrists, elbows, shoulders, hips, feet,
knees affected
Main joints involved
Severe AMC
● nearly every body joint involved including jaw
and back
Almost whole body, lots of other complications involved
Types of AMC
• Wide spectrum of congenital deformities
(Lot of different areas effect or could just be one)
Basic classification:
● Only limb involvement
● Limb and trunk involvement
● Craniofacial or visceral involvement
● Severe central nervous system dysfunction
• At least 21 recognized forms of AMC
● Syndromes that include AMC as set of symptoms
Distal arthrogryposes
Just distal extremeities involved
Amyoplasia
primary form of AMC
ETIOLOGY ARTHROGRYPOSIS MULTIPLEX CONGENITA
Usually a second diagnosis
• Not entirely understood, many factors contribute
• It can be a component of conditions caused by environmental agents, single gene defects,
chromosomal abnormalities, etc
● Abnormal nerve, muscle, and connective tissue development
● Possible neuropathic cause
● Lack of intrauterine movement
● Genetic factors
● Environmental factors
Lack of intrauterine movement
Lack of movement in the uterus
SYMPTOMS ARTHROGRYPOSIS MULTIPLEX CONGENITA
Typically symmetrical but not always
• Born with multiple joint contractures in limbs
• In most common form, amyoplasia, typical deformities are severe and symmetrical:
● Knee & elbow joints may appear thickened
● Muscles may be absent or incompletely formed
● If anterior horn cells in spinal cord are absent, may experience paralysis
● Skin- absent or diminished creases
● Intelligence normal
● Sensation intact
● UE & LE involved
AMC SYMPTOMS: Contractures
● Distal joints affected more than proximal
● Limitation of movement
● Limited jaw ROM
AMC SYMPTOMS: Deformities/Malformations
Less of muscle mass and see lots of connective tissues
● Craniofacial
● Spine
● Respiratory
● Limb
● Skin
● Cardiac
● Nervous system
● Muscle
● Connective tissue
AMC DIAGNOSIS
• Dx in utero via ultrasound
• Dx after birth when two or more joints in more than one limb are fixed from birth
• Thorough medical history and physical exam
• X-rays
• Additional tests
● blood test
● muscle biopsies
● imaging studies
• CT, MRI
• Differential Diagnosis
ACTIVITIES IMPACTED BY AMC
• Physical activity limited due to orthopedic problems
• FM/GM skills
• Oral and speech development
• Dependence on others
• Social participation
• Walking
• ADLs
ARTHROGRYPOSIS MULTIPLEX CONGENITA TREATMENT (team and goal)
No cure but less reduce contractures and lets get them independent
Tx team:
● pediatrician, neurologist, orthopedic surgeon, geneticist, speech therapist, physical therapist, occupational therapist....
Goal of tx:
● Improve function, not cosmesis
● Lower limb alignment and establishment of stability for ambulation
● Upper limb function for ADLs
• Therapy and bracing attempted first over surgical correction
AMC INTERVENTION
Keep joints moving as much as you can
Serial casting: slowly growing with casting to get motion
• Early AROM & PROM is key
• Focus on maintaining and increasing functional ROM and strength
• Splinting
• Serial casting
• Daily stretching/ PROM
• Adapted equipment
• Training for ADLs, school, play, and work performance
• Family education/Home programs
• Psychological adjustment
support for child and family
• Alternative therapies:
● Aquatic therapy
● Hippotherapy
AMC PRECAUTIONS
• OT/PT and stretching
● may be harmful in some patients depending on dx
• Recurrence of deformities post stretching is common and surgery is often indicated
• Splinting combined with OT/PT preferable to continuous casting
● splints/casts may restrict movement
• Pre/Post- op precautions
● Airway management
● Anesthesia can be difficult secondary to vascular access restriction
● Intubation
AMC SURGICAL INTERVENTION
• Goal:
● Improve limb position and function
• Improvement can be made, however most patients will still have persistent muscular &/or joint limitation due to underlying condition
• Bony procedures/bony fusions
• Tendon transfers
• Muscle releases
AMC PROGNOSIS
• No cure
-Life span is normal but they just look different
• Prognosis varies
● Depends on natural history
● Depends on response to therapies
• Life span usually normal, however:
● Lethal forms of AMC often cause miscarriage, stillbirth, or neonatal
death secondary to malformation so severe, its impossible for child to
live
● Scoliosis may compromise respiratory function
● 50% pts with limb involvement and CNS dysfunction die within 1st
year
• AMC disorders are non-progressive
● With therapy and surgery, contractures frequently improve
● Regression of gains made is common
• Independence in ambulation and function can be achieved in some cases
Why is AMC non progression?
Non pro because you don't lose but if you don't
use muscle it goes in atrophy
WHAT IS MUSCULAR DYSTROPHY (MD)?
• A group of over 30 genetic diseases where muscle fibers are unusually susceptible to damage
• Characterized by progressive muscle weakness and degeneration
• Varies in age of onset, who is affected, severity,
pattern of affected muscles, and symptoms
• Incidence of many types of MD is unknownn* as symptoms vary widely
TYPES OF MD
Duchenne MD
Becker MD
Myotonic MD (aka Steinert's disease)
Limb-girdle MD
Congenital MD
Facioscapulohumeral (FSHD) MD
Oculopharyngeal MD
Emery-Dreifuss MD
Distal muscular dystrophy
Duchenne MD
• is most common form MD
● Will be discussed in detail
Becker MD
● similar to Duchenne but less severe and progress slower
● have faulty or not enough Dystrophin
● Sx onset usually teens but may occur later
Myotonic MD (aka Steinert's disease)
● most common adult form
● Sx: prolonged muscle spasms, cataracts, cardiac abnormalities, and endocrine disturbances
● characterized by long, thin faces with drooping eyelids; swan-like neck; floppy/high stepping gait
● inability to relax muscles voluntarily
● muscles of face usually affected first
Limb-girdle MD
● hip & shoulder muscles usually affected first,
● some cases - becomes difficult to lift front part of foot so frequent tripping
● Sx begin from early childhood to adulthood, affects boys and girls equally, severity of weakness varies
Congenital MD
● Sx's apparent at birth or before 2 years
● some forms progress slowly with mild disability while others progress rapidly with severe disability
Facioscapulohumeral (FSHD) MD
● Onset in teen years, can affect boys and girls
● Slow progressive muscle weakness of face, arms, and around shoulders and chest
● sx's vary from mild to disabling, scapular winging when raises arms, slope to shoulders, decreased ability to raise arms above shoulder height, masklike facial appearance
Oculopharyngeal MD
● first sx usually= drooping eyelids
● Other sx: weakness of muscles surrounding eyes, face, throat leading to swallowing difficulties
● onset usually in adulthood (40's-50's)
Emery-Dreifuss MD
● Less common
● Primarily affects boys-usually by 10 years
● Muscle weakness pattern: contractures form before significant muscle weakness identified
● Common contractures: heel cords, elbows, muscles of posterior neck
● Cardiac complications
Distal muscular dystrophy
● Begins childhood or adulthood
● Does not affect intellect
● Not considered life threatening
● Affects distal musculature first
• With time other muscle groups may be affected: heart or swallowing muscles
DUCHENNE MUSCULAR DYSTROPHY (DMD)
-present at birth but start to become clear at 3-5
• most common type of MD
• approximately half of all MD cases are DMD
• affects 1 in every 3,500 to 6,000 male births each
year in United States
• primarily affects boys (in rare cases- affects girls)
• onset between 3-5 years old
DMD: ETIOLOGY
• caused by genetic mutation leading to absence of dystrophin (a protein involved in maintaining
muscle integrity)
• DMD has an x-linked recessive inheritancee* pattern and is passed on by the mother
• majority of these genetic mutations are inherited
(approx 2/3 cases) however some (approx 1/3
cases) occur spontaneously in the mother's egg or the developing embryo
• can run in a family even if only one person has it
mostly genetic but sometimes spontaneously
DMD: SIGNS
• early stages: skeletal muscles of pelvis, thighs, shoulders, and upper arm are gradually weakened (usually in that order)
Usually lower than upper
Progressive muscle weakness
• This pattern of muscle weakness would lead to difficulty with what activities???
Walking, tolieting, moving around community and home
DMD: SYMPTOMS
• delayed walking
• frequent falls
• difficulty getting up from a lying or sitting position
● Gower's maneuver/sign
• trouble running and jumping
• trouble climbing stairs
• difficulty maintaining balance
• difficulty raising arms
• waddling gait
GOWER'S MANEUVER
How kids get off the floor with this problem
Different than us
Due to progressive weakness
DMD: course of disease is fairly
predictable & progresses
rapidly- involving muscles in arms, legs and trunk and later heart & respiratory muscles:
● begins with children who are late learning to walk
● toddlers with enlarged calf muscles
● preschooler with DMD appears clumsy and falls often, trouble climbing stairs and getting up from floor
● by school age- child may walk on toes or balls of feet with slightly rolling gait; has a waddling and unsteady gait and falls easily; to keep balance- sticks belly out and puts shoulders back; also has difficulty raising arms
● most kids with DMD lose ability to walk around 7 to 12 years old
● By teenage years, respiratory & heart muscles may become involved
DMD huge calf muscles
Huge due to atrophy so extra fat not muscles
DMD more signs
• respiratory muscles become affected
● sx include shortness of breath, headaches, mental dullness, difficulty concentrating or staying awake, nightmares
● may need assistance for breathing
• can develop cadiomyopathy -at risk of heart
failure
• learning disabilities
• issues with pain and sensation not typically associated with DMD
• usually have control over muscles of bladder and
bowel and have normal sexual functions
DMD: DIAGNOSIS
• not usually identified until a child is 3-6 years old however can be diagnosed earlier
• important to get formal dx as other diseases have some of same sx's as DMD
• important to determine if weakness is resulting from muscles themselves or in the nerves that control them
-weakness of muscle itself
DMD: TREATMENT
• Like general MD, treatment is *aimed to slow
progression* of the disease, to help symptoms and
prevent complications, maximize independent function, inhibit physical deformity and provide full access to society
• Tx can include therapies (OT, PT, ST, respiratory), orthotics, surgery, medications, etc.
• Mutidisciplinary team of physicians, nurses, therapies, social work, psychologists, nutritionists, etc.
Goal to maintain independence as long as possible
First for to prevent than changes to adaptative equipments
DMD TREATMENT- MEDICAL
• surgical and other procedures for problems resulting from MD
● contractures- tendon release surgeries
● scoliosis- spine fusions
• pacemaker if heart problems
• Respiratory- may lead to invasive mechanical
ventilation involving a tracheostomy vs noninvasive
device through use of a mask, nosepiece or mouth
piece
• drug therapy
● corticosteroids (ex: prednisone)
● anticonvulsants
● immunosuppressants
● antibiotics
• Precautions: meds do have side effects such as
prolonged use leading to weaken bones and increase fx risk
DMD TREATMENT- THERAPIES, ASSISTIVE DEVICES, ETC.
• therapies & assistive devices goal = improve QOL
and sometimes lengthen life
• ROM exercises
• strengthening exercises
● need to monitor how much- too much can cause
muscle damage
• aquatic therapy, swimming and water exercises
recommended often
● keeps muscles toned without causing unnecessary stress on them
DMD TREATMENT- THERAPIES, ASSISTIVE DEVICES, ETC continued
• adaptive equipment & mobility aides
● orthoses (braces)
● standers
● use of canes, walkers, wheelchairs
● other mobility aides such as transfer devices, shower chairs, electronic beds
• Cognitive intervention
• Intervention to help with tasks of work, recreation, daily living
• Lifestyle
● vaccination for pneumonia and influenza shots are important
● no special dietary restrictions or additions are known to help DMD although
many assume it does secondary "protein issue"
• diet should be high in fiber and fluid
• caloric intake should be monitored as mobility decreases, especially if on certain meds
• coping & support:
● CG and family support- involves commitment physically, emotionally, and financially
● DMD results in many challenges in school, home and all aspects of life
● support groups, breaks for CGs, building support team, encourage continued
normal family activities, education on not being overprotective, education to
treat child as any other child with discipline, responsibility, love
• education
IN REVIEW: ROLE OF OT (DMD)
• Maximize independence as long as possible
• Self care activities
• Assistive technology to promote independence at home, school, leisure, and work activities
• Leisure very important- promote balance
• ROM and strengthening exercises
• Fit and proper use of adaptive equipment
• Environmental modifications
• Adaptive techniques for ADLs & IADLs
• W/c and equipment evaluations and
recommendations
• Education: ex: energy conservation
• Emotional support; psychosocial issues
• Incorporating meaningful, age appropriate activities to promote participation
DMD PRECAUTIONS/CONTRAINDICATIONS
• individuals with DMD may have unexpected, adverse reactions to certain types of anesthesia-
important to let medical team know of pt's DMD to avoid complications
• should get cardiac evals & monitoring due to risk of cardiomyopathy
• be aware of medication side effects
• active exercise is good but need to be careful of overexertion and fatigue
• be aware of possible cardiac and respiratory
issues/precautions
DMD: PROGNOSIS
• No cure for DMD
• shorten lifespan- live to approx 30's or 40's
• due to respiratory muscles becoming affected,
even with mechanical ventilation, many don't
survive due to respiratory failure before the age of 40
-hard for families to cope
THIS SET IS OFTEN IN FOLDERS WITH...