What are the recommended management strategies for maintaining mobility in children diagnosed with Duchenne Muscular Dystrophy?

Maintaining mobility in children diagnosed with Duchenne Muscular Dystrophy (DMD) requires a multidisciplinary, individualized management strategy focused on preserving muscle function, preventing contractures, and supporting posture and mobility through physical therapy and orthotic interventions. A tailored physical therapy programme should be promptly initiated, emphasizing progressive muscle-strengthening exercises against resistance to target specific functional goals such as enhancing skill development, maintaining walking ability, and preventing secondary complications like contractures and pain. This programme should be regularly reassessed to ensure goals are met and remain appropriate to the child’s evolving needs ¹.

Incorporating 24-hour postural management strategies, including low-load active or passive stretching, helps delay contracture and skeletal deformity development, which are common in DMD due to progressive muscle weakness ¹. Training parents and carers to assist with these postural management techniques is essential to optimize adherence and effectiveness ¹.

Orthoses should be considered based on individual needs to improve posture, walking efficiency, and prevent contractures or hip displacement, which is a significant concern in neuromuscular disorders like DMD. The design and fitting of orthoses must be carefully tailored and monitored to avoid discomfort, pressure sores, or functional limitations ¹.

Regular monitoring for hip displacement is critical, as hip migration can impair mobility. Clinical signs such as pain, leg length discrepancy, or reduced hip range of motion should prompt imaging and specialist assessment. Early detection and management of hip displacement can help maintain mobility and reduce complications (Canavese and Sussman, 2009).

Following interventions such as botulinum toxin injections, intrathecal baclofen, or orthopedic surgery, an adapted physical therapy programme remains a cornerstone of management to sustain functional gains and mobility ¹.

Overall, the management strategy integrates physical therapy, orthotic support, vigilant monitoring for musculoskeletal complications, and family involvement to maintain mobility and quality of life in children with DMD. This approach aligns with broader neuromuscular disorder management principles emphasizing individualized, goal-directed therapy and proactive prevention of secondary impairments (Canavese and Sussman, 2009) ¹.