Common Facts 4 DMD is a recessive, genetic disorder Most common X chromosome linked disorder Disorder of the motor neuron, neuromuscular junction, and muscle Most common in males Affects 1 in every 3500 males Onset of symptoms occur between the ages of 1-4 Diagnosis usually occurs around age 5 Rapidly progressive loss of muscle contractility due to myofibril destruction Causes loss of ambulation around age 9 Lifespan from late teens and early 20s to 40 years old Classical Presentation Pseudohypertrophy in calves Proximal muscle strength decline Clumsiness Gower’s Sign Treatment Prevention of contractures Preservation of mobility Avoid overexertion and immobilization Preservation of strength and ROM Aquatic Therapy? Evidence Clinical Relevance Aquatic Therapy for children with Duchenne Muscular Dystrophy (DMD) and other Neuromotor Impairments Andrew Stethen and Adam Hooten Bellarmine University Bibliography Effects of aquatic interventions in children with neuromotor impairments: a systematic review 3 Effectiveness of aquatic therapy in children with neuromotor impairments including muscular dystrophy 11 out of 173 articles reviewed met criteria for inclusion Duration of aquatic therapy ranged from six weeks to two years Six studies used aquatic therapy twice a week, two studies applied it once per week, and the other three studies did not specify Most frequent duration of session was 30 minutes Results: Seven articles reported improvement in body functions and activity level. No reports of negative effects due to aquatic therapy. Further research needed with this population. Effects of a regular aquatic therapy program on one individual with Duchenne Muscular Dystrophy: A case study 2 Evaluate the impact of regular aquatic therapy on: Quality of life (QOL) Motor Function Pulmonary function One session per week for six weeks Results: Increase in strength and QOL. Pulmonary function and 6 min walk test remained same. The impact of aquatic therapy on the agility of a non- ambulatory patient with DMD 4 Verify the impact of aquatic therapy on non- ambulatory children with DMD. 60 minute sessions for a total of 10 sessions Results: Aquatic therapy contributes to maintaining vital capacity and diminishing respiratory frequency. Decrease in minute volume, flow volume, peak cough flow. The relationship between aquatic therapy, ambulation abilities, and power wheelchair utilization in males with DMD 1 34 males participated in the study randomly split into control and experimental groups. Results: Statistically significant difference between groups on the ability to ambulate independently with and without an assistive devise. Statistically significant difference in distance the child could ambulate prior to fatiguing. No difference between when the children received their first power wheelchair. 1.Duval E, Terp K. The relationship between aquatic therapy, ambulation abilities, and power wheelchair utilization in males with Duchenne's muscular dystrophy. Journal Of Aquatic Physical Therapy [serial online]. March 2008;16(1):16. Available from: CINAHL, Ipswich, MA. Accessed November 21, Early D, Iannaccone S. P.7.14 Effects of a regular aquatic therapy program on one individual with Duchenne Muscular Dystrophy (DMD): A case study. Neuromuscular Disorders [serial online]. October 2013;23(9/10): Available from: Academic Search Premier, Ipswich, MA. Accessed November 21, Getz M, Hutzler Y, Vermeer A. Effects of aquatic interventions in children with neuromotor impairments: a systematic review of the literature. Clinical Rehabilitation [serial online]. November 2006;20(11): Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed November 21, Silva K, Braga D, Hengles R, Beas A, Rocco F. The impact of aquatic therapy on the agility of a non-ambulatory patient with Duchenne muscular dystrophy. Acta Fisiatr [serial online]. June 2012:19(1):42-45.Available from: omeArquivo=en_v19n1a09.pdf. Accessed November 21, omeArquivo=en_v19n1a09.pdf Introduction Conclusion While the evidence is not sufficient in this population yet, there were positive signs that aquatic therapy could be an option for children with DMD or other neuromotor impairments. The buoyancy of the water allows initiation of movement possibilities that are not likely to be achieved on land 3. DMD is a progressive disease and aquatic therapy may allow for more movement in water than land as the disease worsens. The evidence shows that there are no negative effects of aquatic therapy with this population, so it may be a viable option before or as DMD progresses. Aquatic therapy may improve strength, QOL, VC, and delay use of a power wheelchair in this population. The literature on aquatic therapy for children with DMD is scarce but the research is promising. Some research suggest that with a 60 minute aquatic therapy session at least once a week for 6 weeks can increase the strength and QOL in children with DMD. Other research suggest increases in pulmonary function with 10 sessions. However, other research suggest no significant benefit with aquatic therapy in children with DMD. There is no set criteria for aquatic therapy for children with DMD and further research is needed to help physical therapy be successful in treating DMD. Future Research: All studies looked at children who were already in a power wheelchair. Studies need to look at how aquatic therapy can delay the onset of use of a power wheelchair. Studies with larger sample sizes in order to increase the validity of the research. Longitudinal studies to see what long term benefits are with children that maintain aquatic therapy for longer periods of time. Look at the benefits of beginning an aquatic therapy program early in the onset of DMD.