1. Muscular Dystrophy Dayna Ryan, PT, DPT Winter 2012

2. Overview –Genetically determined –Progressive degenerative course –Dystrophyic muscle fibers degeneration, regeneration, fibrosis General Signs & Symptoms –Muscular degeneration –Hypotonia –Muscle atrophy –Pseudohypertrophy in Becker’s only! Muscular Dystrophy

3. Etiology

8. Becker’s Characteristics Toe walking ▫Due to pseudohypertrophy in bilateral calf muscles Gower’s Sign ▫http://www.youtube.com/watc h?NR=1&v=IpoT46EAuCU&fe ature=endscreenhttp://www.youtube.com/watc h?NR=1&v=IpoT46EAuCU&fe ature=endscreen

9. Facioscapulohumeral Characteristics Clavicles rise up Shoulders droop Scapulae wing Pouting lower lips

10. Limb Girdle Characteristics Abdominal protrusion Waddling gait http://www.youtube.com/watch?v=TKL 5krEsiVIhttp://www.youtube.com/watch?v=TKL 5krEsiVI

11. Duchenne’s Muscular Dystrophy Similar clinical presentation as Becker’s MD but progresses more quickly Increased lumbar lordosis Proximal muscle weakness Positive Gower’s sign Child walks on toes because of contractures in calf muscles Positive Trendelenburg sign (weak gluteus medius)

12. Duchenne’s Muscular Dystrophy Usually lose ambulation by 10-12 years Scoliosis happens in most cases Respiratory problems an issue once child is wheelchair bound

13. Diagnosis ▫Blood test (enzymes from damaged muscles) ▫Genetic testing ▫EMG, Ultrasonography, Muscle biopsy Treatments ▫No cure. Glucocorticoids. ▫Surgery, bracing, assistive device ▫Prevent or reduce scoliosis & contracture (especially in Becker’s) ▫Avoid strenuous exercise