Ever noticed a child using their hands to push on their legs to stand up? This is Gower’s maneuver, a classic sign of muscle weakness, often seen in Duchenne Muscular Dystrophy (DMD). Early detection can help in better management. 

If such signs are present with a child, it is recommended to consult a physiotherapist or neurologist for evaluation. 

Physiotherapy Rehabilitation Protocol for Duchenne Muscular Dystrophy (DMD)

Duchenne Muscular Dystrophy (DMD) is a progressive neuromuscular disorder requiring a structured physiotherapy plan to maintain function, prevent contractures, and improve quality of life. Below is a step-by-step rehabilitation protocol for individuals with DMD at different stages.

1. Early Phase (Ambulatory Stage)

Goal: Maintain strength, flexibility, and functional mobility while delaying progression.

Assessment:

• Baseline muscle strength (Manual Muscle Testing, MMT)
• Range of motion (ROM) assessment
• Gait analysis
• Functional tests (e.g., 6-minute walk test, North Star Ambulatory Assessment)

Intervention:

1. Stretching & Range of Motion (ROM) Exercises

•    Passive stretching of gastrocnemius, hamstrings, hip flexors, and iliotibial band to prevent contractures.
•    Performed daily (3–5 reps, 30 seconds each).

2. Strength Training (Submaximal & Low-Resistance)

•    Focus on proximal muscle groups (e.g., glutes, quadriceps).
•    Avoid eccentric exercises to prevent muscle damage.
•    Functional movements like sit-to-stand and stair climbing.

3. Gait & Posture Training

•    Encourage heel cord stretching to prevent equinus deformity.
•    Use of orthotic devices (AFOs) to prevent foot drop.
•    Promote proper posture to prevent lumbar lordosis.

4. Breathing Exercises

•    Diaphragmatic breathing to improve respiratory function.
•    Blowing exercises (balloons, spirometer) to enhance lung capacity.

5. Hydrotherapy (Optional)

•    Low-impact exercise to improve mobility and reduce joint stress.

2. Transitional Phase (Loss of Ambulation, Early Non-Ambulatory)

Goal: Prevent contractures, support respiratory function, and maintain independence.

Assessment:

• Joint contractures (hip flexors, knees, and ankles)
• Pulmonary function (spirometry, cough strength)
• ADL assessment (eating, dressing, transfers)

Intervention:

1. Passive Stretching & Positioning

•    Maintain joint mobility and prevent scoliosis.
•    Night splints/AFOs to prevent ankle contractures.

2. Respiratory Physiotherapy

•    Assisted cough techniques (manual and mechanical).
•    Breathing exercises with inspiratory muscle training.

3. Seated Mobility & Transfers

•    Wheelchair training (posture support, cushion adjustments).
•    Transfer techniques to reduce caregiver burden.

4. Functional Independence Training

•    Adaptive equipment (feeding aids, dressing supports).
•    Occupational therapy for daily activity modifications.

3. Late Phase (Advanced Non-Ambulatory Stage)

Goal: Optimize comfort, respiratory support, and prevent complications.

Assessment:

• Severe contractures and scoliosis progression
• Respiratory decline (oxygen saturation, cough ability)
• Nutritional intake and swallowing assessment

Intervention:

1. Contracture & Pain Management

•    Positioning with custom seating systems.
•    Passive ROM exercises to reduce stiffness.
•    Pain relief techniques (heat therapy, massage).

2. Advanced Respiratory Support

•    Non-invasive ventilation (BiPAP/CPAP).
•    Airway clearance techniques (mechanical cough assist).
•    Suctioning and secretion management.

3. Palliative & Supportive Care

•    Psychological support for the patient and caregivers.
•    Quality-of-life interventions (music therapy, relaxation techniques).
•    Hospice care when required.

Conclusion

Physiotherapy in DMD focuses on maintaining mobility, preventing complications, and optimizing quality of life. A multidisciplinary approach with physiotherapists, occupational therapists, and respiratory specialists ensures comprehensive care tailored to the individual’s progression.