Aquatic Influence on Mobility of a Child With Duchenne Muscular Dystrophy: Case Study

Abstract

The study was initiated because one of the authors had a child in the family with Duchenne muscular dystrophy (DMD). The author was concerned about what could be done to improve the quality of life of this child. The hypotheses explored whether hydrotherapy could bring any relief or advantage in functional mobility to an individual with DMD and whether a water environment facilitates mobility, pleasure, and joy for a young child with Duchenne muscular dystrophy. Our sample had three individuals, all of them boys, 9-11 years of age. Two were the control group and didn't practice any kind of physical activity and the other one was our two-year longitudinal case study during which he experienced hydrotherapy practice two times a week for forty-five minutes each. We applied the Egen Klassifikation (EK) scale to quantify the degree of movement limitation present at each of five measurement points over the two years. The variables analyzed were the physical activity issues and the EK scale values. The descriptive results showed that all three individuals increased their EK scale values over time, showing the inevitable progression of the disease. The individual who participated in the water activity sessions had the slower increase that we inferred, meant less deterioration in functional movement. No inferences can be drawn from these limited data, especially because only one individual experienced the water activities. This study does provide the impetus for subsequent, larger controlled studies to see if they could replicate these initial case study results.

Fisioterapia aquática em indivíduos com distrofia muscular: uma revisão sistemática do tipo escopo

“…There was a predominance of studies that investigated the effects of immersion on the pulmonary system 13,17,24,26,27,[29][30][31] and studies related to the postural control system and functional performance 18,21,22,[28][29][30]32,33 . According to the definition by Shumway-Cook and Woollacott 35 , musculoskeletal systems, internal representations, adaptive mechanisms, anticipatory mechanisms, sensory strategies, individual sensory systems and neuromuscular synergies contribute to postural control, terminology that was considered most suitable for this study.…”

“…According to the definition by Shumway-Cook and Woollacott 35 , musculoskeletal systems, internal representations, adaptive mechanisms, anticipatory mechanisms, sensory strategies, individual sensory systems and neuromuscular synergies contribute to postural control, terminology that was considered most suitable for this study. All studies that investigated postural control systems were grouped with investigations into functional Klassification (EK) 18,22,32,33 and the six-minute walk test (6MWT) 6,19,20,30 . The tests used to evaluate functional performance were gait assessment using a Likert scale 22 , functional range test 22 , timed function test 30 , and zigzag agility test 18 .…”

“…The scoping review allowed identifying that over the past ten years there has been an increasing number of studies evaluating the effects of aquatic physical therapy in patients with DM, mainly with DMD. However, there was a predominance of studies with small samples (up to three individuals) of the descriptive 18,23,[28][29][30][31]34 and quasi-experimental types 26,32,33 . The only randomized controlled clinical trial 6 detected is a pilot study that verified the feasibility of an aquatic physical therapy program associated with ground physical therapy in six centers in the United Kingdom.…”

“…Postural control/functional performance was measured by validated 38 or reliable 39 instruments for DMD, such as EK scale 18,22,32,33 to assess functional impairment in daily living activities, and 6MWT 6,19,20,30 to assess gait performance. The North Star Ambulatory Assessment was suggested by Hind et al 6 As the disease progresses, there is an increased risk for pulmonary and cardiac changes 3 .…”

“…Twenty records were selected, published between 1998 and 2018, with a predominance of Brazilian studies 13,17-28 , followed by North American 29-31 , Portuguese 32,33 , one British 6 , and one from northern Cyprus 34 . The types of studies found were as follows: one case series 31 , one retrospective experimental 17 , one randomized controlled clinical trial 6 , three quasiexperimental 26,32,33 , five cross-sectional 13,17,19,20,24 and eight case studies 21,23,25,[27][28][29][30]34 . Objectives also found were effects of immersion on energy expenditure 19,20,28 , psychological aspects (selfperception, stress, pleasure and joy) 25,33,34 , quality of life 30,31,34 and body mass index 33 .…”