Aquatic physical therapy in the treatment of a child with merosin-deficient congenital muscular dystrophy: case report

Abstract

This case report describes an aquatic therapy program for a child with Merosin-Deficient Congenital Muscular Dystrophy. Objective: This study sought to investigate the effect of aquatic physical therapy on the speed and the rate of energy expenditure while moving around on a flat surface, in addition to the functional reach of the upper limbs suffering from the proximal weakness that affects these patients seeking greater independence. Methods: The Motor Function Measurement (MFM) and the Functional Reach Test (FRT) were used as assessment tools; the Energy Expenditure Index (EEI) was measured in seated locomotion, as well as the time spent, and muscle activation was measured via electromyography (EMG). The program lasted 12 weeks and included activities to improve mobility and agility as well as reaching from the seated position. Results: In the MFM the change in the score of the two dimensions (D2 and D3) that the treatment focused on was 6.8%. The functional reach improved by 16 centimeters (cm) and the amount of time moving while sitting decreased by 19 seconds (s). Energy expenditure decreased by 252.31 beats per minute (bpm). Conclusion: The aquatic physical therapy was effective for agility improvement in seated locomotion and upper limb functionality of a 6-year-old child with Merosin-Deficient Congenital Muscular Dystrophy.

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

“…Regarding postural control, studies have presented variables such as measuring range of motion 29 with goniometer, muscle strength with dynamometer 30 , and muscle activation with electromyography equipment 28 . Functional performance was analyzed mainly by Egen Most of the study participants had DMD, aged between 5 and 22 years old; in two studies, participants had limb-girdle muscular dystrophy 23,29 and one study presented congenital dystrophy 28 .…”

“…Regarding postural control, studies have presented variables such as measuring range of motion 29 with goniometer, muscle strength with dynamometer 30 , and muscle activation with electromyography equipment 28 . Functional performance was analyzed mainly by Egen Most of the study participants had DMD, aged between 5 and 22 years old; in two studies, participants had limb-girdle muscular dystrophy 23,29 and one study presented congenital dystrophy 28 . Eight studies reported that individuals performed associated therapies, such as motor physical therapy 6,13,22,[27][28][29]31 , respiratory physical therapy 22,27 , occupational therapy 22,28 , home exercises 30 and adapted sports 31 (Table 1).…”

“…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.…”

“…The average water temperature was 32.7 °C (±1.6) and immersion was at the seventh cervical vertebra level 13,24 , xiphoid process [18][19][20] , and varied levels 29,31 . The types of activities developed were strengthening 6,21,28,31 , passive and active stretching 6,21,26,29,31,34 , breathing exercises 17,18,21,27,31,34 , exercises for trunk control 6,18,21,28,31 , gait 6,17,29 , body balance exercises 6,29 , jumping 29 , running 29 , swimming 29,34 , diving 27 , transfer training 28 , wheelchair handling 18 , besides specific exercises (not described) of the Halliwick concept, Bad Ragaz Method and hydrokinesiotherapy 25 , adaptation activities to the aquatic environment 23,34 . Brazil.…”

“…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 .…”