Electrical Stimulation and Muscular Dystrophy

Blog #2 - Week 5

For my final blog, I have decided to discuss e-stim and the potential benefits for muscular dystrophy patients.  On a personal note, I have been interested in electrical stimulation ever since I was a young child. I remember reading articles about various Russian athletes using electro-stimulation to increase strength and performance. It was not until joining the PTA program, however, that I understood the many different types of e-stim. They all produce an electrical stimulation, but the current and values of each vary and are used for different methods of treatment (i.e. reducing pain, muscle contraction, etc.)

The study I researched involved nine children affected with either Duchenne or Becker muscular dystrophy. They underwent a low-frequency electrical regimen with stimulation directed toward their right anterior tibialis muscle. The goal of the treatment was to measure changes in dorsiflexion of the stimulated right leg compared to the non stimulated left leg.

Four of the boys were stimulated and measured for a three-month period.  No changes resulted from the treatment. The five remaining boys underwent treatment for nine months and did show some improvement in right ankle torque / dorsiflexion compared to their left leg. According to the article, “6 measurements made during the stimulation program revealed that changes of torques in the ankle of the right stimulated extremity were significantly different from the changes of torques in the ankle of the left nonstimulated extremity.”

It appears electrical stimulation can offer some benefit to patients with muscular dystrophy, but only if sustained over a long period of time. 

Article link: ncbi.nlm.nih.gov/pubmed/1557085

Non copyrighted image courtesy of: activlifetech.com.au/shin/
Written & posted by: Josh W.

PT for Muscular Dystrophy and other degenerative diseases

Physical therapy is slightly different when you are dealing with a degenerative disease, like MD.
This is because in an orthopedic or injury situation there are often set goals for improvement to gauge a patient's progress, and you should see constant improvement as the body heals.  The article listed below states that when physical therapy is used for a person that has a degenerative disease, the focus should be on helping that person remain at the highest functional level possible at any given point.



picture can be found: HERE


Therapists treating patients with MD, will most likely be dealing with pediatrics due to the nature of the disease.  This makes it very important that therapy is fun and engaging for the child, more so than rigorous and exhausting.  The needs and wants of the child should always be put first in order to provide care that is rewarding for the child.  This population will most likely have a shortened life span and therapy should not be another thing they resent in life.



picture can be found: HERE

In summary, the therapist should focus on making the activities fun and engaging while trying to keep the child at the highest functional level possible.  This will ensure the child is getting the highest level of care and will actually look forward to going to physical therapy.


Full article can be found HERE

Muscular Dystrophy and Joint Contractures

Blog #2 - Week 4

This week I started to think of other symptoms experienced by those with muscular dystrophy besides the obvious muscle weakness. The first thing that came to mind was contractures from a lack of movement. A good stretching routine should be part of everyone’s treatment plan, but I noticed during my clinical experience, most patients relied solely on the therapist for increasing range of motion. This led me to wonder if a type of machine existed, that could help to motivate patients to increase their stretching routine- outside of scheduled therapy.

According to Wellmark Blue Cross and Blue Shield:

 “Physical Therapy procedures and special mechanical stretching devices also referred to as dynamic splinting devices have been developed to increase range of motion without damaging the affected joint or its related muscles, tendons, and connective tissue. Several types of dynamic splinting devices are available:

• Dynamic (low-load prolonged stretch devices permit resisted active and passive motion within a restricted range).
• Bi-directional (static progressive stretch devices maintain the joint in a set position, but permit manual modification of the joint and
  may allow for active motion without resistance).
• Patient-actuated (serial stretch devices allow resisted active and passive motion within a limited range).

The use of dynamic splinting devices are proven for improvement of range of motion after surgery or injury when physical therapy alone has not been effective. The use is limited to joints of the knee, elbow, toe, finger, and wrist.”

As mentioned above, several options are available today that could help reduce contractures experienced by patients. The following website goes into further detail regarding research and the type of equipment available.

Studies are ongoing and the findings are investigational for a variety of diseases and conditions, including muscular dystrophy.

Image courtesy of: jointactivesystems.com
Posted and written by Josh W.

Muscular Dystrophy and Gene Therapy

Muscular Dystrophy and Gene Therapy

I found this study that the University of Missouri-Columbia performed regarding MD and gene therapy interesting and can have a huge impact on how physical therapy can be used more.  The link to the study can be found below:

https://www.sciencedaily.com/releases/2015/10/151022141722.htm





This study was successfully performed last year on dogs after having researched the method for 10 years. After successful animal trials, it is now possible that human trials could begin in the near future.  In simplest terms, the study tries to address the gene mutation aspect of MD, which causes the disruption of the production of the protein known as dystrophin.  This could then allow muscles to develop as they would in a health human being.



In order to do this type of treatment, scientists had to come up with a miniature version of the gene which is known as a "microgene."  This gene is then sent to all of the affected muscle of the test subjects, which were mice to begin with before progressing to dogs.

This is huge progress with the fight against MD, because the diseased dogs were shown to have normal muscle development just a few months after the gene was administered.  This would allow PTs and PTAs to deliver more therapy than what used to be possible due to lack of muscle mass.  If humans can have a similar response that the dogs have had, this could be life-changing for many people affected by MD. Patients could benefit form the overload and specificity principles of exercise and actually experience varying degrees of hypertrophy.

Coenzyme Q10 and Muscular Dystrophy

Blog #2 - Week 3

Coenzyme Q-10 is formed in the human body and utilized in energy production and scavenging free radicals. It is an important nutrient for optimum health and endurance. Two clinical studies evaluated the effectiveness of coenzyme Q-10 with patients affected with various types of muscular dystrophies. The first trial included twelve patients, the second trial fifteen. Patients blood level was tested and coenzyme Q-10 results ranged from .5 - .84 (low). Both groups were treated for three months with 100 mg daily doses of coenzyme Q-10 or a placebo.

In the group taking the supplement, improved physical performance was confirmed. This led to the supported theory that muscular dystrophy patients do have a deficiency of coenzyme Q-10 and consuming the oral supplement can help to reduce symptoms and restore some physical health. The most effective dose of coenzyme Q-10 still requires research that is more extensive; however, the study did conclude that patients affected with muscular dystrophy should be treated for an indefinite period with the supplement.

Image courtesy of: mskcc.org/cancer-care/integrative-medicine/herbs/coenzyme-q10

Research article: sciencedirect.com/science/article/pii/092544399500040B

Written & posted by: Josh W

Duchenne Muscular Dystrophy (DMD)

In today's blog I wanted to go into one of the more common types of muscular dystophy, Duchenne Muscular Dystrophy or DMD.  DMD is very similar to another type of MD known as Becker MD, which is a slightly less severe variation of the disease.  Both of these types will nearly always affect boys rather than girls and will be diagnosed at a young age, usually between 3 and 6 years old.

DMD is a genetic disease and is caused by an X-linked recessive gene.  This is what cause the disease to be very rare in females, because it would require two copies of the gene on each X chromosome.  Parents will usually notice excessive clumsiness, difficulty with stairs, inability to jump, leg pain, and arm weakness at a level that is behind a normal child's motor development.  One of the tell-tale signs that it is Duchennes is the presentation of Gower's sign, which is seen below.  It indicates the child has difficulty moving from sitting to standing.





Another indication is large calves, where fatty tissue is replacing muscle mass and is usually noticeable in the legs first.  It is important that parents notice their child is falling behind in order to begin PT and other measures to help the child in their development as soon as possible.  Also preparing the child and the family for shock that their child will most likely be in a wheelchair by the age of 12 due to decreased LE strength.



Info regarding diagnosis and symptoms:

http://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/muscular_dystrophy_90,P02771/

Picture can be found at:

https://www.google.com/search?q=gower%27s+sign&biw=1920&bih=955&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjqtpKoh_3KAhULFj4KHcF-CH0Q_AUICCgD#imgrc=qUlG-ecmr66mOM%3A

Muscular Dystrophy and Creatine Supplementation

Week 2 – Blog #2

For my second blog, I decided to discuss alternative methods of increasing strength levels with Muscular Dystrophy patients. For years, athletes have taken supplements to improve performance, strength, and power. Creatine monohydrate is a legal performance-enhancing supplement that occurs naturally in certain foods (red meat) and is normally produced in the body. It has been studied extensively for many years with most evidence showing positive results. 

In my research, I came across 12 different studies (involving 266 people) that were reviewed, combined, and evaluated. Affected test patients were given creatine monohydrate supplements, either short-term or long-term, and results found improved muscle strength by an average of 8.5% among patients with various types of Muscular Dystrophy.

Creatine subjects also gained an average of 1.4 pounds of lean body mass compared with patients given the placebo treatments. The supplement is cell volumizing, which could explain the weight gain. Perhaps introducing supplementation to Muscular Dystrophy patients could offer some benefit as they experience muscle loss and strength weakness, with diminished levels of naturally occuring creatine. I will be looking into other supplements next week to research if they can also offer additional benefits to patients with Muscular Dystrophy.

Note: All images are royalty free and courtesy of pixabay.com

http://www.webmd.com/news/20070202/creatine-may-help-muscular-dystrophy

Written and posted by: Josh W

Blog #1- Week 2

After doing quite a bit of research regarding Muscular Dystrophy for this research blog, I came across a story that overlapped some of my interests along with MD.  I grew up with a heavy influence of camping, hiking, and general outdoor experiences.  It is something I am very thankful for and plan to introduce my children to as well.  Disabilities like MD can happen to anyone, and it is important to live life to the fullest no matter what the consequences.

For obvious reasons, MD can be make outdoor experiences more difficult than a healthy person.  For one, you cannot make nature handicap accessible and many areas may require a certain amount of athletic ability to access.  I found a story on the Marquez family, who have an 8 year old son that suffers from Duchenne MD.  After their son was diagnosed, the family decided they wanted to live life to the fullest despite their hardship.  The first thing they decided to do was hike the Half Dome in Yosemite National Park.  They did this by carrying their 55 pound son in a backpack and taking turns.  This was necessary due to the degenerative muscles the son was experiencing.

I thought this was a great story of people being optimistic despite having a person in the family suffering from MD.  I think that this story can also help to inspire people to create experiences for children that have disabilities, like MD.  Stories like this make people realize they can still do things they thought may have been impossible due to unfortunate circumstances.

Muscular Dystrophy & Qi-Gong

Blog #2 - Week 1

I must admit my understanding of Muscular Dystrophy before this assignment was limited. I was first introduced to the disease as a child from Jerry Lewis telethons, but my only personal experience with Muscular Dystrophy as an adult came from assisting patients during my clinical rotations. The common occurrence I noticed among those affected involved muscle weakness with a loss of balance, especially when trying to ambulate. Intervention treatments consisted of what one would expect from a novice PTA intern. Although they were effective and gave the desired result, I could not help and contemplate if something more could be done.

My background before learning about physical therapy revolved around the world of martial arts. I started training at an early age and instructed others throughout my teenage years and twenties. This led me to thinking, what if there was a way to incorporate martial arts with physical therapy. To my surprise, it has already been implemented (to a small degree).

In the martial arts world, there are many different styles with different philosophies. To simplify things, disciplines can be summarized as either a “hard” or “soft”. Soft styles teach more of a slower type body movement and integrate meditation and breathing techniques into the curriculum. MD patients already have a diminished capacity for exercise. They must utilize a sub maximal training program to maintain mobility and posture. This led to me thinking that perhaps performing techniques from a softer martial arts style would offer benefit.

One 2004 research study took 36 MD patients and divided them into two groups. Group 1 was instructed in the art of Qi Gong (similar to Tai Chi) and group 2 was used for comparison. The researchers tested and documented balance of the all participants using the Berg-Balance Scale before and after a three-month training program. The end-results were the test group improved their balance by +0.2!

The comparison group displayed a decrease in balance by -1.3. The rating of perceived health was also maintained by the Qi Gong participants, which was not the case for the comparison group.

Does this research mean all MD patients should perform Qi Gong? No, every patient is unique and requires an personal evaluation and treatment plan. Another thing I have realized is that for every study result there is another study that discredits the information. Nevertheless, it is interesting (to say the least) and I believe a step in the right direction.

Note: All images are royalty free and courtesy of pixabay.com.

Link #1
http://www.ncbi.nlm.nih.gov/pubmed/15204513

Link #2 Peer Reviewed Article (College log in required) http://eds.b.ebscohost.com/eds/detail/detail?vid=16&sid=7f6d097e-4c57-4de0-868d-84e66271c0fa%40sessionmgr112&hid=119&bdata=JnNpdGU9ZWRzLWxpdmU%3d#AN=106678178&db=rzh

Written and posted by: Josh W
Date: 02/02/16 - 7:54 PM Eastern

Muscular Dystophy

For our first blog on the topic of Muscular Dystophy (MD), we wanted to give an overview of the disease and how it can be categorized.

MD is an inherited disease that damages and weakens your muscles over time due to a lack of protein called dystrophin.  Without dystrophin, the body cannot maintain normal muscle function.  This will lead to abnormalities with walking, swallowing, and other coordinated muscular activities.  Most people will lose the ability to walk eventually, and there is no known cure for MD.  A copyrighted picture can be seen below that shows the effects of MD on normal muscles.

There are over 30 different types of muscular dystrophies and the symptoms can vary. The types can be included in the 9 categories listed below:

-          Duchenne Muscular Dystrophy

-          Becker Muscular Dystrophy

-          Congenital Muscular Dystrophy

-          Myotonic Dystrophy

-          Facioscapulohumeral (FSHD)

-          Limb-Girdle Muscular Dystrophy

-          Oculopharyngeal Muscular Dystrophy (OPMD)

-          Distal Muscular Dystrophy

-          Emery-Dreifuss Muscular Dystrophy

MD is usually diagnosed while in childhood, but can occur at any age.  Males are more likely to be diagnosed than females.  In order for a person to be diagnosed with MD, blood tests, electromyography tests, or a muscle biopsy must be done.  These tests can confirm the presence of certain enzymes released by the damaged muscles.

While MD cannot be cured, there are treatment options to manage symptoms and slow the progression of the disease.  These options include:

-           corticosteroid drugs

-           assisted ventilation

-           medication for heart problems

-           surgery to help correct the shortening of your muscles

-           surgery to repair cataracts

-           surgery to treat scoliosis

-           surgery to treat cardiac problems

More detailed information regarding an overview of MD can be found at the link below:

http://www.healthline.com/health/muscular-dystrophy#Overview1

Written By: Adam B
Posted By: Josh W
01/01/2016 - 7:40 PM Eastern

Just testing this site.