Duchenne Muscular Dystrophy (DMD) is a progressive disease. The inability to walk is common in early adolescence, and with the restriction to a wheelchair at this stage of the disease, the wheelchair becomes the patient's only form of locomotion. Their agility in the wheelchair is a key factor for the functional independence of these individuals. Objective: The objective of this study was to verify the impact of aquatic therapy on non-ambulatory children with DMD. Method: This study has a prospective, interventional, clinical character. The patient underwent ten sessions of aquatic therapy as an intervention, using the following assessment tools: EgenKlassifikation scale, zigzag agility test, oxygen saturation (SatO 2 ), respiratory rate (RR), forced vital capacity (FVC), tidal volume (TV), minute volume (MV), peak cough flow (PCF), and maximal inspiratory (PImax) and maximal expiratory (PEmax) pressures. The intervention protocol of aquatic therapy was defined focusing on the agility in maneuvering the wheelchair. Results: Improvement in agility was observed in moving wheelchair, maintenance of the EK scale score, and a decrease in TV, MV, and PCF. Conclusion: The results showed that for this patient, aquatic therapy may intervene positively in his mobile agility in the wheelchair.

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.

original RESUMO Introdução. A Distrofia Muscular de Duchenne (DMD) é uma doença progressiva, caracterizada pela degeneração progressiva das fibras musculares necessitando de maior demanda energética durante as atividades funcionais. Desta forma, é imprescindível a avaliação clínica do gasto energético em diferentes atividades e ambientes. Objetivos. Analisar o gasto energético de crianças com DMD durante a marcha nos ambientes aquático e terrestre. Método. Participaram deste estudo 8 meninos com DMD (10,4±0,5 anos), deambuladores, colaborativo para a realização dos testes, não estavam inseridos em programas de reabilitação e não apresentaram doenças associadas. Foi realizado o Teste de caminhada de 6 minutos e calculamos o índice de gasto energético (IGE) através da fórmula: FC final -FC inicial dividida pela velocidade (metros/segundo), sendo expresso em batimentos/ minuto nos meios aquático e terrestre. Resultados. Observamos que no ambiente aquático os pacientes com DMD percorreram um distância menor, comparado ao solo (p=0,012). Quanto ao Índice de Gasto Energético (IGE), os pacientes com DMD obtiveram uma média no solo de 0,43±0,15 e na água de 3,69±0,44 (p=0,012). Conclusões. Os pacientes percorreram uma distância menor e com um gasto energéti-co maior no ambiente aquático, quando comparado com o terrestre.Unitermos. Distrofia Muscular de Duchenne, Marcha, Metabolismo Energético, Ambiente Aquático Citação. Silva KM, Hengles RC, Verdiani MB, Cecconi ME, Rocco FM, Braga DM. Análise do gasto energético na Distrofia muscular de Duchenne nos ambientes aquático e terrestre. ABSTRACTIntroduction. Duchenne muscular dystrophy (DMD) is a progressive genetic disease, characterized by progressive and irreversible degeneration of muscle fibers, requiring energy demand during functional activities. Given this characteristic, energy expenditure becomes a key factor in a rehabilitation program. So, it is essential energy expenditure clinical assessment in different environments. Objective. Analyze the energy expenditure of children with DMD during gait in aquatic and land environments. Method. The study included 8 boys with DMD (10.4±0.5 years), ambulating and collaborative for testing. They were not included in rehabilitation programs and had no associated diseases. It was applied 6-minute walk test (6MWT) in land and aquatic environment, and calculate energy expenditure index by the formula: End FC -divided by the initial speed FC (meters/ second) and is expressed in beats/minute in the aquatic and terrestrial. Results. It was observed that DMD patients walked (p=0.012) a shorter distance in water in relation to the ground. DMD patients had (p=0.012) higher average of energy expenditure in aquatic environment (3.69±0.44) when compared to land (0.43±0.15). Conclusion. The patients walked a shorter distance and with higher energy expenditure in aquatic environment.Keywords. Muscular Dystrophy Duchenne, Gait, Energy Metabolism, Aquatic Environment Citation. Silva KM, Hengles RC, Verdiani MB, Cecconi ME, Rocco FM, Braga DM....

RESUMOObjetivos: Descrever a atuação da fisioterapia aquática funcional no arrastar na postura sentada em uma criança com amioplasia congênita. Descrição do Caso: Uma menina de três anos de idade, portadora de amioplasia congênita, participou de um programa de reabilitação composto por 24 sessões de fisioterapia aquática. As avaliações foram realizadas no primeiro dia, após 12 sessões e ao final do programa. Foram mensurados o tempo de arrastar na postura sentada e os itens 24 (sentada no tapete mantém braços livres por três segundos) e 25 (sentada no tapete toca brinquedo pequeno na frente), da dimensão sentar do instrumento Gross Motor Function Measure 88 (GMFM-88). O tratamento foi um programa de exercícios com objetivo de ativação muscular, flexibilidade, transferência de peso e estabilização de tronco na postura sentada. Após a intervenção de fisioterapia aquática, verificou-se melhora da função motora, com maior velocidade de deslocamento na posição sentada. Conclusões: Verificaram-se resultados positivos após o programa de fisioterapia aquática aplicada a essa paciente com amioplasia congênita. Observou-se evolução no controle de tronco, melhorando sua estabilidade e repercutindo em sua funcionalidade, com aumento da velocidade no arrastar na postura sentada. DESCRITORES: AMIOPLASIA CONGÊNITA; ARTROGRIPOSE; HIDROTERAPIA; REABILITAÇÃO. ABSTRACT Aims:To describe the role of aquatic therapy in drag on sitting posture in a child with congenital amyoplasia. Case Report: A three-year-old girl with congenital amyoplasia participated in a rehabilitation program consisting of 24 sessions of aquatic therapy. The evaluations were performed on the first day, after 12 sessions and at the end of the program. The time of drag in the seated position and the items 24 (sitting on the mat keeps arms free for three seconds) and 25 (sitting on the carpet plays small toy in front) of the sitting dimension of the instrument Gross Motor Function Measure 88 (GMFM-88) were measured. The therapy consisted of an exercise program with the goals of muscle activation, flexibility, weight transfer and trunk stabilization in the seated position. After the aquatic therapy intervention there was improvement in motor function, with greater displacement speed in the sitting position. Conclusions: Following the aquatic therapy program applied to this patient with congenital amyoplasia, positive results were verified. There was improvement in trunk control, increasing its stability and reflecting on its functionality, with greater speed in drag in the sitting posture.

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