The impact of aquatic therapy on the agility of a non-ambulatory patient with Duchenne muscular dystrophy

Abstract

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.

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 .…”

“…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 . Only one study used Vignos scale for disease staging 22 (Chart 2).…”

“…The programs lasted 21 (±24) weeks (minimum 6 weeks, and maximum 89 weeks), on average, and only one study showed a two-year followup 22 . 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 .…”

“…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.…”