Wednesday, August 31, 2016

Scoliosis (Non-ambulant patient with Duchenne muscular dystrophy )

Scoliosis is a frequent complication in the
untreated scoliosis is associated with multiple complications such as compromised seating and trunk balance, discomfort, pain and difficult attendant care, exacerbation of any underlying cardio- respiratory dysfunction.

non-ambulant patient with Duchenne muscular dystrophy (DMD). Weakness of the para spinal muscles leads to trunk and body positional changes facilitating the development of a progressive collapsing scoliosis.
Research suggests that up to 90% of boys would develop scoliosis without intervention. A physical therapist may be the best person to monitor the spine, as he or she is likely to see the child more often than his medical specialists and will be able to detect early change.
Parents can play an important role in protecting their son’s spine by carefully and routinely checking his posture in his chair. As a young man grows, changing the dimensions of his chair helps maintain the best upright posture without his having to lean.




What can be done?
The following are some management approaches that may be offered to slow down the progression of the scoliosis in your child:
#Standing and walking have a protective effect on the development of scoliosis. It will benefit children who are able to walk (supported or unsupported) to keep mobile and encourage symmetrical supported standing (for example with standing frames) in those who can stand for as long as possible.
Those children who walk well but who have an increasing scoliosis (an uncommon situation) may benefit from wearing a plastic spinal support called a brace.
For young children who are unable to walk, a spinal brace may be recommended to delay the progress of scoliosis until most of the growth of the spine is completed and allow optimal sitting position of your child.
If your child is sufficiently well grown, or if the curve is progressing quickly or the breathing or heart function deteriorates an operation to correct the scoliosis and stabilize the spine is likely to be the treatment of choice.
Modified seating arrangements for their electric wheelchairs might be an alternative solution for those children who are overweight or where surgery is declined or not an option in view of severe respiratory or cardiac problems.