Functional Gains Through Individualized Strength Training in a Pediatric with Duchenne Muscular Dystrophy

INTRODUCTION AND PURPOSE Duchenne muscular dystrophy (DMD) is one of the most severe forms of inherited muscular dystrophy. It is a progressive genetic disorder and the most common neuromuscular hereditary disease, primarily affecting boys. The disorder leads to progressive muscle weakness and typically presents in early childhood. This case report presents the clinical outcomes of an individualized, low-resistance strength exercise intervention in a 5-year-old pediatric patient diagnosed with DMD. The objective is to evaluate the safety, feasibility, and potential effects of the intervention on muscle strength, endurance, functional performance, and quality of life. Through an individualized and structured physical therapy program, we aim to illustrate that individualized strength training can be a beneficial component in the multidisciplinary care of children with DMD. PRESENTATION The patient is a 5-year-old male who presented to the physical therapy clinic with the assistance of his mother. He exhibited a waddling gait (difficulty in walking) and had a diagnosis of DMD, confirmed 3 years ago. His primary impairments included difficulty in walking and rolling, with increasing limitations in balance and mobility, as indicated by functional assessments. Pain was scored 8/10 on the Visual Analog Scale, impacting his daily living. Clinical assessment revealed lumbar hyperlordosis and anterior pelvic tilt. A surgical scar was observed in the left thigh. Palpation indicated hypertrophy of the left quadriceps muscle. Passive Range of Motion (ROM) in both hip and knee flexion was limited bilaterally due to pain at the end range. The patient suffers from general muscle weakness, particularly in both hip and knee muscles. DISCUSSION DMD is a progressive neuromuscular disorder caused by mutations in the dystrophin gene, leading to muscle weakness and gradual loss of function. Physical therapy plays a critical role in managing the mechanical and functional impairments associated with DMD. A multimodal approach that combines manual therapy, therapeutic exercises, postural training, and pain management techniques has been shown to be effective in reducing pain and improving function. This case report demonstrates that an individualized, low-resistance strength training program can lead to significant clinical outcomes in a pediatric patient with DMD. CONCLUSION An individualized, low-resistance strength training program, designed according to the patient’s functional limitations and abilities, can help reduce pain, enhance mobility, and improve muscle strength, thus improving overall functional outcomes.