It is estimated that 1 in every 3,500-5,000 males born in the United States are born with Duchenne Muscular Dystrophy (DMD). DMD is a debilitating disease that progressively weakens skeletal, cardiac, and pulmonary muscles due to the lack of the protein dystrophin. This results in great physical disability and shortened lifespans. Patients often are non-ambulatory by late teenage years with death occurring in the mid-twenties. Current physical therapy treatments are limited, leaving those with DMD to rely on symptom management and compensations for physical limitations, rather than remediation or rehabilitation. This project presents a case of an 8-year-old individual diagnosed with Duchenne Muscular Dystrophy (DMD) who shows clinical signs of decreased ambulation ability. Currently he is only using pharmaceuticals to help slow the progression of the disease. Physical therapy treatments are palliative with the patient being instructed to participate in age-appropriate activities and interventions only including fabrication of nighttime stretching braces. This project addresses the following PICO question: Does the use of electrical stimulation for strengthening result in increased ambulation longevity and increased functional independence in individuals with Duchenne Muscular Dystrophy when compared to standard physical therapy treatment? The results of the evidence selected for analysis are mixed. Benefits and detriments have both been shown in mdx mice, Golden Retriever, and human studies. Two human studies analyzed show that boys who are younger and have a slower progression of the disease respond better to electrical stimulation strengthening, whereas another study ultimately reports the opposite. Animal studies show promise, but it is morally and ethically challenging when applying the same research design to human subjects. The young age of the DMD population is also a limiting factor in studies, as patients cannot always follow direction or give credible answers to questions in regards to muscle soreness, fatigue, and functional limitations. It is therefore acceptable to make assumptions about the treatment of DMD based on the studies of other muscular dystrophies. Muscular exercise is important for all patients with muscular dystrophy to build strength, develop endurance, and maintain overall health. Electrical stimulation strengthening is often used as an adjunct to traditional exercise, especially in populations with physical limitations. What this systematic review highlights is that the protocol of electrical stimulation use for strengthening in the DMD population is vague. It is unclear which type, frequency, and duration of electrical stimulation would prove to provide the most beneficial long-term effects. With contraction-induced muscle damage being the biggest concern, this review highlights the need for more research and clear-cut parameters and protocol for electrical stimulation strengthening. It is therefore recommended that future clinical trials should include randomized controlled trials, withhuman subjects participating as both experimental and control subjects, longitudinal outcomes, and examination of multiple muscle group stimulation.
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Muscular Dystrophy; Electrical Stimulation
Borders, Lindsey F.. "Electrical Stimulation Use in Duchenne Muscular Dystrophy - An Evidence Based Analysis." (2016). http://digitalrepository.unm.edu/dpt/18