At the age of six, he had already developed contractures with the calf muscles being the most severely affected (Larsen & Lubkin, 2013). By the age of nine climbing stairs and rising unaided was impossible, and at ten years, he was confined to a wheelchair. He has weakening trunk muscles which can easily cause scoliosis. His diaphragm muscles are also weakened which makes breathing and coughing difficult, and increases chances of lung infection. Complications such as sleep-disordered breathing; ineffective cough and nocturnal hypoventilation are being experienced. The patient also has difficulties learning through listening and attention span is low (American Thoracic Society, 2010). DMD symptom management The focus of this study is the symptom management of neuromuscular and skeletal muscles. In a review article by a team of 84 practitioners representing the specialists who provide care to DMD patients selected by Centre for Disease Control (CDC), they independently rated the interventions and assessments that are used in DMD management (DMD Care Considerations Working Group, 2009). From this assessment, CDC expert panelists came up with management interventions for the neuro and skeletal muscles for a DMD patient at the stage in which this patient is. The first intervention for muscle strength and function is pharmacological intervention to address the progression of muscle degeneration in a DMD patient. The treatment that the review focuses on is the use of the glucocorticoids to optimize strength and function of these muscles. Glucocorticoids slow the collapsing of muscle strength, as well as its function, thereby reducing the risk of scoliosis and stabilize pulmonary function. The initial RCTs of patients on 0.75 mg/kg daily dose of prednisone for six months showed improvement in muscle strength. Prednisolone and deflazacort are other glucocorticoids that were shown to be effective on a daily dose instead of alternate days. These medications were shown also to prolong ambulation and in patients that have become non- ambulatory showed reduced risks of progressive scoliosis and stabilization of pulmonary function. There is no agreed time to start the glucocorticoids therapy since this is based on serial assessments, as well as parental report in the disease’s three phases. However, for a patient who has lost ambulation such as this one, the CDC experts review points the therapy can be introduced or continued in order to preserve upper limb strength, reduce progression of scoliosis and slow down a loss of respiratory and cardiac function. The review concludes that other supplements could be used to manage the neuro and skeletal muscles weaknesses such as coenzyme Q10, carnitine, and antioxidants such as fish oils, vitamin E, green tea extracts and amino acids. In another review article by the CDC expert panel on the implementation of multidisciplinary care in the management of DMD, the expert panel of the CDC project addresses skeletal and respiratory management (DMD Care Considerations Working Group, 2009). In spinal management, the earlier management with the use of glucocorticoid treatment is retaliated to curb progression of scoliosis and a small chance of developing vertebral compression fractures caused by osteoporosis.
An essay "Duchenne Muscular Dystrophy" reports that his legs weakened and had to push his knees in order to stand. His calves began to swell later with fibrous tissue, which felt firm and rubbery, rather than muscle. He then began walking with adding gait due to the weakened legs…
Skeletal muscle fibres are the voluntary group of muscles that are range from the small muscles in the eyes to the large and powerful muscles in the calf that cause leg movements. Anatomically skeletal muscles are composed of a number of fibres and each fibre is then further composed of smaller sub-units.
In the 1870s, descriptions of people (particularly boys) who grew weaker over time, lost mobility, and died young became increasingly prominent in the medical field. During that period, these descriptions were documented in medical journals. In the next decade, Guillaume Duchenne, a French neurologist, provided a comprehensive evaluation of 13 boys with the most prevalent and severe form of the disease (Parker & Philip 14).
It is X-linked and affects mainly males. DMD occurs when a particular gene on the X chromosome (DMD gene) undergoes mutation and the protein dystrophin is not formed. The present article discusses the epidemiology, pathophysiology, anesthesia management with relevance to DMD.
DMD is generally identified by the age of five through its symptoms of delayed motor ability and weakness of the proximal muscles. The consequences of DMD are severe for the individual (Wu, Kuban, Allred, Shapiro & Darras, 2005).
, Ladewig, Ball & Bindler (2007, 1762), “bones provide a rigid framework for the body, muscles provide for active movement, and tendons and ligaments hold the bones and muscles together. Alterations in musculoskeletal functioning, therefore, can have a significant impact on a
The major cause for all kinds of muscular dystrophies is believed to be mutations that take place in individual genes encoding numerous proteins. Among the latter one can find extracellular matrix proteins, cytoplasmic enzymes, transmembrane and
Anatomically skeletal muscles are composed of a number of fibres and each fibre is then further composed of smaller sub-units. These smaller fibres are called as myofibrils. The cell membrane of the muscle fibre is called as the
This means that any of these diseases can surely arise even though no one in the family has ever been affected or has the abnormality. This paper is going to examine closely one of these muscular dystrophy disorders which is Duchenne muscular dystrophy (DMD).
This is because individual state governments feel that the national government has too much power and goes beyond its boundaries on most issues. Although the conflicts between the national government and individual state governments
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