None listed
Conditions
Brief summary
Duchenne muscular dystrophy is a progressive disorder which affects muscle strength in boys and results in the loss of the ability to walk between 9 and 13 years of age. Along with muscle weakness the boys often also experience muscle tightness, particularly in their calf muscles. This in turn causes them to walk on their toes, which makes standing and walking balance more precarious. Boys with DMD undertake physiotherapy prescribed stretching programs and use night splinting to address this muscle tightness but commonly these are not sufficient to overcome the muscle shortening. Surgical lengthening has been shown to have a beneficial effect on ankle contracture in boys with DMD. This is very invasive and has not been shown to be associated with any improvement in strength or function. Below knee serial casting is used in some overseas centres as a treatment option for calf shortening. This project aims to assess the effectiveness of below knee serial casting on the length of calf muscles and walking ability in boys with DMD. We hope to assess whether short periods of serial casting will maintain calf muscle length, improve gait, and maintain or improve motor function. The boy’s gait, muscle length and motor function will be assessed before and after serial casting and then at 3 monthly intervals for a twelve month period.
Interventions
Bilateral below knee serial casting using soft cast maximum of four sets of casts applied for up to two weeks total.
Sponsors
Royal Children's Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
Male
Age
4 Years to No maximum
Healthy volunteers
No
Inclusion criteria
- Aged 4 years or greater - Independently ambulant over a distance of at least 75 metres and able to complete a 6 minute walk test - With a measurable calf contracture (ie maximum PROM ankle dorsiflexion less than or equal to 0 degrees with the knee fully extended) - With full passive knee extension or a knee flexion contracture less than 10 degrees - With quadriceps lag less than 5 degrees - With hip and knee flexor and extensor strength of at least grade 4 plus on manual muscle testing (Mendell and Florence 1990). - Who are cognitively and emotionally able to cope with the treatment - Whose family supports the treatment and undertakes to complete the protocol
Exclusion criteria
- Aged under 4 years - unable to ambulant 75 metres and unble to complete a 6 minute walk test - passive knee extension or a knee flexion contracture greater than or equal to 10 degrees - With quadriceps lag greater than 5 degrees - With hip and knee flexor and extensor strength of less than grade 4 plus on manual muscle testing (Mendell and Florence 1990).
Outcome results
None listed