Question

19-year-old non- ambulatory male with pneumonia Chief Complaint: 19-year-old non-ambulatory male with pneumonia. History: James Fenlow, a 19-year old male, is immobile and hospitalized for pneumonia. He has a long history of progressive weakening of his muscles. In the first year of his life, James reached many gross motor skill milestones, such as holding his head up, rolling over, sitting, and standing, at normal times. However, he did not walk until age 16 months, and by age two, started to assume a lordotic posture while standing but not while sitting, A Gower's sign was noted by age four, as was a Trendelenberg gait. Over the next several years, he suffered progressive muscle weakness, most notably in the proximal musculature of the arms, pelvis, and legs. By age 9, he required orthotic braces to assist his walking, and by age 11, he was confined to wheelchair ambulation. In his early teen years, James was still able to use eating utensils, write, and type on a keyboard, though these functions have declined over the past year. At 16, he was hospitalized with bronchitis requiring antibiotic treatment, but recovered. Throughout the years, James has had no history of muscle pain or spasm, chest pain, or irregular heartbeat. He was diagnosed with a learning disability in the fourth grade, but has progressed through the grades with tutorial assistance. The only mearann hat he normally

Answer 1

1) Occupational therapist can utilize certain techniques to help James be as independent as possible in his self care activities, particularly by providing assistive devices such as a power wheelchair with a standard Joystick and removable armrests for ease of transfer. As the Scoliosis worsens, James needs lateral support while sitting. Chest straps are useful in this regards. Slings and other movable arm supports allow James to continue to eat, write and read independently. As grip strength decreases, he may require adaptive, built up utensils. Occupational therapist can also help to slow the development of contractures by assisting with daily passive and active range of motion exercises, providing appropriate positioning for activities and providing splints or braces to hold limbs in proper positions. Occupational therapist can also help other family members cope with the disability by educating them and providing solutions to problems that may arise in school or elsewhere.

2)The average lifespan of an individual with Duchenne Muscular Dystrophy is 26 but with excellent medical care , patient may survive upto the age of 30s or 40s.

Some of the common causes of death in DMD are:-

a) Respiratory failure due to complications of treatment such as mechanical ventilation and tracheostomy procedures.

b) Heart failure due to dilated cardiomyopathy.

3) Duchenne Muscular Dystrophy might be treated with the help of Gene therapy and Stem Cell therapy after research 10 years from now. Method of gene therapy may be adopted to correct the mutation that leads to Duchenne muscular dystrophy that can permanently correct the defect in the gene.

Stem Cell therapy may be used in future to treat this condition after research which helps in regeneration of muscles and preventing the progressive loss of muscle strength.