Duchenne Muscular Dystrophy: Safe Activity, Monitoring and Function

Condition framework

DMD is a progressive X-linked neuromuscular condition associated with loss of dystrophin. Function and risks change over time, so care should be coordinated with a specialist neuromuscular team.

Physiotherapy supports comfortable range, safe mobility and participation, contracture-risk management and early recognition of change; it does not reverse the underlying disease.

Assessment and monitoring

• Review walking, transfers, stairs, falls, fatigue, pain, school participation, sleep, orthoses, equipment and family goals. Ask about recent decline rather than assuming every change is gradual progression.
• Use stage-appropriate measures agreed with the specialist team, such as the North Star Ambulatory Assessment, timed tasks, range records and participation reports.
• Coordinate respiratory, cardiac, orthopedic and bone-health surveillance. New breathlessness, chest pain, syncope, rapid functional decline or suspected fracture warrants prompt medical review.

Activity and exercise reasoning

• Encourage enjoyable, individualized submaximal activity when medically appropriate. Avoid prolonged inactivity, exhausting sessions and high-load eccentric work that causes marked pain or prolonged weakness.
• A programme may use short bouts of low-to-moderate effort movement, gentle active-assisted range and functional tasks with planned rest. Dose must be individualized; generic resistance prescriptions are not suitable for every stage.
• Use positioning, comfortable range routines, orthoses or adaptive equipment when indicated. Do not force painful stretching.

Progression and family partnership

• Monitor symptoms during activity and recovery later that day and the next day. Reduce load if fatigue is disproportionate, pain persists or function worsens.
• Progress participation, movement quality or duration conservatively, changing one variable at a time. Co-design goals with the child and family and coordinate with school and the multidisciplinary team.
• Do not attribute temporary decline solely to disease progression without considering injury, illness, pain, sleep or cardiopulmonary change. Good rehabilitation is proactive, coordinated and adaptable.