Ankle-Foot Orthosis in Duchenne Muscular Dystrophy: A 4 year Experience in a Multidisciplinary Neuromuscular Disorders Clinic.
OBJECTIVE
To assess Ankle-Foot-Orthosis (AFO) requirement and ambulation in Duchenne Muscular Dystrophy (DMD) patients seen over a period of 4 y at a multi-disciplinary Neuromuscular disorders clinic (NMD).


METHODS
A study was conducted in university quaternary research hospital with DMD patients confirmed by MLPA (multiplex ligation - dependent probe amplification) method and were evaluated between January 2012 and December 2015. Their ambulatory status, detailed neurological and functional status were recorded. Requirement of AFOs was determined and provided.


RESULTS
In total 126 DMD children reported to the NMD clinic. Mean age at presentation was 7.6 y (range 2 to12 y, SD 2.1). Mean duration of illness at first evaluation was 3.4 y (range 0.5 to 10 y, SD 2.0). AFO's were advised at a mean age of 8.5 y (range 7 to 12 y, SD 1.8). Fifty-nine patients were advised AFO as resting or walking splint. At last follow-up 113 patients were still ambulatory whereas 13 had become wheel chair bound. Out of 59 patients, 48 were still wearing AFOs and the remaining discontinued AFOs for various reasons.


CONCLUSIONS
Children with DMD require wearing of AFOs as resting or walking splint, mostly in first or early second decade of life. As there is some gap between onset of clinical signs and requirement of orthosis, follow-up preferably at a multidisciplinary clinic at regular intervals is desirable for timely intervention in the form of AFOs or other splints to prolong ambulatory status in these patients.
Department of Neurological Rehabilitation, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, 560029, India. drgupta159@yahoo.co.in.
Anupam
A
Gupta
Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India.
Atchayaram
A
Nalini
Department of Neurological Rehabilitation, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, 560029, India.
Shanti Prakash
SP
Arya
Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India.
Seena
S
Vengalil
Department of Neurological Rehabilitation, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, 560029, India.
Meeka
M
Khanna
Department of Neurological Rehabilitation, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, 560029, India.
Rashmi
R
Krishnan
Department of Neurological Rehabilitation, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, 560029, India.|Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India.
Arun B
AB
Taly
D002648:Child; D002675:Child, Preschool; D005260:Female; D061826:Foot Orthoses; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000534:rehabilitation*; D016896:Treatment Outcome
Ankle-foot-orthosis; Duchenne muscular dystrophy; Locomotion