DMD Non Ambulatory b. Hand function a.

Galeazzi  LLD (bila positive) dan raba

c. ADL greater trochanter
ANAMNESIS d. Restriction in school/play/sport/leisure b. Thomas test
1. Identity: sex, age, school 8. History of family illness Prone
2. Chief complaint: 9. Psychosocioeconomy 14. Trunk look: deformity (scoliosis)
a. Unable to stand / walk / ADL a. Environmental factor: family/caregiver, 15. Trunk Feel: tenderness, spasm
b. Weakness home accessibility (toilet, stairs, wch access) 16. Trunk move: MMT trunk extensor
c. Trunk deformity b. Personal factor: education, work, role 17. LE Move: MMT hip extensor, ankle plantarflexor
d. Recurrent cough psychological problem, hope Sitting on the bed
e. Easily fatigue 18. Functional mobility
3. Symptoms of DMD: PHYSICAL EXAMINATION a. Supine to sitting
a. Onset of weakness Supine-undressed 19. Sitting posture
b. Weakness of LE: tip toe walking, often 1. General condition, Vital sign a. Trunk control
falling, cant climbing stairs, cant 2. Nutritional status b. Posture anterior:
standing 3. Visual/ auditory response c. Posture posterior: shoulder, scoliosis
c. Gower sign: difficulty rising from 4. Communication: receptive, expressive d. Posture lateral: shoulder
sitting, use hand and arms to hold on 5. Oromotor: Drooling, lipseal, buccal tone, tongue protracted/retracted, kyphosis
the lower limb when try to standing and jaw movement, feeding 20. Special test: meryon sign
d. Weakness of UE: cant rising the arm 6. Respiratory : breathing pattern, mouth 21. Hand prehension
4. History of diagnosis/treatment breather, chest retraction, secondary breathing 22. Sitting balance: static / dynamic
a. Biopsy/DNA/EMG/Lab muscle, auscultation (slem) 23. Chest expansion
b. Drugs 7. UE Look: trophy (pseudohypertrophy deltoid), 24. Check out wheelchair
c. Rehabilitation deformity a. Seat width 2 inch
d. Home program: breathing exercise 8. UE Feel: tone, tenderness, spasm, sensibility, b. Seat depth 2 inch
5. Complication ukur muscle belly deltoid c. Back height 2 inch
a. Respiratory problem 9. UE Move : ROM (shoulder, elbow, wrist), MMT d. Seat height 4 inch
i. Recurrent cough general (proks<distal) e. Arm rest height 1 inch
ii. Fatigue 10. LE Look: trophy (pseudohypertrophy gastroc), f. Leg length 2 inch
iii. Short of breath deformity (subluksasi)
iv. Respiratory tract infection 11. LE Feel: tone, tenderness, spasm, sensibility, REHABILITATION PROBLEMS
b. Deformitis: ukur muscle belly gastroc 1. Activity/participation:
i. Scoliosis 12. LE Move: passive ROM a. Transfer/ambulation
ii. Contracture a. ROM and MMT hip flexor b. ADL
6. Associated problemcognitive problem b. ROM hip abduction, adduction c. Hand function
a. Problem on learning at school c. ROM and MMT knee extensor d. Restriction in job/school/leisure
7. Activity/participation d. ROM and MMT ankle dorsiflexion 2. Respiratory problem:
a. Transfer/mobilisation/ambulation 13. Special test: a. Limited chest expansion
 b. Airway clearance problem
c. Exercise intolerance
3. Deformity: scoliosis, contracture
4. Psychosocial problems

REHABILITATION GOALS
Short term
1. Prevent further scoliosis: adaptive sitting device,
flexibility exercise, proper positioning
2. Maintenance of ROM: passive gentle muscle
stretching

Longterm goal

1. Management of cardiorespiratory complication

a. Regular evaluation of lung function:
spirometry, MIP, MEP
b. Breathing exercise:
i. Incentive spirometry
ii. Air stacking exercise
iii. Deep breathing exercise
c. Evaluation of risk of cardiomiopathy