Uso de órteses em membros inferiores em pacientes com distrofia muscular de Duchenne
USA – a progressiva perda de força muscular e o apareciemento de contraturas são justificativas para o uso de órteses. Há ainda controvérsias quanto ao uso e ao melhor momento de uso. Nesta pesquisa os autores fazem uma revisão do uso das órteses em Duchenne. O resumo em inglês deste artigo pode ser lido abaixo:
(IN PRESS:Journal of Prosthetics & Orthotics. 18(4):111-19, 2006) Lower Limb Orthotic Management of Duchenne Muscular Dystrophy: A Literature Review.
Phillip M. – USA
Although currently incurable, Duchenne muscular dystrophy remains treatable. The characteristic gradual loss of functional muscle and the concurrent developments of progressive contracture are often indications for orthotic interventions. As the disease progresses through the abbreviated life of the young man, he will encounter three functional stages: independent ambulation, assisted ambulation, and wheelchair mobility. Although controversy continues as to the appropriate role of orthoses during each of these stages, some generalities may be gleaned from a review of published literature. Specific patterns of weakness, accommodation, and contracture development characterize the initial stage of independent ambulation. Orthotic intervention is often confined to nighttime splints to slow the development of equinus contracture. As weakness and contracture progress, balance becomes increasingly precarious, and independent ambulation is ultimately precluded. Many authors have suggested that a degree of ambulation may be maintained during this phase by combinations of surgery, knee-ankle-foot orthoses and aggressive rehabilitation. The popularity of such procedures has declined since its peak in the 1970s and 1980s. Appropriate timing, patient selection, and rehabilitation appear to be essential in obtaining optimal outcomes. Weakness and contracture continue to progress until even assisted ambulation is precluded and wheelchair confinement ensues. Some authors have suggested a limited role of orthotic intervention in the form of postoperative positional ankle-foot orthoses to prevent recurrence of deformities. The relevance of corticosteroids, fracture incidence, and cognitive ability are also discussed.
