Duchenne Children’s Balance Deteriorates as Disease Progresses, Study Finds

The balance of children with Duchenne muscular dystrophy who are moving becomes worse as the disease progresses, suggesting that balanced-focused interventions may improve the children’s ability to handle everyday tasks.

The study, by researchers at Hacettepe University in Turkey, noted that Duchenne progresses differently in different children. That suggests that, in addition to biological factors, variations in care, socioeconomic status, and physiotherapy can impact disease progression, the researchers said.

The study, “Effects of functional level on balance in children with Duchenne Muscular Dystrophy,” was published in the European Journal of Paediatric Neurology.

Balance is crucial to performing a variety of tasks. Its loss not only increases Duchenne children’s  risk of injury, but also sets restraints on how function in daily life. Impaired balance limits mobility, partly because of its physiological impact and partly because of a fear of falls. Compromised mobility, in turn, restricts independence and social participation.

The study looked at both dynamic balance — or balance while moving — and static balance — or balance with someone is stationary.

Although it is well known that children with Duchenne have balance problems, the researchers noted that no previous study had examined balance in different stages of the disease.

Researchers recruited 52 Duchenne patients aged 6 to 11. The children were in their initial disease stages, corresponding to the first three levels of the Brooke Lower Extremity Functional Classification scale. Children in level 1 can ascend four stairs swiftly and without help, while those in level 3 must take stairs slowly and with the help of a handrail.

The research team divided the groups by severity of their disease, with each group containing 17–18 patients. The study also included a group of 17 healthy controls of the same age.

To measure dynamic balance, researchers used the timed up and go test (TUGT). The children were asked to stand from their chair, walk three meters at their usual speed, then return and sit down on their chair again.

Children in level 1 — the group with the best balance — had worse balance than the controls, researchers found. And the balance deteriorated as the disease progressed, with patients in group 2 having worse balance than in group 1, and in group 3 having worse balance than in group 2.

Researchers assessed static balance using the pediatric functional reach test (PFRT). It is performed both in a seated and standing position. It requires children to raise their arms 90 degrees and reach as far as possible.

Although all Duchenne patients performed worse than controls while seated, the differences were not statistically significant. In a standing position, only patients with level 3 Duchenne had significantly worse balance than healthy controls. Patients in the first two levels also had worse balance than their healthy peers, however.

Based on their findings, the research team proposed that physiotherapy programs should focus on maintaining Duchenne children’s balance.