Physical · Muscular Dystrophy

What is it?

It is a genetic disorder caused by a faulty or missing gene, either inherited or occurring as a spontaneous mutation.

Progressively, the muscles themselves begin to die. As muscle cells break down and fat cells form in their place, the muscle weakens and loses the ability to contract.

Usually the voluntary muscles are the most vulnerable, but some forms of muscular dystrophy may also weaken the heart and respiratory (involuntary) muscles.

What causes it?

Muscular dystrophy is a genetic disease that is characterised by a progressive muscular degeneration.

Incidence

Muscular Dystrophy occurs in approximately 1 in 3500 male births

Medical Considerations

There are two main types of muscular dystrophy:

Myotonic
This type includes when the muscles cannot relax after contraction.

Duchenne
This is when the muscle tissue is degenerating and being replaced with fatty tissue. This is the most common form and quickest degenerative muscular dystrophy.

Characteristics

Some, but not necessarily all, of the following characteristics may be present in varied degrees of severity:

• Progressive difficulty in everyday activities, e.g., writing tires hands easily
• Muscle weakness and wasting
• Joint stiffening
• Spinal curvatures
• Clumsiness in walking
• Enlarged calf muscles as fatty tissue replaces healthy muscle
• Tendency to walk on the toes as heel cords shorten
• Difficulty or inability in lifting arms or legs
• Cannot get up from the floor without pushing with hands on thighs or supports
• Heart problems and respiratory impairment
• Slurring of words as mouth and tongue muscles weaken

Support

Students may feel depression and experience social withdrawal. Be sensitive to changes and notify parents of any concerns.

Further Information

The Special Ed Wiki

Lesson Preparation & Materials

• Try a variety of modified tools .
• Minimize the amount of writing required by student by utilizing PowerPoint presentations/handouts and other techniques to keep pace with the rest of the class.
• An additional set of text books should be provided to the student so that he does not need to transport heavy text books to and from school (or from one classroom to another).
• Provide a copy of notes from class, access to a computer to type or download notes, pencils with special grips, a tape recorder or the ability to copy another student’s notes, if needed.
• If writing is a problem, he may need to take oral tests. If assignments are too taxing in terms of the amount of writing required, a condensed assignment may be given. Alternatively, a verbal report may be given instead of a written one. Computers are usually helpful and typing is often easier than writing for your student.

Teaching Strategies

• The board in the classroom may have to be lowered if the student is in a wheelchair.
• Boys are at risk for language processing difficulties. Your student may not be able to process the same amount of information or instructions as his peers. He may also have problems responding to questions or expressing himself.
• Problems with organisation, planning and prioritising are often evident.

Feedback & Assessment

• Promote the use of muscles whenever possible and appropriate. Encourage the student to be as active as possible to keep healthy muscles in condition as long as possible.
• Adapt Physical Education activities so the student can participate (e.g. use lightweight equipment).
• Be alert for signs of withdrawal and depression, the student may feel less part of the class as the condition progresses.
• Meet with the student and the parents early in the school year to help determine the student's individual needs and progress.
• Encourage active participation and use of rewards to help boost self-confidence.
• Extended time for projects, assignments, and exams. Allow time to finish assignments and exams. Even if extra time is necessary, completing a task will do much to develop the feeling of self-confidence.
• Provide consistent encouragement and support for students.

Classroom Management

• Schedule bathroom breaks or allow student to leave class a bit early to manoeuvre through the building. Classrooms should be close together to minimise distance walked throughout the day.
• Preferential seating in the classroom will allow a student to safely navigate the classroom and access his class environment so he/she can fully participate and doesn’t feel out of the loop.
• Specialised seating may be utilised. Ensure that tables are suitable for a wheelchair if necessary.
• Make sure student has access to elevators or ramps.
• Students with DMD often prefer working in mixed-ability pairs or groups to working alone or as a whole class. Most students prefer flexible rather than fixed groups selected by the teacher.
• In consultation with a physiotherapist, encourage physical activity to foster social relationships. This gives the student a break from the seated position. Standing for two to four hours per day may have both physiological and psychological benefits.
• Social Skills lessons allow opportunities for interpersonal interactions.
• Be aware of signs of depression or isolation and deal with accordingly – contact parents, talk with student, talk with counsellor and other supports. Be alert for signs of withdrawal and depression. The student may feel less a part of the class as the condition progresses.

Peers & SLSOs

• Practical Tasks that include a “Project manager” that leads their group through the investigation but doesn’t necessarily perform the experiments. Assistance throughout the practical with any tasks that require physical manipulation that is beyond the student’s abilities. Utilise a ‘Buddy system’.
• Talk to the class about muscular dystrophy, and if the student is comfortable with the situation, have the student explain any specific needs. Encourage other students to find out how they can assist and when they should assist.

Have I...

• Provided audio recordings and technological supports?

• Issued handouts of summaries and lesson notes?

• Established a peer mentoring program or SLSO support?

• Adapted assessment tasks and deadlines?

• Established a reward system and method for students to self-monitor progress?