Exercise. To keep as strong as possible and prevent contractures, probably the best therapy, at least at first, is to stay active, to walk, run, and play. While range-of-motion and stretching exercises may help it is even better to involve the child in games, work, and other activities that keep his joints flexible. Even though he is slow and awkward, encourage him to take part. Feeling sorry for him and just letting him sit is the worst thing you can do.

Braces. Long-leg braces should not be used until absolutely necessary, as they will let the child's legs grow weaker faster. Sometimes lightweight plastic ankle splints, worn day and night, will help delay ankle contractures and keep him walking better.

If contractures of the knees and hips begin to develop, try resting or sleeping with 'sand bags' to press down the legs and help straighten them.

Other aids. The child will reach a point where he needs to use crutches. Later, (often by age 10) he will not be able to walk. Do not force him when it becomes too hard. Instead, try to obtain or make a wheelchair. (See Chapter 65 to 67.) At first, the child may be able to roll it himself. But as his weakness progresses, he may need to be pushed.
Breathing deeply is important, especially when the muscles that move the lungs begin to waken. Encourage the child to sing loudly, to shout, to blow whistles, and to blow up balloons.

Other Problems

• Getting fat is a common problem in children with dystrophy. The child needs to eat a healthy balanced diet. But take care not to let him eat too much-especially sweet things. Extra body weight will make walking, breathing, and other activities more difficult for his weakening body, and will make it harder for family members to lift him.
  
  
• Constipation (hard, difficult stools) may become a problem. Drinking lots of liquid helps. So does eating fruits and vegetables, and foods with lots of fiber.
  
  
• Spinal curve can become severe (see picture of Tito drawing, below). A corset or body brace may help hold the child in a straighter position so he can use his arms better and breathe better.
  
  
• Arm weakness in time may become a problem for self-care and eating.
  

You can make a simple aid to help get the hand to the mouth CAUTION: If elbow contractures develop, it is probably better to leave them, as a bent elbow is more useful than a stiff, straight one

Learning to draw and paint can be fulfilling. In Los Pargos, and organization of families of disabled children in Mexico, 4 brothers with muscular dystrophy have all become very good artists. Their paintings have won prizes in contests and are sold to raise money for the group. The best artist of all was the oldest brother, Tito. He took pride in his paintings and enjoyed teaching the other children. He did one of his best paintings, a sea turtle with wings, a week before he died, at age 17.

PREVENTION: The only way to prevent muscular dystrophy is for women who may have the dystrophy gene not to have children. This mostly means sisters of affected boys and close relatives on the mother's side. If you have one son with dystrophy, other sons will be likely to have it too. You might consider not having more children.

OTHER MUSCULAR DYSTROPHIES AND MUSCULAR ATROPHIES

The type of dystrophy just described-also called progressive, pseudohypertrophic, or Duchenne's muscular dystrophy-is the most common. But here are many different types of muscular dystrophy and muscular atrophy. All start little by little: some in early childhood, some between ages 13 to 19, and some in adults. All steadily get worse. Some types, however, almost stop after a certain age, and the person may live to active old age, although handicapped.