Speech Therapy and Respiratory Training in Advanced Muscular Dystrophy

Muscular dystrophy (MD) is a collection of hereditary conditions marked by a loss of muscle mass, respiratory issues, speech difficulties, and a progressive weakening of the muscles. Muscular dystrophy of any type does not yet have a cure, although there are treatment options that can help patients control their symptoms and enhance their quality of life. Among these include physical therapy, occupational therapy, speech therapy, respiratory care, surgery, and pharmaceutical therapy.

Some varieties of muscular dystrophy, like Duchenne muscular dystrophy, cause weakening in the face and oral muscles that regulate the tongue, lips, soft palate, cheeks, and diaphragm, resulting in speech and voice quality issues. Respiratory problems are a leading cause of death. Muscular dystrophy affects respiratory function through intercostal and diaphragm muscle weakening, which often manifests after losing the ability to walk in adolescence and adulthood. However, the onset of respiratory symptoms varies significantly. Ventilatory assistance is often necessary during this stage of the illness.

Causes of Respiratory Problems in Muscular Dystrophy

• Loss of respiratory functioning
• Shallow breathing
• Inadequate breathing during sleep ( Nocturnal hypoventilation)
• Respiratory muscle weakness
• Pneumonia
• Regular cough
• Respiratory insufficiency
• Weakening of diaphragm (primary muscle for respiration)
• Postural problem like scoliosis

How to Diagnose Respiratory Function in Muscular Dystrophy

• Spirometry
• Pulmonary Function Test
• 6-minute walk test
• Lung monitoring every 6 months
• Chest radiography
• Evaluation of sleep disorder breathing

Respiratory Training in Muscular Dystrophy

As weakness and loss of function in a patient's upper limbs develop and continue, and the patient is no longer able to move his or her hand to the mouth, respiratory impairment becomes a greater possibility, requiring careful respiratory monitoring and consideration of therapeutic therapies. Treatment of muscular dystrophy depends on the breathing symptoms.

Airway Clearance: To avoid a condition called pneumonia, individuals with duchenne muscular dystrophy must maintain effective airway clearance. Ineffective airway clearance can speed the development of respiratory failure and mortality; however, early intervention to promote airway clearance can prevent hospitalisation and minimise the incidence of pneumonia.

Respiratory Muscle Training (RMT): RMT used has been chosen based on the type of muscular weakness present consequently, Inspiratory muscle training (IMT) is used for inspiratory weakness and expiratory muscle training (EMT) for expiratory weakness. RMT can begin in the early stages of the disease and can be used with youngsters. RMT may enhance lung capacity and respiratory muscle strength in some muscular dystrophy. Improvements in respiratory function translate into clinically significant changes in shortness of breathing, voice, quality of life, or physical capability. Other techniques used for Respiratory training;

• Manual technique way of respiratory training
• Mechanical technique way of respiratory training
• Nocturnal ventilation
• Full-time ventilation

Protect Breathing Function in Muscular Dystrophy

Early respiratory assessment, inspiratory muscle training, and ventilatory support can significantly reduce complications and hospitalisation risk.

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Speech Problem in Muscular Dystrophy

Speech issues can start with physical weakening. Patients with DMD can show speech issues such as delayed onset, difficulty finding words, and non-fluent speech.