#apaperaday: Evaluation of fatigue and fatigability in people with Duchenne muscular dystrophy using a dynamic arm support – a pilot study

In today’s #apaperaday, Prof. Aartsma-Rus reads and comments on the paper titled: Evaluation of fatigue and fatigability in people with Duchenne muscular dystrophy using a dynamic arm support – a pilot study

Today’s pick is again from Porto and the pilot test of fatigue and fatigability in Duchenne patients with and without using a dynamic arm support by Alberts et al published in Disability and Rehabilitation: assistive technology DOI: 10.1080/17483107.2024.2388284

With improving care Duchenne patients are reaching adulthood and live longer. Maintaining upper arm function will facilitate activities of daily living. Upper arms will become weak and also fatigable.

Authors explain the difference between fatigue (feeling of tiredness/perception) and fatigability (fatigue that is measurable in muscles with an EMG). They developed a dynamic arm support (DAS) and here wanted to test fatigue/fatigability in 5 Duchenne and healthy individuals.

They had a test set up that involved drinking (bringing glass to mouth) and reaching – with breaks in between. This was done with and without the DAS. This revealed that Duchenne patients with showed less fatigue and fatigability when using the DAS, especially when reaching.

This was also seen in healthy individuals, though they fatigued less. The study was done at 2 different timepoints (6-9 months apart) and Duchenne patients progressed even with the DAS (which they also used at home).

When using the DAS Duchenne patients were able to do more repetitions (reaching & drinking). For some patients less muscle activity was needed when using DAS. However, it was challenging to measure as movement was different with/without DAS due to e.g. bending neck without DAS.

Authors discuss that ideally 3D movement analysis is used for a more detailed study. Patients used the DAS at home but how much varied a lot between <4 hours per week to more than 10 hours per week. Authors discuss that in the future the time using it should be better monitored.

For a pilot study it revealed initial results suggesting less fatigue/fatigability, but it also highlighted things to change when assessing this in a larger group (which is why you do a pilot). Thanks to the authors for sharing the findings of the pilots so we can all learn.