Chest Physiotherapy for Children
In Muscular Dystrophy, the muscles are weak, along with the other trunk and spine muscles. The children tend to use their diaphragm muscle more when breathing than we would normally, which is why they may develop a longer, thinner looking chest. When the children get a chest infection, the inability to take good deep breaths and cough forcefully may make the clearance of excess thick phlegm that occurs more difficult. This is when chest physiotherapy is useful to help clear the lungs and get the phlegm into the mouth where it can be spitted out. Chest physiotherapy works by helping to drain the secretions out of the lungs and get them to where they can be removed or swallowed.

The main techniques used are
Postural drainage
Postural drainage involves laying the children in certain positions, dictated by the shape of the lungs to allow gravity to help drain the secretions towards the mouth. In some chest infections, only specific parts (lobes) of the lungs have excess secretions, while in other infections most or all of the lobes will be affected.The most commonly used positions involve the child lying tipped head down over pillows on his/her back, front and sides. The other position used, mostly with small children, is sitting.
Percussion
This is when the child’s chest is clapped gently with cupped hands to help shake the secretions loose. Most children find this quite soothing and effective, even though it may sound as though it hurts.
Breathing exercises and ‘Forced expiration techniques’ (FET)
Breathing exercises are used to help the child increase air entry into the lungs, as effective deep breaths also help to loosen the secretions that occur as a result of the infection. There are several different ways of teaching deep breathing and FET (which is sometimes called ‘Huffing’)
Assisted coughing
This can be useful for very weak children who have a lot of difficulty getting the phlegm to the back of their throats to swallow it. It involves putting your hand under the diaphragm, on the child’s tummy and pushing firmly upwards to give more force to the cough. This technique is not difficult to do but needs practice to get the timing correct with the child’s attempt to cough.

Positioning & Seating in Muscular Dystrophy
The spine is a complicated series of bones joined together to allow bending forwards and sideways and for rotation to be possible. Normally, the spine is held straight by the action of many spinal muscles and the abdominal (tummy) muscles working together. In babies, these muscles are weak but get stronger in due course of time as they grow up, allowing for rolling, then sitting and eventually standing, walking and more complicated movements.

In muscular dystrophy, these muscles remain weak and could affect the child’s ability to progress towards their expected milestones of development. The shape of the spine then becomes affected by gravity pushing down, by asymmetrical muscle power (i.e. one side being stronger than the other) and by joint contractures, particularly in the hips.

Some very weak children may need to wear a spinal jacket to help them to sit. Others may need to start wearing a jacket when they begin school because they spend a lot of time sitting down. Some of them may need to start wearing one for intermittent periods of time, as they grow taller and need extra support. Standing is strongly recommended as it helps to strengthen their spinal muscles. It is an easier position in which to control symmetrical movements, and in a ‘Lordotic’ posture, (one where the child appears to be leaning backwards) rotation of the spine is much more difficult. Besides, standing also stretches the hips.

Standing may be done in a standing frame, in a swivel walker or in calipers, but it is very crucial that whatever the child stands in, his/her spine is held straight. It is never possible to say that the child’s spine will or won’t remain straight and in most cases there will be some deterioration in posture as the child grows. The important thing to remember is that exercises, standing and wearing a spinal jacket when advised, will lessen problems in the long term.

In some cases, spinal surgery may be recommended for an older child but the decision to go ahead will have to be taken by you, the child himself/herself and doctor, all of you put together. If surgery is not a possibility, then it is imperative that the spine is supported to help prevent further deterioration. Seating becomes a higher priority and it really can help. Positioning and seating are very crucial for your child to enable him/her to perform any function in the best possible manner. Besides, it goes a long way in helping to prevent spinal and joint–related problems.

As a baby, it is good and advisable for your child to go through the normal experiences of lying on the back, sides and tummy, even though he/she may find lying on the tummy, a position from which he/she can do very little. A rolled towel placed under the chest will help your child to try and push down through the arms and try to lift the head and trunk. Just because your child finds certain things difficult, there’s no reason why he/she shouldn’t try, because that would provide the child with some good exercise.

A good supportive seat is essential all along. A cradle is often too soft and a firmer seat is better. Baby bouncers and baby walkers should be avoided as they do little to improve posture and trunk control. There are many good high chairs in the market which are convertible to floor chairs. In the case of very weak children, special seating would be necessary and your therapist would be able to arrange for this.

Wheelchairs should also be supportive. Avoid those that have a bar at the front which cannot be removed. The back of the chair should be the type that could be brought up to almost the upright position for the child when he/she is awake, and only be reclined when he/she is particularly tired or sleeping. The foot rest should be at the correct height to prevent the feet from dangling or the knees being pushed up. The depth of the seat should support almost the entire length of the child’s thighs without digging into the back of his/her legs.