Update on Duchenne muscular dystrophy.

Treatment in muscular dystrophy should be prospective and aimed at maintaining maximal function so that the patient can be as independent as possible for as long as possible. DMD must be diagnosed early, not only to enable genetic counseling concerning future pregnancy and screening of female siblings, but also to stage physical therapy to delay muscle contracture. Surgery, when indicated, should anticipate realistic functional goals (standing, walking, transfer), and enable immediate postoperative mobilization. Bracing should be suitably provided and orthoses appropriately constructed to assure maximal support with minimal weight. Spinal deformity must be prevented when feasible and appropriately treated when present. Maximal function in wheelchair-confined patients can be enhanced through the use of an apparatus that encourages proper sitting posture and utilizes residual strength. Complications must be anticipated and vigorously treated. Attention should be paid to the psychic as well as the somatic aspects of this disease. Optimal treatment of the patient with DMD should be multidisciplinary, aggressive, and conducted in an atmosphere of intelligent concern. This approach minimizes the frustrating aspects of DMD while it maximizes the benefits obtained through available care. In this manner, the quality of life for the patient with muscular dystrophy can be significantly enhanced and his life expectancy extended.