Multidisciplinary Clinical Care

Home Our Services Multidisciplinary Clinical Care

Our children affected by DMD need the right diagnosis and special professional care and medical interventions as per global recommendations. It is no longer appropriate to look on DMD as a condition that is inevitably fatal in childhood as the majority can now be expected to reach adulthood with proper care and love. The experts stress that the best management of DMD requires a multidisciplinary approach, with the input of specialists from different areas of care and intervention. An appropriate multidisciplinary approach for management of these children includes the services of many clinical specialist doctors, lab facilities and specialized equipment like spirometer, Echo cardiogram and Electro cardiogram machines, care givers and rehab specialists.

With the release of the final recommendations from Centre for disease control (CDC, USA) and Treat-NMD on Standards of care for DMD affected children, MDCRC have been conducting Multidisciplinary Clinical care camps for kids with Duchenne Muscular Dystrophy and Becker Muscular Dystrophy for this purpose.

1. Diagnosis and Management of Duchenne Muscular Dystrophy – part I
2. Diagnosis and Management of Duchenne Muscular Dystrophy – part II

MDCRC handles children in five stages, Presymptomatic, Early ambulatory, late ambulatory, early non-ambulatory and late non-ambulatory. In these clinics, the parents register and give their consent for the examination. This is followed by lab investigations, ECG, X-Ray chest & Spine, Pulmonary Function Tests and clinical examination by the specialist panel of doctors with appropriate advice as per international guidelines with the expertise of the doctors for our Indian children.

Complete team with Paediatricians, Neurologists, Orthopedicians, Rehab specialists, Physiatrists, Pulmonologists, GI, Nutrition and the Diagnostic team has been formed. Evaluation forms were prepared by the team as per CDC USA & Treat NMD International Guidelines. MD Care camps are conducted on Saturdays at MDCRC.

 

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Our Services

Physiatrist

  • Vital link between the medical team and the rehabilitation team
  • Disease progression of the child was evaluated individually
  • Holistic approach to management considering the rehabilitation needs of the patient while developing a treatment plan
  • Focus on strategies to prevent complications
  • Prescribe Orthotics according to child’s need
  • Rehabilitation and education combined in a personalized program that maximize each patient’s residual abilities

Respirative Care

As a result of dystrophin deficiency, patients with DMD experience a progressive loss of muscle fibre that eventually affects the respiratory muscles. The resulting respiratory failure is the most common cause of premature death in patients with DMD.

Respiratory muscles are progressively compromised in children with DMD, the expiratory muscles being the most commonly affected. Even short periods of physical inactivity can contribute to muscle weakness and reduced respiratory capacity. There is evidence that breathing exercises can improve respiratory function in patients with DMD.

Stretching Therapy

Regular stretching is of enormous benefit for children with Duchenne muscular dystrophy. Performing a daily stretching routine is the most effective way to prevent loss of flexibility. When done correctly, it can prevent muscle contractures and deformities and ultimately improve physical ability and prolong independence.

Suspension Therapy

This technique helps to free a body part from the resistance of friction while it is moving the part. It is suspended in a sling attached to a rope that is fix to an appropriate point above the body segment This is applicable in cases in which the patient not able to do the movement actively.

Movement Therapy

Can do passively, actively and actively with assistance This helps to increase blood circulation, maintain joint range of motion and also prevent developing muscle tightness and thereby prevent contracture.

Aerobics Training

Aerobic exercise helps to maintain overall fitness, especially cardiac and respiratory health. If muscles are intact and functioning, then resistance, or strengthening exercise helps to increase muscle mass.

Gait & Co-ordination Training

It helps to

  • strengthen muscles and joints
  • improve balance and posture
  • build endurance
  • develop muscle memory
  • retrain legs for repetitive motion
  • lower risk of falls, while increasing your mobility

Postural Correction Training

The recognition of abnormal postures is important as they ultimately interfere with activities of daily living, function and quality of life. The assessment and management of posture is thus one of the most important aspects of the medical and rehabilitative care of these patients. First aim is to diagnosis of postural defect, then start giving proper stretching and strengthening exercises as early as possible which helps to prevent further postural defects.

Electrotherapy

IFT, Ultrasound, Electrical Stimulation, FIR are some of the equipment used for treatment. It mainly helps in:

  • Relaxation of muscle spasms
  • Improved local blood circulation and flow.
  • Re-education of muscles using targeted stimulation
  • Management and reduction of pain
  • Facilitation of healing of muscle injury

Group Exercise Therapy

Exercising with a Group is motivating. It will even spark some friendly competition. It can be fun also.

Occupational Therapy

  • Play therapy for very small children.
  • Activities involving gross and fine motor hand function such as clay modelling, puzzle solving, craft activities.
  • Balance training In swiss ball such as ball bouncing, prone in the ball, lateral trunk flexion in the swiss ball.
  • Obstacle crossing which will promote balance and proper weight shifting for ambulant kids.
  • Bed mobility with and without assistance to promote trunk activity.
  • Teaching energy conservation and modified day to day activities.
  • Helping in living a quality life.

Play Therapy

Play therapy is a form of therapy primarily geared toward children. In this form of therapy, a therapist encourages a child to explore life events that may have an effect on current circumstances, in a manner and pace of the child’s choosing, primarily through play but also through language.

Yoga Therapy

In the rehabilitation centre in Coimbatore, regular yoga sessions are being taught by a trained Yoga teacher, who is imparting this wonderful knowledge to the benefit of the children and families. Apart from regular physiotherapy, ‘Yoga’ is also imparted with the rehab management. Mainly because, yoga and its benefits are holistic and it addresses the respiratory health in an extra ordinary way. Pranayama, Kapalapathi and Bhastrika are very helpful to maintain good lung function.

We believe yoga will contribute towards good breathing practices and help in improvement of basic gait and respiratory function. We have specially planned exercises and yoga sessions for parents and children to enable them to cope better. Children are evaluated on a regular basis for their consistent effort and their performance is recorded.

Benefits include

  • Improve body flexibility and balance.
  • Improved cardiovascular endurance (stronger heart)
  • Improved digestion.
  • Enhanced overall muscular strength.
  • Relaxation of muscular strains.
  • Weight control.
  • Increased energy level

Virtual Reality

We have started Virtual Reality in rehabilitation. With the growing accessibility of computer-assisted technology, one option for rehabilitation programs for individuals with Duchenne muscular dystrophy (DMD) is the use of virtual reality environments to enhance motor practice. There is a need to support individuals with Duchenne Muscular Dystrophy (DMD) to achieve optimal functionality in everyday life and with meaningful tasks and activities, throughout stages of the disease progression. Thus, technological developments have created an exciting opportunity for the use of affordable virtual reality (VR) systems with different kinds of interaction devices, providing an efficient and fun tool for enabling improvement in motor performance.

Rehabilitation Aids

We provide Orthotics such as Foot drop Splints, Hip Knee Ankle foot Orthotics (HKAFO), Knee Ankle foot Orthosis (KAFO), Ankle Foot Orthosis (AFO), Knee Brace, Callipers, Gutter splint to the children according to their specific needs. These customized Orthotics are being assessed and evaluation done by a Physiatrist & Rehabilitation Medicine Expert for every child once in a month.

Training

Training was offered to the professionals (Community Health Nurses, Teaching professionals, Officials in Differently abled welfare organization, Integrated Child development Scheme), who serve as a liaison between the community and the health fraternity. This in turn creates an integrated network to cater to the children and families afflicted by this condition. We have trained over 15,000 people to identify the children with Duchenne in both rural & urban across the state. By this collaborative effort we could raise awareness on the existing government schemes amidst to the families.

Village Health Nurses Training

Training was provided to the public Health workers through out the state. Nearly 10,000 health workers were trained to identify the children with the symptoms in rural & Urban.
Traning-VHN
Doctors Training

Doctors Training

Refresher courses and subject specific training for doctors provided this equipped Primary Health centers to identify children with Duchenne over 500 clinicians trained till date.

ICDS Training

Integrated Child Development Scheme official (Anganwadi Teachers) were trained for early identification of symptoms as they are well equipped to cater to the children below 5 years.

training-SSA

SSA Training

Special Educators play an important role in government schools to train and educate children with special abilities we did not miss this opportunity to collaborate with them and conduct camps in school premises.

Screening Camp

Screening camps were conducted in each & every district of the state. We had conducted more than 3000 children were screened to identify the kids with symptoms
screeningcamp-1
camp in rehab

Camps in Rehabilitation Centers

Screening camps was conducted regularly for the patients rehabilitation centers like Myopathy Kappagam, Veeravanallur & also at Amar Seva Sangam, Ayakudi in Tirunelveli district for the genetic diagnosis. 

Door Step Screening

Field Visit

Our Community Outreach workers have reached at the door steps of more than 1000 houses to screen the children with symptoms of DMD who otherwise had no means to reach the hospital or camp sites.
Door Step Screening-field visit

IEC Activity

Information , Education, Communication (IEC Activities like Rally, Marathons, Holding plug cards in traffic signals and newspapers to create awareness among the public to bring about an inclusive society and equity.
IEC Activity

Volunteer and Support Group

We have more than 500 volunteers across the state to help us the families in the respective districts. Networking is going on yet to strengthen the volunteer group.
Volunteers Group

Ambulance

Rehabilitation services are offered on a regular basis for the children affected with Duchenne Muscular Dystrophy who are residing in and around Coimbatore and Tirupur. The children are brought to the Rehabilitation centre in MDCRC from their door steps in a customized van with a ramp that is wheel chair accessible.
Ambulance (2)
Ambulance (1)

Prenatal Counseling

Prenatal genetic counsellor works with individuals, couples, or families who are more likely to have a child with a birth defect or genetic condition. This helps in early stage of pregnancy to identify genetic abnormalities. People who are currently pregnant or planning having a child in the future should consult with a prenatal genetic counsellor to learn more about the condition in question, to better understand its complications, and to explore options for prenatal screening, testing and/or assisted reproductive techniques. They will make the family understand the clinical information, what to expect and how to prepare for the birth of the child with special needs and discuss abortion or adoption options as well.

Group Counseling

Group counselling is a form of counselling where a small group of individuals gather to discuss, interact, and explore an issue, helping to gain mutual support and motivation. The key idea behind this is, struggling with specific issues may lead to isolation, and a feeling that you are alone in dealing with your problem. Enhancing emotional expressiveness, group counselling attempts to lessen this social isolation by assembling people with similar issues to enforce that difficulties are not singular to one person. Additionally, knowing other people with similar problems may be soothing for an individual, who may not have access in their own family and friends to people with the same problem.

Individual Counseling

Individual counselling is a one-on-one counselling between the family and a trained Genetic counsellor, in a safe, compassionate, and confidential atmosphere. During the session, the genetic counsellor gains more details from the family by making them comfortable enough to share their feelings. By doing so, the family is able to identify those aspects of their lives that they would like to enhance. Thus, it encourages them to have a clear insight of themselves and others. By gaining the insight they will realize what’s troubling them and what they actually want in life.

Reproductive Counseling

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Tele-Genetics

Due to COVID19, tele-genetics services made genetic counselling feasible via internet, it provides consultations faster through both telephonic and video call. Tele-consultation saves time by helping families in this pandemic get consultations without travelling long distances. Also this technique is a quicker way to assist families with any emergency needs.

Psychosocial Counseling

Psycho-social refers to both the individual’s psychological and social dimensions. This counselling is an activity in which the counsellor provides time, attention, respect that is required to discuss, find and describe ways of living more resourcefully. It enhances the individual’s mental and emotional health.

In Person

    Select Date & Time for Appointment *

    Name of the patient *

    Age *

    District *

    ID proof of the patient *

    Contact number *

    Alternate contact number (optional)

    Have you done Genetic test? (optional)

    Upload Genetic report (optional)

    Tele-genetics

      Select Date & Time for Appointment *

      Name of the patient *

      Age *

      District *

      ID proof of the patient *

      Contact number *

      Alternate contact number (optional)

      Have you done Genetic test? (optional)

      Upload Genetic report (optional)

      What mode do you prefer to have genetic counseling session? *

      WhatsApp Number

      Email id

      Genetic Test done in MDCRC

        Name of the child *

        Name of the registering parent *

        Country *

        State *

        District *

        Phone number (preferably WhatsApp number) *

        MDCRC ID No. (check your genetic report given by MDCRC) *

        Genetic Test done elsewhere

          Name of the child *

          Name of the registering parent *

          Country *

          State *

          District *

          Phone number (preferably WhatsApp number) *

          No Genetic Test done

            Name of the child *

            Name of the registering parent *

            Country *

            State *

            District *

            Phone number (preferably WhatsApp number) *

            Sample Collection

            Collect 3ml of blood

            Transfer blood into EDTA tube

            Shake the EDTA tube to avoid blood clot

            Gently shake the tube to avoid blood clot

            Pack the sample in courier cover

            Pack the sample in courier cover

            Place-the-sample-in-a-box

            Place it in a box

            Labelled-EDTA-tube

            Label the tube with Patient name and Date

            Molecular Diagnostics, Counseling, Care & Research Centre (MDCRC)

            Located at: 7th floor, Royal Care Super Speciality Hospital,

            1/520, L & T Bypass Road, Neelambur, Coimbatore – 641062

            Ph. No: 9489053703, 9489053704

            DNA extraction

            • Extraction of DNA is the process to isolate the DNA from whole blood.
            • We use simple manual method to isolate DNA from the nucleus of the cell
            • 3-5 ml of blood is more than enough to identify the genetic disorder Duchenne Muscular Dystrophy (DMD)

            Multiplex-Polymerase Chain reaction (mPCR)

            • mPCR is used to detect deletions in Dystrophin gene
            • Most deletions occur in hotspot regions
            • Testing is done by PCR for 30 exons (as per SOP)
            • Turn-around time for reports will be 3 to 4 weeks

            Multiplex-Ligation dependent Probe Amplification (MLPA)

            • MLPA is used to detect both deletions and duplications of 79 exons in Dystrophin gene
            • Testing is done by MLPA (as per SOP)
            • Turn-around time for reports will be 2 months

            Next generation Sequencing (NGS)

            • NGS is used to detect other mutations including point mutation, small deletions or insertions, single base changes, or splicing mutations
            • Testing is done by Next Generation sequencing method
            • Turn-around time for reports will be 3 months

            Report Generation

            After molecular analysis, report will be generated based on the parameter on which it is diagnosed and the report will be handed over to genetic councilor

            Counseling

            After analyzing the reports, the Genetic councilor will convey the condition of the disorder to their parents. They also advice parents how to prevent the Duchenne to next generation.
            Counseling