CLINICAL APPLICATION OF PHOTOBIOMODULATION IN DMD: AN OBSERVATIONAL CASE STUDY

Sunday, November 24, 2024

10:00 AM – 10:15 AM East Coast USA Time

Location: Meeting Room 557, 5th Floor, RI Convention Center

Presenting Author(s)

Elizabeth G. Harvey, PT, DPT, MSR, PCS, DHS (she/her/hers)

Owner
ABC Therapies LLC
Moncks Corner, South Carolina

Co-Author(s)

JL

Jenna Lammers, MSR/PT, CNT, PCS

Clinical Evaluator/Physical Therapist
University of Florida
Gainesville, Florida
SS

Stephanie Salabarria, BHSc

Clinical Research Coordinator
University of Florida
Gainesville, Florida
JB

Julie Berthy, APRN, DNP

Clinical Research Manager
University of Florida
Gainesville, Florida
GW

Glenn Walter, PhD

Professor and Vice-Chair UF College of Medicine
University of Florida
Gainesville, Florida
BB

Barry Byrne, MD, PhD

Professor And Associate Chair UF ME-Child Health Res Institute
University of Florida
Gainesville, Florida

Background & Purpose:

Introduction: Duchene Muscular Dystrophy (DMD) is a progressive genetic disorder characterized by severe muscle wasting and inflammation due to a lack of functional dystrophin in the muscle cell wall1,2. While many of the comorbidities associated with DMD are managed by some combination of physical therapy (PT), 2 steroids, and disease-modifying therapies, novel approaches to providing care for DMD patients are needed.
Photobiomodulation (PBM) has delayed muscle cell degeneration in MDX mice by modulating dystrophin gene and protein expression3, reducing oxidative stress1,3,4,5,6,7,8, improving mitochondrial function6,8, and modulating growth and myogenic regulatory factors1,4,6,7,8,9. The anti-inflammatory effects are equal to prednisolone or glucocorticoids, with the added benefit of muscle regeneration and angiogenesis in mice7,10

Objectives: Three objectives were identified: (1) ) quantify muscle findings from MRI studies in DMD, (2) link MRI and other objective measurements to the clinical use of PBM, and (3) determine the feasibility of using PBM in this population.

Case Description:

Methods: Under an IRB-approved N=1 study (IRB201700087), the patient received PBM 2x/week for 12 months and completed the following outcome assessments every 3 months: Magnetic resonance imaging (MRI), North Star Ambulatory Assessment (NSAA), Rise from Floor (RFF), 10-meter run test (10MRW, 6-minute Walk Test (6MWT), Styku body analysis, and others.

Outcomes:

Results: The patient reported ease of use with independent operation. Following interim analysis (6 months), there was a 12% increase in total NSAA score and an overall increase of 0.7s on the 10MWR time from baseline. Total distance walked on 6MWT and RFF remained stable. Styku findings revealed a 3.6% increase in bone mass, 0.9% decrease in subcutaneous fat, and a 10.8% decrease in visceral fat from baseline. MRI analysis Skeletal MRI interim analysis (6 months) shows a 7% decrease in the muscular tissue’s water component (wT2) in the Gastrocnemius medialis, 8.5% decrease in wT2 in the Soleus, and 4.6% decrease in wT2 in the Tibialis anterior likely signaling a decrease in muscle inflammation from baseline. Twelve month findings (March 2024) will be shared at the Pediatric Conference.

Discussion:

Conclusion: Photobiomodulation has the potential to benefit patients diagnosed with DMD. Future work is needed to increase the sample size and prove statistically significant benefits. A frequency of three times a week seemed most beneficial for changes in body composition; however, function was regained with even two times a week. Functional gains were observed despite two major physical injuries during the year. Additionally, MRI interim analysis signaled a decrease in inflammation in the lower leg muscles making MR a potential biomarker for monitoring the progress of photobiomodulation therapy.