DMD children will lose the ability to walk independently and will start using a wheelchair on a more regular basis. They will still be able to use their arms to propel themselves around, but increased weakness will start spreading to the arms and neck. They will continue to be able to use their arms and fingers so they will still be able to write and use a computer. 

Lungs will weaken, which may lead to difficulties with breathing. Breaths may become shallower, and the ability to cough lessens. This may lead to more chest infections because it's harder to clear mucus and germs from the chest. As breathing weakens, oxygen levels in the blood may fall, leading to tiredness, irritability, headaches on waking, inability to sleep and vivid dreams. Breathing respirators, and cough assist technologies can help with this. In time, support will be needed breathing, first overnight and then during the daytime.

The heart muscles will also be affected. This is called cardiomyopathy, and there are treatments available to help.

AREAS TO CONSIDER 

 - physiotherapy to remove mucus from the chest

 - non invasive ventilation

 - techniques to increase the air flow into the lungs

 - breathing respirators

 - hoists

 - monitor for scoliosis

 - bone drugs (bisphosphonate treatments)

 - regular echocardiogram tests for the heart

 - heart medication (ace inhibitors, beta blockers)

 - promoting independence

 - support for frustration, anger and emotional distress

 - respite for carers

 - ask consultant about a sleep study (if sleepy in the day or headaches)

 - DEXA scans to monitor bone strength