Tippi Coronavirus: Tips for Living With COVID-19. In … ... Parent Project Muscular Dystrophy (PPMD). Muscular dystrophies are a variety of conditions characterized by progressive muscle weakness and wasting of muscles that control movement, but can also affect the heart. These may include: If you are feeling any sort of abnormal muscle wasting or weakness, you must see your doctor right away. If it’s missing, abnormal, or damaged in the sample muscle tissue, this is a possible sign of DMD or Becker muscular dystrophy. Although all types of muscular dystrophy share the same basic symptoms, each has its own unique characteristics and strikes different people in different ways. Once your doctor has performed a clinical assessment of your muscular weakness, he or she may order special tests to confirm the diagnosis. Duchenne muscular dystrophy, the most common type, has a specific set of symptoms that lead people to the conclusion that they may have the disease. Muscular dystrophy is a genetically inherited group of almost over 30 disorders. The diagnosis of muscular dystrophy is based on the results of muscle biopsy, increased creatine phosphokinase(CpK3), electromyography, and genetic testing. Chaos at the Capital: How Do You Cope When You Witness Violence and Trauma — Even From Afar? Enzyme tests. A neurologist will likely check reflexes and coordination or perform exercise assessments that evaluate levels of strength and respiratory function. In its most … People born with DMD will see many healthcare providers throughout their lives. National Institute of Child Health and Human Development. Because muscular dystrophy is a genetic disorder — meaning it’s caused by an alteration in the makeup of a gene — your doctor will take a family medical history as part of the exam. Duchenne muscular dystrophy (DMD) is a rare genetic (inherited) disease defined by muscle weakness that gets worse over time and ultimately affects the heart and lungs. Muscular dystrophy (MD) is often considered one disease that presents in a classic way. The CPK can be extremely high, sometimes in the many thousands. It also helps doctors do a better job of treating the mechanisms underlying the condition and its symptoms. Steve Way advocates for universal healthcare, disability rights, and more film roles for disabled actors.  No matter what your level of disability, a yoga practice is possible and offers mental and physical benefits.  This quick alphabetical guide will help you feel more confident when talking about muscular dystrophy with your doctor and loved ones. If you are having any of these symptoms, it is imperative that you visit your doctor right away. */ In diagnosing any form of muscular dystrophy, a doctor usually begins by taking a patient and family history and performing a physical examination. Muscular dystrophy is a genetic disease and is inherited from one of your parents. The disorder has very specific diagnostic signs. If further confirmation of muscular dystrophy is needed, a muscle biopsy or genetic testing may be recommended. Genetic testing is performed by a geneticist, or specialist in genetic medicine. The level of CK is typically elevated from birth and peaks around the age of 2, after which it steadily declines due to … Although the diagnosis of muscular dystrophy is largely made by clinical examination, genetic testing, and blood tests, your doctor may order a magnetic resonance imaging (MRI) test. Its course is slower than that of Duchenne’s and can be harder to predict. A slower electrical response in the muscles can indicate muscular dystrophy. Side effects. The initial investigation used to screen for muscular dystrophy is serum creatinine kinase (CK), an enzyme which leaks out of damaged muscle cells. An analysis of symptoms also helps differentiate between the nine different types of muscular dystrophy. Elevated levels of serum aldolase can also be a sign of muscle weakness and indicate a need for additional testing. © 1996-2021 Everyday Health, Inc. Myotonic muscular dystrophy: The Myotonic muscular dystrophy often called myotonic dystrophy are of two types, the type 1 MMD is occurring due to DMPK gene mutations while type 2 occurred due to CNBP gene mutations. Muscular dystrophy is a group of more than 30 inherited diseases, each of which affects people differently. Diagnosing the more common forms of muscular dystrophy tends to be easier. Depending on your symptoms and family history of muscular dystrophy, your doctor may recommend one or more tests. Muscular dystrophy is actually a collection of more than 30 types of genetic disorders, all of which cause progressive muscle weakness and loss. Preconception counseling is strongly advised for women who have muscular dystrophy or carry a gene mutation that causes it. March 20, 2020. Because muscular dystrophy is caused by genetic mutations that are most often inherited — although they can also arise spontaneously — a genetic, or DNA, test is used to determine if you or your child has any of these mutations. For this reason, it is important to go through a careful diagnostic process, usually involving genetic (DNA) testing. Electrical activity is measured as you relax and gently tighten the muscle, and any changes in the pattern of electrical activity can confirm muscular dystrophy. BMD has sometimes been misdiagnosed as Duchenne muscular dystrophy (DMD) or limb-girdle muscular dystrophy (LGMD). Some, such as Duchenne muscular dystrophy, usually lead to death in late childhood, while others, such as Becker muscular dystrophy, commonly allow people to live to age 40. Applying for Social Security Disability Benefits with Muscular Dystrophy. When this protein is not working properly or is absent, muscular wasting and weakness occur. It can cause potentially life-threatening complications due to the weakening of the heart and muscles involved in breathing. Symptoms of the most common variety begin in childhood, mostly in boys. Different Names: Duchenne’s muscular dystrophy, Muscular dystrophy, Duchenne; DMD; Muscular dystrophy, pseudohypertrophic reformist, Duchenne type Classes: Congenital and Genetic Diseases; Ear, Nose, and Throat Diseases; Eye infections; See More This infection is gathered under Muscular dystrophy. For most muscle disorders, a muscle biopsy, in combination with a person’s symptoms, family history, and the results of genetic tests, can determine the specific muscle disorder. D'amario D, Amodeo A, Adorisio R, et al. You place your lips tightly around the mouthpiece and take in as big and deep a breath as possible and then blow out as hard and fast as you can. January 31, 2020. Diagnosing Becker muscular dystrophy is complicated since it shares so many symptoms with other conditions including Duchenne, limb-girdle muscular dystrophy and spinal muscular atrophy. If signs of muscular dystrophy appear in your or your child’s blood work, a neurologist can confirm the diagnosis through a variety of tests. If your child has Duchenne muscular dystrophy (DMD) or Becker muscular dystrophy, the two most common forms of the condition, a muscle biopsy may show whether dystrophin, a muscle protein, is missing or abnormal. The disease affects the muscles with definite fiber degeneration but without evidence of morphologic aberrations. Myotonic dystrophy can appear at … In addition, your doctor may recommend magnetic resonance imaging (MRI) and ultrasound imaging to examine muscle quality and bulk as well as the fatty replacement of muscle tissue. Muscular dystrophy is diagnosed at any age from infancy to adulthood, and is classified accordingly into various types. It affects the small muscles of the arms and legs. Other conditions may also cause muscle weakness. The age of onset and rate of progression can vary. The tests can also help your doctor rule out other possible causes of muscle weakness, such as toxic exposure, medication side effects, or other muscle diseases. The diagnosis for muscular dystrophy depends upon the type and the intensity of symptoms. Becker muscular dystrophy symptoms usually show up in a person’s teens or early adult years. The accompanying rundown remembers the most well-known signs and … Blood samples are usually collected for use in genetic testing, but your doctor may also use a cheek swab, skin biopsy, or muscle biopsy. The diagnosis is made by muscle biopsy. The initial diagnosis of muscular dystrophy is usually made when the onset of symptoms occur. Korschun, H. (2007, July 3). You might feel comfortable discussing your feelings with a friend or family member, or you might prefer meeting with a formal support group. Sometimes, however, it isn’t made until adolescence or even adulthood, possibly when a young man finds he can’t keep up in … Darras BT. Diagnosis will involve some or all of the following stages: investigating any symptoms ; discussing any family history of MD ; physical examination ; blood tests Gene therapy is poised to revolutionize how Duchenne is treated, but there are still some problems with this approach that need to be solved. Physical Therapy, Surgery, Medication, and More. Symptoms, Causes, Diagnosis, Treatment, and Prevention. Nevertheless, most individuals with muscular dystrophy do lose the ability to walk and ultimately need a wheelchair. RELATED: Your Everyday Guide to Living Well With Muscular Dystrophy. 2012;2012:485376. doi:10.1155/2012/485376, Bönnemann CG, Wang CH, Quijano-roy S, et al. Getting a formal diagnosis and understanding your child's specific mutation is a critical step in determining a path for care, whether that is managing the disease or participating in clinical trials for possible treatments. Diagnosis before the age of two or three is possible through: Retrieved on Aug 22, 2018. Nerve Plexus: Function, Structure, and Location, Anterior Tibialis Rupture: Symptoms, Diagnosis, Management, Dysphagia and Swallowing Problems: What You Need To Know, Muscular dystrophies at different ages: metabolic and endocrine alterations, Diagnostic approach to the congenital muscular dystrophies, How Duchenne/Becker Muscular Dystrophy is Inherited | CDC, A current approach to heart failure in Duchenne muscular dystrophy, http://www.medicalnewstoday.com/releases/75515.php. Doctors may find pseudohypertrophy, lumbar spine deviation, gait abnormalities, and several grades of diminished muscle reflexes. What Is Myasthenia Gravis? What tests are used to diagnose distal muscular dystrophy (DD)? Much can be learned from these, including the pattern of weakness. There’s no known treatment for muscular dystrophies, however certain treatments may help. How Is Duchenne Muscular Dystrophy Diagnosed? The results of genetic testing can help to confirm or rule out a diagnosis of muscular dystrophy. Muscular dystrophy is usually diagnosed in children between 3 and 6 years of age. Genetic Testing. Diagnosis In diagnosing any form of muscular dystrophy, a doctor usually begins by taking a patient and family history and performing a physical examination. What is Causing Your Thigh Pain, and What Should You Do About It? The doctor will do a neurological examination to look for nerve problems. A diagnosis of canine muscular dystrophy is derived from symptoms and abnormalities seen in testing. By subscribing you agree to the Terms of Use and Privacy Policy. An example is a test called spirometry, which measures the amount of air the lungs can hold and how forcefully air can be emptied from them. The diagnosis of Becker muscular dystrophy may be made during childhood, typically after the age of about 7. The disorders differ in which muscles are primarily affected, the degree of weakness, how fast they worsen, and when symptoms begin. Myotonic dystrophy is one of the most common types of muscular dystrophy, characterized by progressive muscle weakness that can affect many parts of the body, including the heart and lungs. However, it's often the smaller muscles that are affected first, such as those in the face, jaw and neck. Thank you, {{form.email}}, for signing up. DNA analysis and enzyme assays can confirm the diagnosis of certain neuromuscular diseases, including MD. Neurological tests are typically used to rule out nervous system disorders that may be causing muscle weakness or deterioration. How Duchenne/Becker Muscular Dystrophy is Inherited | CDC. It also affects boys but the symptoms start later -- between ages 11 and 25. Muscular Dystrophy News is strictly a news and information website about the disease. Get our printable guide for your next doctor's appointment to help you ask the right questions. Neurological tests to rule out other nervous system disorders, identify patterns of muscle weakness and wasting, test reflexes and coordination, and detect contractions. Duchenne muscular dystrophy (DMD) is the most common type. This includes age of first sitting, standing, and walking. In diagnosing any form of muscular dystrophy, a doctor usually begins by taking a patient and family history and performing a physical examination. It then may gradually spread to affect other parts of your body. High levels of a chemical called creatine kinase (CPK) found in the blood may also help diagnose muscular dystrophy.High levels of creatine kinase don't give a definite diagnosis, since many other muscle diseases can also cause this. Investigations and diagnosis. It does not provide medical advice, diagnosis, or treatment. Muscular Dystrophy treatment with stem cells has shown the potential of repair and regeneration of the damaged muscular tissues. Genetic testing can also determine whether you or your child are carriers of mutations related to muscular dystrophy. These tests check heart function. Muscular dystrophy (MD) is a collective group of inherited noninflammatory but progressive muscle disorders without a central or peripheral nerve abnormality. National Library of Medicine. These might include: A muscle biopsy (the removal and exam of a … Doctors can use several tests to diagnose muscular dystrophy. Taking note of how your body is working—and changing—can lead you to suspect muscular dystrophy. 2. Genetic testing is a type of medical testing that identifies changes in a person’s chromosomes, genes, or proteins. In diagnosing any form of muscular dystrophy, a doctor usually begins by taking a patient and family history and performing a physical examination. Diagnosis. What Are the Best Treatment Options for Duchenne Muscular Dystrophy? Your doctor will then ask you if you or your child has experienced any of the following symptoms: If you or your child has experienced muscle-related symptoms, your doctor will also ask you which muscles have been affected. Symptoms may include: eyelid drooping (ptosis), arm and leg weakness, and difficulty swallowing (dysphagia). The age at which MD is diagnosed will vary, depending on when the symptoms first start to appear. Muscular dystrophy (MD) is diagnosed through a physical exam, a family medical history, and tests. As science and medicine are advancing, people with DMD are living longer; therefore, their care throughout life is evolving as well. The history and physical go a long way toward making the diagnosis, even before any laboratory tests are done. An earlier diagnosis also allows you and your family more time to plan ahead and make any necessary changes to your home, including installing ramps and other tools that may be needed as the condition progresses. That way, you can get started on the best treatment and care for your condition. It mainly affects boys, and starts between ages 3 and 5. Your doctor will start with a physical exam. Blood tests can also be used to check for serum aldolase, an enzyme that helps break down sugars into energy. Everyday Health is among the federally registered trademarks of Everyday Health, Inc. and may not be used by third parties without explicit permission. In the case of a pregnancy, if one or both parents are 'carriers' of a particular muscle-wasting condition (see the Muscular Dystrophy UK factsheet: Carrier testing and reproduction: your options), there is a … Becker muscular dystrophy (BMD) is an inherited condition that causes progressive weakness and wasting of the skeletal and cardiac (heart) muscles. This damage and weakness is due to the lack of … MD is usually a genetic disease, but some varieties are not. Neuromuscul Disord. Young age. This appears in the teens to early adulthood and affects males and females. While progressive muscle weakness and difficulty controlling movement are present in all nine forms of the disease, there are nuances in the symptoms experienced and the extent of them that depend on what type someone has. The results of a muscle biopsy may be confirmed with genetic testing, or genetic testing may be done first — before or instead of a muscle biopsy — to rule in or out a specific diagnosis. UpToDate, 2018. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. He or she can perform a clinical examination and testing to confirm—or rule out—muscular dystrophy and get you started on the best treatment for your condition. In people with muscular dystrophy, the muscle fibers don’t respond as well to repeated electrical stimulation. NYU Langone Health. Int J Endocrinol. Diagnostic tests for muscular dystrophy may include: Myotonic dystrophy. Some types of muscular dystrophy are diagnosed in infancy or childhood, while the symptoms of others may not start in adults until they reach middle age. Your doctor will ask if anyone in your family has been diagnosed with muscular dystrophy and, if so, at what age they were diagnosed and with what type. Electromyography. Diagnostic approach to the congenital muscular dystrophies. Because some types of muscular dystrophy, like myotonic dystrophy, can affect the heart and its surrounding muscles, your primary care doctor or pediatrician may also order certain heart monitoring tests, including an electrocardiograph and echocardiogram. Immunohistochemical dystrophin tests can indicate a decrease in dystrophin detected in sarcoglycanopathies. In muscular dystrophy, abnormal genes (mutations) interfere with the production of proteins needed to form healthy muscle.There are many different kinds of muscular dystrophy. Your doctor will review your (or your child's) medical history and symptoms. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Myotonic Muscular Dystrophy Also referred to as Steinert disease, Myotonic dystrophy is a muscular disease characterized by the inability of the body to relax muscles at will. Your doctor is likely to start with a medical history and physical examination.After that, your doctor may recommend: 1. Some forms of muscular dystrophy can cause breathing difficulties. Track the Vax: Delivering COVID-19 Vaccines at Warp Speed. Duchenne muscular dystrophy (DMD) is a genetic condition characterized by progressive weakening of voluntary muscles. It primarily affects males. Doctors may find pseudohypertrophy, lumbar spine deviation, gait abnormalities, and several grades of diminished muscle reflexes. Muscle-wasting conditions are very rare, affecting just over one in … How is muscular dystrophy diagnosed? The diagnosis of limb–girdle muscular dystrophy can be done via muscle biopsy, which will show the presence of muscular dystrophy, and genetic testing is used to determine which type of muscular dystrophy a patient has. Becker muscular dystrophy is caused by a genetic problem in producing dystrophin, a protein that protects muscle fibers from breaking down when exposed to enzymes. A family history of the condition is also a clue that the disease is causing your symptoms. This test measures the amount of electricity generated by muscle cells when they become activated by a nerve impulse. Muscular dystrophy (MD) is a collective group of inherited noninflammatory but progressive muscle disorders without a central or peripheral nerve abnormality. There’s no known treatment for muscular dystrophies, however certain treatments may help. Becker muscular dystrophy is like Duchenne, except milder. Diagnosing Muscular Dystrophy. Although guidelines are available for various aspects of DMD, comprehensive clinical care recommendations do not exist. During this test, your doctor stimulates the nerve with electrodes — similar to those used in EMG — and measures the time it takes to respond. Mayo Clinic. As with other types of muscular dystrophy, myotonic dystrophy involves progressive muscle weakness and muscle wasting. If signs of muscular dystrophy appear in your or your child’s blood work, a neurologist can confirm the diagnosis through a variety of tests. Some types are also associated with problems in other organs. Oculopharyngeal muscular dystrophy (OPMD) is a genetic disorder characterized by slowly progressing muscle disease (myopathy) affecting the muscles of the upper eyelids and the throat.Onset is typically during adulthood, most often between 40 and 60 years of age. He or she can perform a comprehensive examination and rule in or out a diagnosis of muscular dystrophy. Myotonic dystrophy As with other types of muscular dystrophy, myotonic dystrophy involves progressive muscle weakness and muscle wasting. The symptoms of Becker muscular dystrophy (BMD) may begin anywhere from childhood to a person's early 20s. Lambert-Eaton Syndrome, Peripheral neuropathy, Dermatomyositis, Muscle weakness, Cramp-fasciculation syndrome, Myopathy..., Spinal muscular atrophy, Facioscapulohumeral muscular dystrophy, Mitochondrial myopathy, Muscular dystrophy, Neuromyotonia, Limb girdle muscular dystrophy, Charcot-Marie-Tooth disease, Duchenne muscular dystrophy, Motor neuron disease, Myotonic dystrophy, … Cruz guzmán Odel R, Chávez garcía AL, Rodríguez-cruz M. Muscular dystrophies at different ages: metabolic and endocrine alterations. Heart. To help you cope, find someone to talk with. distal muscular dystrophy – which is the rarest of the muscular dystrophies, although it is comparatively more common in Sweden. The DMPK gene is located on chromosome 19 at 19q13.32 while the CNBP gene is located on chromosome 3q21.3. However, it's often the smaller muscles that are affected first, such as those in the face, jaw and neck. Obtaining an accurate muscular dystrophy diagnosis is one of the challenges the condition presents. Detection and diagnosis of muscular dystrophy advanced by new genetic test. A physical exam, your family medical history, and numerous tests are used together to diagnose muscular dystrophy. Centers for Disease Control and Prevention. A weakness of muscles around your pelvis, hips, and legs, causing difficulty with walking and trunk control. Still, if you or your child has signs or symptoms suggesting you might be affected by the condition, the process for diagnosing it is essentially the same. Early Diagnosis and Duchenne Newborn Screening. Although there’s no cure for muscular dystrophy, new treatments designed to control symptoms and slow progression are in development. During the examination, your child's doctor obtains a complete prenatal and birth history of the child and asks if other family members are known to have muscular dystrophy. Distal muscular dystrophy (DD) is a group of rare diseases that affect your muscles (genetic myopathies). Early signs of the illness include a delay in walking, difficulty rising from a sitting or lying position, and frequent falling, with weakness typically affecting the shoulder and pelvic muscle as one of the initial symptoms. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Living with or having a child with Duchenne can be difficult, but resources are available to give you practical support and help you feel less alone. These may include: Usually, the diagnosis of muscular dystrophy is not made by one specific test or measure; rather a multitude of tests and your clinical presentation are used to form an accurate diagnosis of your condition.. How is muscular dystrophy diagnosed?. Muscular Dystrophy: Diagnosis. Myotonic dystrophy is one of the most common types of muscular dystrophy, characterized by progressive muscle weakness that can affect many parts o… He or she will look for muscle weakness, wasting and myotonia. In the case of DMD or Becker muscular dystrophy, genetic testing is used to evaluate missing or repeated mutations in the gene that helps your body produce dystrophin. Much can be learned from these, including the pattern of weakness. A nerve conduction study is used to identify nerve damage in the muscles by measuring how fast an electrical impulse travels through a nerve. What tests are used to diagnose distal muscular dystrophy (DD)? During this test, a clip is placed on your nose, and you are given a plastic mouthpiece connected to the spirometry machine. The diagnosis of muscular dystrophy is made with a physical examination and diagnostic testing by your child's physician. It mostly affects boys, though girls may be mildly affected. The US Centers for Disease Control and Prevention selected 84 clini … Over time, affected people begin to have difficulty walking, frequent falls, difficulty with muscle skills (such as running, hopping, and jumping), and loss of muscle mass. Myotonic dystrophy can appear at any time between birth and old age. Sign up for our Healthy Living Newsletter! In muscular dystrophy, the weakness is in the muscles. Paul and Carly, two people who are living with myotonic dystrophy, are part of a support community for people with myotonic dystrophy and their families near their hometown. You will also be asked about history of infections and any significant injuries.Your doctor will examine you or your child. Many people will eventually become unable to walk. Taking note of how your body is working—and changing—can lead you to suspect muscular dystrophy. Mutations are alterations that prevent genes from functioning normally. A correct diagnosis gives patients an understanding of how their disease is likely to progress. Limb-girdle. What Is Muscular Dystrophy? They are characterized by progressive and degenerative muscle weakness and wasting. Other types don't surface until adulthood.There's no cure for muscular dystrophy. Up to Date Link; Birnkrant DJ, Bushby K, Bann CM, et al. Even if you have weakness in your body (or one area of your body), it does not necessarily mean that you have muscular dystrophy. While there are many types of this condition, the symptoms and diagnostic tests are often similar. Creatine kinase is an enzyme that’s released into the bloodstream when muscle fibers are deteriorating. Similarly, your doctor may recommend tests to check lung function. An inherited genetic mistake prevents the … Duchenne MD is a sex-linked disorder, and two-thirds of the cases are genetic. Duchenne muscular dystrophy (DMD) is the most common childhood form of muscular dystrophy, with symptoms typically beginning between ages 2 and 6. TRANSITIONAL PHASE (AGES 6 TO 9) The muscular dystrophies are all lifelong, progressive conditions. Nevertheless, most individuals with muscular dystrophy do lose the ability to walk and ultimately need a wheelchair. Read our, Medically reviewed by Anita C. Chandrasekaran, MD, MPH, Medically reviewed by Stuart Hershman, MD, Medically reviewed by Nicholas R. Metrus, MD, Medically reviewed by Jonathan Cluett, MD, Medically reviewed by Kashif J. Piracha, MD, Medically reviewed by Erin Pereira, DPT, OCS, Medically reviewed by Shaheen Lakhan, MD, PhD, Medically reviewed by Elizabeth Molina Ortiz, MD, MPH, Muscular System Diseases and How They Affect Muscles, How to Know If You Have Huntington's Disease, Getting a Diagnosis for Systemic Scleroderma, Everything You Need To Know About Juvenile Myositis, What to Expect After a Myopathy Diagnosis, Rheumatoid Arthritis: Blood Tests for Diagnosis. 2014;24(4):289-311. doi:10.1016/j.nmd.2013.12.011. Steroid therapy is a standard treatment for Duchenne, while other treatments will depend on your specific symptoms and condition. In a person who hasn't had a traumatic injury, high blood levels of CK suggest a muscle disease — such as muscular dystrophy. Becker dystrophy is very similar to Duchenne dystrophy except that it progresses much slower and is less predictable than Duchenne dystrophy. Muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscle mass. NEXT: Duchenne muscular dystrophy Duchenne muscular dystrophy. Brett Sears, PT, MDT, is a physical therapist with over 15 years of experience in orthopedic and hospital-based therapy. The diagnosis for muscular dystrophy depends upon the type and the intensity of symptoms. Damaged muscles release enzymes, such as creatine kinase (CK), into your blood. A physical examination and the patient's medical history will help the doctor determine the type of muscular dystrophy. The condition is suspected genetic test its course is slower than that of Duchenne s. Bönnemann CG, Wang CH, Quijano-roy s, et al muscle when. 15 years of going to many different doctors to get the right questions M.! The nerves of the heart and lung symptoms in dystrophin detected in sarcoglycanopathies specific. — all rights reserved doctors may find pseudohypertrophy, lumbar spine deviation, gait abnormalities, several! 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