As a parent or a caretaker watching your loved ones with muscular dystrophy relentlessly fade away is very devastating.

Muscular dystrophy having a worldwide prevalence of 1 male child in every 3500 individuals each year is a debilitating genetic condition affecting the skeletal muscles. This leads to loss of motor skills and the skeletal and muscle formation deteriorate over time, and as the disease progresses many are essentially paralyzed from the neck down.

In this race against time, we at NeuroGen Brain and Spine Institute stand strong alongside you.

We bring to you the single most revolutionizing therapy medical science has to offer for your dear ones with muscular dystrophy- stem cell therapy for MD. This plays a great role in stabilizing the symptoms seen in MD as well as decreasing the rapid progression of the disease. Along with the therapy provided, we also have an excellent rehabilitation program conducted by our team of highly competent and dedicated therapists, to help our patients gain back their independence for their everyday activities.

At NeuroGen Brain and Spine Institute, our only aspiration is to fill each day of your life with a little joy, a little laughter.

OUR SUCCESS STORIES

  • Standing up and doing his activities independently is like a miracle come true for 11 year old boy who was until now wholly dependent on his wheelchair.
  • A 12 year old girl diagnosed with a rare form of muscular dystrophy, after stem cell therapy, can now whistle, speak properly and even climb stairs with reduced fall frequency.
  • A 16 year old boy is really happy to be able to walk with lesser support.
  • 40 year old dentist diagnosed with Becker's muscular dystrophy, resumes his old job after stem cell therapy.

What is muscular dystrophy?

The first historical account of muscular dystrophy appeared n 1830, when Sir Charles Bell first wrote an essay about progressive muscle weakness that he observed in young boys. Twenty decades later, we now refer to this muscle wasting as ‘muscular dystrophy'. The term ‘dystrophy' is derived from the Greek dys, which means ‘difficult' or ‘faulty' and troph which means ‘to nourish'. Muscular dystrophy (MD) refers to a group of more than 30 genetic diseases that cause progressive weakness and degeneration of skeletal muscles used during voluntary movement. These disorders vary in age of onset, severity, and pattern of affected muscles. All forms of MD grow worse as muscles progressively degenerate and weaken.


What is the cause of muscular dystrophy?

Muscular dystrophies are a group of inherited disorders that involve a disruption in one of the thousands of genes that program proteins that are critical for muscle integrity. It results from a error in the dystrophin gene, which provides coding for a protein that determines the structure of muscle tissues.

This means that the cells that maintain the muscles can no longer fulfill their role and this leads to progressive muscle weakness and disability. Many MDs occur through spontaneous changes in the gene structure and then those defects can also be transmitted from one generation to another. MD can be inherited in three ways:-

  • Autosomal dominant inheritance occurs when a child receives a normal gene from one parent and a defective gene from the other parent.
  • Autosomal recessive inheritance means that both parents must carry and pass on the faulty gene. The parents each have one defective gene but are not affected by the disorder.

X-linked (or sex-linked) recessive inheritance occurs when a mother carries the affected gene on one of her two X chromosomes and passes it to her son.


What are the different types of muscular dystrophy?

There are nine types of muscular dystrophies. This group of genetically distinct disorders share clinical and pathological characteristics but vary in age of onset, rate of progression, distribution of weakness, severity, inheritance pattern, and molecular defect. They can be described as follows:-

TYPE AGE OF ONSET SIGNS AND SYMPTOMS
Duchene 2 to 6 years general muscle weakness and wasting; affects pelvis, upper arms, and upper legs; eventually involves all voluntary muscles
Becker adolescence to early adulthood identical to Duchenne, but less severe; progresses more slowly than Duchenne
Congenital birth general muscle weakness and possible joint deformities
Distal 40 to 60 years weakness and wasting of muscles of the hands, forearms, and lower legs
Emery- dreifuss Childhood to early teens weakness and wasting of shoulder, upper arm, and shin muscles
Limb-Girdle Late childhood to middle age weakness and wasting, affecting shoulder girdle and pelvic girdle first
Facioscapulohumeral Childhood to early adult age facial muscle weakness and weakness with some wasting of shoulders and upper arms
Myotonic 20 to 40 years weakness of all muscle groups accompanied by delayed relaxation of muscles after contraction; affects face, feet, hands, and neck first
Oculopharnyngeal 40 to 70 years affect muscles of eyelids and throat causing weakening of throat muscles, which, in time, causes inability to swallow and emaciation from lack of food

What are the treatment options available for muscular dystrophy?

Muscular dystrophy is one of the most difficult disorders to treat. Although, its pathogenesis is well understood there is no known cure available for any of the types of muscular dystrophy. Conventional methods of coping with the disease include exercise, drugs that slow down or eliminate muscle wasting like anabolic steroids and supplementation.

Drug Treatment Steroids have been demonstrated to be efficacious in slowing the progression of muscular dystrophy especially DMD and in delaying the loss of independent ambulation, stabilize muscle strength and preserve pulmonary functions.

Corticosteroids may enhance myoblast proliferation and promote muscle regeneration. Alternatively, steroids may inhibit muscle degradation by stabilizing lysosomal-bound proteases or muscle cell membranes. Finally, prednisone could reduce muscle damage and necrosis through its immunosuppressive and anti-inflammatory effects.

Rehabilitation Management of muscle extensibility and joint contractures is a key part of rehabilitation management. Physical therapy, occupational therapy, speech therapy and other recreational therapies play a very important role in helping the patient to go about his daily activities and increasing their own independency.

Gene Therapy The advent of science and technology has lead to the development of newer therapeutic options for muscular dystrophy. One such approach is gene therapy. The aim of the Gene Therapy is precisely to introduce these genes into the patients to normalize the gene expression and protein production. Although it might seem like an easy task, in reality it is quiet daunting due to the complexity of human genes and gene expression.

Several novel strategies for replacing or repairing the defective gene are in development, with early encouraging results from animal models. In most of the gene therapies a normal gene is inserted into the genome to replace the abnormal gene causing the disease. This can be done using viral vectors, Antisense- Induced Exon Skipping or Read through Stop Codon Strategies.

However, the high cost and lack of human clinical trials, makes gene therapy an apprehensive approach.

The treatment options that are currently being used for muscular dystrophy address the symptoms but fail to act at a cellular level. They do not regenerate the lost muscles or reverse the pathology of the disease. Also, Muscular Dystrophy is a genetic disorder and hence no treatment can repair the core changes in the defective genetic structure.


How stem cells work in muscular dystrophy

New ideas for treating MD are under development. Recent research has thrown light on the potential ability of stem cells to regenerate and repair the damaged muscle cells. Stem cells are cells that are at an early stage of development. This means they have the ability to turn into any type of cell in the body and undergo self renewal.

Under physiological conditions the ability of adult muscle to undergo regeneration is largely attributed to a distinct subpopulation of muscle cells, termed satellite cells. These cells are considered to be the main cell type involved in skeletal muscle regeneration. Stem cell therapy holds great promise as a treatment for MD by providing cells that can both deliver functional muscle proteins and replenish the stem pool.

  • The mechanisms by which stem cells may function include
  • Differentiation and cell fusions
  • Secretion of cytokines
  • Increase oxygen supply and contribute to vascularization in the damaged area.

All these mechanisms help in tissue remodeling, decrease inflammation and prevent cell death; together contributing to the formation of healthy cells.

Adult stem cells transplanted from various tissues; such as the bone marrow, have been reported to develop in cells of the mesoderm that form the muscle cells; thus restoring the stem cell pool that help in tissue regeneration and repair.


The NeuroGen outcome

Muscular dystrophy is an emotionally, physically and financially draining condition crippling not only the patient but others around as well. After years of research, stem cell therapy has emerged as an effective treatment option for this otherwise hopeless condition.

At, NeuroGen BSI, we have treated over 350 patients of Muscular dystrophy with 94% patients showing overall improvements in the clinical symptoms.

After transplantation our patients have shown have increased trunk muscle strength, limb strength on manual muscle testing and balance. Besides, they have also improvement in ambulation, hand function, increase in stamina and better trunk balance. Together, they make it easier for the patients to live more independently.


Our stem cell transplantation protocol does not only alter the clinical conditions of a patient, but also aims to repair and stop further progression of muscle wasting that occurs in Muscular dystrophy. This has been demonstrated by the MRI-MSK reports of these patients.


Objective radiological improvements seen in a case of muscular dystrophy after stem cell therapy

Can muscular dystrophy be a contagious disease?

A: No it is not a contagious disease .It is mainly a hereditary disorder.

Is muscular dystrophy always hereditary?

A: not always. Many investigations states that about 1/3 of all boys suffering from Duchene/Beckers muscular dystrophy have no family history.

It is often mentioned that there are several types of Muscular Dystrophy seen in people. Which is the most common type of muscular dystrophy?

A: The most common type of muscular dystrophy is Duchene and second most common is Beckers. This is followed by limb girdle muscular dystrophy which is the third most common form.

What is the first sign I will notice if my child has Duchene muscular dystrophy?

A: He may start talking and walking late. But these features are seen in many other different conditions. Most parents notice that the child is not running as fast as the other kids. The child may also get up from the ground, in a different way, using his hand for support and may have difficulty in climbing stairs.

How is muscular dystrophy transmitted?

A: Muscular dystrophy can be transmitted from either of the parent via an affected gene.

  • In DMD the mother is a carrier of affected gene and the disease is transmitted to the male child. Each male born to such mother is on 50% risk of being affected and each female child born is at 50% risk of being a carrier.
  • In myotonic dystrophy, one of the parent is the carrier.
  • In limb girdle muscular dystrophy: the transmission could be via a recessive gene, meaning both the parents are carrier which means that both transmit the disease. It could also be inherited as a autosomal dominant disease ,that means that one defective gene is enough to manifest the problem/condition. Both male child and female child can be affected with the disease.

My son had Duchene muscular dystrophy, can my daughter or me be a carrier?

Yes. There are 50% chances of her being the carrier. Genetic testing for ascertaining it is available.

Can this disease be detected during pregnancy?

A: In utero diagnosis of DMD is possible, if there is history of previous child or sibling having this disease/condition is known.Chorionic villus sampling or amniocentesis followed by DNA testing (MLPA) can possibly give some answers.

Can muscular dystrophy be detected at birth?

A: If there is a family history and a reasonable suspicion, then maybe.Howver, the symptoms may not be apparent until the child is at least several years of age.

Will Muscular Dystrophy occur only in children?

A: Not necessary. For example facioscapulohumeral, myotonic and limb girdle muscular dystrophy begin later in life .They are slow in progression and less severe than the childhood forms.

What are few early signs of adult muscular dystrophy?

In a few instances, such as facioscapulohumeral dystrophy a weak smile or inability to whistle may indicate a beginning. Similarly, in Limb girdle MD weakness of shoulders and hip is seen and in case of Myotonic MD there is apparent weakness of feet and hand.

Why are muscles enlarged/big in Muscular dystrophy?

A: The muscles are replaced with fatty or fibrous tissue. This condition is known as pseudo hypertrophy.

What are the treatment options to help child with muscular dystrophy to prolong his walking?

A surgical release of tight or contracted muscle and immediately standing next day can help. Second option would be serial casting. These options can help children of muscular dystrophy to prolong walking independently.

Is there any other method to help my child stand and walk?

Regular physiotherapy/exercises can help keep the child ambulatory. Standing with the help of push knee splints and high boots is found to be effective. Surgery becomes the best option when the muscles become very tight and are not stretchable at all.

My child is confined to wheelchair; can surgery help him to regain his walking?

A surgery can help straighten the joints. Surgery becomes the best option when the muscles become very tight and are not stretchable at all. However, walking would depend on the muscle power of the lower limbs.

How does physiotherapy and occupational therapy help muscular dystrophy patients?

These therapies help in preventing contractures, keep muscles strong, help in transfer, improve efficiency of functional activities like standing, walking etc.

Can exercises be harmful?

If exercises are done beyond the patients’ capacity, they can lead to deterioration. The patient should not get tired or fatigued. Ample time or rest has to be given between exercises.

Aquatic therapy is really coming up as a therapy option. Can swimming benefit?

Swimming is found to be a very good exercise for the child/patient of muscular dystrophy. It is advised to be brought into practice from a very early age. Helps to increase endurance, increases muscle strength and good work up for the respiratory and cardiac muscles.

What is the cause of death in muscular dystrophy?

Respiratory muscle weakness, leading to respiratory difficulty is the major cause of death. As the muscles weaken, the child develops scoliosis or bending of the spine. This leads to crowding of the muscles of the chest and the ribs. Cough reflex becomes hampered. Patient becomes prone to chest infection, which leads to breathing difficulty.

Cardiac muscle weakness and cardiomyopathy, leading to heart failure and is another major cause of death in muscular dystrophy patients.

Can stem cell therapy prolong a muscular dystrophy patient’s life?

Ans: the aim of stem cell therapy is to strengthen the muscles, prevent or slow down the degeneration of the muscles . If the patients is ambulatory/walking, the goal is to keep them walking. This indirectly could delay respiratory muscle weakness and prevent scoliosis. This could then prolong overall life expectancy , by reducing the chances of respiratory complications.

How does stem cell therapy work?

The biological task of stem cells is to repair and regenerate damaged cells. Stem cell therapy exploits this function by administering these cells in high concentrations directly in and around the damaged tissue, where they advance its self healing and repair.

Are there ethical concerns surrounding adult stem cell research and therapy?

Bone marrow transplantation has been used successfully for genetic disorders of blood, such as sickle cell anemia, thalessemia, as well as cancers such as leukemia. Since our therapy uses these very cell, which are harvested from the patient’s own body (autologous cells), there are no major ethical concerns. Ethical concerns are primarily on the use of embryonic stem cells (which we do not use).

Is the treatment painful?

The therapy is done under local anesthesia and a mild sedation. There is no significant pain or discomfort during or after the procedure.

Does the treatment have any side effects?

Stem cell therapy is minimally invasive and reasonably safe. None of our patients have shown any neurological deterioration so far in connection with the stem cell therapy itself. Some side effects, such as headache (spinal headache) lasting 3-4 days which is generally self limiting, neck/back pain, vomiting, some mild rash or pain at the site of bone marrow aspiration/stem cell injection may occur. However, like any other medical or surgical treatment unexpected complications are always a possibility. These complications may be related to the medicines given, the stem cell procedure, the anesthesia, and the rehabilitation or to any of the preexisting medical or neurological conditions.

How long will it take me to know that I have benefitted from the treatment?

Maximal improvements are seen around 3-6 months after the treatment. However, in many patients there are slow progressive improvements that continue for several months/years later. Most patients do show some immediate improvements also i.e. before the discharge, in some of their symptoms.

Is the transplantation of the stem cells done once or more than once?

The decision to do the therapy a second time is taken after seeing the progress/improvements after the first therapy. If the patients show some encouraging improvement, then the case is reviewed by the entire medical and rehabilitation team and a second treatment may be recommended. This may be done anytime between 3-6 months of the first therapy.

Can other treatments be taken at the same time?

We will review what other medications the patient is already on. In most cases we do not discontinue any already going on treatment. Please inform us about any medications you are taking beforehand.

How much improvement will the patient have?

This is difficult to predict, since this a new therapy. It depends on multiple factors such as age of patient, type of illness, duration of illness and extent of rehabilitation taken after the treatment.

At Neurogen BSI, we have treated over 350 patients of Muscular dystrophy.
Over all improvements were seen in 94% patients.

We have published our results in “Cell Transplantation” - an international journal. This paper reports our clinical results in 150 patients of muscular dystrophy (DMD, LGMD, BMD) who were administered autologous BMMNC intrathecally, followed by multidisciplinary rehabilitation. Evaluation after transplantation showed improvements in the trunk muscle strength, limb strength on manual muscle testing, gait improvements, positive changes in the assessment scales such as the FIM and the Brooke and Vignos Scales

Our data is regularly published in various medical and scientific journal (available for reading on our website). You are strongly advised to study these before proceeding with treatment.

"Frequency of falls reduced after Stem Cell Therapy"

A 12 year old girl was suffering from a rare form of Muscular Dystrophy. She has a strong family history of Muscular Dystrophy. Weakness progressed in her legs when she was 9 years old. She started experiencing difficulty while getting up from the floor and climbing stairs. The weakness also progressed to her arms and face. This left her face expressionless. Her speech was unclear and she faced difficulty in closing her eyes, pursing her lips. She struggled with performing the routine activities which involved raising her arms overhead.She could barely play with her friends and faced difficulty doing all those activities children her age could easily perform. With these problems, she decided to come to NeuroGen, to take stem cell therapy.

When we first saw her, her muscles were softer and weaker than normal children of her age. Her cheek muscles were especially weak. She complained of easy fatigability after the daily activities. Various tests were performed to find out which muscles were weak. The study of muscles, EMG, showed the primary pathology of the muscles and confirmed the diagnosis. MRI scan showed that Muscle Fibers were replaced by fat tissue, because of this the muscles looked of normal size but there strength had reduced. We carefully assessed the strength of each muscle and found that the weakness was more pronounced in the muscles of left upper limb and left lower limb. We identified the muscles that needed more attention and planned our treatment accordingly.

She underwent stem cell therapy where the stem cells were carefully injected in the spinal fluid and the muscles that were identified during examination; Frontalis, Orbicularis oculi, Nasalis, Orbicularis oris, Levator superior, Levator Inferior, Abdominals, Deltoid, Rhomboids, Adductor of shoulder, Glutei and Adductor of hip. After injecting the stem cells, the patient underwent rigorous rehabilitation. She was given her various exercises to strengthen the weak muscles. She was taught to perform the daily activities in an easier way. Activities likerolling on bed, lifting the waist up while in bed, getting up in all four's position. Strengthening of all muscles of respiration. Occupation therapists worked to reduce her difficulty with using arms for overhead activities and hand movements in finer activities. All these exercises were also given to be performed at home. She was given a CD containing these exercises so they could be performed in a correct way.

Within the first week of the treatment the blood marker of her disease, enzyme, CreatininePhsopho Kinase (CPK) showed a great reduction. The concentration of this enzyme in blood increases with more and more muscle damage. Reduction in its levels suggests reduced muscle damage. The enzyme levels in blood before the treatment were 425 units which reduced to 139 units.

After three months when she visited us, some of leg muscles showed improvement. She felt more energetic. We could see some facial expressions as well now. She was more cheerful. She could whistle closing her lip properly. It was much easier for her to climb the stairs. She could speak clearly. She could walk much better with reduced frequency of falls.


Muscular Dystrophy Patient starts walking with Lesser Support

A 16 year old boy visited NeuroGen with complaints of gradually increasing muscle weakness and history of similar illness in family. When he was only 4 years his parents observed that he was falling frequently while walking. Slowly they realized that the strength of his muscles was reducing. He stopped walking completely due to this weakness when he was only 11 years old. Slowly the muscle weakness also progressed to upper limbs and he could not do any overhead activities either. His muscles were tight and coupled with the weakness it further restricted the movements. When he was 10 years old his calf muscles were so tight that they had to be surgically lengthened. Within 5 years muscles of the back of the thigh, Hamstrings, also had to surgically lengthened.

At the age of 16 when he visited us, he had already stopped walking since 5 years and undergone 2 surgeries to lengthen the muscles. Although he could manage to do most of his daily activities on his own, he could not walk and used wheel chair to move around. When we examined him we found that the weakness of muscles was all over however the muscles of the lower limbs were weaker than upper limb. Various tests like MRI showed increased fatty tissue within the muscles and EMG confirmed the muscular pathology. Blood enzyme levels, which is the marker of this disease called CreatinePhospho Kinase (CPK ) was 2630 units ,much higher than normal and indicated muscle degeneration.

With these findings we carefully identified muscles that were weakest and designed the stem cell thrapy accordingly. We first took the bone marrow to separate the stem cells. Once the cells were separated in the laboratory they were then injected in the spinal fluid and the relevant weak muscles. The muscles we injected the stem cells were Deltoid, Triceps, Biceps, Brachioradialis, Rhomboids, Trapezius, Pectorals, Back Extensors, Abdominals, Glutei, Quadriceps and Adductors of hip. He rested on the day of transplantation of the stem cells however from the very next day he was given a rigorous exercise and rehabilitation program. He was also informed about the importance of this. The rehabilitation consisted of exercises that targeted strengthening the weak muscles, maintaining the length of the weak muscles to prevent any tightness in future, prescription of orthosis to prevent such tightness and deformity. He was trained to perform his daily activities in an easier way. He was also made to stand with the help of these assistive devices. Occupational therapists also worked on getting the control of torso and upper limbs, regaining the hand function for various day to day activities.

Within 7 days of treatment the pain in his calf muscles while standing had reduced. Also the blood markers of muscle damage had reduced to 917 units. When he visited NeuroGen again after 3 months he was walking with push up knee splints and bilateral support. He was very happy as he was walking again after almost 7 years. He could stand for longer time, do exercises easily, could lift up to ½ a Kg weight in his hands. He was functionally a little faster. However he still experienced difficulty in getting up from the bed. 6 months after the stem cells he could walk for more than an hour with the push up knee splints and only a single hand support. He could also stand longer and did not get tired as quickly. Although using his hands functionally had not improved his arm muscles were stronger than before. He was advised to continue the exercises.

He was really very happy that he could now walk with lesser support and for a longer time.


40 Years Old Resumes Job After Stem Cell Therapy

All of us here at NeuroGen had a chance to meet this mighty spirited dental surgeon. With an established Becker's Muscular Dystrophy since childhood he completed his education in dentistry and then further in dental surgery. When he was only 12 years old, he noticed weakness in his leg muscles. He would fall frequently while running. He noticed he was getting tired very easily with minimal activity and slowly started having trouble climbing up and down the stairs. He had a flourishing practice till his middle ages. His weakness kept growing and he could not walk at all by the age of 35, he still continued with his work. He made changes in his workplace to make sure that the quality of care he provided is not affected by his condition. He used to go to the clinic before his patients arrived, to have enough time to set up and so his patients don't have to witness the difficulties he had in moving about. At the age of 40 he the weakness grew more profound, especially in upper limbs and he found it increasingly difficult to maintain the pace of his practice. Being a dedicated professional he was not very concerned about the progressing weakness and the way it will affect his patients. He had found out about various treatment options and with the hope that he will be able to stand up again and resume his practice the way it was before, he came to NeuroGen.

When we examined him clinically we found that his leg muscles were very weak with hardly any strength for any movement. The upper limb strength was still much better and the muscles of the large joints like shoulders, scapulae were much stronger than smaller peripheral joints like elbow, wrist and hand. He was dependent on others for most of his daily activities. He used many trick movements to perform the tasks of daily living and work. We carefully selected the weakest of all the muscles. He underwent stem cell therapy followed by rigorous rehabilitation. The stem cells were injected in spinal fluid and in Biceps, Triceps, Hamstrings, Quadriceps, Glutei, Back Extensors and Abdominals. Physiotherapy treatment aimed at improving the strength of the muscles. Various exercises were given for these muscles. He was trained to use these muscles in functional positions. Occupational therapists worked to improve his hand function and improve his functions to suit his work better. Psychological counseling was given to maintain his confidence and motivation.

Seven months after the treatment he could sit without support. He could independently move from his chair to bed and back. After 5 years he could now stand with the help of a push up splint and bilateral support. He could dress faster. Do exercises easily for longer time. With enough support he could also take a few steps. Determined to resume his practice, in the view of the improvement he underwent stem cell therapy for the second time. This time the stem cells were injected in Rhomboids, Deltoid, Biceps, Triceps, Brachioradialis, Abdominals, Back Extensors, Glutei, Quadriceps, Hamstrings, and Adductors of hip.

Eight months after taking the stem cell therapy for the second time, he can now walk with the help of the walker and splints. He performs his exercises with an ease. He required only a minimal support for his daily activities. HE could also climb up to 5 stairs with support. His upper limb muscles did not show a great improvement but functionally he was a lot more independent. He could dress faster and with minimal assistance. Toilet activities and bed mobility was also independent.

15 months and 3 stem cell therapy treatments later, he can stand using splints and walker without any human support. He can climb stairs. He is independent in most of the activities of daily living. He has also resumed his practice and is successful dental surgeon once again. He is still determined to get better and better. His example provides hope to many others with this disease. It provides hope for stem cell therapy. He is an inspiration for all of us here at NeuroGen. It is results like these that keep us going with task of taking stem cell therapy forward.


From wheelchair to standing with splints and walker

An eleven year boy with profound muscular weakness came to Neurogen for treatment a couple of years ago. When he was only 5 his parents noticed the muscular weakness and this weakness kept on progressing. Initially he only had difficulty getting up from the floor. Slowly he had trouble climbing up and down the stairs. By the age of ten he couldn't even walk. This weakness prevented him from taking part in all the play and fun activities with his classmates and friends. His parents were very concerned about this and therefore sought treatment with us at NeuroGen.

When we assessed him we found that the muscles of the large joints were very weak but the muscles of the peripheral joints were relatively stronger. We carefully charted the power of all the muscles. His muscles were softer and weaker than boys his age. Because of this weakness and reduced function he had developed tightness in his calf muscles. The tightness and weakness resulted in the knock knee and foot deformity. Although he was quiet independent in taking care of the activities of personal hygiene, he could move around and wheel chair bound, otherwise needed parents support. He struggled in performing the activities of day to day routine especially the overhead activities. Various tests also supported our clinical examination. The blood marker of the disease Creatine Phospho kinase was elevated. Blood reports showed its value to be 4015 units where as normally it should be between 60 – 400 units / liter.

Based on the assessment we carefully designed a treatment protocol for him. Based on the muscle strength charting we carefully injected the stem cells in Quadriceps, Tibialis Anterior, Peronei, Abdominals, Glutei, Deltoid. He then underwent carefully designed rehabilitation program. The physiotherapists worked to strengthen his muscles, maintain the length of the tight muscles so that there will be no more deformities. They made him stand with help of splints. Occupational therapists taught him how to perform the activities of daily living in a better way.

Within the first seven days, he felt that his stamina had improved. He found his leg muscles strength had improved. After 2 years he could now walk about 80 steps with the help of splint and walker. His calf muscles were softer now and tightness had reduced. The blood marker CPK levels reduced to 1847 units / liter. A year after the stem cell therapy he could walk 500 steps with the help of splint and walker. He could perform exercises with ease and for a longer time now. He could write better his handwriting had improved and he did not get tired while writing.

Because of all the improvements he decided to undergo the treatment again. Stem cells were administered in the weakest muscles as well as in the spinal fluid. Seven months after the taking the stem cell therapy for the second time, however, he felt that his stamina had reduced. Fatigue used to set in early even with the activities of daily living, like drinking water. He therefore decided to undergo stem cell therapy for the third time.

After taking the stem cell therapy thrice now, he feels he has improved a lot. He can walk with the help of splints and walker. He can do most of his activities of daily living independently. His hand writing has improved. He is happy after receiving the stem cells.