TDFS Tridimensional Dynamic Fascial Stimulation - potential tool for functional mobility in
Duchenne muscular dystrophy – Pilot study
M. Marfin-Martin, MSc¹, S. V. Fontes, PhD¹, H. Jäger, PhD², R. Schleip, PhD²,
A. B. Oliveira, PhD¹, F. Lehmann-Horn, PhD ².
¹Setor de Investigação de Doenças Neuromusculares, UNIFESP Universidade Federal de São Paulo,
São Paulo, Brasil.
² FASCIA Research, Division of Neurophysiology, Ulm University, Ulm, Germany.
ABSTRACT
Background: In Duchenne muscular dystrophy (DMD) the increase of muscular fat content and
fibrosis generates a reduction of range of motion (ROM) of the joints. Boys with DMD develop a
disorganized body causing severe systemic consequences, especially after relying on a wheelchair.
Classically, physical therapy contributes for prolongation of life and as a palliative care in late stage
by respiratory management. However, it has never been tried to reduce contractures and
deformations via fascia manipulation. Objective: To test the hypothesis that physical intervention
through manual fascia stimulation may influence the range of motion (ROM) in boys with DMD.
Methods: The TDFS Tridimensional Dynamic Fascial Stimulation was chosen, whose protocol is
being tested in cycles of 10 sessions (3 mini-cycles of 3 plus one closure session; 90 minutes each).
It proposes to reach simultaneously the musculoskeletal system, meningeal and visceral core. Two
patients (male, 8yo, 1 ambulant, 1 wheel chair) received 6 weekly sessions; afterwards 1 patient
(male, 9yo, wheel chair) received 20 weekly sessions. ROM was measured by a gravitational
fleximeter: - before and after 6 sessions; - before, after 10, and after 20 sessions. Results: 6 sessions:
a) ambulant – 24 movements in the girdles and limbs at each side, and 10 movements of the trunk
(total 58): 33 movements (56,9%) increased, 20 (34,5%) decreased, and 5 (8,6%) maintained. b)
wheel chair boy - same movements, except the 2 side bending of the trunk (total 56): 22 movements
(39,3%) increased, 33 (58,9%) decreased, and 1 (1,8%) maintained. 20 sessions: – 18 movements in
girdles and limbs at each side, and 01 (flexion) in the trunk (total 37): a) after 10 sessions: 19
(51,4%) increased, 10 (27%) decreased, and 8 (21,6%) maintained; b) after 20 sessions: 16
movements (43,2%) increased, 11 (29,7%) decreased, and 10 (27%) maintained. Discussion:
Increases and decreases in ROM can be beneficial or not depending how the initial values are lower
or higher than those of normal people. Trunk flexion increased and stabilized afterwards, while
girdles and limbs changed both to more and less flexibility. Conclusion: The TDFS method was able
to evoke changes of ROM towards more as well as less flexibility, both in the ambulant and the
wheel chair DMD patients. Further research is needed to understand the details of appendicular
ROM changes without treatment as well as those possibly induced by TDFS.
Key words: TDFS Tridimensional Dynamic Fascial Stimulation, neuromuscular diseases, Duchenne
muscular dystrophy, ROM, body reorganization.