Which combination of criteria is typical prerequisites for serial casting in a child with Duchenne muscular dystrophy?

• A. Quad strength 3+/5; Ability to stand with Gower's sign; Ambulate short distances with casts
• B. Quad strength 4+/5; Cannot stand; Ambulate long distances with casts
• C. Quad strength 3-/5; No Gower's sign; Ambulate unlimited with casts
• D. Quad strength 2/5; Negative Gower's sign; Cannot ambulate with casts

Answer: (A)

Serial casting in Duchenne muscular dystrophy is most appropriate when there is enough preserved strength to participate and the child can still move and bear weight, even if with compensations. The best combination reflects a level of quadriceps strength that allows movement against gravity (not full resistance), the presence of proximal weakness evidenced by a Gower’s sign while still being able to stand, and the ability to ambulate for short distances with the casts. This shows that the child can benefit from maintaining range and delaying contracture progression without being non-ambulatory or unable to participate in the casting process. Other scenarios either imply too little strength to gain from casting, lack the typical proximal weakness pattern seen in Duchenne, or indicate being unable to ambulate with casts, making them less appropriate for this intervention.