developed by the US Centers for Disease Control and Prevention, and were published in 2010. An update was published in 2018. Physical therapy Physical therapists are concerned with enabling patients to reach their maximum physical potential. Their aim is to: minimize the development of contractures and deformity by developing a programme of stretches and exercises where appropriate anticipate and minimize other secondary complications of a physical nature by recommending bracing and durable medical equipment monitor respiratory function and advise on techniques to assist with breathing exercises and methods of clearing secretions Future developments There is no cure for any of the muscular dystrophies. Several drugs designed to address the root cause are under development, including gene therapy (Microdystrophin), and antisense drugs (Ataluren, Eteplirsen etc.). Other medications used include corticosteroids (Deflazacort), calcium channel blockers (Diltiazem) to slow skeletal and cardiac muscle degeneration, anticonvulsants to control seizures and some muscle activity, and immunosuppressants (Vamorolone) to delay damage to dying muscle cells. Physical therapy, braces, and corrective surgery may help with some symptoms while assisted ventilation may be required in those with weakness of breathing muscles. Outcomes depend on the specific type of disorder. Prognosis Duchenne muscular dystrophy is a rare progressive disease which eventually affects all voluntary muscles and involves the heart and breathing muscles in later stages. Life expectancy is estimated to be around 25–26, but this varies. With excellent medical care, affected men often live into their 30s. David Hatch of Paris, Maine, may have been the oldest person in the world with the disease; he lived to at least the age of 56. The most common direct cause of death in people with DMD is respiratory failure. Complications from treatment, such as mechanical ventilation and tracheotomy procedures, are also a concern. The next leading cause of death is cardiac-related conditions such as heart failure brought on by dilated cardiomyopathy. With respiratory assistance, the median survival age can reach up to 40. In rare cases, people with DMD have been seen to survive into their forties or early fifties, with proper positioning in wheelchairs and beds, and the use of ventilator support (via tracheostomy or mouthpiece), airway clearance, and heart medications. Early planning of the required supports for later-life care has shown greater longevity for people with DMD. Curiously, in the mdx mouse model of Duchenne muscular dystrophy, the lack of dystrophin is associated with increased calcium levels and skeletal