For management of NMDs a knowledge of normal joint range of movement (ROM) is essential, and this of course has some variability depending on age. For general assessment a physical review and discussion with the family will help you identify any key joints to assess. These can be the joints you focus on in subsequent assessments. A quick visual and passive checking of ROM can help identify why a functional task may be limited. In some children, e.g., MDC1a, a full body review is needed for completeness.

Presence or absence of contractures may assist in diagnosis

• Contractures appear alongside muscle weakness
• When individuals cannot move joints through full range – this leads to contractures
• Muscles that cross multiple joints are at high risk from contractures
• As weakness progresses this impacts the biomechanics of walking and contractures are more likely
• Joint laxity can contribute to mobility issues particularly in the very young child.