Hand versus mouth for call–bell activation by DMD and Becker patients

Severe hand dysfunction is common in patients with Duchenne muscular dystrophy (DMD) and may preclude the use of conventional call–bells. We prospectively evaluated a call–bell with two hand-controlled interfaces (push-button and key-pinch) and two mouth-controlled interfaces (sip-or-puff) in 32 consecutive DMD and Becker patients. Patients called intentionally 348 times, using the sip-or-puff device 237 times and the hand-controlled interfaces 147 times. Use of the hand-controlled interfaces correlated with key-pinch strength (R = 0.366; P = 0.04). Six patients reported being unable to call with the hand interfaces and five patients reported temporary call failure due to inaccessibility of the sip-or-puff interface. Ease-of-use scores on a visual analogue scale were best for puff, followed by sip then key-pinch interrupter and push-button (8.7 ± 2.1, 7.5 ± 2.7, 6.2 ± 3.9, and 0.5 ± 2.0 respectively; ANOVA: P < 0.00001). In conclusion sip-or-puff devices should be considered more often to provide neuromuscular patients with greater independence.