In the late ambulatory stage of Duchenne muscular dystrophy (approximately ages 7-12), which of the following is typically observed?

• A. Increased difficulty walking (braces, assistive devices)
• B. Improved coordination
• C. Decreased fatigue
• D. Early complete independence

Answer: (A)

In the late ambulatory stage of Duchenne muscular dystrophy, the key pattern is progressively worsening weakness that makes walking more difficult, often requiring braces or other assistive devices to maintain ambulation. This happens because dystrophin deficiency leads to gradual loss of proximal muscle strength, especially in the hip and thigh muscles that are essential for a stable gait. As those muscles weaken, children lose endurance and develop gait abnormalities, sometimes needing ankle–foot orthoses or similar supports to help them walk and stand safely.

Coordination does not improve at this stage, fatigue typically increases with activity, and complete independence is unlikely given the progressive nature of the weakness, so those options don’t fit the typical progression seen in this age range.