Physical Therapy Online

Hi,
Today I had a patient, four and a half year girl, who has spastic cerebral palsy. The mother was complaining of the patient's inability to stand and walk independantly.

She is pre-term baby; cried immediately after birth with low birth weight. She was not able to do any activities after birth for two years. Then, she was on physiotherapy treatment for the next six to eight months. That way, she achieved sitting with forward hand support. Thereafter, no medical or physiotherapy treatment was given.

Now, the patient has grade-1 spasticity in hamstrings and TA bilaterally with hamstrings, TA, adductor and hip flexor tightness. She can sit independantly with crouch position. She does transitions in and out of sitting, also pulls to kneeling and standing with support. She stands with bilateral knee slightly , foot plantaflexed and pronated with slight anterior pelvic tilt. She does well aligned weight shifts forward and lateral. She has good equilibrium reactions in sitting and quadripode. Her motor developmental age is one year.

She can grasp and release the objects; can make buildings of three or four blocks; can feed herself with spoon; can assist in wearing and unwearing of clothes; can speak normally. So, her fine motor development age is two years.

I think her impairments are inappropriate muscle force generation, poor selective control of truncal muscle and poor coactivation of antagonist and agonist muscle. So, my main goal of treatment is:

• to prevent secondary complications like contracture
• to improve hip and trunk control
• to improve pelvic stability and mobility
• to strengthen anti-gravity muscles (back and hip extensors)
• to recommend dynamic AFO to facilitate activity and limit inappropriate joint movement and alignment.