Hi spaceangelz

the most likely reason is because of damage to the motor tracts in the spinal cord and that your patient has quite extensive damage. Basically it would be a case of incomplete spinal cord injury. that would be the most likely reason for all the impairments whether deformity or joint laxity.

Sounds like she has major movement impairment syndromes resulting from weakness?

Has she also got contractures (or eve spasticity) in the antagonist muscles? Have you conducted a detailed muscle chart of her? Can you explain all the gait abnormalities by this? eg:

Internal rotation by weak hip lateral rotators
patella translation by weak quads etc. And what about sensory disturbance, particularly proprioception?

Can the joint laxity not be explained by marked weakness? that is usually the most likely problem although if your patient has anaesthesic joints this could be an additional problem. For example the Anterior tibial translation may be gross weakness of the hamstrings

If you are going to have success with orthotics I think you have to be really clear about what deformity/instability you are trying to tackle in relation to walking and the underlying impairments behind the deformity/instability. As a general rule you want to do the minimal amount of orthotic intervention to obtain the maximal benefit.


How has your patient gone with strengthening post surgery? Hopefully she has had had a really intensive strengthening programme targeting the paretic muscles and has reached a plateau. If not is there more that could be achieved here?

Have you got a report on the Wikipedia reference-linkMRI or CT of the spinal cord post surgery? that could give a bit more information