Paediatric Physiotherapy for stroke patients (9 yr old girl)

[ajay.misra]

Dear All

My child, 9 year old Anusha, suffered infarcts on both sides of the brain on 23rd June 2007. All sensation in the limbs was lost. She can't speak. She can see and hear and recognise us. She still can't eat properly by the mouth and is on a RTF (nasal feed tube) support still for nutrition. After being in a hospital for 5 weeks, we have been told that paediatric physiotherapy is our best bet to restore limb functions.

While we have engaged a physiotherapist here at Calcutta, we do not have much knowledge or expertise in paediatric physiotherapy, particularly for such a young child. Her therapy is continuing and there has been miniscule improvement in limb functions.

I would request all of you to give me information / inputs on your experiences of similar situations.

The idea is to find out if I am missing out on any related issue and if I should be doing more.

Thank you all for your time and effort.

Ajay, Calcutta, India

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[nareshpatel]

Hi Ajay,
Hi Ajay sorry to hear about your daughter,,,,but i will pray to god for her......anyway c in this case you can find some Physical Therapist who did his master in Neuro , they can also handle this case better.....and don't worry at all she will be all right..........actually i really don't know about culcutta more otherwise i could have suggest you better PT. Any way don't worry everything will be fine.....c u bye t c

[Zee]

Hi, was it a total loss of sensation? is the sensation improving? does it seem to be coming back? you may do some sensory stimulation with her like hydrotherapy, massage or even electrical stimulation.
how are her motor movements? is she able to move her limbs? you can do some assisted exercises with her through range. slowly see if she is able to move her limbs with lesser support day by day. again, electrical stimulation and hydrotherapy is a good form of therapy provided she is medically stable.
it really depends on what is her current ability and it's rather difficult to give advice without assessing the child but i hope this helps.

[physiobob]

Maybe if it is possible you might ask you Physio to post an assessment for us using your username. That way we might better make some suggestions in any areas in which they feel they might need some assistance.

I suppose we should feel some comfort that children are extremely malleable and recover from many difficulties during growth. Is it known why you daughter suffered these bilateral infarcts? This might assist us if we know about any other condition she might have?

Our thoughts are with you during this difficult time.

[saurabharora1974]

hi ajay,
For you, what u need to do is to understand the problem completely and then decide on your actions that what you should do and what you should not.
The first suggestion that you should find a physio who had done master's in neuro is a wierd suggestion. you find a good physio with any kind of degree and with a decent kind of exposure to the cases and he can handle the matter efficiantly.
your daughter has suffered infarct in the both cerebral hemispheres, i would definately like to know the cause of it, any ways thats for later, lets see loss of sensation, it is quite relevent that she has lost movements of all the four limbs, right, see let us talk in broad prospect, little people(kids) have a greater ability to regenerate things, better ability to recoop with the problem.
your physio must perform complete and proper P.N.F. (proprioceptive neuro-muscular facilitation). complete muscular streches, and bending exercises,
no electrical stimulation right now atleast you'll have to wait and see the progression before you go for an eletrical stimulation plan for her, besides she needs to be aware of the surroundings, if she has'nt got any kind of breathing problem you can take her out, to see around. you see the point remains at one dot only, greater exposure to all of the surroundings, the more she'll have to use her senses the better they will become, its 23rd-june case its now over a month so there must be a certain amount of spasticity in her too, for which your physio should be very careful not to be opposing it, but making a way with it.
over and above all what i suggest is that if we work really hard on it we can get some real good and unexpected results.
we can even have a phone chat and i can make you understand more of the things.
dr saurabh arora
B.Pt.
phone +919837384746
e-mail saurabharora1974@yahoo.com
thanks

[razan]

hi there sorry to hear wut ur going thru...
anyway lately we've seen alot of success stories of repetitve passive movement in other words simply try to hang her by use of a special carrier on a treadmill and passively move her legs immitating the action of walking .. this may take months and needs alot of patience..
for provoking swalowing muscles simply apply some ice on the throat area in fast unrythmic manner for 3 minutes 3-5 times daily...
for her feeding use Pediasure from Abbott it will give her complete diet in a cup it also contains some essential fatty acids that are proven to get a lot of progress in such neurologic cases....
best of luck dear

[vmacbean]

Can I just express my concern at the fact that people are recommending - and indeed stating that this patient "needs" to do - certain things with a patient that they have never met, assessed, or even seen any medical history of. This question was posted by a non-medical person and to even mention, let alone advise the use of, specific treament modalities seems to me to be highly unethical and potentially dangerous. I realise that Ajay has asked for advice but I feel that only general advice should have been given, certainly not telling his child to start drinking and performing swallowing exercises - these have the potential to be highly unsafe.

I wish Ajay all the best with his daughter's recovery and hope that he has managed to find a therapist he's happy with.

[physiobob]

Can I just express my concern at the fact that people are recommending - and indeed stating that this patient "needs" to do - certain things with a patient that they have never met, assessed, or even seen any medical history of. This question was posted by a non-medical person and to even mention, let alone advise the use of, specific treament modalities seems to me to be highly unethical and potentially dangerous. I realise that Ajay has asked for advice but I feel that only general advice should have been given, certainly not telling his child to start drinking and performing swallowing exercises - these have the potential to be highly unsafe.

I wish Ajay all the best with his daughter's recovery and hope that he has managed to find a therapist he's happy with.

I could not agree more. I have in fact emailed Ajay directly and asked if he/she or their physio might write some updates about what this history of this condition is. I suppose they have their hands full right now so it might be a few days before we get any more information

[sarapollo08]

HI,
I would first ask ur physiotherapist to make a thorough assessment of ur daughter based on which only goals can be set up on which will be the appropriate treatment canbe trained .
In general u can try proper positing of the limbs to avoid contractures and splinting if necessary,mild passive movts and streching to be done regurarly,frequent turnings in bed to be done .

ur daughter ll recover quickly with all hopes
prathap

[Manchester Neuro Physio]

Dear Ajay

I hope your daughter is doing well, I agree that if the physiotherapist treating your daughter need advice you should point the direction of the forum. Many heads are often more useful than one.

Regards

[Bobath Physio Manchester]

Dear Ajay,

Having read through the other posts I would like to add that physios would be unable to give treatment advice without your daughter's medical history. However, if you would like speciliast advice, The Bobath Centre is a speciliast physio centre for children mainly with cerebral palsy. They may be able to help or refer you to further professionals who can. Their website is Bobath Centre - Cerebral Palsy Treatment

Hope this was of some use.