spastic diplegia

hi
i'm treating a 10 year girl with spastic diplegia.she has spasm in knee flexors and hip adductors,internal rotators when she came to me.and now i managed the thing with regular stretchings to knee flexors and strenghtening the knee extensors.but unable to reduce the hip adductor spasm.she is unable to flex and abduct her hips, extend her hips normally.here is the present condition of her lower limb joints:

hips - extension - normal bil
flexion - 0 to 5 degrees bil (AROM)
0 to70 degrees bil(PROM)

ext rotation - absent (AROM)
int rotation - hips rotate internally involuntarily and can rotate to neutral on command.

abduction - 0 to20 degrees (AROM)bil
0 to40 degrees (PROM)
adduction -10 degrees (AROM)BIL
15 degrees (PROM)


Knee - flexion -0 t0 110degrees (AROM)bil
0 to 120 degrees(PROM)

extension -120 to 30 degrees(AROM)bil
120 to 0 degrees(PROM)


ankle -dorsiflexion -0 to 7 degrees(AROM)BIL
0 to 15 degrees(PROM)
plantar flexion -0 to 10 degrees(AROM)
0 to 15 degrees(PROM)

she can sligtly flex and extend her metarsal and interphalyngeal joints and always keep the foot in inversion.can everse it on command.unable to bear her weight on the lateral border of the foot .all the above said conditions are getting improved day after day except hip flexion and aduction.plz suggest me any other treatment. she has been under my care since 4 months. she can stand with little support but with knees flexed to 20 to 25 degrees. she can walk in waddling gait with her KAFOs on with a tetrapod walker. all the above joint ranges got improved from 0 due to stretchings and strenthening.i've tried electrical stimulation but she she is so stubborn due to her odd experiences with that in the past when she was under care of other therapists.:( .

bye ,
prem.

hi. what is the cause of the spastic? is there any disease or mental retardation the girl has?
And another thing is, are used to vojta and/or child bobath therapies? it could be really usefull concepts. there are some special and really good techniques for spastic release etc.
cheers

she is a CP KID.as told by her parents she was normal til her 3 rd month and they observed her milestones getting delayed and the baby's flexed hands and legs.i've no idea about bobath's.plz guide me .
thank u,
bye.

You can go for anti -scissoring orthosis. Let her practice with kafo and a anti-scissoring orthosis . Slowly she will develop the pattern and the required strength. Else she can go for neurolysis of obturator nerve.

Hi..........now days im with delayed mile stones .most probably this condition relate to d/mile stonesw ,well you have to treat her by bobath method and dont apply any electrical stimulation it will increese the spasticity . you can reduced the hip adduction by puuting some roll under her thighs as well as contioun passive streachings..............regards.salma

Fateema , you are repeatedly claiming electrical stimulation to be a contraindication in spasticity. Do you have any evidence based study or relevent article on it ?

Hi
From the above mentioned information about the child. Further assessment should be done for effective intervention:
- Check if the child has Pattela Alta, because this will reduce the effectiveness of Quadriceps pull so, the child will never be able to do full knee extension actively.
- Check if the child suffers from any femoral or Tibial torsion
- Check both ankles in open and closed chain.

I would like to suggest the following:
- Facilitate extension postural pattern of movement
- Use Kay reverse posture walker, this will facilitate the upright posture.
- if possible refer the child for Botulinum Toxin A Injection in the spastic muscles particularly hips Adductors.
- I agree with Fateema regarding using Bobath approach and not using elictrical stimulation.
Best regards

HI,
well i just want to know what is kay reverse posture walking .now days im with cp center ,and need to have some information.......i want to ask to Mr jawwad .
thanks....

Hi Fateema
There are many kinds of walkers in the market. the front walker (child hold it from front and walk) like ordinary walking frame or rollator and the back one which is like Kaye reverse walker. In this kind of walkers, child hold it from behind and walks forward, Kaye walker facilitate upright posture and has a stop in the back wheels so the walker will not walk backward and this give the child more stability, you can also add pelvic stabilizer for more stability to those children with poor lower trunk control and have lack of dissociation between pelvic and trunk. Her I insert a website link, so for more information you just click on it. of course there are many brand names now for the same kind of this walker.
http://www.cplqld.org.au/ets/otherpr...ng/kaye/walker

HI JAWWAD,
thanx for your usefull links and suggestion ,i will apply it for children ...............but i dont is it available easily in karachi (pakistan ) or not
well .byeee

You're most welcome Fateema.Actually I'm from Jordan and I'm not sure if it is available in Pakistan but it should be in such country.
By the way my name is not Jawwad it is IAwwad (Ibrahim Awwad)
Best wishes

Dear physiosanskrati or anyone else

I am a father of twin daughters afected by CP. I am trying to educate myself on how to best halp them. Out therapist is using Bobath with great success.

I see in your first comment that you recommend anti -scissoring orthosis. Do you mind explain what this is or referring me to any reading material where i can learn. My one daughter has a extremely spastic gait with scissoring of the pointed foot each time she trys to stand and walk

Hello, I'm new on this forum, my son is 7 years, and is diagnosticated with cp, spastic diplegia (Little disease). I agree with others regarding electric stimulation ...IS TOTTALY CONTRAINDICATED... Unfortunattely Vojta is a GREAT method till 6 ...max 9 month old...so...altought THE BRAIN is so "free", this "nervous pathing" is inefficient after 9 month....GOOd but inefficient...

I think the main GOAL in this disease is the BALANCE. And sequential aproach !!! Need a LIFE TIME...I'm a FATHER ...and believe me all...I KNOW... try KAFO, try dinamic orthosis, BUT REMEMBER...without balance and a proper muscle tone....nothing is GOOD....neighter surgical options...you just destroy your child...(surgical can heal an EFFECT not a CAUSE....)

HEALTH to ALL PLANET !!!

hi mr. iawwad

could u pls provide me a detail info. about "dissociation"......upper limb frm trunk and thn pelvis........the procedure too

regards
shruti