Case of the week - 13/08/98

This case is to be presented for discussion at the European Society for Movement Analysis in Children Annual Meeting in Belfast, 24^th-26^th September 1998.

Discussion is welcomed before the event. Address any comments to CGA ([n/a]). 

C is a 6 1/2 year old boy with a diagnosis of spastic diplegia. He now uses bilateral AFOs and elbow crutches and is able to walk distances of up to 100m being limited by fatigue. He has had no previous surgical intervention but has had injections of Botulinum Toxin to the hamstrings on three occasions (at 4 yrs, 4 yrs 7 mths and 5 yrs 6 mths). There was a response to all injections and the parents feel the response to the most recent injections was the best. He had gait analysis at 5yrs 11mths with surgery being recommended. Whilst on the waiting list he has shown some improvement and is now able to walk 10m without his crutches but with splints. Given this we were asked to repeat the analysis. 

Temporo-spatial parameters:
Speed 0.5 ms^-1
Stride length 0.72 m
Left step length 0.34 m
Right step length 0.37 m 

He has generalised symmetrical muscle weakness and patterned movements. Resting tone is raised at the ankle and less so at the left knee and hip. Results of the rest of the physical examination are given below.

Movies (PC users get the QuickTime plug-ins here - right mouse-click "Save Link as..." - Windows 95/NT and 3.1)

The movies will open in new browser windows so you can view them simultaneously with analysis.  

3D Kinematics left ... 3D Kinematics right  ... 3D Kinematics both sides

... points for discussion:

• C has a posterior pelvic tilt with a pronounced double bump pattern. The double bump is often associated with bilateral hip flexor tightness. However, C has a negative Thomas test and a good range of hip flexion and extension during gait. Is there another explanation for the double bump?  
• In the short term we will be re-injecting C’s hamstrings. What is the effect of this likely to be? (come and see the follow up data at ESMAC!) 
• In the slightly longer term what can be done to help C?

What people said...

Case supplied by Richard Baker
Case prepared by Mag. Andreas Kranzl
 

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Maintained by DDr. Chris Kirtley, Andreas Kranzl
Last modified on Wednesday, 13-August 1998.