Case of the Week 2/12/99: right hemiparesis

from The Hong Kong Polytechnic University & Tuen Mun Hospital, Hong Kong

Animation by Polygon

Clinical Details

4.5 yo female. Normal birth history and healthy postnatally. Walking at 1 year, but was noticed to fall frequently. Analyzed prior to Botox injection of the right gastrocnemius.

Range of Motion (all measurements in degrees)

Joint	Sagittal (R; L) ext-neut-flex	Frontal (R; L) ab-neut-ad	Transverse (R; L) ext-neut-int
Hip	30-0-140; 30-0-140	60-0-30; 60-0-30	abduction, hip @ 90: 90; 90 prone: 90-0-88;70-0-88
Knee	5-0-150; 5-0-150 SLR: 68; 70 Grab (hip @ 90): 10; 0 Ely: -ve; -ve
Ankle	Knee extended: 15-0-60; 45-0-60 Knee flexed: 20-0-60; 50-0-60

Muscle Tone (Ashworth-Bohannon)

Group	Right	Left
Hip adductors	1	1
Knee extensors	1	1
Knee flexors	2	1
Plantarflexors	2 (no clonus)	1

(1 = normal, 2 = slight increase with catch)

Manual Muscle Test

Joint	Muscle	Right	Left
Hip	flexors extensors abductors adductors	5 5 5 5	5 5 5 5
Knee	flexors extensors	4 4-	4+ 4+
Ankle	dorsiflexors plantarflexors	4- 4-	4+ 4+
Toe	extensors flexors	4- 4-	4+ 4+

Movies

	Right	Left	Front	Back
QuickTime	right.mov	left.mov	front.mov	back.mov
AVI	right.avi	left.avi	front.avi	back.avi

Motion Analysis

	Right	Left	Right/Left
Velocity			0.77 m/s
Stride Length			0.71 m
Step Length	0.31	0.37 m
Cadence	138	129	123 st/min
Kinematics	rkinem.jpg	lkinem.jpg	kinem.jpg
Kinetics	rkinet.jpg	lkinet.jpg	kinet.jpg
EMG	remg.avi (animation)	lemg.avi (animation)	emg.jpg

... points for discussion:

What are the main kinematic and kinetic abnormalities?
What abnormalities are there in the right gastrocnemius EMG?
How would you classify this little girl's hemiparesis?
Is the knee flexion at contact a primary or secondary abnormality?
Do you expect her to benefit from Botox injection?

What people said...

Case prepared by Dr. Chris Kirtley & referred by Nerita Chan

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