Case of the week: 25-2-2005

Supplied by Amitesh Narayan, Dept. of Physiotherapy, Kasturba Medical College, Mangalore, India

History

She has attained the following milestones:

• Social smile: 4 months
• Follow with eyes:  4 months
• Head holding: 8 months
• Rolling over: 1 year
• Sitting: 1 yr 10 months
• Standing: 1 yr 10 months

• Dynamic Spasticity in Tendo-Achilles, adductors of hip, pectorals, pronators, rectus femoris
• Tightness currently seen in pronators, pectoral, Hamstrings (mild)
• (Earlier there was tightness in Tendo-Achilles, hip adductors, rectus femoris, mild amount in hip flexors, hamstrings
• Deformities-rocker bottom, left external tibial torsion, leg-length discrepancy of 1 cm. ?Subluxation of left hip
• MMT: all muscles are above grade 3 except hip abductors, hip extensors which are around grade 2
• Gait
• She has a strong extensor synergy when she walks,
• Walks with stiff legs
• For clearance of lower extremity she extends her back and clears it (due to rectus femoris Spasticity associated with extension synergy)

• She can come to sit, stand with support, crawl, stands independently with AFO for less than 1 min.
• She is a very bright girl, communication is normal
• Other systems are normal

Movies
 

	MPG	AVI
Frontal (with AFOs)	front (6Mb)	front (700kb)
	back (370kb)
Sagittal (without AFOs)	right (6Mb)	right (1.6Mb)

Points for discussion

Our concerns are:

Whether botox given to her adductors, rectus femoris can help her along with stabilization of the rocker bottom?

Whether muscle release is a better option?

Whether there is instability at the hip?

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