Case of the Week: 27th April 1999

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

5 year old boy with spastic diplegia. Walks with the aid of bilateral AFOs and a K-walker.

As can be seen in the animation below, he demonstrates quite a marked assymetrical tonic neck reflex (ATNR).

The gait is somewhat stop-go, and there are occassional moments of "freezing", after which the ATNR seems to be associated with a new burst of activity.

He was examined before and 4 months after bilateral Botox injections to the gastrocnemius muscles.

Temporal-spatial Parameters

Velocity	Cadence	Stride Length	Step Length	Stance Duration
0.09 m/s	42 steps/min	0.26 m	R = 15 cm; L = 11 cm	R = 86%; L = 90%

QuickTime Movies

Unaided Gait	With AFOs	With K-Walker	After Botox
Left side	Left side	Right side	Right side
Front view			"freezing episode"
Back view	Back view		Long

3D Gait Analysis results (Vicon 370 Version 2.6, full-body marker set, VCM kinematics)

Pre-Botox	Left/Right/Normal
Post-Botox	Left/Right/Normal	Left Variability	Right Variability

Pre/Post Comparison: Left ... Right

... points for discussion:

is this patient's ATNR helping or hindering his gait?
do you think his gait can be improved?
what is the main problem?
is the gait likely to improve or deteriorate with time?
what else can be done?

What people said...

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

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Maintained by Dr. Chris Kirtley, Andreas Kranzl
Last modified on 27th April. 1999.

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