Case of the week - 17/09/98

 

 

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

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

Case supplied by: Het Roessingh, Research & Development, Enschede, The Netherlands.

Case J.S. is a 22 year old male, with asymmetrical spastic diplegia. He is an independent ambulator walking with a crouch gait, and complains of increasing amount of effort in walking.

In the past he has been treated with a tendo-Achilles lengthening on both sides (1977) and a phenol injection of the obturator nerve on both sides (1993).

Medication: Liorisal (5mg) with little to no effect.

Clinical examination shows deformities in almost every tested joint. Tone and reflexes are very high. Duncan Ely, confusion test and ankle clonus are positive on both sides. Generally he has good strength, but standing balance is poor.

Results of clinical examination:
 
 
R.O.M. (R)
R.O.M. (L)
Strength (R)
Strength (L)
hip flexion
80
80
5
5
hip extension (Thomas test)
-5
-5
5
5
hip abduction
15
10
5
5
hip adduction
10
10
5
5
hip internal rotation
50
60
    
hip external rotation
0
-10
    
knee flexion
150
150
5
5
knee extension
-10
-10
5
5
popliteal angle
80
80
    
ankle dorsiflexion (knee flexed)
0
5
    
ankle dorisflexion (knee extended)
-5
-5
4
4
forefoot inversion
20
10
    
forefoot eversion
70
70
    
foot/thigh angle
0
-5 (int)
    
bimalleolar axis
10 (ext)
20 (ext)
    
femoral anteversion not tested because of high tone   
 
Energy consumption was assessed using the Oxycon.

The test reveals high RQ values. Steady state was not reached during the test.

This indicates continuous anaerobic energy production during walking.

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.
 
 
 
  
movie format QuickTime QuickTime
  left and front side right and back view

3D Kinematics right and left

... points for discussion:

What people said...

Case supplied by Richard Baker and  Het Roessingh, Research & Development, Enschede, The Netherlands.
Case prepared by Mag. Andreas Kranzl

Email your comments to [n/a]

Maintained by DDr. Chris Kirtley, Andreas Kranzl
Last modified on Wednesday, 17-Sep. 1998.

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