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Physiotherapy assessment and managment of 19 years old spastic Cerebral Palsy child

 

















Name  : Xyz
Age /sex  : 19 years /M 
Dob  :  2nd May 2002
Birth cry :  Yes
Order of baby  : 1st 
Delivery  type   : C section 
Term of baby :  Full term 


WEIGHT      :3 kg

Seizures   :   parents get to know about Seizures when he was 3 month old 

But valprine was started day after the birth 


                         


Feeding habit : he used  to eat  all type of food 


Maternal information  

 


gestational      :  No 

diabetes           :  No 

BP                      :  No

Thyroid             : No

Any infection  : No 


Gross Motor 

(Physical and Functional  Assessment )

Neck holding achieved 

Sitting achieved  

ROLLING achieved 

He is able to get up from the floor himself 

He is able to do Bed to floor but unable to move from floor to bed himself  

Kneeling with support 

Half kneeling  with support 

He used to walk with minimum support 

Standing with support using orthotics 

Poor siting Dynamic  balance 



 Speech 

Bubbling sounds only 

 Incomprehensive  Sounds 



   Tightness 

 Bilateral TA and Tibialis  Anterior 

 Bilateral Mild medial hamstring

 Bilateral medial hip flexor 

 Bilateral pronater tightness

 Bilateral  rectus  femoris  tightness 

 

Weekness 


Gross muscle weekness of

 bilateral upper limb 

,lower limb and

 truncal muscle


 




GMFSC LEVEL   Level 4 


 Deformity  


Hip dislocation  or subluxation  : still under review

Scoliosis   left side Scoliotic  curvature 

Kyphosis.-: mild kyphotic posture due to poor sitting position

Foot and ankle   : Ankle everted Dorsi  flexed 

Bilateral  Mild  hand in  Pronation 

Crouch gait present 

 


MMT


Gross Muscle strength  lower limb   ≤ grade 2/5

Gross Muscle strength  upper limb  ≤ Grade 2/5

Core muscle strength  : poor 


USING WALKING or Mobility Aids: Not yet  


Using Standing  Frame : Yes 


Physiotherapy management 


 BASIC PHYSIOTHERAPY EXERCISE LEVEL 1

JOINT Alignment bilateral upper limb and lower limb 

Range of motion exercises  of bilateral  upper  limb and  lower limb 


Bilateral Stretching  of T A 

Bilateral  Stretching  of medial hamstring 

Bilateral Stretching  and alignment  of hip flexor 

Bilateral static   Stretching of pronater 




Weight  bearing activity 



BILATERAL  Hand weight bearing  


SUPPORTED  QUADRUPED  WEIGHT Bearing 


Front SUPPORTED  KNEELING  with or without  AFO 


High sitting  Oriented activity 


High sitting on block or chair with back support  while feet on the ground 

High sitting without  back support  while feet on ground 

High sitting  while feet off the floor 

High sitting with reach  ( if possible  add

 this too)


Supported High Sitting-to Standing activity   

Kneeling oriented  activity  static  and Dynamic 






 Standing oriented  

Standing on Frame 

Standing without  Frame with the help of AFO AND leg Gaiter 

Front support  standing 

Back support  /wall supported  Standing 


Core muscle strengthening exercise 



Excerise  to for Scoliosis curvature.


Reach out in quadruped  position 

Bridging 

Lying on sofa or bed in side lying position in left side  

Heel sitting  hands on floor move slowly  slowly  toward convex side 

Core strengthening 

Positioning like side sitting  convex side 


Advice :

Solid Ankle foot orthosis  

Full length lower limb Metalic Gaiters  

Boston Brace  (for Scoliosis)

CP chair 

Modified Wheel Chair

Parallel  bar walking 


NOTE= All Standing oriented  weight  bearing activity should be performed with the help of AFO , Gaiters   and spinal brace 


Dr.Akshya Raj Chandra PT

(MPT Neurology)

Ph +7827068869

Active Learning Child Development Centre 

H N -D 93 Sector 49 noida uttar pradesh 
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