Case Studies

Case #1

Miss N.Gupta (Name changed), came to ICD for the first time at 18 months with increased stiffness in the legs, reported slow walking development. Although there was no history of birth problems, she was sent for a workup with a brain MRI and it was normal and a diagnosis of cerebral palsy was made. According the assessment, she was placed in a solid AFO and her mother was encouraged to have her move using a posterior Rollator and intensive therapy. By age 2 years, she started walking independently and by the age of 3 years, she was walking on her toes but falling a lot due to her speed. Then, she was asked  to wear an articulated AFO and was advised to continue the physical therapy program where she had good continued improvement upto the age of 4 years. Therefore, she was continued for another two years in the same program. By age 6 years, her therapist who was working with her felt that there had been no additional progress in the past 6 months. At this time, her physical examination demonstrated a popliteal angle of 50 degree, knee extended ankle dorsiflexion of 5 degree, and bilateral and knee flexed angle dorsiflexion of 15 degree. Internal rotation of the hips was 70 degree with external rotation of 20 degree. Other ROM were normal. Kinematics demonstrated increased knee flexion at foot contact, premature ankle dorsiflexion, and internal rotation of the hips. The gastrocnemious had 2+ spasticity and the hamstrings and hip adductors had 1+ spasticity. Her mother was given the option to have either dorsal rhizotomy or orthopedic surgery, and she chose to do the orthopedic surgery. Miss.Gupta had bilateral hamstring lengthening, gastrocnemious lengthening, femoral derotational osteotomy. One year after surgery, her gait had improved with better knee motion and correction of the internal rotation. This improvement was maintained 4 years later. It is expected that this girl will likely not need more surgeries and that she will be an excellenyt ambulator as an adult.