Case Studies – spritelypt

Gianna is a 4-year old girl with bilateral cerebral palsy, GMFMCS level IV. She has mixed tone with components of both spasticity and dystonia. Over the last month she has been acting differently, with loud vocalizations, irritability, agitation, increased muscle tone, sleeplessness, and episodes of teeth grinding. Everyone in her family has been feeling heightened stress. Is Gianna in pain? She can’t clearly relay what she is feeling and where it hurts because she is non-verbal. There is no obvious swelling or redness on any area of her body. As her PT, how can you tell if she is experiencing pain?

Gianna’s situation is common. The SPARCLE study in Europe identified that children with CP experience more pain than their peers and that pain can lead to a lower quality of life, decreased participation, and family stress. Pain has been found to decrease quality of life more than the physical disability itself. As a health practitioner, it can be difficult to determine the presence of pain unless there is a visible sign, localized pain, or the child can verbalize what they are feeling. Continue reading “Case Study- Pain”

Devin likes to go fishing; it’s his favorite hobby. He is a five-year old boy with a diagnosis of bilateral cerebral palsy, GMFCS level 1. Devin perches at the river’s edge in a deep squat in order to catch a glimpse of the trout beneath him.

Deep squatting is useful for a variety of reasons, like getting close to the floor to see something clearly, or to rest without getting on knees or bottom. It requires adequate hip flexion range, ankle range, and postural control. It is a developmental milestone.

When I look at the drawing of Devin, I wonder why:

Devin has an inverted foot position on right.
His low back position shows excessive lumbar flexion during a deep squat.
His pelvis is posteriorly tilted.
He is stabilizing, or limiting his degrees of freedom, by bracing his right elbow on his right knee and resting his chin firmly on his left knee.

Continue reading “Case Study- Supporting one Boy’s Love for Fishing”