Patrick's Journey

Patrick is 4 years old and presented with right-sided hemiparesis with weakness in upper-right and lower-right limb.

He also had flexor synergy with increased tone, extensor synergy in lower-right limb with equinus foot with inversion and genu recurvatum in the knee. (Ashworth scale: 3).

Neurological Assessment:

Higher Functions - Normal: Able to follow and respond well.

Motor Examination:

Reflexes: Brisk on the affected upper-limb and lower-limb side.

Sensation: Normal in all dermatomal levels.

Proprioception and Stereognosis: Normal.

Muscle Tone: Increased in both upper and lower limb and flexor synergy in upper-limb and extensor synergy in lower-limb.

Posture: Able to stand with support. (support required by holding on with both hands)

Sitting: Low sitting (cross leg): able to sit by leaning to affected side,

High sitting: Able to sit with minimal support using unaffected upper-limb.

Walking: Able to walk with bilateral support. (cirumduction and toe walking with extended knee joint)

Fine motor functions: Patrick can do certain activities with his upper-limb such as holding a bottle of milk, packet of crisps or a spoon. His handgrip is fair.

Functional Tasks: Mostly dependent during activities of daily living (Functional Independent Scale: 3)

Mobility: Bum shuffling only.

Cognitive Properties: Good understanding and can try and repeat any activities.

Treatment Goals:

To reduce tone in the upper and lower limbs on the affected side
To improve hand function
To improve strength in upper and lower limbs
To correct posture
To improve sitting and standing balance
To improve walking
To improve CSF flow and spinal stimulation

Treatment Procedure:

Proprioceptive neuromuscular facilitation (PNF) techniques for upper and lower limbs

Primary movement therapy for upper and lower limbs

Spinal stimulation to improve autonomic nervous system and to improve the flow of cerebrospinal fluid (CSF).

Strength training for upper and lower limbs

Core muscle strengthening (ball activities)

Postural balance

Gait training

Co-ordination activities

Hand functions

Play therapy

Progress Report:

After the first 4 sessions...

Patrick’s muscle tone had improved and now it is graded 2 using the Ashworth scale. His movements in his upper-limb and lower-limb are good. He is able to do to precise activities such as picking up beads, hitting keys on a piano, and turning pages in books and holding a fork and a spoon.

His sitting posture has improved. During cross sitting he is able sit without support, which he was unable to do before the treatment. He can also sit in a high couch without support and able to move his upper and lower limbs.

His balance has improved and now he is able to squat down and stand up by himself, able to stand with minimal support or holding a rail by himself. He is also able to go on his knees (kneel sitting) without any support and move on his knees on a soft surface for a good distance.

After 8 sessions...

He was able to walk with minimal support, holding the therapist’s or his mother’s hand and able to walk in and around the house with support. Patrick is now able to go on the treadmill with a minimum speed of 0.5 miles/hour for about 5 minutes.

After 12 sessions...

He was able to do fine-motor activities such as picking up small articles, or feeding himself sitting at a table. He has improved his functional independent level score from Grade 4 to Grade 3. His tone has remarkably reduced in his both upper and lower limbs which enables him to stand and walk and he is now also able to use his hands for functional grip.

Patrick is now able to ride his new tricycle by himself. He can now get on and off it and ride himself without support. Patrick is also able to climb stairs with minimal support.

Overall, his cognitive abilities have improved after receiving the twelve sessions of spinal therapy (To improve neuro-muscular stimulation and also to improve CSF flow from brain to spinal cord and vice versa).

Patrick has benefited from the fast oscillating technique to reduce tone in his upper-limb and lower-limb and with spinal stimulation and strength training techniques.

Patrick continues to attend for therapy and his mother is delighted with his improvement and she thinks that he will improve further by attending regularly for treatment at the First Step Therapy Centre.

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