Joined: March 23, 2001
From: Berlin, NJ, USA
I have only been working as a peds PT for a few months now. I work at a school for children with CP. I got into this field because I have a daughter with CP. I have a passion for trying to help kids with CP gain motor function. I read everything I can get my hands on -- old and new from the Bobaths to Leonard to Shepherd.
This is probably only the first of many requests for help I will be sending out. I have a student with spastic diplegic CP, about 12 years old, with a long history of sitting inside of his LE's ("W-sitting"). He ambulates with an Ottobock Bugsy walker, but his gait pattern is painful to watch. His hips, knees and ankles move excessively in every direction. To say that he suffers from ligamentous laxity would be an understatement. I have asked the parents to remind him not to "W-sit." (Although I think its a little late for this.) I have been trying to work on activities that will help increase muscle strength in LE's to help with support and stability at the involved joints. While doing this I have to provide manual support at the knees and hips to get a somewhat normal alignment.
From what I've been able to find in the literature, I'm afraid his ligaments are going to eventually snap -- they've been permanently deformed and if immobilized they would change in physical properties so as to become more brittle.
I haven't been able to find any literature about surgical procedures to repair this type of damage. I thought of using orthopedic knee and ankle braces during therapy (mom and dad don't like orthotics --they think it makes their son look disabled). I thought maybe if I showed them what he looked like walking with more stability at the knees and ankles they might reconsider. Maybe I could try the SWASH for the hips?
Andrew, I would appreciate any guidance or suggestions.