Effect of SynPhne in a Cerebral Palsy Child: A Case Study

Dr Alakananda BanerjeePresident

Dharma Foundation of India

Personal history• Patient name : XYZ• Age/Sex : 6 year/Male • Right hand dominant• Diagnosis :Mild cerebral palsy; Static Encephalopathy• History– Full term caesarean delivery– Neonatal jaundice– Seizure- 2 times, one- 3years of age, one- last year

Medical History

• Botox injection given in both lower limbs – twice

• On medication:• Syndopa plus• Valporate

MRI Findings

• Bilateral focal abnormalities in the thalamus and internal capsule, most likely sequelae of perinatal hypoxic ischemic encephalopathy.

Complains

• Difficulty in bed mobility

• Dependent in daily living activities

• Difficulty in using both hand (eating and drinking)

Ongoing Rehab

• Had 22 sessions of Neuro Feedback (Cognitive) Training at Department of Neuropsychology, NIMHANS Bangalore

• Patients attends regular physical and occupational therapy.

SynPHne

Target to improve difficulty in using right (dominant) hand for eating and drinking.

Assessment

Tone (Modified Ashworth Scale) Right Left Hand N N Wrist Flexor 1 1 Elbow Flexor 1 1 Shoulder 0 1 Hip Flexor 1+ 2 Hip Add. 2 2 Hams 2 2 TA 3 3

Assessment

Voluntary control Right Left

Shoulder Good GoodElbow Good GoodHand Good GoodHip Fair FairKnee Fair FairAnkle Poor-fair Poor

Patient response: Slow to initiation of movement

AssessmentHand function Gross motor GRIP and release - PRESENT (RT>LT) Object transfer- present (rt>lt) Fine motor Tip to tip- partial present (fair) Pad to pad- poor Manipulation- poor Three jaw chuck- poor Bowel and bladder- sensation present Spinal disability- none

AssessmentThe Quality of Upper Extremity Skills Test

(QUEST)• This measure evaluates quality of upper extremity function in four

domains: dissociated movement, grasp, protective extension, and weight bearing.

• It is designed to be used with children who have neuromotor dysfunction with spasticity and has been validated with children from 18 months to 8 years of age

• Measures % of disability (of all four domains)

http://informahealthcare.com/doi/abs/10.1080/J006v13n02_01

• QUEST on 4/2/2015- 53.5%

Assessment Nine Hole Peg Test

• This test was originally introduced in 1971 as part of a study on strength and dexterity. (Kellor, Frost, Silberberg, Iversen, & Cummings).

• The Nine-Hole Peg Test (9HPT) is used to measure finger dexterity in patients with various neurological diagnoses

• Intended Population :Patients with Stroke, Brain Injury, Parkinson's Disease, cerebral palsy, multiple sclerosis

• Measures in seconds

4/2/2015 : RIGHT SIDE - 143 SEC

International Classification of Functioning

b163 Basic cognitive functions

b167 Mental functions of languageb710 Mobility of joint functionsb7301 Power of muscles of one limb

b735 Muscle tone functions

b760 Control of voluntary movement functionsd110 Watchingd166 Readingd170 Writingd410 Changing basic body positiond415 Maintaining a body position d440 Fine hand used445 Hand and arm used510 Washing oneselfd520 Caring for body partsd530 Toiletingd540 Dressingd550 Eatingd560 Drinking

e115 Products and technology for personal use in daily livinge310 Immediate familye355 Health professionals

• icf.xlsx

•Difficulty in speaking

•Weakness in both arm and leg

•Abnormal movement in both arm and leg

•Difficulty in bed mobility

•Dependent in daily living activities

•Difficulty in using both hand

•Cant go to school independently

•Difficulty in reading/writing

•Unable to sit and stand independently

•Articulation- b320.2

•Basic cognitive function- b163.1

•Muscle power function-b730.2

•Control of voluntary movement

function- b760.1

•Copying- d130.2•Changing basic body position- d410.3•Maintaining body position- d415.2•Caring of body part- d520.2•Dressing-d540.2•Eating -d550.2• drinking--d560.2

•Right hand dominance ,cooperative

Cerebral palsy

•Fine hand use- d440.2 (holding a pen, using mobile phone, flipping a card)•Hand and arm use- d445.2(holding ,lifting, transfer and release)•Writing- d170.3•Reading- d166.3

Xyz

6 year

Botox injection Given last month1 4/2

•High living condition (over protection)- (e315.-2) •Immediate family support-(e310.+4)•Health professionals e355 +4

•Difficulty in speaking

•Weakness in both arm and leg

•Abnormal movement in both arm and leg

•Difficulty in bed mobility

•Dependent in daily living activities

•Difficulty in using both hand

•Cant go to school independently

•Difficulty in reading/writing

•Unable to sit and stand independently

•Difficulty in grasping

Articulation- b320.2

•Basic cognitive function- b163.1

•Muscle power function-b730.2

•Control of voluntary movement

function- b760.1

•Copying- d130.2• Changing basic body position- d410.3•Maintaining body position- d415.2•Caring of body part- d520.2•Dressing-d540.2•Eating -d550.2• drinking--d560.2

•Right hand dominance, cooperative

Cerebral palsy

•Fine hand use- d440.2(holding a pen, using mobile phone,flipping a card)•Hand and arm use- d445.2(holding ,lifting, transfer and release)•Writing- d170.3•Reading- d166.3

Xyz

6 year

Botox injection Given last month1 4/2

•High living condition (over protection)- (e315.-2) •Immediate family support-(e310.+4)•Health professionals e355 +4

Treatment Intervention for short term goal

Target:• Fine hand use- d440.1 (holding a pen, using mobile

phone, flipping a card)• Hand and arm use- d445.1(holding a pen, using

mobile phone)

SynPHne:Products and technology for personal use in daily living

- e115.

SynPhNe

•Difficulty in speaking

•Weakness in both arm and leg

•Abnormal movement in both arm and leg

•Difficulty in bed mobility

•Dependent in daily living activities

•Difficulty in using both hand

•Cant go to school independently

•Difficulty in reading/writing

•Unable to sit and stand independently

•Articulation- b320.2

•Basic cognitive function- b163.1

•Muscle power function-b730.1

•Control of voluntary movement

function- b760.1

•Copying- d130.2•Changing basic body position- d410.3•Maintaining body position- d415.2•Caring of body part- d520.2•Dressing-d540.2•Eating -d550.2• drinking--d560.2

•Right hand dominance, cooperative•Products and technology for personal use in daily living e115.+4•High living condition (over protection)- (e315.-2) •Immediate family support-(e310.+4)

Cerebral palsy

•Fine hand use- d440.1 (holding a pen, using mobile phone, flipping a card)•Hand and arm use- d445.1(holding a pen, using mobile phone)•Writing- d170.3•Reading- d166.3

Xyz

6 year

Botox injection Given last month2 27/2

• VID-20150227-WA0011[1].gif

Quantitave Analyses

QUEST ( Quality of Upper Extremity Skill Test)

NINE HOLE PEG TEST

QUESTIONS ?