Indian Journal of Physiotherapy & Occupational Therapy-An International Journal

Abstract

Cerebral palsy is a disorder of posture and movement that occurs secondary to damage to immature brain before, during or after birth. Pronounced secondary conditions include epilepsy, speech or communication disorders, eating problems and oromotor issues, sensory impairments, mental retardation, learning disabilities and/ or behavioural disorders.

We here present a case of spastic diplegic with oromotor spasticity and balance problems. The association of oromotor muscle spasticity and topographic classification has not been established but research quotes its occurrence with spastic tetraplegics most. Hence we found this a rare phenomenon. We would like to draw the reader's attention on physiotherapy intervention to the objective and subjective improvements in both initial complaints. Hence we emphasis the importance of adherence to a tailor made objective specific physiotherapy home programme

Case presentation

An 8 year old girl, Asian complained of hoarseness of voice, difficulty in climbing stairs and frequent falls. She was born to a primigravida mother who under went regular antenatal instructions from obstetrician. In 8th month, diagnostic ultrasound revealed abnormal curvature of foetal spine. Natal and postnatal period was uneventful. Delayed development was reported in gross and fine motor functions and speech and language domain. Objective findings included spasticity of mastigatory muscles(Modified ashworth score 2) and PBS scores of 46/57. Moderate tightness of gastrosoleus, rectus femoris and hamstrings. After 3 months of home programme she had marked improvement in tone (ashworth score 1 +), PBS (53/57) and voice quality.

Conclusion

1. Involvement of oromotor spasticity is an underreported entity in spastic diplegia.

2. Home programme schedule plays very important role in the management of balance, coordination and speech issues in mild spastic diplegics.

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