Faculty of physical therapy

Pharos University
Case Study about Diplegia
Dr/ Asmaa Awad
Ahmed Naeem Ghopashy
ID : 50814310
 History of the patient
Name: Mousa Seif
Age: 2.5 Years
Gender: Male
Medical History:
He suffers from hypoxia during his birth that had caused damage to some
of brain cells. He began physio therapy since he was 8 months.
 Physical Examination
He suffered from severe spasticity according to modified Ashworth scale, he
termed grade 3 in the scale because he has aspastic lower limbs passive
movement is very difficult, his mother found difficulty changing his
pampers.
The adductors muscles iliopsoas and caif muscles have severe spasticity.
But in the other hand, he has good trunk control abdominal and back
muscles are very good.
The both upper limbs have grade 1 in the modified Ashworth scale.
 Role of Physical Therapy
When he was 1.6 months injected with Botulinum toxin (Botox) and had a
cast for 2 weeks in a stretched position
After removing the cast starting with physio therapy program 3 session at
the day containing: -
 Stretching adductor, iliopsoas and caif muscle
 Strengthen all lower limb muscles
 Pelvis control exercises ( kneeling exercise , bridging and half bridging
exercise )
 He starts using AFO (ankle foot orthosis)
 Creeping exercise to learn reciprocal movement
 Stop and recover from standing exercise
 Squatting exercise
 Abdominal and back exercise
 Standing catch stand then two sticks then one stick then try to stand
alone.
He starts standing alone after 4 month from removing the cast
Now he begins in a new program containing gait training exercises: -
 Walking on treadmill learning bipedal
 Walking from pelvis
 Walking by walker
 Walking by sling in both hands
 Walking inside obstacles
 Walking by one hand
After 6 months, he had another Botox injection and cast for 2 weeks.
After removing the cast, he started a new stretching and strengthen
program for 1 month and gait training exercises after this month.
He started to take a step alone after 2 months removing the cast.
His steps are so slowly and short but with the time doing his gait training
program now he can walk alone for along period of time and long
distance and can walk in the street faster.