short case

1. 14 yr , boy , the only living child with multiple neonatal deaths from nonrelated elderly parents.
can u assess the secondory and thirtiary disabilities this child had from his CP?

profoundly intellectually handiapped boy with spastic quadriplegia). he is not dysmorphic, growth parameters seem age appropriate but i would like to plot them in appropriate grpwth charts.

the lower limb examinations shows(marked disability. bedridden child. the limbs are in wind swayed posture, left hip is disloccated (missed this last week) with marked wasting in both limbs. there is no normal or abnormal movements noted. the right ll has more contracture than right, how ever the feet are surprisingly without any contractures. the hips are also not in adduction contracture which may be already been treated.

the abdomen is not full, feacal matter are not palpable neither the urinary bladder is. (SIT AT PATIENT"S LEVEL - ask for a chair if you want or kneel down). he is still wearing pampers."to end i would like to do a PR exam to look for fecal impaction.

higher mental function; do not assume patient can not speak, talk to patient, ask for name, see face trying to make some voice). check eye fixation. and hearing, speech is affected

physiotherapy is for preventing contractures (splints, serial casting to slowly stretch muscles. splints to prevent contractures, assist in position n function, eg. and strenthening the muscles (agaiunst gravity). OT is to faciliate wearing clothes, changing nappies, etc.

Bitox is not helping the knee since patient is not able to weight bear.

check SCOLIOSIS. treat with position. suregery is not helping much.

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