Summary: Results of first seven months of therapy to six children, aged 2 to 4 years, with moderately severe Cerebral Palsy, given Hyperbaric Oxygen Therapy, Intensive Standard Therapy of CP (Occupational Therapy + Physiotherapy + Special Education + Speech Therapy) and Nerve Block as required. Last reviewed January 21, 2007

Midway results of UDAAN Multimode Therapy

On completion of HBOT (40 sessions), Nerve Block, Acupuncture (3 months) and 7 months of OT/PT, Speech Therapy and Special Education

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Therapy given: May 2001 to December 2001

Demography

  1. Six children with moderately severe cerebral palsy
  2. Age: 30 months to 42 months average 32 months;
  3. Sex 5M 1F
  4. Type: CP Quadriplegic 4; Diplegic 1; Athetoid 1

Regimens:

  1. Hyperbaric Oxygen Therapy (40 sessions)
  2. Botox (1 case: AP) or Phenol Nerve Block (3 cases)
  3. Acupuncture for 3 months
  4. Occupational Therapy + Physiotherapy + Speech Therapy + Special Education for 7 months

Item assessed

# Of children improved / # of children who had the problem out of six CP children

Recovery from abnormal reflexes

MORO

3/3

ATNR

1/1

STNR

4/4

Improvement in Joint Flexibility:

Rt. Shoulder Flexion up to 180°

5/5

Rt. Shoulder Extension up to 180°

5/5

Rt. Elbow Extension up to 140°

5/5

Rt. Wrist Extension up to 70°

6/6

Rt. Hip Extension up to 125°

5/5

Rt. Hip Abduction up to > 42°

5/5

Rt. Knee Extension up to 120°

5/5

Rt. Ankle Dorsiflexion up to 18°

5/6; Partial 1/6

Lt. Shoulder Flexion up to 180

5/5

Lt. Shoulder Extension up to 180°

5/5

Lt. Elbow Extension up to 140°

5/5

Lt. Wrist Extension up to 70°

6/6

Lt. Hip Extension up to 125°

5/5

Lt. Hip Abduction up to > 42°

5/5

Lt. Knee Extension up to 120°

5/5

Lt. Ankle Dorsiflexion up to 18°

5/6; Partial: 1/6

Recovery from deformities

Lumbar Lordosis

1/1

Kyphosis

3/3

Scoliosis

2/2

Posterior Pelvic Tilt:

1/1

Hip Abducted

2/5; Partial: 3/5

Hip Medial Rotated

2/; Partial 2/4

Knee Flexed

2/4; Partial 2/4

Ankle Eversion

3/5; Partial 2/5

Cubitus varus

1/1

Gross Motor Skill Improvement

Head Control

1/1

Supported sitting

1/1

Unsupported sitting

0/1; Partial 1/1

Get to sit

1/3

Supported on 4 position

5/5

Unsupported on 4 position

4/5

Supported knee standing

3/3

Unsupported Knee Standing

4/6

Supported Standing

4/4

Unsupported Standing

4/6

Supported get to stand

3/5

Improvement in Mobility

Rolling

2/2

Creeping

3/3

Bottom Shuffling

2/4

Bunny Hopping reduced

2/2

Crawling

4/5

Supported walking

3/6; Partial 1/6

Fine Motor Skills improvement

Hands in midline

2/2

Voluntary grasp

2/2

Voluntary release

3/3

Transference

2/3

Tower of two cubes

3/4

Points with index finger

2/3

Scribbles

3/4

Imitates vertical strokes

5/6

Imitates circular scribble

1/6; Partial 3/6

Imitates Horizontal stroke

2/6; Partial 2/6

Tower of 6 cubes

3/6; Partial 2/6

Imitates a cross

2/6

Activities of Daily Living improvement

Finger feeding

4/4

Spoon feeding

2/6

Drinking from a glass

4/6

Indicating need for toilet

3/5; Partial 2/5

Sits on commode

5/5

Undress before toilet

0/6; Partial 5/6

Speech development improvement

Comfort sounds, crying and vocal play

3/3

Babbling

3/4; Partial 1/4

Socialized babbling

1/4; Partial 3/4

First word

1/4; Partial 1/4

Phrase

2/6; Partial 1/6

Simple sentence

1/6; Partial 2/6

Complex sentence

2/6

Pre-Speech Skill Development

Lip function

2/4

Tongue function

2/6; Partial 4/6

Hard/Soft palate function

Normal in all

Mandible function

3/6; Partial 3/6

Voice Pitch, Intensity, Quality

3/5; Partial 1/5

Phonation duration

3/6; Partial 2/6

Breath Control

0/5; 4/5

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INDEPENDENT ASSESSMENT AT THE LEADING REHABILITATION UNIT OF NORTHERN INDIA:

These six children were periodically referred as Outpatient cases to the Rehabilitation Department of Safdarjung Hospital, the leading such unit in Northern India, with request for stringent assessment of their disability level. Thus, they have so far been assessed before therapy, after HBOT (after 2 months) and again after completing Nerve Block and Acupuncture Therapy (after 6 months).
This is the summary of the independent Safdurjung Report. Status as of TODAY (April 2003) included.

AG

Female child, Dyskinetic CP with diplegia was assessed on 14.05.01. Pt was reassessed on 6.12.01 and showed improvement in following areas :

Gross motor

Started standing with wall support
Can come to quadrip position

Ambulation

 Although she still do bottom shuffling but she attempts to crawl

Fine motor

Started untying shoe laces and Velcro straps

Feeding

 Started eating with spoon -  2 years
Can drink water with glass -   2 years

Cognition and Perception

 Started concentrating on TV Programs
Can sort out colors
Can make out what is eatable
Tries to come to quadrip position when the child watches animals

Speech

Babbling

Comments

No significant change was noticed in speech.
Cognition and perception areas before therapy. She was at 1 year of developmental age and now she is at 2½ years. In fine motor skills she was at 9 months level and now she is at 2+ years of developmental age
TODAY Independent walker, with markedly controlled athetoid movements. Showing continuous improvement still.

TM

Male child diagnosed as CP with MR with microcephaly. Patient was reassessed on 7.12.01 and was observed that child has shown improvement in following areas

Gross Motor

 Standing balance is improved
Although he is still walking with support but now he can walk with little more ease. Using Gaiters and AFOs
Muscles are more relaxed now
Voluntary control is also improving
Fine Motor Started folding papers
Started untying shoe laces
Started unbuttoning
He can screw and unscrew jar caps
He can break chapati (unleavened bread)
Learning to make circle
Speech

Sentence of 3-4 words

Cognition and perception

Normal for his age

Comments

Patient has shown good improvement in speech and fine motor skills, muscles are more relaxed now
TODAY Independent walker. Attends a normal KG School.

AK

Male child diagnosed as C.P. Spastic (Diplegia). Child was reassessed on 16.07.01. The main areas of improvement
Gross Motor Sitting and standing balance slightly improved. Child can sit with his own hand support for 30 minutes and can stand with wall support
Started  Creeping
Now started coming to crawling position
Voluntary Control is better at ankle
Speech Have a good command on 3 word sentences
Fine motor Tries to participate in dressing activities
Now he started folding papers
Can untie shoe laces
Screw/unscrew jar cap
Conclusion In Gross Motor: child has come up from 6 months to 9 months of developmental age
In Fine motor: from 1 year to 3 years
In Speech: from 1½ to 2 years
TODAY Lost to follow up. Last heard six months ago was progressing well.

AP

Male child with CP Spastic Quadriplegia. Patient was reassessed on 5.12.01 and was observed that he was showing improvement in following areas.
Gross Motor Sitting & standing balance improved
Can stand with wall support
Now muscles are relaxed
Fine Motor Started folding paper
Can untie the shoe laces but cannot tie them
Started doing unbuttoning
Can string the beads
Feeding Started breaking chapati (unleavened bread) with both hands
Writing Can mark straight lines
Cognition and Perception Normal for his age
Speech Normal for his age
Comments Child has shown good improvement in fine motor skills and speech
TODAY Lost to follow up. Last heard, was progressing well.

SA

Male child with CP Spastic Quadriplegia. Patient was reassessed on 11.12.01 and it was observed that he showed improvement in following areas:
Gross Motor Started walking 2-3 steps but feels insecure
Standing with the help of gaiters and AFOs without support for few seconds.
Fine Motor
Started Untying shoe laces
Feeding Started faking water with both hands
Cognition and Perception Eye to eye contact improved
Started following commands e.g. he brings what he is asked to e.g. Towel, Plate, Glass
Started indicating his desire to have water by action
Indicates for Urine Started recognizing – ball, spoon, glass
Attracts to colorful things
Speech No charge
Comments Good improvement in cognition and perception
TODAY Independent walker. Still showing steady improvement. Attends UDAAN School.

AS

Female child with CP Spastic Diplegic. Patient was reassessed on 13.12.01 showed improvement in following areas.
Gross Motor Started rolling over
Started sitting with support
Muscle are more relaxed now
Tries to creep
Fine Motor Skills Release of object achieved
Now can hold for little longer duration
Feeding Hand to mouth feeding possible
Cognition and perception Attempting to wave Ta-Ta
More alert towards surroundings
Eye to eye contact is better
Speech Same
Comments Gross motor - Child has shown improvement i.e. he was at 4 months level and now he is at 7-8 months of   developmental age
Fine motor skill -from 6-9 m to 12 m
Feeding - 0-9 m
Cognition and perception- 1 to 1+
Speech - Same
TODAY Lost to follow up. Last seen Oct. 2002, was progressing further well.

For SPECT Scan pictures, Click here

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