CASE
PRESENTATION
DEMOGRAPHIC DATA
NAME :- Anushka mishra
AGE:- 9 years
GENDER:- female
ADDRESS:- Ahmedabad
Hand Dominance:- Right handed
Chief complain :- difficulty in getting up from
lying position; difficulty in walking
HISTORY
PRESENT HISTORY
PAST HISTORY
PERSONAL HISTORY
SOCIO-ECONOMIC HISTORY
FAMILY HISTORY
EDUCATIONAL HISTORY
DRUG HISTORY
Present history:-(history given by
patient’s mother)
• Anushka was able to stand,sit and walk upto 2 years of
age.after 2 years of age,she felled while playing ,then after
difficulties in standing and walking arose.
• Weakness started occuring in hip muscles which made
difficult for her to play and walk like other kids.
• Parents thought that weakness might be due to
nutritional deficiency as she was not eating green
vegatables and healthy food,so they did not consulted to
any doctor for this problem.
• In january 2025,her parents consulted at spine institute
(Dr.Dishant sir) and advised for starting physiotherapy
treatment.
From january 2025,anushka started taking
phsyiotherapy treatment at neuro and pediatric dept
of government physiotherapy college.
Prenatal history
History of hypothyrodism during pregnancy.
on the last day of 8th month,mother had breaking of waters.
On the first day of 9th month,c-section was performed at
kolkata.
Anushka and aditya (twins)were delivered.
Difference in both delivery is approx 2-5 minutes.
Post natal history
After c-section,mother got iron deficiency anemia.
Blood transfusion was done;blood was donated
by her husband.
Past History:-
Socio-economic History:-
The patients socioeconomic status is good and the
patient can afford and spend money for proper
treatment.
Kuppuswamy scale :
Family History:-
Anushka’s brother aditya is diagnosed with
anterior horn cell disease.after 2-4 years,he was
unable to walk and stand independently.
Functional status of aditya:wheelchair based
DRUG HISTORY
investigation
OBSERVATION
POSTURE
TROPHIC CHANGES
INVOLUNTARY MOVEMENT
MUSCLE WASTING
GAIT
EXTERNAL AIDS
posture
sitting: anterior
Ears on same level
Right shoulder slight
depressed
Elbow flexed and on
level
Fingers abducted
Ankle (b/l)
plantarflexed
Sitting : lateral
Ear pinna and
acromion process in
line
Cervical vertebrae in
normal lordosis
Thoracic in normal
kyphosis
Lumbar : flat back
Sitting : posterior
Ears in alignment
No lateral deviation
of spine
Iliac crest in level
Standing : anterior
Neck in centre
allingment
Right shoulder
slightly depressed
Both Elbows in level
ASIS in level
Knees in level
Standing : lateral
Ear pinna and
acromion process in
alignment
Cervical vertebrae in
normal lordosis
Standing : posterior
Neck in center
Right shoulder slight
depressed
No lateral deviation
of spine
Iliac crest in level
Knees in level
Supine : anterior
Neck in center
Right side depressed
Elbow in level
Right side fingers
abducted
Iliac crest in level
Kness in level
Ankle in alignment
Trophic changes: none
Involuntary movements :- none
Muscle Wasting :-
Swelling :- absent
External aids :- none
PALPATION
Swelling :-
swelling is absent on both side
Tenderness :-
Absent
Scar :-
Absent
Vital Signs
Temperature :- 97.9
Respiratory Rate:- 16/min
Pulse Rate :- 74/min
Blood Pressure :- 140/87
EXAMINATION
HIGHER MENTAL FUNCTIONS
CRANIAL NERVE EXAMINATION
SENSORY EXAMINATION
REFLEXES
MOTOR
COORDINATION
BALANCE
GAIT
FUNCTIONAL ASSESMENT
HIGHER MENTAL FUNCTIONS
CONSCIOUSNESS
ORIENTATION
MEMORY
ATTENTION
HIGHER COGNITIVE FUNCTION
⚫ 1. information & vocabulary
⚫ 2. calculative
⚫ 3. abstract thinking
⚫ 4. constructional ability
BEHAVIOUR
READING AND WRITING
Consciousness
Scale is used to check consciousness
The patient is fully consciouss.
GCS shows 15 score
Patient is totally alert.
Orientation
The patient is oriented to place, person as well
as time.
Patient is also oriented to talks, dates as well as
current affairs taking places
Memory
Patient’s memory is not affected
Patient is having proper immediate, short as
well as long term memory.
Attention
Patients sustained attention is normal.
Patients alternate attention is normal.
Patients divided attention is normal.
Perception and Cognition
The patient perception as well as cognition is
normal.
Behaveiour
normal
Higher cognitive function
The above mentioned all activity are easily
performed by the patient.
By above examination we can
conclude that the patients higher
mental functions re not affected
CRANIAL NERVE ASSESMENT
1- OLFACTORY : intact
2- OPTIC : intact
3- OCCULOMOTOR : intact
4- TROCHLEAR : intact
5- TRIGEMINAL : intact
6- ABDUCENT : intact
7- FACIAL:-intact.
8- VESTIBULOCOCHLEAR: intact
9- GLOSSOPHARYNGEAL: intact
10- VAGUS : intact
11- ACCESSORY : intact
12- HYPOGLOSSAL:intact
SENSORY EXAMINATION
SUPERFICIAL SENSATION
1:- TOUCH:- The patient is having feel of touch
on both the sides of body.
2:-TEMPERATURE :- The patient can easily
differentiate between hot and cold
temperature.
3:-PAIN :- The patients pain sensation is normal
patient experience pain on pricking needle
on both the side.
DEEP SENSATION
Proprioception :- normal
Kinesthetia :- normal
DEEP SENSATION are normal in all the sides
of body.
CORTICAL SENSATION :
1 :- STEREOGNOSIS
2 :- TACTILE LOCALIZATION
3 :- BAROGNOSIS
4 :- TWO POINT DISCRIMINATION INTACT
5 :- DOUBLE SIMULTANEOUS STIMULUS
6 :- GRAPHESTHESIA
7 :- RECOGNIZATION OF TEXTURE
REFLEX TESTING
SUPERFICIAL REFLEX
1. corneal reflex :- normal
2. conjuctival :- normal
3. Plantar :- normal
4. Abdominal above T10 :- normal
below T10 :- normal
DEEP REFLEX
LT RT
1 BICEPS (C5-C6) 2 2
2 TRICEPS (C7-C8) 2 2
3 KNEE(L3-L4) 2 2
4 ANKLE(S1-S2) 2 2
VISCERAL :
⚫ RT LT
1 light INTACT
2 accomodation INTACT
3 cilliospinal INTACT
MOTOR EXAMINATION
TONE
NORMAL MUSCLE TONE IN UPPER LIMBS
AND LOWER LIMBS
MANUAL MUSCLE TESTING
MUSCLES RIGHT LEFT
SHOULDER 3 3
FLEXORS
EXTENSORS 3+ 3+
ADDUCTORS 4 4
ABDUCTORS 4 4
I.ROTATORS 4 4
E.ROTATORS 4 4
MUSCLES RIGHT LEFT
ELBOW FLEXORS 5 5
EXTENSORS 3 3+
WRIST FLEXORS 4 4
WRIST 4 4
EXTENSORS
FINGER FLEXORS 4 4
FINGER 4 4
EXTENSORS
SUPINATORS
PRONATORS
MUSCLES RIGHT LEFT
HIP FLEXORS 2 2
EXTENSORS 3 3
ABDUCTORS 3 2
ADDUCTORS 2 2
I.ROTATORS 2 2
E.ROTATORS 2 2
KNEE FLEXORS 3 3
KNEE EXTENSORS 3 3
ANKLE PF 3+ 3+
ANKLE DF 3+ 3+
MUSCLES RIGHT LEFT
ABDOMEN 3 3
TRUNK 4 4
EXTENSORS
TRUNK ROTATOR 4 4
NECK FLEXOR 5 5
NECK EXTENSOR 5 5
MUSCLE RIGHT LEFT
Upper trapezius
Middle trapezius
Lower trapezius
Serratus anterior
rhomboids
TIGHTNESS
Tightness was observed in following muscles.
RANGE OF MOTION
JOINT NORMAL ACTIVE PASSIVE
LEFT RIGHT LEFT RIGHT
SHOULD 0-170-180 0-180 0-180 0-180 0-180
ER
FLEXION
EXTENSI 0-40-50 0-50 0-50 0-50 0-50
ON
ABDUCTI 0-170-180 0-180 0-180 0-180 10-180
ON
ADDUCTI 170-180-0 180-0 180-0 180-0 180-0
ON
IR 0-70-90 0-90 0-90 0-90 0-90
ER 0-80-90 0-80 0-80 0-80 0-80
JOINT NORMAL ACTIVE PASSIVE
LEFT RIGHT LEFT RIGHT
ELBOW 0-140-160 0-160 0-160 0-160 0-160
FLEXION
EXTENSIO 140-160-0 160-0 160-20 160-0 160-0
N
WRIST 0-80-90 0-90 0-90 0-90 0-90
FLEXION
EXTENSIO 0-70-80 0-80 0-80 0-80 0-80
N
ULNAR 0-35-45 0-45 0-45 0-45 0-45
DEVIATIO
N
RADIAL 0-20-30 0-30 0-30 0-30 0-30
DEVIATIO
N
SUPINATI 0-80-90 0-90 0-90 0-90 0-90
ON
PRONATIO 0-80-90 0-90 0-90 0-90 0-90
N
JOINT NORMA ACTIVE PASSIV
L E
LEFT RIGHT LEFT RIGHT
HIP 0-130-140 0-130 0-130 0-130 0-130
FLEXIO
N
EXTENSI 0-20-30 0-30 0-30 0-30 0-30
ON
ABDUCT 0-40-50 0-50 0-50 0-50 0-50
ION
ADDUCT 0-20-30 0-30 0-30 0-30 0-30
ION
IR 0-40-45 0-45 0-45 0-45 0-45
ER 0-40-45 0-45 0-45 0-45 0-45
JOINT NORMA ACTIVE PASSIV
L E
LEFT RIGHT LEFT RIGHT
KNEE 0-130-140 0-140 0-140 0-140 0-140
FLEXIO
N
EXTENSI 130-140-0 140-0 140-0 140-0 140-0
ON
DORSI 0-20-30 0-30 0-30 0-30 0-30
FLEXIO
N
PLANTE 0-40-50 0-40 0-40 0-40 0-40
R
FLEXIO
N
EVERSIO 0-15-20 0-20 0-20 0-20 0-20
N
INVERSI 0-30-40 0-40 0-40 0-40 0-40
ON
COORDINATION
EQUILIBRIUM TESTS AND NON
EQUILIBRIUM TESTS ARE NORMAL
BALANCE
SITTING STATIC BALANCE:GOOD
SITTING DYNAMIC BALANCE:GOOD
STANDING STATIC BALANCE:GOOD
STANDING DYNAMIC:FAIR
GAIT EXAMINATION
Step length :-
Stride length:-
Step width :-
Leg length discrepency:
:-from asis to medial malleolus-69 cm(on both sides)
o Chest expansion:
o inspiration expiration
o Axilla 60 61.5
o Nipple 59 60.5
o Xiphoid 56 58
Functional tests and scales:
1. six minute walk test:the patient covered 260
metres within 6 minutes.
Timed up and go test:
Time taken to rise from floor:21 seconds
Climbing four stairs test;
(if the time taken to climb four stairs is >8
seconds, then the patient has a higher chance of
losing ambulation within 12 months)
North star assessment for limb girdle
type muscular dystrophy
Icf:
Activity limitations:
1. Difficulty Getting Up from Lying Position:
2. Difficulty with Standing for Long Periods
3. inability to Run, Jump, or Play Actively
Partcipation
1. Difficulty attending school
2. Difficulty with Household Chores
3. Limitations in Family and Social Events
current management for this patient:
Bridging exercises
Curl-ups
Superman exercises
Sit to stand exercises
Balance training
Gait training in parallel bar
GOALS
⚫ Thank you
