A Technical Neuro-Orthopedic and Neuropediatric Report on Requirements Needed for a Successful Rehabilitation of a Disabled Adolescent

Background/Purpose: Children with movement disorders often lose their ability of walking in adolescence. Therefore rehabilitation is particularly complex and demanding.

Methods: 13 and 1/2-year-old boy was admitted immobile with unknown spastic movement disorder. Contractions in flexion of both knees, still continuing after soft-tissue surgery on both legs. Complicated postsurgery outcome with lesion of the left ischiadic nerve, sensomotoric deficit and neuropathic pain. Known lumbar scoliosis and partially fixed subluxation of the left knee. Aim: Retrieval of mobility.

Results: MRI of cranium and spine was normal. Unsuspicious EEG. Evidence of a disordered metabolism of dopamine. Oral substitution of dopamine resulting in a much better sequence of movements. Still lacking evidences of a multigene panel dystonia/dyskinesia. Successful drug-treated pain relief. Improvement of the initial deficit of 40 degrees bayonet positioned knee extension to 15 degrees on the left by using bilateral femoral ortheses without increase of the subluxation limiting the femoral anterior shift, shift back of the pivot, and distracting torque. The decreased muscular power of the knee extensors (MFT 2+) is dynamically supported by the ortheses. The trunk is supplied with a Chêneau-like brace. At discharge, he is taking some steps freely in plane area in- and outdoor. In school, he is using the posterior walker.

Conclusion: A successful rehabilitation was only possible by a simultaneous cooperation of neuropediatrics and neuro-(technical) orthopedics. The multidisciplinary care of these patients is challenging and often only possible while inpatient.