This longitudinal study aimed to investigate the impact of long-term physiotherapy intervention on function and participation of a child with CP and ASD, in order to expand literature base for evidence synthesis.
After taking informed consent by parents, a 5-year-old Indian female, diagnosed with ASD and infantile hemiplegia was studied for more than 9 years. At the time of presentation, the child was unable to stand and walk without support. On examination, the child displayed weakness of left side of the body along with hypertonicity. She had tightness of left elbow flexors, wrist flexors, forearm pronators, hamstrings and calf muscles. She used bottom shuffling as means of mobility. She was dependent for all activities of daily living. She did not use left upper extremity to reach or grasp. Besides, she could not speak or follow commands. She used peripheral vision, displayed stereotyped movement of fingers in front of eyes, and had strong inclination towards spinning circular objects. Her gross motor function measure (GMFM) score was 32%.
The physiotherapy intervention included strength training of the weak muscles using weight cuffs, neurodevelopmental treatment (NDT) approach for facilitating transitions, modified constraint induced movement therapy (CIMT) for enhancing the use of left upper extremity, sensory integration (SI) approach for adaptive motor output, functional stretching and use of bilateral ankle foot orthoses. Later, balance training and visual perceptual skills training were added.
After 8 months of physiotherapy, she could stand and walk without support. Her GMFM score improved to 66%. Also, she started reaching and grasping objects by left hand. Intervention was adapted as needed. By the age of 6 years, she was able to get up from the floor independently using half kneeling to standing transition. At 7 years of age, the child was able to negotiate stairs holding onto the railing. By 8 years of age, she was playing in the park and with siblings. Between 9-11 years of age, the child underwent telerehabilition due to pandemic. Post-pandemic, child got enrolled in an inclusive school at the age of 12 years. At 14 years, she was independent in eating, drinking and dancing at school.
Long-term physiotherapy intervention improved function and participation of a child with dual-diagnosis of CP and autism. Future investigations with larger sample size are recommended.
As a result of child's improved independence, her mother resumed job and the family began to attend social gatherings. Physiotherapy positively impacted the quality of life of the whole family. Thus, motivation and compliance to therapy must be emphasised.
Autism Spectrum Disorder
Longitudinal study
