Rehabilitation and Psycho-Social Nursing in a Child with Cerebral Palsy after Patellar Ligament Advancement
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 18, Issue 5
Abstract
Patellar ligament advancement is also known as patellar operative correction. Surgeons cut open the tibial tubercle, move the patella to the position of the tibial tubercle, and then move down tibial tubercle. This operation helps to relax the patellar ligament and stretch the lower limb [1]. We present a youth in crouched gait with cerebral palsy given patellar ligament advancement. This case highlights the need to perform comprehensive rehabilitation assessment and psychosocial nursing on children with cerebral palsy after surgery.A Chinese male was born premature of gestation by normal vaginal delivery in 2002. His mother suffered from vaginal bleeding at 30 weeks. Then she went to hospital to give birth to a male baby weight nearly but no more than 2kg naturally after using oxytocin. The baby was gradually been found that his motor function development was slower than other children of the same age. He can neither sit up straight nor keep head up at seven months. He didn’t stand until he was 2 years old. Lumbar selective posterior rhizotomy (SPR) repair of spinal dura mater was performed in a hospital in Guangzhou, China in 2005. After that, his scissors gait was improved. In April 1st, 2017, right patellar ligament advancement, right peroneus longus muscle transposition, and plaster fixation were performed to this boy in our hospital. He came to our hospital for the first course of rehabilitation training after surgery in September 15th, 2017. In November 3rd, 2017, he was still unable to stand or walk alone. So he admitted to our hospital for the second course of rehabilitation training for 4 weeks. On limb function physical examination, we found that his hands can grasp, but the fine motor function of fingers was not well. When he was in supine position, he lifted his left leg with slightly bent while right leg was straighter than the left one. When he was assisted to stand, his left knee was in crouched position. We also assessed the Barthel index, muscle strength and muscle tension, pain, anxiety, and fall risk for him. After comprehensive assessment, we found that the primary nursing issues for this patient were dyskinesia and anxiety. For dyskinesia, different types of rehabilitation treatments were performed. Theses treatments including physical therapy (PT), MOTOmed, acupuncture of traditional Chinese medicine (TCM) and Electro encephalographic (EEG) biofeedback therapy. During all the rehabilitation training, nurses first explain the current functional status, objectives, and precautions to patient and his family. Then nurses educated them that training should be done gradually to avoid fatigue and injury and should be paid enough attention to safety. Rehabilitation nursing training was ought to be practiced in the ward twice a day. These training including resistance training and active motion, for example isotonic contraction and isometric contraction. Arch bridge movement and shell movement (see in Figure 1 were also recommend to the patient ten times in each group. Center of gravity transfer was also instructed as no more than 15 minutes at a time. After a week’s rehabilitation nursing training, the patient can transfer his weight and stand on his own. From that on, stand training was taught to the patient for at least 4 days until he can walk with the aid of a walker at November 16th. Walking training was applied since then. The patient can walk on his own at November 22nd.
Authors and Affiliations
Xiaomei Liao, Nianjin Gao, Yan Li, Shanshan Luo, Xiaowen Zhu
Keywords
Related Articles
- EP ID EP622688
- DOI 10.26717/BJSTR.2019.18.003206
- Views 158
- Downloads 0
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