Rehab technology is an integral part of rehabilitation in children. Synphne may be an important part of paediatric rehab in future

1. Effect of SynPhne in a Cerebral
Palsy Child: A Case Study
Dr Alakananda Banerjee
President
Dharma Foundation of India

2. Personal history
• Patient name : XYZ
• Age/Sex : 6 year/Male
• Right hand dominant
• Diagnosis :Mild cerebral palsy; Static Encephalopathy
• History
– Full term caesarean delivery
– Neonatal jaundice
– Seizure- 2 times, one- 3years of age, one- last year

3. Medical History
• Botox injection given in both lower limbs – twice
• On medication:
• Syndopa plus
• Valporate

4. MRI Findings
• Bilateral focal abnormalities in the thalamus and
internal capsule, most likely sequelae of perinatal
hypoxic ischemic encephalopathy.

5. Complains
• Difficulty in bed mobility
• Dependent in daily living activities
• Difficulty in using both hand (eating and drinking)

6. Ongoing Rehab
• Had 22 sessions of Neuro Feedback (Cognitive)
Training at Department of Neuropsychology,
NIMHANS Bangalore
• Patients attends regular physical and occupational
therapy.

7. SynPHne
Target to improve difficulty in using right (dominant)
hand for eating and drinking.

8. Assessment
Tone (Modified Ashworth Scale)
Right Left
Hand N N
Wrist Flexor 1 1
Elbow Flexor 1 1
Shoulder 0 1
Hip Flexor 1+ 2
Hip Add. 2 2
Hams 2 2
TA 3 3

9. Assessment
Voluntary control Right Left
Shoulder Good Good
Elbow Good Good
Hand Good Good
Hip Fair Fair
Knee Fair Fair
Ankle Poor-fair Poor
Patient response: Slow to initiation of movement

10. Assessment
Hand function
Gross motor
GRIP and release - PRESENT (RT>LT)
Object transfer- present (rt>lt)
Fine motor
Tip to tip- partial present (fair)
Pad to pad- poor
Manipulation- poor
Three jaw chuck- poor
Bowel and bladder- sensation present
Spinal disability- none

11. Assessment
The Quality of Upper Extremity Skills Test
(QUEST)
• This measure evaluates quality of upper extremity function in four
domains: dissociated movement, grasp, protective extension, and
weight bearing.
• It is designed to be used with children who have neuromotor
dysfunction with spasticity and has been validated with children from
18 months to 8 years of age
• Measures % of disability (of all four domains)
http://informahealthcare.com/doi/abs/10.1080/J006v13n02_01
• QUEST on 4/2/2015- 53.5%

12. Assessment
Nine Hole Peg Test
• This test was originally introduced in 1971 as part of a study on
strength and dexterity. (Kellor, Frost, Silberberg, Iversen, &
Cummings).
• The Nine-Hole Peg Test (9HPT) is used to measure finger dexterity
in patients with various neurological diagnoses
• Intended Population :Patients with Stroke, Brain Injury, Parkinson's
Disease, cerebral palsy, multiple sclerosis
• Measures in seconds
4/2/2015 : RIGHT SIDE - 143 SEC

13. International Classification of
Functioning
b163 Basic cognitive functions
b167 Mental functions of language
b710 Mobility of joint functions
b7301 Power of muscles of one limb
b735 Muscle tone functions
b760 Control of voluntary movement functions
d110 Watching
d166 Reading
d170 Writing
d410 Changing basic body position
d415 Maintaining a body position
d440 Fine hand use
d445 Hand and arm use
d510 Washing oneself
d520 Caring for body parts
d530 Toileting
d540 Dressing
d550 Eating
d560 Drinking
e115 Products and technology for personal use in daily living
e310 Immediate family
e355 Health professionals

14. • icf.xlsx

15. •Difficulty in speaking
•Weakness in both arm and leg
•Abnormal movement in both
arm and leg
•Difficulty in bed mobility
•Dependent in daily living
activities
•Difficulty in using both hand
•Cant go to school independently
•Difficulty in reading/writing
•Unable to sit and stand
independently
•Articulation- b320.2
•Basic cognitive function- b163.1
•Muscle power function-b730.2
•Control of voluntary movement
function- b760.1
•Copying- d130.2
•Changing basic body position-
d410.3
•Maintaining body position- d415.2
•Caring of body part- d520.2
•Dressing-d540.2
•Eating -d550.2
• drinking--d560.2
•Right hand dominance ,cooperative
Cerebral palsy
•Fine hand use- d440.2 (holding a
pen, using mobile phone, flipping
a card)
•Hand and arm use-
d445.2(holding ,lifting, transfer
and release)
•Writing- d170.3
•Reading- d166.3
Xyz
6 year
Botox
injection
Given last
month1 4/2
•High living condition (over protection)- (e315.-2)
•Immediate family support-(e310.+4)
•Health professionals e355 +4

16. •Difficulty in speaking
•Weakness in both arm and leg
•Abnormal movement in both
arm and leg
•Difficulty in bed mobility
•Dependent in daily living
activities
•Difficulty in using both hand
•Cant go to school independently
•Difficulty in reading/writing
•Unable to sit and stand
independently
•Difficulty in grasping
Articulation- b320.2
•Basic cognitive function- b163.1
•Muscle power function-b730.2
•Control of voluntary movement
function- b760.1
•Copying- d130.2
• Changing basic body position-
d410.3
•Maintaining body position- d415.2
•Caring of body part- d520.2
•Dressing-d540.2
•Eating -d550.2
• drinking--d560.2
•Right hand dominance, cooperative
Cerebral palsy
•Fine hand use- d440.2(holding a
pen, using mobile phone,flipping a
card)
•Hand and arm use-
d445.2(holding ,lifting, transfer
and release)
•Writing- d170.3
•Reading- d166.3
Xyz
6 year
Botox
injection
Given last
month1 4/2
•High living condition (over protection)- (e315.-2)
•Immediate family support-(e310.+4)
•Health professionals e355 +4

17. Treatment Intervention for short term goal
Target:
• Fine hand use- d440.1 (holding a pen, using mobile
phone, flipping a card)
• Hand and arm use- d445.1(holding a pen, using
mobile phone)
SynPHne:
Products and technology for personal use in daily living
- e115.

18. SynPhNe

19. •Difficulty in speaking
•Weakness in both arm and leg
•Abnormal movement in both
arm and leg
•Difficulty in bed mobility
•Dependent in daily living
activities
•Difficulty in using both hand
•Cant go to school independently
•Difficulty in reading/writing
•Unable to sit and stand
independently
•Articulation- b320.2
•Basic cognitive function- b163.1
•Muscle power function-b730.1
•Control of voluntary movement
function- b760.1
•Copying- d130.2
•Changing basic body position-
d410.3
•Maintaining body position- d415.2
•Caring of body part- d520.2
•Dressing-d540.2
•Eating -d550.2
• drinking--d560.2
•Right hand dominance, cooperative
•Products and technology for personal use in daily living e115.+4
•High living condition (over protection)- (e315.-2)
•Immediate family support-(e310.+4)
Cerebral palsy
•Fine hand use- d440.1 (holding a
pen, using mobile phone, flipping
a card)
•Hand and arm use-
d445.1(holding a pen, using
mobile phone)
•Writing- d170.3
•Reading- d166.3
Xyz
6 year
Botox
injection
Given last
month2 27/2

20. • VID-20150227-WA0011[1].gif

21. Quantitave Analyses

22. QUEST ( Quality of Upper Extremity Skill Test)

23. NINE HOLE PEG TEST

24. QUESTIONS ?