Q: My 4-year-old daughter walks on her toes. Her muscular development is not as it should be. Her right leg seems to be slightly stiff and bent at the ankle. Her left leg and feet are stiff too. She has low appetite since birth and is underweight. Her mental health is slow, as compared to my elder daughter. She has a good grasping power, if taught. She has memorised 5-6 nursery rhymes, alphabets, has learnt to use pencil, etc. She is talkative. She had high fever, a day after her birth, which continued for more than a week. During this she was hospitalised treated. The fever was cured, but the cause of the fever was not diagnosed. She was able to control her neck at 6 - 7 months. She was able to sit at 9 months. She was able to stand with support at 1 year and was able to walk at 1 year and 7 months. She has been diagnosed as a case of mild spasticity. She is on Lioresal since a year. She was advised exercises for lower limbs, but we were not able to give much time to the exercises. Presently she can walk on plane floor, but tends to lose balance on uneven floor. Play schools have refused admission to her due of this. How should I proceed? Is there a cure for this problem in India or abroad?

A:From the description given, it seems that your daughter has Spastic Diplegic Cerebral Palsy (CP). What it means is the brain suffered an irreparable damage during that prolonged fever she had after birth. This has led to a spectrum of problems affecting intelligence, speech (at times) & locomotor function (standing & walking). A child with CP grows into an adult with CP. We as professionals intervene appropriately to help the child cope best with his/her problems. Depending on age and the degree of involvement, the management needs to be tailored but should always be multi-disciplinal. This means a Pediatric orthopaedic surgeon, Developmental pediatrician. a PT & OT person and an orthotist need to converge on the patient at regular intervals. The control of the spasticity is the key but can become difficult with growth. The endeavour is always to achieve near-normal gait. Your daughter needs to be assessed by a paediatric orthopaedic surgeon who would co-ordinate with other med professionals. As far as your daughter is concerned, proper management should get some good results.