Eye Training

there is spastic diplegia quality. Spastic quadriplegia is a term to avoid altogether. It was taken and copyrighted by spinal injury. Just don't use that term. Widespread anoxia or toxic versions (carbon monoxide etc.) cause TOTAL BODY [favored term goes here... they're all wrong anyway as these are never just spastic -or- dystonic -or- rigid -or- athetoid or...] But, there are bilateral hemiplegia cases – they don't look nor act like total body involvement nor spinal quadriplegia. OK, got that. We have a kid who is called left hemiplegia but he seems to be on toe on BOTH sides. Remember mirroring? Seeking symmetry? When the walking stops does the unexpected on-toe side go down flat? Feels OK when sitting even when that knee is extended? Mirroring. But, you looked and tested and that seems a bit reactive to quick passive dorsiflexion. Oooo, a low grade spastic diplegia trying to sneak by. Under a general anesthesia you will miss this completely. OK. Let's assume we have a hemiplegia. What do we make sure to say we see or say we did not see? Look for the stance leg to bend into swing phase. The thigh flexes to initiate swing. A troublesome plantar flexion makes the swing clearance requirement high and so some side sway and even extra knee flexion might be seen. But, if that knee bends into swing then you only have equinus to fix surgery, casts, AFOs – whichever fits the resistance level. NEVER use AFO to CORRECT plantar flexion stiffness. That will rocker the foot. The midfoot will yield before the plantar-flexion source. If a cast, then only to the arch. No forefoot or same as AFO. Only cast what slack comes with the knee bent. No pressing force at all. We have seen crushed talus with ankle nerve damage from extruded bone.