Joaquin Monti - Cerebral palsy (Argentina) Posted on February 10, 2014
Name:Joaquin Monti 
Sex:Male
Age:5 years old
Country: Argentina
Diagnosis: Cerebral palsy
Admission Date: 2014-01-11
Days Admitted to the Hospital:28
Before treatment:
The patient was born when his mother was 33 weeks pregnant. At the birth, the patient's weight was about 2.130kg, the Apgar scoring 9-10 point. The patient suffered suddenly from respiratory dysfunction 6 hour after birth. The local hospital gave the patient Ventilator for breathe. 10 days later, the patient's breathing was restored to normal. His family member found the patient had poor motor function when the patient was 1 year old. He was sent to a local hospital and was diagnosed with Cerebral palsy and hypoxic-ischemic encephalopathy. The patient started rehabilitation when he was 1 year and a half. The patient's four limbs still had poor motor function and high muscle tone even though he had underwent rehabilitation. He took Baclofen and Asmavitan for therapy. He couldn't sit-up or walk by himself. With some assistance, the patient stands in a scissors gait manner. His waist and back had poor muscle strength. He could turn over and crawl. The left upper limb was the main power supply when he crawls. Right upper limb had no obvious active movement. He had no problem with language and comprehension. For further treatment, the patient came to our hospital. From the onset of disease, the patient had normal spirit and sleep. He also had normal defecation.
Admission PE:
Bp: 104/60mmHg; Hr: 96/min, height: 104cms, weight: 17kgs. There were no yellow stains or hemorrhagic spots on skin. There was no congestion in pharyngeal. The respiratory sounds in both lungs were clear, with no dry or moist rales. The heart sounds were strong; the heart rate was faster than normal. The rhythm of his heartbeat was in order, with no obvious murmur in the valves. The abdomen was smooth, with no pressing pain or rebound tenderness. The liver and spleen were not palpable under the ribs.
Nervous System Examination:
Joaquin Monti was alert. His speech was normal. His memory and orientation abilities were almost normal. The comprehension and judgment were normal. Both pupils were equal in size and round, the diameter was 3.0mms, both eyeballs could move freely and the pupils reacted normally to light stimulus. There was no nystagmus. The forehead wrinkle pattern was symmetrical. The bilateral nasolabial sulcus was equal in depth. The tongue and the uvula were centered in the mouth. The teeth were shown with no deflection. Bilateral soft palate muscle strength was strong. His four limbs had movement disturbance. The muscle strength of left upper limb was at level 5. The muscle strength of right upper limb was at level 3. The muscle strength of both lower limbs was at level 2-3. The muscle strength of waist and back was weak. He could turn over and crawl. The left upper limb was the main power supply when he crawls. He was unable to sit-up by himself. He always falls to right side when he sits with support of both hands. He could kneel from supine position or prone position. He could sit on his heels in a stable manner. With some assistance, he could stand. His walking posture presented with scissors gait. The muscle tone of the four limbs was higher than normal. The tendon reflex of both upper limbs was normal. The tendon reflex of both lower limbs was normal. Bilateral abdominal reflexes were normal. Bilateral Hoffmann sign was negative. Bilateral sucking reflex was negative. Bilateral palm jaw reflex were negative. The jaw reflex was positive. Bilateral Babinski sign was positive. He couldn't cooperate with the examination of sensory system. He did the finger-to-nose test and digit opposition test in a slow manner. He was unable to finish the heel-knee-shin test. He was unable cooperate with other coordinate movement examination. There were no signs of meningeal irritation.
Treatment:
After admission, Joaquin Monti received the relevant examinations and was diagnosed with cerebral palsy. The patient received nerve regeneration treatment and stem cell activating treatment. He received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves, activate autologous stem cells and to nourish the neurons. This was combined with neurological rehabilitation treatment.
Post Treatment:
The patient's growth and development are quicker than before. Height: 105cm, weight: 18Kg. The muscle strength of back is increased than before. He can maintain a seated position independently without support and doesn't fall to side ward. The movement ability of the right upper limb has improved. The active exercise of the right upper limb has increased. The flexibility of right upper limb's joints has increased. The right upper limb has changed from paralysis to more active movement. The range of motion at joints has increased. The patient can crawl with the support of the upper limbs alternately. Right upper limb can be raised to a higher range. Right hand can touch the top of his head in sitting position. Right hand has gained grasp action. He can grasp and put down pen, the flexibility has improved. He can point thumb with forefinger and middle finger. Both lower limbs suffered from spasm and could not move. After treatment, the lower limbs can move and the function has improved obviously. The spasm and high muscle tone are alleviated obviously. He took medication to reduce muscle tone. With some assistance, the patient's scissors gait is alleviated, the associated action is reduced. He has walks with both legs alternately.
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Email:
2014-03-13
Dear Dr Wang,
Thanks a lot for your answer.
I´m glad to tell you that Joaquin is making a lot of progress, actually he has already started primary school. Next week we will send detailed information about his situation including the results of his blood tests.
Thanks a lot again, and I await for your answer.
Best regards,
Juan Marcos Salazar
Date: 2014-04-01
Dear Sir,
We write to you in order to send you recent details of Joaquin Monti´s situation.
He still haven´t done the blood tests because Joaquín suffered form tonsillitis since march 16th. He has received Amoxiciline 750 mg 3,5 mg twice a day for 10 days. During this process, his temperature range went form 37,3 ° to 37,6° on the first two days. We were advised to wait for at least 4 days after finishing the antibiotics therapy to do the blood tests, once we have the results we will send them to you.
We would like to know if you consider that this condition could affect the stem cells treatment and if you agree with the way in which Joaquin was treated, since it is very likely that it may happen again in the future.
On the other side, we send you the information that provided by Joaquin´s therapists:
Kinesiology:
Better control of trunk equilibrium, improvement on trunk´s tone and on upright posture.
Better alignment in sat position, improvement on the mobility range in the flection of active knee.
In what regards to lower limbs spasticity, no improvements were shown.
Improvement in muscular volume.
Occupational Therapy (TO):
It was shown a lowering in right upper limb´s spasticity.
It was shown a larger range of active movements in arms. He can lift arms at different altitudes.
Considerable improvement of trunk´s position. (see picture)
He is able to start and conclude activities in adequate time.
It was shown an improvement in what regards to attention, concentration and memoru during activities.
Improvements in tasks´ comprehension.
Improvements in skills and abilities when grabbing objects of different sizes using upper right limb.
In what regards to upper left limb, he is able to perform activities that require skills and coordination of fine motor.
Speech and Language therapy:
Improvement in trunk firmness. He can remain in sit-down position in a better way and with less instability.
In some occasions, left eye shows deviation.
Enrichment of gaming skills. He shows more plasticity and creativity.
He was unable to play games before, now this aspect is more organized.
He can organize and plan activities.
Besides this information, we would like to ask you some questions regarding the vaccines that Joaquin is supposed to receive this year:
1) Sabin (poliomyelitis or child palsy): it is given with active (alive) virus, but if requested he can receive the version of inactive virus. Which option do you recommend?
2) Triple Viral booster shot (measles, mumps and rubella). It is given with attenuated virus. Do you recommend its use in Joaquin´s condition? Under which circumstances?
3) DTP ( Diphtheria, Pertussis and Tetanus). It is given with dead or inactive bacteria. Do you recommend its use?
4) Anti- Flu vaccine (Trivalent Infuenza vaccine) Inactive virus (2013 strain). The years Joquin received this vaccine, he got sick, he showed flu-like symptoms and got fever. Last year, he did not receive the dose and only had mild tonsillitis and mild flu.
Please, advise us whether you recommend the use of all or any of these vaccines or not.
The last question we have for you it the following: doctors here want to know which procedure was used in your clinic to lower Joaquin´s defenses, were Corticosteroids used? If so, which kind and which doses?
Date:2015-1-21
Hi John, how are you.
I am writing to consult you if you can send the results of clinical blood tests December you attached in the mail. Actually we did not send before and that had been misplaced.
I would like to confirm whether we should continue making analyzes Joaquin every two months.
I also wanted to tell you that we communicate with family Uruguay by oryzanol but were told they did not have and that it is impossible to get.
Also wanted to say that the questions that we did to Susan with the translator the day we were in the library of the Roses were not responses from the clinic still did not write us.
Regarding the status of Joaquín, we believe that your right hand is better because sometimes used and opens it. Not so her legs still very spasticity. No if doctors may tell us something about this.
Of course as always, many thanks.
I hope your answer
regards
Alina