LATE-STAGE PHYSIOTHERAPY IN CHILDREN WITH DANDY-WALKER MALFORMATION: EVIDENCE FROM TWO PROSPECTIVE CASES WITH ATAXIA CONTROLS
DOI:
https://doi.org/10.32782/2522-1795.2025.19.4.3Keywords:
Dandy-Walker malformation, physiotherapy, balance, functional improvement, muscle toneAbstract
Purpose. This study aims to assess the impact of a comprehensive physical rehabilitation program on balance, motor function, and activities of daily living in children with Dandy-Walker malformation (DWM).Methods. Two patients with DWM were included in this study. The prospective case study with controls was conducted involving two children with DWM and two age-matched controls with ataxia of other origins All participants were aged 11 to 14 years. Both patients underwent Ventriculoperitoneal shunting before the 12 months age. This study focuses on late-stage physiotherapy for DWM patients. Physical assessment of patients with DWM before the physiotherapy program revealed lack of balance, upper limb predominant muscle hypotonia and impaired motor control. Our approach for Dandy-Walker malformation is focused on mitigating symptoms and addressing functional impairments resulting from cerebellar dysfunction. The neurodevelopmental approach used emphasizes a functional progression of motor skills, mirroring typical development. Baseline and three-month follow-up assessments were performed using the Berg Balance Scale to evaluate static and dynamic balance. In this study, Electronic goniometer was used to measure the passive and active popliteal range of motion.Findings. Results of assessment with the Berg Balance Scale reflect not only changes in the balance. Improvements of muscle tone in all 14 functional positions resulted in motor functional improvement of patients (sitting, standing, picking up objects and others). All additional motor maneuvers tested in patients showed improvement. The Berg Balance Scale (BBS) scores improved from 9 to 13 and 9 to 11 in the two DWM patients, respectively, indicating functional balance gains. The applied neurodevelopmental approach was adapted from established rehabilitation protocols used in children with Developmental Coordination Disorder (DCD). Conclusions. Late-stage physiotherapy interventions for individuals with Dandy-Walker malformation should be personalized and adapted to the age of the patient, stage of recovery, and functional needs. This approach should not only focus on improving motor function but also on developing compensatory strategies and adaptive skills to enhance overall quality of life. The applied physiotherapy strategy for functional and balance recovery typically used for DCD patients showed high efficacy in the rehabilitation process of DWM patients. Further studies with a large sample size including the DWM patients can prove the high efficacy of this protocol.
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