Non-surgical Intervention of Knee Flexion Contracture in Children with Spina Bifida: Case Report

[Purpose] The purpose of this case report is to describe for the first time, the use of serial casting in the management of knee joint flexion contracture for a young child with spina bifida. [Case Description] The child was 6 years old, and had L3-L4 spina bifida level lesion with quadriceps muscle strength grade 3 +. The child had previously received weekly physiotherapy including stretching for knee flexion contracture on both lower limbs, but without improvement. [Results] The knee flexion contracture, which was not corrected with passive stretching, improved with casting from - 40 degrees knee extension to -5 degrees knee extension as measured by a standard goniometer over a period of 4 weeks. Careful measures were taken to ensure skin integrity. At follow up after one-year, the child could ambulate independently with the help of walking aids. [Conclusion] The outcome indicates that using serial casting and follow-up with the use of bracing may be useful for enhancing the walking ability of a young child with spina bifida with knee flexion contractures. Further investigations of serial casting as well as investigation of serial casting with other interventions are warranted.