PHYSIOTHERAPY MANAGEMENT IMPROVES FUNCTIONAL RECOVERY IN ACQUIRED DYKE-DAVIDOFF MASSON SYNDROME

*1 Assistant Professor, Department of Neurophysiotherapy, MMIPR, Maharishi Markandeshwar University, Mullana Ambala-Haryana, India. 2 Assistant Professor, MMIPR, Maharishi Markandeshwar University, Mullana Ambala-Haryana, India. 3 Professor and Principal, MMIPR, Maharishi Markandeshwar University, Mullana Ambala-Haryana, India. 4 Professor, Physiotherapy College, Punjabi University, Patiala, Punjab, India.

Masson in 1933.The study conducted on 5000 CT studies of the head over 2-year period found 10 subjects with hemiatrophy of cerebral cortex [1].This type of cases are rarely encountered in Clinical practice.The DDMS is characterised by variable degree of facial asymmetry, seizers, contralateral hemiplegia, and mental retardation.Radiological characteristic shows unilateral loss of cerebral volume and compensatory bone alteration in the calvarium, such as thickening, hyperpeuma-tization of the paranasal sinuses and mastoid cells as well as elevated petrous ridge and greater wing of the sphenoid bone [2].The Cerebral injury that may occur early in life or in utero are the main cause of these findings.The etiology can be categorised as congenital and acquired.In congenital type, the symptoms are present at birth or immediate after birth and there is no etiological factor.Intrauterine vascular occlusion might be the cause for cerebral damage during intrauterine life.In acquired type, the symptoms are related to cerebral damage that occurs in the perinatal period or later stage.The gold standard for diagnosis of DDMS is CTscan and MRI [2].As this is a rare case there is lack of evidence for diagnosis and management.Most of the available studies is in the form of case report and case series [3].Management consist of control of seizures with appropriate anticonvulsant, as most patient with this disorder present with seizures.Additionally physiotherapy, occupational therapy have crucial role in functional training [4].However, upto our knowledge no literature is available which explores the physiotherapy management of acquired DDMS, i.e. the aim of present case report is to explore the management strategies.normal.At the age of 22 years she got married and after 1 year she had delivered a normal child.She had difficulty in performing ADL with right upper limb, as there was a significant developmental change in skin and muscles (Fig. 1).She was able to walk without assistance but lack of bilateral arm swinging was reported.On examination the elbow & wrist flexors were spastic grade-2 in Modified Ashworth Scale (MAS).Her sensory function was normal.She also reported low back pain since 2 years.Functionally she was independent.The MRI revealed evidence of encephelomalacia with surrounding gliosis.Overlying sulcal spaces and left sylvian fissure were found to be prominent.There was dilatation of left lateral ventricle.Left cerebral hemisphere was relatively smaller in size with signs of wallerian degeneration.There was also loss of volume of left cerebral hemisphere with mild ipsilateral calvarian thickening.Left thalamus and basal ganglia too showed the loss of volume (Fig. 2).However upto our knowledge there is lack of study which explores the physiotherapy management of acquired DDMS, therefore the aim of present case report is to propose or explore the treatment approaches based on available literature in cortical reorganization and cortical plasticity.

CASE DESCRIPTION
A 27 year old female presented with episodes of seizures and difficulty in performing ADLs with right upper extremity in physiotherapy OPD.Subjective examination reveals that she was born with normal delivery and was apparently normal at birth to 3 years of age.At the age of 3 year, her parents reported that there was a developmental difference between right side upper and lower extremities with lack of movements.Her behaviour and communication was   It has been reported that repetitive activity alone is not enough to produce representational plasticity.Functional reorganization is found to be greater for task that are meaningful [9].So it can be hypothesised that in acquired DDMS task specific exercises or purposeful task, Constraint induced movement therapy, Dual task training [10], along with repetition will useful in regaining function and enhanceing cortical reorganization.Additionally the somatosensory stimulation in the form of transcutaneous electrical stimulation, Cortical stimulation can be combined with above mentioned rehabilitation protocol to enhance functional recovery and cortical representation plasticity in DDMS.The study on 12 healthy subjects who performed hand, finger, wrist and elbow movements under controlled condition revealed a clear large scale somatot-ophy of the M1 with distinct subregion controlling the foot, arm, and tongue [11].Statistically significant differences were found in geometric centres of gravity between elbow, wrist and fingers.So the above mentioned rehabilitation protocol can be incorporated in management of DDMS aimed to enhance functional recovery and brain plasticity.However the present report is focused to explore the rehabilitation strategies and not on treatment effects, the further experimental study is required to elaborate the effective rehabilitation protocol and its results to improve the functional activity and cortical reorganization in case of acquired DDMS.
is rarely encountered case in physiotherapy practices.The present case study states functional recovery after the physical therapy intervention.However present report cannot be generalised for this population because it is a single case report.Further study is required with this population to form and elaborate an effective treatment protocol.

Manoj
Deshmukh et al.PHYSIOTHERAPY MANAGEMENT IMPROVES FUNCTIONAL RECOVERY IN ACQUIRED DYKE-DAVIDOFF MASSON SYNDROME.

Fig. 1
Fig. 1 (a,b): Showing the attitude of limb and shortening of right upper extremity.

CONCLUSION
Manoj Deshmukh et al.PHYSIOTHERAPY MANAGEMENT IMPROVES FUNCTIONAL RECOVERY IN ACQUIRED DYKE-DAVIDOFF MASSON SYNDROME.