Background: A 6-year-old male was accompanied by his mother and grandmother with a primary complaint of attention deficit hyperactivity. In addition, his mother reported hypotonia, clumsiness, speech, motor delays (both gross and fine), and oculomotor issues.
Methodology: Fundoscopy revealed a 2:1 vein to artery ratio in the right eye, and a 1:1 ratio in the left eye. His hands were cool and sweaty, with increased perspiration of his left hand. He had global hypotonia, but more pronounced in his lower extremities, where he had absent deep tendon responses with and without reinforcement. While prone, when his knees were flexed so that his heels approximated his buttocks, and his heels were easily able to hyper-extend to touch the examination table. Upon performing shoulder range of motion, a scratch test was performed and both of his fingers were able to touch T7 spinous process. During intake Saccadometry only 7 of the 100 assessed saccades were fast enough be recorded. During intake Video Oculography (VOG) testing, he had numerous head movements and eye movements throughout the testing. Vertical eye movements were more impaired than horizontal eye movements. Optokinetic eye movements were present in all directions, but had reduced frequency to the right, left, and upward optokinetic stimuli. On dynamic computerized posturography, he was asked to stand still in multiple positions: head neutral, left, right, up, and down with eyes open and eyes closed. He had an overall average stability score of 53.719%. While not a true measurement of stability at his age, this gives us an objective baseline of his ability to stand still. He had both a positive spinal galant and positive rooting reflex on the right. The vestibulo-ocular reflex was intact bilaterally, with an enlarged right pupil. A right palatal paresis and hypertrophied pharyngeal tonsils were observed.
Intervention: An intensive treatment plan consisting of nerve stimulation, visual evoked potentials, vision therapy, vestibular rehabilitation, therapeutic activities, and multi-axis rotational therapy was implemented 3 times per day, for 5 contiguous days.
Outcome: After 5 days of treatment, the patient was able to generate 50/50 saccadic eye movements. While dysmetric and heteroskedastic, this suggests an improvement in the integrity of the frontal lobes and its sub-cortical systems. The formerly present primitive reflexes were now appropriately absent. Muscle tone normalized with his heels approximating his buttocks and scratch test allowing him to reach T3 spinous process. Although his pharyngeal tonsils are still enlarged, his soft palate is no longer asymmetric. His patella reflexes are now both intact and 1+ without reinforcement. His “balance” scores average is now 72.94% 9 (+35.7%), suggesting a greater ability for him to stand still when instructed to do so. His VNG exhibited increased ability to remain fixated on a stationary and moving target. He also demonstrated an increased focus ability and communication throughout the week.
Conclusion: This case demonstrates a significant improvement in tone, coordination, balance, ocular motor function, and communication in a child with developmental delays, after 5 days of intensive ReceptorBased Rehabilitation.