Structured Physiotherapy Associated with Significant Functional Gains in a Child with Type II Diastematomyelia and Spina Bifida

Dear Editor, Type II diastematomyelia associated with spina bifida is a rare and complex form of spinal dysraphism, frequently accompanied by neurological and orthopedic impairments that limit functional recovery. Published evidence describing rehabilitation outcomes in such presentations remains limited, particularly following surgical detethering.[1,2] Here, we report functional changes observed following structured physiotherapy in a 4-year-old child after surgical detethering. The child was born preterm at 32 weeks of gestation and was diagnosed on day 12 of life with type II diastematomyelia, tethered cord, lipomyelomeningocele, syringomyelia (D10–D11), and extensive posterior bony defects. Laminectomy and detethering were performed at 3 years of age. Postoperatively, she developed progressive distal lower-limb weakness, sensory impairment, crouched gait, bilateral foot deformities, recurrent plantar skin injuries, and frequent falls (approximately 10–15 episodes/day as reported by caregiver). At referral for physiotherapy, baseline assessment revealed a gross motor function measure (GMFM) dimension D score of 59.5, dimension E score of 25.0, and a WeeFIM mobility score of 14/35. A structured physiotherapy program was delivered over 6 months. Sessions were conducted three times per week and lasted 45 min each. The program targeted strength, postural control, balance, and functional mobility. Interventions included core and lower-limb strengthening, neuromuscular electrical stimulation to the dorsiflexors and quadriceps, and balance training. Task-specific gait training, ankle–foot orthoses, and caregiver education were also incorporated. GMFM was used to objectively track changes in gross motor performance due to the absence of condition-specific measures for spinal dysraphism.[3] The WeeFIM mobility domain was used to assess functional independence in activities of daily living. Following intervention, caregiver-reported fall frequency reduced to one to two episodes per day, representing an 85% reduction. GMFM dimension D (standing) improved from 59.5 to 66.6, indicating better standing balance and transitional movements. GMFM dimension E (walking, running, and jumping) improved from 25.0 to 43.2, reflecting gains in walking- and stair-related activities. WeeFIM mobility score increased from 14 to 22/35, suggesting greater independence in functional mobility. Neuropathic plantar skin lesions progressively decreased, with healing of existing lesions and no lesions observed by the end of intervention. Despite factors traditionally associated with poor prognosis, clinically meaningful functional gains were observed. Although findings from a single case cannot be generalized, observed improvements align with emerging rehabilitation literature emphasizing early, task-specific, and goal-directed physiotherapy in pediatric spinal cord disorders and spinal dysraphism. This report highlights the potential contribution of structured physiotherapy in enhancing functional outcomes following surgical management of pediatric spinal dysraphism.[4] Acknowledgments The authors would like to thank the child and her family for their cooperation throughout the rehabilitation program. We also acknowledge the clinical team at RV College of Physiotherapy for their support. Ethical policy and Institutional Review Board statement Institutional Ethics Committee approval was not required for this single-patient case report. Written informed consent for participation and for publication of all clinical details was obtained from the child’s parents. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest Author contributions HM: conceptualization, patient assessment, physiotherapy intervention, data collection, manuscript drafting, and revision. MM: literature review, data organization, manuscript review, and critical editing. Both authors approved the final manuscript.