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Chiropractic Care of a 10-Year-Old Boy With Nonorganic Gait Disorder: A Case Report

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Abstract

Objective

The purpose of this case report is to describe the multidisciplinary management of a boy with nonorganic gait disorder.

Clinical Features

A 10-year-old boy presented to a chiropractic clinic having had a concussion 1 week prior. He presented with lower limb muscle weakness and ataxia while weight bearing. He was referred immediately to the emergency department, from which he was sent to a neurologist at a children’s hospital. The neurologist’s diagnosis was nonorganic gait disorder.

Intervention/Outcome

Treatment consisted of physiotherapy, occupational therapy, and a psychiatric assessment. Chiropractic care including manipulative therapy was initiated 6 months after diagnosis. After 1 year, the gait disorder was resolved.

Conclusion

The addition of chiropractic care to conventional treatment may have been supportive in the recovery process for this patient. The condition required 1 year to resolve, with questions remaining as to whether the symptom resolution was a result of treatment or natural history.

Introduction

Nonorganic gait disorder (NOGD) is a heterogeneous group of movement disturbances that are inconsistent and incongruous with organic gait disorders and may be associated with underlying psychiatric disease.1 The diagnosis is made after examination fails to reveal any organic source for the presentation of a condition that follows some form of emotional or physical trauma. There are established gait patterns associated with different conditions. Nonorganic gait disorder does not fall into any of the categories and may commonly present as a hybrid combination of several different gait patterns. The condition is usually relieved with psychotherapy, but a certain percentage of cases do not respond to traditionally established treatment.2

Nonorganic gait disorder presents as an uncommon and challenging clinical entity. Part of that challenge seems to be simply in applying a label to the disorder. This condition may be also termed psychogenic movement disorder, conversion disorder, functional movement disorder, and conversion motor paralysis disorder. An accurate diagnosis is essential to rule out organic disease as a cause for the gait disorders. The purpose of this paper is to describe a case of a patient with NOGD that developed after mild head trauma.

Section snippets

Presenting Concerns

A 10-year-old boy presented to a chiropractic clinic with complaints of leg weakness 5 days after hitting his head while swimming. He was previously seen after his injury in the emergency department for neck pain, tingling of the left index finger, dizziness, bilateral blurred vision, and unsteady gait. He did not report having any signs of confusion, dizziness, fever, or headache. His mother stated that the emergency department personnel diagnosed him with a concussion and sent him home. Over

Discussion

To the author’s knowledge, this is the first case study reporting the chiropractic management of a child with NOGD. Nonorganic gait disorder is an uncommon and diagnostically challenging consequence to physical or psychological trauma. The accepted treatment protocol involves the use of a neurologist, psychologist, physiotherapist, and occupational therapist. A large percentage of these patients respond well to the treatment if they are diagnosed in a timely manner. There remain a certain

Conclusion

In addition to conventional treatment, chiropractic care may have been supportive in the recovery process for this patient. The condition required 1 year to resolve, with questions remaining as to whether the symptom resolution was a result of treatment or natural history.

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Contributorship Information

  • Concept development (provided idea for the research): D.E.W.

  • Design (planned the methods to generate the results): D.E.W.

  • Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): D.E.W.

  • Data collection/processing (responsible for experiments, patient management, organization, or reporting data): D.E.W.

  • Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): D.E.W.

  • Literature search (performed

Practical Applications

  • Chiropractic care may have contributed to a change in symptoms for this patient.

  • The implications of this outcome indicate that there may be a role for chiropractic care in the treatment of similar conditions.

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  • Cited by (1)

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