Case Study: Post-Surgical Rehabilitation for Congenital Hip Dislocation

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Managed in the physiotherapy department, with playful therapy approach

I had the privilege of working with a young child diagnosed with congenital hip dislocation in the early years of my practice. The child, a 3-year-old, was brought to the clinic by his mother following a corrective surgical procedure for the dislocation. The primary goal was to assist with post-surgical rehabilitation and support the child in regaining functional mobility.

Presentation and Common Complaints:

The child presented post-surgery with:

• Limited movement in the affected hip joint

• Difficulty with weight-bearing on the affected leg

• Reduced ability to perform basic functional tasks, including standing and walking

• Lack of confidence in using the affected leg due to pain and stiffness

• Emotional distress (fear of movement, crying when attempts were made to engage the affected limb)

Assessment:

I began by conducting a thorough assessment:

• Range of Motion (ROM): Limited abduction and flexion on the affected hip side

• Muscle Strength: Weakness in the hip abductors and gluteal muscles

• Posture: Bilateral asymmetry with compensatory weight-shifting

• Functional Mobility: The child was unable to stand or walk without assistance

• Emotional Response: Initial fear and reluctance to engage in physical activity due to pain and discomfort

Treatment Approach:

Given the child's age and emotional response, I employed a playful, child-friendly approach to rehabilitation, ensuring that therapy sessions were engaging and fun. The key interventions were:

1. Play-Based Movement Therapy:

  • Incorporating games and playful activities to encourage voluntary movement of the affected hip
  • Activities like crawling through tunnels, stepping over soft obstacles, and “walking” on balance beams were used to promote weight-bearing and hip stability
  • The child was encouraged to play with toys that required him to squat, bend, or move in various directions, thereby activating the hip and surrounding muscles

2. Active and Passive Range of Motion Exercises:

  • Gentle assisted movements to gradually restore hip mobility, ensuring the child’s comfort and preventing any resistance
  • Active exercises included reaching games that encouraged stretching and flexing of the hip, while passive mobilizations were done to maintain joint fluidity

3. Strengthening and Functional Mobility Training:

  • Assisted standing with support bars and slowly introducing walking with minimal support
  • Progressively increasing weight-bearing activities by using playful equipment like mini trampolines and play mats to simulate walking patterns
  • Strengthening exercises focused on the hip abductors and quadriceps to improve stability and functional movement

4. Parental Involvement and Education:

  • I encouraged the mother’s active participation, teaching her how to assist the child in functional activities at home.
  • Provided guidance on safe handling techniques, positioning, and home exercises to reinforce the therapy sessions.

5. Gradual Introduction of Walking and Running Activities:

  • As the child’s strength and confidence grew, I introduced small walking tasks, such as walking with assistance along a line of toys or reaching for toys placed just out of reach.
  • This playful approach not only encouraged walking but also made the task enjoyable, increasing the child’s willingness to participate.

Outcome:

Over several weeks of consistent, engaging therapy, the child made remarkable progress.

• Functional Milestones: The child was able to stand independently and take his first steps with minimal assistance.

• Mobility: By the end of the treatment, he was running in the department, displaying excellent weight distribution and hip stability.

• Emotional Development: The child’s confidence grew significantly, and he began to enjoy the process, showing little to no resistance during the sessions.

• Parental Feedback: The mother expressed immense satisfaction with the progress, and the child happily engaged in his daily activities at home.

At the end of the rehabilitation program, both the child and his mother left the clinic with smiles, marking the success of a playful, functional, and patient-centered rehabilitation approach.


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