Medical Student Philadelphia College of Osteopathic Medicine Snellville, Georgia
Introduction: Cerebral palsy (CP) is the most common cause of neurological and motor disability in the pediatric population, and manifests with varying degrees of severity. Due to complications involving motor, functional, and cognitive impairment, patients with severe CP generally experience a shorter life expectancy. Over the past 30 years however, mortality rates have declined and most children with CP survive into adulthood. The recent trend of increased life span in this population presents an interesting phenomenon in which patients in their 20’s must transfer from the familiarity and comfort of pediatric care into adult care. PCPs inheriting these patients may have different levels of experience managing CP and its complications. This case emphasizes the unique challenges faced during this transition period, including decreased compliance with routine healthcare visits, delayed or misdiagnosis due to communication barriers, and developing rapport among patient, caregiver, and physician.
Case Study: A 27-year-old wheelchair-bound, nonverbal female with CP is brought to the ED by her mother complaining of progressive right abdominal pain for one month. The pain is constant and aggravated when transferring with assistance. Over-the-counter NSAIDs seem to help, as she will stop crying temporarily. Of note, the patient aged out of pediatric care two years ago and has yet to find a PCP with whom she feels comfortable; therefore her family has largely relied on the ED to manage her healthcare. Vitals are normal. CBC, CMP, lipase, and urinalysis are unremarkable. She is referred to a PCP for outpatient management, where she is prescribed antibiotics for a suspected UTI. However, one month later she returns to the ED for persisting symptoms, during which time an abdominal x-ray reveals a subacute right pelvic fracture.
Discussion: There is an abundance of literature identifying the gap in medical care that exists for adults living with CP. However, this case provides a unique example of a patient’s prolonged suffering and delayed diagnosis as a result of the interruption in healthcare. From an osteopathic perspective, rational treatment is guided by understanding basic principles of body unity and the interrelationship of structure and function. Utilizing a holistic approach in the medical management of adults with CP can help personalize care by focusing on the nuances of each patient for a treatment best tailored to them. Future research can be done to bridge the gap in care between pediatric and adult CP care.
