Pre- and Postoperative Rehabilitation of Craniopagus Conjoined Twins: A Case Report
Pradeep Kumar Sahu1, Garima Singh1, Deepak Kumar Gupta2
1Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
Insights
Physical therapy for craniopagus conjoined twins (CCT) showed significant gains in one twin but limited progress in the other. Rehabilitation for CCT requires prioritized balance and postural control interventions.
Area of Science:
- Medical rehabilitation
- Pediatric physical therapy
- Conjoined twins research
Background:
- Craniopagus conjoined twins (CCT) present unique challenges for surgical separation and subsequent rehabilitation.
- Early and structured physical therapy is crucial for optimizing functional outcomes in CCT survivors.
Aims:
Describe the pre-operative and post-operative stages of physical therapy examination, rehabilitation interventions and outcomes in craniopagus conjoined twins (CCT).
Methods:
27-months old total vertical types III CCT were admitted for surgical treatment. A structured rehabilitation program (functional mobility, balance training, sensory stimulation, communication, orthotic management, and caregiver education) was delivered post-operatively at different stages of surgery. The total duration of post-separation rehabilitation was 15 months for Twin A and 23 months for Twin B.
Results:
Pre-operative WeeFIM was 67/126 for both the twins. Post-separation, Twin A improved to a state of complete independence in walking, step climbing, and hand function with a discharge WeeFIM score of 84/126. However, Twin B was completely dependent in bed mobility and transfer activities during discharge (WeeFIM-18/126). Minimal change in functional status was noted in Twin B (discharge FSS score-19/30). Both the twins were transferred to a regional hospital for long-term care. At 67 months of age, Twin B lost his life due to chest infection.
Conclusions:
Vestibular based therapies, balance, and postural control may be prioritized in the rehabilitation process of CCT. Greater communication and coordination among physical, occupational therapists and other rehabilitation professionals are recommended for successful outcome in these unique cases.
