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Chiropractic Journal of Australia : CJA March 2013
Chiropractic Journal of Australia Volume 43 Number 1 March 2013 15 INTRODUCTION Strabismus or esotrophia, more commonly known as cross-eyed, is a manifest misalignment of the visual axes and one of the most common childhood visual disorders, occurring in 3-4% of the population.1 In 1974, Graham reported a prevalence of 5.66% based on an observation of 4,832 children born in the City of Cardiff.2 In a survey of 60,000 optometric eye examinations, each with orthoptic assessment, Stidwill3 found that 5% had a binocular vision anomaly. An estimate of the prevalence rates found that of the 3,075 binocular anomalies, 74% had concomitant strabismus. Recent reports describe the prevalence of pediatric strabismus as ranging from 0.12% in 1.5-year-old Japanese children4 to 20.1% in a cohort of low birth weight English children.5 In a study to assess the psychosocial implications of growing up with and living with socially noticeable strabismus, Satterfeld and colleagues6 found that indeed, psychosocial difficulties relating to socially noticeable strabismus are not just a problem for school-children but also for teenagers and adults. In addition, the child with strabismus exhibit delayed achievement of developmental milestones. Andrea L. Parisio-Ferraro, B App Sci (Comp Med) M Clin Chiro CACCP Private Practice of Chiropractic, Melbourne, Vic, Australia Joel Alcantara, DC Research Director, the International Chiropractic Pediatric Association, Media, PA, USA Chair of Pediatric Research, Life Chiropractic College West, Hayward, CA, USA. This study was funded by the International Chiropractic Pediatric Asso- ciation, Media, PA and Life Chiropractic College West, Hayward, CA Confict of Interest Notifcation: The authors declare no confict of interest Received: 5 October 2012, accepted 15 January 2013 The Chiropractic Care of an Infant Female with a Medical Diagnosis of Strabismus: A Case Report. ANDREA L. PARISIO-FERRARO and JOEL ALCANTARA ABSTRACT: Objective: To describe the chiropractic care of an infant female with a medical diagnosis of strabismus. Clinical Features: An 18-month-old female with strabismus and a history of surgical care to correct her visual dysfunction is presented. Neurological examination revealed primitive refexes with Galant’s and Moro retained. No abnormalities were detected with the rooting, palmar, plantar, tonic neck, and Babinski’s refexes. Pupillary and accommodation refex were unremarkable. The positions of cardinal gaze revealed diffculties of the left eye with upward movement and abduction. The right eye revealed slowed and awkward movements throughout the entire test. Inspection of the eyes revealed bilateral esotropia. Intervention and Outcome: The patient was cared for with chiropractic spinal adjustments in combination with cranial-sacral therapy with positive outcome. The patient’s strabismus improved as confrmed by ongoing consultations with an ophthalmologist. Conclusion: This case report provides supporting evidence that infants with strabismus may beneft from chiropractic care. INDEX TERMS: (MeSH): CHIROPRACTIC; STRABISMUS; ESOTROPIA; HEALTHCARE Chiropr J Aust 2013; 43:15-8. For example, they demonstrate impairment in sensorimotor development and gross motor milestones.7 To a child who is learning to grow and develop, this places considerable stress on learning, balance and crawling, walking and position sense and can be very stressful for the child to understand and interpret their environment. Treatment of strabismus in children can range from the very simple such as an eye patch8 to the use of corrective lenses, the use of botulinum toxin9-10 to invasive surgery.11 These treatment options have poor compliance7, have questionable effectiveness and risk of adverse events.10 In the interest of evidence-informed practice and explore for the possibility of chiropractic as a complementary and alternative approach to the care of the child with strabismus, we present this case report. CASE REPORT The mother of an 18-month-old infant presented for chiropractic consultation and possible care. The infant's mother was concerned about the cosmetic appearance of her daughter's eyes due to strabismus and the possible effects it may have on her development and socializing skills. The history examination revealed a car accident occurring during the 2nd trimester of her pregnancy with the exact week of gestation as unknown. The mother was examined at a hospital for possible injuries but was released from the lack of need for hospitalization and further medical care. She did however experience low back pain into her sacrum region as a result of the motor vehicle collision but she described it as minimal discomfort and did not seek advice or therapy. The child's mother indicated that she gave birth to her daughter at the hospital, which was induced on her due date. Total labour time was 5.5 hours, including the third stage of labour. No forceps or suction was used, although the child was OP (occiput posterior) presentation.
CJA December 2012
CJA June 2013