Pre- and Postoperative Rehabilitation of Craniopagus Conjoined Twins: A Case Report

Abstract

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.

Keywords:

• Outcome
• physical therapy
• rehabilitation
• surgery
• type III craniopagus

Acknowledgements

We express our thanks to all craniopagus team members for their dedicated efforts in managing the twins.

Disclosure Statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Consent

Images of twins are attached in the manuscript file with consent from parents.

Additional information

Notes on contributors

Pradeep Kumar Sahu

Pradeep Kumar Sahu, MPT, is a Physiotherapist at Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.

Garima Singh

Garima Singh, MPT, is a Physiotherapist at Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.

Deepak Kumar Gupta

Prof. Deepak Kumar Gupta, Mch, PhD, is a Neurosurgeon and Professor, Neurosurgery at All India Institute of Medical Sciences, New Delhi, India.

Ashok Kumar Mahapatra

Prof. Ashok Kumar Mahapatra, Mch, is a Vice Chancellor at SOA University, Odisha, India and former Head, Neurosurgery at All India Institute of Medical Sciences, New Delhi, India.

Shashank Sharad Kale

Prof. Shashank Sharad Kale, Mch, is a Neurosurgeon, Professor and Head, Neurosurgery at All India Institute of Medical Sciences, New Delhi, India.