Our little Miracle Girl Cassandra Fruck

C assandra Fruck was born a little over 7 years ago. Cassie as she is fondly known, has cerebral palsy as a result of an intraventricular hemorrage which she suffered in utero. The hemorrhage resulted in left sided hemiplegia and a condition called hydrocephalus. Since her birth she has undergone numerous hospital stays and operations including a shunt operation, a shunt infection and a second shunt insertion.
Cassie Fruck age 7 left sided hemiplegia CP, hydrocephulus an VP Shunt











The doctors new very early on because of her brain injury that Cassie had cerebral palsy. Even as a baby Cassie did not move her left hand normally, she could not hold her head up very well, she did not sit up at 7 months and she never crawled. Cassie has a team of people that have gotten her to the high functioning beautiful child she is today. She has physiotherapists, occupational therapists, pediatric neurosurgeon, orthopedic specialist, pediatirc orthotist as well as an entire extended family that has stood by her and supported her through every step of her development.

Despite her rocky start into this world, our precious little miracle attends grade 2 at Fessenden Public School. She is such a bright spot in our lives as well as all other lives she touches. She has a contagious smile: great personality and is just a well-rounded loveable , fun 7 year old. She has some limitations but she doesnt let this hinder her attempts at playing with kids her own age; trying to nurture those younger than her and being the best little sister she can be to her sister Julia, whom she adores.

Cassandra with her big sister Julia. Julia is such an inspiration to Cassie. Julia actively participates in physiotherapy after school program to motivate and encourage Cassie. It makes the program lots more fun and the girls get time together bonding!





Through out the years as Cassie has grown and developed into a typical 7 year old the muscles on her affected side have become prone to being shorter than those on Cassies stronger sideof her body secondary to decreased use. With the result of growth ( And Cassie is going to be tall!) Cassie's left foot has a shortened heel cord and tends to invert (turn in), such that she is walking on the outside border of her foot. Cassie's left hand is contracted and tight and her left thumb is stiffening inward.

Cassie needs to have an orthopedic surgery on her left foot. The medica named for her surgery is a medial column lengthening;lateral column shortening and a tibialis anterior transfer. Dr. Sarah Burrow's is Cassie's orthopedic specialist. Before this surgery can be performed Cassie's foot needs to be improved through Botox injections and Serial Casting.
Botox is a medication that relaxes spastic muscles. In Canada, it is approved for the treatment of equinovarus foot deformity arising from gastrocnemius spaticity in cerebral palsy. It is also very effective in treating spasticity in other muscle groups of various etiologies. A good medical article to read if you are interested is "The use of boulinum toxin in paediatric hypertonia". This article outlines the major use of Botox in children like Cassie.

Cassie's goals for the use of Botox as a treatment are to improve the range of motion in her left ankle and foot. To improve her walking abilities and to improve her left arm and hand function. The pharmacological effect of this medication only lasts for approximately three months. Therefore Cassie needs repeated injections to maintain the clinical improvements. Cassie also needs other treatments such as vigorous physiotherapy and serial casting.

Serial casing is a process of applying light weight fiberglass casts on Cassie's leg. Every week the angle of the cast is changed to slightly stretch the muscles and move the joint a little closer to the correct position. The serial casting sessions are an integral part of her orthotic management. The goal of serial casting is to restore the soft tissue extensibility of her muscles using normal physiologic adaptation mechanisms without compromising strength and power. Maintaining the muscle in a stretched position for 5-7 days results in new muscle cell growth which makes the muscle longer and the foot and leg more functional. . After the serial casting sessions a new custom ankle foot orthotic will be made. Cassie' new brace will improve her ability to function during every day activities.

Cassie at Chedoke's After School Physiotherapy Clinic with her physiotherapist Lindsay.



Stay tuned for a blog about Botox injections and Serial Casting. As well a special thank you to the Ancaster Community, St Johns Evangelical Lutheran Church and Fessenden Public school for Financial assistance to assist Cassie in receiving treatment!!