International Journal For Multidisciplinary Research

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Effect of Physiotherapy and Submalleolar Orthosis in a 20-Month-Old Premature Child with Delayed Motor Development associated with hypotonia, knee hyperextention and foot pronation: A Case Study

Author(s) Ms. Ritambhra Kumari
Country India
Abstract Abstract
Background
Premature children commonly experience delayed motor development due to hypotonia, muscle weakness, and poor postural control. These impairments may lead to functional limitations such as difficulty in crawling, standing, walking, and maintaining balance. Foot pronation and knee hyperextension are frequently observed during weight-bearing activities. Early physiotherapy intervention along with orthotic support may help improve motor development and functional independence.
Objective
To evaluate the effect of physiotherapy combined with submalleolar orthosis (SMO) in improving motor milestones, muscle strength, balance, and functional activities in a premature child with delayed motor development.
Case Description
A 20-month-old premature female child with a history of neonatal hypoxia and delayed motor milestones was referred for physiotherapy management. On assessment, generalized hypotonia, bilateral foot pronation, knee hyperextension, poor standing balance, and muscle strength below Grade 3 were observed. The child was unable to crawl, stand, or walk independently.
Intervention
A structured physiotherapy rehabilitation program was planned according to the child’s functional needs. Treatment included play-based activities, milestone-oriented training, balance exercises, gait training, crawling practice, stair-climbing activities, and strengthening exercises for core and lower limb muscles, especially the quadriceps (VMO). Progressive resistance training using loop bands and weight cuffs was later introduced. Submalleolar orthosis (SMO) was provided to improve foot alignment and stability during weight-bearing activities.
Outcome Measures
Outcome measures included assessment of motor milestones, muscle strength, balance, knee control, foot alignment, and activity level before and after intervention.
Results
Gradual improvement was observed following regular physiotherapy sessions. The child achieved independent crawling within two weeks and independent standing after approximately two and a half months. Walking was initiated shortly afterward, followed by stair-climbing activities. Muscle strength improved from below Grade 3 to Grade 4. Standing balance, postural control, activity level, and confidence also improved significantly, while knee hyperextension and foot pronation were reduced with SMO support.
Conclusion
Physiotherapy combined with submalleolar orthosis was effective in improving motor development, balance, muscle strength, posture, and functional independence in this premature child with hypotonia and delayed motor development. Early rehabilitation intervention may play an important role in achieving functional milestones and improving quality of life in similar pediatric cases.
This case study describes the rehabilitation of a 20-month-old preterm child with delayed motor development linked to hypotonia, knee hyperextension, and foot pronation is described in this case report. Sub-malleolar orthoses (SMO) and a systematic physiotherapy regimen were administered to the youngster. Crawling, standing balancing, walking, and other functional activities all showed steady improvement. During the therapy phase, postural control and muscle strength also improved. The study emphasizes how crucial early physiotherapy intervention is for enhancing children with developmental delays' motor milestones and functional independence.
Keywords Hypotonia, Delayed motor development, Physiotherapy, SMO, Pediatric rehabilitation
Field Physical Science
Published In Volume 8, Issue 3, May-June 2026
Published On 2026-05-15
DOI https://doi.org/10.36948/ijfmr.2026.v08i03.77794
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