SINGAPORE: Blessed with breathtaking atolls, Maldives is not known for its medical facilities. Mrs Aisha Maajidh acknowledged this, which was why she chose to deliver her only son Mohamed Akil Abdul Maajidh, in nearby Sri Lanka. Unfortunately, the birth in 2003 did not go as planned.

The 40-year-old homemaker revealed: “Akil had a breech birth and did not get enough oxygen during delivery. He stayed in the hospital for two months and the doctors told me it was highly likely that his brain would be affected.”

A subsequent MRI revealed that Akil had suffered brain haemorrhages and soon began to display slower than normal development. He developed epileptic seizures and struggled to meet developmental milestones.

Aisha and her tourism executive husband had initially considered seeking treatment in the United States but decided that it was too far. Desperate and running out of options, they eventually turned to the President of Maldives for help. It paid off. Not long after, the Maldivian government office informed them that it had located a doctor in Singapore who could help them.

Rollercoaster of emotions

When Akil first arrived in Singapore in 2005, Aisha was still unaware of the exact diagnosis of her then two-year-old son’s condition. That, however, was cleared up after meeting Dr Phuah Huan Kee, who was at the time, Consultant and Head of the Paediatric Neurology Service at KK Women’s and Children’s Hospital (KKH).

Scans, including an MRI, revealed that Akil had cerebral palsy, a term that encompasses a group of non-progressive and non-contagious conditions that cause physical disability. Akil subsequently began intensive physiotherapy as well as speech and occupational therapy over several months before returning home. He improved somewhat but the discontinuance of physiotherapy at home gradually diminished any progress he had made. Aisha decided to bring Akil back to Singapore in February 2006.

Dr Phuah had recommended Botox to help loosen Akil’s tight muscles and reduce spasticity in his legs to achieve better results from his physiotherapy. So with Aisha’s permission, Botox was administered to both of Akil’s legs.

Akil and his mother remained in Singapore for another eight weeks before returning home. His parents were happy with the progress he had made, as he was now able to walk a short distance unassisted.

The joy was short-lived as the temporary effects of Botox began to wear out. By his third birthday in September 2006, Akil stopped walking because he was constantly falling down. And when he did walk, he would do so on tiptoe.

Aisha said: “It was like a rollercoaster ride. One minute we were depressed, then overjoyed, and before long, we were disappointed again.”

A permanent solution

In April 2007, when Akil returned to Singapore, he saw Dr Seow Wan Tew, the current Head and Senior Consultant of Paediatric Neurosurgery Service at KKH.

Dr Seow assessed Akil’s condition and suggested he undergo a Selective Dorsal Rhizotomy (SDR). He explained: “This surgery will benefit children with spasticity. It will help those with diplegia to walk better and also help in the nursing care of others, like those with spastic quadriplegia.”

For SDR to achieve the best results, it was important that Akil be prepared for it with intensive physiotherapy. Dr Seow turned to Ms Sarah Wong, a senior physiotherapist from Kids Focus Physiotherapy, who used to work in KKH. Ms Wong received her fellowship in paediatric physiotherapy from St Louis Children’s Hospital and Rehab Institute of Chicago in the United States, and has presented numerous research papers in local and international medical conferences.

Dr Seow said: “Rehab is the most important resource. We also need intra-operative monitoring to identify the correct nerve roots during surgery, and of course patients with parents who are prepared to invest the time required for intensive post-surgical therapy.”

Intra-operative monitoring involves the very complex process of identifying the sensory nerves (not motor nerves) that need to be cut and how much of it to cut. The nerves also have to be painstakingly tested for the desired response.

Although not every child with cerebral palsy will benefit from SDR, for Akil, it did. He had the right type of spasticity, the right kind of condition that the surgery can target and most importantly, the right kind of family support such as his mother’s unwavering commitment.

“Dr Seow rightly felt that Akil will be much better off by not going under the knife right away. Instead, he wanted to look toward long-term results, which is why intensive physiotherapy was required to prepare him for the surgery that is going to reduce his stiffness,” said Ms Wong, who worked closely with Akil for four months.

On July 31, 2007, the little Maldivian boy underwent SDR surgery.

No looking back

“The first thing I noticed after surgery was that his legs looked a lot better. He still couldn’t stand but then Sarah worked on him and results began to show,” recalled Aisha.

Ms Wong added: “Part of the plan was also to continue intensive physiotherapy after surgery to work on Akil’s balance and walking techniques as well as build his strength. He would initially collapse to the ground but as he got stronger, he became enthusiastic about getting on his feet and using them.”

Aside from improving physically, Akil also became a happier child and was more expressive than before. Ms Wong said: “I was always trying to get him to do jigsaws but never could. After the surgery, he could sit on the floor and pick up the knobbed jigsaw pieces to fit them together and thereafter, get up on his own.”

By his fourth birthday in September 2007, Akil was walking by himself and even climbing a few stairs. At Akil’s most recent check-up with Dr Seow in February 2008, Aisha said excitedly: “Now he is walking all over the house and shopping centres by himself. He is steadier and stronger. Sometimes he even shakes about and dances.”

While there is undoubtedly still a long way to go for Akil, Ms Wong is upbeat that with the right sort of environment and therapy, he will be soon able to communicate with other people and ultimately go to school.

“We intend to move him along to acquire other skills like his speech and language, using a pencil and scribbling with crayons. We also have to work on developing his play skills such as pushing a ball, jumping and going to the playground,” said Ms Wong, who has provided Aisha a home programme to establish continuity in her son’s rehabilitation.

Upon Ms Wong’s recommendation, Akil’s parents have enrolled him in the Excelerate V.2 programme in Singapore. This is an intensive multidisciplinary special needs programme that will focus on developing his fine motor, speech and language, and cognitive skills with input from the relevant therapists.

“At one point, I was so worried that he would spend the rest of his life in a wheelchair. But thanks to all the doctors and therapists in Singapore, my son can now walk,” said Aisha, looking proudly at her bubbly son.