title: Rehabilitation of Conjoined Twins Pre- and Postsurgical Separation.
abstract: OBJECTIVE
  Describe the rehabilitation, including two episodes of inpatient rehabilitation, early intervention, and outpatient services, of conjoined twins.
  
  
  METHODS
  The patients were 14-month-old female ischiopagus tripus twins that received 3 months of rehabilitation (mobility, feeding, communication, developmental skill training, developing adaptive equipment, educating caregivers) preseparation surgery. Surgery occurred at 24 months. At 27 months, the twins were admitted to inpatient rehabilitation, receiving 4 months of rehabilitation promoting strength, endurance, gait training, feeding, communication, developmental skill training, orthotics, adaptive equipment, and caregiver education. Presurgical WeeFIM was 18/126 (twin A) and 19/126 (twin B), and 28/126 (both twins A&B) postsurgical. Prior to surgery, patients performed supine to sit transfers with supervision.
  
  
  RESULTS
  Following surgery, each twin sat and performed bed mobility independently. Twin B performed wheelchair mobility and supported standing at anterior surface with assistance. Discharge WeeFIM was 42/126 (twin A) and 45/126 (twin B). Twins performed floor mobility by scooting, stood at an anterior surface with assistance (maximum for twin A, minimal for twin B), and propelled a manual wheelchair indoors (minimal assistance for both twins A & B).
  
  
  CONCLUSIONS
  Rehabilitation of conjoined twins improved presurgical functional status and addressed the unique functional needs of each twin postseparation.
authors.affiliation: a The Children's Institute , Pittsburgh , Pennsylvania , USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Tozzi
authors.affiliation: b Physical Therapy Program, The University of Findlay , Findlay , Ohio , USA.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Van Zant
mesh_terms: D002675:Child, Preschool; D004435:Eating; D005247:Feeding Behavior; D005260:Female; D018737:Hand Strength; D006801:Humans; D007223:Infant; D008124:Locomotion; D009788:Occupational Therapy; D009989:Orthotic Devices; D010347:Patient Care Planning; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D004856:Postural Balance; D011300:Preoperative Care; D019651:Plastic Surgery Procedures / Q000534:rehabilitation*; D012656:Self-Help Devices; D013060:Speech; D013070:Speech Therapy; D016896:Treatment Outcome; D014428:Twins, Conjoined / Q000601:surgery*; D014910:Wheelchairs
keywords: Conjoined twins; occupational therapy; physical therapy; rehabilitation; speech and language therapy; surgical separation