Parth is the only child of a non-consanguineous marriage. He delivered vaginally at 34 weeks with good Apgar score and Bw of 3-2 kg. He was very floppy at birth with narrow palpebral fissures. There were no neonatal complications or H/o convulsions or any major illness.

• His motor milestones were delayed with neck holding at 8 months and unsupported sitting at 2 1/2 yrs, cruising with marked ataxia at 5 years of age.
• Mental milestones were fairly normal – social smile 2 month, speech at 2 1/2 yrs but unclear and sphincter control by 5 years. No drooling.
• Mastication good, Mild ptosis, nystagmus and squint present.
• He was in kindergarten at 2 1/2 yrs and later in a special school. He knows nursery rhymes, colours, identifies pictures speaks slowly and slightly unclear but in full sentences.
• He has been receiving PT and OT since the age of 2 1/2 yrs (now mainly at his school.)
• Neurologically – there is hypotonia marked in lower limbs with intention tremors in UL and truncal and gait ataxia Nystagmus + Cerebellar dysarthria + No extrapyramidal signs.

Developmental evaluation:

• Can come to sitting position on own from supine position, comes to standing posture using both hands for support against the wall, cruising laterally with ataxia - broad based gait, can stand with both hands for support.
• Moves by crawling or in sitting position crossed by sitting possible squatting or sitting position. Crossed by sitting possible.
• Squatting with support, can feed himself dry snacks with mild hand-mouth incoordination, cannot suck with a straw. Sips well from a glass, cannot manage to wear clothes.
• Handwriting slow and limited.
• General understanding and intelligence fairly good.

Improvements after G – Therapy:

Nystagmus disappeared, speech and balance improved within the first two months of G therapy. He could now stand with support of one hand only, was walking independently on the crutches. Hand-mouth coordination and handwriting showed improvements as well. His learning ability, and social behaviour was much better after G Therapy. He was more confident – riding a bicycle, writing and counting 1-20 and asking intelligent questions.