Amy's Case
Amy's Patient Case Information
Age: 3y 4 months at time of video
She was born full term without complications. No diagnosis. Evaled by PT at 20 months because she was not walking, (walked tripping over her feet and constantly falling).
Parent's goals: Dad was concerned because feet turn in a lot which inhibits her stability.
Medical diagnosis/health condition: referred to major medical center neuromuscular clinic, no diagnosis yet: genetic testing negative. Had Brain MRI: results not available.
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PT history: Amy has tried theratogs (strapping TA, obliques, and counteract IR) which made a difference, but parents reluctant to buy and put on everyday. Has tried lite gait to see if helpful....once or twice. PT has been doing as much core as she can, modified single leg stance, function etc.
Questions: Would love any advice on where to focus.
Orthotics: New physiatrist ordering hinged AFOs--- not sure that is the way to go...
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Case 1
Case 1
Exam questions:
Functional status:
Loading response:
​Midstance:
Terminal Stance:
Swing:
Musculoskeletal findings:
​What joints are likely to be restricted?
What soft tissue structures are likely to be restricted?
What structures are receiving excessive stress in the movement system?
Neuromotor and Motor control findings:
In which muscle groups do suspect atypical tonic contraction?
If you had a magic wand and could grant the patient improved selective motor control for one muscle group, what would it be?​
Sensory Perception and Pain:
What is your hypothesis for the impact of the patient's cortical map due to her neurological health condition and her current motor experience?
How might lack of sensory information be contributing to her gait impairment?
What areas might be at risk for:
Tissue damage pain
Lack of awareness of tissue damage pain (hypoperception)
Amplified pain
Relevant systems screening:
What body systems might be impacting function?
Individual:
Regular/goal activities:
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Structural demands of current/goal environments:
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Patient Goal(s):
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Caregiver Goal(s)
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Engagement with therapy and orthoses:
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Key findings: What are the suspected drivers and limiting factors for this patient?
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Intervention
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Goals
What are relevant goals?
Body Structure and function:
5 years old:
45 years old:
Activities:
5 years old:
45 years old:
Environment, Participation, and Personal Factors:
5 years old:
45 years old:
​What are goal areas that might be in conflict (ICF levels/family goals/patient goals/team member goals)? Who is right?
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Manual Therapy
Demonstrate the joint mobilizations that might be appropriate.
Demonstrate the soft tissue mobilizations that might be appropriate.
What extra strategies might you use to increase the effectiveness this patient?
Neuroplasticity questions
Demonstrate/describe 3 activities to promote neuroplasticity/cortical map plotting of foot/ankle. Bonus points for creative activities/games NOT mentioned in the course. How will you progress the complexity for cortical map development?
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Strengthening questions
What motor learning strategies will you try to maximize the patient's motor skills?
Demonstrate the progressive resistive exercises you plan to do with the patient. How will you modify for her?
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Pain and Health Condition Education :
What are your hypotheses around the patient's experience of pain? Discuss how you would you address this in a treatment session?
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What should the patient know about her health condition now, and what do you want to teach her as she gets older?
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What are 3 resources you can see for her movement system?
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Systemic Access To Resources: