Case D

Exam questions:

Functional status: 

Loading response: Shock absorbtion?

​Midstance:  (1) shank WFL, (2) excessively reclined shank, or (3) excessively reclined shank?

​Terminal stance: Therapeutic gait?

Swing?

Musculoskeletal findings:

What structures are receiving excessive stress in the movement system?

Which muscles have altered line of pull?

Neuromotor and Motor control findings:

In which muscle groups do you observe

·       Impaired timing for function?

·       Altered tonic contraction?

​What strategies are available to for balance reactions?

Sensory Perception and Pain:

What is your hypothesis for the usefulness of the LE cortical map for function?

Relevant systems screening:

What systems might be contributing to S’s gait impairments? Any referrals you want to make?

Individual:

           

Key findings: What are the suspected drivers and limiting factors?

Goals:

What are relevant goals for S?

Body Structure and function:

Activities:

Environment, Participation, and Personal Factors:

​What are goal areas that might be in conflict (ICF levels/family goals/patient goals/team member goals)? Who is right?

 

Pain and Health Condition Education:

Neuroplasticity questions:

Demonstrate/describe 3  activities to promote neuroplasticity/cortical map plotting of the LEs. Bonus points for creative activities/games NOT mentioned in the manual. How will you progress the complexity for cortical map development?

 

Manual Therapy:

Demonstrate the joint mobilizations that might be appropriate

Demonstrate the soft tissue mobilizations that might be appropriate .

How might you modify techniques?

Strengthening questions (Page 133-148):

Improved strength in what 3 muscle groups would make the biggest functional difference ?

Demonstrate the progressive resistive exercises you plan to do. How will you modify for him?

Case Information 

28 yo make s/p cva 8/20.

He started going to therapy elsewhere and then has been with us since around November.  He circumducts and has hip flexor weakness. Eversion is 2+ and hip flexion is  3-/5.  

He supinates at initial contact with some toe flexion.

Toe flexion worsens with increased effort.

Foot slap when he walks faster and continues to worsen.

Very motivated in therapy.

Previously worked in construction.

Has type 1 diabetes and high blood pressure. 

Case 1

Case 1