Mindy's Case Study

Exam questions (P 4):

Functional status: 

Loading response: 

​Midstance:

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 improved selective motor control for one muscle group, what would it be?​

Sensory Perception and Pain:

Do you expect that the patient has a well developed cortical map of the foot ?

What areas might be at risk for:

Tissue damage pain

Lack of awareness of tissue damage pain (hypoperception)

Amplified pain

Relevant systems screening:

Individual:

What resources to do you see?

 

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

Goals (P5):

What are relevant goals?

Body Structure and function:

Short term:

DKM (23 year old): 

Activities:

Short term:

DKM (23 year old): 

Environment, Participation, and Personal Factors:

Short term:

DKM (23 year old): 

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

Manual Therapy (P 123-131):

Demonstrate the joint mobilizations that might be appropriate.

Demonstrate the soft tissue mobilizations that might be appropriate.

Neuroplasticity questions (P 149-161):

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? 

Strengthening questions (P 133-148):

What motor learning strategies will you try to maximize motor skills?

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

Pain and Health Condition Education (P 161-166):

  • What are your hypotheses around his experience of pain? Discuss how you would you address this in a treatment session?

  • What are 3 resources that help his movement system?

Systemic Access To Resources:

As compared to his age-matched peers, what relevant resources might be harder for his to access due to societal structures? How can you as his PT support him to counteract those disadvantages? 

The patient in the video is a 4.10 year old with history of premature birth, diagnosed with spastic diplegia after onset of walking around 2 years.

Stiffness and strength asymmetry is apparent with L side more involved. 

She was in kiddie gaits with SMOs prior but initial contact still on forefoot and knee unstable on L in mid stance. 

She had 2 rounds of Botox with min to no impact and finally convinced parents to do serial casting this past fall.

ROM gains excellent and orthotic follow up with day time solid AFOs and night hinged AFOs.

She’s doing fairly well AFOs but is limited in squatting play, stairs and not getting full stride on L.

Phsyatrist wants to hinge the AFOs or cut them down to PLS.  I would like to see more gastoc contribution to push off which I’m thinking would help with stride and power so maybe can get left arm down with running. 

Case 1

Case 1