Deb'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? 

Born 10 2017 in Columbia

10/2019 choking incident caused him to have a heart attack which lead to pneumonia and months in hospital

After this he has to learn to walk again

March 2020 brought toUS after being adopted

January 2021 started wearing sure step orthotics.  Before wearing the orthotics mom reports that he would often give her his feet to rub.  He does not do this now when he wears the orthotics.

 

He walks with stiff legs and a wide base of support.  Just starting to run.  Even in sitting his feet are severely pronated with minimal to no weight bearing on the lateral border of his feet and if his weight is shifted forward he curls his toes and further abducts his toes to the point that his big toe under his second toe especially on the right side.  To raise up on his toes he weight bears on the top of curled toes.

 

We were wondering if he could be a case study.  And what information (videos/pictures) you need from the family.  To add more complication to the case I have only seen him virtually at this time.  The family is okay if I come in person to teach them some manual therapy.

 

Case 1

Case 1