Trish'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? 

John is 14 yo very sociable, but non-verbal. Communicates with facial gestures, I believe limited use of pecs board, receptive higher then expressive although he is always smiling & vocalizing as you can hear! Can follow simple one step directs but with manual prompting.

He has Zellwegers Syndrome, wears glasses & bilateral hearing both of which do not correct vision or hearing to 100%. 

He is the patient I had in mind when asking about possible atypical bone development as Zellweger syndrome causes delayed calcification & hyper mobility. He has a LLD of L LE being 1/2 longer.  His DF is very restricted at talocrual axis to 12 degrees shy of neutral or PF.

He is in articulated AFO with posterior check strap that is usually set with no allowance for DF, as when it is loosened to allow DF he has difficulty walking.

He is severely pronates and looks like he has been that way for long time as you can guess from calluses over navicular! His calcaneus is way, way high! Lots of restrictions in his soleus around heel cord. He is my co-workers patient. Trying to get her to investigate serial casting because this poor kid is just DF at mid foot & you can see it going right up the chain to his knees, hips, spine! Ugh!

 

Case 1

Case 1