Name: WF

Age/gender: 6 y/o male

Health condition/medical background:  CP, history of SPML to B HS and gastrocs

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Exam findings: 

Functional status: Walks IND, began walking around 2-2.5 years old, falls frequently

Relevant structural/functional MS findings: 

Limited B DF ROM (L more limited than R), significant B knee hyperextension, B medial tibial torsion. With DF stress test - supinates

Relevant NM exam findings from physical exam:

Impaired recruiting (R>L sided impairments in motor control)

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Sensory pain:

No reports of pain

Relevant system screening findings (e.g. Autism spectrum, cardiopulm, GI health conditions): 

NA

Regular/goal activities: Attends school? Any recreation activities?

Structural demands of current/goal environments: Any stairs or ramps?

Patient Goal(s):  Skipping, running, jumping (overall participation w/ friends at school)

Caregiver Goal(s) -  Improved gait mechanics/alignment

Engagement with therapy and orthoses:  Good

Clinical questions: Overall would love ideas from the group for improving alignment/gait mechanics (either from an orthotics or treatment perspective). It's been difficult finding the right brace design because he presents with both excessive tibial inclination and hyperextension in stance. Also tough to balance our PT goals (shifting his COM more posteriorly and improving alignment) and WF's goals (running/jumping with his friends). 

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Exam questions:

Functional status: 

What category is WF at midstance (WFL, inclined shank, reclined shank)?

What do you see in the transverse and coronal plane?

Is the GS functioning eccentrically to control tibial motion and foot posture during LR? Midstance? Terminal stance? 

What is your hypothesis for what's driving these gait changes for WF? 

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:

If you had a magic wand and could improve motor control in one muscle group for WF, what would you chose?

Sensory Perception and Pain:

Where might WF be likely to experience pain in the future?

Relevant systems screening:

How might hypo recruitment of trunk stabilizers be impacting gait?

Individual:

How could we support WF's motivation to move and keep up while maintaining musculoskeletal safety? 

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Key findings: What are the suspected drivers and limiting factors for WF? What do you see as his resources? 

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Intervention:

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Goals 

What are relevant goals for WF?

Body Structure and function:

6 year old: 

30 year old: 

Activities:

6 year old: 

30 year old: 

Environment, Participation, and Personal Factors:

6 year old: 

30 year 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 for WF.

Demonstrate the soft tissue mobilizations that might be appropriate for WF.

What extra strategies might you use to increase the effectiveness for WF?

 

Neuroplasticity questions

Demonstrate/describe 3 activities to promote neuroplasticity/cortical map plotting of foot/ankle for WF. 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 WF's motor skills?

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

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Pain and Health Condition Education :

How will you discuss WF's health condition with him? With his family?

What does he need to know about pain?

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Systemic Access To Resources:

What challenges do you expect WF might face in the future that might be different than his typically developing peers?