LK

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Name: LK

Age/gender: 3 year old female

Health condition/medical background:  33 week ex-preemie, L club foot s/p casting as a baby and 2 achilles tendon lengthenings (most recent April 2021), T6 hemivertebrae, LLD,  feeding intolerance, speech delay

Exam findings: 


Functional status: Able to walk independently for long distances, currently does not have any bracing, but did wear inserts in the past


Relevant structural/functional MS findings: 

Decreased L ankle DF ROM, hard end feel (feels like it is at the TC joint, not achilles; LLD (~1/4-1/2"), Decreased R trunk sidebend


Relevant NM exam findings from physical exam:

Normal tone, no spasticity

Sensory pain:

Able to report pain with some consistently, but does not report at ankle. Unsure if she has full sensation.


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

feeding intolerance, history of g-tube use for poor weight gain, respiratory issues when in the NICU


Regular/goal activities: Ascend/descend stairs, ambulate with symmetric weightbearing, jump with symmetric take-off and landing, R and L SLS for 3 seconds


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


Patient Goal(s):  Play!


Caregiver Goal(s)Increase symmetry of movement, improve age-appropriate GM skills


Engagement with therapy and orthoses: Great engagement with therapy, has worn orthotics in the past without resistance


Clinical questions:  Guidance on bracing following serial casting. It seems like she is compensating a lot with her midfoot/forefoot and we aren't sure what type of brace/orthotic to pick.

 

Exam questions:

Functional status: 

What category is does LK present with at midstance (WFL, inclined shank, reclined shank)?

What do you see in the transverse and coronal plane?

Musculoskeletal findings:

​What structural (static) variants might there be in the shape of the foot bones that are contributing to her presentation? 

What structures might receiving excessive stress?

What do you anticipate for the development of her MS system due to her variants?

Neuromotor and Motor control findings:

What impact will her MS variants have on her NM development? 

Sensory Perception and Pain:

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

 

Relevant systems screening:

Individual:

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

Intervention:

Goals 

What are relevant goals for LK?

Body Structure and function:

3 year old: 

30 year old: 

Activities:

3 year old: 

30 year old: 

Environment, Participation, and Personal Factors:

3 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?

Manual Therapy

Demonstrate the joint mobilizations that might be appropriate.

Demonstrate the soft tissue mobilizations that might be appropriate.

What extra strategies might you use to increase the effectiveness?

 

Neuroplasticity questions

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

Strengthening questions

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

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

Pain and Health Condition Education :

How will you discuss LK's health condition with her? With her family?

Systemic Access To Resources:

What systemic challenges might LK face? How can you as her PT help to mediate this?

Case 1

Case 1