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PT 7326 Neuroanatomy Case Study #1

PT 7326 Neuroanatomy Case Study #1. Jessica Wells, SPT Kayla Tweedy, SPT. Examination. Mrs. Reddy 53 y/o female Lives with husband & 2 dogs High School Librarian Right hand dominant MOI: unknown, but PMH: MVA 6 months ago. Physical Examination. A&O x 3 Well nourished & hydrated

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PT 7326 Neuroanatomy Case Study #1

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  1. PT 7326 Neuroanatomy Case Study #1 Jessica Wells, SPT Kayla Tweedy, SPT

  2. Examination • Mrs. Reddy • 53 y/o female • Lives with husband & 2 dogs • High School Librarian • Right hand dominant • MOI: unknown, but PMH: MVA 6 months ago

  3. Physical Examination • A&O x 3 • Well nourished & hydrated • Vitals WNL • Brachial & radial pulses intact

  4. Neurological Examination • Normal cognitive function • Cranial nerves intact

  5. Motor Examination • UE reflexes diminished • Biceps (C5) & Brachioradialis (C6) • Bilateral UE STR: • Deltoid (C5) 3/5 • Biceps (C5-6) 3+/5 • Triceps (C7) 4+/5 • LE STR and movement WNL • Slight atrophy of deltoid

  6. Sensation Examination • Loss of temperature discrimination in C4-C6 of both UE in cape-like distribution • Bilateral LE sensory testing WNL

  7. Tract Problems • Spinothalamic: pain & temp from both sides of body cross in SC and ascend, but are stopped at C4-6 and unable to reach brain. • Lateral Corticospinal Tract Fibers affected causing muscle weakness.

  8. Pathology • Syringomyelia • Central cord syndrome • Fluid-filled cavitation (cyst) of central canal • Gradual progression from anterior white commissure to anterior horn cells • More frequently seen in men • Estimated prevalence: 8.4 per 100,000 people

  9. Diagnostic Techniques • CSF Analysis • Plain X-Ray • Myelography • CT Scan • MRI • Real Time Ultrasonography (rare) • Intraoperative Spinal Sonography

  10. MOI • Falls • MVA • Sports Injuries • Due to Spinal Cord Injury • Due to Chiari Malformation • Exact pathogenesis unknown

  11. Surgical Interventions • Suboccipital/cervical decompression • Laminectomy & Syringotomy • Shunts • Fourth Ventriculostomy • Neuroendoscopic Surgery

  12. Evaluation: Disablement Model • Pathology: central cord syndrome • Impairment:  STR in both arms • Functional Limitation: pt cannot lift arms over head • Disability: pt cannot return to her job restocking books

  13. Prognosis • Pt is expected to progress well towards goals 2º to family support and eagerness to return to work • The prognosis is fair due to possible progression of disorder

  14. Goals • LTG 1: pt will be able to stock 10 books on a 6 ft shelf (one book at a time) alternating arms without pn in 4 weeks to allow for return to work • STG 1: pt able to perform 2x10 shoulder flexion exercises using yellow theraband in 2 wks

  15. Goals cont. • LTG 2: pt will be able to cook a meal without injury at clinic kitchen within 4 wks to allow for safe cooking at home. • STG 2: pt will be able to explain proper safety techniques as taught by PT within 2 weeks. • If temperature discrimination returns prior to D/C, will reassess goals.

  16. APTA Practice Pattern • 5E: Impaired Motor Function and Sensory Integrity Associated with Progressive Disorders of the Central Nervous System

  17. PT Intervention • Pt Education Re: safety • ROM • STR Training • Functional Training (ADLs) • Stretching • Promote Relaxation • Long term, intensive rehabilitation is necessary

  18. References • APTA. Guide to Physical Therapist Practice. 2nd edition. Alexandria,VA: APTA; 2003. • Miller B, Michael K. Intraoperative Spinal Sonography; A Case Study of Syringomyelia. Journal of Diagnostic Medical Sonography. 2008; 24:228-233.

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