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Neuropsychiatry Case Presentations

Neuropsychiatry Case Presentations. Jean Picton Bentley Lead Physiotherapist Neuropsychiatry Ross Farmer Head of Physiotherapy & Clinical Exercise. Heterogeneity. Co morbid mental illness History of abuse Emotional support networks Differential diagnoses Past experience

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Neuropsychiatry Case Presentations

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  1. Neuropsychiatry Case Presentations Jean Picton Bentley Lead Physiotherapist Neuropsychiatry Ross Farmer Head of Physiotherapy & Clinical Exercise

  2. Heterogeneity • Co morbid mental illness • History of abuse • Emotional support networks • Differential diagnoses • Past experience • Previous exposure to therapies

  3. Individualised Symptoms • Habits reinforced by some of the characteristic postures displayed in mental illness. • Evidence of abuse to the body in form of eating disorders, self harm accidental injury. • Surgical interventions and extent of scarring • Co-morbid physical illness • Longevity of symptoms and consequent level of deconditoning, • Pre morbid levels of abilities and fitness

  4. Challenges • Establishing the therapeutic relationship • Avoidant behaviour • Patients motivation • Consistencies of approach

  5. Lily • Background • 27 year old female • Previous nurse training • Hx of migraine 11 years with associated numbness left arm • RTA 9 years ago • Minor contusion • Family Hx of stroke • Developed hemiplegic symptoms 7 years ago

  6. Lily • Presenting condition • W/C dependent • Independent ADLs • Standing transfer • Left arm paralysis & numbness • Headaches & light aversion • Kyphotic posture • Pain: LBP & L GHJ

  7. Lily • Past Interventions • Medications for migraine headaches • Neuro outpatient physiotherapy • Inpatient admission • Community Physiotherapy • Pain Management Clinic • CBT Outpatients

  8. Lily • Inpatient Treatment LU • MDT Package • CBT • OT • Physio • Medical-Assessment/Medication Review • Psychological Testing • Nursing

  9. Lily • Physio • Core strengthening • Postural work • Mobility exercises • Mobilisation techniques • Pain relief techniques • Specific muscle strengthening • Gait re-education/standing posture • Balance Work • Gym/Dance • Ongoing referral

  10. Christopher • Background • 34 yr old male Caucasian • Hx physical Abuse • ?Diagnosis Cerebral Palsy • Developed weakness in army • Non epileptic seizures • Tremor in whole body • Decreased mobility/wheelchair user

  11. Christopher • Presenting Condition • Difficult angry behaviour • Back pain • Stiff lower back posture • Decreased range of arm elevation • Stiff shuffling gait – few steps • Reduced neck mobility with dystonic posturing • ADL Independent

  12. Christopher • Past Interventions • Social services involvement • Pain clinic • Community Physiotherapy • In patient admission medical post suicide • CBT therapy

  13. Christopher • Inpatient Treatment LU • MDT Package • OT • Physio • CBT • SALT • Dietician • Nursing • Medical Assessment/Medication Review • Psychological Testing

  14. Christopher • Physio • Engagement time • Ax and Hx of back problem • Core strengthening • Mobilisations to neck • Gait training – Zimmer frame • Posture re-education • Ongoing physio

  15. Sue • Background • 19 yr old female • High Achiever / Athletic • Severe Viral Infection / CA • Developed Tremor / Weakness • Loss of power in three limbs • Electric Wheelchair with restraining straps.

  16. Sue • Presenting condition • Shaky neck posture • Shaky right arm held by strap • Thin legs with no sensation and movement • Prominent neck posturing • Drinks with straw • Uses right hand to work electric W/C

  17. Sue • Inpatient Treatment LU • MDT Package • OT • Physio • CBT • SALT • Dietician • Nursing • Medical Assessment/Medication Review • Psychological Testing

  18. Sue • Physiotherapy • CST / Soft Tissue techniques • Core strengthening / Postural work • Sitting Balance work • Muscle Activation work /Big ball • Mat work • Specific limb strengthening • Walking re-education • Dance / Gym work / Running

  19. Evidence Based Practice

  20. Points of Note • Recovery from distal to proximal • Motor returns before sensory • Patients don’t harm themselves • Usually are independent for functional tasks especially toileting. • Avoidant behaviours reduce as they become more committed to the intervention and find positive gains in their new found abilities.

  21. Finding an evidence based approach • Narrative learning • Clinicians with 30 years experience in MH • Hypothesis based on Extrapolated Theory

  22. Applying Theory Graded Exercise Therapy Functional Rehab Graded Motor Imagery Posture, Core, ROM, mm Recruitment (NOT STRENGTH) Education Legitimisation

  23. Theories Applied & Progressed • Graded Motor Imagery • Imagery • Laterality / Distorted Body Image • Mirror Therapy • Bowering 2012 (Systematic R/V of Chronic Pain) • Education • Brox 2008 (Systematic R/V of Back Schools) • Legitimising Physical Recovery • Woolf 2011 (Central Sensitisation) • Graded Exercise Therapy • PACE trial 2011 (Chronic Fatigue)

  24. Contact us… • Jean Picton-Bentley • Neuropsychiatric Physiotherapist • jean.picton-bentley@slam.nhs.uk • Ross Farmer • Head of Physiotherapy & Clinical Exercise • ross.farmer@slam.nhs.uk

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