1 / 15

Case Study IV

Case Study IV. Joni Williamson Sean Hester. Examination. Mrs. Jenkins 29 y/o female Lives with her husband and 1 small child Stay at home mom MOI: unknown PT needed due to limited mobility PMH: ED visit 2 days ago, sent home on Vicodin, recently recovered from flu Right hand dominant.

sinead
Download Presentation

Case Study IV

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Study IV Joni Williamson Sean Hester

  2. Examination • Mrs. Jenkins • 29 y/o female • Lives with her husband and 1 small child • Stay at home mom • MOI: unknown • PT needed due to limited mobility • PMH: ED visit 2 days ago, sent home on Vicodin, recently recovered from flu • Right hand dominant

  3. Examination Physical Examination: • A&O x 3 • Vitals elevated due to obvious pain • Peripheral pulses intact • Appears well-nourished and stated age • Altered facial expressions

  4. Examination Neurologic Examination: • Cranial nerves intact • Short term memory deficits found

  5. Neurological Exam Motor Systems: • R UE – STR 2/5 with spasticity • L UE – STR 4/5 with normal tone • R LE – STR 2-/5 with spasticity • L LE – STR 4/5 with normal tone • DTR: R – hyperreflexia L - WNL

  6. Neurological Exam Sensation: • Light touch test: • Pain elicited with dull (non-noxious) stimulus • Further sensory is contraindicated due to hypersensitivity of pain.

  7. Pathology • THALAMIC SYNDROME- from a CVA to the posterior cerebral artery. • Thalamic pain due to spinothalamic, VPL/VPM damage • Contralateral hemiparesis due to interuption of the corticospinal tract • Emotional/behavioral issues- due to motor involvement in the face • Choreaathetoid movements

  8. Evaluation: Disablement Model • Pathology- Thalamic Syndrome • Impairment- Decrease strength of R UE and R LE • Functional Limitation- pt is unable to ambulate • Disablity-pt can’t ambulate at home to take care of her child

  9. Prognosis • The overall prognosis for this patient is fair. • The strength in the UE and LE can be increased, but the ultimate success depends on the ability to control the pain that will be everlasting.

  10. Intervention • Pain control • Gate training • Strength training • Stretching • ROM • Pt and caregiver education • Aquatic Therapy

  11. Interventions • There is no surgical treatment for this syndrome. • A multidisciplinary approach will be needed to treat the patient. • Pain medications (prescribed and NSAIDS) have been used to manage the pain as best as possible. • In some cases medicinal marijuana is prescribed to help manage pain • Study conducted (2007) using vestibular caloric stimulation (COWS) to treat thalamic pain syndrome on two patients. • Both participants showed decrease pain immediately and long-term (4-7 weeks) after the treatment.

  12. Goals • LTG: Pt to increase strength to 4/5 in R UE and LE in 8 wks to be able to lift and care for her small child. • STG: Pt to demonstrate 3/5 strength in R UE and LE in 4 wks. • LTG: Pt to ambulate 400 ft on an even surface with a cane in 8 wks in order to independently walk from the bedroom to the kitchen and back. • STG: Pt to ambulate 100 ft on an even surface with a cane in 2 wks.

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

  14. PT Implications • Impaired motor function • Gait training • Strengthening • Stretching • ROM • Impaired sensory integrity • Pain control • Progressive loss of function • Pt and caregiver education

  15. References • Ramachandran V S, McGreoch P D, Williams L, Arcilla G. “Rapid Relief of Thalamic Pain Syndrome Induced by Vestibular Caloric Stimulation.” Neurocase 2007;13:185-188. • Schott G. From thalamic syndrome to central poststroke pain. Journal of Neurology, Neurosurgery, and Psychiatry 1995;61:560-564.

More Related