Case Scenario

Here are several case scenarios that we have created to assist you in considering how the Kwic resource could be useful for making decisions about a particular client.

• Pediatric Neuromuscular (2)

  Alex is a 6 year old female on your home care PT caseload with left hemiplegic CP and delayed motor and cognitive development.

  Examination findings:

  • Visual-spatial deficits
  • Short attention span
  • Decreased active movement in right upper extremity
  • Increased muscle tone in his elbow flexors
  • Poor abdominal strength and core stability
  • Decreased range of motion at his right shoulder, elbow and wrist
  • Independent ambulation with loss of balance on uneven surfaces

  Therapy Goal: Improve right upper extremity function during dynamic balance tasks.

• Pediatric Neuromuscular (1)

  Ahmed is a 10 year old male with left hemiplegic cerebral palsy at Gross Motor Function Classification System (GMFCS) level 2. He is in grade 5 and is your client in school health support services. He is typically quite sedentary, is a bit overweight, and is not a fan of organized sports activities, but he would like to be able to participate more with his peers in gym class and during recess activities. He wears a left ankle foot orthosis (AFO).

  Examination findings:

  • Unable to jump
  • Difficulty walking over uneven surfaces, unstable with some falls on grass and gravel
  • His 6 Minute Walk Test score and Gross Motor Function Measure Challenge Assessment scores are significantly reduced compared to what is normal for other children his age at his GMFCS level
  • Left hip, knee and ankle strength is 4/5

  Therapy Goal: Improve dynamic balance and strengthen left leg to facilitate ability to participate in recess activities such as hopscotch and four-square.

• Pediatric Musculoskeletal

  Jackie is a 15 year old female soccer player with a grade II right ankle sprain. She is 3 weeks post her injury and is a patient in your outpatient clinic.

  Examination Findings:

  • Ankle range of motion: R Plantarflexion 0-30 degrees and dorsiflexion 0-10 degrees
  • Single Limb Stance: Right 10 s (decreased). Left 60 s (normal)
  • Able to run ¼ mile at moderate speed before reporting pain of 5/10 in lateral aspect of ankle
  • Strength on manual muscle testing: Dorsiflexion 3+/5, Plantarflexion 4/5, Inversion and Eversion 4/5

  Therapy Goal: Increase strength in right ankle to enable return to play.

• Adult Cognitive

  Quan is a 21 year old male who suffered an anoxic brain injury 3 weeks ago secondary to smoke inhalation from a house fire. Quan is your patient in a rehabilitation center.

  Examination findings:

  • Difficulty with motor planning and coordination
  • Memory and executive function deficits
  • Rancho Los Amigos Level V (Confused, inappropriate)
  • Follows simple commands consistently but has difficulty with multi-step processes
  • Able to stand unassisted with contact guard for five minutes

  Therapy Goal: Improve ability to participate appropriately in a physical activity that requires selective attention to task and two step response selection.

• Adult Musculoskeletal

  Jack is an 81 year old male who is 2 months post left total knee replacement. He is a patient in your outpatient PT clinic.

  Examination findings:

  • Examination findings: Ambulates with single cane for balance
  • Reports using his furniture for support when walking in his home
  • Reports that he fell twice in his home last month, but no reported injuries
  • Fatigues easily with physical activity
  • Left hip and knee strength grossly 4/5
  • Left knee extension -10 degrees, full knee flexion

  Therapy Goal: Improve dynamic balance to promote greater physical endurance in standing.

• Adult Neuromuscular

  Marie is a 45 year old female who was diagnosed with Multiple Sclerosis 3 years ago. She has been referred to your outpatient PT clinic for gait and balance training due to a history of falls, especially when reaching in standing and during mobility activities. She complains of fatigue and you note that her movements are slow.

  Examination findings:

  • Bilateral lower extremity strength grossly 4/5
  • Sensation intact to light touch and proprioceptive testing
  • In sitting, she is able to reach out of her base of support (BOS) forward and to each side
  • She stands independently, without upper limb support
  • Is independent but requires upper limb support for turning 180 degrees, reaching above shoulder height, and stepping in standing.
  • Berg score = 28/56 indicating a high fall risk

  Therapy Goal: Promote ability to stand independently while doing functional upper extremity activities of daily living.