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Case VIII Megan Ivy, SPT Junie Flores,SPT

Case VIII Megan Ivy, SPT Junie Flores,SPT. Examination. Mr. Donald Jones 62 y/o male Lives with his wife in a one-story home Retired Carpenter Right hand dominant MOI: LOC/ fall outside home Once medically stable, referred to PT by MD for L hemiplegia. Examination Continued.

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Case VIII Megan Ivy, SPT Junie Flores,SPT

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  1. Case VIIIMegan Ivy, SPTJunieFlores,SPT

  2. Examination • Mr. Donald Jones • 62 y/o male • Lives with his wife in a one-story home • Retired Carpenter • Right hand dominant • MOI: LOC/ fall outside home • Once medically stable, referred to PT by MD for L hemiplegia

  3. Examination Continued Physical Examination • A & O x 3 • HR 70, RR 16, BP 124/82 • Peripheral pulses intact • Slightly over-nourished, appears stated age

  4. Examination Continued Neurologic Examination • Cranial Nerves intact • Difficulty localizing objects: distance, motion, spatial relationships • Visual-spatial agnosia • Appears to be unaware of deficits. • Anosognosia • Wife states pt. is having difficulty recalling familiar routes, settings. • Topographical disorientation

  5. Examination Continued Motor Systems Examination • L Side: • UE- diminished STR, hypo-reflexia • LE- flaccid paralysis, areflexia, no voluntary mvmt • R Side: • UE/LE- Normal strength, movement, MSR’s

  6. Examination Continued Sensory Examination • L Side: • LE > UE- Diminished vibratory sense, hot/cold recognition, light touch • R Side: • Normal sensation

  7. Follow-Up Same: • R side intact • Distribution of sensory loss • Anosognosia, topographical disorientation, visual-spatial agnosia Different: • Left UE hyper-reflexive • Left LE exhibits spastic paralysis & Clonus

  8. Overview • L Side: • UMNL signs LE>UE • R Side: • Normal • Visual-spatial deficits & anosognosia What’s the diagnosis?

  9. Pathology Right Anterior Cerebral Artery CVA *Non-Dominant Hemisphere CVA*

  10. Review • ACA Supplies blood to . . . • Medial aspect of frontal and parietal lobes, basal ganglia, and anterior 4/5 of the corpus callosum

  11. Evaluation: Disablement Model

  12. Prognosis

  13. Intervention Strategies to improve: • Sensory Function • Strength • Motor Learning • Postural Control and Functional Mobility • Balance • Locomotion • Aerobic Function • Feeding and Swallowing

  14. Intervention Continued • Most helpful in first 6-18 months

  15. Time-out

  16. Review: Donald Jones- Retired Carpenter

  17. PT Implications for Donald Jones *Safety and feedback!!

  18. Goals • LTG: Pt will amb x 100’ /c HW SBA over level surfaces at DC to facilitate safe home mobility. • STG: Pt will amb x 50’ /c HW Min Asst over level surfaces in 1 wk. • LTG: Pt to travel marked route from kitchen to bathroom in <5 minutes with <10 verbal cues in 6 weeks to allow for home mobility. • STG: Pt to travel marked route from kitchen to bathroom in <10 minutes with <20 verbal cues in 4 weeks.

  19. APTA Practice Pattern Primary Preferred Practice Pattern: • 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System- Acquired in Adolescence or Adulthood Associated Preferred Practice Pattern: • 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling

  20. References • Bowman, J.P. and Giddings, F.D. Strokes : an illustrated guide to brain structure, blood supply, and clinical signs / James P. Bowman, Frank D. Giddings. Upper Saddle River, N.J. : Prentice Hall, 2003. • C. C. Goodman, Fuller, K.S., Boissonnault, W.G. Pathology : implications for the physical therapist. Philadelphia : Saunders, 2003. • Netter, F.H. The CIBA Collection of Medical Illustrations Volume 1: Nervous System Part II: Neurologic and Neuromuscular Disorders, p. 149. CIBA Pharmaceutical Company, Summit, NJ 1986. • O'Sullivan, S.B. and Schmitz, T.J. Physical Rehabilitation: Assessment and Treatment, 5th ed. Philadelphia, PA: F. A. Davis, 2007. • Willard, F.H. Medical Neuroanatomy: A Problem-Oriented Manual with Annotated Atlas. Philadelphia, PA : Lippincott, 1993.

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