Case Study: This case study aims to bring together the components of physiotherapy assessment important for monitoring for neurological stability.
Name: Trisha
Age: 8 years
Video Time: 45.40 – 57.26
Watch the following video of Trisha.
Write out a summary of assessment findings for Trisha:
Functional abilities:
Gait: (with GRAFOs) Overuse of upper limbs when walking. Decrease pelvic control. Lateral trunk sway. Bilateral intoeing. Hips remain flexed throughout. Decreased active hip extension bilaterally Lumbar lordosis throughout gait cycle. Hip hitching of both legs to assist with foot clearance during swing.
(Without GRAFOs) Further decrease in pelvic control and increased use of upper limbs. Increased base of support to accommodate the increase in intoeing when GRAFOs are removed. Increase hip and knee flexion throughout gait cycle. No heel strike (foot drop evident)
Standing: (With GRAFOs) Flexion of hips and knees. Lordotic posture of lumbar spine. Reduced pelvic control and stability
(Without GRAFOs) Increase in hip and knee flexion (crouch in stand). Decreased stability and control particularly at the ankle. Considerable difficulty standing still and maintaining her balance. Active flexion and extension of knees due to difficulty maintaining a static position and to assist with balance.
SLS: (With GRAFOs) (L) & (R) Momentary only. Poor pelvic control and stability. Unable to maintain a level pelvis.
(Without GRAFOs) unable to SLS
Musculoskeletal Findings:
Hips: (L) FFD 5 – 10 degrees (R) FFD 0-5 degrees
Knees: NAD
Feet: Reach plantargrade
Internal Tibial Torsion (L) > (R)
Spine: Lumbar Lordosis – not fixed
Potential Problem Areas:
1. Need to monitor hip ROM and muscle length 2. Need to monitor spine and lumbar lordosis 3. Internal tibial torsion can make ambulation difficult, but at present is controlled by her orthotics. 4. Potential for knee problems due to trunk sway when walking 5. Significant energy expenditure when walking 6. Lower limb joint integrity due to gait pattern 7. Potential difficulty with participation in exercise and recreational acitivites.
Plan:
1. Review 12 months unless concerns arise earlier 2. Education regarding monitoring for neurological stability and signs of deterioration 3. Skin care education 4. Education and discussion re appropriate mobility incorporating a balance between walking and use of wheelchair 5. Education re long term mobility and how to minimise the potential deterioration of lower limb joint integrity 6. Encourage participation in active recreational activities and maintaining fitness.