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musculoskeletal physiotherapy case studies

The case studies based in acute settings highlight transferable skills which may impact on the approach to treatment of the patient with neurological impairment. Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Clinical Case Studies in Physiotherapy: A Guide for Students and Graduates: Guthrie, Lauren Jean: Amazon.nl Selecteer uw cookievoorkeuren We gebruiken cookies en vergelijkbare tools om uw winkelervaring te verbeteren, onze services aan te bieden, te begrijpen hoe klanten onze services gebruiken zodat we verbeteringen kunnen aanbrengen, en om advertenties weer te geven. Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. However, given the low numbers of physiotherapists reported to be practising MRP in the UK and the eclectic approach reported, a similar approach has been taken when compiling this chapter. Freezing noted at doorways. Musculoskeletal case studies for medical students. What psychosocial issues might this lady have to address as part of her rehabilitation process? Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Case studies in neurological physiotherapy, In neurological physiotherapy the evidence base for treatment interventions is a developing one (Pomeroy & Tallis 2002). 4 Multiple mechanisms have been hypothesized as potentially leading to the age-related loss in muscle mass and strength that is characteristically seen. This gentleman presents with some weakness of the right upper limb, can exercise be used to increase muscle strength in this patient? CHAPTER NINE Case studies in care of the elderly Jennifer Nitz, Susan Hourigan Case study 1: Colles’ Fracture from a Fall 304 Case study 2: Bilateral Osteoarthritis in Knees 305 Case study 3: Palliative Care – Working in Community as Part of a Community Palliative Care Team 307 Case study 4: Post-operative Hemicolectomy 309 Case… What problems can be associated with spinal cord injury at T5? There is a progressive loss of skeletal tissue muscle mass and strength with aging. These topics will be covered by using practical examples, utilizing case studies of real life clients who have musculoskeletal problems as a result of dysfunctional spinal movement. Musculoskeletal Physiotherapy(MACP): Example plan for part-time study (three years) (registration is for 6 years so these modules could be taken over a more extended period) Year 1 Research Theory and Application AND Musculoskeletal Physiotherapy – Evaluating Practice (one week). Musculoskeletal (MSK) physiotherapy teams within Midlands Partnership NHS Foundation Trust (MPFT) historically used a variety of outcome measures including the EuroQol (EQ-5D-5L) alongside condition specific PROMS and a patient experience-reported experience measure, in line with Chartered Society of Physiotherapy (CSP) recommendations. You can either filter the innovations by 'Region' or 'Type' or use the keyword search above to find specific words or phrases. Chapters five to eleven take you through case studies related to various areas of physiotherapy. Studies by. What positions are favourable in terms of maintaining oxygen saturations in acute stroke management? These areas are: respiratory physiotherapy, orthopaedics, neurological physiotherapy, musculoskeletal out-patients, care … Why does this patient require full ventilatory support? Introduction. Read as many books as you like (Personal use) and Join Over 150.000 Happy Readers. Correction achieved by movement of upper limbs or by stepping left leg to increase base of support, No attempts to increase BOS by stepping right lower limb, Further progression of balance assessment abandoned due to patient confidence and health and safety concerns, Decreased step length evident, with decreased heel strike on left and no heel strike on right, Decreased stance phase on right lower limb, Circumduction of right lower limb during swing phase, with decreased dorsiflexion during swing, Elevated shoulder girdles bilaterally, unable to release upper limbs to achieve reciprocal arm swing, No trunk rotation evident during observation. What difficulties could increased tone at this stage pose for long-term rehabilitation goals? Geriatric Physical Therapy: A Case Study Approach Staples WH. Requested transfer to local rehabilitation unit to be closer to family and friends, Lives with parents in terraced house. Understanding the content + Active … Case Studies Read More » Dense low tone noted throughout left upper and lower limbs, No subluxation evident at left glenohumeral joint, Oxygen saturation – 94% on 28% oxygen via face mask, Palpation – reduced basal expansion bilaterally, On auscultation – reduced air entry with bronchial breath sounds in right basal lobe, 72-year-old female with right-sided hemiplegia primarily affecting the upper limb following CVA 6/52, Low tone in upper limb proximally with subluxation of glenohumeral joint, Increased tone in right wrist, fingers and elbow, with moderate associated reaction evident on activity, Complained of severe headache immediately prior to collapse at local bingo hall, CT scan showed extensive haemorrhagic stroke affecting the thalamus. Rubber Pulley Lagging. She wishes to highlight the need to be vigilant towards red flags, in particular septic arthritis, as this case study highlights the devastating consequences of missed early diagnosis. Mattress very soft, offering little resistance to downward force needed to achieve this movement, Only gold members can continue reading. Agreement has been reached re: transferring studies. Began to deteriorate physically 3 years ago without any acute periods. A musculoskeletal physiotherapist’s creative research capacity building journey Purpose To describe a musculoskeletal (MSK) physiotherapist's clinical academic journey involving the unique elements of design and creative practice, focusing on knowledge mobilisation and implementation in line with research capacity building for, within and by practice. Unable to affect level of tone within the lower limbs with handling, On repositioning to assist with nursing care, rolling performed via a log-rolling technique due to difficulties with increased tone in the lower limbs. Each chapter is allocated to a certain area. Below are some examples of advanced practice level members throughout the UK in different specialities. On low dose currently being closely monitored by specialist nurse, who is visiting at home every 2 weeks, Furosemide – diuretic used to treat heart failure, Lives in a two-storey house with bathroom and bedroom upstairs. 45-year-old man who suffered an incomplete disruption of C3/4 following a motorbike accident, Recently discharged home, ventilated and has a 24-hour package of care provided by a dedicated nursing team who all undertook an extensive training package at the regional spinal unit once appointed to their post, Contracted a chest infection 2/52 ago. Prior to weaning commencing physiotherapy intervention was kept to a minimum due to concerns with increasing intra-cranial pressure. The patient is now wearing a brace, which is due to be reviewed in the next few weeks. If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. The case studies presented in this chapter aim to touch upon each of these areas, highlighting the role of the physiotherapist, the need to develop an underpinning knowledge of the pathophysiology of a condition in order to set appropriate goals and the need to work as part of a multi/inter disciplinary team. MLA Citation "Musculoskeletal Cases." What are the treatment priorities in the acute phase of stroke management for this gentleman? Terms of Use 2 In addition, over the course of an individual’s lifespan, the muscle fiber loss noted as a consequence of aging results in a decline of between 25% and 40% of the cross-sectional area of the muscles of the thigh. The second most popular approach was identified as the Motor Re-learning Programme (MRP), though this was practised by only 4% of the respondents. Patient reports concerns that his wife would be unable to offer this degree of support as she is in increasing levels of pain, In side lying able to drop feet over side of bed, though required assistance to push upper body into sitting position. No apparent difficulties noted, Experiencing marked difficulty rolling – initiates movement by reaching forward with right upper limb. His medication has been changed, but increasingly difficult home circumstances have triggered an urgent referral. Walking approximately 50 m both indoors and outdoors. Large base of support, with knees pushed back into full extension to adopt close-packed position of the joint, Pelvis – anterior tilt, with increased lumbar lordosis, Centre of gravity falling posterior to the knee joint, Shoulders elevated bilaterally, unable to release upper limbs to ‘relax’ into standing posture, Balance assessed in standing by applying small forces anteriorly, posteriorly and laterally to central key point. ... Case Studies Physiotherapy ... Physio Med offers to solution to help NHS employees to recover more quickly and safety from musculoskeletal injuries and conditions that required treatment. How might these be addressed in collaboration with nursing team members who work with this gentleman? Has had a full course of antibiotics but was unwell at the time and nursed in bed, Nursing staff report difficulties in achieving a good sitting posture in attendant powered wheelchair since chest infection. Otherwise it is hidden from view. Mercer C, Jackson A, Hettinga D, Barlas P, Ferguson S, Greenhalgh S, Harding V, Hurley Osing D, Klaber Moffett J, Martin D, May S, Monteath J, Roberts L, Taylor N, Woby S. Chartered Society of Physiotherapy (2006). Select the case you want to view in the table below. Much of the evidence available informing neurological physiotherapy practice supports the MRP as an effective treatment approach in the management of neurological conditions. The following case studies outline the different ways in which Mitchell Physiotherapy can assist you. 203.205.21.159 Some of the details in these case studies have been changed to protect the person’s identity. Staff are trained in respiratory management and provide manual hyperinflation and suctioning at regular intervals, Paraplegic; reports being able to feel pain though unable to localise. 22-year-old female, suffered a head injury 4 years ago following an RTA in which she was a passenger, With rehabilitation made a good recovery and has now been in part-time paid employment for 6/12 as an administrative assistant, On starting work, complained of high levels of fatigue. The following patient is on intensive care following admission via A&E 2 weeks ago. 2,3 The loss of muscle mass can be significant and has been reported to be approximately 30% in several studies. We welcome examples and case studies from all aspects of physiotherapy practice, research, education, and service delivery. Patient positioned in powered adjustable bed, upper limbs supported on pillows maintaining alignment throughout, End of bed raised to position lower limbs with hips in approximately 70° flexion and knees at approximately 30° flexion, Passive movements performed to all upper limb joints, Shoulder extension difficult to assess due to positioning in bed, Full range of movement available at shoulders and elbows, though distal increase in tone noted toward end of range. This blog is a written by Mary Taylor a musculoskeletal physiotherapist and manager of a persisting pain service and orthopaedic interface clinic in Devon, UK. CLINICAL CASE STUDIES IN PHYSIOTHERAPY provides invaluable advice and practical guidance on cases and problems encountered on a daily basis allowing you to work with ease and confidence. What would the initial goals of physiotherapy management be for this gentleman? CLINICAL CASE STUDIES IN PHYSIOTHERAPY provides invaluable advice and practical guidance on cases and problems encountered on a daily basis allowing you to work with ease and confidence. Uses a powered wheelchair for indoor and outdoor mobility, Currently using a banana board with the assistance of one for all transfers, Home care staff have reported increased difficulties with transfers, with one member of staff having injured her back during transfer from bed to shower chair, Sacral pressure sore – district nurse visits three times weekly for dressing. The Effect of Rhythmic Auditory Stimulation on a 75 year old male with Parkinson's- A Case Study; The Management of Parkinson’s Disease Symptoms with Tai Chi Exercise Program: A Case Study; The outpatient physical therapy experience of a 63 year old male with right cerebellar ischemic stroke: a case study Each chapter is allocated to a certain area. Aging presents the human body with many challenges as it relates to the musculoskeletal system. ... Our Managing Musculoskeletal guides and videos have been developed by our chartered physiotherapists to help those suffering from pain and limited mobility suffered from a recent musculoskeletal accident, injury or trauma. Thrombolytic treatment was not administered in this instance – why was this the case? On rolling increased tone within the neck and trunk extensors evident, Further assessment postponed due to patient agitation. The area of respiratory physiotherapy reaches a number of patient groups, both in the in-patient and out-patient settings. Unable to bring centre of gravity forward over changing base of support to achieve stand, With facilitation and verbal prompts able to ‘slide’ forward in chair using upper limbs to initiate movement. This case study is about a 57 year old lady with right shoulder pain after volunteering to walk a dog for a non for profit charity organisation. Initial prognosis following haemorrhagic stroke is poor; however, recovery after the acute episode can be significant. Click on "View" in the last column to see the history and detailed X rays. This process is referred to as sarcopenia and invariably leads to decreased functional ability in the aged. What risk assessment needs to take place when evaluating moving and handling intervention? How would you prioritise these goals and why? Musculoskeletal Case Study. There is no standardised or set route into advanced level practice. Today she states that she is having increasing right shoulder pain over the past couple of weeks. This was supported by Davidson & Waters (2000) who reported that the majority of physiotherapists questioned (88%), professed to use the Bobath approach, although the majority of these also used other approaches in the treatment of their clients.   •  Privacy Policy Noticeable soft tissue adaptation and increase in tone in the upper limbs may lead to difficulties for this gentleman in using the powered wheelchair. Suctioning technique reviewed by senior nursing staff for all team members to ensure correct sterile technique adhered to during procedure, Passive movements usually performed twice daily to all joints of upper and lower limbs through range. What problems can be identified for this gentleman? Clinical Case Studies in Physiotherapy E-Book: A Guide for Students and Graduates - Ebook written by Lauren Jean Guthrie. Grow Get better over time and watch yourself flourish. Patient complained of pain on movement, though unable to localise, Full range pronation available, marked increase in tone noted at approximately neutral when moving toward supination, with wrist and fingers developing flexor pattern, Nursing staff present report that this has become an increasing problem since chest infection and they are concerned about skin integrity. No movement initiated at head or lower limbs, With verbal prompting able to move lower limbs into crook lying, turn head in direction of movement and reach upper limb across the body in the direction of movement. Geriatric Physical Therapy: A Case Study Approach, https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=1773§ionid=119285437. 9 Muscle fiber denervation occurs, although it is not clear whether denervation precedes muscle wasting or is a result of it. 10,11 Finally, the excitability of both spinal and cortical tissues decreases with age, and this is complicit in the age-related decline seen in skeletal muscle function. Search Show all Exact phrase All words Any word. In book: Clinical Case Studies in Physiotherapy: A guide for students and graduates (pp.215-301) Chapter: Chapter 8: Case studies in a musculoskeletal outpatients setting Neurological physiotherapy covers a broad area of practice spanning intensive care, acute, rehabilitative and community services. Introduction. No repeat CT scan conducted as yet, Initially medically unstable with physiotherapy input focussed in positioning and respiratory monitoring. We focus on musculoskeletal techniques, manual therapeutic techniques and how to implement them. Patient asked to push against the pressure to maintain midline standing, Unable to activate postural control mechanisms at the ankles to correct for postural threat. What is meant by the term glenohumeral joint subluxation? Good upper limb function, able to carry out most functional tasks, with just fine control affected, Unable to drive on discharge due to epilepsy following head injury, though has now returned to driving, Lives alone in a one-bedroom ground floor flat, On discharge from hospital, lived with parents, moved to own accommodation 1 year ago and has lived independently since, Parents are supportive, but now only call when needed as daughter has worked hard to achieve her independence following her RTA, Works part-time as an administrative assistant at a local architects, looking to increase hours to full-time once she feels physically able, Returning to a more active social life – enjoys going out with friends, bingo and cinema, Mobilising independently indoors at time of visit. PGCert Musculoskeletal Physiotherapy Practice Students will integrate the theory and evidence base of musculoskeletal practice. Difficulty in self-propelling due to poor sitting balance, Becoming increasingly frustrated with lack of independence, Recently had catheter removed, now intermittent self-catheterisation with assistance from nursing staff with a view to full independence. Stiffness in lower back preventing movement beyond patients ‘normal’ range, Left scapula protracted, but can align with verbal prompting, Right scapula – reduced tone evident with scapula protracted and medially rotated, Right humerus medially rotated with significant subluxation evident, Unable to recruit activity at shoulder girdle or glenohumeral joint, Increased tone noted at elbow flexors with associated reaction evident on activity, Increased tone of right wrist and finger flexors – increasing with any activity, Some soft tissue adaptation noted in right wrist and fingers, unable to achieve full extension nor accept a base of support through palmar aspect of the hand, 55-year-old male admitted via A&E following collapse, CT scan showed sub-arachnoid haemorrhage (SAH) of the left anterior cerebral artery (ACA), Current problems relate to standing balance, unable to stand unaided. This site uses cookies to provide, maintain and improve your experience. It is therefore suggested that any preparation for a new area of clinical practice should include familiarisation with the approach adopted in that area. During chest infection unable to perform all movements fully due to positioning and marked increase in tone, Tracheostomy tube changed during chest infection, communicates effectively by staff lip reading, Mild asthmatic – controlled well with inhalers. Lives in halls of residence, but was due to move into shared housing with friends at start of next academic year, Has been in contact with local university about the possibility of transferring her studies to allow her to live at home. Some of the details in these case studies have been changed to protect the person’s identity. Musculoskeletal Conditions: Case Studies WSAVA/FECAVA/BSAVA World Congress 2012 Donna Carver, BSc(Hons), Physio, DAVN (Surgical), MCSP, RVN ... Physiotherapy treatment techniques Evaluation and progression of treatment. Are there any other services which you may access to continue treatment for this patient? 1 The reduction in muscle mass is most prominent in the lower extremities and is characterized by a preferential atrophy of type 2 muscle fibers. Chapters five to eleven take you through case studies related to various areas of physiotherapy. These studies have sought to isolate the components of neurological physiotherapy treatment and what concept of treatment physiotherapist’s professed to use. Appointments are arranged to coincide with daughters visits, Reports difficulty getting in and out of daughter’s car when attending last clinic appointment, Complains of dry mouth due to diuretic treatment Taking frequent sips of water through a straw Experienced a number of episodes of coughing during subjective assessment, Recurrent chest infections over past 12 months, Sinemet (CR) – controlled release – medications are released over a 4–6-hour period to prevent fluctuations of levadopa levels, Ropinirole – dopamine agonist – just commenced as symptoms worsening. Sports & Musculoskeletal Case Studies. What symptoms could be associated with occlusion of the right middle cerebral artery? What treatment options may be available to you in order to address the goals identified? What problem list would you establish for this patient? You have been asked to see him by the lead nurse in the team due to difficulties with positioning. female who presents to your office with right shoulder pain. What treatment interventions might you access in order to manage this problem? This case study is about a 57 year old lady with right shoulder pain after volunteering to walk a dog for a non for profit charity organisation. Oxidative processes stimulate inflammation and the cascade of biochemical reactions associated with it. The following gentleman was discharged 4/52 ago from a regional spinal unit. Detailed assessment had to be postponed due to concerns with increasing blood pressure. Has previously returned to full normal functional levels following these incidents, GP referred to consultant neurologist, who diagnosed MS following a number of investigations, Reviewed 6 monthly by Consultant and 3 monthly by MS nurse, 5/52 ago complained of feeling unwell with associated loss of movement in right lower limb. What other outcome measures may have been used in your assessment of this lady? Download for offline reading, highlight, bookmark or take notes while you read Clinical Case Studies in Physiotherapy E-Book: A Guide for Students and Graduates. Patient reports hand position causing concern though wants to be able to sit out in wheelchair so that he can spend more time with his sons, Once blood pressure stabilised, patient hoisted into wheelchair to enable assessment of lower limb alignment and sitting position, Tilt in space wheelchair, with rear wheels set back to accommodate the weight of the portable ventilator, Gutter arms to provide support for upper limbs, which can be positioned into pronation with wrists and fingers in neutral position after approximately 5 minutes to allow tone to settle following hoisting, Head support in situ though able to maintain alignment of head independently, Lateral trunk support maintaining trunk position, Hips at 90°, positioning aided by gravity as hoisted into wheelchair in tilted position, Increased tone at knees into extensor pattern, unable to flex knees passively beyond 140° on right and 130° on left to place feet on footplates, Increased tone at both ankles, held in plantarflexion and inversion.

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