Functional Neurological Disorder Case Study: Difference between revisions
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== Examination == | == Examination == | ||
<span style="font-family: 'Times New Roman'; font-size: 27px; font-weight: bold; background-color: transparent; text-decoration: underline; line-height: 1.38;">Subjective :patient/family goals)</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-style: italic; vertical-align: baseline;">Patient History: </span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">A 20 year old female reported to physical therapy with numbness and severe weakness on the left side of her body, specifically her leg. The patient was recently involved in a bicycle collision with a motor vehicle 3 days ago when she was on her way home from school at a small community college. The patient reports the vehicle clipped the front of her bike while crossing an intersection, causing her to crash hard on her left side. The patient doesn’t remember if she hit her head, but she was wearing a helmet. She only recalls feeling very startled and dizzy after the collision with a couple of scrapes on her left leg from the pavement. The patient was taken to the local, rural hospital to screen for a concussion, which came back negative, where she was then released from the hospital. Since the injury 3 days ago, the patient reports her dizziness has converted to double vision and difficulty swallowing like there is a lump in her throat.</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Patient reports having increased stressed and difficulty completing school work in the past couple of weeks.</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-style: italic; vertical-align: baseline;">Systems Review: </span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; vertical-align: baseline;">Cardiac</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">: </span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Shortness of breath</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Chest pain</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; vertical-align: baseline;">Gastrointestinal</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">: </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Difficulty swallowing</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Nausea</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; vertical-align: baseline;">Musculoskeletal</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">: </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Pain in the legs or arms</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; vertical-align: baseline;">Neurological</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">: </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Headaches</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Dizziness</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Diplopia</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Tinnitus</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Muscle weakness LLE</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Paresthesia in LLE</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; vertical-align: baseline;">Urogenital</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">: </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;"> </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">None to report</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-style: italic; vertical-align: baseline;">Medical History: </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">No medical history to report</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-style: italic; vertical-align: baseline;">Chief Complaint: </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Difficulty walking and loss of balance</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-style: italic; vertical-align: baseline;">Prior or Current Services Related to Current Episode: (use relative date days, months, years)</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">MRI, labs, and EMG reports all normal</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; text-decoration: underline; vertical-align: baseline;">Self Report Outcome Measures</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; text-decoration: underline; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">LEFS</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">FABQ</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; text-decoration: underline; vertical-align: baseline;">Physical Performance Measures</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; text-decoration: underline; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-style: italic; vertical-align: baseline;">Outcome measures</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">*4 Square Balance Test:</span> | |||
* | <span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">*BERG: 26/56 </span> | ||
* | <span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">*10MWT: 1.04m/sec (Normative for female 20yo: 2.47m/sec)</span> | ||
* | <span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">*STS x 5: 14.2sec (Normative for 19-49yo: 6.2 +/- 1.3 sec)</span> | ||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; text-decoration: underline; vertical-align: baseline;">Objective : Physical Examination Tests and Measures</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-weight: bold; text-decoration: underline; vertical-align: baseline;"> | |||
</span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-style: italic; vertical-align: baseline;">Objective: </span><span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">slurred speech, trouble hearing PT during eval while speak at normal volumes; patient presented with difficulty walking with decreased gait speed, a limp on her left side, during questioning pt grinded teeth and gave very painful expressions during MMT</span> | |||
Physical Exam | <span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; font-style: italic; vertical-align: baseline;">Physical Exam</span> | ||
* Neurological: negative, however patient complains of agitation with wearing long pants | <span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">* Neurological: negative, however patient complains of agitation with wearing long pants</span> | ||
* Vitals | <span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">* Vitals normal</span> | ||
* No reproduction of symptoms | <span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">* No reproduction of symptoms</span> | ||
*DTR: normal | <span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">*DTR: normal</span> | ||
*ROM: WNL passively, but difficulty with full hip & knee ROM to march in place | <span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">*ROM: WNL passively, but difficulty with full hip & knee ROM to march in place</span> | ||
*MMT: | <span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">*MMT: </span> | ||
* | |||
<span style="background-color: transparent; vertical-align: baseline;">Left quadriceps, hamstrings, gluteal muscle group, dorsiflexors: 4/5</span> | |||
<span style="font-size: 27px; font-family: 'Times New Roman'; background-color: transparent; vertical-align: baseline;">Note: During MMT of quadriceps, hamstring contracted in opposition and vice versa with hamstring MMT</span> | |||
* | |||
<span style="background-color: transparent; vertical-align: baseline;">All of other muscles on left side and right side: 5/5</span> | |||
<br> | |||
== Clinical Impression == | == Clinical Impression == |
Revision as of 21:34, 23 March 2015
Author/s[edit | edit source]
Whitney Greene, Kayla Foster, Scott Gwinn, Jesse Koerner from the Bellarmine University Physical Therapy Program's Pathophysiology of Complex Patient Problems Project.
Abstract
[edit | edit source]
In patients diagnosed with conversion disorder, physical therapy can be an important part of a quicker recovery. During physical therapy the focus should be on what the patient is doing correctly and emphasis is placed upon the physical gains of the patient. The patient must be progressively challenged while integrating behavior modifications among functional mobility programs. Research shows the most productive interventions include gait training, strengthening, neuromuscular re-education and balance training, with a full recovery expected for most patients. Conversion disorder may also be referred to as functional gait disorder, hysterical paralysis, psychomotor disorder, conversion reaction, or chronic neurosis.
Patient Characteristics
[edit | edit source]
Demographic Information: (occupation/vocation, gender, age, etc.)
Student
Female
20 years old
Caucasian
Medical diagnosis if applicable Diagnosed with high anxiety
Co-morbidities None in medical hx or pt reported
Previous care or treatment
Examination[edit | edit source]
Subjective :patient/family goals)
Patient History:
A 20 year old female reported to physical therapy with numbness and severe weakness on the left side of her body, specifically her leg. The patient was recently involved in a bicycle collision with a motor vehicle 3 days ago when she was on her way home from school at a small community college. The patient reports the vehicle clipped the front of her bike while crossing an intersection, causing her to crash hard on her left side. The patient doesn’t remember if she hit her head, but she was wearing a helmet. She only recalls feeling very startled and dizzy after the collision with a couple of scrapes on her left leg from the pavement. The patient was taken to the local, rural hospital to screen for a concussion, which came back negative, where she was then released from the hospital. Since the injury 3 days ago, the patient reports her dizziness has converted to double vision and difficulty swallowing like there is a lump in her throat.
Patient reports having increased stressed and difficulty completing school work in the past couple of weeks.
Systems Review:
Cardiac:
Shortness of breath Chest pain Gastrointestinal: Difficulty swallowing Nausea Musculoskeletal: Pain in the legs or arms Neurological: Headaches Dizziness
Diplopia
Tinnitus
Muscle weakness LLE
Paresthesia in LLE
Urogenital: None to report
Medical History: No medical history to report
Chief Complaint: Difficulty walking and loss of balance
Prior or Current Services Related to Current Episode: (use relative date days, months, years)
MRI, labs, and EMG reports all normal
Self Report Outcome Measures LEFS
FABQ
Physical Performance Measures Outcome measures
*4 Square Balance Test:
*BERG: 26/56
*10MWT: 1.04m/sec (Normative for female 20yo: 2.47m/sec)
*STS x 5: 14.2sec (Normative for 19-49yo: 6.2 +/- 1.3 sec)
Objective : Physical Examination Tests and Measures Objective: slurred speech, trouble hearing PT during eval while speak at normal volumes; patient presented with difficulty walking with decreased gait speed, a limp on her left side, during questioning pt grinded teeth and gave very painful expressions during MMT
Physical Exam
* Neurological: negative, however patient complains of agitation with wearing long pants
* Vitals normal
* No reproduction of symptoms
*DTR: normal
*ROM: WNL passively, but difficulty with full hip & knee ROM to march in place
*MMT:
Left quadriceps, hamstrings, gluteal muscle group, dorsiflexors: 4/5
Note: During MMT of quadriceps, hamstring contracted in opposition and vice versa with hamstring MMT
All of other muscles on left side and right side: 5/5
Clinical Impression[edit | edit source]
Summarization of Examination Findings[edit | edit source]
Working Diagnosis and Targeted Interventions
Intervention[edit | edit source]
- Phases of Interventions (e.g. protective phase, mobility phase, etc.)
- Dosage and Parameters
- Rationale for Progression
- Co-interventions if applicable (e.g. injection therapy, medications)
Outcomes[edit | edit source]
Findings Over time
Discussion[edit | edit source]
Summary Statement which should include related findings in the literature, potential impact on clinical practices
Related Pages[edit | edit source]
add links to related pages here
References[edit | edit source]
References will automatically be added here, see adding references tutorial.