Traumatic Brain Injury - Case Study Part 2: Difference between revisions
No edit summary |
Kim Jackson (talk | contribs) m (Changed protection level for "Traumatic Brain Injury - Case Study Part 2": Course Page ([Edit=⧼protect-level-ppadmin⧽] (indefinite) [Move=⧼protect-level-ppadmin⧽] (indefinite))) |
||
(17 intermediate revisions by 6 users not shown) | |||
Line 1: | Line 1: | ||
== | == Presenting Condition == | ||
For background information go to | |||
[[Traumatic Brain Injury - Case Study Part 1]] | |||
BP 116/84 Supine | == Assessment == | ||
=== Initial Physiotherapy Assessment in the ICU === | |||
Pulse 114 bpm | * GCS 6 (Eyes <sub>1</sub> Voice <sub>2</sub> Motor <sub>3)</sub> | ||
* Pupils Right 6+, Left 5+ | |||
O<sub>2</sub> Saturation 94% on 30% O<sub>2</sub> | * BP 116/84 Supine | ||
{| | * Pulse 114 bpm | ||
| | * O<sub>2</sub> Saturation 94% on 30% O<sub>2</sub> | ||
| colspan="2" |Upper Limb | {| width="800" border="1" cellpadding="1" cellspacing="1" | ||
|- | |||
! scope="col" | | |||
! colspan="2" scope="col" |Upper Limb | |||
! colspan="2" scope="col" | Lower Limb | |||
|- | |- | ||
! | |||
|Left | |Left | ||
|Right | |Right | ||
Line 22: | Line 25: | ||
|Tone | |Tone | ||
|Decreased | |Decreased | ||
| | |NAD | ||
|Decreased | |Decreased | ||
| | |NAD | ||
|- | |- | ||
|Power | |Power | ||
| colspan="4" |Unable to participate in manual muscle testing | | colspan="4" |Unable to participate in manual muscle testing | ||
Spontaneous movements are uncoordinated | |||
|- | |- | ||
| | |Coordination | ||
| colspan="4" |Unable to Assess | | colspan="4" |Unable to Assess | ||
Spontaneous Movements Impaired | Spontaneous Movements Impaired | ||
|- | |||
|Range of Movement | |||
| colspan="4" |Active - No Response to Cues, Spontaneous Movements observed | |||
Passive - Within Normal Limits | |||
|- | |||
|Sensation | |||
| colspan="4" |Unable to participate in formal testing | |||
Does react to some tactile stimulation | |||
|- | |- | ||
|Proprioception | |Proprioception | ||
Line 42: | Line 53: | ||
|Reflexes | |Reflexes | ||
|Decreased | |Decreased | ||
| | |NAD | ||
|Decreased | |Decreased | ||
| | Plantar - Upgoing | ||
|NAD | |||
Plantar - Downgoing | |||
|- | |- | ||
|Behaviour | |Behaviour | ||
| colspan="4" |Restless ++ | | colspan="4" |Restless ++ | ||
|- | |||
|} | |} | ||
== | === 2 Months Post Injury === | ||
Tracheostomy Removed, Self ventilating on room air. | * Tracheostomy Removed, Self ventilating on room air. | ||
* PEG remains in situ for feeding. | |||
PEG remains in situ for feeding. | * Can attend Gym for Rehabilitation | ||
* Currently using a wheelchair for mobility | |||
Can attend Gym for Rehabilitation | * GCS 10 (E<sub>4</sub> V<sub>2</sub> M<sub>4</sub>) Not following commands, No speech but an occasional physical aggressive outburst | ||
* Mask like expression of face, wide open eyes and constantly raised eyebrows giving an alarmed or surprised impression, consistent with abnormal tone and sensation | |||
Currently using wheelchair for mobility | * Poor eye contact | ||
* Flexed posture with poor trunk and head control | |||
GCS 10 (E<sub>4</sub> V<sub>2</sub> M<sub>4</sub>) Not following commands, No speech but occasional physical aggressive outburst | * Subluxation of Left GHJ (Two Fingers Breadth) | ||
{| width="800" border="1" cellpadding="1" cellspacing="1" | |||
Mask like expression of face, wide open eyes and constantly raised eyebrows giving an alarmed or surprised impression, consistent with abnormal tone and sensation | |- | ||
! scope="col" | | |||
Poor eye contact | ! colspan="2" scope="col" |Upper Limb | ||
! colspan="2" scope="col" | Lower Limb | |||
Flexed posture with poor trunk and head control | |||
Subluxation | |||
{| | |||
| | |||
| colspan="2" |Upper | |||
|- | |- | ||
! | |||
|Left | |Left | ||
|Right | |Right | ||
Line 86: | Line 86: | ||
|Right | |Right | ||
|- | |- | ||
| | |Tone | ||
| | |Increased | ||
| | |NAD | ||
| | |Increased | ||
| | |NAD | ||
|- | |- | ||
|Power | |Power | ||
Line 103: | Line 103: | ||
(Not to Command) | (Not to Command) | ||
|4/5 | |4/5 | ||
|- | |- | ||
|Coordination | |Coordination | ||
| colspan="4" |Unable to Assess | | colspan="4" |Unable to Assess | ||
During Spontaneous Movements Coordination Impaired | |||
|- | |- | ||
| | |Range of Movement | ||
|Glenohumeral Joint: | |||
|Glenohumeral Joint | |||
External Rotation 45° | External Rotation 45° | ||
Line 137: | Line 124: | ||
Wrist Full Range of Movement | Wrist Full Range of Movement | ||
|Full Range of Movement All Joints | |Full Range of Movement | ||
All Joints | |||
|Hip Full | |Hip Full | ||
Knee Full | Knee Full | ||
Decreased Achilles Length | Ankle Decreased Achilles Length | ||
* DorsiFlexion with Knee Ext. -10° | * DorsiFlexion with Knee Ext. -10° | ||
|Hip Full | |Hip Full | ||
Line 148: | Line 136: | ||
Knee Full | Knee Full | ||
Decreased Achilles Length | Ankle Decreased Achilles Length | ||
* DorsiFlexion with Knee Ext. -5° | * DorsiFlexion with Knee Ext. -5° | ||
|- | |||
|Sensation | |||
| colspan="4" |Unable to participate in formal testing | |||
Does react to some tactile stimulation | |||
|- | |||
|Proprioception | |||
| colspan="4" |Unable to Assess | |||
|- | |||
|Reflexes | |||
|Increased | |||
|NAD | |||
|Increased | |||
Plantar - Upgoing | |||
|NAD | |||
Plantar - Downgoing | |||
|- | |||
|Behaviour | |||
| colspan="4" |Restless ++ | |||
|} | |} | ||
{| | {| width="800" border="1" cellpadding="1" cellspacing="1" | ||
| | |- | ||
| | ! scope="col" | | ||
| scope="col" |Static | |||
|Dynamic | |Dynamic | ||
|- | |- | ||
Line 175: | Line 182: | ||
|- | |- | ||
|Gait | |Gait | ||
| colspan="2" |Unable to | | colspan="2" |Unable to Initiate | ||
|- | |- | ||
|Wheelchair | |Wheelchair | ||
Line 183: | Line 190: | ||
| colspan="2" |Dependent for All | | colspan="2" |Dependent for All | ||
|} | |} | ||
Considering what we now know, outline the key impairments and activity limitations for James. What outcome measures might you use with James and why? Have a conversation with your colleagues, please share your knowledge with others and answer their questions where you can. | |||
== Discussion == | |||
Considering what we now know, outline the key impairments and activity limitations for James. What outcome measures might you use with James and why? Have a conversation with your colleagues, please share your knowledge with others and answer their questions where you can. | |||
[[Category:Course Pages]] |
Latest revision as of 12:20, 2 March 2022
Presenting Condition[edit | edit source]
For background information go to
Traumatic Brain Injury - Case Study Part 1
Assessment[edit | edit source]
Initial Physiotherapy Assessment in the ICU[edit | edit source]
- GCS 6 (Eyes 1 Voice 2 Motor 3)
- Pupils Right 6+, Left 5+
- BP 116/84 Supine
- Pulse 114 bpm
- O2 Saturation 94% on 30% O2
Upper Limb | Lower Limb | |||
---|---|---|---|---|
Left | Right | Left | Right | |
Tone | Decreased | NAD | Decreased | NAD |
Power | Unable to participate in manual muscle testing
Spontaneous movements are uncoordinated | |||
Coordination | Unable to Assess
Spontaneous Movements Impaired | |||
Range of Movement | Active - No Response to Cues, Spontaneous Movements observed
Passive - Within Normal Limits | |||
Sensation | Unable to participate in formal testing
Does react to some tactile stimulation | |||
Proprioception | Unable to Assess | |||
Reflexes | Decreased | NAD | Decreased
Plantar - Upgoing |
NAD
Plantar - Downgoing |
Behaviour | Restless ++ |
2 Months Post Injury[edit | edit source]
- Tracheostomy Removed, Self ventilating on room air.
- PEG remains in situ for feeding.
- Can attend Gym for Rehabilitation
- Currently using a wheelchair for mobility
- GCS 10 (E4 V2 M4) Not following commands, No speech but an occasional physical aggressive outburst
- Mask like expression of face, wide open eyes and constantly raised eyebrows giving an alarmed or surprised impression, consistent with abnormal tone and sensation
- Poor eye contact
- Flexed posture with poor trunk and head control
- Subluxation of Left GHJ (Two Fingers Breadth)
Upper Limb | Lower Limb | |||
---|---|---|---|---|
Left | Right | Left | Right | |
Tone | Increased | NAD | Increased | NAD |
Power | 0/5 | 4/5 | 0/5 Ankle
1/5 Hip 1/5 Knee (Not to Command) |
4/5 |
Coordination | Unable to Assess
During Spontaneous Movements Coordination Impaired | |||
Range of Movement | Glenohumeral Joint:
External Rotation 45° Internal Rotation 40° Flexion 90° Abduction 60° *Painful Grimace at End of Range GHJ Movement Elbow Full Range of Movement Wrist Full Range of Movement |
Full Range of Movement
All Joints |
Hip Full
Knee Full Ankle Decreased Achilles Length
|
Hip Full
Knee Full Ankle Decreased Achilles Length
|
Sensation | Unable to participate in formal testing
Does react to some tactile stimulation | |||
Proprioception | Unable to Assess | |||
Reflexes | Increased | NAD | Increased
Plantar - Upgoing |
NAD
Plantar - Downgoing |
Behaviour | Restless ++ |
Static | Dynamic | |
Sitting Balance | Assist x 2 | Unable - Tends to Extend |
Standing Balance | Max Assist x 2 | Unable - Tends to Extend |
Bed Mobility | Assist x 2 | |
Lie to Sit | Assist x 2 | |
Sit to Stand | Max Assist x 2 - Tends to Extend | |
Gait | Unable to Initiate | |
Wheelchair | Dependant - Currently in Tilt in Space | |
ADLs | Dependent for All |
Discussion[edit | edit source]
Considering what we now know, outline the key impairments and activity limitations for James. What outcome measures might you use with James and why? Have a conversation with your colleagues, please share your knowledge with others and answer their questions where you can.