Traumatic Brain Injury - Case Study Part 2: Difference between revisions

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== Initial Physiotherapy Assessment in the ICU ==
== Initial Physiotherapy Assessment in the ICU ==
GCS                6 (Eyes <sub>1</sub> Voice <sub>2</sub> Motor <sub>3)</sub>
GCS                  6 (Eyes <sub>1</sub> Voice <sub>2</sub> Motor <sub>3)</sub>


Pupils                Right 6+, Left 5+
Pupils                Right 6+, Left 5+
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Pulse                  114 bpm 
Pulse                  114 bpm 
O<sub>2</sub>  Saturation   94% on 30% O<sub>2</sub> 


{| width="800" border="1" cellpadding="1" cellspacing="1"
{| width="800" border="1" cellpadding="1" cellspacing="1"
|-
|-
! scope="col" | 1st Column Heading
! rowspan="2" scope="col" |
! scope="col" | 2nd Column Heading
! colspan="2" scope="col" |Upper Limb
! scope="col" | 3rd Column Heading
! colspan="2" scope="col" | Lower Limb
! scope="col" | 4th Column Heading
|-
|-
| 1st column 2nd row
|Right
| 2nd column 2nd row
| 3rd column 2nd row 
| 4th column 2nd row
|-
| 1st column 3rd row
| 2nd column 3rd row
| 3rd column 3rd row 
| 4th column 3rd row
|-
| 1st column 4th row
| 2nd column 4th row
| 3rd column 4th row 
| 4th column 4th row
|-
|}
 
 
O<sub>2</sub>  Saturation   94% on 30% O<sub>2</sub>  

{| class="wikitable"
|
| colspan="2" |Upper Limb
| colspan="2" |Lower Limb
|-
|
|Left
|Left
|Right
|Right
|Left
|Left
|Right
|-
|-
|Tone
|Tone
|Decreased
|Decreased
|N
|NAD
|Decreased
|Decreased
|N
|NAD
|-
|-
|Power
|Power
| colspan="4" |Unable to participate in manual muscle testing - spontaneous movements are uncoordinated.
| colspan="4" |Unable to participate in manual muscle testing  
 
Spontaneous movements are uncoordinated
|-
|-
|Sensation
|Coordination
| colspan="4" |Unable to participate in formal testing, does react to some tactile stimulation.
|-
|Co-ord
| 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
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|Reflexes
|Reflexes
|Decreased
|Decreased
|N
|NAD
|Decreased (Plantar - Upgoing)
|Decreased  
|N (Plantar  - Downgoing)
Plantar - Upgoing
|-
|NAD
|ROM
Plantar  - Downgoing
| colspan="4" |Active - No Response to Cues, Spontaneous Movements observed 
 
Passive Within Normal Limits
|-
|-
|Behaviour
|Behaviour
| colspan="4" |Restless ++
| colspan="4" |Restless ++
|-
|}
|}


Revision as of 22:46, 29 September 2019

Presenting Condition[edit | edit source]

For background information go to

Traumatic Brain Injury - Case Study Part 1

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
Right Left Right Left
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 ++

Assessment at 2/12 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 wheelchair for mobility

GCS 10 (E4 V2 M4) Not following commands, No speech but 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

Repetitive non purposive movements of RLL 

Subluxation of  Left GHJ (Two Fingers Breadth)

Upper LImbs Lower Limbs
Left Right Left Right
Tone  N N
Power 0/5 4/5 0/5 Ankle

1/5 Hip

1/5 Knee

(Not to Command)

4/5
Sensation Unable to Assess
Coordination Unable to Assess - During Spontaneous Movements Cordination Impaired
Proprioception Unable to Assess
Reflexes ¯ ¯
ROM 

Muscle Length

Glenohumeral Joint (GHJ);

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

Decreased Achilles Length

  • DorsiFlexion with Knee Ext. -10°
 Hip Full

Knee Full

Decreased Achilles Length

  • DorsiFlexion with Knee Ext. -5°

Function

Staticic 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

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. Go to Discussion.

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