Traumatic Brain Injury - Case Study Part 2: Difference between revisions
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[[Traumatic Brain Injury - Case Study Part 1]] | [[Traumatic Brain Injury - Case Study Part 1]] | ||
== Initial Physiotherapy Assessment in the ICU == | == Assessment == | ||
=== 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> | ||
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{| width="800" border="1" cellpadding="1" cellspacing="1" | {| width="800" border="1" cellpadding="1" cellspacing="1" | ||
|- | |- | ||
! | ! scope="col" | | ||
! colspan="2" scope="col" |Upper Limb | ! colspan="2" scope="col" |Upper Limb | ||
! colspan="2" scope="col" | Lower Limb | ! colspan="2" scope="col" | Lower Limb | ||
|- | |- | ||
! | |||
|Right | |Right | ||
|Left | |Left | ||
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|} | |} | ||
== | === 2 Months Post Injury === | ||
Tracheostomy Removed, Self ventilating on room air. | Tracheostomy Removed, Self ventilating on room air. | ||
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Subluxation of Left GHJ (Two Fingers Breadth) | Subluxation of Left GHJ (Two Fingers Breadth) | ||
{| | {| width="800" border="1" cellpadding="1" cellspacing="1" | ||
| | |- | ||
| colspan="2" |Upper | ! scope="col" | | ||
! colspan="2" scope="col" |Upper Limb | |||
! colspan="2" scope="col" | Lower Limb | |||
|- | |- | ||
| | ! | ||
|Right | |||
|Left | |Left | ||
|Right | |Right | ||
|Left | |Left | ||
|- | |- | ||
| | |Tone | ||
| | |Decreased | ||
| | |NAD | ||
| | |Decreased | ||
| | |NAD | ||
|- | |- | ||
|Power | |Power | ||
| Line 115: | Line 118: | ||
(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 Cordination Impaired | |||
|- | |- | ||
| | |Range of Movement | ||
|Glenohumeral Joint: | |||
|Glenohumeral Joint | |||
External Rotation 45° | External Rotation 45° | ||
| Line 149: | Line 139: | ||
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 160: | Line 151: | ||
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 | |||
|Decreased | |||
|NAD | |||
|Decreased | |||
Plantar - Upgoing | |||
|NAD | |||
Plantar - Downgoing | |||
|- | |||
|Behaviour | |||
| colspan="4" |Restless ++ | |||
|} | |} | ||
{| | {| width="800" border="1" cellpadding="1" cellspacing="1" | ||
| | |- | ||
|Staticic | ! scope="col" | | ||
| scope="col" |Staticic | |||
|Dynamic | |Dynamic | ||
|- | |- | ||
| Line 187: | Line 197: | ||
|- | |- | ||
|Gait | |Gait | ||
| colspan="2" |Unable to | | colspan="2" |Unable to Initiate | ||
|- | |- | ||
|Wheelchair | |Wheelchair | ||
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| 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. | |||
Revision as of 22:52, 29 September 2019
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 | |||
|---|---|---|---|---|
| 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 ++ | |||
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 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 Limb | Lower Limb | |||
|---|---|---|---|---|
| Right | Left | Right | Left | |
| Tone | Decreased | NAD | Decreased | 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 Cordination 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 | Decreased | NAD | Decreased
Plantar - Upgoing |
NAD
Plantar - Downgoing |
| Behaviour | Restless ++ | |||
| 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 | |
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.
