Traumatic Brain Injury - Case Study Part 2: Difference between revisions
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== Presenting Condition == | |||
For background information go to | |||
[[Traumatic Brain Injury - Case Study Part 1]] | |||
== Assessment == | |||
=== Initial Physiotherapy Assessment in the ICU === | |||
* GCS 6 (Eyes <sub>1</sub> Voice <sub>2</sub> Motor <sub>3)</sub> | |||
* Pupils Right 6+, Left 5+ | |||
* BP 116/84 Supine | |||
* Pulse 114 bpm | |||
* O<sub>2</sub> Saturation 94% on 30% O<sub>2</sub> | |||
{| width="800" border="1" cellpadding="1" cellspacing="1" | |||
|- | |||
! scope="col" | | |||
! colspan="2" scope="col" |Upper Limb | |||
! colspan="2" scope="col" | Lower Limb | |||
|- | |||
! | |||
|Left | |||
|Right | |||
|Left | |||
|Right | |||
|- | |||
|Tone | |||
|Decreased | |||
|NAD | |||
|Decreased | |||
|NAD | |||
|- | |||
|Power | |||
| colspan="4" |Unable to participate in manual muscle testing | |||
Spontaneous movements are uncoordinated | |||
|- | |||
|Coordination | |||
| colspan="4" |Unable to Assess | |||
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 | |||
| colspan="4" |Unable to Assess | |||
|- | |||
|Reflexes | |||
|Decreased | |||
|NAD | |||
|Decreased | |||
Plantar - Upgoing | |||
|NAD | |||
Plantar - Downgoing | |||
|- | |||
|Behaviour | |||
| colspan="4" |Restless ++ | |||
|- | |||
|} | |||
=== 2 Months Post Injury === | |||
* 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 (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 | |||
* Poor eye contact | |||
* Flexed posture with poor trunk and head control | |||
* Subluxation of Left GHJ (Two Fingers Breadth) | |||
{| width="800" border="1" cellpadding="1" cellspacing="1" | |||
|- | |||
! scope="col" | | |||
! colspan="2" scope="col" |Upper Limb | |||
! colspan="2" scope="col" | 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 | |||
| colspan="4" |Unable to Assess | |||
During Spontaneous Movements Coordination Impaired | |||
|- | |||
|Range of Movement | |||
|Glenohumeral Joint: | |||
External Rotation 45° | |||
Internal Rotation 40° | |||
Flexion 90° | |||
Abduction 60° | |||
<nowiki>*</nowiki>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 | |||
* DorsiFlexion with Knee Ext. -10° | |||
|Hip Full | |||
Knee Full | |||
Ankle Decreased Achilles Length | |||
* 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 | |||
|- | |||
|Sitting Balance | |||
|Assist x 2 | |||
|Unable - Tends to Extend | |||
|- | |||
|Standing Balance | |||
|Max Assist x 2 | |||
|Unable - Tends to Extend | |||
|- | |||
|Bed Mobility | |||
| colspan="2" |Assist x 2 | |||
|- | |||
|Lie to Sit | |||
| colspan="2" |Assist x 2 | |||
|- | |||
|Sit to Stand | |||
| colspan="2" |Max Assist x 2 - Tends to Extend | |||
|- | |||
|Gait | |||
| colspan="2" |Unable to Initiate | |||
|- | |||
|Wheelchair | |||
| colspan="2" |Dependant - Currently in Tilt in Space | |||
|- | |||
|ADLs | |||
| colspan="2" |Dependent for All | |||
|} | |||
== 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.