Traumatic Brain Injury - Case Study Part 3
6/12 Post Injury
Upper Limbs | Lower Limbs | |||
Left | Right | Left | Right | |
Tone | N | N | ||
Power | 2/5 | 4/5 | 2/5 Ankle
3-/5 Hip 3-/5 Knee |
4+/5 |
Sensation | Unable to Assess | |||
Coordination | Impaired | |||
Reflexes | ¯ | ¯ | ||
ROM
Muscle Length |
GHJ Flexion 110°
Abd 90° IR 40° ER 50° Ext 40° Elbow Full ROM Wrist Full ROM |
Full all joints | Hip Full
Knee Full ¯Muscle Length TA DF with Knee Ext.-5° |
Hip Full
Knee Full ¯Muscle Length TA DF with Keee Ext. 0° |
Current Function
• No use of oxygen
• Blood Pressure within normal limits
• Supervision with Mat Mobility
• Contact Guard with Stand Turn Transfers
• Contact Guard to Minimal Assist of 1 & Supervision of another for Gait 1200’
• Minimal Assist of 1 & Supervision of 1 on 20 steps reciprocally with a Handrail
• Minimal Assist of 1 & Supervision of 1 on 6 Inch Curb
Discharge Planning Considerations
- Family Support
- Environment
- Equipment
- Further Rehabilitation Needs
What treatment goals would you select for James? What considerations would you make towards James discharge planning? Have a conversation with your colleagues, please share your knowledge with others and answer their questions where you can. Go to Discussion