|This assignment will help students integrate knowledge and skills developed in this course as well as previous courses. Specifically, analysis of the case study will help prepare students to perform the following: engage in problem-solving related to assigned interventions, respond to changes in client status,consider the impact of determinants of health on client well-being, collaborate with other team members, and communicate effectively and sensitively with clients.|
|1. This assignment must be completed individually.|
|2. Read the case study carefully.|
|3. Answer the questions using the textbook and previous course materials as a resource.|
|4. Your answers should be typed, with each question clearly labeled. You may answer in point form, as long as your provide your instructor with enough detail to follow your train of thought, and you use correct spelling and punctuation.|
Case Study: Complex Regional Pain Syndrome
You are the PTA/OTA in a multidisciplinary private clinic that is located in a large medical building with family physicians, specialists, a medical lab, and a pharmacy. The clinic includes two full-time physiotherapists, two chiropractors, a massage therapist, and a part-time occupational therapist. The clinic has a full range of therapeutic modalities including TENS, IFC, Laser, ultrasound, and basic exercise equipment such as a stationary bike, a treadmill, free weights and balance training equipment.
You are working with Keith Riverside, a sixteen-year-old high school student who has been diagnosed with complex regional pain syndrome (CRPS), a severe chronic pain syndrome that involves the sensory, motor and autonomic nervous systems. He has no other medical concerns.
Four months ago, Keith twisted his right ankle playing basketball, and was treated immediately with ice and elevation. In the emergency rooms, x-rays failed to reveal a fracture. Keith was sent home with a diagnosis of a grade II ankle sprain and instructions to continue icing, wrapping the ankle with a tensor bandage, and using crutches for NWB ambulation.
Two months later, the pain was continuing to get worse instead of better, so his family physician requested an MRI, which revealed a stress fracture of the calcaneus. Keith was given a hard cast for one month. His pain continued to increase, so his family physician removed the cast. At that time, the physician noted persistent edema, sweating, allodynia (pain from stimuli that are not usually painful) in the foot and ankle and increased temperature in the lower leg and foot. He sent Keith for a bone scan which revealed a decrease in bone density. The physician diagnosed Keith with complex regional pain syndrome, prescribed Percocet and referred him to your clinic.
Prior to his injury Keith was active in sports at school, including basketball, volleyball and downhill skiing. He has not been able to participate in sports since then. He dropped his physical education class, but has been able to continue with his other courses. He has also limited his time socializing with his friends, because he finds it embarrassing when he can’t keep up.
Keith lives with his mother, stepfather and ten year-old half-sister in a townhouse with several flights of stairs. He has a good relationship with all of his family members, including his father, who lives out of town but speaks regularly with him on Skype. Because of his age, Keith qualifies for publicly-funded physiotherapy services, which is fortunate because Keith’s stepfather was laid off from his construction company, so money has been tight, despite financial support from Keith’s father.
Significant Findings from the Physiotherapy Assessment (chart # 2355):
Current Role of the Physiotherapist:
Keith and the physiotherapist have established the following short term goals:
The physiotherapist is currently seeing Keith three times per week after school. The treatment session with the physiotherapist consists of manual therapy, acupuncture, desensitization to touch using textured cloth, and gait training with manual assistance inside and outside of the parallel bars.
Current Role of the PTA:
Your role with the client is to administer contrast baths for desensitization to cold, teach Keith AROM exercises of the ankle, gentle strengthening exercises of the knee and practice ascending and descending stairs.
Questions (50 marks – 15% of final TecMod mark):
Today is 8 days after the initial assessment. Keith reports that his pain has decreased to an average of 8/10 in the previous 24 hours and is currently 7/10. You measure the active range of motion in his right ankle and find that he is able to dorsiflex to 10⁰ and plantarflex to 50⁰. You practice crutch walking and find he is able to ambulate with a normal gait pattern X70 m with partial weight bearing independently. You practice stairs with him and find he is able to ascend and descend 2 flights independently with crutches and no railing with partial weight bearing. You feel that Keith is doing so well; it might be time for the physiotherapist to conduct a full reassessment.
Document today’s session with Keith using SOAP format. Be sure to include information about Keith’s progress towards his short term goals.(12 marks)
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