E-materials

Chapter 7 E-materials




Case Study 7.1






Physiotherapy assessment




The physiotherapist assessed Mr L the next day.


He was found to be disorientated to time and place, but was able to follow one-step instructions. On admission Mr L’s AMTS was 3/10.


He could move his upper limbs through range. There was moderate rigidity on passive movement especially at the elbow and wrist of the left upper limb.


He was able to move his lower limbs on command, but had residual weakness of the left lower limb especially the hip flexors and quadriceps (grade 4/5 Oxford scale) with reduced range of movement at the left ankle (plantargrade just achieved).


The physiotherapist noted reduced muscle bulk of the quadriceps bilaterally and degenerative changes in both knees.


The physiotherapist and a physiotherapy assistant assessed Mr L’s ability to complete bed transfers.


He was able to transfer from lying to sitting with moderate assistance of 2.


He appeared to be fearful of moving and required reassurance when rolling.


He was able to sit unsupported on the edge of the bed.


On the first attempt to stand using a wheeled frame, Mr L pushed himself backwards and tried to pull up holding on to the frame.


To make the transfer to the chair safer, the physiotherapist used a rota-stand with the assistance of 2.


The physiotherapist gave a handover report to the nurse in the bay and documented Mr L’s current functional ability.


The physiotherapist identified that Mr L was unable to transfer independently (lying to sitting and sit to standing) due to fear of falling and when moving from one position to another. In addition he had generalised weakness precipitated by the acute illness.


He was at risk of falls due to cognitive impairment with possible delirium, residual left-sided weakness and reduced muscle power in addition to gait and balance impairment.


The physiotherapist also noted that Mr L had been unable to get up from the floor following his falls.


When the physiotherapist discussed what Mr L would like to achieve, he stated that he would like to go home. The physiotherapist involved Mr L’s wife in goal setting.


The physiotherapist helped Mr L to break this goal down into smaller short-term goals. The short-term goal was to be able to transfer consistently with assistance of one in 2 days and to mobilise with a rollator frame 6 metres with assistance of one in 4 days.


The Elderly Mobility Scale was chosen as an outcome measure (initial score 0/20).


The physiotherapist referred Mr L to the occupational therapist.




Nov 5, 2016 | Posted by in MANUAL THERAPIST | Comments Off on E-materials

Full access? Get Clinical Tree

Get Clinical Tree app for offline access