PTNow cases describe specific aspects of patient or client management that highlight key points made in Clinical Summaries. Search by keyword, or select a diagnosis.
The patient is a 63-year-old female with a diagnosis of frozen shoulder, who is referred to an outpatient physical therapy clinic by an orthopedic surgeon. She reports that her symptoms began approximately 4 months ago for no apparent reason. The patient is right-handed and complains of right-shoulder pain and stiffness, which have become progressively worse over the past several months.
Trina is a 10-month-old girl who has cerebral palsy (CP) with right hemiplegia. She is classified as being at level I of the Gross Motor Function Classification System (GMFCS), with primary motor involvement affecting her right side. Referred for physical therapist examination and management, she is seen at home with her mother and brother present.
Bobby is a 10-year-old boy with cerebral palsy (CP), with primary motor involvement affecting his lower extremities. He was born prematurely at 29 weeks' gestation and was hospitalized for 7 weeks. Bobby is referred for physical therapy at an outpatient clinic to participate in an 8-week intensive program during the summer.
Ms O is a 21-year-old female, first-generation college student referred to a physical therapist 2 weeks after a motor vehicle accident (MVA) in which the patient was struck by a fast-moving vehicle (medical diagnosis ICD-10 code V43.52XA). Standard cervical radiographs (lateral, AP, and odontoid) were taken in the emergency room and reported by the patient to be negative.
Ms Wilson is a 64-year-old woman with a 10-year history of COPD who had a series of 3 COPD exacerbations over a 4-month period. These exacerbations required medical intervention with antibiotic treatment and oral steroids, but she was never hospitalized.
Mrs O is a 68-year-old woman with GOLD stage III COPD. She is referred to physical therapy due to a 2-month history of increased dyspnea on exertion and reduced ability to perform daily activities following a 4-day hospital stay for COPD exacerbation (she did not require intubation). Her past medical history includes hypertension and osteopenia, common comorbidities of COPD, and left breast cancer status/post mastectomy.
Ms T is 70-years-old and has diabetes, diabetic neuropathy, hypertension, and degenerative joint disease of the knee. Referred to a physical therapist for her knee pain, Mrs T also expresses concern about falling. The therapist administers the AGS Falls Screen (1):
Mr C is 24 years old with an unremarkable past medical history. He was admitted to the hospital with progressive deterioration of strength and diagnosed with Guillain-Barré syndrome. As the weakness advanced, he required mechanical ventilation and was admitted to the ICU. After 3 days, he was referred to a physical therapist.
Patient is a 30-year-old female with a history of right-sided headaches, after a motor vehicle accident, which occurred 1 month ago. Since the accident she reports having constant headaches. Her pain is described as a dull ache. The pain is located in the neck, back of the head, and it sometimes travels to the front of the head and into the eye. She reports daily headaches that can last anywhere from 30 minutes to hours.
This case discusses an individual in the early stage of Huntington disease (HD). As HD is a slowly progressive disease, individuals in the early stage usually have minimal activity limitations and participation restrictions. However, they may demonstrate some motor impairments and, more often, subtle cognitive impairments.
This case discusses an individual in the late stage of Huntington disease (HD). Patients in this stage show minimal volitional control of limbs and often present with a predominance of rigidity rather than chorea. Passive range of motion is limited and contractures may be present. Ambulation is limited or even impossible, and maintaining a sitting position is often difficult. As a result, there is a considerable risk for aspiration or respiratory infections, pressure sores, and/or contractures. Patients may exhibit difficulty with communication or may be unable to vocalize at all.
Mr R is a 49-year-old man diagnosed with HD 17 years ago, with gradual progression of symptoms since then. In the past 3 months, this patient has fallen 4 times and has experienced a noticeable decline in his walking ability and balance which limited his daily activities and self-care.
73-year-old, active woman underwent a routine cardioversion for atrial fibrillation but developed multiple complications, including sepsis and respiratory failure.
Ms M is a 30-year-old woman who comes to an outpatient physical therapy clinic because she recently began experiencing pain in her posterior left knee and thigh toward the end of her normal, daily 2-mile run. Upon taking the history, the physical therapist (PT) discovered that Ms M was diagnosed with a relapsing-remitting type of multiple sclerosis (MS) 3 months ago.
Ms S is a 60-year-old woman who was diagnosed with relapsing-remitting multiple sclerosis (MS) 20 years ago. She complains of increased difficulty walking, especially outdoors, which limits her ability to independently go shopping.
The purpose of this case is to describe how to address a patient's needs where the overall expectation is a further decline or deterioration in function, and the physical therapist's goals are to maximize function and quality of life, while preventing secondary complications.
Rebecca is a 56-year-old accountant. She has a 10 year history of posterior neck pain, which has progressively increased over the past 4 weeks. She is unable to recall a precipitating event.
Mr M is a 55-year-old man with a spinal cord injury (SCI) classified as a C5 AIS D central cord syndrome. His injury occurred when he was operating a tractor and struck a pothole, which partially ejected him from the vehicle and caused him to strike his head on the machine.
Mrs B is a 75-year-old woman with severe bicompartmental knee osteoarthritis (OA). She visits an outpatient physical therapy clinic 3 weeks following left cemented posterior cruciate ligament (PCL)-sparing total knee arthroplasty (TKA). A paramedian incision was used.
Mrs L is a 45-year-old woman who reports urinary incontinence. She has delivered 3 children vaginally (one set of twins) and delivered her fourth child by cesarean section. She reports that her symptoms began with her last pregnancy 8 years ago and worsened in the past 3 years. Urinary incontinence affects her daily activities and she says that she "does not leave the house on bad days."
The physical therapist's examination shows a negative left Dix-Hallpike Test; however, in the right Dix-Hallpike Test, Ms L develops an upbeating and rightward torsional nystagmus with vertigo that lasts for 25 seconds, indicating posterior SCC involvement. The therapist treats Ms L with the canalith repositioning treatment (CRT) (Epley maneuver) and schedules her to return in 1 week.
In the right Dix-Hallpike Test position, Mr Q develops a downbeating nystagmus with vertigo that is persistent. The physical therapist is not certain whether there is a torsional component to the nystagmus, but she suspects there is, and she decides on a tentative diagnosis of anterior semicircular canal (SCC) cupulolithiasis. The Left Dix-Hallpike Test is negative.
Mr S is unable to say which side provokes his vertigo. He says that he does not have nausea, vomiting, or imbalance. His past medical history includes current lumbar disk herniation with radiating pain. He rates the current intensity of his pain as 4/10 on visual analog scale and says it can be as severe as 9/10.
Mrs D is a 68-year-old woman who is referred to physical therapy with reports of the onset of vertigo 2 weeks ago when she got out of bed and the world spun for about 10 seconds. Her current complaints include vertigo, nausea, vomiting, and imbalance. Her last episode of vertigo occurred this morning when she got out of bed.
Cerebral Palsy in Adults [NG119]
Disorders of Consciousness
Headaches Associated with Neck Pain
Non-specific Low Back Pain
Physical Activity Throughout Pregnancy
Functional Gait Assessment
Oswestry Low Back Pain
Veterans RAND 12
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