TEST Case Studies Copy

Case Study #1:

This 11 y.o. child was born with a type three ulnar deficiency and malformation syndrome including oral facial malformation. Patient’s cognitive skills, language and motor skills were normal for her age. She recently underwent surgery to repair the subluxation and dislocation of the radial head and ulnar two digits. She had an intact thumb and web space and could perform prehensile function. This patient was referred to therapy immediately after cast removal. Patient was anxious and did not want her arm touched but did not have central sensitization.

1. Why was this patient appropriate for mirror therapy?
2. Was neuroscience education appropriate for her ?
3. How would you progress with rehab?

Case Study #2:

This 28 y.o. mother of 3 children was referred to therapy for evaluation and treatment. The referring physician said she had signs of being a symptom magnifier. Her chief complaint was a strip of pain approximately 3 inches wide down the front of the leg from the groin area to the ankle . In reviewing her chart is was noted that she had a traumatic childhood and had seen a psychologist 5 years before. She did not want any tactile sensation on her entire leg. Your evaluations were negative for any pathology including Complex Regional Pain Syndrome.

1. After evaluation what would your next step be?
2. Was Graded Motor Imagery suggested to patient?
3. What outcome would you expect from this patient?

Case Study #3:

This 16 y.o. patient underwent an above knee amputation for a non-malignant tumor removal. Prior to seeing you, he just had the post-op dressing removed and had complained of pain in the residual limb as well as phantom limb pain. The pain was described as a burning sensation around where the sutures were prior to removal. Stump wrapping was not possible because of the burning pain. He complained of the pain moving to his non-involved leg especially when lying down. Desensitization and sensory relearning were shown to the patient to be used at home.

1. With the symptoms being burning pain that spreads to the other limb, as well as disproportionate phantom limb pain, what would you start first?
2. Was bottom-up treatment or top-down treatment indicated?
3. Would you treat him as an outpatient or have him exercise at home? His next appointment for a stump sock was in two week with the prosthetist.

Your Challenging Patient:

Provide a brief description of one of your patients whose outcome was not as good as you had expected.

Do you think they would have been a candidate for a GMI/Mirror Therapy program?

• If yes, how would you structure the GMI/Mirror Therapy program for this patient?
• If no, why not?

What questions do you have for the instructor about utilizing a GMI/Mirror Therapy program for this patient?