Physiotherapy student needs help with 2 cases

**Johan88** · 15-12-2010 04:12 PM

Hey, I have a case I've been been curious about how to handle.
I'm gonna copy it here.

 Mr Maasdam is an 84-year old patient, former textile worker, who lives with his wife in sheltered accommodation. His wife is 80, but she is in better shape than he is; she still cycles and does the shopping, cooks, and does most of the housekeeping. Mr Maasdam has a few mild TIA’s. His blood vessels are bad (he has bypasses of the a.iliaca on the right and left), moreover, he is diabetic. Five years ago, he incurred a subcapital fracture of the humerus on the left side and this was the last time he cycled. His upper arm did heal, but the function of his left shoulder is impaired.

 Mr Maasdam has a severe Wikipedia reference-link

scoliosis which is equilibrated. The Romberg test is positive. In reaching or shifting his balance, Mr Maasdam loses his balance easily. The GUGT test (get up, walk 3 meters, come back and sit down again) takes Mr Maasdam 30 seconds (this is slow); furthermore, the performance (especially the balance) is poor. The active function of the lumbar column and thoracic column is impaired. Especially extension is difficult, this becomes more difficult after repeating it a few times. Passive extension is also limited, but the amplitude is clearly greater than in active movements, the end feeling is stiff. The mobility of the left shoulder is impaired (a capsular pattern is involved).

His only motivation is his grandchildren and football.

Now how does Diabetes Cause a TIA stroke, and how is his spine situation explained in easier terms.

And what does the amplitude in active greater than passive tell you?

And how is the best way to train his get up from a bench to standing transfer?

I am happy for all feedback

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**gcoe** · 19-12-2010 11:29 PM

Hi Johan88

this is an interesting case and you have quite a few things to work through.

Just before discussing it : is your case hypothetical or is it a real case? Have you used a pseudonym? You must protect your patient's confidentiality and you must meet the requirements of your country re: confidentiality. So there are ethical and legal requirements that control you posting such a case on the internet. Have you met these requirements?

More than happy to help but this needs to be established.

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