Severely progressed Friedreich's ataxia totally dependent I need clever PT

[REHABILITATION]

Hello guys

I have pt with severly progressed Friedreich's ataxia
she is 45 yrs old , she is totally dependent for transfer & even bed mobility
severe spasticity 3/4 at ashworth scale ,I am confused what can I do with her even her head control is poor
severe deformity bilaterl( pes cavuaus)
poor sitting balance both static & dynamic
standing is not applicable

I need help pleaaaaaaaaaaaase

I think if I will work on her head control stretching & Passive ROM for her head
& some NDT
like pull to sit ,,,,, any Idea or suggession

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[physiobob]

Really interesting stuff. I'd write out a problem list and work on each element as a starting point. What can you do for her feet. What bracing or support devices might be appropriate. Might a tilt table or standing frame be of use?

It is a neurological disorder and it's not going away so let's look for support and not cure. Time to be creative. Hopefully we'll get a few comments from Neuro PT's with good experience with F.A. patients.

[REHABILITATION]

i am waiting guys for your replies

[estherderu]

Hi rehab.....

It is possible that your patient is in pain because of the spasticity. Another problem might be respiratory. Does your patient have a scoliosis?

What is her biggest problem, can she, or someone who knows her well, tell you this?

I would try and find out first because that will help define your treatment goals. (hers and yours)
As long as you do not know sufficient I would think massage, think relaxing, think pain relief.....see what your hands can do for her.....

When you know more, get back to us....

Esther

[REHABILITATION]

estherderu

hello
since the 1st time I already finish my eval

I asked her about her goal what does :she wants to be as independent as much as possible
to roll over Rt & Lt ( to improve her bed mobility)

& related to pain she did not record any pain

thank you very much

[REHABILITATION]

yes she got scoliosis

guys I am waiting for your replies

[HighRevinDPT]

*I would certainly focus on Head/Neck Control; consider Cervical PNF Patterns Contract-Relax Patterns
*Have you tried Rhythmic Trunk Stabilization in Sitting to facilitate Trunk Control (i.e. Perturbations)
*Do you have available Ergometer equipment (i.e. UE/LE Cycle or Both) with available PROM options? Cardiovascular training is also important in this population.
*Orthoses considered for foot deformities?
*How advanced is the Scoliosis (<40 or >60); a brace may still be an option for the curvature as muscle weakness shows poor correlation with the idiopathic scoliosis observed in Friedrich's Ataxia.
*If your forced to PROM, I would certain attempt Bilateral PNF Flexion Patterns of the UE to facilitate Trunk Extension and Thoracic Expansion to address the issues of the Scoliosis and decrease the risk of cardiopulmonary dysfunctions secondary to the advanced curvature.

Keep me posted on your progress and I will see what I am able to contribute

[Fyzzio]

Hi,
before you think of any treatment approaches, you need to be clear as to what it is what you would like to achieve!!! like:

What are the patients goals? Or the family/ caregiver goals?
Who send the referral?
What is the purpose of the Physio intervention?
What are the medical interventions? Are they considering Botox?
What kind of equippment have you got available?

???

Regards,
Fyzzio