can u help me :)

[pt-noona]

salam

I hope they can help me in this case A 8y.r old girl c/o moderate back pain when sitting ,sleeping, watching TV for long time &urine and stool incontinent , the pt delivered with congenital deformity in spine (spina bifida –MMC) & hydrocephalus , she done closure of MMC& VP shunt after few months of birth .

She is alert, cooperative , coherent

Wheel chair pt, short neck , Rt shoulder lower than Lt ,kyphosis, L.L deformity (hip flex /abd /ext.rot-knee flex, ankle PF)

ROMFor U.E
Lt U.E is WNL
Rt shoulder is LOM due stiffness in all direction
Rt elbow ,wrisr, finger are WNL
For L.E
Lt& Rt hip are limited in extension,adduction,internal rotation .<<<PROM
Lt & Rt knee extension is limited <<<PROM
Lt& Rt ankle limited in dorsiflexion<<< PROM
NECK:
Neck extension is WNL
Neck flexion is limited due to contact between her chin & sternum
Rotation is limited in Rt but WNL in Lt side .

MMT:All m.s for U.L are grossly graded 3/5 with pain at end of rang of Rt shoulder
L.L
0/5 <<< paraplegia

Sensory:-superficial &deep sensation in both U.E----- Intact
-sensation for both LE------- Impair

[U]ADL:[/U] dependent in wheel chair transfer ,toilet,dressing

Gait:In wheel chair -- can be control her movement very good when use it.
In the floor--- she move in floor by 2 way
1st--cross sitting in floor ,put both hands in floor and move it forward /backward
2nd -prone position then move by both hands like crawling .

My treatment plan for her are
• Breathing ex.’s
• Strengthen ex’s for both U.E
• Flexion back ex’s
• Wheel chair ex’s (Body lift using from wc arm &wheels)
• Moving by wc to increase her velocity
• Self Passive ROM ex’s
• Transfer from wheel chair to bed & opposite
• Resistive ROM ex’s for neck

For all physio
What can be add for ttt plan?!!!

[estherderu]

dear pt noona,

For backpain I suggest you give her massage. The old classic swedisch massage to relax and improve circulation should work fine.

She will need to understand that she should not stay in one position for too long.
Tell her to move whenever she feels like moving, in whatever direction she feels is OK (and possible) = ideomotion.
Teach her to ask others to move her if she cannot do so herself herself.
Even passive movement can often help people in pain from being in the same positions for long (bedridden)

good luck.
Do you know about the www.ifglobal.org website?
Is great and with a lot of information in many languages.

good luck

Esther

[physio74]

hi,
i think you may need to give here sensory stimulation, like warm and cold water, pressure stmulation,
also you may teach and advice realtives or care givers the advices for all the other day time , imean how to give here 24 hours treatment, not only the pt set

[pt-noona]

Esther
Thank u very much for these great suggestions

I did not know this wonderful site
But after considering it
I found a lot of useful information and what do I need to clarify further the situation to the mother of the patient

again thanx alot Esther

[pt-noona]

physio74
Thank u very much for these great suggestions
((give here 24 hours treatment, not only the pt set)))

nice words
I tried this and I hope to link him

[estherderu]

dear pt-noona,
there is another site worth visiting - the WHO site
on it various papers and whole manuals on a number of subjects.

http://whqlibdoc.who.int/hq/1996/WHO_RHB_96.5.pdf

papers on:
Rehabilitation for Persons with Traumatic Injuries (2004)
Promoting independence following a stroke: a guide for therapists and professionals working in primary health care (1999)
Let's communicate: a handbook for people working with children with communication difficulties (1997)
Disability prevention and rehabilitation: a guide for strengthening the basic nursing curriculum (1996)
Rehabilitation surgery for deformities due to poliomyelitis (1993)
Promoting the development of young children with cerebral palsy: a guide for mid-level rehabilitation workers (1993) in 4 languages
Guidelines for the prevention of deformities in polio (1990)
and

http://www.who.int/disabilities/publ...the%20web).pdf also available in french

I hope this helps a little more

kind regards
Esther de Ru

[pt-noona]

Thank you very much Estherderu
We have benefited a lot from you