orthostatic intolerant wheelchair dependent patient

Hi - wonder if anyone has seen this anywhere else.

I've been asked to see a young female patient with 'orthostatic intolerance' and 'hypermobile' joints. She has been using a wheelchair for many years due to these symptoms and says she is now unable to work. On meeting her, she reports she has never fainted or lost consciousness so isn't at risk of syncope, and that hypermobility is the reason for the chair. Scores 2/9 on Beighton scale. Refuses to even attempt to walk or use a stick or frame for fear of damaging wrists, but self-propels in the chair no problem. Is on new treatment for orthostatic symptoms that has significantly helped other patients with orthostatic hypotension - but she makes no improvement in mobility after months of treatment.

Now says a neuro has mentioned 'vestibular' problem, but I can't see that justifying being chair dependent. Also was never prescribed a chair, but bought it herself.

Any suggestions on where to go from here?

Sounds like you need a long discussion as to why she felt the best thing was a wheelchair. Perhaps fear was the initial issue. That may take some time to gain her confidence and I would perhaps introduce a session on what her condition is, set some measures to assess it in realtime so she can see if she is being symptomatic from a physical standpoint. If you look to some of the causes and then address those on a small scale with a medium term goal. It does make me think of treadmill unweighted walking in a suspension harness. Have you access to one? She can't fall in that and she can exercise in safety.

---------- Post added at 08:41 AM ---------- Previous post was at 08:38 AM ----------

p.s. a score of 2/9 is not very hypermobile. I score more than that The Beighton modification of the Carter and Wilkinson Scoring System - The Hypermobility Syndrome Association

Or you start from a completely different angle:

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I've been asked to see

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Who has asked you? Why doe she need Physio?
Obviously -for whatever reasons- the young lady has made the decision that she cannot walk and needs a wheelchair.
You could do the vestibular testing yourself, just to be sure. But, I presume, the lady will have positive findings for whatever test you will undertake. I think there is absolutely no point in trying to find the origin for the presentation. :-)

I would go like this:
Ask the patient, why she is coming to Physio. What is the goal or goals she would like to achieve. How does she believe to get there?
You will probably find that she has got some answers to those questions.
Take that as a start and go from there.

Good luck,
Fyzzio