CASE PRESENTATION

DIKSHA SOLANKI
BOT 4th year
 1) DEMOGRAPHIC PROFILE

• NAME: Kusum lata

• AGE: 52 yrs
• SEX: female
• ADDRESS: manglapuri , Delhi
• DIAGNOSIS :

• CHIEF COMPLAINTS:
 sudden onset of weakness in both lower limb & urinary
incontinence.
 not able to stand , sit, stand & walk.
 difficulty in doing ADLs
 2) HISTORY TAKING

• HISTORY OF PRESENT ILLNESS:

Complaining of intermittent mid back pain for last 5 years. On 3
nov 2022, sudden onset of weakness of both lower limb with
inability to pass urine.
• PAST HISTORY :
D/O of spine TB diagnosed in 2017 .
• FAMILY HISTORY : husband , 1 daughter and 2 son
• MEDICAL HISTORY:
No relevant medical history
• PERSONAL HISTORY:
 no alcohol
 No smoking
 Likes homemade food only
 Likes guava
• ON OBSERVATION
 conscious
 Body built- mesomorph
 Mode of ambulation- wheelchair
 Attitude of limbs- in sitting
scapula: slightly depressed, retracted
shoulders: neutral
elbow: flexed
Wrist: neutral
Fingers: slightly flexed
LOWER LIMB
Hip: flexed
Knees: flexed
Ankle: neutral
Foot: slightly inverted
 Any visible deformity: kyphotic deformity
 Personal hygiene: good
• ON EXAMINATION
a) HIGHER MENTAL FUNCTIONS
o Consciousness: alert and conscious
o Vision: present
o Hearing: present
o Speaking: present
 SENSORY EXAMINATION

 SUPERFICIAL SENSATION
Touch intact impaired
pain intact intact
temperature intact impaired
pressure intact impaired
 DEEP SENSATION
kinesthesia intact intact
properioception intact impaired
vibration intact impaired
 CORTICAL SENSATION
sterognosis intact impaired
barognosis intact
tactile localization intact impaired
graphesthesia intact impaired
• MOTOR EXAMINATION
RANGE OF MOTION

UPPER LIMB is normal
LOWER LIMB

ELBOW flexors 5 5
extensors 5 5
WRIST flexors 5 5
extensors 5 5
FINGERS flexors 5 4
extensors 5 4

 DEEP TENDON REFLEXES

RIGHT LEFT
Biceps jerk present present
Triceps jerk present present
Supinator jerk present present
Knee jerk
Ankle jerk
Plantar response
  CONTRACTURES : No contracture visible.

 COORDINATION
Eye hand coordination : present
Fine motor coordination : present

 BALANCE
STATIC : sitting: good
standing: CNBT
DYNAMIC : sitting : fair
standing : CNBT
  HAND FUNCTIONS
hand dominance is RIGHT
INITIATION is GOOD
• REACH RIGHT LEFT
Forward good good
Upward fair fair
Backward poor poor
Overhead poor poor

• GRASP
Cylinderical good fair
Spherical good fair
Conical good fair
Hook good fair
Disc good fair
• PREHENSION RIGHT LEFT
Tip to tip good poor
Pad to pad good fair
3jaw chuck fair poor
Lateral pinch fair fair
• IN HAND MANIPULATIONS
Transfer fair fair
Shifting fair fair
Rotation fair poor
• RELEASE IS GOOD
• BILATERAL
Symmetrical good
Asymmetrical poor
• COGNITION
Orientation : good
Attention : sustained
alternative good
divided
Memory : ST: good
LT: good
remote: good
Problem solving: good
Reasoning: good
• PERCEPTION:
Depth perception
Somatognosia intact
Visual perception
 FUNCTIONAL ABILITIES
rolling : assisted
turning: assisted
supine to sit: dependent

• ADLs ( FIM)
1. MOTOR COMPONENT 2. COGINITIVE COMPONENT
SELF CARE : Comprehension 7
Eating 6 auditory/Visual 7
Grooming 3 Expression
Bathing 3 Verbal / Non-Verbal7
Dressing U /L 5 Social Cognition7
Dressing U/L 5 Social Interaction
Toiletting Problem Solving 6
SPHINCTER CONTROL: Memory 7
Bladder Management 1
Bowel Management 1 COGNITIVE SUBSCORE 41

TRANSFERS:
Bed/Wheel Chair/ Chair 1 TOTAL FIM SCORE 73
Toilet 1
Bath/Shower 3
LOCOMOTIONS
Wheel Chair/Walking 2
Stairs 1
MOTOR SUBSCORE 32
 PROBLEMS IDENTIFIED

• Unable to sit independently

• Left hand functions are fair
• Functional abilities like supine to sit is dependent
• Serratus anterior muscle weakness that’s why shoulder don’t
abduct more than 90.
• Left hand is slightly weak
• Spasticity in lower limb.
• Unable to perform ADLs like transfer from wheel chair to bed,
bathing and toileting.
 Goals
• Short Term Goals
– To increase Left Upper Limb strength.
– To decrease spasticity in Lower Limb.
– To improve Posture.
– To improve Hand Functions.

• Long Term Goals

• To Develop Strength in Lower Limb.
• To Improve ADLs like transferring and IADLs
 Intervention (FOR)
• NDT
• PNF
• Brunstorm's approach
• Bio-mechinal FOR