CASE DESCRIPTION Raneen Allos and Hunter Lamarch

29 – year- old female with right sided cervical pain with radiculopathy in the
C4-C5 nerve root path. She has pain with left rotation and right side bending,
along with pain radiating down her right UE and weakness. She hasn't noticed
strength loss anywhere else, but she is having trouble sleeping. She has also
been getting headaches. She presents with forward head and elevated right
shoulder compared to the left.
Her symptoms began three weeks ago, after moving into her new apartment.
The patient believes she injured herself pulling a couch into the apartment up
steps.
PMH includes appendectomy and episodes of depression about a year ago
(following her son's father leaving her as a single mother). No medications and
no known allergies. The patient is raising her 4-year-old son alone with limited
monetary support (no child support ~4 months). The patient is also taking
online college classes and is worried about paid time off from her workplace
and taking care of her son.
Waitress
Both Hunter and Raneen had listed tasks such as walking
through the restaurant with trays of food, reaching over the
table, and taking orders. They had noted similar ROM
requirements for said tasks.
Hunter observed a different environmental factor such as the
changes in movement patterns when the floor is wet versus
dry or if the lighting changes. Raneen noted the difference in
the waitresses' movements when the restaurant became busier
versus when It was less congested.
Socially both students noted that communication with other
wait staff, managers, and customers could affect their
patterns throughout the day. Raneen mentioned that if there
are co-workers or costumers who are rude to the server, this
may change their movements as they may try to avoid rude
customers or take paths to walk around coworkers.
Raneen noted that when there are generational differences,
coworkers may perform tasks differently. An older waitress
who has worked in the same restaurant for many years will
move more fluidly and swiftly than a new one who is still
learning their way around. Hunter also mentioned that older
wait staff may have increased difficulties with multitasking or
using new technology in the restaurant.
SIMILARITIES AND DIFFERENCES
Data analyst
Both Raneen and Hunter had expanded on the tasks of
typing on a computer, rotating head/eye tracking between
two screens, and retrieving folders from a desk. Both
students had similar ROM values for said movements. A
task Hunter had noted was how the data analyst he
observed manipulated his mouse while using his computer,
as well as sit<>stand from his desk to other areas of his
workspace.
Raneen noted the differences between working from home
versus working in the office, while Hunter observed the
ergonomics of the analyst's desk area, noting deficits that
could be fixed. Both students had noticed the social factors
of experiencing burnout with a task so tedious.
Hunter made note of the physical difficulties that may
come with an older person having to perform this task for
long periods of time, potentially having pain with sitting or
decreased ROM for certain tasks. Raneen noted the
generational difficulty of learning new software or 2
switching from paper to computer notes.
THERAPEUTIC EXERCISE- Chin Tucks

CASE E1 1 Begin with 5 reps of 5 second holds in supine.

Progress to 10x10 second holds.
Monitor pt for compensation, pain, or reproduction of
symptoms

Starting position Ending position

3
Starting position

NEURO RE-ED-CASE E1 3
Scapular squeezes
3x30, 2-3x per day

Ending position 5
 Starting position

THERAPEUTIC ACTIVITY-
CASE E1

Weighted ball lift- waist height to shoulder height

4x30

Ending position 7
 THERAPEUTIC EXERCISE-
CASE E2

Prone I's Y's & T's

1-3 lb. dumbbell, depending on pt. tolerance/ form
8-12 reps. x 3 sets, 3-4x/ wk.

Starting I Y T

9
Starting position Ending position

NEURO RE-ED-CASE E2
Wall Angles
12-15 reps x 3 sets, 5-6x/ wk.

11
THERAPEUTIC ACTIVITY-
CASE E2
Workplace ergonomic assessment to improve posture

Before assessment After assessment

13
RATIONALE FOR INTERVENTIONS 5
• We used cervical/ thoracic muscle strengthening and core stabilization exercises to improve posture and prevent injury when
moving boxes/supplies into new home. These exercises are will increase strength and endurance in the postural muscles that
will allow the patient maintain proper posture for a longer period of time. Strengthening of these muscles will improve the
posture of the patient, reduce the amount of forward head position, reduce headaches, prevent spine injuries, and improve
pain (4,5). This will be important because the patient is still moving into her apartment and has a four-year-old son that she
has to be able to pick up.

• Proprioceptive and coordination exercises were chosen increase the patient's awareness of their poor posture and increase
strength and stabilization of muscles. Tactile cueing was used to facilitate patients muscle action and provided external
feedback to proper position of the body. These exercises are intended to have the patient be self-aware of their posture and
be able to self-correct themself.

• Eye tracking/ head movement exercises were used to reduce the number of headaches the patient is getting. Additionally, the
patient worked as a data entry for one of the cases and she has to be able to look at monitors and track many different digits
on the screen.

• An obstacle course was used to strengthening the upper extremity and improve balance when walking around objects. This
exercise is salient for the patient because she worked as a waitress in one of the cases and she has to be able to do this every
15
day.
SUMMARY OF CLINICAL
REASONING PEARLS
The students learned many important skills about exercise
prescription from this assignment. We learned which
exercises made sense based upon our patient's
presentation and their perceived mechanism of injury. We
also learned how to differentiate between exercises to
match the patient's goals. The most difficult part of this
assignment was ensuring that the goals of the
interventions matched the patient's therapeutic goals. We
wanted the exercises to be salient and different between
the two patients as they are different people (even if their
injuries are so similar!)

16
REFERENCES
1. Sullivan JL. Interventions for the Cervical Spine.
PowerPoint and Lecture presented at PTH 646
Interventions I; February 21, 2022; Mount Pleasant, MI.
2. Kisner C, Colby LA, Borstad J. Therapeutic exercise:
foundations and techniques. Seventh edition. F.A. David
Company: 2018.
3. Neuromuscular Re-Education in Orthopedic Physical
Therapy. ACE Physical Therapy and Sports Medicine
website. https://ace-pt.org/neuromuscular-re-
education-in-orthopaedic-physical-therapy/ Accessed
June 15, 2023
4. Andraka JM. Thoracic Spine and Rib
Interventions. PowerPoint and Lecture presented at PTH
646 Interventions I; March 1st, 2022; Mount Pleasant,
MI.
5. Abd El-Azeim AS, Mahmoud AG, Mohamed MT, El-
Khateeb YS. Impact of adding scapular stabilization to
postural correctional exercises on symptomatic forward
head posture: a randomized controlled trial. Eur J
Phys Rehabil Med. 2022;58(5):757-766.
doi:10.23736/S1973-9087.22.07361-0 17