PT EVALUATION:

METABOLIC AND ENDOCRINE

CONDITION
BINALA
CAPULE
JALEA
LAUREL
YAP
 SUBJECTIVE DATA

OBJECTIVE DATA

ASSESSMENT DATA
 Subjective Information
Last 2001
- The 59 yr old female pt. reported that she is
experiencing jt pain, fatigue and sensations of heaviness
in her chest. She undergone two subsequent test of
serum ferritin which resulted to increase in level of serum
ferritin ( 614.8 and 498 ng/ml normal range is from 11.0-
306.8 ng/ml). she was then referred for genetic testing,
which revealed that she was heterozygous for the H63D
mutation of the HFE gene but negative for the C282Y
mutation. her serum ferritin level is continuously being
monitored every 2 months.
 Subjective Information
October 2007
- Pt experienced muscle cramps in her legs,
abdomen and chest causing for her blood values
to be monitored monthly in November and
December of 2007 and a phlebotomy was
perfomed.
 Subjective Information
February 2008
- She revisited her Haematologist for her
bimonthly check up and it shows acceptable
levels of serum ferritin level and no phlebotomy
was performed.
 Subjective Information
Nine days after the February monitoring
- Pt had a fall result of slipping on icy pavement
resulting to trauma. She reported intense pain
and bruising of her left thigh. pt is also
experiencing limited function of her (L) LE and
she requested for a referral to a PT.
 Objective Information
Ocular Inspection
- L thigh presents with dark purple area of ecchymosis from medial groin region
distally with smaller areas noted on the posterior and anterior thigh.
ROM
- LOM of hip flexion with knee extended prior to pain onset (45°)
Gait Analysis
- Unable to actively move leg from due to pain and weakness upon gait and
transfers (VAS 8/10 at worst, 4/10 at best)
- (+) antalgic gait; (-) assistive device (husband supports patient upon gait)
- Unable to single leg stance on (L)
ADL Analysis
- Needs assistance upon transfers and dressing
- OPTIMAL (Outpatient Physical Therapy Improvement in Movement Assessment
Log) has a grade of 72, which is interpreted as inability to perform activities
consisting the questionnaire.
 Assessment
Initial Session Goal
- Focused on treatment of soft-tissue injuries
with edema massage and soft-tissue
mobilization
- PROME of L knee and hip to maintain joint
mobility
- Additional motion, strength, balance, and
proprioception exercises added as tolerated
by the patient
 Assessment
4 weeks re-evaluation (active motion without pain)
- Weakness of hip extension (3-/5), hip abduction (3/5),
and knee flexion (4/5)
- PROM is at 70° at pain onset
- Patient is now able to balance on R leg for 15 sec and
on her L leg for 5 sec
- Pain is reported to be at 2/10 at worst
- Patient is able to ascend/descend at stairs step-over-
step and walk independently but still needed
assistance with LE dressing (pants, shoes, and socks)
 Assessment
5 weeks after start of PT sessions (6 weeks after fall)
- Patient demonstrated fatigue on PT sessions (initially
attributed to lingering respiratory illnesses combined with
fall-related trauma
- Intensity and variety of exercises increased
- SOB was noted and more frequent rest breaks were
performed.
- Patient still shows improvement in function and pain
reduction
- If the patient had not had a pre-scheduled appointment
with her haematologist within a week of symptom
development, contact would have been made with her
primary-care physician.
 Assessment
*direct connection of symptoms to Hereditary
Hemochromatosis was not made until patient
consulted the haemotologist for a 2 month follow
check-up.
- CBC and serum ferritin profile improved which is
interpreted as both haemoglobin and hematocrit
levels had dropped since February.
- Patient reports of increase in abdominal chest,
foot, and leg muscle cramps
 Assessment
After 17 visits
- HEP to assist with progression of strength and balance
with rest breaks
- Patient visits local fitness centre regularly
- At discharge, OPTIMAL Difficulty Baseline Score had
improved to 43
- Improved knee flexion, hip abduction and extension
strength
- Single leg stance is maintained 20 sec at the right and
15 sec on the left
- Independent transferring and dressing
- Normal gait pattern on level surfaces
Plan
 REFERENCE
• Allen MK. Hereditary hemochromatosis: a
literature review and case report. Physiother
Can. 2010;62(3):276-84.