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Case Study Presentation

Physiotherapy in mental health
by

Jess Williams

on 20 June 2010

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Transcript of Case Study Presentation

Physiotherapy
in
Mental Health A case study presentation Patient X Background information Medical intervention Jess Williams AUT Physiotherapy Yr 4 21 June 2010 Consent gained
Rights considered
28 year old male
Unemployed
Limited social contacts
Lives alone
Pacific/Indian
Admitted to TWT on 30/04/10




Physiotherapy Fibromyalgia * 'Soft tissue rheumatism'
* Pain/stiffness/fatigue
* 18 classifcation points
* Widespread pain 3 months+
* Not just pain
* Self management + medication
Progression Alternatives Reflection Questions? Evidence based practice Goals Massage Physical activity Relaxation Broken family
Significant abuse
Heavy drug use 12 years +
2003-2007 history of psychotic episodes
3 previous suicide attempts
? Schizophreniform illness vs drug induced psychosis
Breach of bail - TWT Previously treated with Olanzapine
Non compliant = lost to follow up
Medication restarted
Lorazepam + zopiclone Reported voices....... ...and hallucinations.... Referral for physiotherapy... First presented on 19/05
Notes checked - consent gained
Subjective:
* Wide spread complaints of pain
* Descriptive of "knots"
* History unclear
Objective:
* Observation
* AROM
* PROM
* Resisted muscle testing
* Palpation
* BATOMI
Main findings Intervention Hard to observe posture
AROM +PROM limited
Inconsistant
Tender points evident
Increased tone
'Ropey' + 'nodular'
BATOMI observations
Problems - Pain and discomfort
- Restrictions in movement Clinical reasoning....... Analysis ? Somatic type pain
? Psychological components
? Chronic pain
? Previous injury
? Fibromyalgia
(NZ Arthritis Foundation, 2009) What next...? * Discussion about options
* Offerred options
* Chose massage
* 20 mins with massage wax
* Appointment booked - Continued with massage
- Education
- Passive stretches
- Breathing
- Sleep strategies
- Exercise programme * Reduce pain

* Increase movement

* Independent management - Blood flow, relaxation + healing
- Self managment and relaxation
(NZ Arthritis Foundation, 2009)
- Relief from anxiety and depression
(Edge, 2003)
- Decreases pain and medication + improves quality of life
(Brattberg, 1999) - Sustainable form of self management
(NZ Arthritis Foundation, 2009)
- Physiology of the respiratory system
- Increase 'body awareness' promote relaxation
(Gustafsson, Ekholm & Broman, 2002) - Endless benefits of exercise!
(Green Perscription NZ, 2008)
- No proven adverse effects
(Martin et al, 1996)
- Just as effective as relaxation
(Martin et al, 1996)
- Positive global effects
(Cochrane review, 2008)
- Aerobic better?
(Cochrane review, 2008)
Acupuncture...?
Other Body work...?
Heat...?
MDT Big team effort already
Chances to make this bigger...? Importance of the 'recovery model'
Importance to not 'slip' To be colourful!
Full transcript