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Assignment- Mind Mapping

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on 21 October 2013

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Transcript of Assignment- Mind Mapping

Mr Kyle Lavine
Deafness in (R) ear
Acquired Brain Injury
Anxiety/ Depression
Effect on Body/Symptoms
Frequent Headaches (left frontal)?
Neck pain (Cervical stiffness)?
Speech?
Sight?
Hearing
Limb control?
Neurological deficits?
Respiratory deficits?
Other?
Aggravators/Alleviators
What are they?
How long do they have that effect?

How do these symptoms, Aggravators/ Alleviators effect ADL's?
Current Lifestyle Habits
Smoking?

Yes/No? Current/previous history.
If yes how long for?
How many per day on average?
Current/previous Physical Activity Levels
Type of PA- Work, Recreational Etc.
How often?
Most preferred types of activity?
What influences this?- Diagnosis/health status?
Diet Habits
Usual daily diet
What influences this?
Work
Bakery Assistant Manager
Currently working Part time.
Unable to work full time due to anxiety and on-going headaches.
Usual Hours per week?
5/5/2012
Considerations for Exercise
Strength/weakness
Balance
Posture
Gait
Communication?
Appropriately considered FITT principles- respiratory deficits?
Increased Fatigue?
Pre-screening

Gait analysis
Bruce/ modified Bruce/6 minute walk test or arm ergo for aerobic capacity using HR and RPE
Standing Posture (visible effects of ABI)
Berg Balance Test
Functional tasks- sit to stand/squat
- wall push ups
Grip Strength
Severity of condition.
Rationale for Pre-screening
Bruce/Modified Bruce: Most widely used test, frequently citated in medical journals, and has normative data to allow comparisons (Ehrman et al. 2009).** Plantar fasciitis/tendononsis my contraindicate this form of testing for this client.
Arm Ergo (seated): More appropriate testing protocol for clients with LL and neurological conditions (Shrieks et al. 2011).
Sit to stand may be more appropriate than squat, as it minimizes time in weight bearing.
Seated grip strength though not functional still a good measure of UL strength, while minimizing weight bearing and LL pain.

Cause?
MVA?
Fall?
Assault?
Sporting Accident?
Ischemia?
Substance Abuse?
Other?
Psychological Impact
Scared to get in a car?
Was the MVA their fault if the cause?
Scared to participate in sport again?
No effect?
Other?
Referral?
Psychologist
Counselor

Multidisciplinary approach to treatment?
Speech therapy?
Audiology?
Exercise Physiology
Other?
Effect on Ex. Prescription
Transport to and from sessions
Compliance
Sleeping Habits
Difficulty getting to sleep?
Restlessness throughout the night?
Waking up feeling tired?
Plantar fasciitis/tendonosis in FHL (L)
For how long?
Pain (VAS)
Effect on ADL's
Ambulating
Working
Standing
Others
Anything he isn't doing?
Pre- screening
ROM/passive active
VAS pain weight bearing/non-weight bearing
MMT for LL
Functional Activities?- Squat/sit to stand
Rationale
fascia irritated
weight bearing painful
Causing decrease ROM ( due to pain)
and muscle weakness/tightness due to de-conditioning and altered biomechanics
(Kisner & Colby, 2007).
Ex. Prescription Considerations
Pain Free LL ROM
Stretching
Limited weight bearing/weight bearing pain free
Hydrotherapy

Partial or complete?
Exercise Considerations
Communication
How long?
Support
Family/ friends
Professional support
Other
Ex. Considerations
Compliance
Keep it interesting
Chose exercises he enjoys doing
Be aware of level of difficulty- (don't prescribe too much hw; he may not do any of it).
Why/result of what?
Diagnosis?
Meds (Lamilis Tablets)?
Decreased QOL?
Decreased Work?
Poor Support?
Increased weight gain?
Weight gain
10kg in 6 months
Is that causing more pain to weight bear?
Podiatrist
Little change in foot px so far
Treatment
Treatment strategy
How long?
How often?
Compliant?
Excessive Fatigue
Other professional help?
Physio?
Other?
Why/result of what?
Headaches?
Work?
ABI?
Poor diet?
Poor sleeping habits?
Depression/Anxiety?
Meds (Lamisil Tablets)?
Other?
Pre-Screening
Fatigue questionnaire
VAS for Fatigue after getting dressed in the morning, walking in from the car park.
Rationale
To understand his limitations
To get an idea of the work load he may be able to handle
Ex. Considerations
Increase rest breaks.
Encourage healthy diet.
Slower progressions
Alter FITT principles according to day to day variations (good/bad days).
Compliance may be an issue.
Possible muscle and joint pain.
Prolonged postexertional malaise.
Avoid exercises the client perceives as stressful, very physically demanding or difficult, as this exacebates fatigue symptoms.
Consider his goals.
Rationale
To prevent/ limit onset of fatigue
Maintain compliance
48 years old
Frequent Headaches
How severe?
VAS pain scale
Do they gradually get worse with time?
Will they prevent him exercising?
How often?
Weekly?
How long do they generally last?
Affect on ADL's?
Exercise?
Working?
Social Aspects of life?
Why/Result of what?
ABI?
Meds (Lamisil)?
Depression/Anxiety?
Work related stress?
Known Triggers?
Ex. Considerations
Ability to concentrate
Performance
Worse on more difficult/heavier activities?
More susceptible to Fatigue.
Current Management
Physio
Pain killers?
Rest?
Sleep?
Water?
Prev Collar bone # (L)
10/2009
How?
Fall
Playing sport/Recreational activity
MVA
Other
Still participate?
How often?-more or less than before?
If not-why not?
Goals- Wants to get back?
Shoulder px?
VAS pain scale at rest and with movement.
How often?
Aggravators /Alleviators
Pain Med?
Rest?- How much?
Particular movements-over head reach/lifting?
Effect on ADL's
Reaching?
Hanging washing?
Getting Dressed?
Washing hair?
Others?
Ex. Pre-Screening
Shoulder ROM
Posture
Scapula Humeral Rhythm
GHJ stability tests
Scratch test
Rationale
Identify weaknesses/abnormalities that may be responsible for the pain
To gain an understanding on what he can/can't do to prescribe exercise
Ex Considerations
Pain (VAS)
Pain management- eg. Meds
Effect of pain meds on exercise
ROM
Treatment Strategies
Physio?
Other forms of Rehab?
Was surgery required?
Were these successful?
Decreased pain?
Full union of fracture?
How long was this approach used?
Where did the # Occur?
Proximal end?
Mid shaft?
Distal end?
Contraindications to Ex.
Malunion at # site
Brachial plexus irritation
Subclavian artery transection
Pneumothorax of the lungs (air between lung and chest wall; collasped lung).
Granado & Dressendorfer, 2013).
Referral?
GP
Other?
Effect on VAS pain scale
Increase, by how much?
Decrease, by how much?
Limited PA
Due to diagnosis/current health status.
Increased weight gain
10kg in last 6 months
Effect on weight bearing activities?
More painful due to more pressure on LL with plantar fasciitis?
What section of the brain?
Frontal?
Temporal?
Parietal?
Occipital?
L or R side?
Effect on QOL
Decrease quality of life
Increase depression and anxiety symptoms
More prone to illness
Possible development to CFS?
Referral
Dietician/nutritionist?
Counselor/mental health professional?
Current Management
How does he overcome the feelings of fatigue?
Frequent rest?
Frequent naps?
Diet?
Stimulants, eg. coffee?
Duration & Frequency of rest
How many times per day?
How many times per week?
What causes this to vary?
(Dressendorfer, 2013)
Pre- screening
QOL questionnaire
Referral?
Counselor/mental health professional?
How long?
Innate?
Caused by ABI?
How does he/family and friends deal with it?
Does he have any particular strategies in place to assist him?
Red Flags
Vomiting persistent/progressive
Seizures
Causes client to wake up from sleep.
Red Flags
Weight change (decreased)
Change in Bowel habits
Polyuria
Daily Duties
Desk work?
Manual handling?
Other?
Current Medications
Elocon and Mometasone Furate
Used for inflammatory relief,prutritic manifestation of corticosteroid responsive dermatoses eg. psoriasis, atopic dermatitis.
Adverse effects: Severe itching, burning, tingling, stinging, skin atrophy, and paraesthesia (uncommon).
Lamilis Tablets
Used for severe ringworm is an allylamine antifungal drug.
Adverse effects: GI upset, depression, appetite loss, joint pain, headache, visual impairment, fatigue, rash, and anxiety though very rare.
Predinsolone
Corticosteroid for non-infected inflammatory eye condition
Adverse effects: Occular hypertension, visual acuity defect, visual field defect
Suffer any adverse effects?
Consider when prescribing exercise
Medical Conditions requiring these pharmaceutical interventions.
History of these illnesses?
Duration of illness
When it first occurred?
Their impact on QOL?
Compliance with medication?
Other treatment strategies?
Frequency/type of Physio
Weekly?
When was this treatment started?
Types of exercises prescribed?
Has it been effective?
Compliant?
Location of pain
Frontal headaches
Tightness around the frontal and occipital regions of the skull
Cx stiffness
Effect on Exercise prescription?
Red Flags
Suicidal ideation (including all statements and gestures)
Suicidal attempts
Use of multiple or potent medications (including anti-depressents which can be fatal in high doses)
Signs and symptoms of abuse
(Trinah, 2013).
Since ABI?
Since decreased work ability?
Physio?
Other forms of rehab?
Full transcript