Hello Claire: I agree with you. As such, I palpated the clients hip and she shows no signs of pain. She does have intact pain response because I accidently pinched her the other day and she just about hit me.
I forgot to mention that there is also the strong possibility that the client is experiencing TIA's. Ron ======================================================= On Wednesday, December 17, 2003, @ 9:25 AM, you wrote: CS> Hi Ron CS> Impacted hip fractures can be really hard to detect on x-ray and CS> can often be incredibly painful for the individual, even though they can CS> actually be quite anatomically stable. CS> all good wishes CS> Claire >>>> [EMAIL PROTECTED] 12/17/03 02:15pm >>> CS> Wow....I have seen such things before in people with progressive CS> neuro disease.....it is hard to pin it on progression per say, because CS> it seems unlikely that there would be an immediate and drastic decline CS> overnight....question: was there any physical trauma (i.e. fracture or CS> anything that required medication or surgical intervention)? It could CS> be the medication. Also, my belief is that sometimes trauma causes a CS> stress to the system that then "causes" a more rapid decline....it has CS> been hypothesized that numerous neurodegenerative diseases respond to CS> stress. CS> David A. Lehman, PhD, PT CS> Associate Professor CS> Tennessee State University CS> Department of Physical Therapy CS> 3500 John A. Merritt Blvd. CS> Nashville, TN 37209 CS> 615-963-5946 CS> [EMAIL PROTECTED] CS> -----Original Message----- CS> From: Ron Carson [mailto:[EMAIL PROTECTED] CS> Sent: Wednesday, December 17, 2003 8:01 AM CS> To: [EMAIL PROTECTED] CS> Subject: [OTnow] Help with Client CS> Hello: CS> I am working with a client who was diagnosed with Alzheimer's Disease CS> approximately 7 years ago. She has shown a steady decline in occupational CS> independence during the years but she has shown a significant decline in the CS> past month. CS> The family is 100% dedicated to keeping their mother at home. CS> The family reports, that about three weeks ago, the client was walking CS> in/out of the home with SBA. While outside, the client fell, apparently when CS> striking at a caregiver. Since her fall, she has shown tremendous decline in CS> her ability to walk, stand and transfer. Prior to the fall, the client would CS> stand in the bathroom while the family cared for hygiene. To day, the client CS> required max assist (X2) to stand. The possibility of a hip injury/fracture CS> remains, but all orthopedic x-rays were negative. CS> The questions I have are: CS> 1. What are the likely causes of the client's recent decline: CS> a. Normal progression of the disease CS> b. Fear of falling/standing secondary to recent fall CS> 2. Based on the above, or any other plausible explanations, what treatment CS> approaches will best facilitate this client to be able to increase her CS> participation in toileting and transfers. CS> Thanks, CS> Ron CS> P.S. I am seeing the client today and Friday and plan to make a decision CS> about which direction to take our remaining therapy. Should we continue CS> working on remediation of underlying issues or begin adaptive strategies to CS> decrease the family's burden and promote the client's safety CS> _______________________________________________ CS> To unsubscribe, visit: CS> http://otnow.com/mailman/listinfo/otlist_otnow.com CS> The OTnow Mail Archive: CS> www.mail-archive.com/[EMAIL PROTECTED] CS> =============================================== CS> _______________________________________________ CS> To unsubscribe, visit: CS> http://otnow.com/mailman/listinfo/otlist_otnow.com CS> The OTnow Mail Archive: CS> www.mail-archive.com/[EMAIL PROTECTED] CS> ============================================== CS> ********************************DISCLAIMER******************************** CS> This email and any files transmitted with it are confidential and CS> intended solely for the use of the individual or entity to whom they CS> are addressed. 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