Cheers, Mike
On Wednesday, Dec 17, 2003, at 14:32 Europe/London, Ron Carson wrote:
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
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