NDT Treatment Planning Worksheet

Transcription

1 Child s Name: Kalab DOB: 01/01/02 Diagnosis: CP-Right-sided Heimplegia DOE: May 29, 2009 Therapist s Name: Mary Rose Franjoine Discipline: PT Current Participation: Attends his neighborhood school with siblings Attends church with family Attends peer related social functions and community recreational events Current Participation Limitations: *Require adult assistance for dressing tasks at school and within the community: *Swimming *Sleepovers Shopping Current Functional Activities: Dressing Current Functional Limitations Requires assistance to don shirt Contextual Factors: Personal Facilitator: Desire, motivation, and determination *Barriers: Attention Environmental Facilitator: Size and type of shirt Barrier: Open environment a busy distracting room Place an * next to the items that the family identifies as immediate concerns/outcomes Adapted with permission from Template Suzanne M. Davis, RPT 6/01 Revised 10/03 p1 J Styer-Acevedo2003/M Prim Haynes

2 Functional Outcome: Kalab will independently don his shirt while standing within 15 seconds, 3 out of 5 trials over 3 consecutive treatment sessions. Subject action verb conditions results/measures time frame Posture & Movement Behaviors (observable) Related Impairments (system level) Standing Posture Asymmetrical alignment with weight shifted on Impaired muscle activation to his left LE Difficulty sustaining and terminating movement in R LE Pelvis position: elevated on right, shifted slightly Ineffective force generation in R LE (hip extensors {glut max and med, to left, slightly posterior rotation quads, dynamic ankle) and trunk Right LE positioned with hip adducted, internal Musculoskeletal rotation, knee flexed with weight on toes Muscular (planter flexion in splints) PROM limitations of right hip, knee, and ankle-foot complex (possible Spine: possible Thoracic Lumbar hypermobility???) (extension) Illopsoas, hamstrings, quads, adductors, gastrocsoleus, everters Structural misalignment of LE Torsion of femur and tibia (possible????) Right UE Alignment Shoulder unlevel, right side lower compared to left Possible Scapular depression, downward rotation and adduction Clavicle slightly vertical (possible???) Humeral extension, abduction, and internal rotation Elbow flexion Forearm pronation Impaired muscle activation Excessive co-activation in UE Difficulty sustaining and terminating movement in R UE Ineffective force generation in R UE (serratus anterior, anterior deltoids, external rotators [mid ranges], elbow extensors [triceps} supinator, and wrist extensors Musculoskeletal ROM PROM limitations of scapula, g-h,elbow, forearm, wrist and hand Adapted with permission from Template Suzanne M. Davis, RPT 6/01 Revised 10/03 p2 J Styer-Acevedo2003/M Prim Haynes

3 Wrist and hand flexed (possible???) Tight musculature: Scapular adductors, lats, pect maj, biceps, pronators, wrist flexors, finger flex, thumb abd & flex Hypoplasia of scapula (possible????) Alignment of carpal rows (possible????) Balance Steady State: ability to maintain symmetrical stance limited, increased WS onto left Single Limb stance on Right - limited Decreased stance time with narrowed BOS (possible????) Anticipatory: Movement of Right UE towards midline, up and over head and /or posteriorly may cause loss of balance (possible????) Proactive & Reactive balance deficits do not appear to interfere with task performance Impaired muscle activation Excessive co-activation in UE Difficulty sustaining and terminating movement in R LE Ineffective force generation in R UE and R LE Musculoskeletal ROM PROM limitations of right hip, knee, and ankle-foot complex (possible???) Muscular tightness: Illopsoas, hamstrings, quads (rectus), adductors, gastrocsoleus, planter flexed with pronation? or supination? PROM limitations of scapula, g-h,elbow, forearm, wrist and hand (possible???) Tight musculature: Scapular adductors, lats, pect maj, biceps, pronators, wrist flexors, finger flex, thumb abd & flex Structural alignment of LE (possible????) Torsion of femur and tibia (possible????) Hypoplasia of scapula (possible????) Alignment of carpal rows (possible????) Adapted with permission from Template Suzanne M. Davis, RPT 6/01 Revised 10/03 p3 J Styer-Acevedo2003/M Prim Haynes

4 Tone Right UE and LE muscle tone increases with movement Trunk tone remains low through out task Muscle Tone increases on right-side as task demands increase Bias toward increased flexor tone in UE Bias toward increased extensor tone in LE Isolated movement in R UE decreases with increase in effort, task demands Movement Initiation Phasic bursts of movement are used to direct right arm placement for shirt donning Phasic burst of LE extensors, limits ability to maintain right foot on support surface for standing Impaired muscle activation Excessive co-activation in UE Difficulty sustaining and terminating movement in R LE Ineffective force generation in R UE & R LE & Trunk Musculoskeletal ROM PROM limitations of right hip, knee, and ankle-foot complex (possible???) Muscular tightness: Illopsoas, hamstrings, quads (rectus), adductors, gastrocsoleus, planter flexed with pronation? or supination? PROM limitations of scapula, g-h,elbow, forearm, wrist and hand (possible???) Tight musculature: Scapular adductors, lats, pect maj, biceps, pronators, wrist flexors, finger flex, thumb abd & flex Structural alignment of LE (possible????) Torsion of femur and tibia (possible????) Hypoplasia of scapula (possible????) Alignment of carpal rows (possible????) Impaired muscle activation Excessive co-activation in UE Difficulty sustaining and terminating movement in R LE Ineffective force generation in R UE and R LE Musculoskeletal ROM PROM limitations of right hip, knee, and ankle-foot complex (possible???) Muscular tightness: Illopsoas, hamstrings, quads (rectus), adductors, gastrocsoleus, planter flexed with pronation? or supination? PROM limitations of scapula, g-h,elbow, forearm, wrist and hand Adapted with permission from Template Suzanne M. Davis, RPT 6/01 Revised 10/03 p4 J Styer-Acevedo2003/M Prim Haynes

5 Coordination Lack of active symmetrical movement of the limbs (UE & LE) Lack of active asymmetrical movement of the limbs (UE & LE) Inability to use R UE and hand as an assist during shirt donning (possible???) Tight musculature: Scapular adductors, lats, pect maj, biceps, pronators, wrist flexors, finger flex, thumb abd & flex Structural alignment of LE (possible????) Torsion of femur and tibia (possible????) Hypoplasia of scapula (possible????) Alignment of carpal rows (possible????) Impaired muscle activation Excessive co-activation in UE Difficulty sustaining and terminating movement in R LE Ineffective force generation in R UE and R LE Limited inter-limb and intralimb dynamic control Impaired muscle synergy Musculoskeletal ROM PROM limitations of right hip, knee, and ankle-foot complex (possible???) Muscular tightness: Illopsoas, hamstrings, quads (rectus), adductors, gastrocsoleus, planter flexed with pronation? or supination? PROM limitations of scapula, g-h,elbow, forearm, wrist and hand (possible???) Tight musculature: Scapular adductors, lats, pect maj, biceps, pronators, wrist flexors, finger flex, thumb abd & flex Structural alignment of LE (possible????) Torsion of femur and tibia (possible????) Hypoplasia of scapula (possible????) Alignment of carpal rows (possible????) Adapted with permission from Template Suzanne M. Davis, RPT 6/01 Revised 10/03 p5 J Styer-Acevedo2003/M Prim Haynes

6 * list as many Posture & Movement Behaviors as is appropriate for the above-mentioned Functional Outcome. Adapted with permission from Template Suzanne M. Davis, RPT 6/01 Revised 10/03 p6 J Styer-Acevedo2003/M Prim Haynes

7 What impairment(s) are listed more than once across the posture and movement behaviors? : Impaired muscle activation: Excessive co-activation in UE : Impaired Motor Execution (Timing & Sequencing Impairment) : Difficulty sustaining and terminating movement in R LE : Ineffective force generation in R UE & R LE & trunk: serratus anterior, anterior deltoids, external rotators [mid ranges], elbow extensors [triceps} supinator, wrist extensors, hip extensors, gluteus max & med, quads, ankle musculature (?) and trunk flexors and extensors Musculoskeletal: PROM limitations of right hip, knee, and ankle-foot complex (possible???); Muscular tightness: Illopsoas, hamstrings, quads (rectus), adductors, gastrocsoleus, planter flexed with pronation? or supination? Musculoskeletal: PROM limitations of scapula, g-h,elbow, forearm, wrist and hand (possible???) ; Tight musculature: Scapular adductors, lats, pect maj, biceps, pronators, wrist flexors, finger flex, thumb abd & flex Musculoskeletal: Structural malalignment of LE Musculoskeletal: Torsion of femur and tibia (possible????) Musculoskeletal: Hypoplasia of scapula (possible????) Musculoskeletal: Alignment of carpal rows (possible????) : List the impairments in prioritized order based upon the functional outcome: 1. : Impaired muscle activation: Excessive co-activation in UE 2. : Ineffective force generation in R UE & R LE & trunk: serratus anterior, anterior deltoids, external rotators [mid ranges], elbow extensors [triceps} supinator, wrist extensors, hip extensors, gluteus max & med, quads, ankle musculature (?) and trunk flexors and extensors 3. Musculoskeletal: PROM limitations of right hip, knee, and ankle-foot complex (possible???); Muscular tightness: Illopsoas, hamstrings, quads (rectus), adductors, gastrocsoleus, planter flexed with pronation? or supination? 4. Musculoskeletal: PROM limitations of scapula, g-h,elbow, forearm, wrist and hand (possible???) ; Tight musculature: Scapular adductors, lats, pect maj, biceps, pronators, wrist flexors, finger flex, thumb abd & flex 5. : 6. : Difficulty sustaining and terminating movement in R LE 8. Musculoskeletal: Hypoplasia of scapula (possible????) 9. Musculoskeletal: Alignment of carpal rows (possible????) Adapted with permission from Template Suzanne M. Davis, RPT 6/01 Revised 10/03 p7 J Styer-Acevedo2003/M Prim Haynes

8 10. Musculoskeletal: Torsion of femur and tibia (possible????) What other considerations might there be in developing treatment strategies? (Include child s dislikes, likes, contextual factors, etc.) 1. Control/limit environmental stimuli during initial phases of learning, slowly add distracters to environment as skill improves 2. Train for diversification different types of shirts: weight, material, sleeves length, neck design, buttons 3. Foster motivation, by setting stage for success 4. Provide community-based success experiences through home program Adapted with permission from Template Suzanne M. Davis, RPT 6/01 Revised 10/03 p8 J Styer-Acevedo2003/M Prim Haynes

9 Impairment Possible Treatment Strategy Expected Change Adapted with permission from Template Suzanne M. Davis, RPT 6/01 Revised 10/03 p9 J Styer-Acevedo2003/M Prim Haynes

10 * list as many possible treatment strategies as is appropriate for the identified Functional Outcome Possible Treatment session outcomes: (based on the identified functional outcome, impairments and expected change) Treatment session outcomes should be functional, with a measurable change in behavior. Adapted with permission from Template Suzanne M. Davis, RPT 6/01 Revised 10/03 p10 J Styer-Acevedo2003/M Prim Haynes