Considering Betsaida and Rick’s clinical presentations, compare and contrast how you would approach their treatment sessions in terms of environment, maximizing their learning, etc. What would be the same? What would be different? (1 point each, 2 points)

Connections between neurons which are rarely used are gradually eliminated to improve organization and efficiency of nueral relationships.  This process is called Synaptic Pruning.  

BJ sustained a TBI after a skateboarding accident. He feels he does not need to be in the hospital, and becomes angry when his family and the nursing staff are attempting to calm him down. He is very focused on returning home. He is able to perform physical activities without difficulty, but you notice that when the task is unfamiliar he becomes disoriented and verbally abusive. How would you go about treating BJ?

History: Betsaida is a 74 y/o Latinx female s/p R CVA 6 weeks ago.  After being medically stabilized, she was in inpatient rehab for 10 days and participated in therapy actively during that time.  She discharged to her daughter’s home so her daughter and son-in-law could assist her as needed, but eventually intends to return to her home.  She was discharged with a tub bench, wheelchair, LBQC, and an articulating L AFO. She now presents for outpatient PT evaluation.  PMH: HTN, DM II, hypercholesterolemia, h/o cataract removal 2013 (current vision 20/70), OA R knee, presbycusis (wears hearing aids) Medications: Glipizide, Zocor, Benazepril, Hydrochlorothiazide, Neurontin. Social History: Was married for 52 years, now a widow. Prior to her stroke, pt lived in a single level apartment with thick carpet.  She enjoys spending time with her family, and traveling to visit national parks. She is a retired administrative assistant. Current Level of Function: Pt is residing at her daughter’s house. There are no stairs to enter, but there are 14 stairs to get to the second floor. The family has arranged the living room with a twin bed for Betsaida to sleep in for the time being. She uses the downstairs half bathroom for toileting but needs assistance getting upstairs for bathing. She has expressed being fearful of falling because she feels unsteady on her feet. Pain: 2/10 in right knee and 3/10 in bilateral feet due to diabetic neuropathy. Cognition/Communication:  Impaired memory, mild left neglect, early signs of dementia. Patient Goals: “I want to return to living in my own home.  I want to be able to get up, use the bathroom, take a shower, and walk by myself.”     Based on this information alone, list 6 of Betsaida’s risk factors for falls (1/2 point each, 3 points total – if more than 6 are listed, only the first 6 responses will be graded):

The next two questions pertain to this case example: Your patient, Lonnie, is a 29 y/o male (he/him) who sustained a C7 AIS A SCI in a boating accident.  He has made friends with another patient on the rehab unit, Sam, a 25 y/o male (he/him) who sustained a C5 AIS A SCI in a car accident.  Describe 1) what the head-hips relationship is and 2) how you would use it in Lonnie’s treatment sessions (2 points):

Kalima is a 26 y/o female (she/her) who was admitted to ICU where you work from the ER. She sustained a closed head injury yesterday when her dog accidentally tripped her as she was walking down outdoor concrete stairs. Your interdisciplinary team is going over her case, and nursing reports that Kalima’s vitals have been stable and she is engaging with staff appropriately.  They are wondering if it would be appropriate for PT to see her or if it’s too soon. Based on the research about early mobilization for people with TBI, which statement is most appropriate? 

Joe (he/him) presents with a sudden onset of vertigo & nausea yesterday when he got out of bed. The results of your positional testing are as follows: Roll Test (-) bilateral, R Dix-Hallpike no nystagmus but a few seconds of mild dizziness, L Dix-Hallpike showed robust L torsional upbeating nystagmus with a latency of 13 seconds & duration of 48 seconds, with Joe becoming very vertiginous & nauseous. What is your diagnosis?

What is your top activity based functional outcome measure you would assess with Lana and why? (1 point)

Anat says that she had a scan done of her head yesterday and that it was negative. She does not understand why she is still having problems. Explain the pathophysiology of a concussion to Anat, avoiding medical terminology/jargon. (1 point)

Mrs. D has had a stroke and is working on her arm and hand function.  Her main goals are to get back to work and to resume playing cribbage with her husband.  She works in a factory sorting small bolts and screws into containers as they go by on a conveyor belt.  Which assessment would be the best choice to help you determine if she is making functional progress towards returning to work?