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OP POISONING CASE STUDY
- 1. SVNIRTAR CASE PRESENTATION ON OP POISONING BY S L ABHIPSA MAYURDEEP BOR
- 2. NAME OF PATIENT- MANOJ KUMAR PUJARI AGE- 39YRS ADD- SUNDARGARH, ODISHA RELIGION- HINDU CHIEF COMPLAIN- DIFFICULTY IN WALKING AND STANDING INDPENDNTLY SINCE 5 MONTHS
- 3. ON OBSERVATION THE PATIENT CAME TO THE DPARTMENT WALKING WITH THE HELP OF A WALKER MENTAL STATE- HE WAS PROPERLY ORIENTED TO PLACE, TIME AND PERSON ATTITUDE OF LIMBS- IN SITTING- THE DIFFERENT BODY PARTS ARE PROPERLY ALIGNED EXCEPT THE ANKLE WHICH IS PLANTAR FLEXED DUE TO FOOT DROP. IN STANDING- THERE IS HEAD FORWARD POSTURE. LUMBAR LORDOSIS SLIGHTLY DECREASED. LEVEL OF B/L ASIS IS LOWER THAN B/L PSIS BODY TYPE- ECTOMORPHIC USE OF EXTERNAL DEVICES- WALKER, ELBOW CRUTCH,DYNAMIC AFO WITH PF STOP
- 4. ON EXAMINATION HMF- VISION, HEARING,SPEECH, MEMORY ARE INTACT RESPIRATION-CHEST EXPANSION AT NIPPLE LEVEL WAS FOUND TO BE 5CM CRANIAL NERVE EXAM-INTACT SENSORY-SUPERFICIAL SENSATION- TOUCH,PAIN INTACT DEEP SENSATION-INTACT CORTICAL - INTACT
- 5. MOTOR-BULK BABINSKI- NOT ELICIT ABLE DTR- BICEPS- 2+ BOTH TRICEPS-2+ BOTH SUPINATOR-2+ BOTH KNEE – 4 ANKLE- 2+ SUPERFICIAL RFLX- ABS ABDOMINAL RFL-ABS TCD – HAMSTRINGS TIGHTNESS , TA TIGHTNESS
- 6. VMC GRADING L/L – HIP JNT FLXN- FAIR TO GOOD EXTNSN- GOOD ABDCTN- GOOD ADDCTN- GOOD EXT ROTATN- POOR INT ROTATN- POOR KNEE FLXN- FAIR EXTNSN- FAIR ANKLE DORSIFLEXION- NIL PLANTAR FLEXION- NIL INVERSION AND EVERSION - NIL
- 7. GAIT ANALYSIS STEP LENGTH- 31.75CM STEP WIDTH-8.89CM STRIDE LENGTH- 57.15CM CAUDENCE- 32 STEPS/MIN STANCE PHASE – HEEL STRIKE – INITIAL CONTACT IS WITH FOREFOOT MID STANCE- KNEE GOES INTO MILD HYPER EXTENSION PUSH OFF – NORMAL SWING PHASE – INADEQUATE TIME PERIOD, THE PATIENT GOES INTO DOUBLE SUPPORT PHASE. PATIENT WALKS WITH NARROW BASE OF SUPPORT AND INADEQUATE STRIDE LENGTH, SCISSORING AND WADDLING PATTERNS CAN BE SEEN IN THE GAIT PATTERN.
- 8. FUNCTIONAL ABILITY 1. ABLE TO ROLL TO BOTH SIDES 2. ABLE TO SIT INDEPENDENTLY FROM SUPINE POSITION 3. ABLE TO STAND WITH MIN SUPPORT 4. ABLE TO WALK WITH ELBOW CRUTCHES
- 9. PROBLEM LIST 1. INABILITY TO STAND AND WALK INDEPENDENTLY 2. HAMS TIGHTNESS 3. TA TIGHTNESS 4. WEAKNESS OF ANKLE JOINT 5. B/L FOOT DROP 6. INADEQUATE SWING PHASE 7. SCISSORING AND WADDLING GAIT PATTERN 8. NO HEEL STRIKE IN STANCE PHASE 9. POOR STANDING BALANCE
- 10. GOAL SETTING SHORT TERM GOAL- 1. REDUCTION OF SPASTICITY IN L/L 2. IMPROVING POWER OF ANKLE DORSIFLEXION AND PLANTAR FLEXORS 3. IMPROVING STANDING AND WALKING BALANCE 4. MAKING PATIENT WALK WITH B/L ELBOW CRUTCH LONG TERM GOAL 1. INDEPENDENT STANDING 2. INDEPENDENT WALKING 3. IMPROVING WALKING ENDURANCE
- 11. TREATMENT CONVENTIONAL TECHNIQUES 1. STRETCHING- FUNCTIONAL STRETCHING OF HAMSTRINGS AND TA 2. STRENGTHENING- GLUTEUS MAXIMUS -U/L BRIDGING STAIR CLIMBING, SIDE WALKING, SINGLE LEG STANDING GLUTEUS MEDIUS – SIDE LYING ABDUCTION USING THERA BAND. 3. ANKLE JT. PASSIVE ROM EXERCISES ANKLE FACILITATION EXERCISES 4. RHYTHMIC EXERCISES- SIT TO STAND STATIC CYCLING STANDING WITH TOE CURLS
- 12. 5. PRONE KNEE FLEXION AND EXTENSION 6. LATERAL TRUNK MUSCLE STRETCHING 7. WEIGHT SHIFTING ACTIVITIES, BALANCE TRAINING, BOX WALKING 8. GAIT TRAINING