PHYSICAL THERAPY MOVEMENT DIAGNOSIS The client had an increased risk of falls, with significant…

PHYSICAL THERAPY MOVEMENT DIAGNOSIS The client had an increased risk of falls, with significant balance impairment and gaze instability consistent with mixed peripheral (bilateral hypofunction) and central vestibular dysfunction postmeningitis (Physical Therapy Practice Patterns 5D and 5A). He also had lower extremity weakness and reduced vertical orientation. His strengths included supportive family and excellent motivation. GOALS 1. Client will be able to ambulate independently in his home without assistive device (4 months). 2. Client will improve gaze stability to 20/80 with head
View complete question PHYSICAL THERAPY MOVEMENT DIAGNOSIS The client had an increased risk of falls, with significant balance impairment and gaze instability consistent with mixed peripheral (bilateral hypofunction) and central vestibular dysfunction postmeningitis (Physical Therapy Practice Patterns 5D and 5A). He also had lower extremity weakness and reduced vertical orientation. His strengths included supportive family and excellent motivation. GOALS 1. Client will be able to ambulate independently in his home without assistive device (4 months). 2. Client will improve gaze stability to 20/80 with head movements at 2 Hz in either direction (4 months). 3. Client will be independent and safe to negotiate a flight of stairs with rail (2 months). 4. Client will be able to maintain standing with eyes open on foam surface .30 seconds (2 months). INTERVENTIONS The client lived 2 hours from the clinic, so many of the interventions were through progressive home exercises. Client was seen one or two times each month, and the program consisted of balance retraining, gaze stability exercises (vestibuloocular reflex [VOR] retraining beginning in sitting, plain background), lower-extremity strengthening, endurance activities, and gait training. Given the patients hearing loss and memory deficits, teaching included demonstration, written instructions, and instruction of the clients wife. The client progressed steadily the first 4 months, then he began not feeling well. He complained of increased nausea and trouble eating and had a slow decline in mentation. At the 5-month visit, the clients condition had declined significantly, and after discussion with the clients physician, he underwent a series of tests which concluded that the patient was having intermittent shunt malfunction. After the shunt revision, the client did improve as noted at the 10-month follow-up visit. KEY TAKE HOME POINTS 1. It is not unusual to have both cranial nerve and CNS involvement with meningitis. 2. Remember to monitor for signs of shunt malfunction, and the importance of educating the client and family members. 3. Use standardized objective measures in case management.

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