Current subjective complaints (from claimant) and objective observations: Mr. Anderson continues to walk using 2 canes, his legs shake when he is walking; he has frequent tremors of his legs while sitting and reports with any movement he has severe back spasms. He said the best his pain ever gets is a 7 and with any activity it is a 10+. He said he has swelling to the low back, and radiation of pain down both legs. The trial of the spinal cord stimulator decreased his pain with the current medications by 50%, but he still rated it at an 8. He feels that with his pain medications and the spinal cord stimulator his pain would be 80% better.
Review of claimant’s stated pain/limitations: He rates it as a 7 at best and up to a 10. Mr. Anderson said the pain interferes with all aspects of his life. It affects his sleep. Mr. Anderson said any activity increases back
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Anderson at the office of Dr. Shah. The permanent spinal cord stimulator was discussed and both agreed to proceed. Dr. Shah told Mr. Anderson he would have an increase in pain for about 3-4 weeks after the insertion is done. This is an outpatient procedure. On 6/5/17 we met with Dr. Rampersaud Pain Management. Mr. Anderson reports over the weekend while putting on his cow boy boots he felt a pop in his low back. He reports he almost went to the hospital emergency room his pain was so severe. Mr. Anderson’s Dilaudid and Percocet have been changed and he was reminded again that he is on a medication taper. On 6/5/17 I was able to speak with Dr. Rampersaud privately and reminded him that the medications were supposed to be decreased and Mr. Anderson continues to push for an increase or no change at all. The permanent spinal cord stimulator was supposed to be placed on 6/12/17. Mr. Anderson said the surgery center tried to get him to come in early but, he had a morning appointment with his bank. So his surgery was cancelled. It has been rescheduled for
Chronic pain is a long term condition, which means it cannot be cured, but the symptoms may be controlled by therapies and medications (Saxon and Lillyman, 2011). When pain is considered chronic, it lasts longer than the expected healing period and there may not be a clear cause (Kraaimaat and Evers, 2003).
The guidelines generate the latest high-quality evidence which can very helpful to Physiotherapists as it will allow them to provide the best quality of care to the patients and improve the quality of their clinical decision making. However, guideline recommendations can be misleading, misinterpreted or wrong for some patients. It is important to evaluate the evidence and see if it is compatible with the patient the treatment is being provided for before selecting the recommended treatment. Furthermore, guideline evidence can be difficult to scrutinise for limitations as this requires a lot of time, resources and skills which is not available for all clinicians. Overall, if used correctly and appropriately Evidence-Based guidelines can be an effective process when Physiotherapists are choosing a treatment for a
In medical practice, it is important to know what procedures should be taken on a patient. Different conditions and scenarios can call for different ways of thinking as well as different uses of equipment. In this day and age, it is important for a medical practitioner to not only knows what is best for their patient, but to also know the importance of equipment – including the right use of said equipment. If a practitioner approaches a patient with a spinal injury, it is essential to know what kind of equipment should be used in order to help the patient, should a Spinal Board be used, or an Orthopaedic Stretcher?
Based upon previous knowledge of spinal cord function, what results from the testing were consistent with a spinal cord injury?
..., Ducker, T.B., ….. Young, W. (1997). International Standards for Neurological and Functional Classification of Spinal Cord Injury: International Medical Society of Paraplegia, 35, 266 – 274.
This case involved a 53 year old man who sustained a significant tear of his rotator cuff while playing baseball. He underwent surgical repair and was given a referral for physical therapy. The referral was to begin passive ROM 3 times per week for 2 weeks then initiate a supervised home program of active exercise for 2 weeks, and elastic resistance exercises for internal and external rotation every other day for a month. 2 weeks after surgery, he had his first PT visit in a sports medicine clinic that was managed by an athletic trainer (ATC).”
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
Dr. Tagge, the lead surgeon, finally updated the family over two and a half hours later stating that Lewis did well even though he had to reposition the metal bar four times for correct placement (Kumar, 2008; Monk, 2002). Helen reported wondering if Dr. Tagge had realized how much Lewis’ chest depression had deepened since he last saw him a year ago in the office, especially considering he did not lay eyes on Lewis until he was under anesthesia the day of surgery (Kumar, 2008). In the recovery room, Lewis was conscious and alert with good vital signs, listing his pain as a three out of ten (Monk, 2002). Nurses and doctors in the recovery area charted that he had not produced any urine in his catheter despite intravenous hydration (Kumar, 2008; Monk, 2002). Epidural opioid analgesia was administered post-operatively for pain control, but was supplemented every six hours by intravenous Toradol (Ketorolac) (Kumar, 2008; Solidline Media,
At the end of the intervention, the Range of Motion,VAS score and Neck Disablity score was recorded at the end of 2 weeks.
Sarah came in on 2/22/18 complaining of vaginal pain and had a rash. She tested positive for hepatitis. On 2/21/18, Sarah took a bath and went to church. While at church she stated having pain and called Patricia to get her. The next day she still was in pain. The reporter examined Sarah, and she had wet soil dirt in the external of her vagina. She had grass and strass on the internal of her vagina. She had multiple redness blisters on the inside of her vagina. Sarah did not make contact, seem shy, and uncomfortable, this could have been due to having the exam done. Sarah told the reporter that she was sitting on the couch without panties on. She said she was not touched or had intercourse with anyone. Sarah is a little slow
through the Eyes of a Participant Observer." Chiropractic & Manual Therapies. Vol. 20, No. 1, 19 Jan. 2012, p. 1. EBSCOhost. 2017 October 25.
Spinal cord injury (SCI) is a medically complex and life-disrupting condition. SCI is one of the most severe injuries which bring sudden and profound life changes that have global effects (Somers, 1992). According to World Health Organization (WHO) report (2011), word wide 20-40 people per million of populations acquire spinal injury every year. It is estimated that in the United States (US) each year there are about 11,000 new cases of SCI and there are currently about 250,000 persons alive with SCI, because of lack of improvements in medical care and survival. The prevalence of people living with SCI has increased, and it is predicted that there will be greater and greater numbers of older patients with SCI (Spinal cord injury: facts and
With 94 patients, 72 women and 22 men, average age 47.5 ± 11.3 years, with chronic nonspecific NP were randomly assigned to receive a GPR or a MT treatment. The experimental group received GPR, whereas the reference group received MT. Both groups received nine 60-minutes long sessions with one-to-one supervision from physical therapists as the care providers. All subjects were asked to follow ergonomic advice and to perform home exercises. Measures were assessed at pre-treatment, at post-treatment and at a 6-months follow-up. Pain intensity [Visual Analogue Scale (VAS)], disability [Neck Disability Index (NDI)], cervical Range of Motion (ROM), and kinesiophobia [Tampa Scale of Kinesiophobia (TSK)] were assessed. Subjects in the experimental GPR group exhibited a statistically significant reduction in pain at post-treatment (P=0.0043), and disability at six months after the intervention (P=0.0113), compared to the reference group (MT). In conclusion, GPR was more effective than MT for improving pain at post-treatment and disability at 6-month follow-up in patients with chronic nonspecific
The use of the term spinal shock has caused controversy with neurologist, relating to mechanism and duration of
In a pain assessment, the pain is always subjective, in a verbal patient; pain is what the patient says that it is. Nurses must be able to recognize non verbal signs of pain such as elevated pulse, elevated blood pressure, grimacing, rocking, guarding, all of which are signs of pain (Jensen, 2011). A patient’s ethnicity may have a major influence on their meaning of pain and how it is evaluated and responded to behaviorally as well as emotionally (Campbell, & Edwards 2012). A patient may not feel that their pain is acceptable and they do not want to show that they are in pain. For some people, showing pain indicates that they are weak. Other patients will hide their pain as they do not want to be seen as a bother or be seen as a difficult patient.