Week 1 STARES - TCCP

Situation
On the 4th day of my placement I was to briefly assess and treat a 4 yr old boy with spastic hemiplegia on his right but also with a slightly affected left side. He had been in on several occasions previously and had been through two treatments of Botox and was due for a third in two weeks. The main issues the boy faced were an impaired gait pattern and decreased right upper limb function. The main issue from the parents point of view was his impaired upper limb function while from the health professional’s perspective his impaired gait was the major issue. The boy was very communicative and happy to be involved in the process and the parents were very supportive and understood the importance of sessions with the centre.

Task
To determine what the individual’s issues are by performing a musculoskeletal assessment, gait analysis and functional capacity assessment. During this session it was not intended to treat the patient as such but simply get an idea of what his current limitations are.

Action
As I have found to be important when attempting to assess and treat children is the development of rapport. Fortunately the child in this case warmed very quickly to us and he was very willing to be involved in the process. Initially I assessed his lower limb range of motion and tone. The main issues found were increased tone in his right leg with dorsiflexion and knee extension. He also had decreased standing balance on his right leg. His gait showed impaired right foot clearance, circumduction, inability to extend his knee and high guard with his upper limbs. His reaching ability was also impaired predominantly when reaching to the right.

Result
This highlighted to me that the main area to work on was strength in the patient’s right lower limb, his gait pattern and also his ability to use and function with his upper limbs.

Evaluation
I believe that I conducted the musculoskeletal assessments correctly but need to improve my ability to apply and determine exactly what each of the more functional tests are inferring. I need to know what to be looking for and how it all applies to the big picture.

Strategies
On the next occasion I will know exactly what I am going to do and to keep the patient involved bring in a an incentive of some form to give him a goal. Sticking at one task for a while then completely stopping it and moving on to another would also ensure the patient is able to focus further. With time being able to find ways to keep a child involved while still keeping on task from a physiotherapy point of view will be an important skill to fine tune.