Week 3 STARES - Fremantle Hospital MS

Subjective - My patient was a 88yo female who was referred to the outpatient clinic for decreased mobility & functional decline. She had a long history of falls with no significant injuries but the frequency of falls had increased markedly in the 2/52 prior to admission. Upon initial Ax she was noted to have very poor dynamic and static standing balance and was found to fatigue very quickly and had to rest for ~30s on the way to the treatment room.

Task - From this it was determined that her treatment should focus on improvement of her balance and fitness whilst still keeping in mind her poor tolerance to exercise.

Action - Assessment involved a Berg balance scale, step test, TUG and assessment of functional movements such as supine to standing. Treatment involved balance exercises to improve her standing balance and ability to adjust to internal & external perturbations. Her protective reactions, especially stepping, would need to be refined for occasions when she cannot maintain her CoG within her BoS. Her tolerance to exercise was also a focus as this would enable her to be more functionally capable upon discharge.

Result - The patient showed poor balance for all aspects of testing and fatigued very quickly with testing. A 6mwt was not conducted on this occasion due how quickly she fatigued but it will conducted during the next session. The patient reported that she felt her balance was worse than normal so it was critical that we give her some exercises from this session so improvements can be made until the next appointment is made.


Evaluation - During the next session it was found that the patient had improved slightly but still would fatigued very quickly. It was also noted that she was leaning slightly to the right when walking, which was not noticed during the initial session. This could possibly have been the cause for her decreased exercise tolerance throughout but as I recognized early on this patient tends to under-report symptoms. Upon a repeated investigation it was found that her R leg (mainly hip flexors) were much weaker than the L which was not found during the first appointment.

Strategies - In future I will learn to interpret what a patient is telling me and determine if it is in fact the truth and if they may be concealing something in an effort to please the therapist in the hope that it is some how going to improve their situation. I learnt how valuable Re-Ax can be since during the initial Ax this irregularity was not picked up. Not only for physio purposes but for other health professionals as well since it could suggest more complex medical issues…which luckily in this case it didn’t. Also my manual muscle testing technique may need to improve since I may not have picked up the weakness the first time. This could have been one of the major impairments that has lead to her current situation.