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Case Study 7

Case Study 7. Meredith Wahl and Anne-Marie Cecala. Examination. Charles Smith 3 y/o boy 2 parents Attends pre-school. Physical Examination. Lethargic, easily fatigued Not as energetic Ataxic gait Nausea/Vomiting Headache. Exam Continued. Strength ROM Sensation All WNL

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Case Study 7

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  1. Case Study 7 Meredith Wahl and Anne-Marie Cecala

  2. Examination • Charles Smith • 3 y/o boy • 2 parents • Attends pre-school

  3. Physical Examination • Lethargic, easily fatigued • Not as energetic • Ataxic gait • Nausea/Vomiting • Headache

  4. Exam Continued • Strength • ROM • Sensation All WNL • All cranial nn intact • All reflexes normal

  5. Berg Balance Scale Total Score = 30/56 • 7. Standing with feet together (3) • 8. Tandem standing (2) • 9. Standing on one leg (1) • 10. Turning trunk-feet fixed (2) • 11. Retrieving obj from floor (2) • 12. Turning 360 degrees (2) • 13. Stool stepping (1) • 14. Reaching forward while standing (2) • Balance FeatureScore (0-4) • 1. Sitting unsupported (3) • 2. Change of position: sitting to standing (2) • 3. Change of position: standing to sitting (3) • 4. Transfers (1) • 5. Standing unsupported (4) • 6. Standing with eyes closed (3)

  6. Pathology • Medulloblastoma • One of the most common brain tumors in children • Usually forms in the cerebellum • AKA Primitive Neuroectodermal Tumor (PNET) • Usu found by CT scan or MRI • Actual dx only by BRAIN SURGERY • Remove skull • Sample tissue (wait for pathology results) • Remove as much as possible

  7. Prognosis • Depends on age of child when tumor found, location, amount remaining after surgery, metastasis, new diagnosis or recurrent • Prognosis for our patient is good. • Older than 2 yrs • 5 yr survival rate of 65-80%

  8. Disablement Model • Pathology – medulloblastoma • Impairment – decreased balance and coordination, fatigue, vomiting • Functional limitation- pt unable to sustain long periods of activity, unable to walk w/out assistance • Disability- cannot play with other children at school, cannot interact with parents at home

  9. PT Goals • LTG: In 2 wks pt to amb on even/uneven surfaces x 100 ft w/out assist to return to school/play activities 3 x wk. • STG: pt to amb on level surface x 25 feet in 5 days • LTG: In 2 wks pt to maintain sitting balance in armless chair w/out assist for 30 min to eat at table with family 2 x day • STG: pt to sit upright for 15 min without assistance with < 4 LOB in 5 days.

  10. APTA Practice Pattern

  11. PT Intervention • Pt and caregiver education • Balance training • Endurance training • Gait training

  12. References • Goodman C, Boissonnault W, Fuller K. Pathology: Implications for the Physical Therapist . Pennsylvania: Saunders; 2003.

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