Dr. Heena solanki

Mpt (neuro)

Name:- Tabasum Ansari

Add:- A-284, bethi collony, mity khadi

Age/ sex:- 17 year/female

Ocupation:- student

Date of addmition:- 21-2-2014

Date of examination:-

Chief complain:-

Pain at whole back, can’t able to stand,

cant able to sit independently , not able

to turn in bed, not get sleep at night if

than also wake up due to pain.

Present history:-

Past history:-

Family history:-

Personal history:-

Socioeconomic history:-

History of pain Duration :

Variation:

Site:

Radiation :

Reliving factors:

Aggravating factors:

Type :

Vas score:

Functional history

Sleep pattern:-

Appetite:-

Weight loss:-

Bladder and bowel:-

General Examination Temperature:-

Blood pressure:-

Respiration rate:-

Pulse rate:-

Colour of skin:-

Clubbing:-

Decubitus:-

Mental stastus:-

Posture

Palpation

Tenderness

Temprature

Scar

Spasm

Bony alignment

Bony tenderness

Edema

Musculo skeletal examination ROM

Upper limb ROM full both side active and passive.

Passive ROM is full both side RT and LT lower limb

Active ROMJOINT RIGHT SIDE LEFT SIDE

HIP AND KNEE 5 AND 10 20 AND 80

ANKLE

DORSIFLEXION 10 5

PLANTER FLEXION 15 10

MMT:-

Upper limb shows grade 4 for all muscle

MMT not check for lower limb due to spasticity.

LLD not present

Examination of spine Gibbus

Hump

Scloliosis kyphosis lorodsis

Chest evaluation Chest expansion reduce

Chest symmetry present

Deformity not present

Neurological examination Muscle tone:- hypertonia present at both lower limb

Right side Left side

Hip flexors 1 0

Knee flexors 4 2

Knee extensors 3 1

Ankle planter flexor 3 2

Clonus

Ankle : present on right side and left side

Patellar : present at left side

Reflexes Right side Left side

Quadriceps exaggerated Brisk

Tendoachilles Exaggerated Brisk

Sensory evaluation Touch:

Light

Crude

Both are intake

Thermal sensation normal

Kinesthetic sensation

Position sensation

Functional assesment

Investigation

X ray

MRI

The Mantoux Test (Tuberculin Skin Test)

DIAGNOSIS Pott’s spine with paraparesis

Confirm Diagnosis

Recover/Maintain Neurological Function

Recover/Maintain Mechanical Spine Stability

Correct or Prevent Spinal Deformity and Possible Sequelae

Functional Return to Activities of Daily Living

Patients with Pott's disease often undergo spinal fusion or spinal decompression surgeries to correct their structural deformity and prevent further neurological complications. There are no established guidelines which dictate treatments that will yield positive outcomes in such patients. However, treatment regimens should address each patient individually, focusing on any impairments, functional limitations and/or disabilities with which they present.

PT Managment Post-Spinal Decompression Surgery Spinal Stabilization Exercises Maitland Back School Exercise and Strengthening

When compared with other physical therapy treatments and self-managment, spinal stabilization exercises were found to produce significantly more positive ratings in global outcomes. Pain and disability, however, did not show significant improvement when compared to the other two treatment options.[13]

PT Managment Post-Spinal Fusion Surgery TENS (Transcutaneous Electrical Neuromuscular Stimulation) Aquatic Therapy Overground Training (Walking Program) Aerobic Exercise Trunk Strengthening

Studies examining the use of TENS have shown higher frequencies are more effective in decreasing neuropathic pain. Aerobic exercise, PT, and trunk strengthening interventions have all attained significant decreases in pain, psychological distress and disability.[14]

Differential Diagnosis Actinomycosis Blastomycosis Brucellosis Candidiasis Cryptococcosis Histoplasmosis Metastatic Cancer, Unknown Primary Site Miliary Tuberculosis Multiple Myeloma Mycobacterium Avium-Intracellulare Mycobacterium Kansasii Nocardiosis Paracoccidioidomycosis Sarcoidosis Septic Arthritis Spinal Cord Abscess Spinal Stenosis Spondylolisthesis Tuberculosis Vertebral Osteomyelitis[