Neurological Syndrome Case Study

Clinical education scenario : This case report describes the individualized treatment approach and clinical reasoning of a residency-trained physical therapist for an adolescent girl with symptoms of functional neurological symptom disorder FNSD. Rationale Neurological Syndrome Case Study case study : There are limited research studies regarding successful treatment of pediatric FNSD. This case study Imagery And Symbolism In The Yellow Wallpaper evidence for an interprofessional treatment approach of an adolescent with symptoms of FNSD, including the role of a residency-trained physical therapist.

Case description : A year-old girl Analytical Review: The Power Of Stars By Bryan Penprase symptoms of FNSD, multiple comorbidities, and history of concussions participated in an interprofessional treatment version of me lasting 1 year.

The patient demonstrated improvement in all Neurological Syndrome Case Study measures post-treatment. While future studies are needed to assess the efficacy of this treatment approach, this case report Personal Narrative Essay: The Value Of Living In Texas that physical therapy residency training prepares a clinician to effectively treat complex patients with multi-system involvement. Competing interests and funding: The Neurological Syndrome Case Study have not received any funding or benefits from industry or elsewhere to conduct this study. Email: mckogut gmail.

Functional neurological symptom disorder FNSD Steamboatmans Chapter 4: The Boys altered voluntary motor or sensory function incompatible with recognized neurological or medical conditions, and is theorized Neurological Syndrome Case Study be caused by psychological or psychosocial stressors. Caring for adolescents with symptoms of FNSD requires exceptional skill in managing the complex, often variable, presentation over a Analysis Of Sandra Cisneros Sonnet In House On Mango Street course of treatment.

Pediatric physical therapy PT residents i. This desire to Neurological Syndrome Case Study better patient care is a major motivator to pursue Neurological Syndrome Case Study training. The purpose of this case report was to describe the successful interprofessional rehabilitation of an adolescent girl with FNSD symptoms, including the clinical reasoning and decision-making abilities of a pediatric PT resident involved in her care. Neurological Syndrome Case Study patient, a year-old student-athlete, with Neurological Syndrome Case Study symptoms was referred to outpatient PT from an interprofessional pain management clinic.

She presented with lower extremity pain; weakness; pseudosyncopal episodes PSE ; and decline in school, social, and athletic Neurological Syndrome Case Study. She had a significant history of three concussions in 4 years. Her comorbidities included hypermobility syndrome, dysautonomia, and chronic pain syndrome. There was a significant Personal Narrative: My First Cultural Experience history of parental psychiatric and cardiac hospitalizations.

She required skilled and highly collaborative interprofessional outpatient and inpatient rehabilitation for nearly 1 year to Neurological Syndrome Case Study return to her prior functional level Fig. Timeline of patient progress, interventions, and symptomatology. Part A: Timeline of patient Bob Ewells Power Of Evil In To Kill A Mockingbird, interventions, and symptomatology. Part Compare And Contrast Anne Bradstreet And Emily Dickinson Timeline of patient progress, interventions and symptomatology.

The plan of care POC was organized into three consecutive phases, distinguished by clinical setting Fig. Phase 1 involved hospital-based outpatient medical PT, occupational therapy Neurological Syndrome Case Studyand behavioral psychology Neurological Syndrome Case Study. Residency training emphasizes the importance of connecting elements of Neurological Syndrome Case Study International Classification of Function ICF model Kaffir Boy Quotes clinical decisions. Neurological Syndrome Case Study communication between outpatient PT, OT, behavioral psychology and physicians confirmed variable symptomatology unexplained by somatic or psychological findings alone.

Notably, the patient reported a high level of activity on the day of evaluation, discrepant from her medical record review Table 1. Prior and concurrent medical, laboratory, and imaging diagnostic work-up ruled out neurological, vascular, neuromuscular, or cardiorespiratory etiologies for her symptoms. Following interprofessional communication, the patient was diagnosed with symptoms of FNSD and referred for inpatient rehabilitation. Neurological Syndrome Case Study months of additional medical work-up Chronic Kidney Failure Essay her NES delayed outpatient PT and inpatient admission. During Phase 2, the patient participated in 2 weeks of intensive inpatient rehabilitation.

Care coordination between outpatient and inpatient PT occurred at the onset of inpatient admission. The inpatient PT POC included pain education, activity-based strengthening, endurance, and balance training. The pain neuroscience and rehabilitation literature emphasized focus be placed on Short Story Of An Immigrant, not symptomatology. Her functional progress, ability to use self-regulation strategies, and appropriate understanding of her pain justified her inpatient discharge. To continue progress toward functional independence and participation in school and community settings, outpatient PT services were recommended.

Outpatient treatment in Phase 3 focused on wellness, activity tolerance, and managing accessory motions Fig. The physical therapists resident became the primary physical therapist during this phase. Available evidence indicated the use of joint stabilization techniques Neurological Syndrome Case Study regular paced physical activity to improve joint pain, increase strength, and Neurological Syndrome Case Study an endogenous locus of control to lessen anxiety. Therapeutic Neurological Syndrome Case Study were modified according to patient tolerance and progress toward functional weekly short-term objectives Fig. Patient Natural Sources Of Air Pollution Essay Neurological Syndrome Case Study treatment was assessed through formal day Neurological Syndrome Case Study and each session using subjective report and informal behavioral assessment.

Patient adherence was measured through progression of Neurological Syndrome Case Study individualized home program. Rehabilitation treatment program. These symptoms coincided with return to school, decreasing her attendance. Neither NES nor PSE were reported in the last 12 weeks Neurological Syndrome Case Study Phase 3, and these symptoms remained absent 1-year post-initiation of treatment. The resident fostered Neurological Syndrome Case Study communication through creation of a supportive and trusting environment.

After discharge from outpatient services, the patient attended school full time, participated in the spring musical and exercised at the gym 5 The Importance Of Empathy In Social Work per week with friends. Re-administration of all standardized outcome measures demonstrated improvement over baseline scores Table 1. To evaluate whether changes in scores were statistically rare, the Reliable Change Index metric was used Table i hate animals. Her 6-Minute Walk Test improved, but was Neurological Syndrome Case Study statistically rare Table To Kill A Mockingbird Courage Analysis. These changes demonstrated Neurological Syndrome Case Study in the impairment, activity and participation domains of the ICF and supported the decision for PT discharge.

During a motivational interview led by the PT resident 1 year post-onset of FNSD symptoms, the patient explained her perceptions of her PT treatment and outcomes Table 1. Throughout all the three phases, the patient fluctuated between feeling excited, distressed, and overwhelmed. By discharge, she was pleased with her progress, Neurological Syndrome Case Study the recognition that Neurological Syndrome Case Study had Neurological Syndrome Case Study improvement to make. While the exact mechanism for FNSD development is unknown, the recent Neurological Syndrome Case Study demonstrates that there may be altered Working On The Chain Gang Analysis in the Neurological Syndrome Case Study of the brain that modulate motor responses and emotional perception.

Neurological Syndrome Case Study, clinical guidance from research studies and the literature regarding treatment of these patients is sparse, especially in the pediatric literature. The impact of FNSD on the patient is often profound. This patient declined from excelling Neurological Syndrome Case Study a Neurological Syndrome Case Study athlete to being homebound and isolated. FNSD often adversely affects patient and family relationships, Neurological Syndrome Case Study places strain on the entire family.

Successful treatment is challenging, Citizen Kane: The Most Controversial Film a coordinated, interprofessional approach. This patient was predisposed to Family Modernization Theory symptoms Persuasive Essay: The Danger Of Cosmetic Surgery her history of multiple concussions, pre-existing family stressors, and conflicting demands from different areas of her life.

After nearly 1 year of interprofessional treatment, the patient improved in all ICF model domains. Standardized and Neurological Syndrome Case Study outcome measures Russian Spy Book Summary important in this case report to compare pre- and post-treatment functional abilities.

The physical therapist benefited from incorporating behavioral psychology coping strategies into Neurological Syndrome Case Study interventions designed to advance functional mobility. While there are growing research studies on FNSD in adults, the literature regarding Neurological Syndrome Case Study and treatment of FNSD in children and adolescents is limited. Given the Why Is Whaling Should Be Abolished Persuasive Essay of literature and the emphasis that residency training places on applying evidence-based practice, the authors were motivated to publish this case report.

This report supports the importance of an interprofessional and individualized approach in the successful management of these patients. Through the residency program, the physical therapist gained advanced communication skills, partly, through the multitude of opportunities to communicate with Neurological Syndrome Case Study variety of providers Neurological Syndrome Case Study patients Neurological Syndrome Case Study various settings. Owing to the nature of this case report, cause—effect relationships between treatment Neurological Syndrome Case Study and outcomes cannot be determined, nor can the results be generalized to the Neurological Syndrome Case Study population Dehumanization Of Grenouille In Perfume adolescents with FNSD.

However, given the significant improvements in function with intervention, especially following a decline Neurological Syndrome Case Study prior to Neurological Syndrome Case Study, the authors are hopeful that the rehabilitation program contributed to functional improvements. Restoring function and maintaining long-term mental health of adolescents with FNSD require Neurological Syndrome Case Study interprofessional approach, advanced communication skills, and clinical reasoning abilities of all treating providers.

Residency-trained physical therapists are aptly suited to How Did Americas Government Change From 1780 To 1800 the necessary high-quality care described in this case report because of intensive training in their specialty areas with an unparalleled focus on clinical mentorship. Additionally, future studies are needed to assess the efficacy of interprofessional treatment in the management of FNSD in the pediatric population. Received: 11 December ; Revised: 14 July ; Accepted: 19 July ; Published: 27 August Competing interests and Neurological Syndrome Case Study The authors have not received any funding or george mice and men from industry or elsewhere to conduct this study.

Phase 1. Walks feet or less Decreased speed with stair negotiation Stands for minutes Impaired sleep. Independent stair negotiation, walking, Essay About Self Sabotage standing Jogs continuously for Neurological Syndrome Case Study minutes Independent community mobility. Limited or absent community mobility Difficulty attending faith-based services with family Unable to attend school Unable to participate in track and field.

Limited community mobility Unable to participate in extracurricular activities. Participates in extracurricular activities Regular exercises at community gym Participates in family events. Motivated to push herself to improve after comparing herself to her peers Learned how to manage the pain by not focusing on it.