PTH 605

Peripheral Nerve Injury Intervention Case Scenarios

Case 1: Your new rehab patient is a 32-year-old male construction worker, husband, and father
was admitted yesterday to inpatient rehabilitation 6 weeks post Traumatic Brain Injury (TBI).
Orthopedic injuries included non-displaced skull, left iliac wing, and left acetabular fractures.
Initial GCS = 10. There was no SCI. CT scan of the abdomen & pelvis 4 weeks post TBI
revealed large hematomas in the left psoas muscle, left gluteal muscles, and the sacral area.
Electrodiagnostic studies revealed marked denervation of left quadriceps and psoas muscles,
without evidence of lumbosacral nerve, root, or plexus involvement.

Physical Examination Findings:

Height 6 0; Estimated femur length: 50cm.
MoCA = 26/30.
Rancho Los Amigos Level = VII.
Normal physical exam, except:
Mild left hip pain
Marked left quadriceps atrophy
Diminished left quadriceps muscle tone with absent patellar reflex
MMT:
o 4/5 left hip flexion, extension, adduction, abduction
o 4/5 left knee flexion
o 0/5 left knee extension
o 4/5 left ankle dorsiflexion and plantar flexion
Absent light touch and sharp/dull discrimination over anterior thigh, medial knee, and
shank. Impaired left knee proprioception.
Requires minimum assistance for stand pivot transfers
Requires moderate assistance with walking up to 150 feet with no assistive device;
fatigues quickly; frequent genu recurvatum
Requires moderate assistance with ADLs
Left LE movement appears effortful and awkward during mobility activities. Patient
often uses his hands to help move his leg during bed mobility and transfers.

PT Problem List:
1. Potential cognitive impairment
2. Decreased left LE sensation; risk for skin injury
3. Diminished LE strength insufficient for independent mobility
4. Cardiovascular deconditioning
5. Unable to walk without assistance, with gait deviations
6. Unable to transfer without assistance
7. Unable to perform ADL without assistance
8. Risk for left LE ROM restriction / contracture
9. Risk for left knee joint injury
10. Risk for falls & fall-related injury
11. Risk for further cardiovascular deconditioning

1
PTH 605
Peripheral Nerve Injury Intervention Case Scenarios
Questions:
1. Discuss this patients prognosis for neural recovery and functional improvement during
the first 6 months post injury.

2. Use the Intervention Process do describe how you would address the patients left
lower extremity movement dysfunction.

a. Describe your evaluation, PT diagnosis, prognosis, & plan of care based on the
patients presentation.

b. What impairments are in the differential diagnosis of the LE movement

dysfunction?

c. What impairments can be corrected? How will you go about correcting them?

d. What impairments will you need to compensate for in the short-term? How will
you go about compensating for them?

e. What activity limitations will you address in the short-term? How will you
address them?

f. For what potential secondary impairments will you implement tertiary prevention
strategies. What will those strategies be?

g. For what potential secondary pathologies will you implement primary prevention
strategies? What will those strategies be?

h. What self-management strategies will you teach to the patient?

2
PTH 605
Peripheral Nerve Injury Intervention Case Scenarios

Heres a potential useful foot orthotic that might be useful.