Goals & Achievements

 

Physiotherapy intervention plan October 2014- October 2015 

 

Presenting complaints

• Right sided weakness (hemiparesis) and underdevelopment.

• Right elbow dislocation

• Limping gait

 

Long term goal

• Strengthening of right side of the body, enhancing symmetry, stimulation of growth/development of the bones by loading

• Preparation for surgical management for elbow dislocation

• Reducing/eliminating limping gait.

 

Short term goals

• Strengthening of right side upper and lower limb & core.

• Reducing stiffness of right side upper and lower limbs

• Reduction of limping gait

• Promote/encourage use of right hand

• Promote proper breathing techniques & chest expansion

 

Management for the above stated goals

• Strengthening through exercise

  • Started with functional electrical stimulation for wrist extensors and dorsiflexors until response was achieved

  • Weight bearing exercises for upper & lower limb

  • Strengthening of right shoulder girdle muscles, extensor group, scapular stabilizers

  • Strengthening of right hip girdle muscles, quadriceps, dorsiflexors.

  • Core stabilization, strengthening of back extensors & abdominals

  • Functional exercises such as kneeling, step-ups, foot placement/position

• Reducing tightness through

  • Stretching of tight structures, hamstring, achilles, hip flexor, internal rotators of shoulder

  • Weight bearing activities

• Reduction of limping gate through

  • Footwear modification

  • Insole (elevation of right foot by about 1 cm)

  • Gait training & functional exercises such as foot placement/position

• Encouragement of use of right hand through

  • Functional training such as catching/throwing a ball

  • Dressing

• Promote proper breathing techniques

  • Breathing exercise

  • Relaxation

 

For July 2014- summer 2015 training continues following the 2013-2014 goals. Training and exercise are altered depending on the progress made. Promotion of the use of the right hand remains a challenge, as it is difficult to monitor outside the practice.

 

 

Achievements October 2013- October 2014.

 

Jigmet has been treated since October 2013. In July his progress was evaluated during my vistit to Leh. Below the achievement of the treatment till October 2014 are listed.

 

• Strengthening

  • Control of pelvis has increased

  • Improved strength in extensor group of upper and lower limb muscles

  • Isolated movement of right foot, improved heel strike achieved

• Reducing tightness

  • Enhanced range of motion (ROM) of right shoulder joint, wrist & foot

• Reduction of limp

  • Knee does not bend outwards as much while walking

  • Foot placement/positioning improved

• Encouragement of use of right hand

  • During treatment right hand use is promoted, but at school and home Jigmet should use his hand more in order for significant improvements to become noticeable. He mainly uses his right hand for supporting functional tasks carried out by the left hand (e.g. tying his laces, dressing, eating)

• Breathing

  • Improved chest expansion when inhaling

  • Increased physical and cardiorespiratory endurance