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KUEP 3134: CLINICAL PRACTICE

Presentation on Case Scenario

(Impairment & Assessment)

SCENARIO 3 Seorang wanita berumur

68 tahun yang mengalami

‘Charcot foot’ yang

memerlukan ‘customised

insole’ pada kaki kiri

beliau. Beliau juga punyai

masalah ‘peripheral

sesorymotor neuropathy’

serta masalah ‘cataract’

pada kedua belah mata.

List down the

potential

impairment

the patient

might have?

In health,

IMPAIRMENT is any

loss or abnormality of

physiological,

psychological, or

anatomical structure

or function, whether

permanent or

temporary.

Charcot foot (L)

LOCOMOTION RESISTANCE

Fractures and dislocations of bones and joints that

occur with minimal or no known trauma.

LOSS OF SENSORY

Loss sensory of the foot. Because of the loss of pain

perception and the loss of the sense of position of the

foot, joints receive repeated injuries.

Calluses and ulcers may form when bony protrusions

rub inside the shoes.

Peripheral sensory neuropathy

LOSS OF SENSATION

Sensory nerves that receive sensation from the skin such as temperature, pain, vibration or touch had interrupted.

Cause numbness, tremor, and gait abnormality on the lower limb.

LOSS OF COORDINATION

Lose coordination and ability to sense position of her limb.

Impedes ability to feel or “sense” her feet, making it difficult to keep a steady gait. She may lose her balance and become more prone to falls.

Cataract in both eye A cataract is a clouding of the lens inside the eye

which leads to a decrease in vision

VISION PROBLEM

Vision is reduced with ageing and visual impairments

affect balance.

BALANCE PROBLEM

Uncorrected visual deficits and balance problems are

reported to be risk factors for falls and fall related

fractures.

Steps involved

in the

assessment of

a patient as

required for a

P&O?

ASSESSMENT is the

process of obtaining

information or data

regarding to the

patients and their

problems and

related to the

treatment

S.O.A.P Assessment

Subjective Observation

- Symptoms the patient verbally expresses or as

stated by a significant other.

Objective Observation

- Symptoms that can actually be measured

Assessment

- Assessment is the diagnosis

Plan

- P&O intervention and treatment

Q & A Relevant to the question

PC (Presenting

complaint)

Morning!, How can I help

you? What brought you

here?

To know the patient intention.

HOPC (History

of Presenting

Complaint)

When – date ? How long

ago?

What happen -? DM ulcer?

To know the detail of the

complication and impairment

that may exist.

FxH (Functional

History)

ADLs – personal, domestic

Mobility – ambulation

To know their daily activity.

PMH (Past

Medical

Surgical

History)

Do you have any other

disease?

Medical: DM, cataract,

peripheral sensory

neuropathy.

Do you done any surgery on

your eyes?

Do you have any numbness

and where is it? How often is

it?

To relate the impairment,

disease and orthotic

prescription.

Q & A Relevant to the question

SH (Social History)

Where do you live and

with whom?

How often you involve in

community?

How will you fund the

insole?

To know the effectiveness of

the insole to the patient.

To know their funding.

SR (Systemic

Review)

Other systems;

Vision: can see well?

Feet: got numbness?

Easy to prescribe the orthotic

design based on their problem.

PsyH

(Psychological

History)

How do you feel now?

“ feel sad, burden to

family member”

To know the patient feeling and

what they want to achieve

based on their needs.

Expectation

What do you expect with

the insole?

“prevent the ulcer”

To acknowledge the patient

understanding on the orthotic

prescription.

Assessment

Eye test

Balance

Gait

Power

Objective Observation

Diagnosis : CMT with cataract on both eye and

having a peripheral sensorymotor neuropathy

Plan (ORTHOTIC GOAL)

Total contact insole

To prevent the further progress of the

charcot foot; stabilize foot minimize the

deformity.

To give protection to the foot as the nerve is

damage.

To give comfort to patient when walking.