Question

A 74-year-old retired male was admitted to hospital s/p fall backward

while mowing the lawn. At time of hospital admission pt presented with paralysis of both arms and uncoordinated movement of legs. Pt's mental status was normal. Vision and hearing were intact. Upon examination, pt was not able to discriminate temperature or light touch of BUEs. Initially, pt was not able to stand or sit up at the edge of the bed. Positive Babinski's sign.
Prior to arrival at this SNF, pt spent 6 weeks in acute rehab and was sent to another SNF for 1 week.
By 3 months pt reports constant tingling in hands and pressure to front of thighs. Pt can feed himself with adaptive equipment and gets around the facility in his wheelchair. 
His medical diagnosis is intervertebral disc disorder with myelopathy, cervical region


5. What type of exercise will he need to improve the strength to the muscles in C6 and C7 myotomes, which are currently at 1/5 strength? Also, justify your answer: explain why you answered this way 


6. Considering the weakness described in the previous question, let's now consider how this will impact Mr. Gibson's ADL function.
a. Name and describe at least 3 tasks, besides feeding himself, that Mr. Gibson should be able to do now.


b. Name and describe at least 5 tasks that Mr. Gibson will not be able to do in his usual way, with reason why for each one. Assume that he was functioning well before the accident and was independent in all areas. 

Answer & Explanation
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5. What type of exercise will he need to improve the strength to the muscles in C6 and C7 myotomes, which are currently at 1/5 strength? Also, justify your answer: explain why you answered this way 

- By 1. tucking your chin - he will sit in a chair with straight back then place his finger on the front of his chin, then he wil slowly draw his chin toward hus neck away from the finger without dropping the head or looking down. 2.) Standing with chin tuck- stand with feet together and arms hanging in the sides, inhale to bring your shoulder up, then roll down and back. Exhale to perform the chin tuck. 3.) Neck rotation - gently turn the neck to so that the chin moves toward the shoulder then stop when you feel stretch. 4.) Maintain proper posture to decrease pressure on the affected nerves. 

- This exercise can help because it will strenghtend the nerves that are affected. This exercise are simple but it can help the nerves and he will not loss the nerves functions. 

6. a. Name and describe at least 3 tasks, besides feeding himself, that Mr. Gibson should be able to do now. 

- He can take care of himself like he will be able to take a bath but with a a little supervison. He can go outside with the help of the wheelchair. He can groom himself like combing his hair. 

b. Name and describe at least 5 tasks that Mr. Gibson will not be able to do in his usual way, with reason why for each one. Assume that he was functioning well before the accident and was independent in all areas. 

-  walk independently  - he will always be using wheelchair because he feels pressure to the front of his thigh. 

-  take a bath without the halp of others, he needs help from others because his right hand is tingling. 

 - do his job normally because he will maybe feeling insecurities with his co workers or he may feel that they are going to bully him. 

- attend gatherings, a person have a feeling that is what we call shyness or he is afraid that they will make fun of him. 

- have sexual life because he should not be allowed to make force. 

 

Step-by-step explanation

The answers are analyze from the situation of the patient given by the student.