The patient is a 25-year-old female who presented to the emergency department with chest pain, back pain, and a headache. She was admitted to the hospital for medical management and continued work-up. She then developed left-sided numbness and tingling and blurry vision in both eyes. Two hours after admission, her symptoms progressed and she reported an inability to move her left lower extremity and complete blindness. Given her admission presentation and presumptive medical diagnosis of “rule out stroke,” the neurologist ordered a physical therapy evaluation. In the subsequent 2 days, the patient underwent diagnostic imaging of the brain and spinal cord and had many laboratory panels performed; all were negative for neurologic pathology. Her primary care physician and neurologist concluded that they could not find any organic cause of the patient's current complaints, and a psychiatric consult was requested. The psychiatric evaluation revealed a past history of physical abuse by her father, although the patient stated that her home life had improved. At this time, the medical team considered the possibility that the patient may have conversion disorder. The patient lives in a single-story home with her mother. Prior to hospitalization, she was a student in a nearby community college and also worked as a grocery clerk. She enjoys dancing in her spare time and stated that she would like to get stronger so she could go back to school and work.
What is her rehabilitation prognosis?
What are possible complications interfering with physical therapy?
What are the most appropriate physical therapy outcome measures for gait and balance?
What are the examination priorities?
- ASTASIA-ABASIA: Unstable, abnormal manner of standing and walking in which a person demonstrates dramatic and unusual sways while attempting to walk; the person tends to recover his/her balance at the last moment, or fall when a family member or a soft object is nearby1
- COLLABORATIVE MODEL: Approach to therapeutic goal setting that allows the patient (and potentially family and/or significant others) to work with the therapist to determine anticipated goals and expected outcomes; agreement of goals by therapist and patient is required, and not assumed; model differs from the team approach in which collaboration is usually limited to members of the interprofessional team (e.g., physiatrist, therapies, nursing, social work)
- KNOWLEDGE OF RESULTS: Type of feedback given after a skill is performed; information about the outcome of the performance of a skill is given, rather than about the specific movements or quality of movements comprising the skill
- TASK-ORIENTED APPROACH: Therapeutic, functional approach to retraining movement in which practice is task-specific and context-specific with an overall goal of functional independence; derived from concepts of motor control, motor learning, dynamical systems theory, and neuroplasticity
Describe the common clinical features of conversion disorder.
List pertinent impairment, activity, and participation level tests and ...
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