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The patient is a 53-year-old, right-hand dominant, obese male (BMI 34.2 kg/m2) who was referred to outpatient physical therapy. During the initial physical therapy interview, he reports that he is “getting weaker” in his legs and trunk. He also states that he gets tired easily, especially at the end of the day, and more than usual. He reports having several falls in the past few months. He recounts that his most recent fall happened in a grocery store 2 weeks ago; he had no injuries except for some bruising. He states that it was the end of the day and he was very tired but had forced himself to go. While inside the store, he reported that he tripped and fell, landing on his right shoulder. The patient reports that he was diagnosed with poliomyelitis at 30 months of age. As a child, he ambulated with bilateral hip-knee-ankle-foot orthoses (HKAFOs) and forearm crutches. During his teens, he abandoned the use of bilateral HKAFOs because “they took a long time to put on,” and he “didn't really need them and walked fine without them.” Instead, he used an ankle-foot orthosis (AFO) on the right foot and forearm crutches, and has used these devices since then. The patient lives with his wife and teenage son. He retired from a sales job 11 years ago. His hobbies include gardening, attending baseball games, and going to the movies with his family. He describes himself as outgoing and a high achiever with a “type A personality” because he is very determined and “never gives up on anything.” He states that he is frustrated that he does not have the energy and strength to do activities that he has done in the past, like going on long walks or gardening. The patient recently had a complete medical work-up including laboratory work and diagnostic imaging of the brain and spinal cord that revealed no active pathological conditions.

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What are possible complications interfering with physical therapy?

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What are the most appropriate physical therapy outcome measures for gait and balance?

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What are the examination priorities?

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Based on his health condition, what do you anticipate will be the contributors to activity limitations?

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  • ANKLE-FOOT ORTHOSIS (AFO): Externally applied orthosis (usually plastic) that surrounds the ankle and at least part of the foot to control position and motion of the ankle, compensate for weakness, or correct deformities; commonly used in the treatment of disorders affecting muscle function such as stroke, spinal cord injury, muscular dystrophy, cerebral palsy, polio, multiple sclerosis, and peripheral neuropathy
  • HIP-KNEE-ANKLE-FOOT ORTHOSIS (HKAFO): Device used for patients requiring more stability of the hip, knee, and lower torso due to paralysis and/or weakness (secondary to paraplegia, spina bifida, recurrent hip dislocation, other neurological impairments); provides pelvic stability in several planes (rotation, side-to-side, front-to-back motions), reduces ...

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