RT Book, Section A1 Jobst, Erin E. A1 Panus, Peter C. A1 Kruidering-Hall, Marieke SR Print(0) ID 1192816284 T1 Antidepressant Agents T2 Pharmacology for the Physical Therapist, 2e YR 2020 FD 2020 PB McGraw-Hill Education PP New York, NY SN 9781259862229 LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1192816284 RD 2024/03/28 AB CASE STUDYR.N. is a 44-year-old man with a primary diagnosis of right transtibial amputation secondary to trauma sustained in a motor vehicle accident. The amputation left the patient with an 8-inch residual limb distal to the knee. While in the hospital, R.N. received physical therapy, occupational therapy, and social services. He was discharged home and immediately began outpatient physical therapy for further amputation rehabilitation, including permanent prosthesis fitting and gait training. Upon initial examination, R.N. demonstrated moderate weakness in the right lower extremity with tenderness and increased sensitivity in the residual limb. He required contact guard assistance with sit-to-stand transfers and demonstrated independence with household distance ambulation with his prosthesis and a front-wheeled walker. R.N. stated that his primary limitation was significant pain in his right residual limb with all weightbearing activities. R.N. is currently unable to work in his lawn maintenance and landscaping business. He admits that this has made him very anxious and unable to sleep at night. He has occasionally been taking diazepam at night to help him sleep and tramadol to help alleviate the pain. Initial rehabilitation interventions included therapeutic exercises focused on bilateral lower extremities and pelvic and trunk musculature and progressive gait training. On several occasions, the therapist noted that R.N. complained of not being able to take a deep breath and a burning and “squeezing” feeling in his chest. Upon further questioning, R.N. stated that this happened almost every night in the early evening and occasionally during the day. He stated that he was having a hard time sleeping at night but did not like taking the diazepam because it made him feel “groggy” in the morning. With the patient’s approval, the physical therapist contacted the patient’s physician to inform her of R.N.’s major complaints.