Clinical Cases

Clinical Case #1: Keep Stepping

For Keep Stepping in Fall 2019, I worked with an 83-year old female with bilateral knee osteoarthritis that lived alone. Her medical history included high blood pressure and chronic shoulder pain from a fractured clavicle. She was taking medication for high blood pressure and cholesterol levels. When I first met her, she presented with forward head posture and showed decreased arm swing with gait, as well as Trendelenberg and circumduction gait deviations. Her primary goal was to maintain her activity level so that she could continue living alone. Long term goals included improved agility, balance, and posture with a score of 8.5 seconds on the 8-foot- up- and- go test and cardiovascular endurance with 510 yards on the 6- minute walk test.

Her initial exercises included the hip 3-way reach, tandem walking, and hip hinge for balance. I also added transverse abdominis activation for core stability and posture. She became frustrated with the transverse abdominis activation and hip hinge even after doing them correctly, so I got rid of them. I instead gave her seated clamshells to improve her hip abductor strength and correct her gait. Her final home exercise program included seated hip abduction with a theraband, chin tucks, scapular retractions with external rotation, weight shift, and mini squats with counter support. I explained and gave her information on the importance of arm swing during gait, effects of forward head posture, and management for osteoarthritis.

I think she felt doing her yard and housework was enough. She also had exercises she was doing from prior physical therapy and only did the ones she liked. Keep Stepping was just another way for her to keep moving. Since she didn't come to the last session, there was no way to determine if she had officially met her goals, but she progressively showed increased awareness of her posture and didn't need as much cueing for gait.

Clinical Case #2: Vertigo

On my second rotation, I got to work with an older woman that had severe vertigo once. Before she started physical therapy, she was being treated for breast cancer for a couple of months, which she said caused her vertigo. One of her main complaints was dizziness if she was on her feet for a long time. A side effect of her treatment included hearing loss, which I found occurs in about 1 in 5 patients that receive the chemotherapy drugs cisplatin or carboplatin. During the session, I had to repeat myself several times and talk louder than normal. At times, I had to remind her to slow down and pace herself. After most exercises, she would need to sit down for a few minutes before moving to the next one.  Interventions included both static and some basic dynamic balance exercises, including tandem stance, 3-way hip exercise, standing marches, and balance board activities, which were done at the parallel bars with contact guard assistance. I suggested tandem walking to challenge more dynamic balance, but my CI said that she had tried it in previous sessions and it had proved to be too much for her.