Last week was spent adjusting into a new setting… from treating patients who were fully independent (Musculoskeletal outpatient) to patients who require min-max (A) (Neuro Inpatient).

Saw a few cases. One which left a deep impression was a patient with ?GBS. It was interesting, though sad for the patient, to witness how the patient’s functional status changed over a course of period within such a short time:

Tue: Prox UL, LL weakness Grade 3/5, (I) bed mobility & transfer, (I) STS, X2 Max (A) amb; tingling sensation in hands and feet

Wed: Prox UL, LL weakness Grade 2+/5, (I) bed mobility with effort, x1 min-mod (A) transfer, x1 min (A) STS, unable to amb; tingling sensation in hands and feet

Thurs: Prox UL, LL weakness Grade 2/5, x1 min (A) supine to SOEOB, x1 mod (A) transfer, x1 (A) STS; tingling sensation in hands and feet

Fri: Prox UL, LL weakness Grade 2/5, x1 mod (A) supine to SOEOB – poor movement pattern, x2 mod (A) transfer; tingling sensation in hands and feet. Tingling in feet worse than before.

Over the 4 days, he also complained of increasing weakness on (R) side of face and difficulty chewing on that side.

From this case, I realized:
- the importance of knowing the pathophysiology of the condition. It is essential for patient education and for consideration during treatment planning.
- the importance of reassessment S/E and O/E, modifying our treatment goals and plans due to the clinical course
- importance of including patient in rehab. Initially I was planning treatment based on impairments and forgot to include patient in goal setting. Later with prompting from the clin tutor, I asked the patient his goals. His goal was to gain (I) in bed mobility. Based on his goal, we retrained the functional activity. The patient improved with practice and was very pleased with the outcome. He was also more motivated with rehab. This made me realize we should always consider patient’s goals in our treatment planning.