On a geriatric placement at a day hospital a female patient presented after a fall. The assessment revealed high scores on the TUG, berg, clinical test of sensory integration and the dynamic gait index and her gait pattern was normal for a lady her age. Manual muscle testing revealed weakness and poor endurance of her pelvic and shoulder girdle muscles. When questioned, the patient reported a noticeable increase in general fatigue within the last 6 months, preceded by the onset and slow progression of fatigue over the past 2 years. My clinical observation and assessment of this patient led me to suspect an underlying neural pathology. An undiagnosed pathology was also suspected by her medical practitioner and she is currently undergoing investigative tests.
When treating this patient with physiotherapy I treat her impairments but am vigilant with continual assessment and modification of her treatment as necessary in accordance with her subjective and objective response. I take this extra care because I want to help her rather than exacerbate her symptoms such as fatigue. I pay extra attention to her clinical presentation because this is all there is to guide treatment as her pathology is unknown.
Upon reflection I think it will improve my skills as a clinician to pay this extra clinical attention to all patients regardless of their diagnosis. No two people are the same even with the same diagnosis. Also, while much is known about the human body and pathology, much remains unexplained and I believe that keeping an open mind even when a diagnosis seems certain and being attentive to clinical signs and symptoms can only enhance practice.
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Diagnosis and its importance... it is interesting how much we rest on a diagnosis, a way of putting a patient in a box, a way a patient puts them selves in a box. I have recently been treating a patient with neurological impairments of no know cause. This patient would love a diagnosis, a name, a source of the impairments... the physios would love a diagnosis... although in the neurological setting, as you mentioned, patients presentations are so inconsistant that you can, only treat what you see...
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