Treatment for weakness vs altered muscle activation pattern...

Hi all,
I am currently on my neuroplacement at SCGH. One of my patient is 65 year old male who had PCI. Patient's gait is ataxic and his balance vary significantly from day to day or even between morning and afternoon of same day. Patient showing lack of insight and often overestimates his abilities.He is really compliant with physio treatment and wants to work hard to improve his functional level however, he is stubborn personality and very inpatient and attempts to do things before full explaination/demo is finished. It is my third week of placement and last two monday's morning I find very upsetting as patient had 2 falls when he was trying to get to toilet on his own even though his "mobility chart" says "ambulation 1 A - close supervision".I was trying to explain to the patient that he needs to call for help, that he could fracture his leg ect. My clinical supervisor said it is qiute common problem that patient is trying to experience his abilities.Hoverever it does not make me feel better. My treatment first consisted of: balance exercises ( static,dynamic with all possible variables), walk, protective responses training and exercises to decrease ataxia AI's and RS's. I've noticed that balance even vary improved whereas I was not satisfied with patient's gait especially his trunk moving forward and backward with preference for backward (the patient tends to fall backward). So after consultation with my supervisor I added more abdominals exercises and moved toward building endurance in walking by increasing distance. Additionally, I noticed some weakness (not significant) in LL and decrease the ability to produce fractionated movements in LL (L>R). Can anyone give me some suggestions what sort of treatment can be used to improve ability to fractionate movements.

Thanks,
Daria

"Likely MS" diagnosis

Hi all,
I am currently on my neuro placement in SCGH. Last week I treated a patient with "likely MS" diagnosis.

This patient presented at the beginning of last week with neurological symptoms such as altered sensation (R) face, double vision lasting for more than 1 hour, decreased hearing (R) with tinnitus, numbness (R) arm plus (R) leg. Everything started suddenly in November 2007 with loss of balance.
I found really hard to treat this very nice and cooperative patient and I had to constantly think about wards I am using and how I communicate with this particular patient. During the treatment I was trying not to use the words that would indicate that patient has definite MS even mentioned earlier neuro symptoms plus fatigue, depression, headaches seem to match MS very well.
The patient has asked one of her friends to find out on internet about MS, another friend who is nurse was helping in interpretation. The doctors were doing extra investigations to confirm/exclude MS diagnosis. I knew that it is very hard time for this patient like wanting for a sentence. On the one hand patient wanted to know as much as possible but on the other hand probably wanted to find out that doctors are wrong. To be honest I wanted to believe that it is not MS, too.
In addition, this patient (female) is only 4 years older than me. She has loving husband, beautiful daughter, good job and suddenly everything may have to change. At the end of week this patient sensation, balance have improved a lot, gait has become more stable but still slow on top of this patient finds balance exercises very tirying and has to concenetrate o lot.
To sum up, I think that treating patients with degenerative disease can be very rewarding but depressing,too

What is patient’s priority?

I finished 1st week of my neuro placement at SCGH. One of my patients case seems to be very interesting when I analyzed his social history, past medical history, his attitudes toward his health. The patient had PCI before that he had 2 episodes of vertigo, blurred vision, slurred speech and couple falls. However, he ignored these signs. He is 65-year-old male with history of HTN, CABGx3 who smokes 25g tabbaco per week and drinks 1 L wine per day. As the patient has own business and lives alone his social circumstances absorbing him more than his health state. Patient verbalized couple times he wants go home even after doctor has educated him about his condition which deteriorated, necessity of further investigation and rest in bed ( head flat to 30°) in order to improve blood supply to his brain. At that stage, it was interesting to see how results of investigation match with signs (↓ level of consciousness). Now I understand what Anne meant by person appears to be sleepy.
I find this case difficult as well as challenging. On the one hand, the patient is very compliant/ cooperative during physio treatment on the other hand he shows unawareness of his state and even ignorance and I know that sorting out his social issue ( own business) is his priority.