Case Study: Complex Regional Pain Syndrome
You are the PTA/OTA in a multidisciplinary private clinic that is located in a large medical building with family physicians, specialists, a medical lab, and a pharmacy. The clinic includes two full-time physiotherapists, two chiropractors, a massage therapist, and a part-time occupational therapist. The clinic has a full range of therapeutic modalities including TENS, IFC, Laser, ultrasound, and basic exercise equipment such as a stationary bike, a treadmill, free weights and balance training equipment. Nursing Assignment Help
You are working with Keith Riverside, a sixteen-year-old high school student who has been diagnosed with complex regional pain syndrome (CRPS), a severe chronic pain syndrome that involves the sensory, motor and autonomic nervous systems. He has no other medical concerns.
Four months ago, Keith twisted his right ankle playing basketball, and was treated immediately with ice and elevation. In the emergency rooms, x-rays failed to reveal a fracture. Keith was sent home with a diagnosis of a grade II ankle sprain and instructions to continue icing, wrapping the ankle with a tensor bandage, and using crutches for NWB ambulation.
Two months later, the pain was continuing to get worse instead of better, so his family physician requested an MRI, which revealed a stress fracture of the calcaneus. Keith was given a hard cast for one month. His pain continued to increase, so his family physician removed the cast. At that time, the physician noted persistent edema, sweating, allodynia (pain from stimuli that are not usually painful) in the foot and ankle and increased temperature in the lower leg and foot. He sent Keith for a bone scan which revealed a decrease in bone density. The physician diagnosed Keith with complex regional pain syndrome, prescribed Percocet and referred him to your clinic.
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Prior to his injury Keith was active in sports at school, including basketball, volleyball and downhill skiing. He has not been able to participate in sports since then. He dropped his physical education class, but has been able to continue with his other courses. He has also limited his time socializing with his friends, because he finds it embarrassing when he can’t keep up.
Keith lives with his mother, stepfather and ten year-old half-sister in a townhouse with several flights of stairs. He has a good relationship with all of his family members, including his father, who lives out of town but speaks regularly with him on Skype. Because of his age, Keith qualifies for publicly-funded physiotherapy services, which is fortunate because Keith’s stepfather was laid off from his construction company, so money has been tight, despite financial support from Keith’s father. Nursing Assignment Help
Questions
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Identify two determinants of health that may affect Keith’s rehabilitation and overall health and describe their potential impacts (refer to the IntRh student workbook and www.thecanadianfacts.org).
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Aside from the Numeric Rating Scale, what is another method of pain assessment that could be used with Keith? Give a rationale for your answer.
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Today is Keith’s first session with the contrast baths. What temperatures would you use for the warm and cool water? Why?
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It is February, the temperature is well below zero degrees and there is a lot of ice and snow. What advice would you give Keith about going outdoors?
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The physiotherapist would like you to teach Keith long arc quads with an 8 lbs weight, but he cannot tolerate the ankle weight around his ankle because of his hypersensitivity to touch. How would you modify the exercise?
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Today the physiotherapist has inserted 5 acupuncture needles in Keith’s lower extremity and one in his hand. He is sitting in a chair in a treatment room. There is a plinth next to him. You go in to check on him and notice he looks pale. He tells you he feels like he is about to pass out. What would you do?
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The physiotherapist has decided to refer Keith to the occupational therapist. What do you think the OT’s role would be with this client?
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Three weeks have passed and Keith’s pain and allodynia have decreased, although he still has trouble tolerating a lot of touch on his foot and ankle. He doesn’t want to take Percocets anymore because they make him “feel weird”. The physiotherapist consults with the physician, and the physician prescribes a gradual decrease in medications. The physiotherapist tries TENS at a frequency of 2 Hz and finds it is effective in helping Keith manage his pain. Nursing Assignment Help