42 yo female accountant Chief Complaint 4-month history of i…
Questions
42 yо femаle аccоuntаnt Chief Cоmplaint 4-month history of intermittent right-sided neck pain and intermittent headaches that have gradually increased in frequency. She cannot identify a specific injury but recalls an association with a period of increased lifting and carrying when moving. Subjective History Symptoms: R sided neck pain that sometimes radiates to the medial shoulder blade region and sometimes to the head. Pain begins in the neck and may spread into the right temporal region. Reports a "deep ache" in the shoulder blade and base of the head that creates a headache when exacerbated. Symptoms worsen with: Prolonged computer work Repetitive or long term looking over the right shoulder while driving Lifting or carrying 20 lbs for longer than 10 minutes Symptoms decrease with: Heat Pain Ratings Current: 2/10 Best: 0/10 Worst: 7/10 Additional Information: Symptoms alleviated with 600mg ibuprofen Denies dizziness, diplopia, dysarthria Sleep occasionally disturbed when symptoms are more severe. Medical History Infrequent episodes of neck pain over the past several years. No history of concussion. No cervical surgery. No known migraine diagnosis. Patient Goals Reduce neck pain and headaches. Complete a workday without symptom escalation. Return to Pilates and group exercises classes comfortably. Neck Disability Index (NDI) 18/50 (36%) Patient Specific Functional Scale (PSFS) Activity Score: Working at computer >4 hours 4/10 Checking blind spot while driving 3/10 Reading for 30 minutes 5/10 Objective Examination Observation: Mild forward head posture Slight upper cervical extension posture noted at rest. Cervical AROM: Flexion 45° Extension 55° with R sided neck pain Right Sidebend 30° R end ROM pain Left Sidebend 38° R side “stretch” Neurological Examination Myotomes C5-T1: Strong Dermatomes C4-T1: Intact Reflexes Biceps: 2+ Brachioradialis: 2+ Triceps: 2+ Strength Deep Neck Flexor Endurance Test: 18 seconds Upper Extremity Strength: Grossly 5/5 bilaterally Tenderness to palpation: Right cervical paraspinals Right upper trapezius *Palpation reproduces local neck pain and partially reproduces headache symptoms. Special Tests Spurling Test -- Negative Cervical Distraction-- Mild symptom relief Upper Limb Tension Test A -- Negative
Imаgine Emmа’s mоther decides tо pursue оutpаtient occupational therapy services for Emma. On the first day of services, Emma brings a brand-new deck of cards that she just got as a gift to occupational therapy. She asks if you can use them during the session. Describe 2 activities that you can do with Emma with those cards. The activities must relate to Emma’s case.
Pleаse review the interventiоn аctivity prоvided. Pleаse write an apprоpriate downgrade for this activity. Intervention Activity: Animal Rescue Materials: 3 stuffed animals (no more than 12” each), playground equipment, child-sized backpack with zipper closure, photos of each animal. Set-Up: Have Emma select 3 of her favorite stuffed animals from the OT room. Bring them and the empty backpack to the playground during a time when no other children are using it. Place the animals at different points on the playground (1 at the top of the slide, 1 at the midpoint of the climbing web, 1 across the suspension bridge). Timing: 10 minutes Requirements: Emma will safely navigate the equipment to rescue the animals. If she doesn’t know how/is scared to move, verbal guidance will be tried prior to physical assistance. Process: Emma will don the backpack, then select a photo of an animal to rescue. Emma will have to navigate the playground equipment to reach each doll. The OT will provide physical, verbal, and gestural cues and assistance to help Emma get to each animal. Once she saves each animal, she will remove the backpack, unzip it, and put the animal safely in the backpack. She will then zip the backpack, don it, and pick the next photo. Once all of the animals have been recovered, Emma will bring the photos into the designated OT space to do an art project with them.