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Cooperative Case Studies
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Cooperative Case Studies - October 11, 2002 8:15:00 PM
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flexion
Posts: 151
Joined: August 7, 2002
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I'm curious if there are DCs and PTs out there that would like to consider a few cooperative learning threads? I personally don't have much background into PT and I would imagine many PTs would be the same with DC.
I propose we pick a sample case that clearly overlaps our skill sets and then we each could comment on how we would handle the case from our perspective in a non-condemning fashion. This could be a way for our professions to understand each other better.
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Re: Cooperative Case Studies - October 12, 2002 10:52:00 AM
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Bournephysio
Posts: 586
Joined: April 25, 2002
From: Calgary
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Interesting idea. It could lead to some interesting discussions even if DCs weren't replying on this forum.
Do you want to start with a short case with a Hx, assessment, your Dx and Rx? If a respondant wants to do different tests or ask specific questions should they make up the answers or ask the person supplying the case study? Everyone should try not to use profession specific jargon. Try and explain what a specific test is or how a specific treatment works.
Doug
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Re: Cooperative Case Studies - October 12, 2002 9:33:00 PM
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flexion
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I'm open to suggestions on how to proceed. I somehow think that a Hx or Dx process would be similar between professions. Definitely the Tx area would be the best learning for our time. Say start with a case that has a Hx and Dx provided and then we start off from where we manage the case.
Anyone have some sample cases?
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Re: Cooperative Case Studies - October 14, 2002 2:40:00 AM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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I'm always most intersted in pediatrics cases such as CP, but I think that most on this forum would rather fancy something in the outpatient ortho area.
Okay then, let's suppose someone walks into your DPT or DC office off the street with neck pain, and shoulder pain upon Hawkins-Kennedy testing. How should the DPT or DC proceed with examination?
Drew
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Re: Cooperative Case Studies - October 14, 2002 4:50:00 AM
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flexion
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To get to the part about Dx/Tx we'd need to get the whole Hx first otherwise there will be a huge number of variables to consider.
Looking the chief complaint (CC) we'd start with a CC:
Primary: Neck Pain (R)
Secondary: Shoulder Pain (R) - noted on forward bending of arm to 90' when someone else turns the shoulder in rather forceably.
I'd want to know about anti-depressants for example. Does anyone have a neck/supraspinatus case OPQRST (onset, etc..) Hx kicking around?
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Re: Cooperative Case Studies - October 14, 2002 1:40:00 PM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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I don't understand what comment you mean. Perhaps you meant to post in the other open forum thread where it's being discussed how the DPT allows for students to apply for post-graduate fellowships upon graduation, whereas you, with a BS or MPT would not be considered.
There is a difference.
Drew
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Re: Cooperative Case Studies - October 14, 2002 2:59:00 PM
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Andrew M. Ball PT PhD
Posts: 855
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From: Charlotte, NC
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SJSJSJSSJ,
THAT offends you? The fact is that there are twice as many PT schools as there were 10 years ago, and 50% of them are DPT programs or will be accepting their first DPT classes next year. The academic standard in physical therapy is now the DPT. Period. End. Like it or not. The professional vision is that we will ALL be DPT's by 2020. If you as a BS or MPT don't agree with that, you're a day late and dollar short in the discussion. Your choice now is to get a t-DPT, or not. That?s not a vision that I particularly agree with, but it is the professional vision. Denial won?t change that.
To become offended at the fact that physical therapy is emerging into a clinical doctoring profession is a waste of your time, and an even bigger waste of mine to respond to. When interacting with another clinical doctoring profession, especially chiropractic, it is incumbent upon us, NOT OPTIONAL, to remind them what we as physical therapists are members of a clinical doctoring profession as well, on an equal rung on the healthcare ladder as they, OD's, and DDS's.
To do otherwise undercuts the value of the DPT, and sabotages the professional evolution of physical therapy --- not to mention the public perception of DPT's (and by extension all physical therapists) within the healthcare community. Your insistence on NOT using DPT de facto relegates physical therapy, even at the BS level, to subordinate to DC. WE ARE NOT! Perhaps you've not thought this through, but I'd counter that your public charge of being "offended" by my initial comment boarders on the inappropriate and anti-professional. Especially for the rare occasion of a DC/DPT collaborative clinical discussion. If you?re content at the level you?re at, and don?t want a DPT or advanced degree, that?s fine, but I will not allow for you to propagate the view that the DPT isn?t the industry standard simply because you don?t agree with the vision, or you?re upset at not having one. That, my friend, would be unethical.
Drew
If you'd like to respond, please do so in the forum about the value of the DPT. This is not the appropriate place. If you choose to respond in any manner other than that of the case discussion, I'll have your posts deleted for violating the rules of this board.
[This message has been edited by Andrew M. Ball PT PhD (edited October 14, 2002).]
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Re: Cooperative Case Studies - October 15, 2002 3:00:00 AM
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Sebastian Asselbergs
Posts: 1227
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From: Barrie, Canada
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Dr. Ball: "If you'd like to respond, please do so in the forum about the value of the DPT. This is not the appropriate place. If you choose to respond in any manner other than that of the case discussion, I'll have your posts deleted for violating the rules of this board."
A tad heavy-handed, are we? Your post does a grave disservice to the professionalism of PT.
In my community, I have NEVER needed a "D" to elicit respect and equal footing status with MDs, DCs, or specialists. I earned that by being a good clinician with years of post-grad training, not by being a lauded academician. The whole issue of respectability and value for a profession coming from a title is plainly laughable; it seems you think the title is a great marketing tool. It may be in the academic world you live (it wasn't in the one I lived in), but between the insurers, the patients, and other health professionals, it just doesn't make a **** bit of difference.....
Now, if you want, you can have me deleted and blocked from the site. It will tell all participants more about you than you may want to admit to...
Sebastian
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Re: Cooperative Case Studies - October 15, 2002 7:58:00 AM
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Bournephysio
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From: Calgary
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Lets try and get this back on track. Does anyone have a good case study? I won't have time to make something up for at least the next week. A shoulder/neck case could be good.
Doug
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Re: Cooperative Case Studies - October 15, 2002 6:02:00 PM
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flexion
Posts: 151
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Initially I would be curious of the exact onset and duration of symptoms, why the previous laminectomy was performed, and how the pain in his shoulder was different than previous to surgery. I would check bloodflow to the arm. I'd order some neck and shoulder x-rays (maybe chest?) and do some cranial nerve testing as a start.
I'd pick 1) out of the differentials if all the tests were clear; but the trapezius fasciculations would still have my interest... CNXI or just C3/4 DJD?
1) Degenerative Disc
2) ALS (Lou Gehrig's)
3) Myopathy
4) CN XI area or Pancoast tumor
Should a few of us give our thoughts on the Dx part and then pick one Dx as the consensus from which we all can then provide how we would Tx?
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Re: Cooperative Case Studies - October 16, 2002 2:30:00 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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SJ, has an EMG been suggested? Fasciculations are thought to be a sign of nerveroot damage - could be ruled out by EMG.
Sebastian
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Re: Cooperative Case Studies - October 16, 2002 7:24:00 PM
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flexion
Posts: 151
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Thanks for the added info. I still would think that the chronic denervation related to a disc would be the most common thing to happen. Sounds strange that all those muscles would develop a tendonitis at the same and the neck isn't involved.
I like the idea of an EMG. That would rule out quite a bit. The trapezius fasciculations still are baffling to me. With the new info, ruled out local tumor and insidious onset I'm more suspicious of something like a syringomyelia secondary to the surgery as well.
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Re: Cooperative Case Studies - October 17, 2002 5:20:00 AM
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Diane
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Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Flexion, you are to be commended for starting this thread. It is the most positive use of this bb I have seen since I joined. Thank you.
SJ, perhaps you meant thyroid, not thymus?
If this were my patient I would check soft tissues to see if lev scap and trap were hung up on one another somehow.(Or any other directional pullers for that matter..) They co- contract and move upon one another but in diagnally opposed directions. Nerves and vessels have to travel between them... These structures will set up pain referral if they feel compromised. They will set up dysfunction (such as increased tone) to the point of making a disc bulge...how would taking out the disc fix the problem if the disc isn't causing the pain?
Fasiculations suggest nerve involvement...and, as per David Butler, nerves can be affected anywhere along their routes, not just at their vertebral exit. Or in this case, maybe their foramenal exit from the skull.... I would definitely assist the soft tissue to move functionally, using all the manual therapy techniques at my personal disposal (including all the renegade ones,) hoping to free up space that can assist circulation to nervous tissue, hoping to move the "pain" pattern off the square that it is on.
Hope this contribution hasn't offended by being practical/intuitive as opposed to EBM. [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
Diane
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Re: Cooperative Case Studies - October 17, 2002 9:39:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Diane,
I'd argue that your comments, although not the quoting of studies, were nevertheless part of the evidence-based decision making process . . . which is the integration of experience and clinical art with the literature base. Because I tend to shout out about reviewing the literature base, I think I've given some RehabEdge members the idea that my position is that if something isn't backed up in the literature, it must not be done in the clinic. That's not at all my position.
I belive that BOTH clinical art and literature base must be taken into account in the evidence-based decision making process. The term "evidence-based-medicine" doesn't imply this, and for this reason, I suggest the term "evidence-based-decision-making," as more descriptive of what the goal acutally is in physical therapy.
One can't exist without the other in the evidence-based decision making process. If more of the experienced clinician ranks of our profession understood that better, perhaps they might feel more comfortable approaching and self-reviewing their clinical art in integration with the literature base. It might not be so scary, or so ego-bruising. If, by the same token, new graduate DPT's had a healthier respect for clinical art, they may not throw out the proverbial baby with the bathwater when they run into an NDT artist who says, "I know what I see, it just works, and that kind of quality can't be measured," after reading the Herndon study which clearly shows that NDT instructors can't tell the difference in the before and after tapes of children treated for 6 weeks with NDT for an hour or more 5 times per week.
As such, I actually think that the best way to approach this clinical case is the way that those using RehabEdge tend to operate --- making no excuses for where their philosophies rest on the strictly literature to strictly art spectrum. True evidence-based decision making strikes a harmonious balance, but some clinicians are more comfortable tilting more one way than the other.
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