Case Study 1

[Mcarrion94]

The patient is positioned in supine at the beginning of her evaluation. The therapist asks the patient to sit on the edge of the bed to perform manual muscle testing, and the patient requires minimal assistance for rolling to sidelying, moderate assistance for transitioning to sitting, and minimal assistance to maintain sitting balance. Which standardized outcome measure is most appropriate to assess functional status?

I don’t understand how the PASS would be an appropriate measure for this patient compared to the FIST. While the PASS certainly assesses across a wider range of functions, given her current level of impairment I would think the FIST more appropriate in the items that are on it?

The patient is preparing for discharge home after 35 days of inpatient rehabilitation. She is independent with bed mobility, requires supervision for safety with transfers, and requires minimal assistance for ambulation. Left hemispatial neglect is the primary impairment interfering with independence, as she continues to walk into objects on her left without maximal cues. Upon returning home, the patient will be alone for three hours per day while her family is at work, so she is procuring a wheelchair. Which is the best option for this patient?

It states the correct answer as Manual wheelchair with low seat-to-floor height. My chosen answer was Power wheelchair with joystick on the right.

While as a therapist in real life I would agree that a manual chair would be appropriate given how early it is in her recovery, I don’t understand what in this question supports a manual chair as an answer. It states nothing regarding use of her arm vs foot propulsion?

As a disclaimer I’m a terrible test taker so it’s entirely possible that I’m approaching these questions more as a clinician than as an assessment of pure knowledge.

• This topic was modified 1 week, 4 days ago by Mcarrion94.

[Chrissy Durrough Lugge]

Hi there!

PASS vs. FIST: Given that the patient is requiring assistance for bed mobility, sitting balance, and presumably transfers and standing – all of which will likely be goals for her PT plan of care – it makes sense to select an outcome measure that quantifies all of these aspects of mobility. The question asks about the best measure for assessing functional status, not specifically sitting balance.

Also, the PASS is a highly recommended outcome measure by the StrokEDGE task force.

Wheelchair selection: The key here is that left neglect is her primary impairment. Power wheelchairs can be dangerous without appropriate perceptual abilities. The patient is walking into objects on her left without cues – and this would likely be exacerbated in a wheelchair that moves faster than she is probably walking. She requires only supervision for transfers and minimal assistance for gait, so we can assume that she has adequate strength for foot propulsion (and possibly UE propulsion- we aren’t given information about UE function). The patient will be alone for much of the day, so a manual wheelchair with brakes accessible to the patient is a better option than a transport chair.

Hope this helps!

Chrissy

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