Upper Limb Case Summary

The disease has affected motor control over his body, but all mental functions, including cognition, have remained unaffected. His upper extremities, lower extremities, and facial muscles have been greatly compromised, thus decreasing his ability to walk, perform voluntary arm and hand movements, and produce coherent speech. Stephen has been using two canes to aid in ambulation but he has recently had trouble walking or standing without his wife’s assistance. Loss of motor control in his upper extremities has made it difficult to grasp the cane hand grips, feed himself, and perform self-care tasks, such as bathing, brushing teeth, and dressing. Stephen’s speech production has been affected causing his words to be slow, slurred, and sometimes incoherent due to decreased motor control of the tongue, mouth, and facial muscles. The disease has also affected muscles involved in swallowing, increasing his risk for choking while eating and drinking.

At this point, coordination is at a point where falls are often major risks, and considering many cases of the disease occur in the elderly, this can become a fatal risk. Close relatives are soon to become unrecognizable and the long term memory of the individual begins to fade as the disease worsens. It is often that at this point of the disease, the patient is put into a care center, as they may become a burden to the family members around them. Emotions swing and become entirely unpredictable and often resistance to care will occur as the patients lose awareness of their condition and become confused with their surroundings.

There did not to appear to be a pelvic disassociation. Due to the shape of the

He was non-verbal and non-ambulatory, spastic quadriplegic and hydrocephalic. He had a history of asthma, and respiratory distress. Due to congenital malformation of his head, neck and trachea he suffered from obstructive apnea. He was mentally retarded with an IQ of 4 and mental age of 2 months. He could respond to his name, and was able to recognize familiar people. He was on G Tube feeding since he was two years old. He had a trach tube in place for breathing, and a sleep apnea monitor was connected to check his breathing and heart rate, while sleeping or

A visit note from Gregory Carico, MD (Internal Medicine), dated 01/23/2017, indicated that the claimant presented with a history of depression. She was involved in a motor vehicle accident on December 9th. She was relieved from work duties from 12/09 to 01/04 and was able to return to work on 01/10. She was again off work on 01/12 for therapy. She had pain in the thoracic part of the back and lower neck to middle back. She was diagnosed with a sprain of ligaments of the thoracic spine. An

An 89 year old patient came to the emergency room from a nursing home. Per the nursing home staff, the patient had a “floppy leg” and grimaced when that leg was moved. The patient’s advance directive paperwork was provided. The patient is non-verbal. An advance directive is a document composed by competent patient’s that ensure the right of self-determination: the right of every person to make their own decisions about their medical treatment, including the right to refuse treatment (Martin, 2013).

For this research paper my client will be known as H.C. This particular client has suffered from multiple diagnoses during his time at Sonoma Developmental Center (SDC). My client has lived at SDC since 1947, at the age of 13 years old. H.C. willingly came to SDC when his family could no longer cope with his behaviors. He liked to be independent and was an active worker when he worked at his job sites. H.C. had a bundle of past achievements that he enjoyed mentioning to his aides by pointing at pictures. At a frail age H.C. could do his activities of daily living, but needs assistance from time to time. Physically H.C. was a short man with balding white hair and had poor eyesight so he wore glasses. His walking gait was failing and his feet would shift against the floor, so he had a walker that he could use. He was socially withdrawn and would only communicate when he felt that his needs were pressed. He had trouble finding words to communicate what he wanted to say and would like to do things on his own rather than relying on staff. He also lived by his set schedule, so anytime there was an appointment set for him he needed to be reminded before his day began.

The codes M419 scoliosis unspecified is not related to the claimant’s established neck condition, nor is it related to carpal tunnel syndrome or cubital tunnel syndrome. The codes I2510 is for atherosclerotic heart disease, which is likewise in no way related to any of the claimant’s established injuries.

Ms. Kreger reported she was driving on M-15 in Davison Michigan. She stated her vehicle was struck by a large truck on the driver side door. She said an ambulance was called and the Jaws of Life had to cut her out. She stated she was then transported to McLaren Hospital. Ms. Kreger was admitted for care. She said her pain is to her pelvis and hip area. I spoke with Joe case manager at McLaren. I confirmed that Ms. Kreger has a fracture to the sacral and RAMI pelvic fracture. He also said Ms. Kreger would be transferred to Briarwood Manor for rehabilitation. Transfer will either take place on 6/13/16 or 6/14/16.

His past medical history is pretty benign. He smoked only in his youth probably quit before he was 30 years old. There were no chronic diseases. His past history included an appendectomy, cataract extraction in the distant past. He did see Mike Pike at Cary GI for esophageal problems and apparently had a couple of dilatations of esophageal strictures. He had been followed by the neurology clinic by Dr. Perkins for sleep apnea and used CPAP for the last several years. He does have glaucoma. His most significant past history was that he had some type of a follicular lymphoma treated by Ken Zeitler. He took a pill which apparently put it in remission and took no radiation therapy or chemotherapy. Apparently, he was living very independently in all his ADL's. He drove, took care of all the finances, could complete all his ADL's and instruments of daily living. He was actually still working buying produce at the farmer's market and distributing it and selling it to various restaurants. All this came to an abrupt ending on 10/13, when he presented to the hospital with an acute stroke was there for a week. He had some abnormal liver findings. They thought it might be a recurrence of the lymphoma but these were biopsied and turned

Before his diagnosis he would demand attention, he would do this by talking out of turn and just wandering around the classroom. He also would find it hard to follow instructions especially if they are presented in a list. Note taking or writing tasks he found more difficult as he lacked fine motor control, so found it hard to read his own writing and would struggle with lower case b’s and d’s (he would get them mixed up). During group tasks he wouldn’t contribute and would often prevent the rest of his group from completing the task. YP1 also had minor speech, language and communication needs, sometimes he would try and say everything that came into his head before he organised his thoughts so what he was saying didn’t make sense, or struggle

He has had two falls recently. They both occurred when he first got out of bed in the morning and started to walk without taking those few seconds to orient himself. One of them resulted in him hitting the bureau. The other one did not result in any injury. He has not had any closed head trauma with the falls and the falls have not worsened in the vertigo. He does have a history of skull fracture 60 years ago due to a motor vehicle accident, at which point, he was in a coma for 18 days. He has amnesia for most of that time. He is unable to tell me if there were any cognitive or movement sequela from that. He does have cervical stenosis with an MRI of the neck over four years ago at Holy Family. He denies any previous brain imaging other than the recent MRI. He does not have a magnetic gait. His gait is not wide based. There is no truncal instability. There is no hesitancy in his gait. There is no

Upon asking about his daily living, he can bath or go toilet on his own. He can feed himself using fork and spoon. He cannot button his shirts smoothly because of his right hands tremor secondary to Parkinson’s disease. No repetition of words or actions, no episode of losing his way to come home. Decline in calculation and using phones.

Malfunctioning Motor Skills – Incapable of body movement. Mutism. Body clenched in a stiff position. No awareness of environment.

The court system, the Department of Family Children and a medical team got involved on behalf of the twenty two year old male and command that he received professional healthcare daily. There was a strict care plan prepared for the critical disable twenty two year and if the care plan was not