Scenarios

1 You have a 75-year-old patient who had a stroke affecting their (R) side. Although they can
now walk, when they do so you notice that they look very unsteady and are tending to fall to
their (R) side.
Important Points:
Stroke affecting right side
Can walk but unsteady and falling to right side
Ideas:
Was a gait analysis done? What compensatory movements provide indications of the
falling to the right side
Quad stick
Oxford scale mm strength testing
Bergs balance scale is option for assessment of falls risk
2 You have a 35-year-old patient who fractured (L) ankle and who was in a left short leg POP
for 6 weeks. The plaster has just been removed.
Important Points:
# L Ankle
L short leg POP 6/52
ROP (Removal of plaster)
Ideas:
NWB
Mm length test good and bad side calf
Mm strength test good and bad (calf, dorsiflexors)
Contractures/weakness in hamstrings, calf, TA
3 You have a 25 year old patient has undergone (R) knee surgery and post-operatively
remained in knee splint for 6 weeks with their knee in 30 degrees flexion position. The splint
has just been removed.
Important Points:
Right knee surgery
Knee splint for 6/52
Knee in 30 degree flexion
Splint just removed
Ideas:
AROM/PROM each side
Contractures of knee flexors - length test
Weakness in knee extensors/flexors - oxford
4 You have a 50-year-old patient who underwent surgery a couple of months ago to repair a
ruptured (L) Achilles tendon. They are now allowed to walk (L) FWB but when they walk you
notice at initial contact that the (L) toes strike the ground (i.e. (L) ankle is in plantar flexed
position) and the (L) knee is flexed.
Important Points:
50 y.o. surgery a few months ago
Ruptured L Achilles tendon
FWB
Initial contact L toe strike - plantar grade
L knee flexed
Ideas:
Mm length test - good and affected side (dorsiflexors)
AROM knee both sides
5 You have a 65 year old who underwent a (R) total knee replacement a couple of months
ago. They report that they are having difficulty getting up out of a chair. When you observe
their movement as they stand up you notice that they lean to their left side and are not
bringing their right foot as far back as their left foot.
Important Points:
65 y.o. Total R Knee replacement - few months ago
Difficulty getting out of chair - look at sit to stand
When stand they lean to L and not bringing R foot a far back as L
Ideas:
AROM/PROM knee both side, pain?
TUG test
Oxford Strength Test ?
Sit to stand analysis
6 You have a 70-year-old patient who has advanced osteoarthritis in their (L) hip. When they
go to stand up you notice that they lean onto their right side and are not leaning forward very
far, and that they move slowly.
Important Points:
70 y.o. osteoarthritis in L Hip
Stand up they lean to R and don't lean forward very much - minimal trunk flex
Move slowly
Ideas:
Sit to stand (Bergs Balance Test or Motor Assessment Scale?)
AROM on Hip
Gait analysis ?
7 You have 18-year-old patient who has Guillain-Barre disease, which caused paralysis in
their legs. At this stage of their recovery you notice that the patient cannot stand up from a
chair without using their arms. When the patient does stand they tend to sag at their hips
and knees (i.e. the hips and knees are slightly flexed).
Important Points:
18 y.o.
Guillain-Barre - paralysis in legs
Cannot sit-to-stand without using arms
Standing: hips and knees are slightly flexed
Ideas:
MAS - sit to stand (for reference)
Oxford Strength Test
Knee and hip flexors and extensors
8 You have a 20-year-old patient who is recovering from a recent (L) upper arm muscle injury
and is having trouble straightening (extending) their elbow.
Important Points:
20 y.o. recovering from L upper arm muscle injury
Trouble straightening/extending elbow
Ideas:
Weakness of triceps
Shortening of biceps/Brachialis
Muscle Length Testing Brachialis/Biceps
Oxford Strength Test - Triceps
9 You have a 19-year-old patient who badly sprained their (L) ankle a few weeks ago is still
having trouble walking. When you observe them walking you note that at mid to end of stance
phase the patient lifts their heel early and they tend to turn their (L) foot out more than (R)
foot. In addition, you note that they have an uneven step length with the (R) step length being
shorter than the (L) step length.
Important Points:
19 y.o. badly sprained L ankle - few weeks ago
Trouble walking
Mid to end stance phase - early heel lift, turn L foot out more than R
Uneven step length R shorter than L
Ideas:
AROM - good and bad ankle
Pain/habit
Strength on calf and length of calf?
10 You have a 65-year-old patient who had a stroke affecting their left side 18 months ago.
The patient is having trouble grasping and manipulating objects with their left hand. At rest the
patient holds their arm with elbow flexed to 70 degrees, forearm fully pronated, and wrist and
fingers flexed. When trying to grasp a cup you note that the patients (L) forearm remains
pronated, (L) wrist remains in a flexed position, and they are having trouble opening and then
closing their fingers around the cup.
Important Points:
65 y.o. stroke 18 months ago
L hand - trouble grasping and manipulating objects
At Rest
Elbow flexed 70 degrees, forearm fully pronated, wrist and fingers flexed (L)
Lifting a cup
L forearm remains pronated, L wrist flexed, difficulty extending and flexing
fingers around cup

Ideas:
MAS - upper arm and hand movement + advanced (6,7,8)
Grip Strength - Dynamometer