The remaining questions focus on the same patient case. You will be given details about the patient and asked to answer questions that reflect your critical thinking about the case. You may see some details repeated. Each time, there is a new question attached to the information, so be sure to read carefully. Now, meet Betsaida…. Patient Name: Betsaida Rodriguez Age/Sex: 74 y/o cisgender female (she/her) who identifies as Latinx Presenting Problem/Current Condition: R hemisphere CVA, onset 1 week ago Setting: Initially presented to the ER via ambulance, was stabilized in ICU. Now has been transferred to inpatient rehab unit to begin intensive therapy (PT, OT, speech). Medical History: HTN, DM II, hypercholesterolemia, h/o cataract removal 2021, OA R knee.  Medications: Glipizide, Zocor, Benazepril, Ibuprofen PRN Social History: Betsaida is a widow who was married for 52 years before her husband passed away. She now lives alone. Betsaida is a retired administrative assistant for a large communications company and has health insurance from that career. She enjoys spending time with her daughter, son-in-law, and 3 grandchildren (ages 3, 4, and 7), and traveling to visit national parks.  Home setup: Single level apartment with one step to enter, no handrails. There is thick carpet in all rooms, except for tile and throw rugs in the bathroom and kitchen.  The bathroom has a shower stall only (no tub), standard toilet seat.  Prior Level of Function: Independent with all ADLs, mobility, and driving. She has a Pomeranian which she walked to a nearby park daily.  She plays the organ at her church every Sunday.  When she travels to national parks, she goes on 1-3 mile hikes on relatively even terrain, due to her knee OA.  Goals: “I want to go home and keep doing the things I was doing before.” How could social determinants of health and/or personal factors potentially impact Betsaida’s care and recovery? Include at least 2 considerations. (2 pts)

You are on a home evaluation visit on a Tuesday with a patient who will be discharged home in 3 days. He needs a wheelchair for all mobility and requires Max A for transfers. He lives with his wife and 8-year-daughter in a rented apartment, all of which is accessible in his wheelchair except for the doorway of his bedroom.  What recommendation to his family would be most appropriate to allow for a safe discharge in 3 days?

Stress with work can affect family interactions; stress with family can affect work interactions.

You are conducting a home visit with a patient to make recommendations once she is discharged from the inpatient rehabilitation program. She has had functional decline and increased fatigue, and was recently diagnosed with multiple sclerosis. She will be using a motorized scooter upon discharge.  Her home is single level, but has four steps to enter. Each step is 7” high. Based on ADA standards, what is your recommendation for the length of a ramp to allow her to access her home? 

Which of the following statements below is true about impaired selective voluntary motor control (SVMC), also known as “abnormal synergy”?

Nomie (they/them) is 14 y/o and recently sustained a severe traumatic brain injury in a motor vehicle accident.  They are able to ambulate 150 feet with verbal cues only from the PT or their mom, before fatiguing and needing to rest.  What FIM score would Nomie receive for locomotion?

Which of the following sources of performance appraisal data is typically more appropriate to inform pay and promotion decisions?

You are treating a patient with a head injury on a Saturday who was evaluated on Friday afternoon by another therapist. You note in the evaluation that the patient has MAS 3 in her left ankle plantarflexors. ROM is within normal limits. What would you expect to see in your patient’s walking as a result of this? Choose all that apply. 

Home setup: Betsaida lives alone in a single level apartment with one step to enter, no handrails. There is thick carpet in all rooms, except for tile and throw rugs in the bathroom and kitchen.  The bathroom has a shower stall only (no tub), standard toilet seat.  Betsaida will be discharging home. With this in mind, identify two anticipated environmental factors related to this case and make a recommendation for each in order to maximize her safety at home. (2 pts)

Movement Analysis:   Posture: Betsaida is sitting in a bedside chair with armrests when you enter her room.  She has mildly kyphotic posture with forward head and shoulders, and posterior pelvic tilt.  Her weight is shifted towards her right side and she is leaning on her right elbow on the armrest of the chair.  Her left arm is flexed at the elbow and wrist, and resting on her stomach. Movement: Betsaida has been using a LBQC for walking. After putting a gait belt on Betsaida, you ask her to stand up and walk a few steps with you.  She immediately scoots forward in the chair a few inches, then rocks back and forth several times as she attempts to stand.  You notice that she is putting the majority of her weight through her right arm and leg, and is shifted away from her left side.  She ultimately requires Mod A from you to stand up.  Once she is standing, she grasps the LBQC with her right hand and walks 50 feet with you on the tile floor.  You notice that she has foot flat contact on the left at initial contact, excess knee and hip flexion on the left as she moves through stance phase, decreased trailing limb posture on the left, a short quick step on the right, then L toe drag through swing phase until she comes back to foot flat contact.  The entire time she is walking, she exhibits excess forward flexion at the trunk, with her left shoulder and pelvis retracted and her LUE more flexed and abducted than it was when she was sitting. She does not attempt to use her LUE at all during this task. When she turns to walk back to her room, she staggers a little and moves more slowly.  She requires Min A from you while she is walking and turning.  She walks back to the bed, turns with Min A, and sits down with good control but with the weight through her right arm and leg again. Considering the phases of the Hedman model of task analysis, describe two specific movement problems that Betsaida is facing, and name the phase in which each problem is occurring. (2 points)