Physiotherapy Update: 6 October 2023
Mr. Mienie has been making clear progress with every session especially since starting with sessions have taken place in the practice. As noted before, we have commenced standing in the standing frame for up to 30 minutes whilst concurrently working on upper limb strength and upper trunk control. In the last 2 sessions, we have started doing active sit -to- and standing endurance in the parallel bars as well, again with clear progress shown between the
sessions where he requires significantly less support to rise and maintain a standing posture. He does however still require continuous support to maintain balance and is not able yet to clearly shift weight or lift his feet. Given his steady progress, I believe that the chances of Mr. Mienie eventually actually achieving a certain degree of walking ability has definitely become a possibility. The process as mentioned previously will however require sustained therapy input
over several months.
I once again would strongly recommend a standing frame for Mr. Mienie at home to facilitate daily standing sessions to improve strength, balance and coordination; he has known it will definitely be possible to manage the rising and sitting at home into the frame with single person support. Your ongoing support will be highly beneficial!
Mr. Mienie was referred for home-based physiotherapy in July 2023 after his recent discharge from an almost year-long hospitalization for neurocysticercosis which led to severe full-bodyparaparesis with complete expressive aphasia. On the initial assessment on 24/07/2023, he presented with the following:
Full body paraparesis with increased tone throughout. He is able to perform restricted active movements of all limbs, trunk and neck however only at a very slow speed and poor muscle control; response to commands is extremely delayed and he therefore remains reliant
on major assistance for ALL aspects – bed mobility, personal hygiene, transfers etc. Despite being able to move his legs slightly he was not able yet to significantly participate in transfers to and from the wheelchair and was essentially primarily lifted by the assistant during pivot transfers with minimal loading onto his legs. As a result of a combination of the prolonged period of being bed-ridden as well as altered muscle tone (hypertonic in flexor muscles mainly), he generally adopted a flexed posture resulting in restricted RoM of multiple joint ranges (hips, knees and shoulders worst with lesser degree of restrictions of the elbows and wrists and fingers)
Due to poor oro-facial muscle control, he is on enteral feeds via a PEG tube. Since July he has received 7 sessions of physiotherapy – initially at home but for the past 2sessions at the practice with gradual improvements:
In practice, we have managed to let him stand in the standing frame – initially for 10 minutes with very restricted hip and knee extension and subsequently for 20 minutes with a much more upright posture and being able to maintain his upper body position with minimal assistance for
short periods. His ability to actively participate in the transfers is improving clearly with each session withworkcurrently starting to focus on achieving independent pivot transfers with only supervision. Mr Mienie is also starting to propel his own wheelchair for a short distance and very slowly at present on level in-door surfaces, strength, co-ordination endurance need to improve significantly to achieve a more functional degree of self-propulsion but he is diligently working on his functional capacity. Mr Mienie only received limited authorization for outpatient physiotherapy and has shown significant improvement in personal function with a major reduction of the burden of care to his primary carers – his wife and sons. He clearly has the potential to achieve significant further improvement and possibly a significant degree of independence in particular in relation to transfers and mobility but most likely also in other aspects of self-care if he is able to continue with regular therapy sessions. Given the extent of weakness and dysfunction emanating from almost a year of hospitalisation and multiple severe setbacks his recovery period is likely to extend over at least another 4- 6 months with weekly and later fortnightly sessions at minimum to fully optimize his ultimate outcomes. An extension of benefits for this purpose would greatly enhance his quality of life whilst further reducing the severe burden of care on his family.
It is also recommended that a standing frame be supplied to allow regular and much longer periods in standing which would have significant benefits both for his strengthening process also on other aspects such as maintenance of bone density, improved bowel function and normalisation of muscle tone among others.
