A 49-year old man was brought to the ER after he fell down and hit his head, after a convulsive episode. On
admission he was confused at first, but slowly recovered his alertness over the next hour. The family states
that this was the first such episode, but that he had complained of a headache several times over the past
few weeks. He complained of nausea, dizziness and was having a hard time remembering his address and
did not remember the injury.
The family reported that he had suffered a stroke a few years ago and this may have triggered his fall, given
his weakness on the right side of his body and frequent loss of balance. The family said further that the
patient doesn’t seem like his old self since he fell. He is now emotionally labile, sometimes irritable and
aggressive, sometimes euphoric and silly, and rather more talkative than usual. He was forgetful – when
beginning a task- he then quickly switched to another task, then another, never quite completing anything.
He seemed to decline in his functional ability anytime his large family came to visit in his hospital room or if
the TV was on during therapy.
Mental Status. On examination, the patient was able to understand and respond verbally to simple, one
step commands, but had difficulty with more complex instructions. He knew where he was and recognized
his family members, but not consistently.
Cranial nerves. The right side of the patient’s mouth drooped a bit, and he smiled asymmetrically. He had
normal eye movements. He could raise his eyebrows when asked, symmetrically.
Trunk and limbs. The patient could use his right arm, but it was quite a bit weaker (3/5, grossly throughout)
when compared with the left arm (4+/5). Right LE was also weak, but stronger than UE (4-/5) and left LE
presented as 5/5, strong, with myotome assessment. The sensation was impaired in the right upper extremity,
grossly, and LE on the right side when a testing patient with a light touch, sharp/dull and two-point
discrimination.
Balance: Patient had difficulty with sitting on the edge of the bed without falling over, particularly to the right
side.
Bed Mobility: Rolling to the right side, independent, but rolling to left side was maximum assist. Bridgingmoderate assist; scooting – moderate assist and used more of the Left side > Right to assist.
Transfers: Sit-stand: Moderate assist on right side, due to right LE giving out upon standing and patient
falling to right side. Chair Transfer from bed: Maximum assist with stand, pivot transfer.
Gait: Moderate assist X 10 steps in parallel bars. Gait was ataxic and patient demonstrated several loss of
balance episodes during the 10 steps forward.

• You may utilize your notes, textbook, power points and any information provided in class to help you
  answer the questions below

1. (3 points)
   What is the level of the neuroaxis for this patient, given the symptoms?

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Which specific neurologic structures appear to be damaged, given his symptoms?

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1. List the top 4 examinations/assessments as physiotherapy you would choose to include for this patient,
   given his symptoms and discuss why you chose them as a priority for this patient? (4 points)

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1. Utilizing a motor control and motor learning approach, please outline your evaluation of this patient by
   listing 5 impairments and related task-oriented problems, with specific environmental-related constraints. (5
   points)
   Impairments T
   
   ask-oriented problems related to impairments Environmental Constraints
   
   Name _______________
2. (part A (4 points) + part B (4 points))
   (A). Complete Gentile’s Task Analysis Chart for the following task (see assigned task instruction)
   Environment Body Stability Body Transport
   No object manipulation Object Manipulation No object Manipulation Object Manipulation
   Stationary
   No inter-trial variability
   Stationary
   Inter-trial variability
   Motion
   No inter-trial
   variability
   Motion
   Inter-trial variability
   B) Discuss specific motor learning protocols for treatment for this patient (i.e. discuss type of practice, sets,
   reps rest time, type of feedback (if any)), for your patient in the assigned task and according to the assigned
   stage -either cognitive, associative, or autonomous stage (refer to instructions for this assignment)
   no plagiarism
   all so simple focus in traumatic brain injury and n cerebellar ataxia