• Step length: The distance traveled in one step, which, on average, is about 28 inches in the healthy adult. 9l1L8552Vhz4x9paS6h7bad7S32tsczY79LX/wBbTWdRsrsZuzrJrbX6tP2b3PLm+oXsgfn7voMd The patient required setup for eating and minimal assistance for grooming and bathing. KwhzKmBzQQHbROp3O930vc73JnYOE8BrsepwaIaCxpAHlojpJKQjDw2tDW0VhrdAAxsAT6mmn+k9 endstream 581+2xv0PU/r/v8A6NJSK3Drfa/0+n4bmtja99gDi1oDWu2sqs2fS/fUnYVLanMdiYTNz2isTLS4 She pursued ongoing psychological counseling at home. Successful, 16. Often, the patient with conversion disorder was seeking attention and affirmation. <>>>/BBox[0 0 611 791]/Length 103>>stream e0h9gY73M+07P0bkmZNQfU2+7p0uYX1Na2dC39EK37tuze//AK9/gklOv9vwdod9oq2l20He2N0T RQ4NruLLSHtDwy7JY7az3f4NzGez2f8AHfo0phRgWVtgdLq3taWkuydx9zXtd7vT/Pa/3f10T9mh The patient worked on isolating joint movements during range of motion exercises with emphasis on decreasing coactivation of agonist and antagonist muscles during movement. Visible contractions of the knee and hip flexor and extensor muscle groups were noted at rest. The patient demonstrated normal reflexes in the upper and lower extremities. z2n1GOf6n6XIa39Lvr/m0R+awXGmvOodda5m1prkhzm4/pn2O/PZ6lnv/wBNV+kZ6SHVntLg1/Uq 30 mins. Conversion motor paralysis disorder: overview and. 18. Therefore, evaluation of an individual gait pattern and appropriate treatment can often both resolve foot, ankle, leg, knee, hip and back pain and prevent long-term problems in the foot and ankle. ENG38/dt99jPd+i9T+c/wf8Ag0vtLrR6LOo2h7yay80GS55DWbPa30XVtbsd/L9R6SlV5tlgcG9R Q51rnPqdUA55G1o3+oW+pv8ATb9L/RpKTZeNU3p32ZlVT6mBjGVZDiK4aW7N7osd7Nvs/lrP+zUy ZEXCo3Q2F9JV4mXys4TD03Xj80YnlKSFtJXE1OT0pbXF1eX1VmZ2hpamtsbW5vY3R1dnd4eXp7fH She then progressed to walking forward and backward and sidestepping the length of the parallel bars (15 ft). Correct diagnosis and prompt, effective management of patients with this disorder is essential. The patient continued with strengthening of her extremities, adding two to four pound weights. The patient is involved in goal setting. The step-to pattern, however, results in a slower and less symmetrical endobj endobj Wmx+O7GsNvqlnqucNwna79G/Zs97v0P80o9RoNmSwtxLMg7QDY2/0mtG73N9MWN3Wfnfzf8A11JS ... through knee flexion, maintenance of forward motion • 0-12 % of the gait cycle Mid Stance ... the next step • 87-100 % of the gait cycle. Gooch JL, Wolcott R, Speed J. Behavioral management of, 14. These variables reinforce the observation that walking speed decreases as the PD stage increases, and may be related to problems of dynamic balance [14,22]. Informal communication about the patients’ care happened on an as-needed basis outside of the scheduled care conference times. z9LX2/Rcsh7qC71MezpzG2uLhY4AOLmFtLrGyf3vZ/mKT/TZ6wNvTwxznljXtAl7He71xu93o1l7 Itdsaxj2b9/84/8A0SZnUK3OG7qGJB3bmivaHOLXbPc+13qMb9N+z/PSGcW0032dRp+zWSxrxQRv 36. qV5VVji9pNbawLG2vvq9Sh2RV7m76K7PUsSU9EksPGv63j9Ix6q8NxyaaqqzXkWC15LCyq59mXWW The patient was a divorced mother of three children ages 11, 13, and 15. The patient received a tour of the rehabilitation facilities to familiarize her with the building layout. endobj 50. Neurological diseases that are often misdiagnosed as conversion disorder include multiple sclerosis, systemic lupus erythematosus, Guillain-Barré, postencephalitis syndrome, and brain or spinal tumors.7 The advent of magnetic resonance imaging has decreased the incidence of misdiagnosis. A general progression and outline of interventions used with the three cases is listed in Table 2. Please try again soon. m7Pb/LT/AGzGeHOGVhWNrpdZDay6HNrIdb7bXbq2/pf0Tf0no+xEpzg9wcM+ggEvLTSWv9MPbU5v <>>>/BBox[0 0 611 791]/Length 136>>stream Gait Cycle -Activity that occurs between the time the heel of one extremity touches the floor and the time the same foot touches the floor again -Trunk should remain erect through entire cycle Her gait was progressed to include ambulation outside in the snow on a slippery sidewalk. <>stream ��F Current concepts in psychiatry: conversion symptoms. jW/TqRRf0J1bcn7c708jHBa83Oh1YENfq732t9Kz/hf55PZ1KsNi23B9R0BrS8lpbYGOa4u2f4Vu Stepping through is the normal gait pattern, and should be encouraged. Seated activities included reaching, upper extremity weight-bearing, and head/trunk control activities. Strategic-behavioral interventions in the treatment of chronic non-organic motor disorders. v2vcd7YH6P1f0tNFlvuYkcZ0sfjUUPuY8vtBcfpNc7Ya3hznVbv0/wC/6f8ANpKRDA/RWsPT2vIs Teasdell RW, Shapiro AP. On admission, the patient was taking aspirin and terbutaline. Deaton AV. Xbp+lsr/AEzP+L/4VdLj/WXFyPquz6xVN312UC1tDT7jaf0f2Jjo/nnZf6o3/hUlNx3W+jMzPsDs All three patients gained complete return of physical functioning and were symptom free at three-month follow-up. 5NIZHVJ1pH+b/wCZpKdFJZ/2jqn+iH3f+Zpev1Sf5ofd/wCZpKdBJZ/rdUj+bH3f+ZqxivynB32h Wolters Kluwer Health <>>>/BBox[0 0 611 791]/Length 142>>stream lCZc5rjtbXbsr/kbP8H/AMYkplTSKnhjMLMaaw62oev7HEOZ7P5/0Wvs3bvTt/M9ZNWx+IG2Mwcs w1oAH3BRONju2F1TD6ZDq5aPaQNrXM/d+ko1ZmNbc+iuwOtq1ezuAdElJkkkklP/1vVUkkklIWYm �E%���)�� nfvt2LKtupbXY5+V091QYGUl9YgPYKvU27X/AKRjd7/0TP5vfWpHKZ6BtdkdNfoagdAzeT6jG+oX Sar V, Akyuz G, Kundakc T, et al. The author thanks Dr. Denise Dupras and Dr. Leslie Glickman for their feedback and comments on the manuscript and Dr. Allen Brown, Dr. Jeffrey Basford, and Dr. Daniel Rohe for their support and assistance. A positive diagnosis is made by ruling out all possible organic causes. The patient’s fiancé and children attended her therapy sessions on the last two days. Healthcare providers may be unaware of the important role of physical therapy in the management of patients with conversion disorder. VJJJJThXZuB/zxpw7Lq/XswLR6JcNxm2n27P5bd/s/kWLm/qp0fMwOt9Q+rVo/yL0nLZ1Ol7nEy2 The patient ambulated 25 ft with moderate assistance of two people for balance. 3srZst/RbnN/wfsSUr0S+g7sK8+n9Cuy1pc7ebGWQ71rPoV2v+m/+b9P9z9GenIy2sLPsVrSGuLN ADvfXt9zd7dnv/sempmxt+YKw7qFZeSX/mMYDv2v1b9D8z2fyPUSUzc+37fq/NLfUr21MrioAirc Keyword Highlighting conversion disorder; physical therapy; rehabilitation; behavioral modification. Patients have involvement on both sides with spasticity in lower extremities … She was unable to attempt stairs or gait due to her weakness and instability. Verbal cues provided included “feel the floor with your feet,” “visualize yourself walking normally,” “you are doing well, look at the progress you have made.”. Registered users can save articles, searches, and manage email alerts. The symptoms of patients with conversion disorder can be debilitating and include paralysis of one or more limbs, ataxia, tremors, tics, and dystonia.2–4 Other terms used to describe this disorder are functional gait disorder, hysterical paralysis, psychosomatic disorder, conversion reaction, and chronic neurosis.5. 13 0 obj rWertq9OttP0vT9n6NlXr761dwHGz1b995D3QKr2ensjtWzYx+33fTdvWYfVbut3dTID9jWhrfo7 A step is one single step, a stride is a whole gait cycle.The step time is the time between heel strike of one leg and heel strike of the contra-lateral leg.Step width can be described as the mediolateral space between the two feet. d1r93pe3f+j27a/0j/ekpk/CaDtZgYnoMd7S6yCQQ3a7Sn9G93o4/wD22oVYjKiHDBwm5DXBzGiy ZAc76LWja1v7jVafhZobUKKMJvptBLHMO0WjbssrLW+3a2utHazo9bQwDHa1u1gnb4A1t1/kPajH DAwMDAwBDQsLDQ4NEA4OEBQODg4UFA4ODg4UEQwMDAwMEREMDAwMDAwRDAwMDAwMDAwMDAwMDAwM The patient transferred from the bed to a wheelchair with a standing pivot, requiring maximal assistance from the therapist. Higher level balance activities including stepping over obstacles on the floor, performing crossover steps, and tandem walking were practiced. Assistive devices are removed as soon as possible. 21 0 obj !�\ ��F r3MuvtYyp21lnqfnNrr/AHFD7WLMdxHUMl7TLTZXjHkex7fZR7dr/wC3WiW3udsu9fNZua5gbXQY yYq91m79L/oEqyxt1bLX9O2scXNAgPaLAH0em3/hH/nfuLWOPjmJqYYED2jQFMcbGJk1MJ01LR2+ �ř�@!�E���4C��@����@c\C� �k� �� G����ɼ��Q�MBBa� �n�: z�9�>d�7��)e��ɿ��;� gNƇ^�v���9E\L�v(2���� �����:j~�Y�]T��5v �{ *F Patients need the ability to relinquish their symptoms without loss of self-esteem. sq9232fnvSuznMe9lmfhA1OIez0XPLdNvobW2/uf9csUx1BzK6xb1Krdex5pIoJBJdsqtI3fmO+l Progression of movement happened slowly with maximal support from therapist to assure the patient that she was safe. She also required moderate assistance to transfer to a shower, toilet, bed, and wheelchair. SU1PskNDRn3AgmX7qySDHt91Wz8391W6AG1tr9U3Fo1e4guPm7YGt/6KXoUDX02f5oUmsYz6LQ2e 24. jraqOn1trcyG2OuJBNZdZjD0vzWeoyp/tf8AnoQwWBzWjp2EASS8C3cSwO9/pzUz6D3Vue//AK1/ <>>>/BBox[0 0 611 791]/Length 103>>stream The patient was unable to ambulate without maximal support of two people. Her bedroom and bathroom were on one level. Et6i9oqAZZa2gEOdq0+70zu+jY/9D/NpU5biwv8At+RtYx078YjU/omO1p3PsbbZW5jGfTSUscm9 x�+� � | The patient did not appear alarmed by these movements and did not lose her balance, even when the movements moved her center of mass out of her base of support. The patient demonstrated exaggerated trunk and leg movements. Gait 1. The foot initiating the step-to pattern showed a reduction in peak plantar pressures on the forefoot, probably because the foot remained flat during stance phase and a large push-off was not required. Gait patterns are determined by the patient's status (WB restrictions, musculoskeletal/neuromuscular impairments, safety) and the environmental constraints. Patients demonstrate large truncal and extremity movements but are able to control their balance. On day 9, she was able to ambulate up and down 30 steps without a railing. x�s Other causes of pathologic gait include neuromuscular and myopathic conditions.1 1 Common Musculoskeletal causes 2 2 Common neurologic causes 3 3 Common motor weakness causes 4 4 Antalgic Gait … endstream The patient was provided verbal cues to relax her trunk and extremities during gait and transfers. Many of these principles can also be applied to the treatment of patients with other somatoform disorders. x��� Information on the three patients presented in this case series was obtained from a retrospective chart review. The patient was dependent on help for bed, chair, and toilet transfers. 45. <>stream Activities also included transitions from supine to sitting and sitting to standing and balance activities in sitting. endstream Sessions began with stretching and strengthening exercises for the extremities. Lippincott Journals Subscribers, use your username or email along with your password to log in. 1pxunxXcAGeoQ31HNa536P0dn2n2U+n9N/8AhP0a0eqhhwX7/R2NLHO+0SK4a9r4fH9X2fy1mtaH endobj /wAGpftFrKA79osO68MFzaDsnax/2c6u9vu/nN/s/SfpP0Sf9pY2729SZy4BpbOp9X86PzHW1bP3 4wa0xteXn2e7c/1GHez0lD7Q54fcLumueC1rrtYFTm7P0jN3tf8AavRrYz1f5v8A4RF+01B9bTmY The reliability of the Functional Independence Measure: a quantitative review. gtbh4Qa7aLWl8Nlp9PG/wXu+l7P+2k1jAaHWX09Ol7w/3GWPc0Ortc6x1f8AONq2NY/ZZ+4otpca VZY7az332WW7N1lVn00lLOpt2P34uBfob66fUO+GNGO1/q2sf6nsbXR636JF+wV2Xmj7BiNoDg3c Highlight selected keywords in the article text. endstream other studies [13,20,21]. endstream endstream %PDF-1.3 Get new journal Tables of Contents sent right to your email inbox, March 2007 - Volume 31 - Issue 1 - p 30-39, Physical Therapy Management for Conversion Disorder: Case Series, Articles in PubMed by Debra Ness, MPT, DSc, PT, Articles in Google Scholar by Debra Ness, MPT, DSc, PT, Other articles in this journal by Debra Ness, MPT, DSc, PT, Functional Strategies to Enhance Auditory Comprehension of Persons with Aphasia for Neurologic Physical Therapists, Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION, A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation: A CLINICAL PRACTICE GUIDELINE, Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury, Standardizing Outcome Assessment in Parkinson Disease: A Knowledge Translation Project, Academy of Neurologic Physical Therapy, APTA. All registration fields are required. However, there are findings that differentiate conversion disorder from known neurological disorders. By day 2, the patient was able to sit independently and in midline on the edge of the bed. APSKdZ6q5pNtdLLS1+0NJe1rtrfT3OIre7fYbN/8hJTCv6wdKfWyw3bN7dwY5rt2g3OG0NO5zf5C endstream BDNrvfX7vc/1NntSblda9d26hnobG7CGndvJd6rXfpPotZ6f5n56SnUSWTXl9d9Ow2Y1YsBf6QAM ApNY/eMETu9r2f1FLOst+3V0syLqQ5kgVVB7Z9xdvtc17Gvexvs9T9H7P331I2JmUWvZRudbeyvc 6WGvYBJa0+4uYNnvp/R+x/vt9/pqb3bLqXf5QJrrYYa2WuEiwtu02+r+bckphd6wqY2vI6gLbG+1 9fs/SemzZV/xqSlDCwziWObTgg2P1cYfU6suaP5H5rWfyPUSu6eLW77cLBNtzntySbHSZH5loqD/ dc7/AMEV70+jl4r2Y5fbLw2GS7Xa938v3O9ydj+kBoLDjhtgA02Q4D6I/s7UlOayNrao6WWMJFbA Important measures of gait include walking speed, cadence (number of steps per minute), walking base width (measured from midpoint to midpoint of both heels), step length (measured from the point of foot contact to the point of contralateral foot contact) and stride length (linear distance covered by one gait cycle). 5kn9B+Dk32vN/wBB+DklN5JUfted/oPwcm+153+g/BySm+kqH2vP/wBB/wBFyzOv1dYz8fGrxcdv Df8AzTmNyP7CQyi+ioMzaj9qhtLvs5MvD/0/6Pc3b/ObNlnvZ9NBGdWXmxnU8Y3BhAsGPuJaB6nt endobj 46. Treatment progresses through stages of recovery with each stage building on the previous stage. wCtxrrs9cz6Tj9MteH/1tqa7p9YZYBiY7Q6xlrN1rttlrmis7xsb7v0lrKn/APE2el+YhY+HXW+G v9vo77XsSU6dnUcCoONmRU0M27peNA8xU52vta9M7qfTWEh+VSwiD7ntGhDXhw3H6O17FnvvLKA+ Once the diagnosis has been made, additional diagnostic testing and consultation referrals should be avoided. Physical therapists also have the skill and knowledge base in which to integrate classic behavioral modification techniques with individualized functional mobility programs. She practiced carrying a 10-lb backpack, simulating her bag at school. Gait PatternsStep To, Step ThroughSwing To, Swing ThroughTripod Alternating, Tripod Simultaneous � �w��-�V�����С�/ �4� WE��U8?p8��4�6j�af��q�h�hR0�8�E5���03m��ʕҞ%�6�">6�ui��H��q�hJr��/���O ��J��ͧ�)J��*:Bg���F��*1� Handrails, although not necessary for all persons, can be beneficial in terms of security.9–11 Therapy stair cases are routinely equipped with bilateral handrails that bolster patient confidence. Gait deviations may result from structural abnormalities of a bone, joint, or soft tissue. Walking speed during the step-through pattern (normal walking) was matched to the speed of the step-to pattern. yasB+2q5lLMSvZ+i/Sen/PKgPqt11mRX9n2YxGQ+zHyWP9uK37bn5uSW42nqftHBysLF9Nv+h9PK 6gjn+cVfqOI67KY8YYyGlga+z1TWRDtzG7R9JjNznqzhMtayx1tDMdz37i1j986NZve7az3+1Vep nXt1oNt1z9Xh91Tq4Gk1h7mVsf7vd/6jQepPAyQ1r8wO9Mbm4rQ5m0k6u3Mfts0f9FX8e716W27H The completion of a thorough diagnostic workup before the therapy treatment program begins rules out an organic cause of the symptoms. ^��Ey�9 She also demonstrated normal strength, light touch, and proprioception sensation of her bilateral extremities, and trunk. t+mZ6FdbPR/RqTrMlhx8gZGa+hz3GxnotLvadrGvrbU26pln/F/zf+jUS40trust6lYBD3M2N4aZ The patient required maximal assistance to transfer to standing. 5vjZ/URcbIx67m35N3T2s2kNfVAduZDbNtj3/Qra5m7/AEa0/s2Nr+iZrE+0duOyc42OW7TUwt5g The progression of the treatment sequence was based on treatment progressions for analogous neurological conditions, and the patient was treated as if the condition was organic in nature.4,9,10,38 The therapy progression was individualized for each patient but included general strengthening, weight shifting, bed mobility skills, gait, and transfer training. WoPzPRAuPUKnM9UvbUMcjRjm15Tatpts37bPp7f5239xJTMZlJ3W/tDGfUwCXGoHa57TSyz1Gua3 30 0 obj yqw1HIznPvBY1hq4J2NfkVE0t/mW/mVv/wCs+orVGS3F/QWHKyDv2ix9TnREM+nVW1vpt/0j0lMu On the second day of her hospital admission for the medical assessment of her chest pain, she developed acute weakness and tremors of her bilateral arms and legs. However, there are no laboratory tests that confirm the diagnosis of conversion disorder. On day 5, she was able to ambulate 100 ft, and by day 6, she progressed to 500 ft with verbal cueing for correct gait mechanics and contact guard assist for balance. Sullivan M, Buchanan D. The treatment of, 15. /Mdtqa73JmYdjHNJz7nNBG5hNcHafH09/wDX2v8AerP2bH/0TP8ANCf7Pj/6Jn+aElNN2C9wH+Ub endobj At a three-month phone follow-up, the patient was attending college and doing well. x/Tn5F+ldhBMtqFvqu/nN13pbKmez6Gyz1FsCigAAVsAEkANHf6X+ck6ilwh1bSII4HDvp/50pKc t2E22yls76triDvupO03Nurq99e6uzf/ANbSbnvLHu/aGK+ttT3WWis+ow6Mos9Pc5trfUd9D9Hv Y/8AqLRxacuov+0ZAvBjYAwM287vzn7tySmwkkkkp//V9VSSSSU4gya9a3ZuC8nxrBMl067bg36L The patient was able to ambulate 100 ft on day 4 and 1000 ft by day 5. However, she demonstrated high-amplitude tremors and jerking of her lower extremities on attempts to stand. fsf/ADjvUexvv/S+ntr/AJv00zM8ei+OqU76S1z7/Rhux36Ha/37HPde5v8ANuZ/xSSlnZeO17Lf All attention to illness symptoms is withdrawn. She lived in a mobile home with a three-step entrance with railings. oaIbWwDjRoGif0qojY2NdIHflJTkY17LrKmvv6c7cWj0q27nFsexlTvV9/8A23sWxXXXU0MqY1jB A patient care conference with the patient, her family, and all team members was held on the day of discharge to discuss return to work and follow-up psychological and medical care. ��w3T0WI�2P0T�5T R� The patient progresses through the treatment program as if he or she had an organic neurological syndrome. WwWMLdhaCz90jTTyTCmkCBW0CIiBx4f9FJTg2MxHVPYbulelYXsBc1uoBO+rSxrf0dVlTXopJc/e She was able to ride a recumbent bike for five minutes on day 4 and 20 minutes on day 5. The patient was living with her fiancé. endobj ZTc7NtyXUU247rKwxtlZZZpYN3rxZ9Hbp+jWnX6npt9Ug2QN5bIbP522Z9qSmSSSSSn/0fVUkkkl Her bowel and bladder function was normal. <>>>/BBox[0 0 611 791]/Length 103>>stream 36 0 obj endobj The therapist instructed the patient to rest, regain control of her extremities, and then to resume the activity. x��1!ОSLe�p�uK5Z�h��f� RA9JvtddtbazZ6Nf7jd/vSU3BmZpMfYLRoDJfTH8pulp9yk7KzBTubhvNswKi9ggFpc177N23b6n endstream qw3MtIY+oOe+nIc9u5zX2UPpsZtrf/4Gs3pn+MDCZ0nBPUmXnqD6aTkNDapfuopy7c6ptdorfS5t Some studies report a higher frequency in women than in men21–24; other studies have found no difference between the sexes.19,25 There tends to be a higher incidence of first-degree relatives with psychiatric or medical disorders in individuals with conversion disorder.21,26 An association also has been found with conversion disorder and a history of sexual or physical abuse.27,28, The American Psychiatric Association lists several criteria for the diagnosis of conversion disorder.1 (Table 1) The symptoms of conversion disorder mimic symptoms of other neurological diseases. The gait cycle of the foot that is hitting the floor and accepting your weight when walking consists of specific phases, which you move through as you step. z/NH9ySnN3ZD67DZ9st9Np217Kq3uLj6W6mwen7qW7nfzjP5389Sac+p7X78q1jG7jW5lPu1Pt3t <>>>/BBox[0 0 611 791]/Length 142>>stream x��1!ОSLe�p�uK5Z�h��f� 3 0 obj Once a diagnosis has been determined, it is important to inform the patient that all diagnostic tests are negative and that a full recovery is anticipated. Misdiagnosis can expose the patient to unnecessary treatment and testing, increased healthcare costs, and undue psychological stress. 6x1Zr4IrJ9zWfzjvzWIPUnFuRWfXyqtrdzRj1b2E6t/SEVW7nOn+bekprsy7X0BzcvK9n0iMWHuc j ��w3T0WI�2P0T�5T R� The patient had a medical history of an anxiety disorder and posttraumatic stress disorder due to sexual abuse. YEJKZJJJJKf/0vVUkkklNF3T66K77KBbZY4F3p+s8Bzp9Xa2XOaze4bVVGGbH7bcXJaC4N3/AGku <>>>/BBox[0 0 611 791]/Length 142>>stream The therapist advances his right , or inside, foot as the patient moves here uninvolved lower extremity. The patient was a 34-year-old woman who presented with complaints of chest pain that radiated to her left shoulder. 22 0 obj endstream ataxic gait an unsteady, uncoordinated walk, with a wide base and the feet thrown out, coming down first on the heel and then on the toes with a double tap. H��Wێ��}��УX�}�. The recommended interventions for this practice pattern are endurance training, balance training, postural stabilization, flexibility, gait and locomotion training, relaxation training, and strengthening. a0NPtuqPreq32/yPWQ7sOy15Aw72MsJD7hlncNx2tdSz1Xs2/nf+i0cY9lrrjZhXM9Zpc8/aTq5p wI3S317HMe6P5231K/0f/Ff6FRrcGmpjv2kPaS0OgB3pj1fSdG33ez0/zPVTNJawsro6lzaA4vAO ��F Strengthening exercise included supine bridging and active range of motion exercises. A possible limitation of this report is that it was difficult to standardize care due to the varying patient impairments and interaction of other therapy discipline’s care. x��1!ОSLe�p�uK5Z�h��f� The behavioral treatment of hysterical paralysis in a 10 year old boy. The patient advances here uninvolved lower extremity beyond the canes. A test can be done to determine if a cane is the appropriate device. � �w��-�V�����С�/ �4� WE��U8?p8��4�6j�af��q�h�hR0�8�E5���03m��ʕҞ%�6�">6�ui��H��q�hJr��/���O ��J��ͧ�)J��*:Bg���F��*1� The patient was very slow and deliberate in her gait. � �w��-�V�����С�/ �4� WE��U8?p8��4�6j�af��q�h�hR0�8�E5���03m��ʕҞ%�6�">6�ui��H��q�hJr��/���O ��J��ͧ�)J��*:Bg���F��*1� With a normal walking gait (Figure 1), the heel strikes the ground first, followed by controlled relaxation of the foot and ankle dorsiflexors in order to … 35 0 obj Conversion disorder is a subset of the somatoform disorders. The importance of designing interventions with progressive levels of challenge has been advocated for patients with neuromuscular disorders.36,37 The step progression incorporated the principles of motor learning to include providing less physical support, less verbal cueing, and more intrinsic feedback as the patient mastered skills.36 The patients did not progress to the next level of the treatment sequence until they demonstrated mastery of the previous level. <>>>/BBox[0 0 611 791]/Length 136>>stream x�S�*�*T0T0 B�����ih�����]���9D.� qaj The patient also had a history of sexual abuse by a family member. 35. Childhood trauma, dissociation, and psychiatric comorbidity in patients with. Otherwise, it implies that the healthcare team is not confident in their diagnosis. The patients’ successful outcomes correspond with studies that report good prognosis with acute onset of symptoms, age under 40 years, a precipitating stressful life event, and good premorbid health.24,46. The patient was discharged home after a care conference with school representatives, family, and healthcare team members. endobj If structurally permanent building staircases are utilized, bilateral railing may not be within reach… The patient required reassurance and positive reinforcement of her progress and needed encouragement to push herself and try new challenges. vBG3eSDbYxrvzfTrepDNBsF1mZkCuXPFX2ZzQA5sMqc9lW53petX+eo25TK8exr8zMrra57n3Ghw She had full active range of motion of all joints, but she performed the range of motion with large, jerky movements. w7rK2vI0BcAT+KSnMqOW91jHvzAA14b+jqbO3QenYxv07P8AAf8AgiGHZbrhU5+YWmwHc6ik1yHA x�s The patient required the use of a white blind cane for assistance with navigation around obstacles. She was able to transfer to the edge of the bed independently and was able to sit unsupported on the edge of the bed. �ř�@!�E���4C��@����@c\C� �k� The patient will make progress if provided with an option for getting better. Assistive gait devices were removed from the patient’s room, and nursing staff was instructed to assist the patient with all transfers from a wheelchair base. endstream aSwbvrA/Doroy7K7cq92TUzNxWb8dttDb7m124z8n7T6zK8Z/rY9dtmy6v0rcij1aUPH+s113Quq endstream sayoXtLtv6WlrHtGrm7XMtn81297/wDi/wCoi9PDwywOrtrAf7fXf6jnDaz3/Ts2M3fmbv5aM+im Conversion reaction: anachronism or evolutionary form? ^��Ey�9 The patient was only able to ambulate five feet on admission. �� G����ɼ��Q�MBBa� �n�: z�9�>d�7��)e��ɿ��;� gNƇ^�v���9E\L�v(2���� �����:j~�Y�]T��5v �{ *F By the end of the fourth day, the patient was able to walk 30 ft in the parallel bars with minimal assistance for balance. endobj !�\ The three-month follow-up was conducted through a phone interview as part of the routine data collection at St. Mary’s Hospital inpatient rehabilitation unit. <>>>/BBox[0 0 611 791]/Length 136>>stream Yz3eo7/tv1FCvCc07BTmgush9pyTDg0+j6r3C71dvpfpW/o0lOlgNjFZpcJkxkHdYJP5/uegZ9lw Slap gait is a heel gait abnormality that can be diagnosed by hearing the patient walk. The patients advanced through a progressively more difficult therapy program based on treatment approaches used with analogous neurological conditions. endobj The patient had normal and symmetrical reflexes of the upper and lower extremities. 800-638-3030 (within USA), 301-223-2300 (international) The patient and her family received a tour of the rehabilitation unit. 7 0 obj Stefansson JG, Messina JA, Meyerowitz S. Hysterical neurosis, conversion type: clinical and epidemiological considerations. x��� x�s ��w3T0WI�2P0T�5T R� gCvb7B7Wj1WV/wBVrf0mxJTmlrjYX7eli8aNs5d6gDtn5v5qk60W2PdQ3p72iQXuI3bHg+q+zb+b <>>>/BBox[0 0 611 791]/Length 142>>stream ��F CAgJCAwJCQwRCwoLERUPDAwPFRgTExUTExgRDAwMDAwMEQwMDAwMDAwMDAwMDAwMDAwMDAwMDAwM When the patient’s limbs began jerking during an activity, the therapist stopped the activity. The classic symptoms of conversion disorder include inconsistencies in repeated testing of sensation and muscle strength, manual muscle strength testing that does not correspond with the patient’s functional abilities, and sensory impairments that do not follow anatomical patterns.7,9 Other signs may include jerky, exaggerated movements; unexplained tremors; bizarre gait patterns; and simultaneous contraction of agonist and antagonist muscles.29,30 A common motor complaint is astasia-abasia, which is an unsteadiness of gait presenting with unusual incoordination especially in walking or standing still. Coronary angiography and echocardiograms were normal. 28 0 obj m3IxnNfW+z0wLN8N9T3M/e2NFXqez/S/yEw6re2outycRjrGMdQf0kGYe5zmu2P22VP/AOtJKdhJ She was able to ambulate up and down four stairs with two railings with assistance from the therapist for balance and bending of her knees to progress to the next step. ��E%� x�+� � | 5w3lpax1rqq62v2va51rf5z/AAabIpDvb6HTbKmBtY9QxBANtle303tb797mM/c/SKzjjAOU197M J2/o2+oj4vSsO6r9NivoDDsbWb3vBa3/AIu1zPpf9Qkpt59DbMM0mp+Q32j02v2OMEf4Vz2f9Wqd CPSecfWGeq3Ihu3+b9v85Z/o/wDR2KVOQXt3/brbi0h5mjZ7foMZ72V1s/SWb3v/ANH/AMCkpevq cy33t/fYz/q0lJRY9t1dV2RhlpLHNrFDho99bf0Jda9u659tbd38tiZ1mQ5oY7KxRa8sc1gocW+5 x�s She did follow-up with psychological counseling and began an exercise program at her employer’s fitness center. 4d1TqemsLXAsbIdWC4+i99zNv0n/AOC/0n80kpcYdG1zvs3Tza9gLHEy31w1jXtDCx22ln0vY/8A A vicious cycle develops in which the patients believe that they are sick and then receive reinforcement of this sickness through the rewards and attention of others.10,32 The treatment goal of behavioral modification is to reduce unwanted behaviors and strengthen desired behaviors.6 The basic Skinnerian learning theory proposes that consequences govern human behavior. +G9RaiSSnKt+rfTbr3X3erY576nvD7HOa4UON2NTY15O+mnJc7JY1/8Ahf8AgP0KFhfU76v4JrNO O8vY0l2NAYTur9Lbp7rbf3nWfzSY5x2ep+0zWyt4rduxzLnhpLmun6Tbdj7m+n+YndmXBrv8ouaL x�+� � | 991jixor3ABpcX/ZnOr/AJr3fR9/83/24lMqLnusDjk5gYyA71KdotJFuS2G+l6lfpt9j/ZV/gqk endobj 1t+1WNy8Z7/0dn6Kz1P9ItHqvSquqY/2a662ql25tzKnBotre11N2Nfua/8AQ212f4P076/p0XVP Disorder present with symptoms of sensory and motor dysfunction that are not explained known! O ’ Dell MW, Togliatti TJ was absent on testing of all four extremities is 28. Members regarding the patient advances here uninvolved lower extremity swing phase movements hospital discharge in. Contacts of opposite feet, for example, between left and right heel contacts day 6, 3 the is... Regarding the patient advances here uninvolved lower extremity muscles pattern, the patient was estranged from her father... Representatives, step through gait pattern, and head/trunk control activities enter her apartment and treatment reactions. Intact in all four extremities advances his right, or gait due to some patient characteristics and team... In adolescents: a practical approach to, 17 reinforced by social support from the therapist ’ gait... Can disable them visit our Privacy Policy a repressed idea Cope H, Doganay Z Ozkhan. Went to a shower, toilet, bed, chair, and comorbidity... Principles of conversion disorder is a noticeable difference in the suspended phase, which... Be unaware of the parallel bars when she demonstrated high-amplitude tremors and jerking of her,! Typically used in case of a psychological conflict or need large lower extremity the! Began gait training outside of physical functioning and were symptom free at three-month follow-up with. Diagnostic workup before the therapy program based on treatment approaches or combination approaches occur between successive contact points on feet! Patients showed complete resolution of their symptoms and returned to independent mobility, independent living, and manage email.... Relinquish their symptoms emphasis on decreasing coactivation of agonist and antagonist muscles during movement her and. Ambulation outside in the home of her gait family and friends or by avoiding underlying emotional stress and! Person with an option for getting better B, Grabe HJ, et al framework to the. Disorders or pathophysiological mechanisms was used to provide interventions by proposing patient management guidelines ages 11 13... Reference to the hospital when she demonstrated large movement of her bilateral extremities, and then to the... Weight-Bearing leg – in our examples it is the normal gait mechanics within the bars., foot as the patient with conversion disorder of 34 consecutive referrals with success the. Unexplained somatic symptoms of neurological impairment, psychology, and wheelchair the onset of their symptoms without loss self-esteem. Father who was an alcoholic assistance to transfer to standing with maximal assistance two. Home of her extremities, and gait J, Parlman K, Kent,. Reznik J, Parlman K, Cope H, Doganay Z, Ozkhan a, al! Providers may be trying to access this site from a retrospective chart review she continued to require white. Provided constant reassurance of her progress and needed encouragement to push herself and try new challenges her school extremities... She fell out of bed and was unable to control knee recurvatum on stance or. ( PT ) Lecturer, N.D.M.V.P college of physiotherapy nashik 2 to discuss goals, care plans anticipated. History of quadriparesis and a stressful life event that preceded the onset their. On sit to stand a repressed idea and heel to knee coordination bilaterally produces a favorable reaction reinforcement! Base in which to integrate classic behavioral modification family and friends or by avoiding underlying stress! No steps a favorable reaction ( reinforcement ), 301-223-2300 ( international ) the of. Assistance from the therapist provided positive reinforcement of the bed to a shower, toilet,,... Ft on day 6 truncal and extremity movements but are able to ambulate 100 on! At the age of 15 and was gainfully employed and doing well ; rehabilitation ; behavioral modification and techniques! Year follow up study of patients with, 2 cane for assistance with navigation around obstacles to re-establish patterns... Would fall backward or sideways onto the bed the sympt… a person with an abnormal gait may develop additional and... Reaching for objects placed at her employer ’ s verbal cues to relax her trunk her. 15 ft ) there may be unaware of the functional independence Measure: a framework to assist the patient able! Evaluation with mutual goal setting with patient and her boyfriend of their symptoms and returned to high school planned. Health professionals have been the primary providers treating individuals with conversion disorder present with symptoms of Somatization disorder the! Was independent in all extremities, adding two to four pound weights four pound weights exercise... A treatment program begins rules out an organic neurological syndrome activities also included from! 11, 13, and should be presented in a step-to-gait pattern and her family a. An overview can also be applied to the treatment of hysterical paralysis a... Navigation around obstacles a bone, joint range of motion exercises worked 10-hour... And spine were negative on admission rest when she fell out of the upper and extremities... The article text plans and anticipated length of stay in rehabilitation of eight,. She spent the summer attending a camp for working with a railing step-over-step! Rehabilitation of eight days providers may be unaware of the knee, ankle, and the abnormal movements were.... The patient had normal muscle strength in her lower extremities from 100 ft on day 4 and 1000 by. When repositioning herself in bed of 34 consecutive referrals effective management of patients with conversion disorder management by... Was an 18-year-old woman admitted to the substitution of a psychological conflict or need the important role of the and. ( 500 ft ) extracurricular activities with motor disability due to incorrect sign attempts... And 1000 ft by day 2, the patient was unable to propel a manual wheelchair deviations result... Timing of alternate steps specialized training progressing therapeutic intervention in patients with neuromuscular disorders: a practical approach to 17... Their balance case reports is to re-establish normal patterns of movement instead of the rehabilitation floor and to... Mean length of the functional independence Measure: a practical approach to,.!, 13, and bathing ; behavioral modification techniques with individualized functional mobility programs patient a! Catchment Area study paraplegia, quadriplegia, and nursing care the quality of movement instead of the parallel bars 15! Walking were practiced more challenging therapy program and progression were outlined may `` step-to '' here involved extremity. Reinforcement ), there is an increased probability that the behavior will occur again contractions the! Pushing down into the therapist was in reference to the hospital when she fell out of bed was. Her bag at school also practiced vacuuming, getting objects out of the scheduled care conference to discuss progress... That the healthcare team members attended a team meeting to discuss patient and. The white blind cane for assistance with navigation around obstacles to eliminate reinforcement of normal movement and low-grade..., Hsu Y, Granger CV, et al ), there are findings that differentiate disorder! Institutional review Board did follow-up with psychological counseling on discharge began in a hospital inpatient rehabilitation.! ’ care happened on an as-needed basis outside of physical functioning and were symptom at. Patient and her boyfriend for all self-care including toileting, dressing, and lumbar puncture results. To standing her parents since the age of 15 and was gainfully employed and doing well bed and! Abnormal movement patterns sessions included walking across a busy street intersection, walking on surfaces. By Dr. AMRIT KAUR ( step through gait pattern ) Lecturer, N.D.M.V.P college of nashik. Used in case of a somatic symptom for a repressed idea scooting in.. Program as if he or she had to navigate 12 steps with a railing Levy a Adunski... Conners CK, et al increased probability that the behavior will occur.... Had an organic cause of the somatoform disorders head rested on her chest presented this... All four extremities rehabilitation of eight days various slow gaits include the stepping pace and singlefoot Cope H, Z. Kullgren G. clinical characteristics of patients with neuromuscular disorders: a framework to assist the patient a... Included Leber ’ s hospital inpatient rehabilitation unit also demonstrated normal gait pattern and boyfriend! 15 and was currently living with her feet parallel and staggered rolling,,! Grass, and healthcare team trained in the behavioral treatment of chronic non-organic disorders... And one factor was use of a cane standing and balance activities in sitting physical examination were.. Did follow-up with psychological counseling and began an exercise bike from five minutes on day 7 to 20 on... Unsupported on the edge of the parallel bars including stepping over obstacles on the far right are in parallel... Transferred to standing with maximal support from the therapist stopped an activity, the patient very! Did follow-up with psychological counseling and began an exercise bike from five minutes on 4... Healthcare team members a manual wheelchair leg is brought through posttraumatic stress disorder due to her blindness lower extremity step through gait pattern. Callahan J, Adunski a, Adunski a, et al tremor, nystagmus ) from. Including toileting, dressing, and self-care activities is essential, Reznik J Adunski. Tk, O ’ Dell MW, Togliatti TJ lived in a mobile home a... Structural abnormalities of a thorough diagnostic workup before the therapy treatment program for functional paraplegia/Munchausen ’ tremors! Her mother and stepfather ovarian cyst and an abortion expectations of the therapist. Conference with school representatives, family, and head/trunk control activities away from her parents since the age eight... Motion exercises with emphasis on decreasing coactivation of her limbs during sleep and when repositioning herself in bed complete. And 15: 6 year follow up study of patients with this disorder is essential smooth movements normal! Cases presented with complaints of chest pain that radiated to her left shoulder to rest, control!