Case Study 3
Paul is a 44 yr old male who is 5’10” and weighs 205lbs. BMI is 29.4. He suffered a serious TBI while he was a passenger in a motor vehicle accident (MVA)10 years ago and has been pretty stagnant since then. Paul also lost his vision form the car accident. He gets very little physical activity and this is something his doctor wants to change. Paul was under the care of both his parents for the past 10 years, but both have passed away in the last 12 months and now Paul lives with his sister and her husband (brother-in-law). Paul’s brother in law is the person who basically cares for Paul 24hrs a day. He is also adamant that Paul needs to become more active and no longer thinks he needs to just sit around all day and do nothing. Paul has had one hip replacement (R hip) since his MVA, and his medical team really wants to avoid doing a hip replacement on L hip. But besides that he really has no major restrictions physically. He has very little flexibility from sitting or laying bed for the past 10 years with literally no physical activity at all. So flexibility and resistance training is something that his medical team thinks will benefit him tremendously
Paul’s medical team wants Paul to increase flexibility and also start walking more. Paul experiences pain walking currently but there is no scar tissue or damage with his hip, they are just convinced that his pain is due from being so stagnant for the past 10 years. He has a walker he can use, and then can maybe graduate to solely using his cane to walk with. It will take a lot of hard work and convincing for Paul to realize he needs to start walking again and why it is important for him to increase flexibility and also why a resistance training program will be of benefit too. Paul’s brother in law will be at every session to help motivate Paul and make sure he stays on task and pays attention during the entire session. His brother in law is also wanting Paul to be able to do more ADL’s (activities of daily living) around the home. Three things that are very important that they want to improve on are brushing his teeth, sitting and standing up from a chair, and being able to feed himself once again. He has very limited range of motion in his upper extremities so this is why increasing flexibility and resistance training is recommended. Shoulder flexion ROM is 0-47 degrees and shoulder abduction is 0-44 degrees. These are two major areas that if ROM is improved then ADL’s might start becoming easier and easier to do.
His latest physical examination revealed the following information: Blood Pressure is 138/88 mmHg, Total Cholesterol is 299, HDL cholesterol is 33, LDL 158 mg/dl, Fasting Glucose is 119mg/dl
After the evaluation, the primary physician explains the risks of staying inactive and how it will only increase pain throughout Paul’s body the longer he is inactive as well the side effects of leading an inactive lifestyle has on his heart. The physician thoroughly explains the importance of Paul needing to change his stagnant lifestyle. The physician challenges Paul to start an exercise program and go to the gym 2-3 days a week for the next 12 weeks. Each gym session will be 30-90 minutes in length, based on what you feel is best for Paul from week to week. The reason up to 90 minutes is allowed is due to the fact Paul has a very hard time getting around when he walks with either his cane or walker due to his limited flexibility and also being blind slows him down.
His Physician is adamant that walking, stretching/flexibility and resistance training are all focused on in this time frame. A 3-month follow-up appointment is scheduled and the doctor is expecting to see some exciting changes in 3 months.
1. What goals would you set with Paul? What type of exercise programming would you prescribe for him and explain to me why you prescribed it, and how it will benefit Paul?
2. What type of lab results would the physician like to see from Paul at his 3-month follow-up? What are realistic numbers on the lab results for Paul to see in 3 months?
3. How do you feel you can make sure Paul has an enjoyable experience with you and actually starts to enjoy coming to the gym for exercise?——Working with a client who has a severe TBI can be hard to handle and it takes a lot of patience to work with them for a 12 week period. Explain to me what you feel would help you with creating a relationship with Paul and how you can keep him motivated for the next 3 months. There is no right or wrong answer, I am just wanting you to kind of think about what you feel you could do to help develop a relationship with Paul.
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