Stephanie Lozano

USC Doctor of Physical Therapy Student Class 2019

[Stephanie Lozano @Stephanie192018]

75 year old pt comes in after falling onto her tailbone about a year ago. First bout off pt at a different location did not help. Came in to this clinic and found to have SIJ dysfunction that was not address previously. Due to cause not being sooner how does that affect prognosis

[Stephanie Lozano @Stephanie192018]

Pt. came in with tingling on and off in C6 dermatom pattern. But would also get the same symptoms and pattern when performing PAs in mid thoracic spine and with upglides to C3-6. Why would that be?

[Stephanie Lozano @Stephanie192018]

74 y.o. pt came to clinic for fall prevention. She is fearful of falling, no hx of falls, and has made sig. gains. With each exercise she asks how she is doing? Educated her on her progress and prognosis, but continues to ask how she is doing w/ all activities. How do I proceed?

[Stephanie Lozano @Stephanie192018]

Pt came in for neck pain and first two treatments pt was treated with neck mobilization but treatment wasn’t helping. Looked at the shoulder and shoulder seemed to be the culprit. Will address shoulder and reevaluate next session. #alwayslookatneighboringjoints

[Stephanie Lozano @Stephanie192018]

Pt is working on re-education of hip musculature. She has progressed well but started to feel overwhelmed w/ progressions. Took time to talk out her feelings and educated her about her POC. Glad I took the time to just talk. Pt felt better and more motivated to do exercises.

[Stephanie Lozano @Stephanie192018]

5 y. o. pt lacks about 20 degrees of knee extension. Need to talk to her MD about getting a dynasplint. Took multiple calls in 3 days to get a hold of the MD. Made me remember there’s more than the tx session to help a pt get better.

[Stephanie Lozano @Stephanie192018]

Pt. only responds to certain phrases to perform movements like super tall to straighten his knees. Have been trying to get pt. to perform step ups - straightening his knee as part of the mvmt, not only at the end. Trying to think of some key words. Any suggestions?

[Stephanie Lozano @Stephanie192018]

Working w/ a pt on postural adaptations to external perturbations. Goal = work on step strategy. Performed exercise as CI demo’d but didn’t get the response expected. Was told I was doing it correctly. After some research, need to talk to CI about new strategies

[Stephanie Lozano @Stephanie192018]

Pt w/ SIJ pathology treated with estim, heat, STM , and MET. Has worked prior. Last tx no pain relief but alignment improved. Pain cont’d to be 8-10/10 w/any movement and R glutes/erector spinae/multifidus continue to be overactive despite tx. PT referred to orthopedic. Thoughts?

[Stephanie Lozano @Stephanie192018]

to have a dx of dementia...
cognitive or behavioral sx:
1. interferes with function
2. pregressive worsening
3. at least 2 of the following impaired:
- memory
- reasoning
- visuospatial abilities
- language
- changes in personality
#PT546week13

[Stephanie Lozano @Stephanie192018]

#PT546week12
Slow progressive symptoms
Cranial nerve involvement = PNS ✅
No infection or CNS signs ❌
Other motor involvement (cervical nerves)✅
Sensation changes ✅
MRI - brain
Meningioma compressing structures
No cerebellum signs - adaptation

[Stephanie Lozano @Stephanie192018]

Concussion - symptoms may progress with time b/c of metabolic changes

Acute subdural hematoma - typically a traumatic event

Chronic subdural hematoma - not a progression of acute hematoma, rather a recurrent bleed into subdural space #pt546week11

[Stephanie Lozano @Stephanie192018]

Pt. presents with headache. Do subjective and exam so you can SNOOP for primary or secondary headache.

Systemic
Neurologic symptoms or signs
Onset: abrupt, peak < 1 min
Older: > 50 years of age
Previous headache hx
Precipitated by valsalva, exertion
Papilledema

#PT546week10

[Stephanie Lozano @Stephanie192018]

#PT546week9 @juliehershberg One sided face droop, 1 UE weak or numb, & speech slurred or the worst headache of your life... maybe a stroke call 911 and make sure the ER docs get a CT or MRI fast to determine if you need rTPA before it’s to late!

[Stephanie Lozano @Stephanie192018]

#pt546week8 @bsargent_usc
Toe walking can be caused by different disease process. Look at M-CHAT-R for risk of autism, look for UMN signs for corticospinal tract lesion, look at MRI for other possible causes. Then refer and treat as needed.

Or maybe your just being sneaky

[Stephanie Lozano @Stephanie192018]

#PT546Week7 Multiple Sclerosis is insidious and episodic but the timeline can look differently -relapsing remitting, secondary progressive, primary progressive, and progressive relapsing. For dx look for lesions disseminated in time and space and r/o other options @juliehershberg

[Stephanie Lozano @Stephanie192018]

@NoraDarakDPT

[Stephanie Lozano @Stephanie192018]

#PT546Week6
Parkinson’s disease -either bradykinesia or resting tremor AND one of the following: freezing gait, flexed posture, rigidity, loss of postural reflexes. UMN signs, autonomic dysfunction, cerebellum signs check you dx. Look at MRI to rule out what you cannot clinically

[Stephanie Lozano @Stephanie192018]

#pt546week5 unilateral vs bilateral vestibular hypofunction. Both peripheral. Need to differentiate -perform head thrust. Positive towards lesion = UVH; positive bilateral = BVH @LibbyKrauseDPT @juliehershberg

[Stephanie Lozano @Stephanie192018]

A pt w/ SCI at a certain level may not present with symptoms correlated with that level. Check for inflammation. It can spread rostral or caudal and symptoms may correlate to where the inflammation is affecting the spinal cord. #pt546week4 @juliehershberg @manjiridahdul