Clinical Scenario

• Following a fracture left hip you make the following observations in your patient:

  • standing posture reveals your patient is weight bearing primarily through their right leg
  • Little movement of the head seen
  • Muscle weakness noted in left hip and thigh area
  • Patient very quiet when standing
• Clinical reasoning:

  • Weight is not evenly distributed across the BoS (think See Saw example)
  • CoG has moved towards the right leg - as left leg was fractured
  • BoS smaller so reach the limits of stability quicker, and more at risks of falls in standing
  • Muscle weakness has reduced somatosensory feedback - muscle weakness in left hip and thigh
  • Therefore over reliance on visual feedback - little movement of the head
  • Quietness suggests cognitive load for task
• Treatment ideas:

  • Go back to the Graded Balance Assessment chart and see if you can work out:
  • Where to start (BoS) with this patient? - start with sitting, but with eyes closed
  • What systems are affected and is there a priority area to address? - close eyes to reduce overreliance of visual system
  • How will you use the principles of motor learning and control to enhance your treatment?