School of Health Sciences

Division of Health Professions

Physical Therapist Assistant Program

CASE STUDY

A 69 year old male presents to the inpatient physical therapy department for evaluation and treatment following an
elective transtibial amputation of the right leg due to dysvascular changes in the limb. This surgery was performed
three weeks prior to this visit and he is worried that the surgical incision is healing slowly. He was diagnosed with
Type 2 Diabetes Mellitus at age 54, and has only recently brought the disease under control with oral Glipizide®
administered in 25 mg extended release tablets. He has a history of frequent falls. He lives with his wife of 45 years
in a multilevel home with his bedroom on the first floor of the dwelling. He plans to return home when his PM&R
physician releases him at a future undetermined date. His wife is in reasonably good health, but fears her husband
might fall again once he returns home. The physical therapist has completed her examination of the patient and
shares the following objective data with you:
Observation and Inspection: Pt presents with ® BKA 2° to DM Type 2. Minimal wound dehiscence with serous exudate
(following posterior flap procedure) despite suture closure to encourage healing by primary intention. Drain has been
removed from residual limb with excellent healing of the portal incision.
ROM: PROM of the trunk and extremities is limited generally; bilateral hips 0-10° extension with very firm end feel;
right knee flexion 15 - 95° with pain at the end of flexion and extension range; left ankle DF 0 - 5° with firm end
feel.
Strength: 4/5 in all UE and LE muscle groups.
Balance: SLS (Single Leg Stance) score 4 seconds averaged over three trials.
Gait: Ambulation with FWW 25’ with min/mod assist x 1 person to advance FWW and provide safety.
Lab Values: Fasting blood glucose level 114 mg/dl prior to coming to therapy this visit; O2 sat 87% at rest during visit.

Answer the following questions regarding this patient:
1 The patient reports “feeling dizzy” when sitting on the side
of the mat table and when standing with moderate
assistance. Provide two (2) possible explanations for the
dizziness he reports.
(5 points).
2 List three (3) specific interventions you would implement
for this patient in the first week of his twice-daily 60 minute
sessions, and prioritize them in order of importance.
Explain why you chose these interventions and placed them
in the order that you did.
(5 points)
3 How would you appropriately involve this patient’s wife in
the physical therapy treatment sessions, since she insists on
being present for each one?
(5 points)
School of Health Sciences
Division of Health Professions
Physical Therapist Assistant Program
1. Pt is taking Glipizide 25 mg in extended release which has
side effects that cause nausea and dizziness.
2. Pt could be experiencing symptoms of hyperglycemia due to
his Type 2 Diabetes Mellitus
3. Pt could also be experiencing dizziness due to low O2
saturation levels of 87%.
1. Increase ROM of R knee flexion and left ankle DF w/PROM-
Heel Slides/ PROM
2. Increase Bilt UE/LE strength to improve MMT from 4/5 to
5/5.
LE- standing 4 way hip on L LE in //bars , seated hip abd/add
isometrics,seated hamstring curls, PF/DF ankle, all to improve
stability and balance during gait training.
UE- Tricep pushups in chair or theraband, bicep curls to
increase UE strength for gait training.
3. Gait training w FWW to increase distance and decrease
assist level.
**PT EDUCATION ABOUT STUMP, AND BEING AWARE OF LIMB AT
ALL TIMES, PROPER SHOE WEAR, AND MASSAGING STUMP.
Keeping her educated on her husbands POC and having her
involved. Providing a HEP and explaining with his wife,and
teaching her ROM exercises she could help him with. As far as
her being involved at each treatment session it’s important to
let her know she's welcome there, and you could even have
her complete the exercises with him.

4 The physician visits during one of the inpatient therapy
sessions and asks you about the patient’s progress in the
presence of several other patients, their family members,
and therapy support personnel. He is particularly interested
in specific goals set for patient performance and reasons
why you think he might not be able to meet these goals.
What is the most appropriate action to take in this instance?
Be specific.
(5 points)
5 The patient asks you to help him understand his diabetes
diagnosis, since he reports that it was never explained to
him in any depth. How would you respond and why? Be
specific.
(5 points)
School of Health Sciences
Division of Health Professions
Physical Therapist Assistant Program
Speaking with the physician in private I feel would be the
most appropriate action to take in this instance. Discussing
with them any concerns and the goals you are working
towards with your patient. I think it would also be beneficial
after speaking with one another to talk to the patient, family,
and the other therapy support personnel to speak with them
about their goals, and how to accomplish them. Reassessing
goals as needed will also be beneficial.
I would explain to him that Type 2 diabetes is a condition
when your body can’t properly respond to insulin and that is
usually secondary to obesity. Explain to him that treating his
Type 2 DM consists of controlling his blood glucose(sugar
levels) through diet, exercise, oral medication or insulin
injections when necessary. Describe to him the benefits of
exercising with his condition and how keeping stress levels
down is beneficial. Explain to him that physical and mental
stress levels can elevate blood glucose and it can make
managing his DM more difficult.