My Physiology/Pathology class has assigned a fictional case study assignment in the past in order to better understand a symptom picture in a massage therapy setting. For a massage therapist, we are always assessing the subjective and objective information to create a treatment plan targeted at relieving the client’s signs and symptoms.
Below is a fictional case study I have written pertaining to a pathological disorder of the Nervous System. At the end I have written 5 discussion question and answers.
Traumatic Brain Injury: Concussion
Rhonda is 46 years old. She called in the late evening to make an appointment complaining of a headache not allowing her to sleep. Her speech was slurred and difficult to understand. Rhonda arrived the next day an hour early for an afternoon appointment. When she signed the logbook she seemed very confused when told in fact the day’s date was Monday. not Sunday. and that her appointment was booked for 12 pm and not 11 pm. When standing up Rhonda asked for assistance to her treatment. She steadied herself along the walls and complained of feeling dizziness after standing up. The entire time Rhonda was in the office she was wearing her sunglasses and mentioned the light irritates her headache. When she removed her sunglasses in the treatment room both pupils were dilated.
- How do I interact with Rhonda during the conversation over the phone?
- Because of Rhonda’s slurred speech I should gather as much subjective information as possible in a few minutes regarding why she needs to get a massage as soon as possible and when she can get in.
- What do I suspect?
- Rhonda is a long – time client who does not drink regularly. The possibility of her slurred speech due to over consumption of alcohol is unlikely. The headache she explains could be a migraine causing the slurred speech. The abnormality of her late night call to make an appointment and slurred speech is a sign something severe is going on and I make a note to very carefully observe her tomorrow.
- What other symptoms of a migraine does Rhonda present?
- Her loss of motor control and dizziness after standing up and complaining of sensitivity to light are symptoms of migraines but her confusion over the date and time of the appointment has lead me to believe her symptoms are not due to a migraine, but something much severe.
- Has Rhonda suffered from any acute injuries?
- While asking Rhonda about all the things she had done in the past 24 hours she mentioned going to church, having lunch with her daughter and then spending the rest of the afternoon in the barn. While outside the wind picked up and a stall door swung and hit her on the forehead. She did not lose consciousness and decided to take aspirin and continue her chores. After dinner is when she started to get a headache, decided to lie down and could not fall asleep.
- What do I suspect?
- An acute injury to her frontal lobes could be the cause of her slurred speech, motor dysfunction, and dilated pupils. The loss of brain function could be due to a Traumatic Brain Injury and a possible concussion. It is important that Rhonda see her primary care physician to assess the severity of the impact on her brain before massage can be performed. Rhonda should be taken to the hospital as soon as possible.