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Referral letter (Nov 2005) - Susan Woll, Sci-Art Center Pforzheim
Susan P. Woll
Heinrich Strasse 235, 8005 Zuerich, Switzerland
25.11.2005
TO: Medical Director of Rehabilitation Services
Dear Sir or Madam:
I am writing at the request of prospective patient Olga Sorokin. Olga participated in a program of Intensive Rehabilitation aimed at Recovery of Motor Control in the Sci-Art Center in Pforzheim, Germany for four weeks during the month of August,2005.
At that time she was found to be Wheelchair dependent for all Activities of Daily living and functioning in the environment. She was also dependent on assistance for Transfers. At the time of the intake evaluation she was found to be Ataxic when attempting to use either of her upper extremities. However there was more problem with motor control on the left than the right. She also had weakness and instability in the Trunk. She was able to support her weight on both lower extremities and make steps. She has a number of Orthopedic problems that were also impeding her participation in Functional activities. The most debilitating is the stiffness in extension in the left knee. The Wolf Upper Extremity motor function test was done and it was clear that all movements in the upper extremities could be completed but the ataxic / fluctuating movements on the left limited success with functional use of the left hand and arm in the open chain . All weight/supporting activities using the arm/Left as part of the Base of support were possible and successful. Olga was able to walk in all gait patterns with the use of upper extremity support bilaterally—walker or table. She was unable to walk alone with a forearm crutch as she had been attempting to do. The gait pattern was characterized by a stiff leg /knee on the left and as well she was wearing a boot type shoe with a lift on the left. This lift was someone's attempt to allow to offset the trunk instability on the right and facilitate swing therefore on the right. In the end effect the right leg was then held stiff and she used a hiphike and circumduction pattern to try to clear the right leg. Olga was convinced that she had a significant leg length difference and therefore had to have the lift. On measuring this proved not to be the case.
After 4 weeks of therapy –six hours per day , Olga was able to walk alone with a table, back walker, or with a closed ladder. As long as she had light contact of both arms/hands on a surface even a surface that she had to move and stabilize herself she was independent in walking. She was very resistant to becoming a full time “walker” and therefore giving up her wheelchair. However she did not use the wheelchair during the six hours in the clinic. She became very stable in her trunk and in the standing posture she was able to use one or both of her arms freely. As well as clinical training including strengthening, endurance training and gait training she participated in a program using weight machines. In addition to the above mentioned program she practiced life skills as well. These included clearing the table and washing the dishes, cleaning the bathroom, doing make-up and a variety of other skills of this type.
Olga received new shoes without the lift on the left and all of the gait training was done with normal tennis shoes and normal gait pattern was possible. She also received a short and flexible orthotic for the right foot. The goal of the orthotic was to give her added medial lateral stability and to facilitate dorsiflexion in swing- or inhibit the habituated pattern that she had been using of plantar flexion, knee extension and hip hike…. Olga was able to walk with a optimal pattern using this orthotic on all types of surfaces. Olga however never was convinced that she did not need the lift and for the most part sat in her wheelchair and wore her boots with the lift in the hotel/evenings.
A copy of the video taped pre and post evaluations was given to Olga when she left the center . As she has let me know multiple time this seems to have been lost.
I do think Olga has the physical potential to be an Independent active young adult. She is highly intelligent and uses her mind/intelligence for all parts of her life except in the area of engaging in the practice required to make the step to Independence. I think that she could benefit from continuing her Rehabilitation in a structured program that also requires her participation in using her acquired skills in her daily life. She would truly benefit from an Independent living program. Please feel free to contact me at any time for more information.
Sincerely,
Susan P. Woll
Bobath Instructor
Physical Therapist