You are on page 1of 4

Patient (MFR)

: Lulu Khusnul B

Nanny

: Febie Fauzia Ilham

Physiotherapist

: Resya Nur Aulia

Condition

: Nanny and MFR are in the pediatric room, waiting for


Physiotherapist to call them in. The physiotherapist then call them
in to assest the nanny and examine MFR.

Dialogue

PT

: Is MFR here? Please come in.

: Yes mam. Morning mam.

PT

: Good morning. Hi MFR, Im Aunty Rere

PT

: Im Physiotherapist here, may i know about his condition? How old is he


mam?

: He is 6 years old, ive been told that he suffered cerebal palsy which attacked
his brain that cause his legs become stiff.

PT

: Ah, i see. Is he born with this disease or is there any cause that make him
become like this?

: No, he was born normal, theres nothing wrong with his body, neither his
brain. But, when he was 7 months old he got high fever and repeated
convulsions. Then, he had been hospitalized for 2 weeks in Thamrin Hospital.
November 2009, he got convulsions again that made his legs stiffed. We went to
Hermina Jatinegara Hospital and the doctor said that he has meningitis Infection.
The doctor referenced us to go to Cipto Mangun Kusumo Hospital to have
advanced examination. He had been hospitalized for 10 days there.

PT

:what happened after examination? Was there any progressive with his condition

or his condition is getting worst?


: After examinations the causes of his meningitis infection was found. It was
from Lung of TB. After that, the kid was directed to have a medical treatment for
a year. After having the program, doctor referenced us to go to Rehabilitation
Departement. He was suggested to have a physiotherapy treatment, at least one in
a week. Because there wasnt significant change with the disease, we decided to
stop the program in Cipto Mangun Kusumo Hospital.

PT

: So, did his family just stop all of the program or did they take him to another

hospital for better treatment?


: Yes, they did take him to another hospital, to Kartika Pavilliun of Gatot
Subroto Hospital, because the kid suffered from urinary system infection. He has
been hospitalized for 3 days on August, 2011. After that the doctor suggested us
to meet Rehabilitation Departement. September, 2011, when he was 2 years 6
months old, he started his physiotherapy treatment at Rehabilitation

PT

Departement, Gatot Subroto Hospital.


: So, how is the progress of the kid now? What kind of the activities that he can

do?
: Now, he can stand up and walk for 2-3 steps. He still come to have a

PT

physiotherapy treatment for two times a week now.


: ah I see. Mam, beside meningitis and the urinary infection, was there any
other problem? Or maybe is there any family who have the same disease with

the kid now his? Either from mothers family nor his fathers family.
: There was ISPA when he was 5 years 1 month old. Emm I think, neither his

PT

moms family or his dads family have the same disease with my kid now.
: oke next question. When his mom pregnant him, do you know have she ever

fall or suffered bleeding??


: she had suffered a bleeding. That was on her first trimester. But she routinely
control her pregnancy to doctor every month. The USG result also shows that the

PT
N
PT
N
PT

kid was okay inside


: and how many pregnancy that she already had?
: She had five times of pregnancy, and hes the third birth
: when she pregnant him, did she consume medicine drug or vitamin?
: in the first trimester, yes she did consume flu medicine
: ah thats everyones disease! So when the baby was born, is he born with

N
PT
N

normal way or some other way? And how old his age at that time?
: the baby was born with caesar at 9 months of pregnancy.
: How about his weight and height mam?
: He was 3000 gr and 51 cm long. His mom had told me that everything was
okay with his condition at the birth time. He got normal round of the head, he

PT
N
PT

didnt suffered any abnormality metabolic system. He just like the other baby
: Then meningitis, urinary system infection, and ISPA were came. Am I right?
: Yes youre right mam
: what about the imunitation? He got all of the imunitation program, wasnt

he?
: Yes he was, his imunitation was completed.

PT

: oke mam, now I want you to remember the age when he able to prone and roll

before he got his condition now.


: when he was 3 months old he could move to prone, and 6 months old to roll. 7

PT
N

months to sit, 11 months to crawl.


: How old is he when he able to stand up and walk by his self?
: He started to stand up and walk when he was 5 years 7 months. He could

PT
N
PT
N
PT
N

stand up and walk with special shoes


: oh, ankle foot orthoses? Then how old is he when he able to smile?
: Ya, I think 1 year old
: How old is he when he able to say mama ?
: He could say mama when he was 9 months old
: How about his food or his milk?
: He had drunk milk until 8 months old, and start to eat tim rice when he was 1

PT

year old. He started to eat by his self when he was 2 years old.
: oke nanny, now Im going to check a his round of head. Hi F lets measure

N
PT

your head (examination of round of the head)


oh good, its 49 cm
Now let me check his heart rate. (Heart rate examination)
good, its 87 time/minute. Its completely normal mam
Now Im going to check his respiratory rate (Respiratory rate examination)
its 24 times/minute from 19-29 times/minute
now lets check your weight and height baby (Nutrition status examination)
the height is 96 cm, weight is 14 kg. Its normal for the kid in their age
And your temperature is normal (Temperature examintaion)
now, mam i need to check his body from every position.
: sure, wait
: let me see.. uhm, the elbow is in straight position, then theres semi-bend of
the hip, both of his legs are attached each other, also theres semi-bend of his
knee, theres deformity of his knee that the knees are formed like an X, and then

N
PT

his finger of the foot are stand on tiptoes.


:yes, i think because of that hes walking like that and need special shoes.
:ya. Oke now Im going to check his muscles (Palpation of muscle spasm)
Hmm theres a spasm muscle here
ok, now lets we move to other position, now try to roll to the right side then
the left side, good. (Rolling inspection)
One more, oke stop let me see for a minute (Prone position inspection)
Now, I have something for you F. Look what I bring? Do you like it? Oke take
it from me with (Crawl on hand and knees inspection)
oke good. Now everybody sit! Nanny youre include. Oke now lets see the
way you sit (To sit and sit position inspection)
Now lets stand up, because were going to play Kapiten song *singing* (To
stand up, stand up, walking inspection)

yay thats good! Oke back sit. May I borrow your hand? (ROM test)
now may I borrow your leg? (ROM test)
nanny do you see that? There are limitations when I tried to move his legs am I
N
PT

right?
:Ya, youre right I see that
:He couldnt straighten his hip and knee. And because both of his knee are
formed like X, he couldnt distant his legs or we called it as abduction.
oke now Im going to check his muscle (Tonus examination)
Ah, his legs muscles are pretty stiffed
Nanny, I indicate there are thightness of his muscles, im going to check it

N
PT

(Thightness examination)
:Yes please, how is it?
:like what Im expect, there are thightness of illiopsoas, adductor, hamstring,

N
PT
N
PT

and tendon achilles muscle.


:is that bad?
:as long as I can stretch his muscle it wouldnt be that bad
:Thank God
:so, this is my diagnose mam, youre kid is having cerrebral palsy spastic
diplegi which make his leg stiffed and formed like X. I found out that hell be
able to walk almost like normal people. He may need his special shoes to put on

N
PT
N
PT

while he walking.
:mam, is the shoes can make his leg become normal?
:Im afraid no, because the shoes is only support the way he walk and stand up
:oh I see that
:After this Im going to start the treatment. The treatment are to inhibit his
stiffness, stimulate him to stand up and walk with properly, and exercise his

N
PT

balance and coordination of walking.


:oh good, so what should I do at home? Is there any home program?
:yes, I want you to exercise him to squad, stand up, squad and back to stand up
again. After that you may teach him to walk between bloster, walk on colour

N
PT

paper that placed in zig zag pattern, and ask him to swim
:oke Ill do that at home
:Yes you have to, because our team working may help much for his ability to
stand up and walk. Because my goal is to make him walk as normal as possible.

You might also like