You Don't Have CP

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[00:01:19] Welcome back to Untold Physio Stories Podcast, I'm a new host, Dr. Erson Religioso III with

[00:01:22] Modern Menial Therapy, Edge Mavilly System and a 4 month online mentoring program, Modern Rehab

[00:01:27] Mastery. This is a solo podcast again, not with Dr. Andrew Rothschild.

[00:01:32] So, recently a patient who I had seen several years ago and I probably even told

[00:01:40] it not told Physio Stories about her.

[00:01:43] She is an adult female and has mild CP with some involvement in her left arm.

[00:01:51] At the time she had come to see me back before I was cash based, her main complaint was,

[00:01:56] you know, difficult to use in her left hand.

[00:01:58] She was able to oppose her index finger in her thumb but otherwise I had difficulty grasping.

[00:02:04] General Titanus, left side of her cervical spine and arm.

[00:02:09] Since I was just getting started with the Edge Tool and doing a lot of ISTM, I just thought,

[00:02:15] hey, you know what?

[00:02:16] I don't really have any experience in using manual therapy, ISTM, self tissue work on someone

[00:02:22] with mild CP.

[00:02:24] So, let me just try this and see what happens.

[00:02:26] That the time I was again transitioning between, you know, more mechanical effects

[00:02:32] and thoughts and explanations to more neurophysiologic.

[00:02:37] So, over the course of several weeks, I had done some just very light ISTM in a forearm

[00:02:42] and all along her hand.

[00:02:44] And we noticed that after each session, she was able to oppose her thumb and her third

[00:02:51] and her fourth digit as well, but difficulty with the fifth.

[00:02:55] Then I ended up introducing her to a mirror box and she said that, you know, she pretty

[00:02:58] much just wanted to live in this thing because sticking her left hand in the mirror box

[00:03:03] and watching it reflect her right hand, it was the first time to her that her left hand

[00:03:08] had appeared to have that illusion of having completely normal mobility and control.

[00:03:14] So she left pretty happy after about a month of care, maybe one to twice a week.

[00:03:20] Fast forward, I haven't seen her in maybe 12 years.

[00:03:25] And recently she's been having similar complaints.

[00:03:29] She changed jobs and now she cleans houses for a living which is very difficult

[00:03:33] against you mostly uses her right arm.

[00:03:36] She told her primary and neurologist and I guess the first crazy thing about this story

[00:03:42] is neither her primary nor her neurologist, new she had CP.

[00:03:48] For me that was just mind blowing. I mean, I think the either the primary or the neurologist

[00:03:53] said, oh you don't have CP and you thought wow, it's a physical therapist. It wasn't completely

[00:03:58] obvious to me and she said well I'm really good at hiding it but I just thought,

[00:04:03] should you be able to hide that from an empty? I don't know, especially in a neurologist.

[00:04:07] I don't know, again, it's part out of our wheelhouse and probably don't see a lot of people

[00:04:14] maybe adults with mild CP. I'm not sure but I just kind of found that disturbing to say the

[00:04:22] least. She was prescribed OT and she did a ton of work. Just traditional exercise is strengthening

[00:04:29] as much as she could with her left arm which is the involved side. And I think the craziest thing

[00:04:36] is that it made her right elbow and right forearm have symptoms. She was using because she basically

[00:04:44] said, you know, her being more aware of most people, she understands the concept of the mirror

[00:04:50] and mirror neurons after I introduced her to the mirror box just that much use and strengthening

[00:04:57] in general exercise of her, of her, involved side may her unenvolved side actually be symptomatic

[00:05:03] and very sore. So I started off with just repeated elbow extension. She had a moderate loss

[00:05:10] of elbow extension with kind of like an empty end feel. I did some ISTM and some repeated elbow

[00:05:17] extension resets. That restored her elbow extension however it was still mildly painful and

[00:05:22] unraged over pressure. I wasn't too worried about that. One thing I realized I probably did

[00:05:29] into so many years ago because I didn't, I was kind of just working on my clinical practice patterns.

[00:05:35] Is that it really assess her cervical spine too much? I may have done some like tissue work

[00:05:40] on her cervical spine and trap it and see, then she have a loss of cervical retraction

[00:05:45] inside bending to the left. She turns out she did. Her neck range of motion is

[00:05:50] probably moderately limited to the right but it was severely limited with side bending

[00:05:54] to the left, especially with cervical retraction. So I started there again. I checked her

[00:06:00] opposition or opposition was still better than when I initially seen her for the first visit last year.

[00:06:07] It may not last year or last several years ago, 12 years ago. She could still oppose to her

[00:06:14] second digit and her third digit but not her fourth. With cervical retraction,

[00:06:21] repeated cervical retraction and side bending to the left along with some soft tissue work

[00:06:25] to the cervical spine and upper traps, then traction retraction inside bending in non-weight bearing.

[00:06:32] Several sets of that her opposition and her four arm motion with a little bit more

[00:06:37] controlled and her elbow motion supination pronation was just a little more controlled. She had

[00:06:43] generally less feelings of tightness. So I added that as a reset. I don't think that was a

[00:06:48] reset for her recovery plan 12 years ago. cervical retraction inside bending to the left. However,

[00:06:55] she's going to have to overpressure with her right hand to kind of pushing into side bending

[00:07:00] to the left. Then I did the standard ISTM on her hand and her forearm and she felt better as before.

[00:07:07] So that wasn't really the highlight of this story. The highlight of this story for me was that the

[00:07:13] her work in reverse and some major exercise and strengthening to her involved side actually made

[00:07:20] her right side so were because as she said her right side is always trying to make up for the lack

[00:07:26] of function and her left side. She was an exercising right side at all but it felt like she had a

[00:07:31] major workout, major dons and she had some significant elbow irritability from all the flexion and

[00:07:37] the pull down and the bicep curls or whatever else she was doing. So let me know what you guys think

[00:07:46] of this story. I thought it was a really interesting case. Hopefully Andrew would join me one of

[00:07:50] these days again. Please rate until it's a story of five stars, especially an apple Spotify as that

[00:07:55] helps our discoverability and you guys have a great day.