Jane-Client Description
Jane is a 43 year old wife and mother of 2, ages 11 and 7. She is responsible at home for homemaking tasks and childrearing. Prior to her motor vehicle accident, she worked as a full time D.A.T.S driver. Jane was rear ended by a 3-ton trunk and sustained cervical strain, commonly known as whiplash. She experiences a constant headache which worsens when driving, shoulder checking, reading and working at the computer. Therefore, this influences her function on the job and in her home tasks. Jane is currently frustrated and stressed because her leisure activities have been curtailed due to prolonged neck flexion. Her sensation and cognitive functioning are intact.
We assume that Jane is right handed.
Primary Deficits & Therapeutic Use of Sculpting.
Strength Deficits
Generalized weakness in left upper extremity (median nerve distribution), tightness in pectoral and scaleni muscles, and rhomboid weakness.
Jane will begin with a soft clay, which will aid in increasing her strength while she is manipulating it. A number of different forearm and hand muscles supplied by the median nerve will be used during this process e.g. pronator teres, flexor carpi radialis, abductor pollicis, flexor pollicis brevis, etc. By moving her arms in different directions during the activity, she will stretch her pectoral muscles as well as other muscles in her upper extremity. These components of the activity include reaching for materials either in front of her or on a shelf as well as wedging the clay. By reaching for materials from higher shelves she may increase the strength of her rhomboids. Jane will be encouraged to use her left hand more than her right because of her weakness and right hand dominance. By modifying the activity throughout her sessions, her functional ability will increase. One modification can be changing the hardness of the clay as well as the size of the sculpture she is making. This will encourage her to use more muscle strength to mold larger and lift heavier amounts of clay.
ROM Deficits
Limitation in range of motion of neck flexion, side flexion, and rotation.
A major concern is her limited neck ROM. Looking at her sculpture from different angles will result in her attempting to move her neck in various directions to her limit of discomfort. If Jane stands while she sculpts she will increase her neck flexion ROM to a normal range by having her look down on her sculpture. By placing tools and materials to her side, she will have to turn her head to look before reaching for something, and her neck ROM can be subtly increased to a normal range. Neck rotation can also be increased by having Jane sculpt an object from a picture of her choice. The picture can be placed in the same fashion as the materials, and moved further back as her ROM increases.
Other Deficits
Pain from her neck to between her shoulder blades and paraspinal muscle spasm.
Sculpting can be adapted to her paraspinal muscle spasm by having her sit while doing the activity instead of standing. Jane's ability to work on the sculpture for longer periods of time can act as a grading measure. By starting with short sessions to the limit of Jane's pain, tolerance may build up and pain may subside allowing her to work for longer periods of time.
Jane's improvements will enable her to complete tasks at home and possibly to get back to work. Also, sculpting will give her an activity to help her vent her stress and frustration, as she has been unable to find an outlet thus far.