50-year old woman who sustained head and cervical spine injuries, treated with cognitive rehabilitation, pain management (cervical spine epidurals, facet joint injections and occipital nerve block), traditional physical therapy and vestibular therapy.
Unable to resume work as a Veterinarian Assistant
Diane is independent in self-care, with need to avoid bending and use external support for all transfers (of another person, walls or furnishings); needs assistance for most homemaking; no longer drives; is unable to use the computer or read more than briefly; and no longer takes walks for exercise, plays with nieces and nephews, is no longer intimate with husband, and socializes minimally with friends.
- Persistent severe right sided neck, head and headache pain, and dizziness
- Intermittent right upper extremity pain and tingling
- Diffuse tightness and trigger points throughout the right paracervical and upper trapezius
- Mildly limited cervical spine mobility with associated dizziness
- Diffuse upper extremity weakness
- Very slow performance times when working with the hands that are below competitive employment levels, including slow typing for less than 10 minutes and limited writing tolerance due mostly to head positioning issues
- Need for head support while seated for up to 1.5 hour
- < 10 minute stand tolerance without external support because of poor balance and dizziness
- Inability to do low level lifts because of increased dizziness; ability to do occasional medium level lifts and brief carries of < 10 pounds
- Impaired cognitive function for the domains of memory, executive function, attention, problem solving, and visual spatial relations on the NeuroTrax BrainCare Testing Suite
- Impaired short term, working memory and delayed auditory and visual memory scores on the Test of Information Processing Skills
- Severe difficulties completing a basic clerical skills test due to inability to maintain sustained downward head viewing for 15 minutes, difficulties concentrating and remaining focused; and performance times below the 1st percentile, albeit with good accuracy scores
Diane’s observed physical and cognitive limitations were consistent with those she reports on a daily basis at home. Physical evaluation findings indicate that Diane lacks the physical capacities to resume work as a Veterinary Assistant that is associated with Medium physical demands, or perform any work associated with Light or Sedentary physical demands based on her ongoing dizziness with movement and need for support during all transitions; inability to find a comfortable head posture to read, write or work at the computer; inability to work with the hands on a sustained basis, or lift 5 pounds at low levels without associated increased symptoms. Cognitive evaluation findings indicate Diane’s ongoing impairments for executive function, memory and problem solving, sustained focus and attention, with resultant headaches when sustained viewing, e.g. of a computer, or downward head viewing is required. Diane’s’ inability to perform at her pre-accident level has negatively impacted her overall quality of life.