Program in Physical Therapy, Columbia University, New York, New York.
Phys Ther. 2011 Sep;91(9):1395-402. doi: 10.2522/ptj.20110033. Epub 2011 Jul 7.
Adolescents who have chronic pain after common orthopedic injuries such as ankle sprains may present a multidimensional clinical problem stemming from both physical and psychological issues. A traumatic incident such as a motor vehicle accident can produce clinical issues ranging from a specific tissue injury to multisystem complications such as complex regional pain syndrome (CRPS) or posttraumatic stress disorder (PTSD). The purpose of this retrospective case report on an adolescent with chronic ankle pain stemming from a motor vehicle accident is to demonstrate how reflection and the evidence base influenced the modification of the plan of care. Description of the screening methods, clinical findings, interventions, and outcomes of the case may help physical therapists identify and improve the quality of care in cases of suspected CRPS and PTSD.
The patient was a 12-year-old girl with a medical diagnosis of recurrent right ankle sprain and with signs of potential CRPS and PTSD. Poor initial response to ankle sprain management led to reflective reconsideration of the diagnosis and plan of care. The revised plan of care supported by the evidence base emphasized empathetic consideration of the traumatic motor vehicle accident and focused on CRPS prevention and management of potential non-physical pain via mirror therapy and motor imagery therapy.
Pain was relieved, behavior improved, and functional movement began to normalize after 3 sessions of mirror therapy and motor imagery therapy.
Patient symptoms were inconsistent with the medical diagnosis, and the clinical outcome of the original plan of care was unsuccessful. Reflection inspired a more-detailed history and systems review, which led to greater understanding and more-effective care.
患有常见骨科损伤（如踝关节扭伤）后慢性疼痛的青少年可能存在源于身体和心理问题的多维临床问题。像机动车事故这样的创伤性事件会产生从特定组织损伤到多系统并发症（如复杂性区域疼痛综合征或创伤后应激障碍）的临床问题。本文通过回顾性报告一名因机动车事故导致慢性踝关节疼痛的青少年病例，旨在展示反思和循证基础如何影响护理计划的修改。对该病例的筛选方法、临床发现、干预措施和结果的描述，可能有助于物理治疗师在疑似复杂性区域疼痛综合征和创伤后应激障碍病例中识别并提高护理质量。
患者是一名 12 岁女孩，患有复发性右踝关节扭伤，存在复杂性区域疼痛综合征和创伤后应激障碍的潜在迹象。踝关节扭伤管理的初始反应不佳导致对诊断和护理计划进行反思性重新考虑。基于循证基础的修订护理计划强调对创伤性机动车事故的同理心考虑，并通过镜像疗法和运动意象疗法预防复杂性区域疼痛综合征和管理潜在非躯体疼痛。
经过 3 次镜像疗法和运动意象疗法治疗后，疼痛缓解，行为改善，功能运动开始恢复正常。
患者症状与医学诊断不符，原始护理计划的临床结果不成功。反思激发了更详细的病史和系统回顾，从而更好地理解和提供更有效的护理。
