More than just WAD

[Sarah Frunzi]

Recently, I conducted an evaluation with a patient having cervical pain that onset around one month after a rear-end MVA where he sustained whiplash. However, the part of this evaluation that was different to me, and something I hadn’t experienced before, was that this patient was diagnosed with tardive dyskinesia. The patient also came with 2-3 papers of typed out past medical history which was very easy to become overwhelmed by at first glance. My mentor advised me to look over the papers and pick out the most important items that may apply to the evaluation and current presentation, which helped refocus my thoughts going into the subjective questioning. During the interview, I could tell that the patient was self-conscious about his TD diagnosis, as it causes frequent involuntary facial movements. I did my best to make the patient feel comfortable and was able to get most of the subjective history I needed. I thought this portion went well overall; however, the objective exam is where I felt I could’ve done a more thorough job. On reflection, I wish I would’ve allowed myself more time to have hands-on assessment of his cervical joints due to the challenge I had feeling the end feel with the presence of muscle activation due to TD. I also wish I allowed more time for treatment and initial home program design. While I was able to provide some treatment and get an HEP started, I felt the rush of the clock and felt my exam was not as specific as I would’ve preferred. If I have a similar encounter in the future, I will try to increase my efficiency with the portions of the subjective and objective exam that I find easier to allow myself increased time on the others that may require me to slow down and process more, especially in the instance a diagnosis is present that I am not well verse in at that time.

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