Millie

## Subjective History ### Home Adaptations Millie resides in a home environment with some slippery floors, although high-traffic areas are carpeted, which may aid in traction. ### Demeanour Not assessed during this session. ### Injury History Millie has been diagnosed with a fractured elbow and has undergone surgical intervention with a plate fitted in her left elbow. ### Current Medication Not assessed during this session. ### Exercise Routine Millie is currently engaging in a walking routine of half an hour twice daily. ## Objective Findings ### Posture Analysis Millie exhibits cranial loading with increased utilisation of her pectoral muscles and a lowered thoracic sling. There is a noted imbalance in her forelimb loading pattern, with a discrepancy between the left and right forelimbs, leading to overloading of the right forelimb and offloading of the left. ### Gait Analysis Millie's gait is characterised by compensatory mechanisms due to the imbalance in her forelimbs, with large hind limb muscles observed as a result of this compensation. ### Range of Motion Assessment Millie demonstrates limited hip flexion bilaterally. ### Palpation Palpation revealed coat changes in the thoracic area with trigger points throughout the epaxial muscles extending into the lumbar region. There is increased tone in the gastrocnemius muscles bilaterally. ### Neurological Testing Not assessed during this session. ## Assessment Millie's current condition is primarily influenced by her recent elbow fracture and subsequent surgical intervention. The imbalance in her forelimb loading pattern has led to compensatory changes, including cranial loading and increased use of the pectoral muscles. The presence of trigger points and increased muscle tone suggests muscular overload and potential discomfort, which may be exacerbated by her current exercise routine and home environment. ## Plan 1. **Exercise Modification**: Adjust Millie's walking routine to shorter, more frequent walks to reduce forelimb overload and allow for gradual strengthening without exacerbating her condition. 2. **Home Environment**: Recommend non-slip mats or additional carpeting in slippery areas to enhance traction and prevent falls. 3. **Manual Therapy**: Implement regular massage and stretching exercises focused on the thoracic and lumbar regions to alleviate trigger points and reduce muscle tension. 4. **Strengthening Exercises**: Introduce targeted exercises to improve forelimb strength and balance, focusing on the left forelimb to address the loading discrepancy. 5. **Follow-Up**: Schedule a follow-up session to monitor Millie's progress and adjust the rehabilitation plan as necessary based on her response to the interventions.