FROM MY PT SCHOOL NOTES · APPLY THE CONCEPTS
Motor Control: Three clinical reasoning cases
These cases turn the chapter concepts into practical questions. Read the situation, name the task and plausible constraints, then expand the reasoning—not a single correct diagnosis.
Case 1. Why is balance different on uneven ground?
A 74-year-old walks comfortably in a well-lit clinic hallway but reports feeling unsteady when crossing grass at dusk with a shopping bag.
Ask yourself: Which parts of the person–task–environment model have changed? What would you assess before prescribing balance exercises?
Open the reasoning
Consider visual information, support surface, vestibular and somatosensory function, strength/power, attention, confidence, falls history, and the demands of carrying. Test the relevant challenges under appropriate guarding; progress toward safer real-world surface and carrying tasks. The scenario alone does not establish a vestibular diagnosis.
Case 2. Toe drag and hip hiking following stroke
A patient catches the toe in initial swing and hikes the pelvis to clear the foot.
Ask yourself: What can you conclude from the gait pattern—and what can you not conclude? List three impairment hypotheses.
Open the reasoning
The observation supports inadequate swing-limb clearance plus a compensation; it does not establish a single weakness or diagnosis. Consider active dorsiflexion, ankle range, knee flexion, hip flexion, sensory input, walking speed, fatigue, and footwear/orthotic factors. Use targeted tests, then select appropriate task-specific practice and supports.
Case 3. A strong grip but poor key use
A person after a neurologic event produces a moderately strong grip but has difficulty orienting a key and inserting it into a lock.
Ask yourself: What abilities beyond grip strength could interfere with the task? How could you test these within the actual activity?
Open the reasoning
Examine visual target localization, grasp preshaping, in-hand manipulation, tactile perception, selective finger control, apraxia, attention and trunk support. Practice using meaningful objects and graded demands; measure object handling and real task completion, not only grip force.
Educational examples adapted from the author’s class-note themes; fictional patient scenarios, not individualized care advice or official exam questions.
