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SOWH TF on DX: OB Case #1: Prolonged bedrest for Pre‐Term Labor 
Reference: Irion JM. Medical Management and Physical Therapy Management of High‐Risk Pregnancy. In, Irion JM and Irion GL. Women’s 
Health in Physical Therapy. Wolters Kluwer/Lippincott Williams & Wilkins. Philadelphia, 2010 
 
Brief Overview: Provide
Woman on bedrest for pre-term labor during pregnancy. Makes her OB a brief overview of the
prototypical patient for
status “high risk”. Can be on bedrest anywhere from 1-12 weeks and whom the movement
system diagnosis you
will describe would be
appropriate.
General Demographics:
18-45 year old pregnant women. May be carrying multiples (e.g., State the age-range of
individuals commonly
twins, triplets, quads or quintuplets) or spontaneously go into preterm affected.
labor. Might be on bedrest for other conditions such as pre-eclampsia or uncontrolled IDDM. General Demographics:
Indicate the sex of
individuals commonly
affected.
General Demographics:
List other key
demographic
characteristics of
individuals commonly
affected (e.g.,
race/ethnicity, primary
language, etc).
History of Current
Patient is a 37 yo white female, gradiva 4 para 3 at 24 weeks gestation Condition: List key data
from the history of a
expecting quadruplets. Pregnancy was fertility induced using in-vitro typical patient that are
related to the movement fertilization with 4 embryos implanted with implantation of all 4; pt. had
system condition (e.g.,
patient concerns,
a tubal ligation X 10yrs. ago after her 3rd child was born. Pt. admitted mechanism of injury or
disease, onset and
to the hospital for bedrest and close monitoring of activity level pattern of symptoms,
expectations and goals,
secondary to medical history and distance from appropriate hospital. Pt.states she fears a decline in her physical status due to bed rest and is concerned about the status of her family and her farm. General History: List
-Complicated high-risk quadruplet pregnancy in woman of advanced other key data, if any,
from the history of a
maternal age; heart murmur of unspecified origin; anxiety disorder. typical patient that are
specifically relevant to
Fetal US reveals all four fetuses progressing as expected for gestational the movement system
condition in individuals
commonly affected (e.g.,
medications, other tests
and measures, past
SOWH TF on DX: OB Case #1: Prolonged bedrest for Pre‐Term Labor 
Reference: Irion JM. Medical Management and Physical Therapy Management of High‐Risk Pregnancy. In, Irion JM and Irion GL. Women’s 
Health in Physical Therapy. Wolters Kluwer/Lippincott Williams & Wilkins. Philadelphia, 2010 
 
history of current
-Uncomplicated previous pregnancies and vaginal births X 3 without any condition, previous
hospitalizations and
medications or complications; no current management for slight ‘heart surgeries, pre-existing
health-related
murmur” that was diagnosed at age 3 and has persisted into adulthood; conditions, social history,
occupation, growth &
states she has had not difficulty with her daily life related to the development, living
environment, family
“murmur”; stopped anti-anxiety med during pregnancy; on buspar prior history, social habits).
to pregnancy. Patient engaged on regular basis in vigorous work activity prior to pregnancy but not routine exercise program. -She remarried X2 yrs. ago and decided to have another child with her -Pt. maintains a 15 acre family farm with goats, cows and chickens which is 1.5 hrs. from the closest hospital with a Level 3 NICU. Her husband is a full-time police officer and only assists with the farm work on weekends. She has 3 teenage children from her previous marriage, all still living at home; husband and children assist with farm work on the weekends only. Pt was still doing all farm work on own up to 22 weeks gestation when MD requested d/c all physical activity. Tests & Measurements:
Visual Inspection: no postural deviations noted when patient is
List key tests that should
be performed and results sitting-up in bed; currently not using any pillows or cushions for
expected for individuals
commonly affected; if
lumbar, cervical support while in a seated position; pt. prefers to sit relevant, key negative
tests should be included. with LEs in FABER position.
Observation of Bed Mobility: pt able to independently roll supine to
sidelying but not consistently using log roll technique Transfers:
SOWH TF on DX: OB Case #1: Prolonged bedrest for Pre‐Term Labor Reference: Irion JM. Medical Management and Physical Therapy Management of High‐Risk Pregnancy. In, Irion JM and Irion GL. Women’s Health in Physical Therapy. Wolters Kluwer/Lippincott Williams & Wilkins. Philadelphia, 2010   Supine to sit in bed: performed with forward trunk/hip-flexion technique rather than rolling to side first; sit to stand from bed independent with Sit-to-stand & bed mobility of supine to sidelying is done slowly Sit to stand from chair requires push-off with hands and momentum trunk flexion to go to standing- currently not sliding to the end of the chair before sit-to-stand; return to sit requires use of hands on seat. Toilet transfer: difficulty with eccentric control to sit; requires assistance from UE on wall and sink to stand up. Pt is holding her breath during most transfers. A/PROM LE: WNL bilaterally with exception of decreased hip flexion
secondary to pregnancy. All motions tested in a gravity-eliminated AROM UE: WNL bilaterally against gravity
AROM Cervical Spine: WNL for all motions
MMT LE: Isometric test in gravity-eliminated position; able to tolerate
full and equal resistance bilaterally at hips/knees and ankles MMT UE: Bilaterally all joints in G/N range
Endurance: SOB noted by patient with short distance walking > 5
minutes; pt. states within the last week, it has been difficult for her to sit up more than 10-15 minutes at a time without needing to lie down SOWH TF on DX: OB Case #1: Prolonged bedrest for Pre‐Term Labor 
Reference: Irion JM. Medical Management and Physical Therapy Management of High‐Risk Pregnancy. In, Irion JM and Irion GL. Women’s 
Health in Physical Therapy. Wolters Kluwer/Lippincott Williams & Wilkins. Philadelphia, 2010 
 
Activity & Participation:
Limited often to either complete or modified bedrest. In this case, pt is List key activity
limitations and
allowed to sit up a few minutes per hour and has toilet privileges. Some participation restrictions patients are on home bedrest and some in-hospital
that typically are evident
in individuals with the
condition.
Key Elements Missing: If NA
there are any other
characteristics that are
key elements of this
movement system
diagnosis and you have
not yet had the
opportunity to describe
them, please list them.
Differential Diagnosis:
List other conditions with
similar presentation that Co-morbidities that magnify the effect of bedrest such as, respiratory
would need to be "ruled
complications, cardiac issues, systemic neurologic disease, etc. out".
Diagnosis: What is the
Postpartum deconditioning secondary to prolonged prenatal bedrest proposed name of the
human movement
system condition?
Rationale for Name of
Primary--Cardiovascular/Pulmonary Pattern B: Impaired aerobic Diagnosis: What is the
basis for the name used capacity/endurance associated with deconditioning. ICD9 Code-786-
to identify the movement
system condition (e.g.,
symptoms involving respiratory system and other chest symptoms anatomic, physiologic,
kinesiologic, response to
movement, response to
Secondary for future: Musculoskeletal Pattern C: Impaired Muscle treatment, etc)?
Function. ICD9 Code-728.2-Muscle wasting and disuse atrophy not

Source: https://dxdialog.wusm.wustl.edu/Presentations%20and%20Publications/Educational%20Sessions%20at%20CSM%202011/Women's%20Health%20Section/Additional%20Case%20Examples/High%20Risk%20bedrest.pdf