Tina Bhakta, Paxton Arsenault, Maya Ahluwalia, and Rachel Coats
Research poster by UNE Occupational Therapy and Physical Therapy students investigating the definition of and recommendations for good sleep hygiene, the limitations of the hospital setting on attainment of sleep hygiene, and the benefits of sleep hygiene for hospital patients.
Inpatient Physical Therapy Management For A Patient With Chronic Pulmonary Complications Secondary To Multiple Lobectomies: A Case Report
Bronchiectasis is a disease defined by abnormal dilation of the bronchi, which is a result of recurrent infections and/or chronic inflammation. A lobectomy is the surgical removal of one lobe of a lung and reduces the symptoms of bronchiectasis. Patients who undergo this surgery are more likely to have long-term pulmonary limitations. There is little to no literature regarding the long term treatment of patients who underwent multiple lobectomies. The purpose of this case report was to describe an appropriate intervention program for an 82-year-old female who suffered from multiple pulmonary complications secondary to multiple lobectomies.
A Weighted Vest Rehabilitation Protocol To Improve Gait In A Patient With Cerebellar Degeneration: A Case Report
Amy Belanger and Kirsten Buchanan
The purpose of this case report was to investigate a combined weighted vest protocol and comprehensive PT program for a 34-year-old with cerebellar degeneration. Cerebellar degeneration (CD) is a rare brain dysfunction that affects motor control. Ataxia is a common manifestation of CD, defined as the discoordination of the limbs or trunk. Interventions that have separately been found to be effective when treating ataxia are postural training, comprehensive physical therapy (PT) and weighted vest protocols. While each of these treatments have individually been shown to decrease ataxia, they have not been used in combination.
Kirsten Buchanan, Nick Allard, David Buchan, Mike Curtin, and Andrew DiPartolo
The Navicular Drop Test (NDT) is used as a clinical measure of mid-foot pronation. Objective measurements are rooted in the trust of the tool. When utilizing the NDT, the tool is the practicing clinician. Research has revealed that experienced clinicians have good-excellent intra- and inter-rater reliability when measuring navicular drop (ND). Current data reports ~25,000 practicing US PTs have < 3 years experience. There is limited research exploring the intra- and inter-rater reliability of less experienced DPTs when performing the NDT. The purpose of this research report was to determine the intra- and inter-rater reliability of three 2nd year DPT students.
Comprehensive Physical Therapy Management Of Peroneal Tendonitis With Associated Painful Os Peroneum Syndrome: A Case Report
Megan Burns and Kirsten Buchanan
Treatment for peroneal tendonitis is well documented. Treatment of Painful Os Peroneum Sydrome (POPS) is not. Currently, there is no research that has investigated the best treatment for a combined diagnosis of POPS and peroneal tendonitis. The purpose of this case report was to investigate a comprehensive plan of care (POC) for a 65-year-old woman with a combined diagnosis of peroneal tendonitis and POPS
Stephanie Chau and Kirsten Buchanan
The purpose of this case report was to utilize ACL injury prevention exercises within a comprehensive physical therapy (PT) plan of care (POC) for a patient with Pes anserine syndrome (PAS). Pes anserine syndrome (PAS) is the inflammation of either the pes anserine bursa, tendon, or both. The incidence and etiology of PAS are unknown at this time. There is limited literature available for the treatment and rehabilitation of PAS. Anterior cruciate ligament (ACL) injury prevention exercises address proper hip, knee, and ankle alignment and decrease the risk of ACL injuries by 52% in females and 85% in males.
Comprehensive Physical Therapy Management Of A Patient With Decreased Shoulder Function And A History Of Breast, Lung, And Oral Cancer: A Case Report
Andrew Chongaway and Amy J. Litterini
Multiple primary cancers are uncommon in the same individual with an incidence rate of 2-17%. Surgery, chemotherapy, endocrine therapy, and Surgery, chemotherapy, endocrine therapy, and radiation may result in immediate and/or long radiation may result in immediate and/or long-term effects on the musculoskeletal, cardiopulmonary, nervous, and integumentary systems potentially resulting in decreased functional mobility and quality of life (QOL) for the individual. The purpose of this case report was to describe a comprehensive physical therapy (PT) plan using manual therapy and therapeutic exercises in the management of decreased shoulder function for a patient with a history of breast, lung, and oral patient with a history of breast, lung, and oral patient with a history of breast, lung, and oral cancers.
Acute Care Physical Therapy And Early Mobilization For A Patient Following Bilateral Staged Anterolateral Total Hip Arthroplasties: A Case Report
The purpose of this case report was to add to the limited literature describing acute care physical therapy (PT) management of patients receiving staged BTHA and to document both episodes of care. Primary hip osteoarthritis (OA) is a leading cause of significant hip pain resulting in disability, joint stiffness, and loss of function. 42% of people with hip OA have it in both hips. Minimally invasive surgery using an anterolateral approach spares the hip external rotator muscles and posterior hip capsule. Staged bilateral total hip arthroplasty (THA): two separate surgical procedures during different hospitalizations. Lower risk of deep vein thrombosis (DVT), but higher risk of complications overall compared to simultaneous bilateral THA. Early mobilization (EM) following THA is associated with lower pain levels and reduced length of stay (LOS).
Functional Mobility For A Patient With Myelodysplastic Syndrome, Chronic GVHD, And Corticosteroid Use: A Case Report
Alyssa Deardorff and Amy J. Litterini
The purpose of this case report is to describe PT interventions for an individual with a cancer diagnosis who received an allo-SCT and subsequently had long-term complications associated with cGVHD, long-term corticosteroid use, and cancer survivorship. Myelodysplastic Syndrome (MDS) is often called pre-leukemia as 1 in 3 individuals will develop Acute Myeloid Leukemia. It is a type of cancer that causes blood producing cells in bone marrow to function abnormally and causes normal blood cells to die earlier. Graft-Versus-Host-Disease (GVHD) develops in approximately 70% of patients following an allogenic stem cell transplant. Donor’s cells attack both the malignancy and the patient’s healthy cells. Treatment for acute and chronic GVHD (cGVHD) is often corticosteroids, which can have detrimental effect on muscle strength, immune function, weight, and mood.
Balance And Strength Interventions For An Older Individual With Peripheral Polyneuropathy: A Case Report
Peripheral polyneuropathy (PPN) is a condition resulting from damage to the peripheral nervous system. PPN occurs in a distal and symmetrical pattern, often affecting the toes and the soles of the feet. Numbness, tingling, paresthesias, or burning are common symptoms of PPN. 20-25% of cases are idiopathic. Can affect functional mobility due to proprioceptive sensory losses and general weakness of extensor muscles, which then results in unsteadiness of gait and impaired balance. Treatment can consist of pharmacological and physical therapy interventions in order to manage symptoms. Recent literature demonstrated that following participation in a strength and balance training program, individuals with PPN experienced significantly fewer falling episodes. The purpose of this case report is to describe the Physical Therapy management of an elderly community-dwelling patient with idiopathic PPN, elevated fall-risk, deconditioning, and a history of bilateral total knee and hip arthoplasties,
Restoring Functional Mobility In An Adult Patient Secondary To Subtrochanteric Femur Fracture Surgical Repair: A Case Report
The National Highway Traffic Safety Administration noted 7,277,000 police reported motor vehicle accidents (MVA) in the United States in 2016.1 As a result, 2,177,000 people were injured. In 2008, approximately 340,000 emergency department visits were because of hip fractures. Femur fractures average $40,000 in medical bills in the first year following injury and another $5,000 in succeeding years. A review of 12 trials resulted in mixed evidence on the necessity of skilled physical therapy (PT) interventions to maximize functional mobility in individuals with femur fractures. The purpose of this case report was to report on the results of skilled PT intervention in treating an individual with a subtrochanteric femur fracture sustained during a MVA.
Barefoot Rehabilitation Of Type II Posterior Tibialis Tendon Dysfunction In A Veteran: A Case Report
Matthew Heindel and Kirsten Buchanan
The purpose of this case report was to examine barefoot training and foot intrinsic musculature strengthening within a comprehensive PT plan of care for type II PTTD. Posterior Tibialis Tendon Dysfunction (PTTD) affects ~10% of the population, where Stage I: medial arch pain, possible pain with heel elevation, and mild ankle/foot swelling, Stage II: Stage I + flexible flatfoot deformity, Stage III: Stage I + fixed flatfoot deformity, Stage IV: tibiotalar degeneration stemming from valgus tilt of talus in ankle mortise. Barefoot training increased plantar surface proprioception, increased activation of foot intrinsic musculature, decreased running injuries. Foot Intrinsic Musculature Strengthening with Short-foot Exercise showed highest EMG for intrinsic musculature improved balance scores in patients with chronic ankle instability, decreased navicular drop in patients with pes planus and hyper-pronation, and increased support of the medial longitudinal arch. Three randomized controlled trials showed positive outcomes with comprehensive plan of care. Studies have yet to include barefoot training or intrinsic foot musculature strengthening in conservative management of PTTD.
A Barefoot Running Program For A College Lacrosse Player With Chronic Exertional Compartment Syndrome: A Case Report
Erica Mazzarelli and Kirsten Buchanan
Barefoot running protocols have been effective in decreasing anterior and lateral chronic exertional compartment syndrome (CECS), but they have not been studied in patients with posterior CECS. Additionally, there is a lack of research that has investigated a barefoot running protocol in a college lacrosse athlete. The purpose of this case report was to examine the effects of adopting a forefoot strike pattern, through a barefoot running program, in a 20-year-old college lacrosse player with posterior chronic exertional compartment syndrome.
A 6 Week Balance And Gait Training Program Using The AlterG For A Patient With Cervical Myelopathy After Spinal Decompression Surgery: A Case Report
Spinal stenosis is the narrowing of the spinal canal which can cause radiculopathy or myelopathy symptoms due to compression of the spinal cord. About 80% of patients of 70 years old have some level of stenosis. There is limited research on prognosis for patients with cervical myelopathy and subsequent spinal decompression surgery. AlterG treadmill (AlterG Anti-Gravity Treadmill M320/F320, Fremont, CA) is an antigravity treadmill that is considered a body weight support system used in progressive gait retraining. The purpose of this case report is to assess the effectiveness of balance and gait training on the AlterG in a geriatric patient with sever cervical myelopathy who underwent spinal decompression surgery.
Gianna G. Pezzano and Amy J. Litterini
The purpose of this case study was to describe a palliative care physical therapy (PT) plan for maintenance of functional mobility and fall risk reduction for a patient with ALS. Ice Bucket Challenge began in 2014 to increase public awareness and funding for ALS. Need for further research was highlighted, in the campaign, for medical treatment and rehabilitation. Typical Presentation for Amyotrophic Lateral Sclerosis (ALS) is male, 60 years old, limb onset. This patient was female, 82 years old, with bulbar onset, limb weakness, and fall risk.
Inpatient Rehabilitation Of A 99-Year-Old Following A High-Impact Unstable Pelvic Ring Fracture: A Case Report
The purpose of this case report was to describe the outcomes of PT interventions for a nonagenarian patient following an unstable pelvic ring fracture and to provide an overview for a plan of care supported by research. Unstable pelvic ring fractures are defined by the displacement and deformity of the pelvic bones. Pelvic fractures are rare and only make up 3% of all skeletal injuries; however, the mortality rate of unstable pelvic fractures is extremely high, ranging from 20-50%. Most pelvic fractures are caused by motor vehicle accidents (MVA) in which patients suffer multiple traumas. When patients suffer multiple traumas including a pelvic fracture, their mortality rate increases by 10%, and their ability to return home after treatment decreases by 33%.
Relieving Low Back Pain And Improving Mobility For An Adult Patient With Progressive Multifocal Leukoencephalopathy: A Case Report
Derek Schwaiger and Matthew Somma
Progressive Multifocal Leukoencephalopathy (PML) is a progressive demyelinating disease caused by the John Cunningham Virus (JCV). There is no FDA approved JCV- specific treatment. This case report examines interventions administered to address low back pain (LBP) and functional mobility deficits.
Natalie Slattery and Kirsten Buchanan
93% of patients who have a total hip arthroplasty (THA) are due to end-stage osteoarthritis. 15-30% of patients who survive a stroke continue to live with a long-term disability. The most common abnormal gait pattern after surviving a stroke is due to hemiparesis. Patients who are deaf require greater visual and tactile cueing during gait training. Gait training has been shown to normalize gait patterns and increase functional mobility in patients after a total hip replacement (THR), THA revision and/or stroke. There is a lack of research investigating the optimal gait training plan of care (POC) for a patient with a THR, THA revision, stroke and deafness. The purpose of this case report was to investigate a comprehensive POC for a patient who is deaf and had a THR, a THA revision and a subacute stroke.
Lumbar radiculopathy is compression of a spinal nerve root, typically due to a herniated nucleus pulposus. It can present as low back pain (LBP) that radiates to one lower extremity (LE) and may be associated with diminished sensation, strength and reflexes on the affected side. The McKenzie approach is an evaluation and treatment technique that focuses on the movement of the nucleus pulposus within the intervertebral disc during trunk movement. This approach involves having a patient perform repeated motions, while monitoring their symptoms for centralization. Centralization refers to the concept that radiating symptoms into the lower extremities can move proximally toward the spine. The purpose of this case report was to evaluate the efficacy of the McKenzie method, along with manual therapy, strengthening and stretching exercises, modalities, patient education and a home exercise program (HEP) for a patient with lumbar radiculopathy. The setting of this episode of care was outpatient orthopedics.
Cameron Vallie and Matthew Somma
The number of Americans who practice yoga jumped to 16.5 million between 2004 and 2008 (87% increase), making it a top 10 modality in alternative medicine according to the National Institutes of Health. Medical Therapeutic Yoga is the practice of yoga in medicine, rehabilitation, and wellness settings by a licensed health care professional credentialed by the Professional Yoga Therapy Institute. Shoulder pain has been found to be the third most common site of musculoskeletal pain in the community. Adhesive capsulitis (AC) is a particularly disabling condition whose incidence is estimated to be between 2% and 5% of the general population and up to 38% in those with systemic diseases such as diabetes, Parkinson’s disease and thyroid disease. The purpose of this case report was to detail the use of yoga therapy in conjunction with joint mobilization and therapeutic exercise on a patient with AC.
Subacute Rehabilitation Following An Hypoxic Ischemic Brain Injury Resulting In Severe Ataxia: A Case Report
The purpose of this case report is to provide physical therapy interventions that were utilized in an inpatient rehabilitation hospital setting for a patient who experienced a hypoxic brain injury. Hypoxic/anoxic brain injuries result from global lack of oxygen to the brain from events such as drowning, choking, and cardiac or respiratory arrest. Certain areas of the brain have more devastating effects when deprived of oxygen as they have a higher metabolic activity and increased utilization of oxygen. One area in particular is the basal ganglia. Anoxic brain injuries involving infarcts of the basal ganglia (containing globus pallidus) can result in involuntary movement disorders such as: Myoclonic jerks, Ataxia, Akinetic-rigid movements, Difficulties in learning new motor skills. Ataxic gait is characterized by: Difficulties with inter- and intra-limb coordination, Decreased speed of ambulation, Irregular stepping pattern, Impaired postural stability, An increased risk of falls.
The purpose of this case study was to assess conservative management of a complete rupture of the long head of the biceps over a six-week period. The long head of the biceps (LHB) stabilizes the shoulder by reducing anteroposterior and superior inferior translation of the humeral head in the glenoid fossa. A tear of the LHB most commonly occurs when the biceps is suddenly loaded against flexion and supination of the elbow. Surgical repair of the LHB has seen 94% satisfaction rates, but with complications. Fifty-six percent of patients who initially chose conservative methods ultimately choose surgery. There is a currently a lack of evidence supporting conservative management of a complete rupture of the LHB.
Blood Flow Restriction Exercises Following An ACL Reconstruction In A 17-Year-Old Female Athlete: A Case Report
Andrew Anich and Kirsten Buchanan
Anterior cruciate ligament (ACL) reconstructions account for over 50% of all sports-related knee surgeries. Due to graft healing, rehab protocols do not allow for high resistance training for several months. Blood flow restriction (BFR) therapy with low load exercise has been suggested to improve quadriceps and hamstring strength and hypertrophy in adults. There is currently a lack of research on the effects of BFR therapy on hamstring strength and hypertrophy following an ACL reconstruction in high school athletes. The purpose of this case report was to assess how BFR therapy affects hamstring and quadriceps strength and hypertrophy in a 17-year-old athlete following ACL reconstruction.
Physical Therapy For Low Back Pain With A Focus On McKenzie Method For Diagnosis And Treatment: A Case Report
Low back pain (LBP) is thought to affect 80% of the population. It decreases work attendance, affects daily activity, and decreases quality of life. Physical Therapy (PT) is a noninvasive form of treatment that may include manual therapy, physical exercise, deep heat modalities, or a combination. The purpose of this case report was to review a multifaceted approach to LBP, including a focus on the McKenzie method and paired with conventional PT for a patient with a recurring episode of chronic LBP.
Gait and Functional Training for a Patient Post-Stroke with a History of Substance Abuse and Psychiatric Disorders: A Case Report
Morgan Costa and Amy J. Litterini
The opioid crisis is the largest drug epidemic in recorded history, resulting in over 500,000 deaths between the years of 2000 and 2015. The abuse of and addiction to opioids are serious global health problems that affect the social and economic well-being of all societies. Drug abusers have a 6.5 times increased risk of stroke. Strokes contribute to the disability and morbidity associated with drug abuse. Drug abuse is a frequent cause of stroke in areas with a high prevalence of comorbidity between drug abuse disorders and mental illness. The purpose of this case study was to outline physical therapy (PT) rehabilitation that utilized task-oriented and gait training in an inpatient rehabilitation facility (IRF) to address gait and functional mobility in a patient following a stroke combined with both substance abuse and psychiatric disorders.
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