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Tissue Plasminogen Activator Effects On Stroke And Physical Therapy Outcomes In Acute Care: A Case Report
Lindsey Leboeuf
An ischemic stroke occurs when blood flow to an area of the brain is restricted by a blood clot. Symptoms include: Numbness or weakness on one side of the body, facial droop, trouble speaking, and trouble walking. Patients can also display decreased balance, ataxia, flaccidity, spasticity, inattention or neglect, and visual changes. Patients who can identify these symptoms within 3 hours of their onset can be eligible to receive tissue plasminogen activator (tPA). tPA works by dissolving the blood clot to enhance blood flow in the brain which helps decreases the damage caused by the stroke. Patients who receive tPA in the effective window often have less disability from their stroke than their counterparts who did not receive the drug. The purpose of this case report is to display the positive effects of tPA and physical rehabilitation following a stroke in the acute care setting.
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Inpatient Rehabilitation For A Cancer Survivor Following A Lumbar Spinal Fusion Secondary To A Pathological Fracture: A Case Report
Nicole Marczak and Amy J. Litterini
Pathologic fractures are considered a skeletal-related event of bone metastasis. Bone metastases indicate a shorter prognosis with the survival rate varying from 6-53 months, depending on the primary type of cancer. Indications for surgery include spinal instability, vertebral collapse with or without neurologic deficit and intolerable pain that is not responsive to conservative treatment. Palliative physical therapy (PT) is provided to the patient and their family to offer education, optimize their functional independence and provide comfort and support. The purpose of this case report was to describe the plan of care for a man with advanced cancer to bone status-post lumbar spinal fusion prior to initiation of cancer treatment.
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Balance And Strength Interventions For An Individual Post Left Sided MCA CVA: A Case Report
Annie McKenzie
Cerebrovascular accident (CVA), or stroke, is the fifth leading cause of death in the United States (US) with more than 140,000 deaths each year. It is the leading cause of long-term disability in the US, reducing functional mobility in more than half of all stroke survivors ages 65 or older. This condition costs the US approximately 34 billion dollars a year and it is estimated to increase to 108 billion per year by 2025. Strokes are caused by the interruption of the blood supply to the brain, which occurs when a blood vessel ruptures (hemorrhagic stroke) or is blocked by a clot (ischemic stroke). The purpose of this case report is to describe the multifactorial management of care for a patient affected by chronic stroke in the outpatient physical therapy setting.
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A Hip Strengthening Protocol For A Patient Following Achilles Repair: A Case Report
Matthew Morris
The Achilles tendon is the most frequently ruptured tendon in the body and rupture most commonly occurs in men ages 30-50. Operative repair has more complications, but lower re-rupture rate, than non-operative management. Early weight-bearing after surgery has been shown to be beneficial. Hip weakness has been associated with lower extremity conditions such as gait deviations, ankle sprains, and knee instability. Previous research has found that individuals with Achilles tendinopathy have hip muscle weakness compared to controls. There is a lack of literature assessing the effect of using a hip strengthening protocol following Achilles repair. The purpose of this case report was to describe a comprehensive hip strengthening protocol for a patient following a left Achilles tendon repair whose rehab was complicated by a right proximal humerus fracture.
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Outpatient Physical Therapy Management Of A Patient Following A Severe Left Middle Cerebral Artery Infarction: A Case Report
Ryan Parnell
A cerebral vascular infarction (CVI) is a loss of blood flow to an area of the brain, which results in cell damage and/or death. The most common occluded artery is the middle cerebral artery (MCA). The incidence of falls within one year following a CVI can be as high as 42-60%. CVIs are a leading cause of long-term disability in the United States. CVIs account for 1 in every 19 deaths in the United States. Common impairments include: abnormal/slow gait, weakness, sensory loss, and decreased endurance. Common gait abnormalities include, genu recurvatum, foot drop,decreased stance phase, and foot slap on the involved side. Evidence based interventions for improving function following a CVI include: gait training, stair training, lower extremity (LE) strengthening, balance training, and aerobic exercise. The purpose of this case report was to describe the outpatient physical therapy (PT) management of a patient (pt) who experienced a severe left MCA infarction.
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Combining A Comprehensive Physical Therapy Program And Electroshock Therapy For A Patient With Plantar Fasciitis: A Case Report
Kathryn Piersiak
Plantar fasciitis (PF) affects 2 million Americans per year and 10% of the population over a lifetime. PF is inflammation to the thick, fibrous connective tissue originating on the medial calcaneal tubercle extending to the metatarsal heads of the foot. A comprehensive physical therapy (PT) plan of care (POC) of proximal strengthening, distal stretching and soft tissue massage (STM) has been shown to improve PF symptoms. Extracorporeal shockwave therapy (ESWT) is a non-invasive modality that uses sound waves to create a controlled microtrauma to the impaired tissue to stimulate a healing response and microvascularization. ESWT has shown to be effective in patients with PF, but has not been used in conjunction with a comprehensive PT program The purpose of this case report was to investigate the recovery of a patient with PF while using a combined approach of conventional therapy, targeted hip strengthening, and electroshock therapy.
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Incline Treadmill Training For A Crush Ankle Injury With An Open Wound: A Case Report
Anna Prokity
Within the industrial workplace, soft tissue injuries to the ankle are common. The ankle is the second most commonly injured region in the body. Past research has shown that average time away from work was 2.5 weeks for a lateral ankle sprain, with 90% of individuals having full return to work at six weeks. Therapeutic activities are part of a comprehensive physical therapy (PT) plan of care that contribute to reintegration into a normal work-load. Treadmill training with an incline has been shown to reduce ankle stiffness and improve active range of motion. There is a paucity of research investigating the use of incline treadmill training in the industrial setting and its use in treatment of crush injuries. The purpose of this case report was to examine the effectiveness of inclined treadmill training as a means of increasing dorsiflexion when mobilizations cannot be utilized in a comprehensive PT plan of care for an acute, grade II lateral ankle sprain with open wounds.
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Using Video And Mobile Applications To Manage Distress Following Acute COPD Exacerbation With Respiratory Failure: A Case Report
Linda Rose Shober
Chronic lower respiratory diseases, mainly chronic obstructive pulmonary disorder (COPD), represent a significant economic burden to the healthcare system and are among the top three leading causes of death in the United States. An acute exacerbation of chronic pulmonary disorder (AECOPD) is a worsening of the respiratory symptoms associated with COPD including dyspnea, increased sputum production, cough, and airway obstruction. Frequent AECOPD influences psychological status and may worsen comorbid anxiety, depression, and increase distress levels. As a result, motivation, mood, and participation in therapy may also be affected. Most exacerbations may be treated effectively on an outpatient basis. A fraction of episodes escalate in severity, resulting in respiratory failure and intensive care or specialty hospital admission. The purpose of this case report is to describe the use of video and mobile applications to promote distress relief during the rehabilitation of a patient with respiratory failure secondary to AECOPD in an LTACH setting.
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Home Health Physical Therapy For A 90-Year-Old Patient Following Transient Ischemic Attack: A Case Report
Kendra Stephens
Transient ischemic attack (TIA) is an episode of focal brain dysfunction that is temporary (<24 >hrs.) and is due to a dysfunction of an arterial territory of the brain. Its most common symptoms include facial droop, arm weakness, and speech difficulty. An estimated 200,000 to 500,000 people per year experience a TIA in the U.S. After having TIA, 1/3 of them will have a stroke within a year. About 25% of people will die within a year after a TIA. While research for secondary prevention of stroke is clear for pharmacological and surgical interventions, there is limited research on non-pharmacological interventions. The purpose of this case report was to describe the immediate home health physical therapy (PT) management of an elderly community-dwelling patient following a TIA.
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Treatment Of A Work-Related Superior Glenoid Labral Repair: A Case Report
Alexandra Touri
A superior glenoid labrum tear is a common injury in the shoulder. The highest incidences of superior labrum tear from anterior to posterior (SLAP) lesions occur in individuals from 20-29 years old and 40-49 years old. Common signs and symptoms include: instability in the joint, shoulder dislocations, pain with overhead activities, decreased range of motion, and loss of strength. SLAP lesions are less commonly seen in the workplace. There is little detail/research about which joint mobilizations/therapeutic exercises are most beneficial for this population. The purpose of this case report is to explore the post-operative PT management of a Workers’ Compensation patient with a superior glenoid labrum lesion.
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Joint Stability And Proprioception Training To Reduce Chronic Pain For A Female Patient With Hypermobile Ehlers-Danlos Syndrome: A Case Report
Ashley Tullo
Ehlers-Danlos Syndrome (EDS) is a heritable connective tissue disorder with many subtypes. Hypermobile EDS (hEDS), the most common subtype, is characterized by generalized joint hypermobility, musculoskeletal impairments, systemic involvement, and a familial history of EDS. Due to the many subtypes of EDS, and general hypermobility, a categorization of all terms was created called the Hypermobility Spectrum Disorder. Patients present with physical, psychological, and central nervous system impairments reducing their quality of life (QoL). The purpose of this case report was to describe the interventions utilized for a 28-year-old female with hEDS and chronic pain with the intention of reducing symptoms and promoting return to work.
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Blood Flow Restriction Therapy For The Treatment Of An ACL Reconstruction With A Meniscal Repair: A Case Report
Nicole Victor
ACL tears make up ~50% of all knee injuries. Meniscal tears are second to ACL injuries in regards to prevalence. Following an ACL reconstruction, high-load resistance training is often used to increase muscle strength. However, rehabilitation after a meniscal repair calls for a longer period of immobilization in order to prevent early loading of the meniscus. Blood Flow Restriction Therapy (BFRT) used in conjunction with low intensity resistance training can produce increased muscle mass of the quadriceps muscles without adding load and stress to the meniscus. While evidence has shown positive results with the use of BFRT after an ACLR, there is limited evidence for using BFRT after a meniscal repair and after both surgeries concomitantly. The purpose of this case report was to investigate the use of BFRT in a comprehensive PT rehabilitation plan for a patient following an ACLR and meniscal repair.
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Muscle Energy Techniques As Part Of A Comprehensive Plan Of Care For A Patient With Hip And Knee Osteoarthritis: A Case Report
Daniel White
Osteoarthritis (OA) is a chronic musculoskeletal condition which affects over 27 million Americans. The hip and knee joints are most affected by OA. Many risk factors are modifiable in the development of OA. While muscle energy techniques (MET) are commonly used to treat lumbopelvic dysfunction, limited evidence exists for its use as part of a comprehensive plan of care in patients with OA. The purpose of this case report was to describe the management of a patient with mild/moderate OA utilizing a comprehensive plan of care including MET.
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Functional Mobility In A Patient With Antiphospholipid Antibody Syndrome Following A Femoral Neck Fracture Surgical Repair: A Case Report
McKenna Young
Antiphospholipid Antibody Syndrome is an autoimmune disease which causes the body to produce antibodies that attack phospholipids, a type of fat. It leads to high rates of blood clot formation in arteries and veins. High rates of blood clots cause stroke, which can lead to balance concerns and increased falls. Fall rates among individuals with chronic disease peak between age 45-64. Fall risk factors include reduced mobility level, imbalance, age, number of co-morbidities, duration of diagnosis, and sex. The purpose of this case report is to investigate a comprehensive physical therapy program that focused on increasing independence and reducing fall risk.
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Delayed ACL Rehabilitation After Autograft Tear During Surgery: A Case Report
Rolene Yousefyan
Anterior cruciate ligament (ACL) injuries are one of the most common knee injuries in female soccer players that require reconstruction and rehabilitation. The incidence rate of autogenous ACL reconstruction (ACLR) complications during surgery are reported as low as 0.2% to 1.7%. There is insufficient information on the most effective rehabilitation protocol for patients with complications during surgery. Many rehabilitation protocols fail to include programs for patients who have general joint laxity. No known studies have reported on the most effective treatment for a patient with generalized laxity and an autograft rupture during surgery. The purpose of this case report was to investigate a delayed physical therapy (PT) treatment plan for a patient with generalized laxity who experienced a rupture of the replacement tendon during surgery.
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Inpatient Physical Therapy Management For A Patient With Chronic Pulmonary Complications Secondary To Multiple Lobectomies: A Case Report
Bayley Archinal
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.
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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.
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Intra-Rater & Inter-Rater Reliability In 2nd Year DPT Students Performing The Navicular Drop Test
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.
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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
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The Treatment Of Pes Anserine Syndrome Using ACL Injury Prevention Exercises: A Case Report
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.
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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.
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Acute Care Physical Therapy And Early Mobilization For A Patient Following Bilateral Staged Anterolateral Total Hip Arthroplasties: A Case Report
Rachel Claussen
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).
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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.
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Balance And Strength Interventions For An Older Individual With Peripheral Polyneuropathy: A Case Report
Hanna Geib
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,
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