The Role Of Physical Therapy Interventions For An Elderly Patient Following Surgical Fixation Of A Fracture Of The Femoral Shaft: A Case Report
In the U.S. approximately half of elderly white females will sustain an osteoporotic hip fracture. One year following surgery most elderly adults have not returned to their prior level of function. Evidence demonstrates the benefits of early weight bearing and mobility post-surgery to improve functional abilities. The purpose of this case report was to document this patient’s response to skilled physical therapy intervention in the inpatient setting, including functional mobility, gait training and therapeutic exercise to maximize the patient's functional ability prior to discharge home.
Acute Care Physical Therapy Status Post Colostomy For A Patient With Colorectal Cancer: A Case Report
Colorectal cancer (CRC) is a malignancy that begins in the colon or rectum. In 2016 there were 724,690 men and 727,350 women living with a history of CRC, with an estimated 135,430 new cases in 2017. Treatment can include local radiation, systemic chemotherapy, and/or surgery to remove the tumor, which can result in the placement of a colostomy. A colostomy entails a surgical resection to a portion of the lower GI tract, which creates an opening in the abdominal wall referred to as a stoma, which provides a new pathway for removal of gas and stool. Clinical Practice Guidelines for enhanced recovery protocols set a standard of perioperative procedures and practices to improve patient outcomes, lessen complications, reduce length of stay, as well as decrease overall health care costs. Early and progressive mobilization has been associated with shorter length of stay and has a strong recommendation based on low quality evidence.
The Use Of Manual Lumbar Traction And Therapeutic Exercise In The Treatment Of A Patient With Low Back Pain: A Case Report
The prevalence of low back pain (LBP) has been increasing in the United States. Manual lumbar traction and therapeutic exercise are two common treatments by physical therapists (PT) for LBP, but there is limited research investigating the combined effects of these treatments on low back pain. The purpose of this case report was to investigate the combined effects of these treatments on LBP.
Vestibular Rehabilitation For A Geriatric Patient With Benign Paroxysmal Positional Vertigo Treatment Failure: A Case Report
Good balance requires integration of sensory information from three systems: vestibular, visual and somatosensory. The vestibular portion of the inner ear contains two types of sensory structures that respond to gravity and head movements: semicircular canals and otolith organs. Crystals of calcium carbonate (otoconia) reside in the otolith organs, but can become dislodged and migrate to the semicircular canals, causing symptoms of vertigo. Benign Paroxysmal Positional Vertigo (BPPV), caused by misplaced otoconia in the semicircular canals, is the most common vestibular disorder. Symptoms include dizziness, nausea, nystagmus, brief episodic vertigo during rapid head movements and specific head positions. BPPV is diagnosed with the Dix-Hallpike test and the gold standard treatment is the Epley maneuver, up to 93% effective at resolving BPPV. Persistent symptoms after initial BPPV treatment indicates BPPV treatment failure. 31-61% of patients with BPPV experience non-positional persistent imbalance, known as residual dizziness (RD), the cause of which remains unclear. RD is common among the elderly, causing impaired functional mobility, increased risk of falls, and decreased quality of life. The purpose of this case study was to document the vestibular rehabilitation of a geriatric patient with BPPV treatment failure.
Strength And Balance Training For A 29-Year-Old Female Who Sustained A Multifocal Stroke: A Case Report
Britney Simonton and Kirsten Buchanan
Stroke is defined as a decrease in blood supply to the brain, and most often occurs in older adults. In the United States, approximately 795,000 people sustain a stroke annually. Risk factors for a stroke include high blood pressure, smoking, diabetes, and high cholesterol. Stroke is the leading cause of disability in the United States. Although research has shown that a balance and strength training program is beneficial for older adults who have sustained a stroke, there is limited research showing if these benefits also hold true for younger patients who have had a stroke. The purpose of this case report was to investigate a comprehensive physical therapy program that included balance and strength training in a 29-year old patient who had recently sustained a multifocal stroke.
Physical Therapy Management Of A Patient With A Lacunar Stroke And Multiple Comorbidities: A Case Report
Strokes are the fourth leading cause of death and the number one cause of long-term disability in the United States. A lacunar infarct is a type of ischemic stroke that occurs within the deepest structures of the brain when one of the small arteries gets blocked. Risk factors for a lacunar stroke include older age, high blood pressure, smoking, excessive alcohol consumption, poor diet, and obstructive sleep apnea. The purpose of this case report was to describe the plan of care for a patient with a lacunar infarct and multiple comorbidities in a long-term care facility with the goal of helping the patient achieve independent functional mobility so that she can return home.
Kelly Trancygier and Michaael Fillyaw
Parkinson’s disease (PD) affects 1.5% of the US population over 65 years of age. PD is typically diagnosed in individuals over the age of 60. There is no cure and the disease itself is not fatal, however, its effects can be very debilitating. PD occurs when the neurons in the basal ganglia of the brain stop producing enough dopamine. Dopamine is a neurotransmitter that helps to regulate body movements and emotions. When there is a reduction of dopamine in the brain, the motor symptoms of PD begin to appear. The purpose of this case was to report the outcomes of multiple physical therapy interventions including aerobic and endurance exercises, strengthening exercises, and balance and gait training on a patient with stage III PD.
In the U.S., the prevalence of stroke is approximately 795,000 annually and is the fifth most common cause of death. Stroke impairments include hemiplegia, sensory loss, dyspraxia, and hemianopsia. The chronic phase of stroke is defined as six months and beyond post-stroke. Nearly 85% of adults will experience low back pain (LBP) at some point in their life. Risk factors for LBP include age, educational status, psychosocial factors, physically demanding occupation, and high body mass index. Low back pain adds a confounding variable in recovery of mobility for patients with chronic stroke (CS). The purpose of this case report was to create an example of a functional strengthening program for a patient with CS impairments and LBP.
The Physical Therapy Management Of A Patient With Chronic Shoulder Dislocations And Chronic Inflammatory Demyelinating Polyneuropathy: A Case Report
Chronic shoulder dislocation is a severe disabling condition that can significantly decrease an individual’s quality of life, most often resulting after neglected acute dislocations, after surgery, or with the presence of unidirectional or multi-directional shoulder instability. Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a neurological disorder characterized by progressive weakness and impaired sensory function in the legs and arms; it is caused by damage to the myelin sheath of the peripheral nerves, and presents with symptoms that include tingling/numbness, weakness of the arms and legs, areflexia, fatigue and abnormal sensation. The purpose of this case report was to describe the physical therapy management and recovery of an individual with chronic shoulder dislocations/instability and CIDP.
A Comprehensive PT Program Utilizing An AlterG Treadmill For A Patient With Lower Extremity Fractures And Charcot-Marie-Tooth Disease: A Case Report
Mark Whitsitt and Kirsten Buchanan
People with Charcot-Marie-Tooth (CMT) disease have a greater risk of falls and subsequent fractures due to lower extremity stiffness, muscle wasting, and balance impairments. Positive pressure treadmill systems, such as the AlterG®, are commonly utilized for orthopedic patients, as they allow for early mobility with decreased symptoms. Minimal research exists that has investigated use of the AlterG® in patients with lower extremity fractures and CMT. The purpose of this case report was to investigate a comprehensive physical therapy program including the use of the AlterG® treadmill for a patient with multiple lower extremity fractures and CMT disease.
Improving Function And Fatigue For A Patient Status Post Thoracoabdominal Resection Of A Gastric Tumor And Chemotherapy: A Case Report
A gastrointestinal stromal tumor (GIST), a type of stomach cancer, occurs when abnormal cells develop in the tissue of the gastrointestinal tract. Stomach cancer is a relatively rare carcinoma that is often not detected until later stages. The purpose of this case report was to document the physical therapy approach for a deconditioned patient due to resection of a malignant stomach tumor and both neoadjuvant and adjuvant chemotherapy.
Application Of Manual Therapy Utilizing Maitland Principles In The Rehabilitation Of A Patient Following Rotator Cuff Repair
Kehinde Aderibigbe and Brian T. Swanson
In the United States, more than 500,000 rotator cuff repairs and shoulder arthroscopies are performed annually. Following surgery, physical therapy (PT) often utilizes various manual therapy (MT) and therapeutic exercise (TE) interventions. Post-operatively, accessory joint mobilizations (AJM) help to prevent adhesions and may decrease excitability of central nociceptive pathways. However, there is no consensus about the most appropriate postoperative utilization and timing of MT following surgery. Maitland describes a framework for clinical decision making that is patient-centric and focuses on frequent reassessment to guide the application of manual therapy. In this framework, comparable signs are identified at initial evaluation, and refer to any combination of pain, stiffness, and/or spasm during a specific movement. An appropriate MT technique is selected and utilized to treat the comparable sign; the comparable sign is reassessed to monitor patient response, and determine the proper progression. The purpose of this case report was to detail the assessment and clinical reasoning utilized during the treatment of a patient following arthroscopic rotator cuff repair (ARCR), with manual therapy intervention guided by the principles of the Maitland approach.
Physical Therapy Treatment Of A Patient With Chronic Low Back Pain And A Previous History Of A Substance Abuse Disorder: A Case Report
Marcus X. Alomar and Brian T. Swanson
The National Survey on Drug Use and Health (NSDUH) reported that an estimated 27 million people in the United States have reported use of an illicit drug within the past month. Low back pain continues to be a major cause of disability in the United States, with an estimated 70 percent of adults experiencing low back pain at some point during their lifetime. Active exercise programs that include pain education and cognitive behavioral therapy demonstrated significant superior outcome at reducing pain intensity, anxiety/depression, disability, and fear-avoidance compared to therapeutic exercise and manual therapy alone for patients with non-specific chronic low back pain. With both illicit and prescription drug use rising in the US, it is likely clinicians will encounter patients with substance abuse disorders, as well as opiate induced hyperalgesia. The use of psychologically informed practice may be beneficial in this patient population. There is ample research on various approaches to treating low back pain, however there is limited research investigating the efficacy of treatment for patients with low back pain and a previous history of opioid dependency. The purpose of this case report was to describe the physical therapy treatment, including pain management strategies, for a patient with low back pain, a previous history of opioid dependency (oxycodone), and apparent opiate induced hyperalgesia.
Kathleen Barnes and Kirsten Buchanan
One million cases of plantar fasciitis (PF) are reported annually in the United States. Studies have separately investigated the effectiveness of physical therapy (PT) interventions as well as steroid injections from podiatry – but not in conjunction with each other. There is a lack of research investigating an interdisciplinary approach utilizing PT and podiatry for PF. This case report investigated an interdisciplinary approach combining physical therapy and podiatry utilizing steroid injections in the treatment of a patient with plantar fasciitis.
Early Utilization Of The 6-Minute Walk Test (6MWT) In An Active Patient After Cardiac Surgery - A Case Report
Christian Boucher and Kirsten Buchanan
Coronary artery disease affects more than 13 million Americans. A sub-population of these patients, despite exercising regularly, can develop cardiac disease. The 6-Minute Walk Test (6MWT) is a functional outcome measure that is easy to implement and has been used across multiple populations. There is limited literature that has investigated the use of the 6MWT on post-operative day one (POD1) after cardiac surgery. Patients participating in self motivated exercise programs prior to surgery are found to excel with early utilization of the 6MWT. For this active sub-population the 6MWT on POD1 may be a more specific and sensitive outcome measure. The purpose of this case report is to investigate the use of the 6MWT as an outcome measure POD1 in a patient after cardiac surgery who participated in a self-exercise pre-op program.
The Use Of Therapeutic Exercises And Manual Stretching For A Patient Following A Total Knee Arthroplasty (TKA) Revision: A Case Report
Total knee arthroplasty (TKA) is an orthopedic surgery involving the total replacement of compartments of the knee joint. Osteoarthritis (OA) is the most common reason for TKA. Risk factors for OA include: obesity, sports-related injuries, and genetics. The artificial knee joint typically lasts between 15-20 years; early failures may occur due to loosening of artificial components, infection, fractures, and instability. Approximately 581,000 TKA procedures are performed annually, and by 2030, the demand for TKA procedures is expected to grow by 673%. The purpose of this case report is to document the potential benefits of prescribed PT interventions, including therapeutic exercise and manual stretching, for a patient who underwent TKA revision. The setting of this rehabilitation process was a skilled nursing facility.
The Use of Manual Therapy In The Treatment Of A Patient With Chronic Low Back Pain And Sciatica: A Case Report
Elia N. Darazi
Low back pain (LBP) is the second most common cause of disability in adults with total costs estimated to be between $100 and $200 billion annually on the US economy. The prevalence of chronic LBP rose significantly over a 14-year interval (1992 to 2006), from 3.9% to 10.2%. Treatment of LBP may be conservative or surgical, with conservative being the mainstream initial treatment before a consideration of a surgical option. A surgical option is usually recommended when there is evidence of worsening nerve damage. In a physical therapy (PT) outpatient setting, chronic LBP is one of the most common conditions encountered. Primary evidence-based treatment options include exercise therapy and manual therapy; both have been shown to benefit many patients. The purpose of this case report is to report the effects of a short-course manual therapy intervention for a patient who presented with chronic LBP and sciatica.
Physical Therapy Intervention For A Patient With Temporomandibular Joint Dysfunction Caused By Two Traumatic Events: A Case Study
Temporomandibular disorders (TMD) are a collection of pathoanatomical dysfunctions of the temporomandibular joint (TMJ) and are associated with a variety of symptoms throughout the head and neck. There is a severe lack of supportive evidence for physical therapy management used in the conservative and/or post-surgical treatment of TMD. The dental profession provides much of the current literature on TMD but is limited in conservative and surgical interventions. Research has shown arthrocentesis to be a beneficial procedure to perform initially; long-term outcomes for pain and functional impairments were comparable with conservative treatment. The purpose of this case report is to provide information regarding conservative and post-surgical physical therapy treatment of TMD due to a traumatic mechanism of injury and describe a physical therapy plan of care for TMD.
Knee pain affects approximately 25% of adults, and as a result limits functional mobility and may induce participation restrictions. Risk factors may contribute to knee pain, with osteoarthritis (OA) being the most prevalent cause in individuals 50 years and older. The rate of knee replacement surgery among individuals 65 and older has increased by approximately eight fold from 1979-2002. Physical Therapy (PT) is a nonsurgical option that offers individuals relief. The purpose of this case report is to review the PT treatment and management for a patient with chronic knee pain, and use evidence based interventions, such as therapeutic exercises, joint mobilization, application of KT, and a home exercise program (HEP).
Physical Therapy Management Of A Patient After Hemorrhagic Stroke Using A Task-Oriented Approach In A Skilled Nursing Facility: A Case Report
Stroke is the leading cause of long term disability in the U.S.; nearly 800,000 Americans have a stroke each year. Subarachnoid hemorrhagic stroke occurs when one of the blood vessels in the brain bursts causing a release of blood which increases intracranial pressure. There is a lack of rehabilitation research in the skilled nursing setting for hemorrhagic stroke. The purpose of this case report is to describe the PT management, using a task-oriented approach, of a patient with a subarachnoid hemorrhagic stroke being treated in a skilled nursing setting.
Physical Therapy Management Of A Patient With Chronic Brainstem Stroke Syndrome To Improve Functional Mobility: A Case Report
Strokes are a leading cause of disability, and the fifth leading cause of death in the U.S. Brainstem strokes are much less common and have a higher mortality rate than cortical strokes. Brainstem strokes can lead to physical impairments including gaze palsies, quadriplegia, ataxia, or cranial nerve deficits, which affect balance and safety, decreasing independence. Repetitive task gait training has been shown to create improvements in patients with stroke. Non-specific gait training can have a transfer effect on gait for patients with stroke. There are fewer accounts of brainstem stroke rehabilitation than cortical stroke rehabilitation due to poor prognosis and high mortality rate associated with brainstem strokes. The purpose of this case report is to describe the physical therapy management of a patient with chronic brainstem stroke with the goal of increasing his functional mobility in both inpatient and outpatient settings.
Therapeutic Exercise In The Treatment Of Greater Trochanteric Pain Syndrome S/P Lumbar Discectomy: A Case Report
Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain, affecting between 1.8 and 5.6 patients per 1000 annually. Inadequate core stability and gluteal weakness contribute to the probability of developing GTPS. GTPS is more common in patients with coexisting low back pain (LBP). Discectomy is effective in treating LBP pain caused by prolapsed lumbar intervertebral discs, however, it does not correct back muscle function. Lumbar stabilization exercises have demonstrated improved quality of life (QOL) outcomes. As both GTPS and discectomy rehabilitation lack defined treatment guidelines, the purpose of this case report is to describe the physical therapy treatment of GTPS in conjunction with simultaneous rehab from lumbar microdiscectomy.
Restoring Gait And Functional Mobility For A Patient With An Ischemic Stroke Through Physical Therapy: A Case Report
During an ischemic stroke, blood flow is impeded due to blocked artery. Stroke is the 5th leading cause of death and the primary cause of disability and dependency in adults in the United States. Patient age and stroke severity, size, and location are strong predictors in prognosis. Stroke rehabilitation during the first three months can reduce mortality. The purpose of this case report is to provide physical therapy management strategies used during an inpatient stay for a patient who experienced an ischemic stroke.
Functional Training In A Patient With Middle Cerebral Artery Stroke With Multiple Comorbidities: A Case Report
795,000 people experience a stroke yearly, making it the leading cause of long-term disability, costing $34 billion. Strokes affecting the middle cerebral artery (MCA) cause impairments of strength, sensation, coordination, and balance of the contralateral side. Recovery from stroke is affected by premorbid status. Cardiovascular disease causes a majority of strokes. The purpose of this case report is to describe a progressive PT plan of care for a patient following MCA stroke with multiple comorbidities in the skilled nursing setting.
Manual and Exercise Therapy For The Treatment Of Chronic Costochondritis In A Male Office Worker: A Case Report
For some patients, the use of techniques that typically comprise a physical therapy (PT) treatment plan for costochondritis, such as high-velocity low-amplitude (HVLA) manipulation, can be intolerable due to pain or even contraindicated because of other comorbidities. This case report describes the successful treatment of a patient with chronic costochondritis utilizing gentler, more conservative manual therapy techniques than those that are typically used in PT management of the condition.
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