Physical Therapy And Cognitive Behavioral Therapy In A Patient With Multiple Co-Morbidities – A Case Report
Jeanine Manubay and Kirsten Buchanan
Traditional physical therapy (PT) interventions can be challenging to implement in the complex patient with multiple comorbidities. Cognitive behavioral therapy (CBT) is a behavioral therapy technique used to change obstructive behaviors and improve functional and emotional health. CBT has shown positive outcomes in patients with cancer and elderly patients with depression, but has not been studied in conjunction with PT in medically complex patients. The purpose of this case report was to document the utilization and outcomes of CBT along with traditional physical therapy for a medically complex patient diagnosed with end stage renal disease and multiple co-morbidities.
Comprehensive Physical Therapy Treatment Following A Surgical Repair Of A Flexor Hallucis Longus Tendon In A Skateboarder: A Case Report
Joseph Marcil and Kirsten Buchanan
Flexor Hallucis Longus (FHL) injuries occur when stress is placed on the great toe. FHL tendinopathies are common in ballet dancers, however, not often seen in skateboarders. The most effective physical therapy (PT) rehabilitation protocol for an FHL tendinopathy and subsequent repair in a skateboarding athlete has not been well documented. The purpose of this case report is to investigate a comprehensive PT protocol, including video feedback after an FHL repair in a skateboarding athlete.
Shoulder Strengthening, Taping And Postural Reeducation In A Breast Cancer Survivor After Bilateral Mastectomy: A Case Report
Breast cancer is the most common cancer experienced by females in the United States. In breast cancer survivors, weakness of the rotator cuff musculature is often considered a contributing factor to rotator cuff pathology. The purpose of this case report was to help fill the gaps in literature by documenting the use of therapeutic exercises to strengthen the shoulder complex, in conjunction with taping techniques for postural reeducation, of a female breast cancer survivor.
Restoration Of Functional Mobility For A Young Adult Patient Following A Severe Motor Vehicle Accident: A Case Report
Over 50 million people world-wide experience non-fatal injuries, and 1.2 million people die as a result of motor vehicle accidents (MVA) annually. Unintentional injury, including MVA, was the leading cause of death in females age 15-24 in 2014. Higher intensity therapy can result in greater gains in functional mobility in rehabilitation settings. Skilled nursing facilities typically care of older patients, but younger patients can also benefit. The purpose of this case report was to document a young adult patient’s response to skilled physical therapy interventions with the goal of returning the patient to prior level of function.
Use Of The Task-Oriented Approach For Chronic Inflammatory Demyelinating Polyneuropathy: A Case Report
Alison Newell and Amy J. Litterini
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an acquired neurological disorder similar to Guillain-Barre Syndrome (GBS) with rare a prevalence of 2-7.7/100,000.7. Etiology and pathogenesis are largely unknown but are thought to be immunological, targeting the myelin of peripheral nerves. Extensive literature exists regarding medical management of CIDP, but limited research exists regarding physical therapy (PT) management for patients with CIDP. Task-Oriented Approach (TOA) is based upon systems theory with influence from motor learning and motor control theories. Systems theory states abnormal movements are related to deficits in one or more system(s) and are comprised of the body’s existing systems’ attempts to compensate. Compensations are not always ideal; interventions can be designed to optimize strategies and complete functional tasks more effectively and efficiently. Using evidence-based resources on CIDP and GBS, this case report poster describes the PT management of a patient with CIDP using the TOA as a framework for clinical decision-making.
Management Of A Patient With Bronchiectasis Using Pulmonary Rehabilitation And Balance Training: A Case Report
Megan Witherow Quarles
Bronchiectasis is a chronic lung disease defined by permanent abnormal dilation of the bronchi. Bronchiectasis often includes airway infection and inflammation. Pulmonary rehabilitation including progressive gait training, stair climbing, and cycling is a standard guideline for the treatment of bronchiectasis symptoms and for symptoms of other chronic lung diseases. Little research has been conducted on the effectiveness of pulmonary rehabilitation for patients with bronchiectasis. The purpose of this case report is to examine physical therapy (PT) management, utilizing pulmonary rehabilitation with incorporated balance training, for a geriatric patient with bronchiectasis.
Use Of Functional Strengthening, Balance Training, And Stretching In The Treatment Of A Patient Following A T11-L5 Spinal Fusion: A Case Report
Anna Sidloski and Brian T. Swanson
There is abundant evidence available regarding treatment approaches for patients suffering from low back pain (LBP), but limited research focusing on physical therapy (PT) treatment status post-multilevel spinal fusion with postural impairments. The purpose of this case report is to describe the management and functional improvement of a patient s/p spinal fusion with severe postural impairments, elevated fall risk, and high levels of back pain.
Subacute Physical Therapy Management For Abnormalities Of Gait And Mobility Following An Acute Accident With Farm Equipment: A Case Report
Workers in the agricultural industry experience 243 injuries per day that result in lost work time, with five percent of these resulting in permanent impairments. Functional decline can occur as a result of prolonged hospitalizations. Endurance and strength of the lower extremities, mobility, and tolerance for ambulation are decreased in this population. Physical therapy (PT) interventions can target these impairments to improve functional ability. The purpose of this case report is to describe the PT management used in a subacute setting to improve functional ability, mobility, and gait in a patient who experienced deconditioning due to prolonged hospitalization following an accident with farm machinery.
Karissa Wells and Kirsten Buchanan
Dystonia can present with symptoms of involuntary muscle contractions, resting tremors, and diminished muscular control. Patients with dystonia can present similarly to patients with Parkinson’s disease due to the association with the basal ganglia. While there is significant research on physical therapy (PT) interventions for patients with Parkinson’s disease there is limited research on the PT evaluation and treatment of patients with dystonia. The purpose of this case report was to describe a comprehensive PT regimen, based on Parkinson’s disease research, for a patient diagnosed with adult-onset dystonia.
Utilization Of Postural Control Training To Improve Gait Symmetry And Walking Ability In A Patient Following A Lacunar Stroke: A Case Report
Hannah C. Wilder and Amy J. Litterini
Alteration in gait is one of the most noted impairments following stroke. Improving walking ability is one of the most common goals amongst patients with stroke undergoing rehabilitation. Current literature describes visual and proprioceptive feedback and task-oriented training as effective in improving gait speed, mechanics, strength, and balance following stroke. Based on the research, postural control training may improve walking ability following stroke. The purpose of this case report is to outline physical therapy rehabilitation that utilized postural control training, task-oriented training, and visual feedback to improve walking ability and functional capacity in a patient following a lacunar stroke affecting the internal capsule, basal ganglia, and cerebellum.
Management Of A Patient Lumbar Spinal Stenosis and Carotid Aneurysm Using Therapeutic Exercise, Education, And Manual Therapy: A Case Report
Lumbar Spinal Stenosis (LSS) is a clinical syndrome of buttock or lower extremity pain, which may occur with or without back pain, associated with diminished space available for the neural and vascular elements in the lumbar spine. Comorbidities frequently complicate the exercise selection of patients in physical therapy. One such comorbidity is a carotid artery aneurysm. A carotid Aneurysm is a bulging or ballooning in the wall of the internal or external carotid artery. Patients who undergo surgical management for carotid artery aneurysm are placed on exercise restrictions based on the size and location of the aneurysm. The purpose of this case report was to describe physical therapy management for a patient with low back pain with bilateral lower extremity radiculopathy in the presence of a complex medical background including carotid artery aneurysm.
Application Of A Short-Term Aquatic Physical Therapy Program For A Patient With Chronic Low Back Pain And Radiculopathy: A Case Report
Chronic low back (CLBP) pain is a common referral to outpatient PT. Radiculopathy has the potential to contribute to back pain. Aquatic PT is utilized at select sites to treat patients with various debilitating conditions. Aquatic PT has been shown to improve quality of life, disability and pain. There is limited understanding on the short-term effects of aquatic PT. Must work within the confines of approved PT visits by local and national insurance companies. The purpose of this case report was to investigate if six physical therapy visits with aquatic intervention for a patient with chronic low back pain and radiculopathy improves a patient’s subjective and objective impairments in relation to his quality of life.
A Progressive Physical Therapy Plan Of Care For A Patient With Charcot-Marie-Tooth Disease Following Myocardial Infarction: A Case Report
Paige Blasco and Kirsten Buchanan
Charcot-Marie-Tooth disease (CMT) is an inherited neuromuscular disease caused by mutations in genes that produce proteins involved in the structure and function of either the myelin sheath or the peripheral nerve axon. The slow degeneration of the nerves results in a decreased ability to communicate with their distant targets leading to symmetric distal muscle atrophy and weakness, hand and foot deformities, and sensory loss. There is currently no treatment that reverses or stops the progression of the disease; however, there are physical therapy (PT) interventions that reduce the level of disability in individuals with CMT. Research has shown that interval and resistance exercise can improve functional capacity, strength and activities of daily living (ADLs) in people with CMT. Myocardial infarction (MI) is often a result of coronary artery disease (CAD), which has an incidence rate of 34.6% in men over 80.10 Immediate exercise interventions in the acute care setting following an MI have shown to positively impact a patient’s functional capacity and quality of life. While rehabilitation practices for CMT and MI have been described separately, there is a paucity of research investigating the optimal physical therapy (PT) interventions for patients who have both health conditions concurrently. The purpose of this case report was to describe a progressive PT plan of care for a patient with CMT following an acute myocardial infarction (MI) in the acute and sub-acute care settings.
Balance And Gait Training To Reduce Fall Risk In A Patient With Bilateral Foot And Hand Deformities Secondary To Rheumatoid Arthritis: A Case Report
Each year, one out of three adults over the age of 65 sustains a fall. Although the risk of suffering a fall increases with age, falls are not an unavoidable aspect of the aging process. Fall risk can be heightened in patients with medical comorbidities that impact the physiological senses which help maintain balance. Rheumatoid arthritis (RA) is a chronic inflammatory disorder that affects the lining of the joints and causes painful swelling that can eventually result in bone erosion and joint deformity. The fall incidence rate in individuals with RA is 0.62 falls per person per year as compared to a fall incidence rate of 0.45 falls per person per year in healthy elderly individuals. The purpose of this case report was to provide an overview of the physical therapy plan of care for a patient at high risk for falls. Procedural interventions focused on balance and gait training while accommodating for the patient’s bilateral foot and hand deformities secondary to RA.
Body Weight Supported Treadmill Training And Overground Gait Training In The In-Patient Setting For An Individual With Chronic Stroke: A Case Report
795,000 people in USA have a new or recurrent stroke each year, leaving them with spatiotemporal gait abnormalities. Following D/C from in-patient rehab, many patients continue to experience activity limitations & participation restrictions secondary to limited walking ability. The use of BWSTT & overground GT has been shown to improve bilateral coordination and gait symmetry for patients with chronic stroke. Evidence for BWSTT rather than overground GT is mixed and does not include representation for the young stroke population. The purpose of this case report was to describe the outcomes of gait speed, efficiency of gait, and fall risk in a young individual following a chronic stroke managed with intense BWSTT and overground GT.
Evaluation And Treatment Of A Patient Diagnosed With Adhesive Capsulitis Classified As A Derangement Using The McKenzie Method: A Case Report
Ashley Bowser and Brian T. Swanson
The McKenzie Method of mechanical diagnosis and therapy (MDT) is supported in the literature as a valid and reliable approach to spine injuries. It can also be applied to the peripheral joints, but has not been explored through research to the same extent. A previous case series detailed the use of MDT in the shoulder; however, the application of MDT in the treatment of adhesive capsulitis has not been previously reported in the literature. The purpose of this report is to demonstrate the assessment, intervention, and clinical outcomes of a patient diagnosed with adhesive capsulitis, who was classified as having a shoulder derangement using MDT methodology.
Use Of The Lower Extremity Functional Scale (LEFS) In A Patient After A First Metatarsophalangeal Joint Implant: A Case Report
First metatarsolphalangeal (MTP) total joint implants are uncommon; however, hemi implants have increased in popularity. The. HemiCAP® (Franklin, MA) implant resurfaces the metatarsal head while leaving the distal phalanx intact. While early results of the HemiCAP(®) implant surgery have been promising, physical therapy outcome measures such as the LEFS have not been extensively studied in this population. The Lower Extremity Functional Scale (LEFS) is a sensitive and reliable outcome measure that has commonly been used in patients with hip and knee dysfunction. While the LEFS has been used for a broad spectrum of lower-extremity pathologies, there is a paucity of research that investigates the use of LEFS in patients who have had a first MTP joint implant. The purpose of this case report was to investigate the use of LEFS in a patient with first MTP HemiCAP® joint implant.
Use Of Core Stabilization Exercise And Medical Exercise Therapy In The Treatment Of A Patient With Chronic Post Partum Low Back Pain: A Case Report
Zachary Chaloner and Kirsten Buchanan
Low back pain and lumbar hyper-mobility are common during and after pregnancy. Chronic postpartum low back pain (LBP) can be difficult to manage. Core stabilization exercises (CSE) have been shown to improve function and reduce pain in patients with chronic LBP due to lumbar instability. Medical Exercise Therapy (MET) has shown good outcomes in reducing pain in patients with LBP but has not been thoroughly investigated in the treatment of chronic post partum LBP. There is limited research reporting the use of a combined treatment protocol utilizing CSE and MET in the treatment of chronic LBP in postpartum women. The purpose of this case report was to investigate a combined physical therapy treatment protocol of CSE and MET on a patient with chronic low back pain 2 years post-partum.
Gait Training, Strength Training, And Pain Management Of A 26 Year Old Female Recovering From A Multiple Sclerosis Exacerbation: A Case Report
Multiple Sclerosis (MS) is an autoimmune disorder where it is thought that the body attacks the myelin sheath covering nerve fibers and disrupts communication in the central nervous system. Presentations are varied with symptoms ranging from loss of vision, poor balance and coordination, tremors, fatigue, pain, and problems with memory and concentration. MS is classified into four types in order of severity: relapsing- remitting, secondary-progressive, primary-progressive, and progressive-relapsing. Evidence links stressful events to increased risk for exacerbations. Treatment of MS can be variable due to the multiple presentations and progressions of disease. Currently little information is available regarding the most effective physical therapy interventions for an acute MS exacerbation under stressful conditions. The purpose of this case report was to document the multidisciplinary rehabilitation of an individual who suffered a severe MS exacerbation after a series of stressful life events.
The Effects Of Specific Training On Balance And Ambulation In A Patient With Stage IV Glioblastoma: A Case Report
Glioblastoma is a malignant brain tumor, often found in the cerebellum. From 2005-2009 there were 109,605 incidences of malignant brain tumors reported in the united states. Specific incidence rates for malignant brain tumors ranged from 5.8 to 11.70 per 100,000 adults 20 years or older. Stage IV is the most rapidly growing and invasive glioblastoma and most common adult neoplasm usually affecting people in the 5th or 6th decade of life. Treatment of glioblastoma frequently involves surgery to excise the tumor followed by radiation therapy. Similar to the growing malignancy these treatments often cause further progressive and even rapid neurological impairments due to their toxic nature. Despite the high rate of neurological and functional impairments in patients affected by brain tumors, there is not a well established rehabilitation treatment for these patients. The purpose of this case report is to provide an overview of the specific physical therapy management strategies used during an in-patient rehabilitation stay for a patient with a diagnosis of stage IV glioblastoma.
Use Of A Task-Oriented Approach In The Physical Therapy Management Of A Patient Following A Posterior Inferior Cerebellar Artery Stroke: A Case Report
3.4% of the 600,000 strokes that occur annually in the United States are cerebellar strokes. Despite the rarity of cerebellar strokes, their impact can cause severe acute neurological morbidity. The posterior inferior cerebellar artery (PICA) supplies the inferior portion of the cerebellum. PICA infarct can lead to deficits in gait and postural stability, coordination, and Cognition and attention. The task-oriented approach has been demonstrated as an effective intervention for patients with cerebrovascular accidents, but limited research has been done on its use in patients with cerebellar stroke. The purpose of this case report was to provide an overview of the physical therapy management in the acute inpatient rehabilitation setting for a patient following a PICA stroke, with the use of a task-oriented approach.
Treatment Of A Patient With Thoracolumbar Scoliosis Utilizing A Regional Interdependence Approach Including Components Of The Schroth Method: A Case Report
Spinal deformity is a challenging spinal disorder in adults. A scoliotic curve of >10 degrees exists in up to 12% of the population. There is little evidence regarding indications for physical therapy treatment in elderly individuals with adult scoliosis. Current study results favor surgical intervention, but not all elderly individuals are surgical candidates. While surgery is the definitive measure, there is limited evidence to guide non-surgical treatment. This case investigated components of the Schroth method, as an adjunct to traditional physical therapy (PT) treatment. A Regional Interdependence approach (RIA) was utilized for a patient with scoliosis referred to PT for chronic low back pain (CLBP).
Use Of Therapeutic Exercise, Functional Endurance And Gait Re-Training In A Deconditioned Patient With Acute Respiratory Failure: A Case Report
The human body requires oxygen-rich blood in order to work efficiently. During respiration, air passes from the nose and mouth and into the alveoli of the lungs. When air reaches the alveoli, oxygen passes into the capillaries as carbon dioxide moves out of the capillaries, otherwise known as gas exchange. Respiratory failure may occur when there is a lack of oxygen passing from the lungs into the blood (hypoxemic), or if the lungs cannot remove carbon dioxide from the blood (hypercapnic). Chronic respiratory failure is caused by conditions such as muscular dystrophy, amyotrophic lateral sclerosis (ALS), spinal cord injuries, or stroke. Acute respiratory failure (ARF) is caused by sudden and serious complication as a result of conditions such as pneumonia, adult respiratory distress syndrome (ARDS), and congestive heart failure (CHF). Supplemental oxygen is typically used for initial treatment. In severe cases, patients may require invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV), followed by physical therapy to restore various functional losses. The purpose of this case report was to document the outcomes of therapeutic exercise, functional endurance activities, balance and gait re-training in a deconditioned patient, following ARF.
Neuromuscular Strengthening Exercises Following ACL And Meniscal Repair In A 15 Year Old Female Athlete With Generalized Knee Laxity: A Case Report
Alyssa Gardner and Kirsten Buchanan
Adolescent females are 4-6 times more likely to sustain a non-contact anterior cruciate ligament (ACL) injury compared to their male counterparts. Generalized knee laxity decreases dynamic knee stability and significantly increases the odds of an ACL injury 5-fold. It is crucial to return the surgically repaired knee to its former function. However, it is just as vital to direct attention to the uninjured knee with joint laxity. Research has found that those who have torn one ACL are six time more likely to tear the contralateral ACL. There is currently a lack of research that directly addresses intervention programs that target specific rehabilitation protocols for the injured and uninjured knee simultaneously. The purpose of this case report was to investigate the use of a progressive neuromuscular control and strengthening protocol in both the ACL injured and un-injured knees in an adolescent female with generalized knee joint laxity.
The Use Of Manual Therapy And Strengthening Exercises To Improve Plantarflexion Strength And Mobility Following Achilles Tendon Repair: A Case Report
An Achilles tendon rupture is classified as ‘chronic’ or ‘neglected’ if it has been untreated for four or more weeks. PT management for all Achilles ruptures is to gain Plantarflexion (PF) strength, ankle ROM, and decrease scar tissue. Neglected ruptures increase scar tissue formation, causing delay in regaining functional strength and mobility. Decreased strength and mobility can lead to gait impairments, activity limitations, and participation restrictions. Literature is limited on best therapy for neglected Achilles tendon ruptures. The purpose of this case report was to add to the literature pertaining to neglected Achilles tendon ruptures and to report upon the outcomes of physical therapy on a patient with severe compensatory gait patterns secondary to a neglected Achilles tendon rupture.
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