Using The Selective Functional Movement Assessment And Regional Interdependence Theory To Guide Treatment Of An Athlete With Back Pain: A Case Report
Incidence of low back pain (LBP) is as high as 36% among adolescents and even more prevalent in those who play sports. The majority of these cases lack an underlying diagnosis and are classified as non-specific LBP. Previous injury and longer durations of pain consistently emerge as prognostic factors in musculoskeletal pain. This affects movement patterns which then continue to contribute to dysfunction. The Regional Interdependence Theory (RI) views all regions of the body as being musculoskeletally linked, with impairments in remote regions to site of pain often being a cause. The Joint-by-Joint Theory compliments RI by arguing that joints alternate in primary function from stability to mobility and when a joint doesn’t carry out its role, the next joint in the chain will, leading to dysfunction. Despite the multidirectional quality of human movement, measurements in PT examination are often uniplanar and lack the functional complexities involved in daily activities. The Selective Functional Movement Assessment (SFMA) is a movement-based diagnostic tool which provides a qualitative standard for movement. The purpose of this case study was to explore the use of the SFMA to guide evaluation and treatment in a patient with chronic LBP and provide an example of its application as a framework for clinicians to use in future evaluation and treatment.
The Use Of Aquatic Therapy In Rehabilitation For A Patient Following Complicated Reverse Total Shoulder Arthroplasty: A Case Report
According to the Aquatic Physical Therapy Section of the American Physical Therapy Association, aquatic physical therapy is the evidence-based and skilled practice of physical therapy in an aquatic environment by a physical therapist, and includes interventions designed to improve or maintain: function, aerobic capacity/endurance conditioning, balance, coordination and agility, body mechanics and postural stabilization, flexibility, gait and locomotion, relaxation, muscle strength, power, and endurance. Reverse Total Shoulder Arthroplasty (rTSA) is designed specifically for the treatment of glenohumeral (GH) arthritis when it is associated with irreparable rotator cuff damage, among other complex circumstances. A typical protocol will progress from joint protection, passive range of motion, and isometric strengthening to moderate strengthening and active range of motion. There is little published on the implementation of a pool environment on rTSA rehabilitation. These patients have a higher risk of dislocation and must avoid GH extension past neutral, combined GH extension- internal rotation-adduction, and overworking of the deltoid, as it is now the primary muscle for upper extremity elevation. The goal in performing an rTSA is to restore “some basic shoulder function” in the GH joint and eliminate pain.3 Normal/full motion is not an expected outcome. The purpose of this case report was to report upon the outcomes of aquatic therapy on the biomechanical and functional retraining of a patient following a rTSA.
Neuromuscular Electrical Stimulation And Quadriceps Strength Following Patellar Fracture And Open Reduction Internal Fixation Surgery: A Case Report
Patellar fractures account for approximately 1% of all fractures and are most common in people who are 20 to 50 years old. Comminuted patellar fractures occur when the bone shatters into three or more pieces and is usually caused by a direct blow to the knee. Open reduction internal fixation (ORIF) surgery is typically needed if the bone is broken into three or more pieces near the center of the patella. Quadriceps weakness is common following this type of injury and surgery, and the literature reflects varying opinions as to what is the best method for regaining strength. The purpose of this case report was to examine the use of neuromuscular electrical stimulation (NMES) in conjunction with traditional exercises for strengthening the quadriceps following atrophy status post ORIF surgery for a comminuted patellar fracture.
Functional Skill Training And Group Therapy Treatment Following A Total Hip Arthroplasty In The Acute Care Setting: A Case Report
Osteoarthritis (OA) is a very common degenerative condition, often developed during middle and older ages, especially in those with more active lifestyles. Although OA can occur in any joint throughout the body, it most often develops in weight-bearing joints, such as the hip. In 2011 more than 28 million people in the United States were estimated to have OA. OA can lead to pain, stiffness, decreased range of motion, decreased strength, and in turn an overall decline in functional ability. Total hip arthroplasty (THA) is becoming more widely utilized as a means for gaining mobility and independence when a person’s degenerative hip is no longer allowing their desired level of function. With the aging population and increased need for THA, research suggests there is a strong need for physical therapy in order for patients to achieve optimal functional results. Current literature supports the use of early mobilization and functional task oriented training, however there is minimal research in support or in refute of the use of group therapy treatment. Although many articles have been published regarding THA, not many include the acute care setting and short-term rehabilitation benefits. The purpose of this case report is to provide an overview of hip OA and THA, and to report on a specific case describing the examination, management, and outcomes of a patient with a THA in the acute care setting.
Hip Muscle Strengthening And Balance For A Patient With Bipolar Disorder Following Hip Fracture: A Case Report
Hip fractures result in more than 258,000 hospital admissions annually for those aged 65 and older. Mortality rate following hip fracture is 10-20%. Among survivors, half will have longstanding disability, only 1/3 will return home, and 19-27% will remain in long term care. Six percent will experience a second fracture within four years. Cost for treatment for hip fractures in the US: $10.3-15.2 billion/year. Over 95% of hip fractures occur as a result of a fall. Direct medical costs for falls in 2013 reached $34 billion. Average hospital cost for a fall injury is $35,000. Neuropsychiatric symptoms negatively affect functional outcomes in patients with hip fractures.
The Role Of Physical Therapy In The Treatment And Discharge Of An Elderly Homeless Patient With Fractures Of The T12-L1 Vertebrae: A Case Report
More than 600,000 are homeless in the USA. Homeless people have higher rates of premature mortality than the rest of the population, especially from unintentional injuries, and have an increased prevalence of mental disorders. Hospitals often encounter difficulty with discharge when homeless patients are medically stable enough to be transferred to a lower level of care. Hospitals risk potential legal action and poor portrayal by the media if a homeless patient claims he/she was discharged improperly.
Restoring Functional Mobility In A Patient With Delayed Onset Of Physical Rehabilitation Following A Hemorrhagic Stroke: A Case Report
Bettie Kruger and G. Noel Squires
Typical rehabilitation post-stroke is initiated as soon as the patient is medically stable. The most dramatic neurological recovery occurs within the first three to six months following medical stabilization. It has been suggested in the literature that early and frequent out of bed activity within the first 24 hours following stroke onset will enhance motor recovery. The patient in this case report was sedentary for three months following the onset of stroke and was non-ambulatory at the time of admission to sub-acute physical therapy. The purpose of this case report is to describe the rehabilitative course, motor recovery, and functional gains for a patient who received delayed rehabilitation following a hemorrhagic stroke.
Strength And Balance Exercises To Improve Functional Outcomes And Mobility For A Patient With Parkinson’s Disease And Co-morbidities: A Case Report
Parkinson’s disease is the second most common age-related neurodegenerative disorder after Alzheimer’s disease. Cardinal features include rigidity, bradykinesia, tremor and postural instability. There is a lack of literature pertaining to the physical therapy management of patients with Parkinson’s Disease and other co-morbidities. The purpose of this case report was to illustrate the physical therapy management of a patient with Parkinson’s disease and other co-morbidities.
Functional Mobility Management Of A Patient With Adult-Onset Hereditary Proximal Motor Neuropathy Following A Tibial Fracture: A Case Report
Timothy Lira and Amy J. Litterini
This patient was clinically appealing and complex because of the combination of an acute fracture due to an injurious fall and significant past medical history (PMH) of both the rare condition of adult-onset hereditary proximal motor neuropathy (AHPMN) and congestive heart failure (CHF). The chronic co-morbidities created the need for an innovative approach to treatment sequencing to potentially mitigate the risk for excessive fatigue, such as positional grouping of interventions and prescribed rest periods. This unique opportunity to document the physical therapy (PT) management of a patient with the combination of both rare and chronic conditions makes this case a valuable addition to the existing literature. The purpose of this case report was to document the outcomes of various functional mobility interventions for a geriatric patient with an acute left (L) tibial fracture secondary to a fall, adult-onset hereditary proximal motor neuropathy and CHF. This case report may help fill a gap in the literature, which is sparse with functional mobility treatment for patients with acute injury in conjunction with a rare, chronic condition.
Agility Outcome Measures And Gait Analysis In The Physical Therapy Rehabilitation Of An Adolescent With An Acetabular Hip Fracture: A Case Report
Emily Lodge and Kirsten Buchanan
Pediatric hip fractures are uncommon. 85 to 90 percent of pediatric hip fracture are a result of high-energy trauma. There is a paucity of literature describing best rehabilitation practices. Agility outcome measures, as well as observational and video gait analysis have not been fully investigated in the rehabilitation of pediatric hip fractures. The purpose of this case report was to investigate the use of agility outcome measures, as well as observational and video gait analysis in the rehabilitation of a fourteen year-old male motocross athlete with a hip fracture.
Use Of Manual Therapy And Sport Specific Re-training In An Adolescent Elite Sprinter With Bilateral Pedicle Stress Fractures: A Case Report
Bilateral pedicle stress fractures are extremely rare, with few cases reported in the literature. The pedicle is known to be the second weakest point of the vertebra, has a short moment arm from the vertebral body, and can resist a large amount of cyclic shear forces. The main causes of lumbar pedicle stress fractures are shear stress and twisting stressors, followed by sudden hyperflexion or hyperextension of the spine. There have been several reports describing pedicle stress fracture in adolescent athletes. However, in those reports the fracture was usually associated with contralateral spondylolysis, and isolated pedicle fractures are rarely found. The purpose of this case report is to detail a conservative approach using manual therapy, Pilates exercises, and sport specific re-training in an adolescent sprinter with bilateral L4 pedicle stress fractures.
The Use Of Postural Reeducation And Strengthening Exercises In The Reversal Of Functional Scoliosis: A Case Report
Non-structural scoliosis: abnormal spinal curvatures that have sufficient mobility, and can therefore resolve with postural change. There is a multitude of research regarding structural and idiopathic scoliosis, but very minimal literature about non-structural (functional) scoliosis and more importantly, how to treat it. The purpose of this case report was to examine the use of stretching, strengthening, and postural reeducation for a patient who presented with a non-structural scoliosis.
Strengthening Exercises And Modalities To Prevent Growth Of Hypertrophic Scarring And Improve Wrist Strength And Mobility: A Case Report
There is no gold standard for evaluation, treatment, and prevention of keloids. Keloids are elevated fibrous scars that extend beyond the original borders of the wound, they do not regress and they tend to reoccur even after surgical excision. Individuals younger than 30, with elevated hormone levels and darker skin tend to be at higher risks for keloids. The most susceptible areas are on areas of high tension like the sternum, shoulders, upper arms, earlobes, and cheeks. Scars are generally evaluated by depth of elevated tissue, color, softness, shape, and orientation. The etiology of keloids is uncertain but it is theorized that genetics plays a factor. Systemic hypertension has been suggested to be an associative factor. The treatments most commonly used include corticosteroid injections, silicone sheeting, compression garments, scar massage, physical therapy, radiotherapy, laser therapy and cryotherapy. Due to the complex and unknown nature of keloids as well as the minimal evidence behind their treatment, this case report serves the purpose of evaluating effects of various modalities and exercises to reduce keloid formation and decrease any functional limitations that arose from it.
Post-concussion syndrome is defined as a group of symptoms occurring after a traumatic brain injury (TBI) that can last weeks, months, or years. The diagnosis of post-concussion syndrome is not well agreed upon, but does include at least three of the following symptoms: headache, dizziness, fatigue, irritability, insomnia, concentration or memory difficulty, and intolerance of stress or emotion. The Centers for Disease Control and Prevention estimates that 1.7 million Americans experience TBI annually. The purpose of this case report is to describe the physical therapy management using vestibular rehabilitation of an adolescent female with post-concussion symptoms two months post-injury.
The Clinical Decision Making And Outcomes Of A Patient With C7, C8 Radiculopathy And Contralateral Upper Quarter Lateral Epicondylitis: A Case Report
Preliminary diagnosis and management strategies exist for both cervical radiculopathy (CR) and lateral epicondylis, however little literature exists describing the clinical decision making and management in the presence of both conditons simultaneously. Management of (CR) (right side) can include neural mobilizations, manual therapy, and exercises. Management of lateral epicondylis (left side) can include eccentric tendinopathy management and manual therapy. The purpose of this case report is to discuss the diagnosis and management for a patient presenting simultaneously with right C7, C8 cervical radiculopathy and contralateral lateral epicondylis.
Conservative Physical Therapy Protocol After Subacromial Decompression And Labral Debridement In A Young Former Competitive Gymnast: A Case Report
Sara Nichols and Kirsten Buchanan
Subacromial impingement syndrome is a musculoskeletal condition characterized by shoulder pain and altered glenohumeral kinematics. Conservative treatment can include physical therapy and corticosteroid injections. Surgical option includes subacromial decompression (SAD). Most patients who undergo SAD are approximately 50-60 years old. There is little to no evidence regarding rehabilitation of young, healthy individuals following SAD. The purpose of this case report was to investigate the conservative protocol of a young, healthy gymnast who underwent SAD and rotator cuff [RC] surgery.
The National Cancer Institute reports that 39.6% of men and women will be diagnosed with some form of cancer during their lifetime. Studies have demonstrated that over half of cancer survivors age 55 and over have fallen in the past year, possibly as a result of treatment and subsequent muscle weakness, difficulty with balance, and impaired walking. Multiple studies have looked at the long term effects of cancer treatment and survivorship, but few studies look at interventions to combat decline in function. The purpose of this case report was to report the interventions utilized in the treatment of an individual post-cancer treatment, with the intention of decreasing future fall risk by addressing three modifiable factors: muscle weakness, balance impairment, and walking difficulty.
Application Of A Balance Training Program In A Patient With Charcot Marie Tooth Disease: A Case Report
Charcot Marie Tooth Disease (CMT) is the most common progressive inherited neurological disease. Proteins in the myelin sheath of both motor and sensory nerves become damaged, resulting in muscle atrophy and reduced sensation. Patients experience difficulty with gait, balance, and independence with ADLs. The RUSK Modified Romberg Program (MRP) is a balance program used for patients with neurological pathologies. There is minimal research on the effectiveness of the RUSK MRP in patients with CMT. The purpose of this case report was to determine the effectiveness of the RUSK MRP in order to improve balance and reduce risk of falls in a patient with CMT.
Sarah Richardson and Amy J. Litterini
Stroke is the leading cause of serious long-term disability for American adults. Most stroke survivors receive physical therapy (PT) and task-oriented rehabilitation is one novel approach. This technique, which shifts the focus from the impairment level to activity level, is known to benefit stroke survivors. However, the benefits for long-term survivors of stroke are not yet well established. PT professionals would benefit from learning about innovative interventions to improve functional mobility for long-term stroke survivors. The rationale for this report was to document the outcomes of a task-oriented approach to rehabilitation on the late effects of stroke. The unique aims were to 1) outline possible benefits in function from repetitive task-oriented training techniques and 2) assess progress of a patient who had received continued PT services >12 months post stroke.
Multimodal Physical Therapy Management Of A Patient With Unilateral Neglect Post-Stroke In An Outpatient Setting: A Case Report
A common behavioral syndrome of stroke is unilateral neglect (ULN) which is defined as the failure to report, respond, or orient to stimuli presented contralateral to the brain lesion. ULN has a negative influence on functional recovery and is associated with a poor functional outcome following a stroke, therefore several rehabilitative approaches have been proposed and implemented to decrease neglect and improve patient recovery. There are currently limitations within the research regarding the efficacy of PT interventions to decrease ULN symptoms. In addition, the optimal PT interventions and treatment strategies is unclear. The purpose of this case report is to describe multimodal physical therapy (PT) management that includes PT interventions to alleviate symptoms of ULN and report upon the outcomes of the various treatment methods for rehabilitation of patients with neglect during functional mobility.
Use Of Complete Decongestive Therapy And A Task-Oriented Approach In Treating Secondary Lymphedema And Improving Ambulation In A Patient Following A Stroke: A Case Report
Every year, approximately 795,000 people in the United States experience a new or recurrent stroke. More than 30% of the survivors cannot walk independently six months following a stroke. Of those who are able to walk independently, only a small proportion can walk with sufficient speed and endurance to be able to function within the community. Paralysis of the extremities leads to a decreased and ineffective muscle pumping action, resulting in lymph stasis. Lymphedema is the tissue fluid accumulation that arises due to impaired lymphatic drainage. Fluid accumulation further increases difficulty with ambulation post stroke. The purpose of this case is to report the use of complete decongestive therapy for the treatment of lymphedema as part of a comprehensive treatment program consisting of a task-oriented approach to improve walking ability in a stroke survivor.
Acute Care Outcome Measures In A Patient Status-Post Right Total Knee Arthroplasty (TKA) Following A Left TKA Staged Five Weeks Apart: A Case Report
Total knee arthroplasty (TKA) is one of the most frequently performed orthopedic procedures in the U.S. Osteoarthritis (OA) is the most common reason for a total knee arthroplasty. Cartilage and bone is removed from the distal end of the femur and proximal end of the tibia and is replaced with metal alloy components that recreate the joint surface. Some evidence suggests that staging bilateral TKA within three months of each other may increase the patient’s risk for mortality and complications. The purpose of this case report was to document acute care outcome measures in a patient who underwent bilateral TKA staged five weeks apart and to assess the possible implications that a short staging period might have on the patient’s ability to recover.
Vestibular Rehabilitation And Cervical Postural Re-education In A Young Athlete Who Presented With Post-Concussion Syndrome: A Case Report
A concussion is a pathophysiological process resulting in neurological impairments in response to a forceful impact directly on or transmitted to the head, neck, or face. ~300,000 concussions occur in high school athletes in the US, making sports 2nd to MVA as leading cause of concussions. Post-Concussion Syndrome (PCS) occurs when side effects are persistent past the 10 day period. 10% of people will develop PCS following a concussion. In previous research, cervico-vestibular rehabilitation and direct attention to the patient’s intolerance to activity is vital in order to return an athlete back to sport. The purpose of this case report was to describe physical therapy (PT) management and outcomes of a young athlete who sustained PCS.
A Three-Week Intensive Pediatric Physical Therapy Plan Of Care For A Child With Spastic Quadriplegia Cerebral Palsy: A Case Report
Brandie Schmierer and Kirsten Buchanan
The benefits of physical therapy (PT) on gross motor function and general strength in children with spastic quadriplegia cerebral palsy (CP) are well documented. There have been no firm conclusions that have determined the optimal duration and intensity of PT interventions for patients with spastic quadriplegia CP. CP occurs as a result of a brain injury associated with birth. Worldwide the prevalence of CP was 1.5 to 3.0 per 1,000 live births in 2009. Previous research demonstrated that PT intervention in children with CP improved gross motor function and strength, decreased the assistance required for mobility, and decreased step length differences. Current research supports a high frequency schedule of PT, however, the optimal intensity and duration of PT has not been determined. The purpose of this case report was to investigate an intensive course of PT for 3 hours a day, 5 days a week, for 3 weeks in a pediatric patient with spastic quadriplegia CP.
Trunk Control And Standing Tolerance Of A Patient With Paraparesis As A Result Of Transverse Myelitis And Mycotic Aneurysm Rupture: A Case Report
Transverse myelitis is a condition where a segment of the spinal cord becomes inflamed. This results in impairments below the level of the inflammation, including paraparesis or paraplegia, autonomic dysfunction, and/or pain. Cerebral mycotic aneurysms are a form of brain injury where an artery bursts and diminishes blood supply to the brain. The resulting impairments vary depending on the area of the brain affected. The purpose of this case report was to describe the interventions provided to a patient with paraparesis as a result of transverse myelitis and multiple cerebral mycotic aneurysm ruptures to progress toward achieving his goals of standing and ambulating with a standard walker and bilateral knee-ankle-foot orthoses (KAFOs).
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