Clinical Reasoning And Intervention Selection For A Patient With Lower Extremity Weakness Following Acute Alcoholic Polyneuropathy: A Case Report
Alcoholic polyneuropathy is a sensorimotor peripheral polyneuropathy. APN usually affects individuals over 40 years old with a history of chronic alcoholism. Most cases occur chronically over several months. Acute cases of APN may develop over the course of weeks. Symptoms of APN include paresthesia and paralysis. There are a variety of suspected mechanisms for etiology for APN. Literature is sparse in relation to physical therapy management and interventions for a patient with acute alcoholic polyneuropathy. The purpose of this case report was to describe the clinical reasoning behind interventions selected for a patient with acute alcoholic polyneuropathy in the acute setting.
Core Strengthening And Lower Extremity Flexibility; A Model For Physical Therapy Treatment Of Acute Nonspecific Low Back Pain: Case Report
Development of effective physical therapy treatment strategies is needed in order to improve outcomes for patients with low back pain. Current practice guidelines support the use of core strengthening in the treatment of low back pain; however, there is limited research investigating the combined use of core strengthening and lower extremity flexibility exercises. The purpose of this report is to describe the physical therapy management and functional recovery of an individual with work related acute nonspecific low back pain.
Multimodal Physical Therapy Interventions Designed To Restore Independence And Motor Control In A Patient With Acute Cerebellar Stroke
Background: The cerebellum integrates sensory perception, coordination, and motor control. Cerebellar stroke accounts for 3.4% of the 600,000 strokes that occur annually in the United States. Due to the rarity of ACS, very little research has been conducted regarding multimodal PT interventions as a treatment option. Purpose: The purpose of this case report was to describe multimodal PT interventions designed to restore independence and motor control for a patient with ACS.
Physical Therapy Management Of A Patient With Stroke Utilizing Muscular Facilitation Techniques In A Skilled Nursing Facility: A Case Report
Background: Stroke is the leading cause of serious long term disability in the United States. Hemiparesis is a well-known impairment following stroke. Trunk musculature asymmetry is also common and often overlooked when assessing a patient’s muscular control. Trunk musculature is an essential link between the upper extremities and lower extremities during activities of daily living. Impairments in trunk musculature can result in decreased safety and balance. Purpose: The purpose of this case is to provide the framework for treatment and an overview of a care plan for a patient following stroke, with special attention to trunk musculature facilitation, in a skilled nursing facility.
Background: Triple arthrodesis is the surgical fusion of the talonavicular, talocalcaneal, and calcaneocuboid joints of the foot. Joint surface preparation includes debridement, removal of cartilage, burring of subchondral bone, and fish scaling of the joint surfaces. The joints are then fused using screws. No inversion or eversion motion, only plantarflexion and dorsiflexion. Primary goals: abolish pain, correct underlying deformities, and restore a stable platform for ambulation. Indicated for severe arthritis, instability, and deformity that cannot be controlled with nonsurgical approaches. Purpose: To provide an overview of triple arthrodesis surgery and to report a case describing the specific outpatient physical therapy management strategies used following surgery.
Inpatient Physical Therapy For A Patient With Dementia After Right Above Knee Amputation: A Case Report
Background: Lower limb amputation is a traumatic procedure that is most commonly performed on individuals who are diabetic or have peripheral vascular disease. Other causes of amputation include infection, trauma or cancer. A sarcoma is a cancer in tissues such as muscle, fat, cartilage, or bone. The treatment goal is to excise and prevent growth or metastasis of the sarcoma. There is limited literature regarding dementia involving motor planning deficits and physical therapy. However, based upon the interventions provided by physical therapists it is believed that individuals with dementia involving motor planning deficits will have some difficulty. Purpose: The purpose of this case report is to describe the inpatient physical therapy management of a patient following right above knee amputation with motor planning deficits.
Outpatient Physical Therapy Management Of A Female Athlete With A Left Anterior Cruciate Ligament Reconstruction And Left Medial Meniscectomy: A Case Report
Background: The anterior cruciate ligament (ACL) is a structure within the knee that prevents anterior translation of the tibia on the femur as well as checks lateral rotation of the tibia and extension of the knee. The ACL is typically injured in noncontact sports by a sudden deceleration prior to a change of direction or landing motion. Female athletes are more than twice as likely to sustain an injury to the ACL. An ACL injury is often accompanied by an injury to the meniscus of the same knee. Purpose: The purpose of this case report is to provide a comprehensive account of the physical therapy treatment provided to a young female athlete after left anterior cruciate ligament reconstruction.
Strengthening And Postural Training For A Patient With Leg Length Discrepancy And Anterior Pelvic Tilt: A Case Report
Background: Leg length discrepancy (LLD) is a frequent orthopedic problem that presents as either shortening or lengthening of one of the lower limbs. Patients with LLD of 1-2cm often present with back or/and lower extremity pain, pelvic asymmetry, scoliosis, and difficulty in gait pattern. Purpose: The purpose of this case report is to describe the physical management of a patient with LLD and left anterior pelvic tilt who experienced pain in the left hip.
The Use Of Electrical Stimulation And Cryotherapy In Pain Reduction For A Patient Following An Arthroscopic Partial Meniscectomy: A Case Report
Background: An arthroscopic partial meniscectomy is a common procedure that consists of removing some of the meniscus from the tibio-femoral joint. It is a minimally invasive surgery. Following the procedure, physical therapy is used to improve function. In many cases, some level of pain management is utilized which may include Transcutaneous Electrical Nerve Stimulation (TENS) and cryotherapy. TENS has been shown to be more effective than pain medication following arthroscopic knee surgery and aid in faster regains of strength and range of motion. Cryotherapy for pain management has been shown to have a significant effect on the level of pain, amount of pain medication consumption, and weight-bearing status in arthroscopic knee surgeries. There is little information about TENS and cryotherapy used together and their effectiveness on pain relief. Purpose: The purpose of this case report is to describe the patient management and outcomes of a patient who underwent a partial medial meniscectomy treated with TENS and cryotherapy with the goal of minimizing pain prior to functional strengthening to return to the workplace.
Physical Therapy For A Patient With Poor Balance Secondary To Charcot-Marie Tooth Disease And Chronic Low Back Pain: A Case Report
Background: Charcot-Marie-Tooth disease (CMT) is one of the most common inherited neuromuscular disorders with a prevalence rate of 1 in 2,500 in the United States. CMT is a form of muscular dystrophy, and is an umbrella term for certain inherited genetic disorders that affect the peripheral nervous system. The genetic disorder is characterized by muscular wasting, weakness, and sensory loss, and is most severe in the distal lower extremities. Common symptoms include foot drop, high-stepped gait with frequent tripping or falls, foot deformities such as high arches and hammer toes, and loss of muscle bulk in the distal lower extremities. Neuropathic pain and fatigue upon exertion are also common symptoms that are underreported. The onset of symptoms is variable depending on the type; however, it is usually prevalent during adolescence or early adulthood. There is no pharmacological treatment for CMT. Clinical approaches include physical therapy (PT) management, orthotics, and surgical interventions for treatment of skeletal deformities. Purpose: This patient was selected for a case report because there was relatively little research on therapeutic interventions for a patient with chronic low back pain alongside balance deficits in this particular patient population, especially for a patient in this age demographic, 45-65. The purpose of this case report was to provide an overview of CMT disease and a description of PT management strategies used for a patient with poor balance secondary to CMT disease and chronic low back pain.
Background: The basal ganglia are located in the and are involved in voluntary motor control, emotional reactions, and cognition. The putamen is housed in the basal ganglia, and is involved in learning and motor skills. Stroke is the 4th leading cause of death in the U.S. and leads to 1 out of every 19 deaths. Stroke is the largest cause of disability in older adults, and the largest consumer of rehabilitation services in the U.S. Hypertension is a major risk factor for causing a stroke, and over 90% of patients that have had a basal ganglia stroke have also had stage 2 hypertension (160/100). Purpose: The purpose of this case report is to summarize the physical therapy management for improving independent functional mobility following a left basal ganglia stroke in the outpatient setting.
Acute Care Physical Therapy Management Of A Former Professional Athlete Following Unicompartmental Knee Arthroplasty: A Case Report
Background: Unicompartmental knee arthroplasty (UKA): replacement of one compartment of the tibiofemoral joint. A balance between an ambitious plan of care and mindfulness of the acute inflammatory process poses a challenge for acute care physical therapists. There is a lack of literature that addresses the acute care physical therapy management of patients who have undergone this procedure. Specifically, little is known about the acute care physical therapy management of former elite athletes who undergo UKA in middle age. Purpose: To describe the acute care physical therapy management of a former professional tennis player immediately following UKA.
The Use Of Medical Exercise Therapy For A Post-operative Gastrocnemius Recession Patient After Multiple Conservative Physical Therapy Treatments Failed: A Case Report
Background: Achilles Tendonitis affects 9% of all recreational runners. Treatment is variable. Surgery is controversial. Gastrocnemius Recession: Small incision to postero-medial lower leg to release gastrocnemius tendon; most commonly used to treat equino-varus contracture; lack of literature when used to treat chronic achilles tendonitis; no known literature for the postoperative physical therapy management. Medical Exercise Therapy (MET): Developed by the Holten Institute; 60 minutes of graded exercise; high repetitions with low weight; functional weight bearing during functional movement patterns. Purpose: The purpose of this case report was to report the use MET for a patient after a gastrocnemius recession as treatment for chronic achilles tendonitis.
The Use Of Parkinson’s Disease Specific Rehabilitative Interventions To Treat A Patient With Lewy Body Dementia: A Case Report
Background: Lewy Body Dementia (LBD), and the role of physical therapy (PT) in treating this population, is scarce in the literature. LBD is considered a differential diagnosis of Parkinson’s Disease (PD); therefore, the idea to use PD specific interventions, primarily Lee Silverman Voice Treatment-Big (LSVT BIG), may be considered a suitable intervention. Purpose: To educate the readers about LBD, how it presents, and how PD related interventions can be used as a treatment.
Outpatient Physical Therapy Management Of A Patient Three Months Following Left Shoulder Arthroscopic Repair Of A Type-II SLAP Lesion: A Case Report
Background: Research demonstrates a drastic increase in the prevalence of type-II superior labral anterior-posterior (SLAP) lesion repairs, and its surgical correction has become the favored method of treatment, because of its ability to effectively improve quality of life (QOL). A type-II SLAP lesion consists of fraying and degenerative changes to the superior labrum, in an anterior to posterior direction, with the biceps tendon detached from the glenoid. Purpose: Document the examination, evaluation, and plan of care (POC) concerning a patient that was referred to physical therapy (PT) three months following the surgical correction of a type-II SLAP lesion.
Irina Fedulow and Katherine S. Rudolph
The perception of pain in patient populations can arise from tissue damage but when pain persists past the point of tissue healing it is thought to relate to abnormal pain processing in the CNS such as persistent central sensitization. Studies have shown that persistent central sensitization occurs in about 1/3 of people with chronic pain from knee OA and this abnormal pain processing can affect motor output and motor adaptation. It is unclear whether individuals with OA and persistent sensitization are predisposed to heightened pain perception or whether they develop heightened pain as a result of the chronic pain from OA. The purpose of this study is to determine the influence of heightened pain sensitivity on motor output and motor adaptation. We designed this study to determine the relationships between central sensitization (temporal summation and conditioned pain modulation) and motor output and adaptations that are measured by the “broken escalator phenomenon”. This poster outlines the preliminary work associated with the design of this study.
Physical Therapy Management Of A Female Adolescent Softball Pitcher With Chronic Low Back And Hip Pain: A Case Report
Background: Low back pain (LBP) in young athletes who participate in sports requiring repetitive flexion/extension/rotation of the spine is common among females, especially during periods of rapid growth. Information collected by Oliver and Plummer on ground reaction forces, kinematics, and muscle activation during the windmill softball pitch indicates how crucial strength and conditioning of the gluteal muscle group is to prevent injury during this movement pattern. Purpose: This case report describes the examination, evaluation, and PT interventions for a female high school softball pitcher with hip and core weakness, and bilateral hip hypermobility leading to low back and hip pain.
Closed-Chain Quadriceps Strengthening And Hamstring Stretching In The Conservative Treatment Of Medial Plica Syndrome: A Case Report
Background: Medial Plica Syndrome (MPS) is a source of anteriormedial knee pain. Caused by irritation of the medial plica (MP) by overuse, repetitive use or direct impact. Plica are folds on the synovial membrane formed as the synovial joint develops. Conservative treatment aimed at decreasing compressive forces at the knee are recommend have. Interventions should include open-chain activities that cause minimal joint stress on the anterior aspect of the knee and hamstring stretching. Tight hamstrings place stress on the anterior aspect of the knee during extension. Purpose: To demonstrate the use of close-chain quadriceps strengthening and hamstring stretching in a case of MPS in an adolescent to improve quadriceps strength and hamstring length, therefore decreasing pain and avoiding surgery.
Anti-Gravity Treadmill And Functional Training For An Army Soldier Following A Femoroplasty And Labral Repair: A Case Report
Background/Purpose: Femoral Acetabular Impingement (FAI) is characterized by three specific types of impingement between the head of the femur and acetabulum. Cam impingement occurs when the head of the femur is abnormally shaped. The head of the femur isn’t round, it is more of a pistol grip shape. It's even referred to as a pistol grip deformity. Due to this abnormal shape, the head of the femur cannot move properly in the anatomically designed ball-and-socket joint. The result is a shearing force on the labrum and the articular cartilage. Minimal amounts of articles were found that truly utilized physical therapy to go above and beyond “normal” activities of daily living like walking and negotiating stairs. Therefore the purpose of this case report is focused on learning the effects of higher functioning therapeutic exercise and the effects of the anti-gravity treadmill in the rehabilitation process of a patient diagnosed with FAI following surgery.
Postoperative Management And Core Stabilization Interventions For A Semi-Pro Football Athlete Following Lumbar Discectomy: A Case Report
Background: Many cases of low back pain (LBP) are idiopathic in nature, however, LBP in result of a herniated intervertebral disc exerting pressure on the nerve root may require lumbar discectomy to relieve sciatica and radiating pain. Although there is evidence to support successful return to work in the general population and return to sports in professional athletes, less is known regarding the interventions that played a role in their return. Purpose: The purpose of this case report is to describe the physical therapy management and core stabilization interventions for a semi-pro football athlete following lumbar discectomy who sustained a herniated disc during recreational exercise and football.
Physical Therapy Management With Emphasis On Quadriceps Strength Training For Chronic Patellar Dislocations In A Female Adolescent With Kabuki Syndrome: A Case Report
Background: Kabuki Syndrome (KS) has a current estimated prevalence at 1 in 32,000. KS is a rare, but highly recognizable genetic disorder manifested in the craniofacial, skeletal, neurological, and cardiovascular systems/regions of the body. Patellar dislocations are common in children with KS due to the presence of hypotonia causing muscle imbalances and joint laxity. Most commonly, treatment of patellar islocations are done conservatively through exercise. Surgical interventions (lateral release, medical imbrication, medial patellofemoral ligament reconstruction, or bone realignment) are considered with continued dislocations. Purpose: Physical therapy management approach with a focus on addressing chronic patellar dislocations through quadriceps strengthening in a 12 year old female diagnosed with Kabuki Syndrome.
Physical Therapy Outcomes In A 28 Year Old Male With A Femoral Neck Fracture Using Aquatic And Land-Based Therapeutic Exercise: A Case Study
Background: Hip fractures occur in approximately 341,000 persons each year in the U.S. Hip fractures at a young age are uncommon and are usually the result of a high-velocity injury or, rarely, secondary to bone pathology. Morbidity associated with an inability to return to a pre-fracture level of mobility often results in a loss of independence, reduction in quality of life, and depression. There is a lack of available literature on the physical therapy management of hip fractures in the younger patient population. Purpose: The purpose of this case report was to investigate the physical therapy management of a 28 year old male who had sustained a femoral neck fracture. A combined approach of aquatic and land based therapeutic exercise was used.
The Effects Of Robot-Assisted Gait Training And Task-Specific Training On ADL Function And Mobility For A Patient After A Stroke: A Case Report
Background: Stroke is the fourth leading cause of death and the leading cause of long term disability in the United States. Repetitive task-specific training has been shown to be favorable in stroke rehabilitation. Robot-assisted gait training (RAGT) incorporates gait training and repetitive task-specific training. RAGT has been shown to increase the likeliness of independent walking ability in patients who have experienced a stroke, especially when utilized in first three months. Currently there is limited research regarding the impact of RAGT on ADL function. Purpose: To describe the impact of robot-assisted gait training in combination with task-specific training on the functional mobility and ADL function in an individual who experienced a middle cerebral artery (MCA) stroke.
The Role Of An International Cross Cultural Interprofessional Healthcare Immersion Program In Doctor Of Physical Therapy Education: An Educational Case Report
Purpose: The purpose of this educational case report is to describe an interprofessional international cross-cultural immersion healthcare program and to discuss the role of this program in the development of Doctor of Physical Therapy (DPT) students’ cultural competence, interprofessionalism, and social responsibility. Description: The Ghana Cross Cultural Health Immersion (GCCHI) program provides annual primary health care services and education in Sekondi, Takeradi and outlying communities in Ghana. Student and faculty participants from the University of New England (UNE) work in conjunction with the Ghana Health Services, Cape Coast University medical students and community health workers in order to meet the health needs of underserved Ghanaian populations. While immersed in the cross-cultural service learning environment, the DPT students engage in interprofessional collaborative care with other students and the Ghanaian and American providers. The GCCHI integration of western health practices with folk medicine is an integral in provision of culturally competent health care. Students and faculty also participate in cultural activities outside of the clinic during their stay. Upon their return students participate in self reflection exercises and a campus presentation.
Physical Therapy Management Of A Patient With A Transtibial Amputation Using An Over-Ground Body Weight Support System: A Case Report
Background: Peripheral Arterial Disease (PAD): Narrowing of the vessels secondary to atherosclerotic plaque buildup, results in ischemia to extremities which can lead to intermittent claudication, decreased distal pulses, impaired healing. Lower Extremity Amputation: 54% of amputations in the USA are due to PAD, either alone or in conjunction with diabetes (Kalapatapau V. et al), transtibial and transfemoral most common, best outcomes with multidisciplinary approach. Body Weight Support (BWS) Systems: Commonly used in patients after stroke or incomplete spinal cord injury; methods: treadmill or over-ground, over-ground allows for assistive device training and varying terrains; parameters: high-intensity, high-repetition, task-specific; lack of research investigating BWS systems after lower extremity amputations. Purpose: The purpose of this case report was to provide a framework for the physical therapy management, including the use of a body weight support system, for a patient with a transtibial amputation in a skilled rehab setting.
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