Outpatient Physical Therapy Following Surgical Repair of a Left Patellar Tendon Rupture: A Case Report
Patellar tendon tears often occur in patients less than 40 years old with forced flexion of the knee. Surgical repair of the tendon is most commonly the treatment following a tear; additionally, performing surgery to repair the tendon in a timely fashion is an important prognostic factor. The purpose of this case report is to outline the deficits following surgical repair of a left patellar tendon rupture, describe specific physical therapy interventions used during 12 weeks of outpatient rehabilitation, and report the outcomes of physical therapy.
Physical Therapy Management Of A Patient With Guillain-Barre Syndrome During and After Pregnancy: A Case Report
Background: Guillain Barre Syndrome (GBS) is a disorder in which the body’s immune system attacks part of the peripheral nervous system. The cause of GBS is still unknown, with suspicions of viral or bacterial infection preceding diagnosis. It can affect people of all ages, gender, or ethnic background, with equal incidence rates in both men and women. The incidence rate for GBS is rare, affecting 1-2 persons in 100,000 annually. Usually begins with distal, symmetrical, onset of paraesthesia, followed by progressive limb weakness. Pain is a common symptom, typically described as a deep ache or cramp in the buttocks, thighs, or between the shoulders. Most patients eventually reach a full or nearly full recovery with the ability to walk unassisted after 3 months and only minor residual symptoms by the end of the first year after onset. Purpose: There is currently no detailed description of PT management for GBS in pregnancy in the literature. The rationale of this case report is to describe a comprehensive program focused around the concept of functional-based interventions to assist a patient with GBS before and after pregnancy to regain independence and safety to complete daily and work-related activities.
Pre-Operative Outpatient Physical Therapy Of A Torn Rotator Cuff And Peripheral Nerve Injury Caused By Anterior Shoulder Dislocation: A Case Report
Background: Due to the high degree of available range of motion of the Glenohumeral joint, it is highly susceptible to instability and injury. 98% of all traumatic shoulder dislocations are anterior. Rotator cuff injuries and peripheral nerve injuries are commonly associated with traumatic anterior shoulder dislocations. Very little literature exists on pre-operative PT. Purpose: To investigate the effectiveness of pre-operative physical therapy (PT) management including passive range of motion, joint mobilization and exercises for a patient with both a torn rotator cuff and suspected neuropraxic peripheral nerve injury.
Physical Therapy Management Of A Patient After A Subacromial Decompression with Acromioplasty And Bursectomy: A Case Report
Background: Subacromial impingement results from repetitive trauma to structures underneath the subacromial arch which can lead to: A decrease in the subacromial space, impingement of the soft tissue, a decrease in functional abilities. Conservative treatment can include: Physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDS), corticosteriod injections, surgical option includes a subacromial decompression (SAD). There is conflicting evidence on the benefits of surgery. Literature is lacking supportive evidence of SAD without RTC repair or performing SAD with both an acromioplasty and bursectomy. Purpose: The purpose of this case report was to investigate the functional outcomes of a patient after SAD with an acromioplasty and bursectomy without RTC involvement.
Physical Therapy Management Of A Manual Laborer With Chronic Rotator Cuff Tendinopathy: A Case Report
Background: Tendinopathy is characterized by tendon thickening, localized pain and chronic degeneration reflective of failed healing. 38% of manual laborers who participate in daily moderate to heavy lifting will experience Rotator Cuff Tendinopathy(RCT). There is a lack of research investigating the PT management of manual laborers who have RCT, but must continue to participate in harmful activities to fulfill occupational responsibilities. Purpose: The purpose of this case report was to describe the PT management of a patient with rotator cuff tendinopathy who, due to work requirements continued to participate in activities detrimental to the health of the supraspinatus and function of the shoulder girdle.
The Physical Therapy Management Of A Patient With Adverse Mechanical Tension Including The Use Of Neural Gliders And Tensioners: A Case Report
Background: Adverse mechanical tension on one’s nervous system can impair a nerves ability to mobilize in relation to its interfacing tissues and lead to sensations of pain, paresthesia and numbness. Common physical therapy intervention includes sliding and tensioning of the irritated nerve and managing the tissues surrounding it. Purpose: The purposes of this case report were to (1) provide overview of adverse mechanical tension and (2) to report a case describing specific physical therapy management approaches and outcomes during outpatient rehabilitation for a patient with adverse mechanical tension.
Balance And Functional Skill Training For A Patient With Cognitive Dysfunction And Impaired Safety Awareness: A Case Report
Background: With advances in medicine, there are increasing numbers of people living who have had a stroke. One of the major factors that can limit improvement is cognitive dysfunction. Cognitive rehabilitation in conjunction with large amounts of repetition can result in lasting neuronal changes. Purpose: The purpose of this case study is to describe the decision making process for physical therapy examination and intervention for a patient who had a stroke with accompanying cognitive dysfunction and decreased
Instrument Assisted Soft Tissue Mobilization and Conservative Management Of Shoulder Pain In An Elderly Male: A Case Report
Background: Shoulder pain is a frequent complaint among the elderly population, numerous etiologies cause shoulder joint pain such as osteoarthritis, adhesive capsulitis, and rotator cuff disease (impingement, tendonitis, and cuff tear). A conservative treatment for shoulder pathology is Augmented Soft Tissue Mobilization (ASTM) that uses specifically designed sold instruments to perform manual therapy. Sound Assisted Soft Tissue Mobilization (SASTM®) is a technique which uses ceramic polymer tools with resonating capability. Limited evidence exists to support the use of SASTM® as a manual therapy treatment. Purpose: The purpose of this case report is to illustrate the physical therapy management of shoulder pain in an elderly male by describing intervention techniques, such as SASTM®, joint mobilization, and therapeutic exercise, using the patient/client management model.
Outpatient Interventions For Femoral Acetabular Impingement Complicated By Hip Osteoarthritis, Labral Tear And L5 Sacralization: A Case Report
Background: Femoral Acetabular Impingement (FAI) is a known cause of hip pain in adolescents and young adults produced by altered hip joint mechanics. Types of FAI include Cam deformity, Pincer deformity or a combination. Abnormal abutment of the femoral head on the acetabular rim, especially during hip flexion and internal rotation (IR) causes a sharp, pinching pain in the groin and lateral hip. Chronic FAI can lead to hip osteoarthritis (OA) and labral and/or chondral defects. It is unknown if there is a correlation between FAI and sacralization.
Background: Increasing prevalence of knee OA and TKA; according to the American Academy of Orthopedic Surgeons, there will have been a half a million TKA procedures performed by 2030. Purpose: The purpose of this case report is to describe the physical therapy management of an in-patient status post total knee arthroplasty.
Test-Retest Reliability And Minimal Detectable Change Of The Modified Fresno Test Of Evidence Based Practice In DPT Students
Erin Pike and Lisa Gerhardt
Poster presenting a research study whose purpose was to determine the test-retest reliability and MDC of the MFT in first, second, and third year DPT students, and to compare the mean total score of the MFT among the three student groups. Using a simple random sample, 21 students were recruited from each of the three UNE DPT classes. The participants completed the MFT twice, separated by 14 days, in a UNE classroom. Students in the third year class completed the validated 13-item MFT and, due to a photocopying error, students in the first and second year class completed an 11-item MFT. The first year students had the lowest 11-item MFT mean score (68.5 points) which was significantly lower than the second and third year student groups (85.7 and 88.2 points, respectively). First year students had the lowest ICC and highest MDC (0.23 and 40.4 points). Third year students had the highest ICC and lowest MDC (0.73 and 23.0 points). The 13 and 11-item MFT has good test-retest reliability for UNE's third year DPT student group. The 11-item MFT has poor to moderate test-retest reliability for first and second year DPT students.
Acute Care PT Management Of A Patient Following A Total Knee Arthroplasty With Partial Weight Bear Orders Secondary To Bone Cyst In The Femur: A Case Report
Background: Total Knee Arthroplasy (TKA): OA is the most common joint disorder in the US. A TKA is a surgical procedure aimed to relieve signs and symptoms of severe osteoarthritis. Acute care following a TKA includes: Swelling management, increasing range of motion, enhancing muscle control and strength in the involved lower extremity, maximizing patient’s mobility with the goal of functional independence. Weight bear status: weight bear as tolerated. Bone Cyst: A bone cyst is a common bone defect found in weight bearing joints such as the knee and hip. They may weaken bone integrity and must be accounted for in patients post TKA procedures. The weight bear status of these patients is typically partial weight bear (50%). There is a lack of evidence investigating PT interventions after a TKA, especially in a patient with a bone cyst and decreased weight bear status. Purpose: This case report investigated the PT interventions, management, and discharge recommendations of a patient with a bone cyst after a TKA in the acute care setting.
Cancer in the cerebellum in a pediatric population is rare. The cerebellum is responsible for: coordination of ongoing movements, postural control, visual gaze, performing smooth purposeful movements. There is limited evidence investigating the physical therapy management of pediatric survivors of cancer, more specifically, in cerebellum brain tumors. The purpose of this case report was to investigate the PT management of a pediatric survivor of cancer who had a cerebellar tumor resection.
Outpatient Physical Therapy Following Surgical Debridement Of Osteochondritis Dissecans Of The Talar Dome: A Case Report
Background: Osteochondritis Dissecans (OCD): Alteration of subchondral bone with disruption of the adjacent articular cartilage; cause unknown, hypotheses include repetitive trauma and or non-traumatic disruption of subchondral blood supply; suspected chondral injury with up to 50% of ankle instability episodes. Treatment Options: Goals: relieve symptoms and improve function; non-surgical: rest, immobilization, NSAIDS; surgical: excision of lesion, excision with cutterage and/or microfracturing, filling the defect with bone graft, antegrade transmelleolar drilling, retrograde drilling, fixation, osteochondral transplantation, and autologous chondrocyte implantation. Purpose: To describe physical therapy treatment and outcomes for a patient following surgical debridement of OCD of the talar dome.
The Use Of An Orthotic Garment System On A Pediatric Patient With Mitochondrial Disease Complex 1+3: A Case Report
Background: Mitochondrial Disease (MD) is a progressive and debilitating disease that is characterized by a loss of efficiency in the electron transport chain and reductions in the synthesis of high energy molecules such as ATP. Orthotic garment systems also referred to as “TheraTogs®”, have been designed to act as a continuous somatosensory guide for proper functional alignment. Theratogs have been used in the pediatric population to treat Cerebral Palsy and Down Syndrome with excellent results but there is no known research regarding the benefits of TheraTogs® in individuals with MD. Purpose: To investigate the use of the TheraTogs® System for postural control, with a pediatric patient with Mitochondrial Disease Complex 1+3.
Improving Functional Independence With Rehabilitation Following A Metastatic Melanoma Brain Tumor Resection: A Case Report
History: A 67 year-old male with a one year history of melanoma complained of headaches 1-2 weeks prior to admission to an acute care hospital with left sided hemiplegia and dysarthria. A head CT scan revealed an intracerebral hematoma and a lesion suspicious for metastasis within the right parietal lobe. A right parietal craniotomy, evacuation of the hematoma and resection of the brain tumor were performed and the pathology revealed metastatic melanoma. Discussion: The patient received 18, 60-75 minute physical therapy sessions over a span of 21 days while in the inpatient rehabilitation unit. This case study utilized many essential rehabilitation interventions to improve functional mobility and self-care. The FIM is a standardized functional outcome measure that was used effectively in this case report to measure the improvement in functional mobility and self-care. Following the removal of the brain tumor, this patient benefitted from intense acute rehabilitation while in inpatient rehab unit to improve upon functional outcomes and become less dependent in performing ADL’s. The rehabilitation team including physical therapy, occupational therapy, speech language pathology, and other health professionals took a multi-disciplinary approach to achieve these desirable outcomes. The patient stated he was satisfied with his overall improvement in functional independence and self care upon discharge to a skilled nursing facility.
Describing Regional Interdependence For A Patient With Lateral Epicondylalgia Managed With Postural Training And Iontophoresis: A Case Report
Background: Lateral epicondylalgia describes a condition where pain and tenderness are present in the wrist extensors, most commonly from repetitive motion activities. Current research suggests the cause is attributed to tissue degeneration due to repetitive stress to the wrist extensors. A concept known as regional interdependence may also influence lateral epicondylalgia. Regional interdependence describes a condition where impairments are present in proximal or distal joint segments and contribute or cause pain to the primary region reported by the patient. Iontophoresis, a common intervention utilized for treating lateral epicondylalgia, is intervention that uses electrical current to drive ionic drugs into the skin near the area of pain or inflammation. Iontophoresis can provide benefits including increased range of motion, decreased pain, and increased functional benefits. Research suggests 6 treatments are adequate for improvement. Purpose: To describe the physical therapy management of a patient with lateral epicondylalgia using a regional interdependence model, utilize iontophoresis to help decrease pain, and examine the relationship of regional interdependence with lateral epicondylalgia.
Outpatient Physical Therapy Management of a Breast Cancer Survivor Following Kyphoplasty with a Complex Medical History
Background and Purpose: There are over 3 million breast cancer survivors in the U.S. Cancer and its treatment can cause a wide variety of long-term physical and psychological problems. The physical therapist’s role is not well defined for this population. The purpose of this case report is to describe the outpatient physical therapy management for a patient with a history of breast cancer as well as considerable additional health issues.
Background: Low back pain (LBP) is one of the most common and costly musculoskeletal diagnosis in America. Approximately 50% of individuals with LBP have recurrent episodes by 1 year, 60% by 2 years and 70% by 5 years. Multiple studies have been inclusive determining a gold standard for cost effective long term outcomes. MET therapy focuses on early functional activity to relieve pain and restore normal movement. Early functional activity is made possible by using counter weights to obtain required range of motion. This system of unloading gives the patient the opportunity to perform exercises in a functional manner. The first phase involves graded exercises to normalize a pathological condition as well as getting rid of pain. In phase two the patient is symptom free and exercise is graded as compared to the patient’s daily activity. Generally treatment lasts for an hour and, exercise are done at 3 sets of 30 repetitions. Low weight is used to compliment the high sets and low reps as a way to condition the muscles and joints in a functional way. Purpose: The purpose of this case report is to show how MET therapy can be used as an intervention for LBP specifically, non radicular LBP.
Functional Mobility And Gait Training During Inpatient Rehabilitation Following Middle Cerebral Artery Stroke: A Case Report
Mortality from stroke is the 4th leading cause of death in the US, and is a leading cause of long-term severe disability among adults. Incidences of disabilities include: hemiparesis, unable to walk without assistance, dependent in ADLs, aphasia, and depression. Stroke survivors represent the largest group admitted to rehabilitation hospitals and approximately 1 in 4 patients with stroke are placed in long-term care. The purpose of this case report is to be a description of practice and interventions targeting functional mobility and gait retraining for patients within inpatient rehabilitation setting.
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