Volume 14:1
Pre-surgical Complications Impacting Post-Operative Care After Left Ventricular Assistive Deice Implantation: Case Study
Laura Flick, PT, DPT & Daniel C. Dale, PT, DPT

Mercer University, College of Health Professions, Department of Physical Therapy, Atlanta, GA

Abstract

Objective: To explore how pre-surgical health status prior to left ventricular assistive device (LVAD) implantation can affect post-operative care.

Patient and Plan of Care: A 51-year-old male presented to the acute care hospital with symptoms consistent with an exacerbation of cardiomyopathy. The patient was started on intra-aortic balloon pump (IABP) therapy via femoral access, immobilizing the patient for seven days. The physical therapy (PT) evaluation was completed one day status post left ventricular assistive device implantation. Findings included impaired strength, balance, and activity tolerance.

Results: The outcome measure used was the Activity Measures for Post-Acute Care (AMPAC). Additionally, length of stay post-operatively and discharge location were observed due to the significance of the case. This patient was hospitalized for 31 days total, with 23 of those days post-op. After two weeks of PT, the patient still required significant assistance for functional mobility tasks. The discharge disposition was to an inpatient rehabilitation facility (IRF). While awaiting discharge to the IRF, the patient made improvements in function specific to transfers and gait. With family education, the patient discharged home with assistance from his family.

Conclusion: Factors including equipment access, medical team decisions, and pre-surgical health status limited this patient from mobilization pre-operatively. Post-operatively, prolonged immobility and PT scheduling limited the patient’s mobilization. Combined, external factors including limited discharge locations and mobility restrictions led to an increased length of stay for this patient compared to hospital and national averages.

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Case Report: Clinical Assessment and Management of an Ischial Tuberosity Avulsion Fracture

Elizabeth Nixon, SPT1; Inez Cabral, SPT1; Claire Beck, SPT1; Abigail Weber, SPT1; Karen Abraham, PT, PhD1; Jacob Manley, PT, DPT, MS, LAT, ATC, CSCS2; Katherine Bain, PT, DPT, ATC, PhD1

1Shenandoah University. School of Health Professions – Division of Physical Therapy, Leesburg, VA;2 PRO Physical Therapy, Winchester, VA

Absratct

Background and Purpose: Ischial tuberosity avulsion fractures (ITAF) occur when a piece of the ischial bone attached to the hamstring tendon is detached from the innominate. ITAF often occurs in athletes between ages 15-19 years during high-impact sports when the lower extremity (LE) is forced into hip flexion and knee extension. The determining factor for surgical versus conservative management is displacement distance. The aim of this case study was to explore conservative management of an ITAF in an adolescent male athlete.

Case Description: A 15-year-old male, elite soccer player sustained a left-sided ITAF during a slide tackle. The patient (pt.) was referred for diagnostic imaging to confirm an ITAF of <20 mm of displacement, to be eligible for conservative treatment. PT intervention included strengthening exercises, functional movements, balance training, and blood flow restriction training.

Outcome Measures: Pt. participated in functional outcome testing at 10 weeks and 7 months post-injury in a research laboratory. Tests included the Y-balance test (YBT), isometric LE strength testing, hip ROM, the Bunkie Test, and the Tampa Scale for Kinesiophobia (TSK-11). The pt’s score indicated a low risk of developing kinesiophobia. At week 12, callus formation was noted at the ischial tuberosity by MRI, allowing the pt. to begin a progressive running program and limited practice. At week 18, the pt. returned to full participation in soccer. At 7 months post-injury, the pt. demonstrated improvements in all functional outcomes.

Conclusions: Based on findings from the functional outcomes assessed, core stabilization, dynamic balance, and strengthening exercises should all be assessed and incorporated into the conservative management plan for an ITAF. While improvements in dynamic balance and strength were identified at the 7-month follow-up, the pt. still had lingering impairments that may predispose him to future injury or re-injury. It is crucial to manage and address all aspects of a pt’s function following injury.

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Evaluation of DPT Students’ Perceptions of Cultural Awareness, Belongingness, and DEI Practices Within Their Programs
Delia D. Stell, SPT, Devina J. Jhala, SPT, Carla F. Huggins, PT, DPT, Allison F. Brown, SPT, Karishma D. Vyas, SPT, Tommy Stell, MS
Georgia State University, Department of Physical Therapy, Atlanta, GA

Absract

Background: Assessing DPT students’ perceptions of cultural awareness and DEI practices can provide programs with a greater understanding of how to maximize DEI education. This study evaluates current students and recent graduates’ (n=264) perceptions of their sense of belongingness (SOB) and cultural awareness (CA) based on their programs’ DEI practices. Results from this study can provide DPT programs with an idea of how DEI and CA training impact students’ confidence in providing care to a variety of patients.
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Mehods: The study was comprised of 48 survey questions regarding DEI practices in DPT curriculums and students’ perceptions of their SOB and CA skills. Questions included subjects’ and programs’ demographics, and the SOB Index (SOBI)1 and CA Scale (CAS)2 instruments. SOBI questions had a 1-4 response scale (1=Strongly Agree-4=Strongly Disagree); lower scores suggested increased SOB. CAS questions had a 1-7 response scale (1=Strongly Agree-7=Strongly Disagree); lower total scores suggested increased CA. Kruskal Wallis tests with Mann-Whitney tests for post- hoc pairwise comparisons were used to examine differences in SOBI and CAS scores among subjects across various characteristics.
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Results: SOBI scores were statistically significant among different genders (p=0.016) and races (p=0.031), with females having a greater SOB than other genders and with white subjects having greater SOB than black or multiracial participants. CAS scores significantly differed among subjects across academic years (p=0.022) and residency statuses (p=0.036). Post hoc tests displayed statistical differences between 1st-3rd year (p=0.010) and 2nd-3rd year (p=0.012) students. Out-of-state students at the time of admission had a notably higher CAS score than in-state students (p≤0.05). Upon comparing current students to recent graduates, there were no significant differences in SOBI and CAS scores within the two groups (p>0.05). 67.30% of subjects learned about CA and DEI from classmates, 59.47% from program curriculums, and 53.67% from clinical experiences.
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Conclusion: The results indicate that in-state DPT subjects experience a greater sense of CA than out-of-state, and female participants have a higher SOB than other genders. Participants showed they were exposed to CA and DEI in various ways, predominantly through classmates and program curriculums. This supports the need for programs to further emphasize CA and DEI in order to improve students’ confidence in treating patients of various backgrounds.
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An Overview of Literature Related to Post COVID-19 Outpatient Rehabilitation
Mikayla Klimas, SPT, Sierra Schertler, SPT, Zachary Davis, SPT, Michael McGee, SPT, Laurie Brogan, PT, DPT
Misericordia University, Department of Physical Therapy, Dallas, PA

Abstract

Objective: To complete a systematic search of available research on the role of physical therapy (PT) with managing post COVID-19 related conditions and common symptomatology in adults in the outpatient PT setting.
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Data Sources: PubMed, CINAHL, Medline, Cochrane, Hand Searches. Study Selection: Searches were conducted to examine current data related to PT interventions and their effectiveness for treating post COVID- 19 conditions in outpatient clinics. Articles were examined by researchers and evaluated for relevance based on the following criteria: articles in English, original peer reviewed articles, adult population (over 18), relevant PT interventions for rehabilitation, post-acute infection of COVID-19. Data Extraction: 18 articles were reviewed and analyzed for relevance to implications regarding post-COVID-19 and potential PT rehabilitation interventions. Interventions were assessed in feasibility and applicability to an outpatient clinic setting. Articles were examined for content regarding the latest updates on disease criteria, manifestations, new classifications, and cohorts emerging as the pandemic progresses.
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Data Synthesis: After article analysis, the findings include a key theme that PT services helped improve overall functional mobility and symptom management in patients after an infection of COVID-19. A combination of pulmonary rehabilitation, strength and aerobic training, and interval training have been shown to improve quality of life and manage residual symptoms of COVID-19.
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Conclusion: PT has a growing role in the management of post COVID-19 deficits as well as implications related to long covid sequelae. By choosing the appropriate parameters and using available knowledge with current research, practitioners can improve patients’ functional mobility by helping resolve current conditions such as shortness of breath and fatigue. The focus of future studies should include more specific interventions and parameters related to managing the condition and finding the most effective treatment strategies.
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Unlocking Potential: Intensive Physical Therapy Prior to Selective Dorsal Rhizotomy, Case Report
Sarah Roach, PT, DPT; Lisa Fraher, PT, DPT, PCS
Mercer University, Department of Physical Therapy, Atlanta, Georgia

ABSTRACT

Background: Selective dorsal rhizotomy (SDR) is a surgical procedure designed to decrease spasticity in children with cerebral palsy (CP). While the current literature supports rehabilitation after SDR, there is an absence of literature describing interventions delivered before surgery and examining their effect on outcomes after surgery in children with CP. This case study describes an innovative approach of prehabilitative, intensive physical therapy to maximize patient outcomes after SDR surgery.
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Case Description: A 6-year-old male with spastic triplegic cerebral palsy functioning in GMFCS Level III participated in a 2-week-long intensive therapy program (3 hours/day, 5 days/week) to improve strength and functional performance before SDR surgery.
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Outcomes: The program was effective in producing clinically significant increases in the patient’s Gross Motor Function Measure (GMFM-88) scores, including: the total score (+3%); goal total score (+6.5%); standing dimension score (+10%); and walking, running, and jumping (+3%) dimension score. Improvements in ambulation and stair climbing ability were also observed, meeting the patient’s prehabilitative therapy goals.
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Conclusion: This case study provides a framework for the progression of goal-directed interventions in an intensive therapy program delivered before SDR surgery. The findings indicate that intensive therapy may improve a child’s overall function prior to surgery. This could lead to better post-surgical outcomes, such as a reduction in the impact of post-operative weakness and a shorter timeline for recovery. This case supports the need for larger-scale studies examining the effect of intensive therapy prior to surgery on post-surgical outcomes in this population.
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