Volume 7:3

 

Rehabilitation Following Bilateral Tibial Intramedullary Nail Placement in an Elite Athlete

Sharon Young Abney, SPT; Deborah Michael Wendland, PT, DPT, PhD, CPed

Mercer University – Atlanta, GA

 

Abstract

Background: Intramedullary (IM) nailing is the preferred method of treatment for tibial stress fractures because of lower rates of complication compared to conservative treatment, however; a high incidence of anterior knee pain has been associated with IM nailing. There is scant literature investigating post-surgical rehabilitation management of athletes who undergo IM nail placement. This case report analyzes physical therapist management of an athlete recovering from surgical placement of bilateral tibial IM nails.

Case Description: This case report describes a 23-year old male collegiate football receiver who underwent bilateral tibial IM nail placement. The subject began participation in a progressive rehabilitation program one day after surgery. The subject participated in two sessions per week for twelve weeks. At the fifth week of rehabilitation, the cyclic training program was initiated and continued throughout the remainder of the patient’s plan of care.

Outcomes: The patient achieved a full, pain-free functional recovery at the end of the twelve-week rehabilitation program as indicated by the Lower Extremity Functional Scale. The patient in this case achieved full, sport-specific functional recovery without anterior knee pain.

Conclusion: The cyclic training program allowed for a controlled, gradual progression of weight-bearing activities with rest periods to allow for soft tissue recovery and decreased bone irritation. Use of a cyclic training technique can be an effective way to strengthen the musculature at an intensity and speed that reduces the risk for anterior knee pain associated with the IM nailing procedure.


 

 

Impact of Student Based Administered Physical Therapy Intervention on Quality of Life in a Patient with Traumatic Brain Injury

Steven Alden, SPT; Chelsea Gibbons, SPT; Miranda Marsh, SPT; Katelyn Wye, SPT; Janice Hulme, PT, MS, DHSc, CEEAA

University of Rhode Island – Kingston, RI

 

Abstract

Background: At present there is no known research that explores the effects of interventions provided by Doctorate of Physical Therapy (DPT) students on improving quality of life in people who have experienced a traumatic brain injury (TBI). The aim of this study was to present a case study examining the effects of DPT student provided interventions on enhancing quality of life for an individual with a TBI.

Case Description: The participant was a 48-year-old male who sustained a TBI at work as a result of a fall. He was evaluated pre and post-treatment by a licensed physical therapist who was blinded to the study and interventions. The Quality of Life after Brain Injury (QOLIBRI) scale was provided to the patient at the beginning and end of a fifteen-month treatment period. The participant was seen one to two times per week by DPT students.

Outcomes: At the conclusion of the fifteen-month period the two scales were compared. Assessment of the two scales resulted in a general trend of increased quality of life in the participant.

Discussion: Limitations such as a small sample size and lack of standardization of procedures may have impacted the results. Future studies altered to decrease the effects of the limitations could provide beneficial information regarding opportunities for people with post-traumatic brain injuries to improve overall quality of life.

 


 

 

A Novel Approach for Addressing Psychosocial Issues for an Athlete Following Ankle Dislocation

Abigail Wilson, PT, DPT; Deborah Michael Wendland, PT, DPT, PhD, CPed

Mercer University – Atlanta, GA

 

Abstract

Background: Ankle dislocation without accompanying soft tissue damage is a rare injury that results from a high force trauma. Such an injury presents with sensorimotor, range of motion, and strength deficits. Additionally, psychosocial factors impact an athlete’s recovery after an injury. The purpose of this case is to highlight the use of anew intervention approach combining modified graded exercise and mental practice to address fear avoidance behavior in an athlete recovering from ankle dislocation.

Case Description: A collegiate athlete presented to an outpatient orthopedic physical therapy clinic for treatment of an ankle dislocation approximately three months after the injury. Impairments at the initial evaluation included: decreased range of motion, strength deficits, and difficulty with ambulation. Treatment addressed psychosocial factors, including tentativeness during functional training, using graded exercise and mental practice within the phases: (1) early introduction of proprioception and closed kinetic chain exercises, (2) return to functional activities, and (3) sport-specific training.

Outcomes: The Lower Extremity Functional Scale (LEFS), 10 meter walk test, and single leg stance improved over nineteen visits. Final outcomes included: LEFS (77/80), 10 meter walk test (typical gait speed: 1.0 m/sec; fast gait speed: 1.5 m/sec), and SLS (one minute bilaterally).

Conclusion: While typical physical therapy relies on functional and sport-specific training, it is imperative to address psychosocial factors when fear-avoidant behavior is apparent. The novel approach provided a progressive exposure to feared tasks, increasing the patient’s confidence.