Volume 9:3

Evidence-based upper extremity program 26 years post-stroke: A case report

Francesca Romeo,PT,DPT, Anna Gray,PT,DPT, Danielle Trias,PT,DPT, Nicole Milad,PT,DPT, Chanel Cohen,PT,DPT,ATC, Jennifer Escobido,PT,DPT, Laura Z. Gras,PT,DPT,DSc,GCS

Ithaca College, Ithaca, NY, USA

Download PDF


Background: Patients who have had a stroke make the most functional gains within 3 years of onset. Upper extremity function may take longer to recover but there is not much research focused on chronic stroke using evidence based interventions. The purpose of this study was to examine the outcomes of a 16-week intervention that combined modified constraint-induced movement therapy (mCIMT), scapular strengthening, mirror therapy, and mental imagery, for a patient 26 years post-stroke.

Case Description: This case report was on a 33-year old male who had a stroke after a brain tumor resection when he was 7 years old. The participant was given a 16-week home exercise program consisting of 4 evidence-based upper extremity interventions. Pre and post-test measurements were obtained using the Canadian Occupational Performance Measure (COPM), Fugl-Meyer Assessment- Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST).

Outcomes: Clinically significant gains were made on the Canadian Occupational Performance Measure for both performance and satisfaction, Fugl-Meyer Assessment-Upper Extremity motor portion, and the modified Closed Kinetic Chain Upper Extremity Stability Test. Non-significant improvements were also made on the Action Research Arm Test.

Conclusion: Modified CIMT, scapular strengthening, mirror therapy, and mental imagery were successfully combined to produce clinically meaningful upper extremity improvements in a person 26 years post-stroke with chronic hemiplegia.


 Management of Left Knee Pain in a Worker’s Compensation Setting: A Retrospective Case Report.

Kevin James B.A., SPT; Dale Schuit PT, Ph.D., MS; David Diers Ed.D., MHS, PT, ATC; Roberta Kuchler O’Shea PT, Ph.D.

Wayne State University – Detroit, MI

Download PDF


Background: Nursing assistants are one of the most commonly injured workers, and knee injuries are common in the workplace. There is limited research available on the physical therapy management of workplace injuries in the nursing assistant population. This retrospective report describes the conservative treatment of a knee injury in a female 24-year-old nursing assistant that occurred in the workplace. 

Case Description: The patient presented to physical therapy with complaints of left lateral knee pain and perceived instability. The knee injury was sustained at work. She was seen initially one week after the injury, with a diagnosis of unspecified knee pain. Initial examination results suggested possible lateral meniscal irritation, and functional deficits including dynamic valgus, loss of ROM, and pain with activities. The patient was seen for eight sessions in three weeks with interventions that included functional strengthening, stretching, biomechanics training, and thermal modalities for pain. 

Outcomes: Numerical pain rating scale (NPRS) score decreased from 5/10 at initial visit to 0/10 by the fourth visit. Knee injury and osteoarthritis outcome scores (KOOS) score increased by 39% for pain, 36% for symptoms, 23% for activities of daily living, 55% for sports and recreation, and 50% for quality of life from initial visit to eighth visit/discharge. 

Conclusions: In this case the patient’s symptoms and functional deficits resolved in 3 weeks, and she was able to return to full work duties.  Her positive attitude toward therapeutic activities could also have contributed to the positive outcome. 


 The Effects of Myofascial Release Technique on the Latency of Delayed-onset Muscle Soreness 

Caleb Dodd, DPT1; Kenneth Paz, DPT1; Michael Piazza, DPT1; Joseph Potesta, DPT1; Kayla Weiser, DPT1; Corrie Mancinelli PT, PhD, GCS1; Jean L McCrory, PhD1; D. Scott Davis, PT, MS, EdD, OCS2

1 West Virginia University School of Medicine, Department of Human Performance & Applied Exercise Science, Morgantown, WV, 2 Marshall University School of Physical Therapy, Huntington, WV

Download PDF

Objective: The purpose of this study was to determine the effectiveness of a manual myofascial release technique (MFRT) in reducing the symptoms of delayed-onset muscle soreness (DOMS) in recreational athletes.

Background: Previous research has shown that many proposed treatments for DOMS are not effective at reducing eccentric induced muscle soreness. One of the most effective interventions has been shown to be manual massage. It is unclear if manual myofascial release is effective in reducing pressure pain threshold and perceived pain associated with DOMS.

Subjects: Thirty recreational athletes were recruited to participate in the investigation; however, 10 subjects did not develop sufficient DOMS (operationally defined as >20% decrease in pressure pain threshold 48hours post exercise) and were excluded from the study. Thus, 20 adult athletes (16 women; 4 men) participated in this investigation. Mean and (SD) for age was 24 years (1.2).

Materials/Methods: Before the initiation of the eccentric protocol to create DOMS, baseline perceived pain level and pressure pain threshold (PPT) were assessed using the visual analog scale (VAS) and pressure algometry, respectively. The PPT measurement sites were standardized according to anatomic landmarks on the right thigh. Participants completed the DOMS protocol, consisting of 5 sets of 25 eccentric quadriceps contractions on a Biodex dynamometer. Forty-eight hours after the protocol completion, pre-treatment measurements were taken to establish the baseline level of DOMS. Participants were randomly assigned to the treatment or control group. The treatment group received the manual MFR technique on the lateral side of the right thigh between the greater trochanter and lateral epicondyle of the femur. Pressure pain threshold and VAS measurements were collected at 5 minutes, 20 minutes, and 24 hours post-treatment. Data were analyzed using a repeated measures ANOVA.  

Results: There was not a significant interaction effect between group and time for PPT (p=0.16) or VAS (p=0.45). There was not a significant main effect for group for PPT (p=0.59) but there was for VAS (p=0.01). There was a significant main effect for time for both PPT (p< 0.03) and VAS (p=0.002).

Conclusions: Based on the results of this investigation, there is inconclusive evidence to support the use of myofascial release technique to reduce pressure pain threshold in subjects with eccentric-induced delayed onset muscle soreness. This study supports long-standing evidence that time is perhaps the most effective treatment for reducing the symptoms of delayed onset muscle soreness. Further research with a larger sample size and a higher dose of the treatment technique is warranted.  

Clinical Relevance: Healthcare providers, coaches, and athletes have long sought to identify effective interventions to reduce and speed the recovery of eccentric-induced delayed onset muscle soreness. There is insufficient evidence at this time to support myofascial release techniques as an effective treatment.


The Use of the Physical Stress Theory in the Care of a Patient Recovering from Necrotizing Fasciitis.

Laura James, SPT; Deborah M. Wendland, PT, DPT, PhD, CPed

Department of Physical Therapy, Mercer University, Atlanta, GA

Download PDF


Background: Necrotizing fasciitis is a rare, but serious critical illness resulting in the need for immediate medical and surgical intervention. Patients often undergo an extensive hospital stay in order to control the infection, placing the patient at risk for severe debilitation and for musculoskeletal impairments such as contracture, skin breakdown, and muscular atrophy. The purpose of this case study is to discuss the use of the physical stress theory (PST) as a guide to physical therapy intervention in a patient recovering from a critical illness. 

Case Description: A 25-year-old female presented to an outpatient orthopedic physical therapy clinic for treatment of generalized weakness following an extensive hospital and intensive care unit admission for necrotizing fasciitis. Impairments at the initial evaluation included decreased range of motion, muscle atrophy, impaired balance, and difficulty with ambulation. 

Outcomes: After 12 weeks of rehabilitation, the patient was able to ambulate without an assistive device, return to a dynamic, high energy job, and demonstrate improved overall strength and muscular endurance.  

Conclusion: The PST can be used to guide interventions that encourage a healthy balance between tissue stress and tissue protection, allowing for the successful rehabilitation of impaired tissues and ultimately the return to function in a patient recovering from a critical illness.