Volume 9:4

Acute Care Physical Therapy Intervention for a Patient Who Presented Post-Op Right Total Hip and Right Total Knee Arthroplasty: A Case Report.

Jason Berlongieri, SPT, Roberta O’Shea, PT, DPT, Ph.D., Robin Washington, PT, Ph.D., CRC, Dale Schuit, PT, Ph.D., MS

Governors State University University Park, IL

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Study Design: Case report.

Background: The incidence of patients undergoing a total hip or total knee arthroplasty is continually increasing. Despite this increase in prevalence, few studies have reported the outcomes of physical therapy (PT) intervention for a patient who has undergone a simultaneous ipsilateral total hip and total knee arthroplasty. The purpose of this retrospective case report is to describe the clinical, functional, and patient reported outcomes impacted by skilled PT intervention in the rehabilitation of a patient who presented to acute care PT immediately post-op simultaneous right total hip (postero-lateral approach) and right total knee arthroplasty.

Case Description: The patient described within this retrospective case report was a 53-year-old Caucasian male who presented to acute care PT post-op day 1 after a simultaneous right total hip and right total knee arthroplasty. This patient had also undergone a simultaneous left total hip and left total knee arthroplasty within six months prior to this episode of care.

Outcomes: Following two days of PT intervention, with two PT sessions per day, the patient demonstrated improvements in pain ratings, functional mobility, gait velocity, ambulation distance, stairs ascended, and active range of motion (AROM) of the right knee and right hip.

Conclusion: PT intervention appeared to be correlated with improvements in functional and clinical outcomes for the patient described in this case report. Future research is needed to determine the long-term effects of PT intervention on clinical and functional outcomes for patients who have undergone a simultaneous ipsilateral total hip and total knee arthroplasty.


Virtual Reality Treadmill Training for Improving Balance and Gait in Individuals with Chronic Stroke: A Systematic Review

Cara J. Kernoschak, Mary E. Miceli, Ava M. Morabito, Courtney L. Wheeler, Gabriele Moriello PT, PhD, Brittany Simpson, PT, DPT

Utica College, Utica, NY

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Study Design: Systematic Review.

Introduction: To synthesize the evidence for the use of virtual reality treadmill training (VRTT) on balance and gait in adults with chronic stroke.

Background: Stroke results in many impairments, some of the most limiting to independence are gait and balance. There are numerous studies on the effectiveness of virtual reality; however, no systematic review focuses solely on VRTT and its effects on balance and gait.

Methods: Six reviewers searched six databases (PEDro, PubMed, ScienceDirect, Proquest, Cochrane, and CINAHL), selecting all articles that met the selection criteria. Article quality was appraised through the use of the PEDro Scale by random assignment to four reviewers. Data pertaining to each study’s methodology, participation information, outcome measures, and results were extracted. Effect sizes were calculated using Cohen’s d.

Outcomes: A total of 11 articles met the selection criteria. The median score on the PEDro Scale for all articles was seven. All six studies that measured the effects of VRTT on dynamic balance found statistical improvements, with effect sizes ranging from 0.78 to 3.51. One of the three studies that measured static balance found statistical improvement in some aspects of sway. Four articles evaluated the effects of VRTT on balance confidence and two of these studies found statistical improvements, with effect sizes ranging from 1.07 to 1.11. Of the five articles that measured spatiotemporal parameters, four studies found statistical significance, with effect sizes ranging from 0.38 to 2.87. Out of the three studies that measured ambulation distance, two studies found statistical differences. Seven of the eight articles that measured gait speed found statistical improvements, with a range of effect sizes from 0.19 to 1.54 and lastly, two studies measured its effect on functional gait ability and found statistical improvements, with an effect size of 1.03 for one of those studies.

Discussion: There is moderate to strong evidence supporting the effectiveness of VRTT for improving dynamic balance and gait in individuals with chronic stroke. Weak evidence indicated there were no effects on static balance. VRTT can be used in addition to conventional physical therapy in order to maximize an individual’s recovery from chronic stroke.


A Case Report: The Role of Physical Therapy in Improving Gait, Strength, and Balance in a Female Patient with Wilson’s Disease

Sarah Chancellor, SPT, Angel Holland, PT, DPT, GCS

University of Arkansas for Medical Sciences, Northwest Fayetteville, Arkansas

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Introduction: The purpose of this article is to demonstrate positive outcomes seen in patient care in an outpatient physical therapy setting for an individual with Wilson’s disease.

Case Description: 38-year old Caucasian female presented to an outpatient neuromuscular physical therapy clinic with a diagnosis of Wilson’s disease. Therapy sessions focused on dynamic balance, increasing activity tolerance and functional strength exercises.

Outcomes: Outcome measures that were used were objective tests performed by the same therapist to ensure as much reliability as possible. Evaluation outcome measures included: walk velocity test at a normal pace, hip abduction strength, modified Clinical Test for Sensory Interaction on Balance (mCTSIB) with the use of the NeuroCom, and two-minute walk test as quickly and safely as possible. A 286% increase was seen in her gait speed at a normal pace, a 43% increase in her ambulation distance activity tolerance and a 22% increase in her quadriceps power were seen at the time of discharge. A significant improvement was also seen in her balance in varying sensory conditions in the most difficult tasks of the mCTSIB assessment.

Discussion: Positive outcomes were seen during this approximately seven-week bout of physical therapy as the patient met 3/8 of her goals and made moderate progress on the other five goals. Physical therapy, without changes to prior dietary and pharmaceutical interventions, made a positive impact on this patient’s independence and safety.


The Effect of Rocktape on Upper Quarter Posture

Kelsi Bennett, ATC, SPT; Zach Gove, SPT, CSCS; Mike Nezworski, SPT; William Streck, SPT; Rachael Wauer, SPT; Janice K. Loudon, PT, PhD, SCS, ATC, CSCS

Department of Physical Therapy Education, Rockhurst University, Kansas City, MO

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Objectives: The goal of this study was to determine the effect of elastic shoulder taping on cervical and shoulder posture.

Background: Forward head posture “FHP” and rounded shoulder posture “RSP” are two of the most common postural problems seen in individuals that sit for prolonged periods. The use of elastic adhesive taping has been shown to improve posture in a variety of musculoskeletal conditions.

Methods and Measures: Nineteen graduate students participated in the study. Cervical and shoulder posture were assessed on the dominant and non- dominant side at baseline, with initial RockTaping of the shoulder and 48 hours following the tape.

Results: Immediately following the application of the Rocktape, all angles increased. After the two days of wearing the tape, postural angles returned to pre-tape values or less. There was a statistical difference in angles of pre-tape versus immediately following tape.

Conclusion: Overall, there is an immediate and significant change in posture with the addition of RockTape to the dominant shoulder, however this effect does not last over a two-day period.


Low Back Injuries in Women’s Gymnastics: An Exploration into the Role of the Physical Therapist.

Hallie Mossman, SPT; Leah Lowe, DPT, PhD, PCS; William D. Bandy, PT, PhD, SCS; Charlotte Yates, PT, PhD, PCS

University of Central Arkansas, Doctor of Physical Therapy Program– Conway, AR

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Study Design: Survey design using questionnaire and interview.

Background: Low back pain affects approximately 80% of gymnasts during their gymnastics career, and diagnosed low back injuries are among some of the most common injuries gymnasts’ experience. With these types of injuries, collaboration between physical therapists (PT) and coaches is essential. The purpose of this study was to examine the prevalence of low back injuries in women’s artistic gymnastics in the state of Arkansas. Additionally, the relationship between gymnastics coaches and physical therapists was explored to identify potential areas of collaboration to minimize these injuries and maximize return to sport.

Case Description: To explore PT/coach collaboration in women’s gymnastics, ten head coaches from gymnastics centers participated in the study. The interview consisted of thirteen questions that investigated the prevalence of back injuries in each gym, the prevention strategies of each gym, and the perceived relationship between gymnastics coaches and PT.

Outcomes: The incidence rate for chronic low back pain or diagnosed low back injuries was approximately 1.5%. Ninety percent of the gyms interviewed currently practice some low back prevention exercises. Seventy percent of the coaches interviewed stated that they did not feel there is currently a collaborative relationship between coaches and PT in the sport of gymnastics. Coaches report lack of direct communication between the PT and the coach as a barrier to collaboration.

Conclusion: Direct communication could improve the relationship between gymnastics coaches and PT in Arkansas, and improving this relationship could benefit gymnasts, coaches, and PT.