1/25. gait analysis in stroke patients to assess treatments of foot-drop.By using the combined, computerized analysis of stroboscopic photography, pattern recognition devices, electromyography and foot switch outputs, gait patterns were studied in 15 stroke patients with foot-drop. Three patients were treated with a peroneal nerve stimulator for five weeks; six received intensive physical therapy; and six received both physical therapy and biofeedback training three times a week for five weeks. Each patient was examined at initial visit and after five weeks. Based upon case evaluations, both the patients with the stimulator treatment and those with biofeedback training showed and maintained improvement of gait pattern following the treatment period. This result suggests that the biofeedback and peroneal-stimulator technique may have a common mechanism that should be exploited in the rehabilitation of stroke patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/25. gait re-education based on the Bobath concept in two patients with hemiplegia following stroke.BACKGROUND AND PURPOSE: This case report describes the use of gait re-education based on the Bobath concept to measure the changes that occurred in the gait of 2 patients with hemiplegia who were undergoing outpatient physical therapy. CASE DESCRIPTION: One patient ("NM"), a 65-year-old woman, was referred for physical therapy 6 weeks following a right cerebrovascular accident. She attended 30 therapy sessions over a 15-week period. The other patient ("SA"), a 71-year-old woman, was referred for physical therapy 7 weeks following a left cerebrovascular accident. She attended 28 therapy sessions over a 19-week period. Clinical indexes of impairment and disability and 3-dimensional gait data were obtained at the start of treatment and at discharge. Therapy was based on the Bobath concept. OUTCOMES: At discharge, NM demonstrated improvements in her hip and knee movements, reduced tone, and improved mobility. At discharge, SA demonstrated improved mobility. During gait, both patients demonstrated more normal movement patterns at the level of the pelvis, the knee, and the ankle in the sagittal plane. SA also demonstrated an improvement in hip extension. DISCUSSION: These cases demonstrate that recovery of more normal movement patterns and functional ability can be achieved following a cardiovascular accident and provide insight into the clinical decision making of experienced practitioners using Bobath's concept.- - - - - - - - - - ranking = 1.5keywords = physical (Clic here for more details about this article) |
3/25. Constraint-induced therapy for a child with hemiplegic cerebral palsy: a case report.A 12-year-old boy with hemiplegic cerebral palsy (CP) presented with decreased function in his left upper extremity. He was treated with a 3-week protocol of constraint-induced therapy (CIT) consisting of six 2-hour sessions of physical and occupational therapy, plus home practice. Improvements in upper-extremity function were found in the mean and median time for completion of the Wolf Motor Function Test immediately posttreatment and at 8-month follow-up. Also, improvements in functional use of the arm were documented with the Assessment of Motor and Process Skills and by patient self-report of use of the upper extremity at home. The results suggest that CIT may be useful in the treatment of upper-extremity dysfunction in hemiplegic CP. Larger, experimentally controlled investigations of the efficacy of CIT and the mechanism of recovery in patients with CP are warranted. The effects of the duration and intensity of CIT protocols need additional study to increase its clinical application.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
4/25. Modified constraint-induced therapy in chronic stroke.Although efficacious, constraint-induced therapy may be difficult to implement in some outpatient settings. This case study examined the effectiveness of modified constraint-induced therapy administered to a patient with chronic stroke, learned nonuse, and a stable motor deficit in his dominant upper limb. The Fugl-Meyer Assessment of Motor Recovery and Action research arm Test were administered twice before intervention, and the motor activity Log and actigraphy were administered once. The patient then participated in half-hour, structured physical and occupational therapy sessions, emphasizing affected arm use, three times per week for 10 wk. It was concluded that modified constraint-induced therapy may be an effective method of improving affected arm function and use in chronic stroke patients exhibiting learned nonuse.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
5/25. Use of a static adjustable ankle-foot orthosis following tibial nerve block to reduce plantar-flexion contracture in an individual with brain injury.BACKGROUND AND PURPOSE: ankle plantar-flexion contractures are a common complication of brain injuries and can lead to secondary limitations in mobility. CASE DESCRIPTION: The patient was a 44-year-old woman with left hemiplegia following a right frontal arteriovenous malformation resection. She had a left ankle plantar-flexion contracture of -31 degrees from neutral. After a tibial nerve block, an adjustable ankle-foot orthosis was applied 23 hours a day for 27 days. Adjustments of the orthosis were made as the contracture was reduced. The patient received physical therapy during the 27-day period for functional mobility activities and stretching the plantar flexors outside of the orthosis. OUTCOMES: The patient's dorsiflexion passive range of motion increased from -31 degrees to 10 degrees. DISCUSSION: The application of an adjustable ankle-foot orthosis following a tibial nerve block, as an addition to a physical therapy regimen of stretching and mobility training, may reduce plantar-flexion contractures in patients with brain injury.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/25. Cerebral and coronary air embolism: an intradepartmental suicide attempt.Uncooperative but alert on arrival, a 21-year-old suicidal man was found suddenly unconscious with agonal respirations 2 h into his Emergency Department evaluation. Initially admitted for ingesting multiple pills and self-inflicting a deep wrist laceration, the patient now had a glasgow coma scale score of 3, a dense left-sided hemiplegia, and an electrocardiogram suggestive of acute myocardial infarction. This constellation of physical findings, together with an echocardiogram revealing bi-ventricular gas artifact, led to a diagnosis of coronary and cerebral air emboli. The patient was urgently resuscitated and then underwent hyperbaric oxygen therapy. Subsequent examination confirmed a full recovery. This article details this unprecedented case, as well as clinically relevant aspects of air embolism.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
7/25. Hemiparesis in hiv infection. rehabilitation approach.persons with acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (hiv) infection demonstrate a wide array of central nervous system impairments and may be at a significantly increased risk for cerebrovascular disease. Cerebrovascular disease can be the first manifestation of hiv infection and may be associated with a treatable etiology. Anticipating more referrals for hiv-related physical disability, we detail the rehabilitation management of three persons with hiv infection and hemiparesis. Onset of hemiparesis ranged from just before to 24 months after an AIDS-defining illness. No specific underlying etiology was identified in two of three patients, consistent with previous observations. rehabilitation interventions included lower and upper extremity orthoses, assistive devices to aid gait and activities of daily living, therapeutic exercise and use of antispasticity medication. All patients made at least mild, temporary gains in functional status. survival ranged from 3 to >6 months from initial contact with rehabilitation services. Neurologic and nonneurologic considerations in the rehabilitation of persons with hiv infection are discussed. We conclude that selected individuals with hiv infection and hemiparesis can benefit from rehabilitation intervention. hiv infection should be considered in any young adult presenting with stroke.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
8/25. Pediatric constraint-induced movement therapy for a young child with cerebral palsy: two episodes of care.BACKGROUND AND PURPOSE: This case report describes the use of "Pediatric Constraint-Induced Therapy (Pediatric CI Therapy)" given on 2 separate occasions for a young child with quadriparetic cerebral palsy. CASE DESCRIPTION: The child was 15 months of age at the beginning of the first episode of care. She had previously received weekly physical therapy and occupational therapy for 11 months, but she had no functional use of her right upper extremity (UE), independently or in an assistive manner. She scored from 5 to 7 months below her chronological age on developmental assessments in gross motor, fine motor, and self-help skills. INTERVENTION: Pediatric CI Therapy involved placement of a full-arm, bivalved cast on the child's less affected UE while providing 3 weeks of intensive intervention (6 hours a day) for the child's more affected UE (intervention 1). Therapy included activities that were goal oriented but broken down into progressively more challenging step-by-step tasks. Pediatric CI Therapy was administered again 5 months later to promote UE skills and independence (intervention 2). OUTCOMES: The child developed new behaviors throughout both interventions. During intervention 1, the child developed independent reach, grasp, release, weight bearing (positioned prone on elbows) of both UEs, gestures, self-feeding, sitting, and increased interactive play using both UEs. During intervention 2, she had increased independence and improved quality of UE movement, as supported by blinded clinical evaluations and parent ratings.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
9/25. stroke rehabilitation therapy in a patient with a cardiac pacemaker for chronic atrial fibrillation.A 65-year-old man was implanted with an artificial pacemaker for chronic bradycardic atrial fibrillation associated with hypertensive heart disease. Five years after the pacemaker implantation, he suffered from a cerebral embolism. Approximately 4.5 months after the ictus, he was transferred to the rehabilitation ward. He had flaccid left hemiplegia and severe disuse syndrome. He could not sit and could tilt his head up for only two minutes because of severe orthostatic hypotension. By modulating the rate-responsive mode of the pacemaker every 2-4 weeks, we were able to rehabilitate the patient. Thus, the patient could sit in a wheelchair for more than three hours. This case emphasizes the importance of examining the mode and function of a previously implanted artificial pacemaker. In accord with varying rehabilitation programs and gradual improvement in a patient's physical activities, periodic modulation of a programmable pacemaker can lead to a better functional outcome during rehabilitation therapy.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
10/25. Haemorrhagic brain injury: a care study.Mark was only 20 years old when an unfortunate sequence of events dramatically altered his life. In July 1989 he sustained two subarachnoid haemorrhages within a fortnight, first from a left anterior communicating artery aneurysm and then from a right middle cerebral artery aneurysm. Both aneurysm were successfully clipped but Mark remained hemiplegic with severe physical and behavioural problems, including incontinence, sexual disinhibition, aggression and uninhibited spitting. In November 1989, he was transferred to a neuro-rehabilitation unit and his management there will be described, showing how his complex problems were managed within enforced environmental limitations.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
| | Next -> |