1/5. Agility and perturbation training for a physically active individual with knee osteoarthritis.BACKGROUND AND PURPOSE: People with knee osteoarthritis (OA) sometimes report episodes of knee instability that limit their activities of daily living. The episodes of instability are similar to those reported by people with knee ligament injuries. The authors believe that modifications of interventions that are used to promote knee stability in individuals with knee ligament injuries can be used to enhance knee stability and function in people with knee OA. The purpose of this case report is to describe the development and implementation of an agility and perturbation training program that was used in conjunction with traditional rehabilitation activities for a patient with knee OA. CASE DESCRIPTION: The patient was a 73-year-old woman with a diagnosis of bilateral knee OA. Her chief complaints were knee pain and episodes of partial "giving way" at the knee during walking, stair climbing, and participation in tennis and golf. The patient participated in 12 treatment sessions at a frequency of 2 visits per week. The rehabilitation program consisted of lower-extremity stretching, strengthening and endurance exercises that were supplemented with a variety of walking-based agility training techniques, and perturbation training techniques. OUTCOME: At the completion of rehabilitation, the patient was able to walk on level surfaces and stairs and return to playing golf and tennis without episodes of instability and with reduced pain. DISCUSSION: Supplementing rehabilitation programs for people with knee OA with a modified agility and perturbation training program may assist them in returning to higher levels of physical activity with less pain and instability following rehabilitation. Further research is needed to determine the role of agility and perturbation training in people with knee OA.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Use of differential reinforcement to treat medical non-compliance in a paediatric patient with leukocyte adhesion deficiency.Leukocyte Adhesion Deficiency (LAD) is a rare immuno-deficiency disorder which results in chronic infections, such as gingivitis, necrotic skin infections and gastrointestinal ulcers. This case describes an 18-year-old male who was non-compliant during an inpatient hospitalization with several aspects of his complex medical regimen, particularly his wound care, physical therapy and use of his crutches. The patient's dressing change protocol was task analysed in order to create a structured, predictable routine by having the subject complete small, discrete steps. A differential reinforcement programme was implemented to provide the patient with tangible reinforcement for general compliance with his treatment, including compliance with dressing changes and physical therapy. Over a 1-month period, the subject's overall compliance with his medical regimen achieved an average of approximately 87%. His compliance with physical therapy and dressing changes both improved to 87 and 80%, respectively, by the end of his hospitalization. During the last week of his hospitalization, the use of his crutches was task analysed and included in his reinforcement programme using a changing criterion design. His average use of his crutches also improved to 80%.- - - - - - - - - - ranking = 0.6keywords = physical (Clic here for more details about this article) |
3/5. Necrotising fasciitis: a life-threatening complication of acupuncture in a patient with diabetes mellitus.acupuncture is used for some conditions as an alternative to medication or surgical intervention. Several complications had been reported, and they are generally due to physical injury by the needle or transmission of diseases. We report a case of life-threatening necrotising fasciitis that developed after acupuncture treatment for osteoarthritis of the knee in a 55-year-old diabetic woman. She presented with multiple discharging sinuses over the right knee. As the patient did not respond to intravenous antibiotics, extensive debridement was performed. She made a good recovery. Since many old diabetic patients with degenerative joint diseases may consider this mode of treatment, guidelines on cleanliness and sterility of this procedure should be developed and practiced.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
4/5. An acute care episode of a patient following bilateral total knee arthroplasty.More patients with bilateral joint problems are choosing to go through one surgery to replace both joints simultaneously rather than having two separate surgeries. The goals of physical therapy following the surgery are to decrease pain, maximize range of motion (ROM) and strength, improve ambulation, and improve overall function. Few studies have focused on the importance of the acute phase of rehabilitation and most concentrate instead on long-term outcomes and outpatient care. The patient was a 62-year-old male diagnosed with osteoarthritis of both knees. The day before the initial physical therapy evaluation, the patient underwent a bilateral total knee arthroplasty. By the end of his stay, active knee ROM increased to -6 degrees to 88 degrees on the right and -6 degrees to 83 degrees on the left. Passive ROM also increased to -5 degrees to 90 degrees on the right and -5 degrees to 86 degrees on the left. The patient was able to perform supine to sit transfers with supervision and sit to stand transfers with contact guard assistance and his ambulation progressed to wvalking 100 feet on level surfaces with a rolling walker and supervision. The positive gains of this patient suggest the potential value of high motivation combined with early aggressive physical therapy.- - - - - - - - - - ranking = 0.6keywords = physical (Clic here for more details about this article) |
5/5. High tibial osteotomy with use of the Taylor Spatial Frame external fixator for osteoarthritis of the knee.BACKGROUND: High tibial osteotomy (HTO) is used to treat medial compartment osteoarthritis of the knee in active patients with varus alignment. In this study we review the clinical and radiographic outcomes associated with the Taylor Spatial Frame (Smith & Nephew), and its use in HTOs, and we include an illustrative case report. methods: In 7 patients with medial compartment osteoarthritis of the knee and varus alignment, the Taylor Spatial Frame was applied to the tibia in the operating room and a proximal tibial osteotomy was performed. patients followed a computer-generated turning schedule until the desired correction was achieved. The frame was removed when the osteotomy site had healed. The lower extremity measure (LEM) was used to assess physical function. Clinical outcome measures relating to the Taylor Spatial Frame included latency, time to correction, time in the frame, number of residual corrections and complications. Radiographic outcomes included preoperative Resnick grades of osteoarthritis, pre- and post-correction limb alignment and tibial slope measurements. RESULTS: Average (and standard deviation) LEM grade at a mean 41 (14) months follow-up after correction was 94% (5%). Average latency was 8 days, time to correction was 15 days, time in the frame was 23 weeks and number of residual corrections was 1.3. Complications were similar to those for external fixators. Radiographic correction goals were met in all patients. CONCLUSION: The Taylor Spatial Frame is a valuable asset when using HTO to treat medial compartment osteoarthritis of the knee.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |