Medicine and Health Sciences Commons^™

Use Of A Task-Oriented Approach In The Physical Therapy Management Of A Patient Following A Posterior Inferior Cerebellar Artery Stroke: A Case Report, Erika Derks

Case Report Papers

Background and Purpose: Stroke is the leading cause of long term disability in the United States. Despite the prevalence of stroke, there is minimal research on physical therapy interventions for patients with cerebellar stroke. The purpose of this case report is to describe a multidimensional intervention program for a patient following a cerebellar stroke, emphasizing a task-oriented approach and motor learning principles. Case Description: The patient was a 78-year-old female who had a right posterior inferior cerebellar artery stroke. She received daily physical therapy for four and a half weeks in the acute rehabilitation setting. The examination revealed deficits in …

Written On By Experience, Akesis Anonymous Author

Akesis

This poem is about a conversation I had with a friend about beginnings, and how any given experience has no intrinsic good or bad qualities, but rather holds whatever we imbibe it with.

What Is My Beginning?, Stephanie Braunthal

Akesis

I find that when we ask about beginnings, we are really asking about the present. How did a person come to be who he or she is today? As I try to answer this question about myself, I am finding it easier to express myself in diagrams (pen on scratch paper) than in words. Perhaps this is a product of being a medical student; or perhaps it is because beginnings are a complex amalgam of static forces and fluid experiences that cannot be expressed linearly through prose...Enjoy!

To Care Is To Treat, Himanshu Malhotra

Akesis

To Care is to Treat is a reflection of a few experiences from my second and third year that have inspired me to become a palliative care physician.

The Narrative Of My Childhood, Nihit N. Mehta

Akesis

I was a weak child from early on, never able to run or play as much as the other kids in my block. Each month I'd visit doctors, trying my best to recover from common colds and coughs. Luckily, all this changed as I matured and in a way I almost began living a "normal life".

However, when it came to deciding what I wanted to be as an adult, I remembered the sick kid I was and how my doctors were always there for me, helping me "find health." This made me realize that I too, could someday be …

The Descent Down The Step One Rabbit Hole, Katelyn A. Hanson

Akesis

At the start of my second year of medical school I was ecstatic to move away from the study of the normal, healthy human body and to begin to immerse myself in the complex mechanisms behind the pathophysiology of disease. I drew this illustration to connect aspects of my personality with the aspects of medicine I was most excited about exploring deeper. This image was drawn with permanent markers on the cover of a binder dedicated solely to preparing for the first part of the medical licensing exam; I looked at this drawing every day as I drove myself closer …

Laurie's Greenhouse, Elizabeth G. Mcandrew, Kelsey Albert

Akesis

Pottery by: Elizabeth McAndrew

Photography by: Kelsey Albert and Elizabeth McAndrew

Modeling: Laurie the Bird

Materials: Wheel thrown pottery - Cone 10 white clay and dipped glaze (cobalt blue and mossy green). Philodendron Heartleaf Plant. Laurie is a parrotlet, which is the second smallest species of parrot. Photo editing was done directly on the iPhone photo application.

This photo represents beginnings because it includes many elements of my life that I drew toward me in the year that I began my medical career. Living alone for the first time, I bought plants so that I wasn't the only living thing …

Beginnings, Nehal J. Shah

Akesis

The beginning of one thing signifies the end of another – for one to start, another must end. With that said, under karmic and Hindu belief, we are constantly in a cycle of beginnings, and endings, until we achieve “moksha” – true oneness with God. Furthermore, within each cycle, there are four stages of life that one hopes to go through, carrying out the ideal goals and progress of each existence. Therefore, this life ultimately is a new beginning to an old soul – a soul that has traveled and journeyed upon eons of time to find happiness, spirituality, completeness …

Beginnings: A Letter From The Editors, Akesis Editors

Akesis

The editors would like to welcome you to the inaugural issue of Akesis.

The Effects Of Neuromobilization Combined With Posture Training In The Management Of A Patient With Cervical Radiculopathy: A Case Report, Courtney Naimi

Case Report Papers

Background and Purpose: Management of cervical radiculopathy can include cervical traction, neural mobilization, manual therapy, and therapeutic exercise, whereas management of lateral epicondylitis can include eccentric tendinopathy management, manual therapy, and therapeutic exercise. Some evidence exists discussing neuromobilization for the management of axial diagnoses. However, there is sparse literature describing neuromobilization for management of both the presence of right C7, C8 radiculopathy and contralateral lateral epicondylitis. Therefore, the purpose of this case report is to discuss the outcomes of neuromobilization techniques for a patient presenting with right C7, C8 cervical radiculopathy with contralateral lateral epicondylitis. Case Description: A 64-year-old male …

Use Of Core Stabilization Exercise And Medical Exercise Therapy In The Treatment Of A Patient With Chronic Post Partum Low Back Pain: A Case Report, Zachary Chaloner, Kirsten Buchanan

Case Report Posters

Low back pain and lumbar hyper-mobility are common during and after pregnancy. Chronic postpartum low back pain (LBP) can be difficult to manage. Core stabilization exercises (CSE) have been shown to improve function and reduce pain in patients with chronic LBP due to lumbar instability. Medical Exercise Therapy (MET) has shown good outcomes in reducing pain in patients with LBP but has not been thoroughly investigated in the treatment of chronic post partum LBP. There is limited research reporting the use of a combined treatment protocol utilizing CSE and MET in the treatment of chronic LBP in postpartum women. The …

The Use Of Manual Therapy And Strengthening Exercises To Improve Plantarflexion Strength And Mobility Following Achilles Tendon Repair: A Case Report, Jason Glikman

Case Report Papers

Background and Purpose: The incidence of Achilles tendon ruptures is 1 in 10,000 per year, mostly affecting 30 to 50 year old males. These ruptures occur from either strong eccentric or concentric contractions of the gastrocnemius/soleus complex during acceleration or deceleration. Impact motions are common causes of this tendon ruptures. Neglected Achilles tendon ruptures occur when 4 weeks pass before treatment. This case report describes the clinical management of a patient with a neglected Achilles tendon rupture with global scar tissue formation due to a 3-month time period between injury and surgical repair, followed by a further 3-month time period …

Neuromuscular Strengthening Exercises Following Acl And Meniscal Repair In A 15 Year Old Female Athlete With Generalized Knee Laxity: A Case Report, Alyssa Gardner

Case Report Papers

Background and Purpose: Adolescent females are 4-6 times more likely to sustain a non-contact anterior cruciate ligament (ACL) injury compared to their male counterparts. Generalized knee laxity decreases dynamic knee stability and further increases injury risk. In patients with a history of bilateral knee hyperextension who have sustained an ACL injury, it’s vital to recover function after surgery, as well as prevent injury in the contralateral knee. A lack of information exists that addresses simultaneous rehabilitation protocols. The purpose of this case report was to investigate the use of a neuromuscular strengthening program in both the ACL injured and un-injured …

Multimodal Physical Therapy Management Of A Patient With Unilateral Neglect Post-Stroke In An Outpatient Setting: A Case Report, Meghan Riley

Case Report Papers

Background and Purpose: Unilateral neglect (ULN) syndrome negatively affects recovery post-stroke and is often associated with falls, longer stays in rehabilitation, and the need for more assistance at discharge. Typical physical therapy treatments include voluntary trunk rotation, visual scanning exercises, mirror therapy, hemispheric activation, sensory awareness training, and lower extremity loading but the efficacy of these treatments is still unclear. The purpose of this case report is to describe multimodal physical therapy (PT) management that includes common PT interventions to alleviate symptoms of ULN and report upon the outcomes of the various treatment methods for rehabilitation of neglect during functional …

Trunk Control And Standing Tolerance Of A Patient With Paraparesis As A Result Of Transverse Myelitis And Mycotic Aneurysm Rupture: A Case Report, Ashley Tomaswick

Case Report Papers

Background and Purpose: Transverse myelitis (TM) is a rare condition in which the spinal cord becomes inflamed resulting in pain, paraparesis or paraplegia, impaired sensation, and/or impaired autonomic function. Approximately two-thirds recover with mild to moderate symptoms, but one-third are left with severe and disabling symptoms. Cerebral mycotic aneurysm (CMA) rupture is a brain injury due to a burst artery resulting in diminished blood supply to the brain. There is literature on beneficial physical therapy (PT) intervention progressions following brain injury, such as bed mobility strategies and pre-gait activities, but there is little published on PT for impairments as a …

Use Of The Lower Extremity Functional Scale (Lefs) In A Patient After A First Metatarsophalangeal Joint Implant: A Case Report, Courtney Brinckman

Case Report Papers

Background and Purpose. The LEFS was initially designed as a functional outcome measure for patients with lower-extremity orthopedic conditions.1 While the LEFS has been used for a broad spectrum of lower-extremity pathologies, there is a paucity of research that investigates the use of LEFS in patients who have had a first MTP joint implant. The purpose of this case report was to investigate the use of LEFS in a patient with a right first MTP HemiCAP(®) joint implant. Case Description. The patient was a 56 year-old male with bilateral pes planus. Conservative treatment for 9 years did not decrease symptoms …

Application Of A Balance Training Program In A Patient With Charcot Marie Tooth Disease: A Case Report, Eduardo Pena

Case Report Papers

Background and Purpose: Charcot Marie Tooth Disease (CMT) is the most common progressive inherited neurological disorder1. Characteristics include muscle weakness and reduced sensation beginning in the distal lower extremities. Individuals with CMT have increased difficulty sensing and maintaining balance. There is minimal research on the effectiveness of balance training and outcome measures in this population. The RUSK Hospital Modified Romberg Protocol (RUSK MRP) is used as a balance-training program for patients with a neurological diagnosis, however no information is available on its effectiveness in CMT. The purpose of this case report was to investigate the effectiveness of the RUSK MRP …

Restoring Functional Mobility In A Patient With Delayed Onset Of Physical Rehabilitation Following A Hemorrhagic Stroke: A Case Report, Bettie Kruger

Case Report Papers

Background and Purpose: Hemorrhagic stroke accounts for 10% to 15% of all strokes and is associated with a high mortality rate. A decompressive craniectomy is a neurosurgical procedure to reduce intracranial pressure in order to minimize risk of mortality and disability. It has been suggested that early and frequent mobilization following stroke onset is optimal for motor recovery. The purpose of this case report is to provide a framework of sub-acute rehabilitation that facilitated motor recovery and functional mobility in a patient with delayed participation in physical therapy (PT) following a stroke. Case Description: A 54 year-old female underwent an …

The Use Of Postural Reeducation And Strengthening Exercises In The Reversal Of Functional Scoliosis: A Case Report, Cory Marcoux

Case Report Papers

Background and Purpose: There is a multitude of research regarding structural and idiopathic scoliosis, but very minimal literature about non-structural (functional) scoliosis and more importantly, how to treat it. The purpose of this case report was to examine the use of stretching, strengthening, and postural reeducation for a patient who presented with a non-structural scoliosis. Case Description: The patient was a 37-year-old female who underwent a left-sided lumbar discectomy at level L5/S1 following an acute onset of left foot-drop. The patient later presented with severe back pain and spasms from an infection of the disc at the surgical site that …

Acute Care Outcome Measures In A Patient Status-Post Right Total Knee Arthroplasty (Tka) Following A Left Tka Staged Five Weeks Apart: A Case Report, Stephanie Sanderson

Case Report Papers

Background and Purpose: Total knee arthroplasty (TKA) is one of the most frequently performed orthopedic procedures in the U.S. Thousands of people undergo TKA every year in hopes of improving their functional abilities and reducing their pain levels. The purpose of this case report was to document acute care outcome measures in a patient who underwent bilateral TKA staged five weeks apart and to assess the possible implications that a short staging period might have on the patient’s ability to recover. Case Description: The patient was a 58-year-old male who following a left TKA underwent a right TKA, secondary to …

Use Of Manual Therapy And Sport Specific Re-Training In An Adolescent Elite Sprinter With Bilateral Pedicle Stress Fractures: A Case Report, Erika Lopez

Case Report Papers

Background and Purpose: Bilateral pedicle stress fractures are extremely rare, with few cases reported in the literature. The pedicle is known to be the second weakest point of the vertebra, has a short moment arm from the vertebral body, and can resist a large amount of cyclic shear forces.1 There have been several reports describing pedicle stress fracture in adolescent athletes.1 However, in those reports the fracture was usually associated with contralateral spondylolysis, and isolated pedicle fractures are rarely found. 1This case report details a conservative approach using manual therapy, Pilates exercises, and sport specific re-training in an adolescent sprinter …

A Progressive Physical Therapy Plan Of Care For A Patient With Charcot-Marie-Tooth Disease Following Myocardial Infarction: A Case Report, Paige Blasco

Case Report Papers

Background and Purpose: Charcot-Marie-Tooth disease (CMT) is a neuromuscular disease that leads to distal muscle atrophy, weakness, and sensory loss. Myocardial infarction (MI) is often a result of coronary artery disease, which has an incidence rate of 34.6% in men over 80. While rehabilitation practices for CMT and MI have been described separately, there is a paucity of research investigating physical therapy (PT) interventions for patients who have both health conditions. The purpose of this case report was to investigate the PT management of a patient with CMT following an acute MI in the acute and sub-acute care settings. Case …

Functional Mobility Management Of A Patient With Adult-Onset Hereditary Proximal Motor Neuropathy Following A Tibial Fracture: A Case Report, Timothy Lira

Case Report Papers

Background & Purpose: Adult-onset hereditary proximal motor neuropathy (AHPMN) is a subcategory of spinal muscular atrophy, caused by survival motor neuron gene mutation. This rare disease, affecting approximately 1 in 10,000 people, presents as proximal weakness and muscle wasting, more commonly in the lower extremities, in addition to gait unsteadiness and difficulty standing. Additionally, the lifetime risk of developing CHF is one in five; Since the diagnosis poses a risk factor for falling, it may increase the likelihood of falls. Regarding seniors over the age of 65, fall-related injuries increased from 49.4% to 58.8% between 2005 and 2013, accounting for …

Core Strengthening And Lower Extremity Flexibility; A Model For Physical Therapy Treatment Of Acute Nonspecific Low Back Pain: Case Report, Todd Wilde

Case Report Papers

Background & Purpose: Effective physical therapy treatment strategies are needed in order to improve outcomes for patients with low back pain. Current trends indicate that treatment effect size could be enhanced by implementing patient-specific management strategies based on examination findings (1, 2). The purpose of this report is to describe the physical therapy management and functional recovery of an individual with work-related acute nonspecific low back pain based on a treatment approach consisting of core strengthening and lower extremity flexibility. Case Description: The patient is a 51 year-old male with a one-month history of low back pain without radiculopathy secondary …

Clinical Reasoning And Intervention Selection For A Patient With Lower Extremity Weakness Following Acute Alcoholic Polyneuropathy: A Case Report, Sarah Uzel

Case Report Papers

Background and Purpose: Acute alcoholic polyneuropathy (AAP) can present with a variety of symptoms including paresthesia and paralysis. There is little literature relating to physical therapy management and interventions for a patient with AAP. It is unclear what constitutes the best medical management and physical therapy practices for these patients. The purpose of this case report was to describe the clinical reasoning behind interventions selected for a patient with AAP in the acute setting. Case Description: The patient was a 33 year old male, who was diagnosed with AAP after two days in acute care. Intervention during the first two …

Application Of A Short-Term Aquatic Physical Therapy Program For A Patient With Chronic Low Back Pain And Radiculopathy: A Case Report, Marc Asta

Case Report Papers

Background and Purpose: Within the confines of approved Physical Therapy (PT) visits from independent and national insurance companies, PTs are often challenged to improve a patient’s impairments and Quality Of Life (QOL) in a limited number of approved visits. The purpose of this case report is to document if six PT visits with aquatic intervention for a patient with chronic low back pain (CLBP) and radiculopathy improves a patient’s subjective and objective impairments in relation to his QOL. Case Description: The patient was a sixty-two year old male who presented to PT with CLBP for the previous forty years secondary …

Vestibular Rehabilitation For A 17-Year Old Female With Post-Concussion Symptoms: A Case Report, Elizabeth Mosley

Case Report Papers

Background: Post-concussion syndrome is defined as a group of symptoms occurring after a traumatic brain injury (TBI) that can persist for durations ranging from weeks to years. The Centers for Disease Control and Prevention estimates that 1.7 million Americans experience TBI annually. Vestibular rehabilitation has been shown to help alleviate common symptoms after concussions, such as dizziness, headaches and impaired balance. The purpose of this case report is to describe the physical therapy management of a patient with post-concussion symptoms two months post-injury. Case Description: The patient is a 17-year-old female with a history of concussion following a syncopal episode …

Functional Training To Reduce Fall Risk In A Patient Following Cancer Treatment: A Case Report, Kristin O'Kelly

Case Report Papers

Background and purpose: The National Cancer Institute reports that approximately 39.6% of individuals will be diagnosed with cancer during their lifetime. Due to the large percentage of Americans affected each year, multiple studies have looked at the long-term effects of cancer treatment and survivorship on physical function. Studies have demonstrated that over half of cancer survivors age 55 and over have fallen in the past year, possibly as a result of treatment and subsequent muscle weakness, difficulty with balance, and impaired walking. The purpose of this case report was to detail interventions aimed at these modifiable factors in a patient …

Gait Training, Strength Training, And Pain Management Of A 26 Year Old Female Recovering From A Multiple Sclerosis Exacerbation: A Case Report, Ellen Cox

Case Report Papers

Background and Purpose: Multiple Sclerosis can be a debilitating disease that affects millions of people. Exacerbations range from mild to very severe. Due to the inconsistent nature of multiple sclerosis, the most effective treatments are still unclear. The purpose of this case report was to document the findings of an individual, who suffered a severe multiple sclerosis exacerbation after a series of stressful life events. Case Description: This case report presents a 26 year old female with a known history of multiple sclerosis. This patient suffered an exacerbation and her level of function went from living independently to unable to …

The Effects Of Specific Training On Balance And Ambulation In A Patient With Stage Iv Glioblastoma: A Case Report, Matt Denning

Case Report Papers

Background and Purpose: A Diagnosis of stage IV Glioblastoma and its treatment often results in many impairments and functional limitations. This case report describes the effectiveness of strengthening, balance, and gait training activities measured by Berg Balance Scale (BBS) and ambulation distances on an individual 62 year old diagnosed with stage IV glioblastoma. The aim of this case study was to implement strengthening, balance, and gait training to improve balance and reduce risk of falls in a patient who had a diagnosis of stage IV glioblastoma, a metastatic brain tumor resulting in progressive neurological impairments. Case Description: A 62 year …