Cpm Exercise

The first 10-14 days after surgery is focusing on keeping the wound dry and clean, being able to straighten the knee, and being in control of the quadriceps. The knee is also iced often to keep swelling and pain down. During physical therapy the focus is on keeping the kneecap mobile, regaining full range of motion, getting strength back to the quads and hamstrings, and regaining balance. Mobility stretching can include; knee extension and flexion which is just bending and straightening the knee, hamstring stretching, that is extending the leg and reaching for toes, and groin stretches, extend both legs as far as you can and lean forward. Strengthening exercises are lunges, squats, leg presses, step ups, calf raises which is going on your toes, hamstring curls lay on your stomach and bend the knee, hip adduction use a resistive band and pull the leg across the body, for hip abduction just pull the leg across the body again against the resistance while keeping the knee

Thus obtaining on proposed rehabilitation program in accordance with the scientific foundations in order to achieve the desired benefit which represents in enhancing the functional efficiency of athletes after ACL surgery for return to their preinjury state and participate in their sports activities.

The interventions that I observed was the use of contrast bath for the Chronic Regional pain, E-stim, Ultrasound, hot packs for the pain management as well as to decrease the stiffness and swelling. The activity that I observed were ROM arc to increase movement in the bilateral upper extremities, sand box to increase core strength, Theraputty, peg boards, cognition pattern puzzles, visual perception puzzles, arm bike (rollator), bolts and screw for fine motor coordination, mini mental test to intact orientation as well as memory. I observed how therapist were teaching the patients to increase independence while transferring from bed to wheelchair to commode. I observed the use of adaptive devices to make the patient as functional as possible with their daily activities such as long handled shower brush, Reacher, sock aid, leg lifter, adaptive heavy weighted utensils and many

2. Demonstrate 3 different postural and walking exercise to help the patient with his walking and learning.

ROM, pain level and strength were all improved on re-evaluation. Short-term and long-term goals were achieved. Treatment plan was to educate HEP, E-stim-unattended, Joint/Soft tissue mobilization, manual therapy, MHP/CP, neuromuscular re-education, Therapeutic exercise and strengthening-increase ROM, and Ultrasound.

The athlete that I was able to facilitate preforming his rehabilitation assignment had a slight fracture in the distal end of his fibula causing a tear in his interosseous membrane, which is the membrane in between the tibia and fibula, and a syndesmosis sprain due to the dislocation of the ankle. The surgery consisted of the athlete having a plate in so the fibula could heal correctly and metal pins in near the distal end of the fibula to connect the tibia and fibula back together. The athlete was not able to put weight on injured leg at all from the time of the surgery until two weeks after the athlete gets their pins removed. At the start of the

Following the cast removal, the patient must undergo a rehabilitation program in order to return to normal movement and function. Heel lifts should be immediately placed in the patient's shoes. The reason why the lifts are placed in both shoes is to relive any pressure or tension in the injured foot and in the non-injured foot to keep the person balanced and not potentially hurt the other side (tendon, hip). Because immobilizing the foot in a cast may cause joint stiffness, muscle atrophy, and blood clots, many doctors recommend an early-motion approach. This approach puts the patient in physical therapy within just a few days after the surgery. Therapy may be needed for up to 4 or 5 months. Ice, massage, and whirlpool treatments may be used at first to control swelling and pain. Massage and ultrasound help heal and strengthen the tendon. Range of motion exercises should begin while in therapy. About 2 weeks after ROM exercises have been used is when the progressive resistance exercises are added. Some of these resistance exercises can be done in the pool. The buoyancy of the water helps people walk and exercise safely without putting too much pressure or tension on the healing tendon. If the patient chooses a splint may be worn while walking for 6 to 8 weeks after the surgery. Then 10 weeks after the surgery aggressive training exercises can

The patient will continue physical therapy 1 day per week for 8 weeks where he will receive moist heat, cold packs, electrical stimulation, massage therapy, ultrasound to the right shoulder by followed by gentle range of motion and strengthening exercises with the goals of reducing pain, improving strength, improving range of motion, improving overall function, and teaching home exercise program.

01/11/16 PT Evaluation Report documented that the patient is showing good progress towards goals, with a decrease in pain in the right lower leg, ankle and foot when ambulating. But the remaining impairments, including reduced strength, limited ROM and gait deviations cause poor ability to ambulate. Continue skilled PT is necessary in order to address the remaining deficits. Sort-term and long-term goals were discussed.

The main focus in the first stage of the rehabilitation problem will be to get 100% range of movement back into the athletes injured knee with no pain being suffered as he currently only has 70% range of movement and 2 months post-surgery the Fowler Kennedy Sport Medicine Clinic suggest that he should have full range of movement (ROM) in his knee (Werstin, 2009). It will hope to achieve this by introducing closed kinetic chain exercises (CKC) which are exercises that use a resistance such as squats and bicycling (Heijne et al, 2004) but also must remember that it is just as vital to maintain the highest level of strength and function possible in the unaffected knee as well, this is important as during the program we will use the unaffected leg as a comparison to assess the progress of the affected knee (Hiemstra et al, 2000). These have been chosen as according to Fleming et al 2003, CKC

The overall objectives that were taken under consideration included nearly all aspects in regards to functionality of the knee (14). Many studies have placed patients recovering from ACL reconstruction on rehab regimens with the hope to improve various aspects concerned with how well and at what levels the knee can function. Treatment programs, accelerated or non-accelerated commonly encompass similar exercises and physical activity such as stretching, strength training, and activation of muscles through electrical stimulation. The intensity and general progression of therapy is where the two significantly contrast. With the use of weight bearing exercises, or strength training within the accelerated regimen, it has been proven to limit muscle weakness as a consequence of immobilization after surgery. Shelbourne carried out this method of intervention every week, 2-3 times per week, while progressively increasing weight and the degrees to which the knee was stretched. The results were assessed using The Cybex Isokinetic Device, a

Patient completed PROM exercises and stretch to increase functional ROM of the L UE. Exercises include:

The CPG recommends that outcome measures such as Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ), or the Foot and Ankle Ability Measure (FAAM) be used before and after interventions. There are no mentions in the case report that the aforementioned outcome measures were used. Measuring and keeping track of progresses is essential as it has been validated in the clinic3. Furthermore, it was not reported that the therapist tried any manual therapy interventions. As noted, joint manipulation to the talocrural joint and soft tissue

Exercises completed during sessions could include stretching on a padded mat to increase swiftness and ability to lift up and out of bed or sitting position, or the pulling apart of elastic bands to increase upper body duration. Other tools such as weights are used in different positions to increase strength and ability with everyday movements such as standing or lifting. However, in an outpatient clinic, patients are homebound and would potentially be capable of participating in a higher form of activity. “It often includes a variety of exercise equipment and machines to improve strength and balance” (The Difference Between Physical, Speech and Occupational Therapy). Machines that are seen in a normal gyms such as a treadmill or stationary bike would be tools used for increased resistance and range of motion on a patient. Lastly, within a home setting, Physical Therapy will be based from the reason their medical status would keep them homebound. The job of the PT would be to improve quality of life and accessibility at home. An example of what the home patient would do could include: walking up and down stairs, strength exercises from the side of the bed or counter, and getting into and out of a vehicle. Overall, however, Physical Therapy’s purpose is to reduce pain, increase movement and agility, and strengthen a weakened area from injury or surgery.

Patient must not bend and squat. No crossing of legs and try not to sit for same position for over 40minutes. Any activity that may over flexed the hips must be avoided.