scholarly journals Gait Re-education Based on the Bobath Concept in Two Patients With Hemiplegia Following Stroke

2001 ◽  
Vol 81 (3) ◽  
pp. 924-935 ◽  
Author(s):  
Sheila Lennon
Keyword(s):  
Physical Therapy ◽  
Cerebrovascular Accident ◽  
Clinical Decision Making ◽  
Sagittal Plane ◽  
Movement Patterns ◽  
Clinical Decision ◽  
Normal Movement ◽  
3 Dimensional ◽  
Therapy Sessions ◽  
Hip Extension

Abstract 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.

Abstract TP87: Comparative Analysis of 3-Dimensional Rotation Angiography versus 3-Dimensional Computed Tomography Angiography for Intracranial Aneurysm Treatment Detection and Planning

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jonathan Park ◽  
Noriko Salamon ◽  
Gary Duckwiler ◽  
Fernando Vinuela ◽  
James Sayer ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Neck Size ◽  
3 Dimensional ◽  
Imaging Tool ◽  
Final Treatment ◽  
Agreement Coefficient ◽  
Majority Consensus ◽  
Management Recommendations

Introduction: 3D Rotational Angiography (3DRA) is the gold standard for intracranial aneurysm (IA) detection, but is invasive and time consuming. While 3DCTA has shown to be sensitive for IA detection, no published studies have compared 3DRA to 3DCTA in guiding clinical management. Our aim was to compare suggested treatment for IA based on 3DRA and 3DCTA vs actual final treatment and outcome. Hypothesis: Management recommendations based on blinded review of 3DRA and 3DCTA for IA do not differ significantly. Methods: Prospective blinded review of contemporaneous 3DRA and 3DCTA was performed for patients with suspected IA. Two interventionalists and two neuroradiologists performed blinded, prospective review of 3DRA or 3DCTA, respectively. IA size, location, and morphology were assessed. After IA characterization, each observer independently recommended optimal therapy (conservative, coil, surgery, combined/other) while blinded to other reviewers’ decisions. Findings were analyzed with Spearman, and agreement coefficient 1 (AC1) inter-rater reliability statistics. Results: 41/52 enrolled patients had IA confirmed by 3DRA (52 IA total). 50/52 (96%) IA were initially identified by 3DCTA (both false negatives seen retrospectively). Average IA sac and neck size measured by 3DRA and 3DCTA correlated closely (p<0.01) and were 9.8 and 5.0 mm vs 9.5 and 4.5 mm, respectively. Treatment recommendations by reviewers for 3DRA vs 3DCTA correlated very strongly (AC1= 0.77), as did reader recommendations within a modality (3DRA, AC1=0.66; 3DCTA, AC1=0.79). For 39/52 (75%) of IA, majority consensus for all readers was reached (3/4 or 4/4 reviewers), which correlated well with final executed treatments (95%). Conclusions: Recommendations for IA treatment based on 3DCTA correlate closely with those based on 3DRA, as well as with actual treatment in a majority of patients. 3DCTA holds promise as a primary imaging tool for IA detection and clinical decision making.

Effect of Hamstring-to-quadriceps Ratio on Knee Forces in Females During Landing

2020 ◽  
Author(s):  
Becky L. Heinert ◽  
Tia Collins ◽  
Carly Tehan ◽  
Robert Ragan ◽  
Thomas W Kernozek
Keyword(s):  
Tibial Plateau ◽  
Clinical Decision Making ◽  
Sagittal Plane ◽  
Return To Sport ◽  
Clinical Decision ◽  
Vertical Force ◽  
Acl Injuries ◽  
Isokinetic Testing ◽  
Drop Landing ◽  
Lower Ratio

AbstractACL injuries in the athletic population are a common occurrence with over 70% associated with non-contact mechanisms. The hamstring to quadriceps ratio is a widely used clinical measure to assess an athlete’s readiness to return to sport; however, its relationship to knee forces and ACL tension during landing is unknown. Baseline isokinetic testing was completed on 100 college-aged females. Subjects with strength ratios 0.4 (n=20) and those with ratios of 0.6 (n=20) returned for an assessment of their drop landing. A sagittal plane knee model determined the low ratio group demonstrated 16.6% larger ligament shear (p=0.000), a 26% increase in tibiofemoral shear force (p=0.026) and a 6% increase vertical force between the femur and tibial plateau (p=0.026) compared to the high hamstring ratio group within 100 ms upon impact. The lower ratio group also demonstrated 9.5% greater maximal quadriceps (p=0.028) force during landing. These findings suggest that the hamstring to quadriceps ratio may be related to knee forces and ACL loading during landing. This metric may augment clinical decision making regarding an athlete’s readiness to return to sport or relative risk for re-injury.

Impact of electrodiagnostic (EMG/NCS) tests on clinical decision-making and patient perceived benefit in the outpatient physical therapy practice

2020 ◽  
Vol 24 (1) ◽  
pp. 170-174
Author(s):  
Mohini Rawat ◽  
Dimitrios Kostopoulos ◽  
Konstantine Rizopoulos ◽  
William Dodson ◽  
Kathy Blair ◽  
...  
Keyword(s):  
Decision Making ◽  
Physical Therapy ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Perceived Benefit

scholarly journals Similarity of Joint Kinematics and Muscle Demands Between Elliptical Training and Walking: Implications for Practice

2010 ◽  
Vol 90 (2) ◽  
pp. 289-305 ◽  
Author(s):  
Judith M. Burnfield ◽  
Yu Shu ◽  
Thad Buster ◽  
Adam Taylor
Keyword(s):  
Decision Making ◽  
Muscle Activation ◽  
Clinical Decision Making ◽  
Sagittal Plane ◽  
Clinical Decision ◽  
Joint Kinematics ◽  
Vastus Lateralis Muscle ◽  
Evidence Based ◽  
Walking Ability ◽  
Repeated Measures Design

Background People with physical disabilities often face barriers to regaining walking ability and fitness after discharge from rehabilitation. Physical therapists are uniquely positioned to teach clients the knowledge and skills needed to exercise on functionally relevant equipment available in the community, such as elliptical trainers. However, therapeutic use is hindered by a lack of empirical information. Objective The purpose of this study was to examine joint kinematics and muscle activation recorded during walking and elliptical training to provide evidence-based data to guide clinical decision making. Design This was a prospective, controlled laboratory study using a repeated-measures design. Methods Twenty adults free from impairments that might hinder gait participated. After familiarization procedures, subjects walked and trained on 4 elliptical devices while kinematic, electromyographic (EMG), and stride characteristic data were recorded. Results Movement similarities between elliptical training and walking were supported by the documentation of relatively high coefficients of multiple correlation for the hip (.85–.89), thigh (.92–.94), knee (.87–.89) and, to a lesser extent, the ankle (.57–.71). Significantly greater flexion was documented at the trunk, pelvis, hip, and knee during elliptical training than during walking. One of the elliptical trainers most closely simulated sagittal-plane walking kinematics, as determined from an assessment of key variables. During elliptical training, gluteus maximus and vastus lateralis muscle activation were increased; medial hamstring, gastrocnemius, soleus, and tibialis anterior muscle activation were decreased; and gluteus medius and lateral hamstring muscle activation were relatively unchanged compared with muscle activation of those muscles in walking. On the basis of EMG findings, no elliptical trainer clearly emerged as the best for simulating gait. Limitations To date, only 4 elliptical trainers have been studied, and the contributions of the upper extremities to movement have not been quantified. Conclusions Although one of the elliptical trainers best simulated sagittal-plane walking kinematics, EMG analysis failed to identify one clearly superior device. This research provides evidence-based data to help guide clinical decision making related to the use of elliptical trainers across the health care continuum and into the community.

scholarly journals "Finis Origine Pendet” – Enhancing Later Learning and Professional Socialization Through an Introductory DPT Course

2005 ◽  
Author(s):  
Kyle Meyer ◽  
Patricia Hageman ◽  
Robert Fuchs ◽  
Amy Tyler ◽  
Gregory Karst
Keyword(s):  
Physical Therapy ◽  
Qualitative Data ◽  
Clinical Decision Making ◽  
Professional Socialization ◽  
Clinical Decision ◽  
First Year ◽  
Socialization Process ◽  
Patient Centered ◽  
First Year Students ◽  
Early Introduction

Background and Purpose: In developing a new Doctor of Physical Therapy (DPT) curriculum, the faculty at a mid-west academic health sciences center decided to introduce course content historically placed near the end of the program’s Master of Physical Therapy curriculum at the beginning of the DPT curriculum. The new DPT curriculum was constructed to promote the value of three central themes; 1) evidence-based practice and 2) patient-centered care, both of which contribute to 3) sound clinical decision making. Faculty theorized that by explicitly expressing these themes in a first semester, introductory course, students would acquire a much needed framework for categorizing and integrating future knowledge, and would begin the professional socialization process earlier in the curriculum. The purpose of this report is to describe the new course and provide quantitative and qualitative data regarding the course outcomes.Methods: Quantitative data were gathered via a survey administered to 75 students, 37 who had completed all three years of the program and 38 who had completed the second year of the program. In addition, qualitative data were gathered from first year student essays summarizing the course and describing its influence on their perceptions of the field. Results: More than 80% of second and third year students agreed or strongly agreed that the course had met all of the primary objectives outlined by the faculty. Essays from first year students also supported many of the purposes envisioned in the development of the course. Conclusion: These outcomes suggest students can value and comprehend more advanced content early in allied health curricula and that the early introduction of such content may aid in organizing subsequent learning and professional socialization.

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