Date of Award

5-2020

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Steven Halcrow

Keywords

Tibia shaft fracture, tibia intramedullaiy nailing, N01mal pressure hydrocephalus, Lower Extremity Functional Scale (LEFS)

Abstract

Background and Purpose: Falls are a major health care concern for the older adult. Injmies related to falls in the geriatric population are not uncommon. Furthermore, individuals with brain disorders are going to be even more susceptible to falls. The purpose of this study was to examine the outpatient physical therapy (PT) rehabilitation of a patient who fell and sustained a right tibial fracture with a past medical history of a brain disorder.

Case Description: This case report describes the outpatient PT management of a patient who presented with a right tibia shaft fracture, post-operative right tibia intramedullary nailing and secondary complications of nonnal pressure hydrocephalus (NPH). Treatment diagnosis included decreased range of motion/mobility, balance/stability, functional movement patterns, performance and tolerance of activities of daily living, and ability to self-manage condition. Patient also had fall risk/safety concerns.

Interventions: The plan of care for this patient consisted of a mix of interventions that were progressed throughout the course of treatment. Interventions included gait training, therapeutic exercise for functional strengthening, endurance, stair training, patient and family education, neuro reeducation, and balance.

Outcomes: Patient was seen for 10 weeks for a total of 17 PT sessions. Patient met all of his goals and increased his lower extremity functional scale (LEFS) score by 23 points from initial evaluation to discharge. At discharge, the patient was at prior level of function but had remaining deficits in balance and gait due to his history of NPH.

Discussion: The patient could have benefitted from continued PT services to continue to improve his balance and gait, but was limited in physical therapy sessions due to the Medicare therapy cap. The patient made clinically significant gains in the LEPS, met all of his goals, and was at his prior level of function. However, the LEFS was used as the sole functional assessment of this patient. The LEFS does not assess quality of life or predict risk of falls. Since this patient was at a high risk for falls, this case report could have benefitted from an assessment to measure balance and risk of falls.

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