Cerebrovascular Accident/THA

One Patients Story to Treatment and Recovery

““The AlterG is a great way to maximize brain plasticity; my patients can’t say enough about how good (it) feels to run again. I love this machine!””

Nancy Byl, PhD, PT, Physical Therapy and Rehabilitation Science, UCSF

One Patients Cerebrovascular Accident/THA Treatment

Renee Wenger, MPT, CLT, MBA and Lisa Sibits, MPT

Introduction

Patient is a 65 year old male who presented to outpatient PT for this episode of care seven weeks s/p R THA (9/21/10). Additional PMH includes CVA (Cerebrovascular Accident) in 2003 with significant R sided hemiparesis, L THA ’09, osteosynthesis for B LE fractures s/p MVA ’71, hypertension, and hyperlipidemia. Patient has been seen in our outpatient PT/OT department for bilateral patellofemoral knee pain treatment in the past and has been very compliant with attending completing sessions with physical therapy exercises and performing his home exercise program. Patient received OT and PT services at a frequency of two times per week during the time of this case study. 

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Goals

Short term and long term goals were established at the time of the initial PT evaluation on 11/11/10. These goals focused on decreasing pain with functional activity; increasing R LE strength and dynamic balance in order to progress with functional mobility skills; increasing ambulation distance, speed and progressing towards ambulation without an assistive device; improving control and decreasing reliance on arm support with stairs negotiation, and improving overall endurance to allow patient to accomplish functional mobility in the community setting.

Functional outcome measures noted below were tracked pre-AlterG and 4 weeks post using the AlterG physical therapy equipment during OP PT:

  • Timed Up and Go
  • 6 Minute Walk
  • Lower Extremity Functional Scale
  • Patient-Specific Functional Scale

History / Progression

Patient has been seen in OP PT two times per week for the above goals. Patient has been WBAT on R LE since surgery with total hip precautions. Patient initiated OP PT at 7 weeks post-op and started ambulation on AlterG at 9 weeks post-op. Patient completed 9 sessions on AlterG within four weeks with the goals of increased gait speed, improved endurance/tolerance for ambulation, better gait mechanics on level surfaces, and progression to ambulation without an assistive device. See table below for details re: AlterG parameters utilized during OP PT sessions.

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Results

Cerebrovascular Accident CVA treatment showed substantial improvement in the majority of his outcome measures in nine sessions on the AlterG within the four weeks. All outcome measures were tracked with ambulation on level surfaces in order to ensure that changes noted on the AlterG translated to functional mobility changes over ground for the patient. The patient used the LBQC for all functional outcomes measures pre- and post-AlterG.

While on the AlterG over the nine sessions, the patient demonstrated an increase in his walking speed as well as an increase in the overall time spent ambulating on AlterG. He improved his gait speed as evidenced by an increase of 259 feet in the 6 Minute Walk test from 357 feet at baseline to 615 feet after nine sessions. He also decreased his time to complete the Timed Up and Go from 36 seconds at baseline to 26 seconds in this same time period. The patient also progressed in independence by the end of the nine sessions to ambulating without an assistive device for up to 100 feet.

The Lower Extremity Functional Scale was chosen as the outcome measure to detect functional change in his daily activity/mobility skills and his scores improved from 37/80 to 44/80 (eight points is the MCD).

The Patient-Specific Functional Scale allowed this patient to rate four activities that were important to him, but initially unable to be performed or the patient had difficulty performing as a result of his R THA. This 10 point scale is scored from 0 (unable to perform activity) to 10 (able to perform activity at the same level as before injury or problem). The patient chose 1) gait speed and rated this category 3/10 initially and 7/10 at the end of nine sessions; 2) gait quality which he rated as 3/10 initially and 6-7/10 at the end of the nine sessions; 3) sit to stand without arm support and rated this category 0/10 and 5/10 after nine sessions; 4) floor to stand which remained a 0/10 pre- and post- as patient continues to have total hip precautions which prevent this transfer at this time.

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