Systems Model Guided Balance Rehabilitation in an Individual with Declarative Memory Deficits and a Total Knee Arthroplasty

Abstract

The clinical management of functional mobility problems of individuals with primary musculoskeletal impairments is complicated by the concurrent presence of neurologic diagnoses. There are few case descriptions present in the literature of clinical decision making in the context of combined musculoskeletal and neurologic impairments. The purpose of this case report is to describe the application and use of a systems model of motor control for defining the appropriate rehabilitation program for an individual with both orthopedic and neurologic impairments leading to complaints of frequent losses of balance and falls during community mobility. RG was a 67-year-old male referred to physical therapy because of balance problems. Review of his previous medical history revealed that he had suffered an anoxic brain injury 5 years earlier but had recovered full independence in activities of daily living (ADLs) with shortterm memory deficits being the primary residual effect of the brain injury. His balance problems developed only after having undergone a unilateral total knee arthroplasty 4 months prior to his initial physical therapy examination. Through examination and evaluation, RG's problems were determined to be consistent with postsurgery induced deconditioning coupled with anoxic brain injury related motor and cognitive deficits. Physical therapy intervention focused on increasing RG's strength, decreasing the range of motion limitations in his lower extremities, balance exercises specific to his dynamic balance deficits, as well as increased amounts of practice to maximize procedural learning. Upon completion of his initial episode of care, RG's musculoskeletal impairments had improved; his scores on balance tests had increased, and his frequency of falls had decreased. Following his discharge, RG continued with a physical therapist designed secondary prevention program. This case report describes the successful rehabilitation of an individual with concurrent orthopedic and neurologic diagnoses. Important components of this rehabilitation course include: (1) the application of a systems model of motor control to guide clinical interventions, (2) the consideration of the effects of memory deficits on rehabilitation outcomes, and (3) the utilization of a secondary prevention program to prevent reoccurrence of balance problems.