Advances In Rehabilitation Research Articles

The effect of rehabilitation and return to activity on anterior-posterior knee displacements after anterior cruciate ligament reconstruction.

Anterior-posterior knee displacements were measured sequentially with the KT-1000 arthrometer on 84 patients after anterior cruciate ligament reconstruction for chronic deficiency. We determined the correlations between the initial onset of abnormal displacements (greater than 2.5 mm between limbs) and time from surgery or the phase of rehabilitation. Group 1 (N = 52) had a bone-patellar tendon-bone allograft and Group 2 (N = 32), an iliotibial band extraarticular procedure in addition to the allograft. The mean followup was 37 months (range, 23 to 65). At followup in Group 1, 24 patients (46%) had less than 3 mm of displacement between limbs, 22 (42%) had 3 to 5.5 mm, and 6 (12%) had greater than 5.5 mm. In Group 2, 23 patients (72%) had less than 3 mm of displacement, 8 (25%) had 3 to 5.5 mm, and 1 (3%) had greater than 5.5 mm. The difference between the groups was significant (P < 0.05). The advanced rehabilitation program of immediate knee motion and early weightbearing, did not result in an increased incidence of abnormal displacements in the early phases. The abnormal displacements typically occurred during the latter two rehabilitation phases (intensive strength training or return to sports). Further, one-third of the abnormal displacement occurred more than 2 years postoperatively.

Critical care elements in a rehabilitation nursing course.

This article describes a specialized rehabilitation education program, based on adult learning theory, that was developed to promote retention of rehabilitation nurses at MetroHealth Center for Rehabilitation in Cleveland. The curriculum encompasses the skills required to care for rehabilitation patients needing both advanced rehabilitation nursing and critical care nursing. Critical care and rehabilitation nurses collaborated in the presentation of topics and were guided by the course coordinators. Learners were chosen based on experience in rehabilitation, with priority given to those certified in rehabilitation nursing. A variety of evaluation methods elicited positive responses. A 6-month postcourse survey also was completed to assess the long-term effects of the course.

Theory-based advanced rehabilitation nursing

Theory-based advanced rehabilitation nursing

Knee Rehabilitation after Anterior Cruciate Ligament Reconstruction and Repair

Reprinted with permission from The American Journal of Sports Medicine 9:3 140-147, 1981. Presented at the Interim Conference of the American Orthopaedic Society for Sports Medicine, February 8, 1980, Atlanta, GA.Address correspondence to: Lonnie Paulos, MD, 2350 Auburn Ave., Cincinnati, OH 45219.The purpose of this paper is to present the specifics and rationale of our postoperative rehabilitation program after anterior cruciate ligament (ACL) reconstruction and compare it with an international survey of 50 knee experts. It is important to stress that what we present is opinion. This opinion, however, is based on principles, guidelines, and specifics which we believe are important.The early phases of our program are based upon time and control of forces, both of which are necessary for ligament healing. The classic parameters of return to play do not indicate healing of ligament tissue and must not be substituted for time restraints.After ACL repair and reconstruction, there are five phases of rehabilitation: maximum protection (12 weeks), moderate protection (24 weeks), minimum protection (48 weeks), return to activity (60 weeks), and activity and maintenance.The maximum protection phase consists of the early healing period and controlled motion period. The early healing period is governed by a principle which requires the absolute control of forces to prevent disruption of the suture line or attachment site. This time will vary according to the surgical technique. We do not allow motion during this period. During the controlled motion period, we allow motion but control external forces to protect ligament healing.The moderate protection phase consists of the crutch-weaning and walking periods. The major goal of the moderate protection phase is to prepare the patient for walking. The principles which govern Phase 2 are that walking activities create large anterior cruciate ligament forces and healing strength is still low. A balance of quadriceps and hamstring forces is necessary for proper knee kinematics. De-emphasis of quadriceps exercises and emphasis of hamstring muscles is appropriate; however, both muscle groups must be strengthened. The crutch-weaning period is designed to allow the gradual increase of motion and strength to sustain walking activities.A paradox of exercise exists for strength building. To push weight from 30 degrees of flexion into full extension will protect the patellofemoral joint but will create large forces on the ACL. Our compromise is to push low weight through a full range of motion. We begin full weightbearing no sooner than the 16th week.The final three phases of our program are designed to develop dynamic stability through strength, coordination, and endurance. Phase 3, the maximum protection phase, consists of the protected activity period from the 24th through the 36th week, and the light activity period from the 37th through the 48th week. Restrictions include no running, no jumping, and the use of a brace full-time. The light activity period allows further time to protect the slow healer. This may be shortened or lengthened, depending upon the patient's condition and goals.Phase 4, the return to activity phase, begins nine to 12 months after surgery. It consists of the advanced rehabilitation period and the running period. The advanced rehabilitation period is designed to achieve maximum strength and further enhance neuromuscular coordination and endurance. The running period begins when the operated leg has at least 75 percent of the strength and power of the normal leg.The activity and maintenance phase consists of the return to sport and maintenance periods. On return to sport, the patient must gradually resume full activity by advancing from skill drills. The maintenance program consists of triweekly strength-building sessions, brace protection during sporting, and avoidance of high-risk activities. J Orthop Sports Phys Ther 1991; 13(2):60-70.

Biomechanical Ankle Platform System

THE Biomechanical Ankle Platform System or BAPS is a sophisticated wobble board which has been developed in America and is now being introduced to Great Britain. It consists of an assymetrically-shaped heavy-duty plastic board, which is reversible for each foot. The intention of the assymetrical shape is to allow full physiological movement about the ankle axis. A hemispherical fulcrum is screwed into the centre of the axis to form the basic wobble board. Use of the board can be made progressively more difficult by first changing the size of the fulcrum, then by adding weight plates on to rods which are inserted into strategically placed threaded sockets. The sites of these weight rods determine which groups of muscles in the lower limb are to be re-educated or strengthened. The whole system has a ‘high-tech‘ appearance having an integral carrying handle and a separate wall rack to store the hemispherical attachments. Having tried the system for three months on patients with various orthopaedic problems at the Royal National Orthopaedic Hospital a t Stanmore, it did not appear to be significantly more helpful than the conventional wooden wobble board that most physiotherapy departments possess. The main criticism is that the board is designed for weight bearing on only one limb, and does not allow adequate space for the other foot, especially when the weight rods are placed medially. Another small problem is that the raised foot shape on which the patient stands is ridged, and has to be frequently scrubbed because skin flakes collkct in it. The cost of this board is approximately €250 and, as such, may not be felt to be a priority for an NHS department with a limited budget. However, advanced rehabilitation centres, private practices and sports injury clinics may find it a useful addition to their treatment modalities/programmes.

Evaluation of an advanced back pain rehabilitation program.

The "Back-Pain Institute" at Sundsvall offers an advanced rehabilitation program to people with long-standing back pain. This program has been evaluated in a controlled prospective study. Data were gathered from questionnaires mailed on three occasions, from the sick insurance office and from the bureau of employment. The effects of the Institute's course on the vocational situation were small. The only significant difference between the experimental group and the control group was in the level of income. Significantly more persons in the experimental group had begun to train their back and significantly more individuals in the experimental group believed that by using the correct working technique they could prevent back pain. No significant changes were found with regard to the subjective feeling of pain.

Knee rehabilitation after anterior cruciate ligament reconstruction and repair.

The purpose of this paper is to present the specifics and rationale of our postoperative rehabilitation pro gram after anterior cruciate ligament (ACL) recon struction and compare it with an international survey of 50 knee experts. It is important to stress that what we present is opinion. This opinion, however, is based on principles, guidelines, and specifics which we be lieve are important. The early phases of our program are based upon time and control of forces, both of which are neces sary for ligament healing. The classic parameters of return to play do not indicate healing of ligament tissue and must not be substituted for time restraints. After ACL repair and reconstruction, there are five phases of rehabilitation: maximum protection (12 weeks), moderate protection (24 weeks), minimum protection (48 weeks), return to activity (60 weeks), and activity and maintenance. The maximum protection phase consists of the early healing period and controlled motion period. The early healing period is governed by a principle which re quires the absolute control of forces to prevent dis ruption of the suture line or attachment site. This time will vary according to the surgical technique. We do not allow motion during this period. During the con trolled motion period, we allow motion but control external forces to protect ligament healing. The moderate protection phase consists of the crutch-weaning and walking periods. The major goal of the moderate protection phase is to prepare the patient for walking. The principles which govern Phase 2 are that walking activities create large anterior cru ciate ligament forces and healing strength is still low. A balance of quadriceps and hamstring forces is nec essary for proper knee kinematics. De-emphasis of quadriceps exercises and emphasis of hamstring mus cles is appropriate; however, both muscle groups must be strengthened. The crutch-weaning period is designed to allow the gradual increase of motion and strength to sustain walking activities. A paradox of exercise exists for strength building. To push weight from 30° of flexion into full extension will protect the patellofemoral joint but will create large forces on the ACL. Our compromise is to push low weight through a full range of motion. We begin full weightbearing no sooner than the 16th week. The final three phases of our program are designed to develop dynamic stability through strength, coor dination, and endurance. Phase 3, the maximum pro tection phase, consists of the protected activity period from the 24th through the 36th week, and the light activity period from the 37th through the 48th week. Restrictions include no running, no jumping, and the use of a brace full-time. The light activity period allows further time to protect the slow healer. This may be shortened or lengthened, depending upon the pa tient's condition and goals. Phase 4, the return to activity phase, begins 9 to 12 months after surgery. It consists of the advanced rehabilitation period and the running period. The ad vanced rehabilitation period is designed to achieve maximum strength and further enhance neuromuscu lar coordination and endurance. The running period begins when the operated leg has at least 75% of the strength and power of the normal leg. The activity and maintenance phase consists of the return to sport and maintenance periods. On return to sport, the patient must gradually resume full activity by advancing from skill drills. The maintenance pro gram consists of triweekly strength-building sessions, brace protection during sporting, and avoidance of high-risk activities.