Early Physiotherapy Intervention Research Articles

FUNCTIONAL OUTCOMES OF LVAD PATIENTS REQUIRING PROLONGED MECHANICAL VENTILATION

Purpose:Patients who require mechanical circulatory support are often severely deconditioned. They may require extended ventilatory support after device implantation. During this time, full body rehabilitation improves the outlook for successful transplantation. The purpose of this study is to illustrate that a physical therapy (PT) program with focus on early mobilization and ambulation can improve functional mobility in LVAD patients requiring prolonged mechanical ventilation. Methods This study describes the PT intervention used in two LVAD pa=. The devices used were Micromed Debakey LVAD and Thoratec LVAD. Special emphasis was placed on early mobilization and ambulation. The use of appropriate ventilatory support and a portable ventilator was imperative so patients could tolerate increased levels of exertion. Results:Both patiens showed significant functional gains during the period of prolonged mechanical ventilation and bed rest. The patient on the Thorated LVAD stayed in ICU for 71 days and was able to ambulate up to 360 feet when transferred out of ICU. He is currently waiting for a transplant. The patient on the Micromed DeBakey LVAD stayed in ICU for 49 days and was able to ambulate up to 600 feet. He subsequently had a heart transplant and was discharged home. Early PT intervention enhances functional outcomes by optimizing cardiopulmonay and neuromuscular status. Improving mobility of LVAD patients has the potential to reduce length of ICU stay by facilitating ventilator weaning as general strength and endurance improves.

The Effect of Early Physical Therapy Intervention Following Elbow Fracture in a Postmenopausal Female with Multiple Medical Problems

Achievement of optimal level of functioning of a patient or client must be one of the main goals of any physical therapy intervention. To achieve this, the physical therapist must look at the interaction of multiple body systems, evaluate and identify disabilities and impairments based on these interactions, and design treatment plans that treat the person as a whole. This evaluation may become complex as the clinician recognizes the significant contribution of associated medical conditions and risk factors in the individual's prognosis and expected outcomes. This case report illustrates the importance of these concepts in the optimal rehabilitation of an individual who sustained an elbow fracture with displacement, and has numerous preexisting medical conditions and risk factors that at the outset may appear to be significant complicating factors in her progress following therapy. Central to her achievement of favorable results included early medical and physical therapy intervention. Key components of the therapeutic intervention include AROM/ PROM to the joint, appropriate scar tissue mobilization and steady progress into functional activities. From the therapist's perspective, it was important to address the injury at hand as well as the various comorbidities affecting the main problem. From the standpoint of the subject, empowerment of the individual to her own health and well-being provided the necessary motivation to achieve optimal function.

Effect of Early One-off Physiotherapy Intervention on Patients Referred with Chronic Musculoskeletal Problems: Pragmatic randomised controlled study

Effect of Early One-off Physiotherapy Intervention on Patients Referred with Chronic Musculoskeletal Problems: Pragmatic randomised controlled study

Evaluation of Motor Function in Young Infants by Means of the Assessment of General Movements: A Review

Optimal management of children with developmental disorders, such as cerebral palsy (CP), requires detection at an early age. The purpose of this paper is to review the predictive value of various forms of traditional neonatal neurological examination and that of a new form of neuromotor assessment of young infants, based on the assessment of the quality of general movements (GMs). The technique of GM assessment is presented and the features of normal, mildly abnormal and definitely abnormal GMs discussed. Essential to GM assessment is the Gestalt evaluation of movement complexity and variation. The quality of GMs at two to four months postterm has been found to have the highest predictive value. The presence of definitely abnormal GMs at this age, ie, GMs devoid of complexity and variation, puts a child at very high risk for CP. This implies that definitely abnormal GMs at two to four months are an indication for early physical therapy intervention.

The effect of a child's disability on mother's mental health.

The prevalence of maternal depression was investigated in the mothers of 96 children: 30 premature infants at risk for the development of cerebral palsy; 35 premature infants considered not to be at risk for the development of cerebral palsy; and 31 healthy fullterm infants. There were equally high levels of depression in all three groups of mothers, regardless of birth status, prediction of disability, or presence of actual disability, throughout the first year of the children's lives. Depressed mothers were, however, found to have significantly more psychosocial stress. An early physiotherapy intervention had no effect on the prevalence of depression in mothers whose children were at risk for the development of cerebral palsy.

Six-Year Follow-up of Early Physiotherapy Intervention in Very Low Birth Weight Infants

Eighty very low birth weight infants assigned to neurologically normal or at-risk groups on the basis of a neurodevelopmental score were previously described. Infants were assigned to physiotherapy or control groups, and the effect of physiotherapy was assessed at 1 year. At-risk infants had a significantly lower developmental quotient than the normal group and no beneficial effect of physiotherapy was shown. Of the original 80 subjects, 49 were reassessed at a mean age of 74.7 months. As observed previously, physiotherapy until 1 year did not influence subsequent outcome in either normal or at-risk children. At-risk and normal children had similar mean developmental quotients at 6 years, but the locomotor score of at-risk children was significantly below that of normal children. Cerebral palsy occurred in 6 of 24 at-risk vs 0 of 25 normal subjects (P less than .01) and remedial therapy was recommended in 17 of 24 at-risk subjects vs 6 of 25 normal subjects (P less than .001). These results confirm that the neurodevelopmental score predicts a risk for either cerebral palsy or soft neurological problems, and early physiotherapy is of questionable benefit in preventing such problems.

Rehabilitation of the Mastectomy Patient: A Randomized, Blind, Prospective Study

After biopsy confirmation of breast carcinoma, women who were scheduled to undergo a modified radical mastectomy had demographic data collected, goniometric measurements of shoulder flexion and abduction, and functional evaluation of the ipsilateral shoulder performed, and upper extremity circumferential measurements at five levels determined. Patients were then randomly assigned either to a group that received immediate postoperative physical therapy or to one that did not. Results represent the combination of data from a pilot study and this subsequent study following appropriate statistical analysis. Sixty-four women in the treatment group showed a statistically significant increase in shoulder range of motion in both abduction and flexion as compared to 51 women who received no physical therapy. The treated group also had fewer problems with five of the six upper extremity functional tasks that were assessed. There were no significant differences between the groups for length of hospital stay, postoperative complications, or upper extremity edema. The authors conclude that early physical therapy intervention makes a significant contribution to return to normal function without increasing the incidence of postoperative complications or prolonging hospital stay.

Physical therapy and dance in the surgical management of breast cancer. A clinical report.

This report describes a creative therapeutic exercise program that is part of a preoperative and postoperative regimen prescribed for patients with breast cancer surgery. Since August 1982, physical therapy has been offered as part of a multidisciplinary breast cancer program at our acute-care hospital. Our physical therapy department provides preoperative and postoperative evaluations and treatment for patients with breast cancer surgery. This treatment is offered on an outpatient basis and includes group dance sessions that are supervised by a licensed physical therapist and a licensed dance teacher. Physical therapy for patients with breast cancer surgery need not be limited to traditional wall-climbing exercises. Early physical therapy intervention should be directed at the unique emotional and physical problems encountered by these patients. Through dance, patients may experience the freedom of total body movement that enhances their adjustment to a new body image. An organized group setting provides a support mechanism that enables patients to share their experiences, fosters a positive attitude toward exercise, and facilitates psychological adjustment to the diagnosis of breast cancer.

A review of therapeutic intervention research on gross and fine motor progress in young children with cerebral palsy.

Recently, perhaps due to increased societal demands for accountability, early intervention programming for handicapped infants and young children has been questioned. Therapeutic intervention provided through occupational and/or physical therapy has been increasingly implemented in habilitation settings for children diagnosed as having cerebral palsy, although research justifying this increase is inconclusive. This review presents a comprehensive evaluation of 18 studies that evaluated early occupational and/or physical therapy intervention for children with cerebral palsy. An analysis of these studies revealed that as research paradigms become more rigorous, support for therapeutic intervention effectiveness decreases. This finding was explained in light of the currently inadequate levels of technology relating to instrumentation and the manipulation of the many variables that have been suggested to affect therapeutic intervention effectiveness.

EARLY INTERVENTION FOR AT RISK PREMATURE NEONATES

In a prospective study of premature neonates of birthweight <1700gm, a) we validated a 12 point neurodevelopmental assessment score (NDAS) assigned at 3, 6, 9 and 12 months corrected age, against a Griffiths developmental quotient (DQ) at 12 months corrected age; b) we assessed the value of early physiotherapy intervention during the first year. According to the NDAS at 3 mths, infants were classified as normal (score 0-4), at risk (5-9) or probably impaired (10-12). Normal (N) and at risk (R) infants were randomised into intervention (+) and control (−) groups. All infants with scores of 10-12 were treated. N+ and R+ infants received physical therapy as outpatients and at home. A physical therapist assigned the NDAS at 3, 6, 9 and 12 mths; the Griffiths test was performed at 1 year by a psychologist blinded for infant group. Fifty one infants have been tested (28N, 23R). Infants classified as R according to the NDAS had a mean DQ of 95.9±9.9 at 1 yr vs 102.6±8.7 for N infants (p<.02). Intervention had no effect in N or R infants: N+ and N− had similar NDAS's of 2; 2; 1; 0 at 3, 6, 9 and 12 mths resp. Similarly R+ and R− had similar scores (6; 3; 2; 1 vs 6; 4; 2; 1 at 3, 6, 9, 12 mths). Our NDAS appears to predict poorer outcome as assessed by the Griffiths DQ at 1 year, while early intervention has no apparent effect on development over the same time period.