Passive Range Of Motion Exercises Research Articles

Heterotopic Ossification Revisited

Heterotopic ossification is the abnormal formation of mature lamellar bone within extraskeletal soft tissues where bone does not exist. Heterotopic ossification has been classified into posttraumatic, nontraumatic or neurogenic, and myositis ossificans progressiva or fibrodysplasia ossificans progressive. The pathophysiology is unknown. Anatomically, heterotopic ossification occurs outside the joint capsule without disrupting it. The new bone can be contiguous with the skeleton but generally does not involve the periosteum. Three-phase technetium-99m (99mTc) methylene diphosphonate bone scan is the most sensitive imaging modality for early detection and assessing the maturity of heterotopic ossification. Nonsurgical treatment with indomethacin and radiation therapy is appropriate for prophylaxis or early treatment of heterotopic ossification. Although bisphosphonates are effective prophylaxis if initiated shortly after the trauma, mineralization of the bone matrix resumes after drug discontinuation. During the acute inflammatory stage, the patient should rest the involved joint in a functional position; once acute inflammatory signs subside, passive range of motion exercises and continued mobilization are indicated. Surgical indications for excision of heterotopic ossification include improvement of function, standing posture, sitting or ambulation, independent dressing, feeding and hygiene, and repeated pressure sores from underlying bone mass. The optimal timing of surgery has been suggested to be a delay of 12 to 18 months until radiographic evidence of heterotopic ossification maturation and maximal recovery after neurological injury. The ideal candidate for surgical treatment before 18 months should have no joint pain or swelling, a normal alkaline phosphatase level, and 3-phase bone scan indicating mature heterotopic ossification.

Percutaneous, Intramedullary Fracture Reduction and Extension Block Pinning for Dorsal Proximal Interphalangeal Fracture–Dislocations

A percutaneous, intramedullary fracture reduction technique for treatment of unstable dorsal fracture-dislocation of the proximal interphalangeal (PIP) joint is described and the clinical and radiological results are reported. We conducted a retrospective clinical follow-up of 16 patients with 18 dorsal fracture-dislocations of the PIP joint. After closed joint reduction, we used an extension block K-wire to maintain the joint reduction. Impacted volar articular fragments were reduced percutaneously under fluoroscopy control using a pre-bent K-wire inserted through the intramedullary canal of the middle phalanx. The patients initiated passive range of motion exercises immediately after surgery. After a mean of 3 weeks, we removed the extension block K-wire and allowed free mobilization. We examined 13 patients with 15 injured fingers at a mean 5-year follow-up (range, 1-8 y). Radiographic reduction of the joint dislocation was achieved and maintained. The mean articular step-off decreased from 2.1 mm (range, 1.6-3.1 mm) to 0.5 mm (range, 0.0-1.2 mm). At the final follow-up, active PIP motion averaged 83° (range, 65° to 97°) with a mean flexion contracture of 3° (range, 0° to 15°). The mean visual analog scale score for digit pain was 1/10. The mean Disabilities of the Shoulder, Arm, and Hand score of 4/100 indicated little functional impairment. Percutaneous, intramedullary reduction of the impacted volar articular fragments associated with unstable, dorsal fracture-dislocation of the PIP joint restores joint congruence and function. Therapeutic IV.

Die arthroskopische Ersatzplastik des anterolateralen Bündels des hinteren Kreuzbandes in Einzelbündeltechnik mit autologer Semitendinosus-/Grazilissehne

Restoration of the function of the posterior cruciate ligament (PCL). Chronic posterior instability with posterior tibial translation of >10 mm. Fixed posterior drawer, local infections at the knee joint, local soft-tissue damage, poor compliance of the patient. Surgery starts with arthroscopic examination of the knee joint and therapy of associated injuries (meniscus and cartilage injuries). Harvesting of the semitendinosus and gracilis tendons is performed via a 3 cm long skin incision 1 cm distally and medially of the tibial tuberosity. The tendons are folded to a four- or five-stranded graft with a minimum length of 10 cm. The femoral tunnel for the graft is drilled via a deep anterolateral portal under arthroscopic control. For drilling of the tibial tunnel, a posteromedial portal is needed. The tibial insertion of the PCL is debrided with a shaver and a specific raspatory. For tibial tunnel placement, a specific closed aimer is used and a Kirschner wire is placed in the center of the tibial insertion. This Kirschner wire is overdrilled using a cannulated drill with a diameter according to the graft size. After femoral fixation, the graft is tensioned in 90° flexion with 80 N. At the femoral and tibial side, a hybrid fixation is performed with a button (flipp tack) and a resorbable interference screw. If there are any signs of posterolateral instability, a posterolateral corner reconstruction is performed before tensioning and fixation of the PCL graft. For 6 weeks, the knee is immobilized in extension with a posterior tibial support (PTS) brace (Medi, Bayreuth, Germany). Passive range of motion exercises should be performed in prone position (first 2 weeks 0-0-30°, 3rd to 4th week 0-0-60°, 5th to 6th week 0-0-90°). After the first 6 weeks, a movable brace is needed at daytime. At nighttime, the patient has to wear the PTS brace. Between 2003 and 2006, a PCL reconstruction in singlebundle technique was performed in 58 patients. In 42 cases, a simultaneous reconstruction of the posterolateral corner was done. The Lysholm Score improved from 62.2 to 88.4 points, the Tegner Activity Score from 3.3 to 5.4 points.

테이핑요법과 수동적 관절범위운동이 노인의 견관절과 손의 민첩성에 미치는 영향

본 연구는 견관절 통증과 관절가동범위에 제한을 가지고 있는 65세 이상의 노인을 대상으로 하여 테이핑요법과 수동적 관절가동범위 운동이 견관절의 통증과 관절 가동력에 미치는 효과를 확인하기 위하여 실시하였다. 이 연구는 비동등성 전후 실험 연구이다. 2009년 9월에 B시의 복지관을 이용하는 65세 이상의 노인들 40명으로 견관절의통증과 관절가동범위, 손의 민첩성을 조사하였다. 수집된 자료는 SPSS Win 12.0을 이용하여 분석하였다. 결과, 테이핑군과 수동적 관절가동범위 운동군에서 노인의 견관절 통증은 감소하였다. 견관절 굴곡, 신전, 외전, 수평외전 범위와 손의 민첩성은 증가하였다. 노인의 견관절 통증의 감소정도와 손의 민첩성 정도는 테이핑군과 관절범위운동군 간에 차이가 나타나지 않았다. 테이핑군에서 관절범위운동군 보다 견관절 신전의 범위가 증가하는 정도가 더 큰 것으로 나타났다. 따라서, 테이핑요법과 수동적 관절범위운동은 노인의 견관절 통증을 감소시키고, 관절가동범위, 손의 민첩성에 효과가 있다고 할 수 있겠다. The purpose of this study was to investigate the effects of taping therapy and passive range of motion exercises for the elderly aged 65 above with shoulder pain and limited of range of motion. This study was a nonequivalent control group pretest-posttest design. Data were collected about shoulder pain, range of motion, hand dexterity from 40 of elderly(exp.:20, con.:20) in B city from August to September, 2009. Collected data were analyzed using SPSS Win 12.0. Shoulder pain was significantly decreased. Range of motion which was flexion, extension, abduction, horizontal abduction. and hand dexterity were significantly increased in the taping group and PROM group. Shoulder pain and hand dextrity was non significantly between taping group and PROM group. Range of motion which was extension more increased taping group than PROM group. It was proven that taping therapy and PROM was effective for shoulder pain, articular range of motion and hand dexterity.

Successful medical management of lumbar intervertebral disc prolapse in a ferret

Thoracolumbar disc herniation was diagnosed in a two-year-old ferret using a myelogram followed by a computed tomography scan. The ferret was paraplegic with no control over urination and defecation. Conservative treatment that included cage rest and passive range of motion exercises for three weeks followed by extensive physiotherapy and hydrotherapy resulted in full recovery two months after the onset of treatment. Although intervertebral disc disease has been reported previously in four ferrets, this is the first report in which a postmyelogram computed tomography was used to demonstrate the herniated disc, and physiotherapy was used as principal treatment modality.

Staff-Perceived Barriers and Facilitators

Staff-Perceived Barriers and Facilitators

Utilization of axillary brachial plexus block in the postoperative rehabilitation of intra-articular fractures of the distal humerus

An effective rehabilitation program is essential to prevent joint stiffness and regain range of motion after surgical treatment of intra-articular fractures of the distal humerus. We evaluated the effect of a physiotherapy program on functional results, that involved passive resistive stretching exercises performed under axillary brachial plexus block after radiographic observation of bone union of intra-articular fractures of the distal humerus treated with open reduction and internal fixation. The study included 21 patients (7 females, 14 males; mean age 34+/-5 years; range 21 to 57 years) who underwent open reduction and internal fixation for intra-articular fractures of the distal humerus. All the patients had closed fractures. Six patients had AO type C1, six patients had C2, and nine patients had C3 fractures. Surgical treatment consisted of a posterior incision, olecranon osteotomy, and fixation of the metaphyseal fragments using two reconstruction plates placed medially and laterally. Active range of motion exercises were started on the third postoperative day. To prevent early development of heterotopic ossification, passive range of motion exercises were avoided. Active stretching exercises were initiated three weeks after surgery. Upon radiographic observation of bone union, axillary brachial plexus block was performed. The physiotherapy program involved passive stretching exercises during nerve block, and active weight exercises after recovery from motor block. The catheter remained in the axillary region for three months, during which functional rehabilitation was continued 2-3 times a week on an outpatient basis. Functional results were evaluated according to the criteria of Jupiter et al. after a mean follow-up period of 31 months (range 24 to 46 months). All fractures united within a mean of 11.9 weeks (range 9 to 17 weeks) except for one type C3 fracture. Functional results were excellent in 10 patients (47.6%), good in eight patients (38.1%), moderate in two patients (9.5%), and poor in one patient (4.8%). Two patients with a moderate outcome had associated multiple fractures in the ipsilateral extremity. Distribution of the functional results according to the type of fractures were 4 excellent, 2 good in type C1; 4 excellent, 2 good in C2; and 2 excellent, 4 good, 2 moderate, and 1 poor in C3 fractures. The mean loss of elbow extension was 16 degrees. The mean elbow flexion, pronation, and supination were measured as 131 degrees, 90 degrees, and 75 degrees, respectively. None of the patients had nonunion at the olecranon osteotomy site, superficial or deep infection, or heterotopic ossification. Three patients developed transient ulnar nerve neuropraxia that resolved spontaneously during the follow-up period. There were no complications related to axillary catheterization. Following surgical treatment of intra-articular fractures of the distal humerus, a regular and pain-free physiotherapy program performed under axillary brachial plexus block on an outpatient basis increases patient compliance and enables early return to daily activities.

Nonoperative Treatment for Undisplaced Scaphoid Fracture

Purpose: We wanted to evaluate the results of nonoperative treatment for acute, undisplaced, stable scaphoid fracture. Materials and Methods: We retrospectively reviewed 24 cases of acute undisplaced scaphoid fracture that were treated at our department from May 1998 to January 2008. The immobilization method was a long or short arm cast. Flexion-extension exercise was permitted during the period of the short arm cast, but pronation-supination motion was prohibited. After the removal of the cast, active and passive range of motion exercise was started immediately. The result was assessed by the Maudsley scale. Results: The twenty four cases were undisplaced or minimally displaced fracture (10 cases of Herbert type A1, 3 cases of A2 and 11 cases of B2) according to the Mayo classification. The average duration of immobilization was 7.16 weeks. According to the Maudsley scale, 19 cases had an excellent result and 4 cases had a good result. One case had a complication of scapho-lunate dissociation. Conclusion: We recommend conservative treatment with cast immobilization as the first treatment of choice for acute undisplaced scaphoid fracture.

A Son's Devotion: Operating a One‐Man Intensive Care Home Facility

In June 2006, Elsa Weiser was a frail elderly Holocaust survivor suffering from congestive heart failure, severe osteoporosis, chronic obstructive pulmonary disease, and asthma. For several years her son, Manny Weiser, a trained emergency medical technician and Hasidic Orthodox Jew, had administered her medications and consulted with her physicians. After she collapsed at her granddaughter's wedding, Elsa was transported to New York's Mount Sinai Hospital. During her three-week recovery, Manny kept constant vigil at her bedside, rarely leaving the room. When Elsa was deemed stable, her physicians advised she transfer to a nursing home. Elsa said to her son, “If you are thinking of putting me in a nursing home, drive me to the cemetery right now and leave me there.” Manny decided to abandon all but essential activities, to sell property to cover expenses, and to prepare himself for the enormous task of taking care of his mother himself at home. Manny purchased and installed essential equipment and trained himself in their use. Elsa's doctor reviewed Manny's plan of care and authorized she be released to her son's care. A system of close communication and consultation was planned with her physicians. Additionally, Elsa would be brought to the ER once every two to four weeks for evaluation and be released to home care when all was judged to be OK. There is nothing special in what I am doing. My mom did everything she could for me. Now I am doing everything I can for her. —Manny Weiser Manny's program of care is meticulously planned and anticipates a large variety of potentially rapid adverse events. Elsa's state can easily shift between extremes. Manny constantly checks for changes in his mother's condition. Routine tasks include vital sign monitoring; frequent checking, adjusting, cleaning, and changing dressings on the tracheotomy site, the g-tube site, and the permacath site; wound care dressing for pressure sores; routine skin and eye care; washing; passive range of motion exercises; and numerous other tasks. Throughout the day, the dozens of required medications are given through the g-tube, via nebulizer, subcutaneously, intramuscularly, and, when necessary, via an IV. There have been ups and downs. In the hospital, Elsa acquired numerous pressure sores, some of which were osteomyelitis positive and gangrenous. A plastic surgeon and Manny treated her legs, using partial debridement of tissue, high-dose antibiotics, and application of surgical collagen preparations. With the course of treatment received to date, the patient is approaching complete recovery. Extended use of a feeding tube resulted in diabetes. During a hospitalization, kidney failure occurred. Manny's mother became the first patient approved for home hemodialysis in New York state, and a NxStage home hemodialysis unit is now being used with a central-line catheter, backed up by the support team of Life Care Dialysis of New York City. The home dialysis unit is now the linchpin of the entire home setup, and it has provided unanticipated benefits. Manny reports very high satisfaction with its seamless integration into his mother's care and performs dialysis six days a week. Rather than Elsa facing the complications of high potassium levels, her dialysis is so efficient that her potassium is maintained at a sufficiently low level to require supplements. Furthermore, the daily, gradual dialysis permits liberal use of intravenous feeds because fluid buildup is low. Additional benefits are better wound healing and less fluid overload in the respiratory system. Manny sleeps in his mother's room, ready to be awakened by the various equipment alarms or an attending nurse. Very brief absences, for administrative needs or to get supplies, are carefully coordinated with nurses. Manny attended Passover Seder upstairs in his family's apartment, but was called back every few minutes by a nurse who was stationed downstairs. On the high holidays, an ICU nurse is hired, allowing Manny to attend synagogue services for a few hours. His children visit him and their grandmother in the room but know not to disturb him when he is attending to her. Kabed et avichah v'et imechah. Honor your father and your mother. Manny says that people rarely reflect on how much their parents do for them. “There is nothing special in what I am doing. My mom did everything she could for me. Now I am doing everything I can for her,” he says. When asked how he manages to do it all, Manny explains that the more one does for one's parents, the more one wants to do. “Come back in a month. You will see. She will be well enough to sit in a wheelchair with only an oxygen tank. I'll be walking her around in the garden, and we will have some coffee together.”

Proximal Humeral Epiphyseal Plate Fracture in a Collegiate Track and Field Decathlete: A Case Study

To present the case of an 18-year-old collegiate decathlete with a Salter-Harris type I epiphyseal plate fracture of the proximal humerus. A collegiate decathlete was playing flag football and fell on an outstretched arm. He was taken to the emergency room and diagnosed with a type I epiphyseal plate fracture. AC sprain, dislocation or subluxation, rotator cuff tear, labral tear. Active and passive range of motion exercises were completed after two days of immobilization. He then started strengthening exercises and returned to competitive activity in 10 weeks. Proximal humeral epiphyseal plate fractures are uncommon injuries, especially in athletes over the age of 15. If an accurate diagnosis is made, an appropriate conservative rehabilitation program can be implemented to safely return an athlete to participation without permanent deformity following a type I Salter-Harris fracture.

Actively Passive: Understanding Voice in Academic Writing

Actively Passive: Understanding Voice in Academic Writing

Treatment of traumatic cervical myelopathy with surgery, prolonged positive-pressure ventilation, and physical therapy in a dog

A 9-year-old dog was evaluated for traumatic cervical myelopathy after a surgical attempt to realign and stabilize the C2 and C3 vertebrae. The dog could not ventilate spontaneously and was tetraplegic; positive-pressure ventilation (PPV) was maintained. Myelography and computed tomography revealed spinal cord compression with subluxation of the C2 and C3 vertebrae and extrusion of the C2-3 intervertebral disk. Surgically, the protruding disk material was removed and the vertebrae were realigned with screws and wire. For PPV, assist control ventilation in volume control mode and then in pressure control mode was used in the first 6 days; this was followed by synchronized intermittent mandatory ventilation until 33 days after the injury; then only continuous positive airway pressure was provided until the dog could breathe unassisted, 37 days after the injury. Physical therapy that included passive range of motion exercises, neuromuscular electrical stimulation, and functional weight-bearing positions was administered until the dog was discharged 46 days after injury; the dog was severely ataxic and tetraparetic but could walk. Therapy was continued at home, and 1 year later, the dog could run and had moderate ataxia and tetraparesis. Hypoventilation with tetraparesis in traumatic spinal cord injury can be successfully treated with PPV exceeding 30 days, surgery, and physical therapy.

Staged Reconstruction for Chronic Rupture of Both Peroneal Tendons Using Hunter Rod and Flexor Hallucis Longus Tendon Transfer: A Long-Term Followup Study

Long-term followup (over 5 years) of staged reconstruction for chronic ruptures of both peroneal tendons using a Hunter rod and the flexor hallucis longus (FHL) tendon is presented. Seven patients with chronic ruptures of both peroneal tendons who had at least two previous surgeries that failed were treated with excision of the remaining portion of the peroneal tendons and implantation of a Hunter rod to the insertion of the peroneus brevis. Patients performed passive range of motion exercises for 3 months before removal of the Hunter rod and transfer of the FHL into the newly formed sheath, attaching it to the insertion of the peroneus brevis on the fifth metatarsal. The patients' ages ranged from 30 to 57 (average 38) years. All were women. All had at least two previous failed procedures (range two to six). The average time from initial injury to the index surgery was 4.6 (range 2 to 7) years. Patients were evaluated by physical examination and a questionnaire. The average range of followup was 8.5 years (range 143 to 167 months). All wounds healed without complications. One patient (a workers' compensation patient) had continued complaints of pain and ambulated with a molded ankle-foot orthosis (MAFO). The remaining six patients reported complete relief of symptoms and returned to full preinjury levels of activity. One patient required a Broström ankle ligament repair 2 years after tendon transfer for a new injury but has remained pain free for the last 62 months. There were five excellent, one good, and one fair result. All patients stated they would repeat the surgery. Staged reconstruction with excision of the remaining portion of the peroneal tendons and reconstruction with a Hunter rod and FHL transfer has been shown to be an effective long-term treatment for chronic peroneal tendon ruptures.

The Effects of Early Aquatic Therapy After Arthroscopic Repair of Rotator Cuff Tear

PURPOSE: To determine the effects of early aquatic therapy after arthroscopic repair of rotator cuff tear on the restoration of the shoulder function. METHODS: Twenty patients after arthroscopic repair of rotator cuff tear were randomly divided into two rehabilitation treatment groups. One (n=10) was early aquatic therapy (AT) group, who performed the aquatic therapy protocols (4 weeks program) from 4th week after arthroscopic repair and then continued advanced range of motion (ROM) exercises with the strengthening exercises of shoulder. The other (n=10) was conventional rehabilitative therapy (CT) group, who performed passive ROM exercises of shoulder for 6 weeks after arthroscopic repair and then continued the same treatment as AT group. Shoulder ROMs for forward flexion and abduction, DASH (Disability of the Arm, Shoulder and Hand) scores were measured after 3 weeks, 3 months and 6 months after arthroscopic repair. In addition, isokinetic peak torques were obtained after 6 months. RESULTS: After 3 months, shoulder ROMs of forward flexion (Δ43.7±19.2 vs. Δ23.5±13.7, p<0.05) and abduction (Δ54.1±26.7 vs. Δ29.0±14.7, p<0.05) were significantly increased and DASH scores were significantly decreased (Δ23.9±7.1 vs. Δ7.2±7.3, p<0.05) in AT group compared with in CT group. After 6 months, isokinetic peak torques of shoulder abduction were also significantly increased (p<0.05) in AT group compared with in CT group. CONCLUSIONS: Early aquatic therapy provides more rapid and effective restoration of the shoulder function after arthroscopic repair of rotator cuff tear. It is assumed that early aquatic therapy provides early and natural mobilization of the shoulder joint under water.

Heterotopic Ossification about the Elbow: A Therapist's Guide to Evaluation and Management

Heterotopic ossification (HO) is a form of pathologic bone that often occurs in the elbow after a substantial traumatic injury and can complicate the functional outcome of the affected upper extremity. This article is designed to help the treating therapist better understand the complex process of HO. The pathophysiology, causes, associated risk factors, and signs and symptoms of HO are discussed in depth. The physician's management, including a classification system, diagnostic tools, and prophylactic measures, are explained. An extensive review of the literature regarding the therapist's management of HO reveals current misconceptions about passive range of motion (PROM). Traditional thought has advocated that PROM is a contraindication when HO is present because it can lead to the development or exacerbate the formation of HO. A review of the literature only reveals a few scientific studies that concluded that forcible manipulation of stiff joints can lead to myositis ossification. Most of the articles that have concluded that PROM is contraindicated have been erroneously based on anecdotal findings. This conclusion is misleading because forcible manipulation of a joint is not synonymous with PROM exercises. This article challenges popular belief and offers some alternative thinking for the therapist treating an elbow injury with HO as well as guidelines for the rehabilitation program.

他動的股関節内旋外旋運動が指床間距離に及ぼす影響

他動的股関節内旋外旋運動が指床間距離に及ぼす影響

The Use of Hydrotherapy for the Management of Spasticity

Introduction. Spasticity is a major problem for the rehabilitation team. Physiotherapy is a vital component of therapy. Oral medication and other modalities such as heat, cold, ultrasound, electrical stimulation, and surgery (neuro-surgical or orthopedic) can also be used. The aim of this study was to compare the effects of hydrotherapy on spasticity and Functional Independence Measure (FIM) scores of patients with spinal cord injury (SCI). Materials and Methods. This is a control case matched study. Twenty SCI patients were divided into 2 groups and matched for age, gender, injury time, Ashworth scores, oral baclofen intake, American Spinal Injury Association, and FIM scores. The control group received passive range of motion exercise twice a day and oral baclofen for 10 weeks. The study group also received passive range of motion and oral baclofen, as well as 20 min of water exercises (at 71 °F, full immersion) 3 times per week. The authors evaluated spasm severity, FIM scores, oral baclofen intake, and Ashworth scales, between groups at the beginning and at the end of the treatment period. Results. Both groups demonstrated a significant increase in FIM scores. However, the hydrotherapy group demonstrated a larger increase (P < 0.0001) than the control group. There was a statistically significant decrease in oral baclofen intake in the hydrotherapy group (P < 0.01). There was no statistical change in the control group. Spasticity was evaluated by the Ashworth scale. There was a statistical improvement in each group (P < 0.01, P < 0.02). However, when compared to the control group, the use of hydrotherapy produced a significant decrease in spasm severity (P < 0.02). Conclusion. Side effects are often seen when using oral drug treatment for spasticity. Adding hydrotherapy to the rehabilitation program can be helpful in decreasing the amount of medication required. Future studies must evaluate benefits of hydrotherapy for rehabilitation.

Pharmacology Review

Extravasation or inadvertent infiltration of fluids into subcutaneous tissue from peripheral intravenous (IV) devices is a common adverse event in newborns. (1)(2) Although fluids occasionally extravasate from central venous lines, the complication is much more common from peripheral catheters, which are used widely in sick neonates. (3) This article focuses on extravasations from peripheral IV devices. Injury to the skin, even in a very immature neonate, results in an inflammatory response and heals by scar formation. (4) Although the scars from many of these injuries appear to improve with time, (5) tissue necrosis from extravasation injury could result in partial or complete skin loss, infection, and nerve and tendon damage, with the potential risk of permanent cosmetic and functional impairment. (6)(7)(8) The incidence of extravasations from Teflon® catheters has been reported to vary from 23% to 63%. (1) A recent survey of regional neonatal intensive care units in the United Kingdom recorded the prevalence of extravasation injury resulting in skin necrosis as 38 per 1,000 neonates, with 70% of these injuries occurring in infants of 26 weeks’ gestation or less. (2) The incidence of extravasation is related closely to the type of device used, insertion site, duration of therapy, infusate administered, patient activity, and gestational age. (1)(3)(9)(10) The fragility of the skin, particularly in the first 2 weeks after birth, and the lack of subcutaneous tissue in preterm neonates makes them uniquely susceptible to injury and skin loss. Extravasation may occur from the tip of the cannula or needle piercing the vessel wall. Alternatively, distal obstruction of the vein due to thrombosis or venoconstriction from irritation of the vessel wall may lead to increased back pressure and leakage from the entry point of the needle or …

Because of the risk of developing heterotopic ossification, are passive range of motion exercises contraindicated following traumatic injuries?

The purpose of “Evidence in Practice” is to illustrate the literature search process to obtain evidence that can guide clinical decision making. This article is not a case report. The examination, evaluation, and intervention sections are purposely abbreviated. A 62-year-old man was referred for outpatient physical therapy 2 weeks after he had fallen and fractured the head of his right radial bone. The fractured radial head was excised the day after the injury, and the patient had been using a sling on his right arm for comfort. The radiology report stated that good bony alignment was observed and that no bony abnormalities were present following surgery. The patient's goal was to return to his job as a courtroom deputy. The surgeon had referred the patient to me for examination, evaluation, and intervention, noting the need to increase range of motion in the right elbow, but he had specifically written “no passive range of motion exercise” on the consultation form. Upon initial examination, range of motion of the right elbow, as measured with a standard goniometer, as described by Armstrong et al,1 was 75 degrees to 115 degrees of flexion, 10 degrees of supination, and 20 degrees of pronation. Because of the surgeon's note, I was concerned that the absence of interventions designed to increase the range of motion of the right elbow could delay the recovery of function, and I was uncertain why he made this request. I therefore contacted the surgeon to discuss his rationale. He said that he was concerned that passive range of motion following a traumatic injury could lead to heterotopic ossification (the appearance of ectopic bone in the soft tissues around the elbow). I proceeded with the initial physical therapist examination of the patient and the creation of an active exercise program, but I …

Effect of Passive Range of Motion Exercises on Lower-Extremity Goniometric Measurements of Adults With Cerebral Palsy: A Single-Subject Design

People with spastic cerebral palsy often receive passive stretching that is intended to maintain or increase joint passive range of motion (PROM) even though the effectiveness of these exercises has not been definitively demonstrated. The purpose of this study was to determine the effect of PROM exercises on 6 adults with spastic quadriplegia and contractures. Four men and 2 women (X =31 years of age, range=20-44 years) who lived in an institution for people with mental retardation participated in the study. The authors used 2 multiple baseline designs. Three participants (group 1) received lower-extremity PROM exercises during phase A; PROM exercises were discontinued during phase B. Three participants (group 2) did not receive PROM exercises during phase A; PROM exercises were initiated during phase B. Data were analyzed using visual analysis and the C statistic. Results varied with the method of analysis; however, phase A and phase B measurements, overall, did not differ for either group. This study demonstrated use of a single-subject design to measure the effect of PROM exercises on adults with cerebral palsy. The authors concluded that the PROM exercise protocol did not have an effect on the lower-extremity goniometric measurements of the participants.