Rehabilitation

Total Knee Arthroplasty

Total knee arthroplasty aka total knee replacement is a surgical procedure that has proven success relieving pain for people who suffer with knee difficulties from an injury, degenerative disorder and inflammation (Klein, 2006). In the United states alone over 300,000 total knee procedures are performed and these numbers increase as younger people need a total knee replacement (Klein, 2006). A total knee replacement procedure is a difficult surgery to recover from and should be taken very seriously. The complication are: severe pain, bruising, swelling, blood clot, temporary and permanent paralysis, infection, numbness and even death.

There are several things that help a person’s total knee outcome a success: good physical health and strength, weight, flexibility, education about the procedure and expected loss of function and nutrition to improve healing. Pre-habilitation is program that our facility offers to encourages your success after this procedure. Pre-habilitation is usually just a few visits to educate you about the produce, nutrition, possible loss of function, strengthen specific muscles and stretch tight muscles and joints.

Klein, L. J. (2006, October 18). Total Knee Replacement (CBM 2003-2). Retrieved from https://www.nlm.nih.gov/archive/20061214/pubs/cbm/tkr.html#110

Pre-habilitation

Pre-habilitation is physical therapy prior to a surgical procedure or chemo therapy for strengthening, conditioning, and education to ensure a successful outcome. Many people feel better prepared for surgery or chemo after a strengthening program because it strengthens weak muscles that could prevent you from getting out of bed, walking to the restroom and walking in the halls. Many times after a surgical procedure or chemo, patients are forced to go to a nursing home or hospital rehab because their functions have diminished, leaving them unsafe to go home (Ries, 2016). Going to a nursing home, or anywhere other than home, can devastate you and your family members. Pre-habilitation will help you prevent unexpected discharge planning.  In addition, prehab will provide post-op education, procedure precautions, home adaptation, and walking with assistance and/or a device, increasing a patient’s success rate.
Pre-habilitation is an individualized plan of care based on your needs and desires. Your therapist will evaluate you and your needs to develop a plan of care and home exercise program. The home exercise program allows you to become comfortable and familiar with the exercise program you will most likely be doing while in the hospital. Some pre-habilitation programs are 1 visit, while others are a few weeks. Our clinic will help you decide what works best for you.
Respectfully,
Sherri Boos, PT, DPT
 References
Ries, E. (2016). Better Sooner and Later: Prehabilitation. PT in Motion, 1-12. Retrieved from http://www.apta.org/PTinMotion/2016/2/Prehabilitation/

Physical Health and Fitness

Physical therapy is much more than just about function it’s about treating the entire patient looking at a fitness and wellness side to patient care too. Physical therapist are well trained in nutrition, exercise and fitness and should be considered experts in rebuilding and restoring movement in patient’s lives.
Physical therapy focuses on helping, teaching and boosting patients to achieve stages of physical activity necessary to reduce and prevent disease (Ries, 2009).  Staying physically active as possible with limitations such as back, neck, hip, knee, ankle, feet or shoulder can be challenging. We recognize patient needs and accommodate fitness opportunities with guidance to remain fit and prevent disease.
The American Physical Therapy Association (APTA) promotes PT / PTA role in physical wellness and fitness and began an campaign called “ Move Forward” to engage physical therapist in assisting the public in wellness and fitness (Ries,2009).
Sincerely,
Sherri Boos
References
Ries, E. (2009). Well Beyond Function. PT in Motion, 1-11. Retrieved from June 2009

Scoliosis

scoliosisScoliosis is a curve in spine that can cause uneven shoulders or hips and curvature in lumbar and thoracic regions. Scoliosis can be diagnosed by performing Adams forward bending test, unless scoliosis is mild an x-ray may be needed.

Complications of scoliosis are low back pain on concave side and secondary hip arthritis. Scoliosis can be addressed through physical therapy and regular exercise. Even small curves should be addressed. Yoga is a healthy stretching and strengthening program that is very helpful practice where imbalances exist.

Sherri Boos, PT, DPT

Complications of Obesity

obesity complicationsObesity is an accumulation of excessive fat that jeopardizes a persons health and imbalance in energy causing excessive weight gain. At least 30% of the world’s population were over weight in 2008, afflicting 200 million males and 300 million females. Causes of obesity are food intake, sedentary lifestyle, poor quality of sleep and genetics. Strategies to avoid obesity are increased physical exercise, improve sleep pattern and proper nutrition. Physical therapy can help patients incorporate healthy lifestyle changes through exercise, diet and sleep to avoid obesity and manage weight.

Vestibular Disorders

Our balance system helps us walk, run, and move without falling. Balance is controlled through signals to the brain
from your eyes, the inner ear (vestibular system), and the sensory systems of the body (such as the skin, muscles,
and joints).

What should I do if I have a problem with balance or dizziness?

It is important to see your doctor if you have unexplained dizziness or balance issues. If you have any of the following other symptoms, be sure to seek emergency medical care:

• Chest pains
• Numbness or tingling
• Falling or problems walking
• Weakness in the legs or arms
• Blurred vision
• Slurred speech
• Sudden hearing loss
• Severe neck stiffness
• Head trauma or injury
• High fever

Dizziness and balance difficulties are symptoms of another problem. The first thing you should do is try to find out
the underlying cause. You should have a medical examination with special attention given to checking for problems
that can be associated with balance difficulties. Unfortunately, in many cases, the dizziness and balance
difficulties cannot be treated medically or surgically. In these cases, the balance problem itself may need to be
treated through balance rehabilitation.

What is dizziness?

If you experience light-headedness, a sensation of losing your balance, or a sense of feeling unsteady, you may be one of the millions of Americans who experience dizziness. Dizziness is one of the most common complaints and affects 20% to 30% of the general population. In fact, dizziness is a common reason that adults seek medical attention. When your balance is weakened, you may feel unsteady, woozy, or disoriented. You may have blurred vision or experience a sensation of movement. It may seem that the room is spinning (vertigo). You may not be able to walk without staggering, or you may not even be able to get up. Sometimes nausea, vomiting, diarrhea, faintness, changes in heart rate and blood pressure, fear, and anxiety accompany the dizziness and balance problems.

Dizziness can be associated with a variety of conditions, including:

• Viral or bacterial infections, including ear infections
• Foreign objects in the ear canal
• Blood pressure changes
• Vascular problems
• A fistula (hole) in the inner ear
• Ménière’s disease
• Medicines or drugs poisonous to the ear or balance system (ototoxic medicines)
• Multiple sclerosis
• Visual disorders
• Tumors, especially of the vestibular portion of the eighth cranial nerve (known as acoustic neuroma)
• Head injury
• Migraine

What is vertigo?

Vertigo is a type of dizziness in which there is a sense of movement or spinning. Changing position, such as sitting up in bed, can make it seem worse. Nausea and vomiting may accompany the vertigo at times.

Balance testing

Balance system assessment is often recommended when a person has:

• Rapid, involuntary eye movement (also known as nystagmus)
• Complaints of vertigo or dizziness

Dizziness and Balance Compliments of

• Balance dysfunction
• Difficulty walking
• Suspected disease of the vestibular system

Tests of the balance system are performed to help determine:

• The cause of the symptoms
• Where in the balance system the problem is occurring
• What changes are happening in the balance function
• How vision, the inner ear, and other sensory systems affect functional balance

Some of the tests of balance can be done in the physician’s office or at the bedside in the hospital. Others require specialized equipment located in the audiology office or clinic.

Balance (or Vestibular) Rehabilitation

Your audiologic (hearing), balance, and medical diagnostic tests help indicate whether you are a candidate
for vestibular (balance) rehabilitation. Vestibular rehabilitation is an individualized balance-retraining exercise program. The retraining teaches compensations that may decrease dizziness, improve balance, and improve general activity levels. Many audiologists provide limited vestibular rehabilitation. However, other clinicians, such as physical therapists are trained to provide more extensive vestibular rehabilitation. Rehabilitation with a clinician who specializes in vestibular rehabilitation may be effective in minimizing or relieving some of the symptoms. This is especially true if the dizziness is caused by head movement, motion sensitivity, or certain positions. Rehabilitation is also excellent for recovery of balance and improving daily functional activities.

When should I see an audiologist?

Audiologists perform audiologic and balance assessment to gather information about your hearing and balance function. Test results help determine the possible causes of dizziness. Results of these assessments, in combination
with medical findings, will provide diagnostic information trained to provide more extensive vestibular rehabilitation. Rehabilitation with a clinician who specializes in vestibular rehabilitation may be effective in minimizing or relieving some of the symptoms. This is especially true if the dizziness is caused by head movement, motion sensitivity, or certain positions. Rehabilitation is also excellent for recovery of balance and improving daily
functional activities.

Sherri Boos, PT, DPT
Yukon Wound Care & Rehabilitation

Cervicogenic Dizziness

 

Neck pain that sometimes follows dizziness and may be hard to figure out for practitioners if the dizziness and neck pain are connected or separate (Wrisley, 2017). Cervicogenic dizziness is difficult to diagnose due to non specific test to confirm a diagnosis. A correct diagnosis is provided to a patient when a neck injury or pain is reported along with complaints of dizziness (Wrisley, 2017).

Patients with cervicogenitic dizziness typically describe symptoms of dizziness during head movement or after remaining in position for a long period of time (Wrisley, 2017). I addition, patients may complain of imbalance that worsens with head movement.

Cervicaogenic dizziness requires a physical examination with complete medical history as symptoms may mimic other causes of dizziness. In an effort to achieve an accurate diagnosis your practitioner will perform specific test to rule out vestibular or central vestibular systems (Wrisley, 2017). Your health care provider may perform a test that causes nystagmus (rapid eye movement) causing dizziness symptoms along with nausea and vomiting. A positive test with subjective findings are usually positive, but false positives do occur.

Cervicaogenic dizziness frequently follows whiplash or head injury and is usually related to brain injury or inner ear injury (Wrisley, 2017). Most patients diagnosed with cervicogentic dizziness recover quickly with routine treatment on the neck using medication, gentle passive mobilization, exercise and posture correction. Patients that do not respond to conservative treatment may require additional vestibular therapy that encompasses eye exercise, balance therapy, walking etc. (Wrisley, 2017).

Respectfully,

Sherri Boos, Pt. DPT
Reference
Wrisley, D. M. (2017). Cervicogenic Dizziness | Vestibular Disorders Association. Retrieved from http://vestibular.org/cervicogenic-dizziness

Soft Tissue Injuries

physical therapist yukonFalls, trauma and sport related injuries cause problems to bones and soft tissue structures. Because soft tissue structures can be strained or even ruptured a grading scale is used to determine damage and proper treatment (Boissonnault, 2011). Grade I soft tissue strain is an over stretch of tissue without rupture. Grade II soft tissue strain is a partial tear in the tissue without disruption to the fascia. Grade I and II injuries cause local tenderness, edema, muscle spasm, bruising and pain with movement (Boissonnault, 2011).

Early treatment for grades I and II consist of rest, ice, compression and elevation. Once the acute swelling and pain subsides approximately 7 to 10 days a referral to physical therapy to restore motion, weight bearing, reduce swelling and pain and restore soft tissue function is necessary.

However, grade III soft tissue injury is more involved resulting in compete tear of soft tissue (muscle) and fasciaresulting in total loss of movement and possible surgical repair. Grade III injuries cause edema, blisters, pain, superficial and deep bruising, and palpable soft tissue defect. Referral to a wound care specialist for debridement and wound healing may be required along with a referral to orthopedic specialist for joint repair. Once the grade III injury is repaired and healing has occurred a referral to physical therapy is protocol to restore motion, reduce swelling and pain, regain weight bearing and normal function.

References

Boissonnault, W. G. (2011). Primary care for the physical therapist (2nd ed.). St, Louis, Missouri: Saunders.