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4612_FM_i-xvi 28/01/16 11:16 AM Page i Improving Functional Outcomes in Physical Rehabilitation, Second Edition 4612_FM_i-xvi 28/01/16 11:16 AM Page ii 4612_FM_i-xvi 28/01/16 11:16 AM Page iii Improving Functional Outcomes in Physical Rehabilitation, Second Edition SUSAN B. O’SULLIVAN, PT, EdD Professor Emerita Department of Physical Therapy College of Health Sciences University of Massachusetts Lowell Lowell, Massachusetts THOMAS J. SCHMITZ, PT, PhD Professor Emeritus Department of Physical Therapy School of Health Professions Long Island University Brooklyn Campus Brooklyn, New York 4612_FM_i-xvi 28/01/16 11:16 AM Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2016 by F. A. Davis Company Copyright © 2016 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Senior Acquisitions Editor: Melissa Duffield Developmental Editor: Molly Ward Director of Content Development: George Lang Art and Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Names: O’Sullivan, Susan B., author. | Schmitz, Thomas J., author. Title: Improving functional outcomes in physical rehabilitation / Susan B. O’Sullivan, Thomas J. Schmitz. Description: Second edition. | Philadelphia : F.A. Davis Company, [2016] | Includes bibliographical references and index. Identifiers: LCCN 2015049619 | ISBN 9780803646124 Subjects: | MESH: Physical Therapy Modalities | Treatment Outcome | Case Reports Classification: LCC RM700 | NLM WB 460 | DDC 615.8/2—dc23 LC record available at http://lccn.loc.gov/2015049619 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-4612-4/16 0 + $0.25. 4612_FM_i-xvi 28/01/16 11:16 AM Page v PREFACE O ur goal is to present an integrated model of thera- session, and (3) at discharge from physical therapy interven- peutic intervention applicable to a wide spectrum of adult tion. Our hope is that the case studies will facilitate meaning- patients engaged in physical rehabilitation. Part I, Promot- ful dialogue between and among physical therapy students ing Function, first addresses the foundations of clinical and faculty. decision-making and provides a conceptual framework for The text utilizes several pedagogical applications. Im- improving functional outcomes. The organization of content portant information is emphasized using boxes and tables provides the student a logical learning progression of inter- for easy reference. Key terms appear in boldface italicfont ventions used to improve motor function, with an emphasis in blue ink and are defined in the text. The Red Flagfeature on task-specific, motor learning, and neuromotor strategies alerts the student to precautions or preventative safety meas- (Chapters 1 and 2). Chapter 3 presents an overview of Pro- ures. The Clinical Notefeature provides additional insights prioceptive Neuromuscular Facilitation. Chapters 4 through based on clinical observations. Chapters in Part I include 13 then present strategies and interventions within the con- group Student Practice Activities to enhance learning. These text of functional skills critical to independent function and activities provide an opportunity to share knowledge and optimal rehabilitation outcomes. Each chapter includes de- skills with student peers and to confirm or clarify the stu- scriptions of suggested interventions accompanied by a dis- dent’s understanding of the interventions. Each student in a cussion of lead-up skills and progressions. Also provided are group is encouraged to contribute his or her understanding descriptions of patient outcomes consistent with the American of, or questions about, the technique or treatment activity Physical Therapy Association’s Guide to Physical Therapist being discussed and demonstrated. Dialogue should con- Practice, together with clinical applications and patient ex- tinue until a consensus of understanding is reached. amples. The interventions presented address many types of The case studies in Part II conclude with guiding impairments and activity limitations that patients may ex- questions designed to enhance students’ critical thinking hibit across practice patterns. They should not be considered skills. Answers to the guiding questions for Case Studies 1 as practice pattern-specific but rather specific to the physical through 10 are provided to students (and instructors) on- therapy diagnosis and plan of care. Our goal is to provide line at DavisPlus (www.fadavis.com). Answers to the useful, practical examples of interventions that can be used guiding questions for Case Studies 11 through 15 are pro- to enhance functional performance. vided only to instructors online at DavisPlus (www.fa- Part II presents 15 case studies in narrative form. In ad- davis.com). The intention of selected answer availability dition, each case study includes an accompanying video ad- for Case Studies 11 through 15 is to provide faculty greater dressing selected elements of the physical therapy plan of care options for incorporating case materials into course assign- available online at DavisPlus (www.fadavis.com). An out- ments, laboratory activities, and group discussions. Student standing group of clinicians from across the country have pro- feedback to the guiding questions based on the answers de- vided examples of patient management strategies based on ef- veloped by the case study contributors can be obtained fective clinical decision-making for patients with a variety of from the course instructor(s). diagnoses, among them are traumatic brain injury, stroke, The text recognizes the continuing growth of the pro- Parkinson’s disease, cerebellar glioblastoma, Guillain Barré fession and the importance of basic and applied clinical re- syndrome, peripheral vestibular dysfunction, spinal cord in- search in guiding and informing evidence-based practice. It jury, and transfemoral amputation. The guiding questions in- also integrates terminology and interventions presented in cluded with each case study are designed to enhance clinical the Guide to Physical Therapist Practice. decision-making and to challenge the student to address the Our greatest hope is that this text enhances students’ unique needs of the individual patients presented. The video understanding of strategies to improve functional outcomes captures each patient at three critical points within the episode that lead to independence and ultimately an improved qual- of care: (1) at the initial examination, (2) during a treatment ity of life for our patients. v 4612_FM_i-xvi 28/01/16 11:16 AM Page vi 4612_FM_i-xvi 28/01/16 11:16 AM Page vii CONTRIBUTING AUTHORS Edward William Bezkor, PT, DPT, OCS, MTC Marianne H. Mortera, PhD, OTR Faculty, Doctor of Physical Therapy Program Assistant Professor of Clinical Occupational Therapy San Diego State University School of Exercise & Programs in Occupational Therapy, Columbia University, Nutritional Sciences, San Diego, California New York, New York Physical Therapist University of California, San Diego Health System, Coby Nirider, PT, DPT Perlman Clinic, Rehabilitation Services, La Jolla, Area Director of Therapy Services California Touchstone Neurorecovery Center, Conroe, Texas Faculty, Professional Doctorate Program Pacific College of Oriental Medicine, Mission Valley, Susan B. O’Sullivan, PT, EdD California Professor Emerita Department of Physical Therapy, School of Health and Cristiana K. Collins, PT, PhD, CFMT, NCS Environment, University of Massachusetts Lowell, Assistant Professor Lowell, Massachusetts Physical Therapy Department, Long Island University, Brooklyn, New York Vicky Saliba Johnson, PT, FFFMT, FAAOMPT President George D. Fulk, PT, PhD Institute of Physical Art, Inc. Chair and Associate Professor Director Department of Physical Therapy, Clarkson University, Functional Manual Therapy Foundation Center for Health Sciences, Potsdam, New York Director FMTF Orthopedic Residency Sharon A. Gutman, PhD, OTR Steamboat Springs, Colorado Associate Professor Programs in Occupational Therapy, Columbia University, Thomas J. Schmitz, PT, PhD New York, New York Professor Emeritus Department of Physical Therapy, School of Health Jennifer Hastings, PT, PhD, NCS Professions, Long Island University, Brooklyn, Professor and Director New York School of Physical Therapy, University of Puget Sound, Tacoma, Washington Edward Taub, PhD University Professor JoAnn Moriarty-Baron, PT, DPT Director CI Therapy Research Group and Taub Training Instructor Clinic, Department of Psychology, University of Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama Massachusetts Lowell, Lowell, Massachusetts David M. Morris, PT, PhD Associate Professor Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama vii 4612_FM_i-xvi 28/01/16 11:16 AM Page viii 4612_FM_i-xvi 28/01/16 11:16 AM Page ix CASE STUDY CONTRIBUTORS CASE STUDY 1. Patient With Traumatic Susan Harkema, PhD Brain Injury Associate Professor Department of Neurological Surgery Temple T. Cowden, PT, MPT University of Louisville Adult Brain Injury Service Louisville, Kentucky Rancho Los Amigos National Rehabilitation Center, Owsley B. Frazier Chair in Neurological Rehabilitation Downey, California Rehabilitation Research Director Kentucky Spinal Cord Injury Research Center CASE STUDY 2. Patient With Traumatic Louisville, Kentucky Brain Injury: Balance and Locomotor Research Director Frazier Rehab Institute Training Louisville, Kentucky Director of the NeuroRecovery Network Heidi Roth, PT, MSPT, NCS Louisville, Kentucky Research and Clinical Physical Therapist Rehabilitation Institute of Chicago, Chicago, Illinois Mary Schmidt-Read, PT, DPT, MS Magee Rehabilitation Center Jason Barbas, PT, MPT, NCS Philadelphia, Pennsylvania Outpatient Rehabilitation Rehabilitation Institute of Chicago, Chicago, Illinois CASE STUDY 4. Patient With Stroke: Home Care Rehabilitation CASE STUDY 3. Patient With Incomplete Spinal Cord Injury, T4: Locomotor Lynn Wong, PT, DPT, MS, GCS Training Caritas Home Care, Methuen, Massachusetts Elizabeth Ardolino, PT, MS CASE STUDY 5. Patient With Stroke: Magee Rehabilitation Center Constraint-Induced Movement Therapy Philadelphia, Pennsylvania David M. Morris, PT, PhD Elizabeth Watson, PT, DPT, NCS Professor, Department of Physical Therapy Magee Rehabilitation Center University of Alabama at Birmingham, Birmingham, Philadelphia, Pennsylvania Alabama Andrea L. Behrman, PT, PhD Sonya L. Pearson, PT, DPT Associate Professor University of Alabama at Birmingham, Birmingham, College of Public Health and Health Professions Alabama University of Florida Department of Physical Therapy Gainesville, Florida ix 4612_FM_i-xvi 28/01/16 11:16 AM Page x x Case Study Contributors Edward Taub, PhD CASE STUDY 8. Patient With Incomplete University Professor Spinal Cord Injury, C7 Director CI Therapy Research Group and Taub Training Clinic Maria Stelmach, PT, DPT, NCS Department of Psychology, University of Alabama at Clinical Specialist/Physical Therapist Birmingham NYU Langone Medical Center Birmingham, Alabama Rusk Institute for Rehabilitation New York, New York CASE STUDY 6. Patient With Parkinson’s Disease Sophie Benoist, PT, DPT NYU Langone Medical Center Edward William Bezkor, PT, DPT, OCS, MTC Rusk Institute for Rehabilitation Faculty, Doctor of Physical Therapy Program New York, New York San Diego State University School of Exercise & Nutritional Sciences CASE STUDY 9. Patient With Peripheral San Diego, California Vestibular Dysfunction Physical Therapist University of California, San Diego Health System JoAnn Moriarty-Baron, PT, DPT Perlman Clinic, Rehabilitation Services Instructor La Jolla, California Department of Physical Therapy Faculty, Professional Doctorate Program University of Massachusetts Lowell Pacific College of Oriental Medicine Lowell, Massachusetts Mission Valley, California Filmed at Southern New Hampshire Rehabilitation Center Filmed at Rusk Institute of Rehabilitation Medicine Nashua, New Hampshire New York, New York CASE STUDY 10. Patient With Complete CASE STUDY 7. Patient With Complete Spinal Cord Injury, T10 Spinal Cord Injury, T9 Darrell Musick, PT Paula Ackerman, MS, OTR/L Director of Physical Therapy Shepherd Center, Inc. Craig Hospital Atlanta, Georgia Englewood, Colorado Myrtice Atrice, BS, PT Laura S. Wehrli, PT, DPT, ATP Shepherd Center, Inc. Craig Hospital Atlanta, Georgia Englewood, Colorado Teresa Foy, BS, OTR/L CASE STUDY 11. Patient With Cerebellar Shepherd Center, Inc. Glioblastoma Atlanta, Georgia Catherine Printz, PT, DPT, NCS Sarah Morrison, BS, PT Physical Therapist SCI Program Director University of California San Diego Medical Center Shepherd Center, Inc. Thornton Hospital Atlanta, Georgia San Diego, California Polly Hopkins, MOTR/L Melissa S. Doyle, PT, DPT, NCS Shepherd Center, Inc. Physical Therapist Atlanta, Georgia University of California San Diego Medical Center Thornton Hospital Shari McDowell, BS, PT San Diego, California Shepherd Center, Inc. Atlanta, Georgia