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Marc J. Philippon, Jesse C. Christensen and Michael S. Wahoff

Objective:

To report the 4-phase rehabilitation progression of a professional athlete who underwent arthroscopic intra-articular repair of the hip after injury during the 2006–07 season.

Design:

Case study; level of evidence, 4.

Main Outcome Measures:

Objective values were obtained by standard goniometric measurements, handheld dynamometer, dynamic sports testing, and clinical testing for intra-articular pathology.

Results:

This case report illustrates improvements in hip mobility, muscle-force output, elimination of clinical signs of intra-articular involvement, and ability to perform high-level sport-specific training at 9 wk postsurgery. At 16 wk postsurgery, the patient was able to return to full preparation for sport for the following season.

Conclusion:

After the 4-phase rehabilitation program, the patient demonstrated improvement in all areas of high-level function after an arthroscopic intra-articular repair of the hip. The preoperative management to return to sport is outlined, with clinical outcomes and criteria for return to competition.

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Bob Murray, John Stofan and Bob Sallis

Objective:

This article summarizes a case of ischemic colitis suffered by a triathlete during an Ironman competition.

Background:

Exercise results in a significant reduction in splanchnic blood flow to help maintain cardiovascular function. When dehydration and heat stress accompany exercise, blood flow to the splanchnic vasculature is further reduced, increasing the risk of local ischemia and tissue injury.

Differential Diagnosis:

Ischemic colitis caused by dehydration and heat stress.

Treatment:

Right hemicolectomy involving a 16-cm segment of ischemic large intestine and appendectomy the day following the race.

Uniqueness:

This case study highlights one of the risks associated with dehydration during prolonged exercise in the heat. Of particular interest are practical interventions to reduce health and performance issues.

Conclusions:

Poor hydration and nutrition practices during intense exercise can affect gut function, impair performance, and jeopardize health. Optimal intake of fluid, carbohydrate, and salt will enhance performance and reduce risk to health.

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Simon Wang and Stuart M. McGill

Spine stability is ensured through isometric coactivation of the torso muscles; however, these same muscles are used cyclically to assist ventilation. Our objective was to investigate this apparent paradoxical role (isometric contraction for stability or rhythmic contraction for ventilation) of some selected torso muscles that are involved in both ventilation and support of the spine. Eight, asymptomatic, male subjects provided data on low back moments, motion, muscle activation, and hand force. These data were input to an anatomically detailed, biologically driven model from which spine load and a lumbar spine stability index was obtained. Results revealed that subjects entrained their torso stabilization muscles to breathe during demanding ventilation tasks. Increases in lung volume and back extensor muscle activation coincided with increases in spine stability, whereas declines in spine stability were observed during periods of low lung inflation volume and simultaneously low levels of torso muscle activation. As a case study, aberrant ventilation motor patterns (poor muscle entrainment), seen in one subject, compromised spine stability. Those interested in rehabilitation of patients with lung compromise and concomitant back troubles would be assisted with knowledge of the mechanical links between ventilation during tasks that impose spine loading.

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William M. Adams, Yuri Hosokawa, Robert A. Huggins, Stephanie M. Mazerolle and Douglas J. Casa

Context:

Evidence-based best practices for the recognition and treatment of exertional heat stroke (EHS) indicate that rectal thermometry and immediate, aggressive cooling via cold-water immersion ensure survival from this medical condition. However, little is known about the recovery, medical follow-up, and return to activity after an athlete has suffered EHS.

Objective:

To highlight the transfer of evidenced-based research into clinical practice by chronicling the treatment, recovery, and return to activity of a runner who suffered an EHS during a warm-weather road race.

Design:

Case study.

Setting:

Warm-weather road race.

Participant:

53-y-old recreationally active man.

Intervention:

A runner’s treatment, recovery, and return to activity from EHS and 2014 Falmouth Road Race performance.

Main Outcomes:

Runner’s perceptions and experiences with EHS, body temperature, heart rate, hydration status, exercise intensity.

Results:

The runner successfully completed the 2014 Falmouth Road Race without incident of EHS. Four dominant themes emerged from the data: predisposing factors, ideal treatment, lack of medical follow-up, and patient education. The first theme identified 3 predisposing factors that contributed to the runner’s EHS: hydration, sleep loss, and lack of heat acclimatization. The runner received ideal treatment using evidence-based best practices. A lack of long-term medical care following the EHS with no guidance on the runner’s return to full activity was observed. The runner knew very little about EHS before the 2013 race, which drove him to seek knowledge as to why he suffered EHS. Using this newly learned information, he successfully completed the 2014 Falmouth Road Race without incident.

Conclusions:

This case supports prior literature examining the factors that predispose individuals to EHS. Although evidence-based best practices regarding prompt recognition and treatment of EHS ensure survival, this case highlights the lack of medical follow-up and physician-guided return to activity after EHS.

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Jeffery T. Podraza and Scott C. White

Background:

Isolated atraumatic posterior glenohumeral instability is rare. Use of thermal capsulorraphy for glenohumeral instability is considered controversial. This case study describes a modified rehabilitation protocol for a patient who underwent a multistep arthroscopic procedure for isolated posterior glenohumeral instability with a postoperative complication of adhesive capsulitis.

Case Description:

A 30-y-old man with a 15-y history of bilateral posterior glenohumeral instability related to generalized hypermobility underwent right-shoulder arthroscopy consisting of a combined posterior labral repair, capsular imbrication, and thermal capsulorraphy. A gunslinger orthosis was prescribed for 6 wk of immobilization. Adhesive capsulitis was diagnosed at the 5-wk postoperative visit and immobilization was discontinued. A modified treatment protocol was devised to address both the surgical procedures performed and the adhesive capsulitis. Residual symptoms resolved with release of an adhesion while stretching 10 months postoperatively.

Outcomes:

Scores of 5 shoulder-assessment tools improved from poor to excellent/good with subjective report of a very good outcome.

Discussion:

The complication of adhesive capsulitis required an individualized treatment protocol. In contrast to the standard protocol, our modified approach allowed more time to be spent in each phase of the program, was aggressive with restoring range of motion (ROM) without excessively stressing the posterior capsule, and allowed the patient to progress to activities that were tolerated regardless of protocol phase. Shoulder stiffness or frank adhesive capsulitis after stabilization, as in this case, requires a more aggressive modification to prevent permanent ROM limitations. Conversely, patients with early rapid gains in ROM must be protected from overstretching the repaired tissue with a program that allows functional motion to be incorporated over a longer time frame. This study indicates the use of thermal capsulorraphy as a viable surgical modality when it is used judiciously with the proper postoperative restrictions and rehabilitation.

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Jeffrey B. Driban and R. Mark Laursen

Researcher Share your experience and wisdom (e.g., publish CASE studies) Write manuscripts that are accessible to clinicians and include take-home messages about the clinical implications of the findings Attend free-communication sessions and ask questions or offer perspective Share peer-reviewed results

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Jessica M. Lutkenhouse

The present case study illustrates the treatment of a 19-year-old female lacrosse player, classified as experiencing Performance Dysfunction (Pdy) by the Multilevel Classification System for Sport Psychology (MCS-SP). The self-referred collegiate athlete was treated using the manualized Mindfulness-Acceptance-Commitment (MAC) protocol (Gardner & Moore, 2004a, 2007). The intervention consisted of eight individual sessions and several follow-up contacts via e-mail. The majority of the sessions addressed clinically related and sport-related concerns, including difficulties in emotion regulation and problematic interpersonal relationships. Based on self-report, coach report, and one outcome assessment measure, the psychological intervention resulted in enhanced overall behavioral functioning and enhanced athletic performance. This case study suggests that following careful case formulation based on appropriate assessment and interview data, the MAC intervention successfully targeted the clearly defined psychological processes underlying the athlete’s performance concerns and personal obstacles, thus resulting in enhanced well-being and athletic performance improvements.

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Ian McGinnis, Justin Cobb, Ryan Tierney and Anne Russ

checklist for cohort studies 1 , 10 and the Center for Evidence Based Management (CEBM) critical appraisal of a case study 9 forms. For each selected study, two researchers independently scored the forms and the averages were used for strength of recommendation. Results of Search Summary of Search

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H. Jan Dordel

Individuals with severe physical and psychomotor modifications after a brain injury need measures of motor training beyond the usual physiotherapy. The effects of an intensive mobility training in the phase of late rehabilitation are reported in two case studies. The coordinative and conditional progresses were controlled by the methods of photographic anthropometry, light-track registration, and bicycle ergometry. Improvements were found in posture and dynamic endurance in correlation with the generally improving motor control. Tests of everyday relevant movements revealed qualitative progresses in the sense of increased motor precision and economy.

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Donna L. Goodwin, Joan Krohn and Arvid Kuhnle

This phenomenological case study sought to understand the wheelchair dance experiences of five children (ages 6-14 years) with spina bifida. The experiences of one boy and four girls were captured using the phenomenological methods of semistructured interviews, journals, visual artifacts, and field notes. The perspectives of their parents were also gathered. The dancer data and parent data were analyzed separately, revealing four common themes: unconditional acceptance, a dream comes true, beyond the wheelchair, and a stronger self. The experience of dancing from a wheelchair was interpreted and understood by reflecting upon the concepts of ableism, dualism, and the minded body.