Case Study 1 11-26-04 - 8:13 PM

Patient is a 73 year old female with a diagnosis of nonunion fracture of the L surgical neck and bayoneting of the humerus into varus. Patient was initiated on therapy in April 2004. Patient has a history of CA of the L breast with lumpectomy and lymph node removal in the LUE. Additional history includes low back pain. Limiting factors towards progress included pain initially at 7/10, mal-positioning of the nonunion fracture, and hx of CA. ROM had 
plateaued when the ATM2 was initiated.

Goals were to increase strength in the lower trapezius and external rotators of the shoulder; to enable the patient to elevate the arm with a decrease in pain within the limited ROM available; stabilize the spine and trunk without exacerbating back pain. Guidelines were to avoid pain, and reduce risk of stress on the nonunion. The therapist was permitted resistive exercise by the physician.

Active ROM was as follows:
Shoulder Flexion 140 Abduction 110 External Rotation 70 Internal Rotation 70

Patient was set up with 5 straps for manual resistive exercise to external rotators, and 3 straps for active assistive lower trapezius elevation. 

The ATM2 enabled the therapist to concentrate on the L shoulder as the trunk was stabilized and supported. The patient's posture was not an issue while in the ATM2. Stabilization prevented substitution of the upper trapezius or trunk side bending during the activity. Strength increased from 3+/5 to 4-/5, pain decreased from 5/10 to 2/10 by 9/30/04 when the patient left for a 3 week trip to Japan.

Case Study 2 11-24-04 - 9:12 AM

Patient is a 83 year old female with a history of R TKR revision secondary to infection on 4/21/04. Patient had the original TKR 5/03 and L TKR prior to 03. Patient's main complain was inability to flex knee.
Limiting factors included prior history of LTKR, pain and limited ROM R knee. Patient had been manipulated under anesthesia subsequent to the revision.

The ATM2 was added to the program on 9/9/04. Her initial office visit was 6/1/04.

Knee ROM at most in the side lying 2 joint stretch position was 70 flexion to -10 extension. Hip extension was 0. Knee pain at most was 6/10. She had an antalgic gait with a straight cane. Distance of 1-2 blocks was tolerated. ROM had plateued with quad strength of 3+/5, hip extensor strength of 3/5.

The ATM2 was initiated at the end of August for hip extension without the resistive band. The positioning on the ATM2 enhanced the active assistive stretches of the quad and psoas muscles (Sara Meeks advanced approached) being performed by the therapist.

By 9/20/04 the patient had reduced her pain medication. She could ambulate up to1 hour or up to 6 blocks without a device with intermittent CG of a second person. Her stride was improved as hip extension had increased 15 degrees even thought knee ROM remained unchanged. When last seen on 11/8/04 she was able to ambulated on the treadmill for ½ hour daily, and ambulate outdoors without any device, or power walk with exerstriders. She was off her pain medication. Strength was 4-/5. Gait and functional level improved despite the fact that knee ROM had plateaued.