Physical Therapy & Rehabilitation Science
DPT (Doctor of Physical Therapy)
Session and Year of Graduation
Laura Frey Law
Background: The ACL is the most frequently injured knee ligament and causes diminished proprioception and mechanical instability. Decreased proprioception has been shown to cause gait deviations in patients with reconstructed ACLs. Patients who have previously suffered a stroke and torn their ACL is relatively rare and not well described in the literature. The purpose of this case study is to address how a previous neurologic condition effects treatment of an orthopedic injury and how preoperative perturbation training may help patients regain normal gait sooner. Case description: This patient suffered a stroke at eight years old, causing decreased somatosensory and use of her right extremities. She tore her right ACL nine years later while playing soccer. Within the first few months of rehabilitation, she had difficulty gaining full knee extension which directly affected her gait pattern. She also showed decreased proprioception and believed her knee to be fully straight when she was in fact lacking between 2-5 degrees of extension. She participated in therapy that focused primarily on range of motion and strengthening. Intervention: Research suggests that perturbation based training before surgery may help patients regain normal gait. Individuals who participate in this therapy in addition to strengthening quadriceps show more symmetrical limb movement between the involved and uninvolved side during gait. There is also reduced co-contraction that may be related to the increased motion during gait, leading to a normalized walking pattern. Discussion: ACL injury and reconstruction should be viewed as a neuromuscular condition in addition to an orthopedic injury. Focus on perturbation training may have helped this patient reach her goals especially since she already had decreased proprioception due to her stroke.
Orthopedic & Sports
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