I understand that mental health is an important topic, but what can I do as a physiotherapist?
As health care professionals we are dedicated to improving a person’s well-being. As physiotherapists, we are comfortable within the realm of physical signs and symptoms, while sometimes neglecting the intimate connection between the physical and mental bodily spheres. It is undeniable that the two are mutually influenced, but how proficient are we as clinicians in recognizing and addressing this importance within a clinical setting?
Do you know what outcome measures are available to you for quantifying suspected mental health disturbances? Are you confident with who you should be referring your patients to, for the appropriate type of care? How equipped do you feel as a physiotherapist, with addressing a suspected underlying mental health imbalance with your patient? If you felt uncertain with any of your answers to these questions, you are certainly not alone.
A person may have knee surgery to treat pain in the joint due to an injury, such as torn cartilage or a torn ligament. It can also treat other conditions, such as osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
This article will look at the different types of knee surgery, the rehabilitation timelines, and what people can do to help speed up the recovery process.
Types of knee surgery
There are various types of knee surgery. The type that a person has will depend on the particular injury to the knee joint.
The impact that loss of mobility can have on hospitalized older adults can reach far beyond the hospital stay, yet there is little consistency in the ways hospitals assess and promote movement, and almost no acknowledgement of mobility as an outcome measure. That needs to change, and soon, say authors of a new white paper advocating for a shift in “a hospital culture that does not value or prioritize mobility.” APTA was among the organizations that participated in a peer review of the document, with member James Tompkins, PT, DPT, conducting the review.
The white paper, produced by the American Geriatric Society’s (AGS) Quality and Performance Measurement Committee, describes the current state of mobility assessment in acute care settings as spotty at best, with a few hospitals conducting regular, validated mobility reviews with patients, and many others using inconsistent assessments or relying too much on hospital physical therapy departments to keep up with tests and measures that could be conducted by nurses. The assessment gaps, coupled with what researchers describe as a “focus on fall prevention at all costs,” result in dramatic and potentially long-lasting losses in mobility in a population already at risk.
A large study has produced strong evidence that a drug commonly used to treat the bone-thinning disease osteoporosis could safely prevent fractures in elderly women who have bones that aren’t as weak.
The study of 2,000 women age 65 and older at earlier stages of bone loss — a condition known as osteopenia — found the drug zoledronatereduced by about one-third the risk they would suffer a break.
“This is an extremely important paper,” says Dr. Ethel Siris, a Columbia University medical professor who specializes in thinning bones and wasn’t involved in the study. “We now know that we have a therapy that has been shown to be highly effective.”
Patellofemoral Pain (PFP) is an umbrella term that describes peripatella or retropatella pain in the absence of other pathologies. Other descriptions for PFP include patellofemoral pain syndrome, anterior knee pain and chondromalacia patellae (Brukner et al, 2017) and is common in loading activities such as squatting, running and stair ambulation (Crossley et al, 2016).
Although numerous intra and extra articulating structures could be responsible for the production of PFP, the actual cause is not entirely understood (Collado and Fredericson, 2010). One consideration is that PFP is a result of an increased loading through the knee, causing peripatella synovitis or damaging the articulating patellofemoral cartilage which, although avascular and aneural could result in an inflammatory cascade that produces synovial irritation (Brukner et al, 2017).
PFP has shown to affect adolescents, young adults, elite athletes as well as members of the general population with incidence rates varying between 15%-45% and is considered one of the most common types of knee pain (Smith et al, 2018).
APTA-supported legislation that protects physical therapists (PTs) and other health care providers who travel across state lines with a sports team is now just a presidential signature away from becoming law. Known as the Sports Medicine Licensure Clarity Act, the bill met with overwhelming bipartisan support in both the US House of Representatives and the Senate, and is on track to receive approval from President Donald Trump.
When it becomes law the legislation will provide added legal protections for sports medicine professionals when they’re traveling with professional, high school, college, or national sports teams by extending the provider’s “home state” professional liability insurance to any other state the team may visit. The law would apply to licensed health care professionals who travel with professional and collegiate teams or other athletes and teams sanctioned by a national governing body. The bill was introduced in the House by Reps Brett Guthrie (R-KY) and Cedric Richmond (D-LA), and in the Senate by Sens John Thune (R-SD) and Amy Klobuchar (D-MN).
“This is a big win for PTs, but an even bigger step forward in safeguarding the health of athletes,” said Michael Matlack, APTA director of congressional affairs. “Once enacted, this law will help to support the realities of health care among teams that travel across state lines.”
The research, led by PhD candidate Maria Matsangidou from EDA, set out to determine how using VR while exercising could affect performance by measuring a raft of criteria: heart rate, including pain intensity, perceived exhaustion, time to exhaustion and private body consciousness.
To do this they monitored 80 individuals performing an isometric bicep curl set at 20% of the maximum weight they could lift, which they were then asked to hold for as long as possible. Half of the group acted as a control group who did the lift and hold inside a room that had a chair, a table and yoga mat on the floor.
The VR group were placed in the same room with the same items. They then put on a VR headset and saw the same environment, including a visual representation of an arm and the weight (see image below). They then carried out the same lift and hold as the non-VR group.
Take Home Message: Following a concussion, athletes typically walk slower and perform poorly on cognitive tasks compared to controls. Hence, a gait task test may be a beneficial concussion assessment.
Many athletes who sustain a concussion suffer motor control deficits, specifically the inability to optimally perform dual tasks (motor and cognitive tasks). However, a challenge to assessing motor control deficits is that we often rely on self-reported balance issues to assess postural control abnormalities, which may lead to inaccuracies in diagnosis and returning an athlete to play. Therefore, the authors sought to determine if an athlete with a concussion completes motor tasks of different complexity (in isolation or when combined with a cognitive task) worse than healthy athletes. Furthermore, they aimed to determine if athletes who have self-reported balance problems following a concussion demonstrate worse gait, stance, or cognitive deficits than those who do not report balance problems. The authors evaluated motor and cognitive function in 49 athletes who sustained a concussion and 65 healthy athletes using the following protocol:
Static standing (single-task standing)
Static standing while completing a cognitive test (dual-task standing)
Walking only (single-task walking)
Walking while completing cognitive test (dual-task walking)
At the end of a long day, it’s tempting to dive into your social feeds or Netflix queue the minute you’ve finished eating. But back before screens bogarted all our free time, an after-dinner stroll was a popular activity and one associated with improved health and digestion. “Italians have been walking after meals for centuries,” says Loretta DiPietro, a professor of exercise science at George Washington University’s Milken Institute School of Public Health, “so it must be good.”
Research backs this up. One small study co-authored by DiPietro found that when older adults at risk for type-2 diabetes walked on a treadmill for 15 minutes after a meal, they had smaller blood sugar spikes in the hours afterwards. In fact, the researchers found that these short post-meal walks were even more effective at lowering blood sugar after dinner than a single 45-minute walk taken at mid-morning or late in the afternoon.
The human digestive system converts food into the sugar glucose, which is one of the body’s primary energy sources—so after a meal, glucose floods a person’s bloodstream. Hormones like insulin help pull that glucose into cells, either to be used immediately or stored away for later use. But for people with diabetes and impaired insulin activity, too much glucose can remain in the blood, which can cause or contribute to heart disease, stroke, kidney disease and other health problems.
Of four research participants living with traumatic, motor complete spinal cord injury, two are able to walk over ground with epidural stimulation following epidural stimulation paired with daily locomotor training. In addition, all four participants achieved independent standing and trunk stability when using the stimulation and maintaining their mental focus. The study was conducted at the Kentucky Spinal Cord Injury Research Center at the University of Louisville (UofL) and is published in this week’s New England Journal of Medicine. The study was funded by the Leona M. and Harry B. Helmsley Charitable Trust, University of Louisville Hospital and Medtronic plc.
This ground-breaking progress is the newest development in a string of outcomes at UofL, all pointing to the potential of technology in improving quality of life — and even recovery — following spinal cord injury. This latest study builds on initial research published in The Lancet in 2011 that documented the success of the first epidural stimulation participant, Rob Summers, who recovered a number of motor functions as a result of the intervention. Three years later, a study published in the medical journal Brain discussed how epidural stimulation of the spinal cord allowed Summers and three other young men who had been paralyzed for years to move their legs. Later research from UofL demonstrated this technology improved blood pressure regulation.