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Mr. T is an 80 year old patient being seen for physical therapy in the intensive care unit following total knee replacement. Mr. T is on mechanical ventilation due to complications following surgery.

The physical therapist wants to find some information on treating patients who are on mechanical ventilation. She consults Rehabilitation Reference Center, keying in mechanical ventilation. She consults the clinical review "Mechanical Ventilation: Physical Therapy."

She reads about mechanical ventilation, including presentation, signs/symptoms, and contraindications. Then she reviews the examination of a person who is on mechanical ventilation. After completing the physical and subjective examination, she goes on to read about the treatment of people who are on mechanical ventilation and the precautions to take.

Note: The above referenced Clinical Review is freely accessible to all readers of the Rehabilitation Reference Center Update. 

Caring for Patients with Lunate Dislocation

Lunate dislocation is a condition in which the lunate bone is dislocated from the lunate fossa of the radius in a volar director into the carpal tunnel or in a dorsal direction. It is typically caused by wrist hyperextension with significant force (i.e. fall on outstretched hand) or forced wrist flexion (e.g. fall on dorsum of flexed, radially deviated hand).

Acute symptoms include pain, severely limited ROM, gross deformity, and swelling of the wrist and hand. There may be a firm, tender mass or palpable step off. The patient may also have impaired sensation and motor function of the hand.

The patient will typically present for physical therapy treatment following surgical stabilization, ligament repair, and postoperative immobilization. Treatment will depend on the surgical procedure and physician orders. Examples of physical therapy treatment include soft tissue mobilization, therapeutic exercise (e.g. passive and active range of motion, strengthening) and modalities (e.g. ultrasound).

You can read the Clinical Review on "Lunate Dislocation" by logging into your subscription of Rehabilitation Reference Center. 

Recently the clinical review "Hamstring Strain" was revised following review under the systematic literature surveillance system.

Information of value to physical therapy practice regarding hamstring strain was a recent Cochrane systematic review and a recent research study. The authors of the systematic review analyzed studies involving four interventions for preventing hamstring strains: a strengthening protocol, manual therapy, a proprioceptive neuromuscular training protocol, and a warm-up cool-down, stretching protocol. There was insufficient evidence to draw conclusions on interventions.

Conclusions drawn from the results of the research study indicate that there are no differences in quadriceps strength when compared to hamstring strength in athletes with and without hamstring injuries. What they did find was the ratio of eccentric hamstring strength to concentric hip flexor strength being lower in the athletes with a previous hamstring injury.