Science Meets Practice: ACL Rehab: Motion Analysis, Isokinetics, EMG, fmri Now What Do I Do for My Patient on Monday?

Transcription

1 Science Meets Practice: ACL Rehab: Motion Analysis, Isokinetics, EMG, fmri Now What Do I Do for My Patient on Monday? Speakers: Terry L. Grindstaff, PhD, PT, ATC Dan Lorenz, DPT, PT, ATC/L, CSCS APTA Combined Sections Meeting American Academy of Sports Physical Therapy Thursday, January 24, 2019: 11:00 AM- 1:00 PM Washington D.C. Course Description: This session focuses on assessment and treatment of persistent muscle dysfunction following ACL injury and reconstruction. Four platform presenters provide insights into contemporary research and then consider the implications of this work through a moderator-led case-study discussion. Since many outpatient physical therapy clinics do not have research laboratory technology, the panel discusses key elements of research findings in context to strategies that can be applied in a typical clinical setting. The session concludes with audience questions and discussion with platform presenters and panel members. Course Learning Objectives: 1. Apply current research to ACL rehabilitation clinical cases. 2. Observe a clinical decision-making model to inform treatment selection based on relevant neurophysiological assessment methods used for individuals following ACL reconstruction 3. Select appropriate interventions to address neurophysiological impairments following ACL reconstruction. Session Outline: 00:00-00:05 Introduction and overview of session format 00:05-00:29 Presentation of 4 research abstracts related to emerging areas of ACL reconstruction research. 00:30-00:40 Moderator-led Q&A/summary of session (TBD) 00:41-01:00 Case study presentation (TBD) with application of current research from abstract presenters 01:00-01:20 Dialogue #1: Assessment of neuromuscular effects of ACL injury: from the research lab to the clinic (Grindstaff) 01:20-01:45 Dialogue #2: Clinical approach to addressing neuromuscular impairments following ACL reconstruction (Lorenz) 01: Moderator-led Q&A/summary of session (TBD)

2 Dialogue #1: Assessment of neuromuscular effects of ACL injury: from the research lab to the clinic (Grindstaff) Clinical Toolbox (Gokeler et al, 2017; Adams et al, 2012) I. Effusion- less effusion à better function (Sturgill et al, 2009) II. Balance a. Star Excursion Balance Test (Y Balance Test) i. Early deficits may be indicative of weakness and impact hop performance at return to sport (Clagg et al, 2015; Garrison et al, 2015) III. Muscle Function a. Isokinetic dynamometer, hand-held dynamometer, isotonic leg extension (Hansen et al, 2015; Bove et al, 2015) i. Obtain objective/quantifiable measure ii. Symmetry and normalized strength to reference standard important (Wellsandt et al, 2017; Zwolski et al, 2016; Pietrosimone et al, 2016; Kuenze et al, 2015) iii. Better strength à Better function (Hartigan et al., 2012; Logerstedt et al., 2013; Schmitt et al, 2012) 1. Early measures predict later. Presurgical and early rehab important b. Quadriceps weakness contributing factors are neurological (e.g. quadriceps inhibition) and peripheral (atrophy) (Ingersoll et al, 2008; Rice and McNair 2010; Pietrosimone et al, 2012). i. Must address cause of weakness (Pietrosimone et al, 2015) IV. Jumping Performance and Quality (Schmitt et al, 2012, 2015; Gokeler et al, 2017) a. Battery of hop tests (vertical, forward, lateral, drop jump) i. Unilateral > Bilateral ii. Symmetry and normalized performance values to reference standard important iii. Early measures predict later iv. Better performance à Better function V. Patient Reported Outcome Measures (Collins et al, 2011) a. IKDC vs KOOS (Hambly et al, 2010) i. Lower scores à strength and hop deficits likely (Logerstedt et al, 2014) ii. Normal scores adequate strength and hop performance b. TSK-11 vs ACL-RSI (Muller et al, 2015)

3 Dialogue #2: Clinical approach to addressing neuromuscular impairments following ACL reconstruction (Lorenz) I. Introduction a. To maximize quad activation: i. Reduce swelling ii. Maximize extension ROM loss of extension affects subjective outcomes (Shelbourne et al, AJSM 2009) 2. Infrapatellar Contracture Syndrome (Paulos et al, AJSM 1987) iii. Initiate and sustain a quad contraction iv. Early WB (Tyler et al, 1998) v. Russian Stim (Arvidsson et al, Orthop 1986; Delitto A et al, PTJ 1988; Fitzgerald et al JOSPT 2003; Lieber et al, J Orthop Res 1996) II. Strengthening Phases a. Eccentrics (Gerber et al, 2006; 2007;2009) b. OKC knee extension (Fukuda et al, AJSM 2013; Perry et al, KSSTA 2005; Tagesson et al, AJSM 2008)JSM 20)08; Glass et al, NAJSPT 2010 III. Physical Qualities of Performance (Lorenz 2016; Lorenz et al, 2011, 2015; Reiman and Lorenz 2011) a. Hypertrophy b. Strength c. Power IV. Single v. Double leg training a. TONS of literature show single limb deficits after ACLR b. When do you transition to double leg? V. Partial or deep squat? (Bloomquist et al, Eur J Appl Physiol 2013; Contreras et al, J Appl Biomech 2016; Bryanton et al, JSCR 2012) a. Bottom line: Deeper you go, the more relative muscular effort of the quads and glutes

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