Brk Case Study Exercise

Procedures- The interventions were provided by the author and two clinicians. B.H underwent 30 to 45 minutes for a duration of 18 months. The two main practice interventions during this case report were to restore gait. Initial evaluation showed a decrease in strength B.H were given strengthening activities such as sitting on a therapy ball doing tossing tasks, and tall kneeling. While using her ankle orthotics, she was given task-specific walking activities.

Standing Activities- Standing activities were given from week 2 to month 10. To help with standing, B.H were given custom posterior leg troughs with Aquaplast. These helped her with standing balance, a lumbar lordosis by extending her legs. Standing activities were done in bouts of 15s to 2 min, with a total of 21 treatments sessions.
Locomotor treadmill training(LTT)-
The LTT began at week 3 and continued for 48 weeks.
The session occurred 1.5 times a week. A 1.5 cm lift was placed on the outside of her shoe to help correct the leg length discrepancy. The initial body weight was 30%. The body weight gradually decreased as improvements in stepping responses were seen in B.H gait parameters. Her initial speed started a .5 mph, but as her skills increase, the speed was increased as well. B.H had one person for each limb and one person to stabilize her trunk, for a total of 3 people used for assistance. Each treatment session was 4-15 minutes, with a total of 73 total training sessions.
Over Ground walking-
B.H starting this intervention at week 4, after starting LTT. B.H used many different assistive devices such as a rolling walker with and without bilateral forearm platform attachment, and platform walker. The platform walker was chosen as the best assistive device that was used by B.H because of weak leg muscles. A total of 137 sessions were given.
Orthoses-
B.H had a hinged Tamarack Joint AFO with a plantar flexion stop for the left leg, but was given a new AFO design for this case report. She was also given an AFO for her right leg, which she did not have before this study. The new AFo design double adjustable ankle joints. After 12 months she was given a new ankle foot orthosis for her weak quadriceps on the left. This helped her to walk independently in the community, after 10 weeks the thigh component of the KAFO was removed.After 3 months she was given addition spinal stability(A Boston brace). She progressed to a soft design, ending with a custom orthotic with a supporting bar and right lateral upright padding.

NMES- At 4 months B.H began NMES to help with knee extension in both knees to facilitate walking over the ground and on the treadmill. An Empu 300 PV unit was used when training. By the 15 months, B.H used the stimulation on both quadriceps throughout the day with a heel switch in her right shoe. There as a total of 126 session involving lasers.