Abstract
A 56-year-old female patient with left total knee replacement was seen at an outpatient physical therapy clinic for 16 sessions. Treatments were provided over an eight-week period by a student physical therapist under the supervision of a licensed physical therapist. The patient presented with a front wheel walker and was evaluated at the initial encounter with Wells criteria, girth measurements, Numeric Pain Rating Scale, goniometry, manual muscle tests, Lower Extremity Functional Scale, Single Leg Standing, Five Times Sit-To-Stand, and gait evaluation. Main impairments included: increased body mass index; edema of left knee; decreased range of motion of left knee extension and flexion; and decreased strength of left knee, hip and ankle muscles. Impairments contributed to activity limitations such as: decreased balance, inability to sitto- stand, gait deviations, decreased sitting and standing tolerance, and inability to kneel, climb stairs and drive. Activity limitations restricted her ability to grocery shop and contribute to her garden club. Based on the test results, a plan of care was established. The main goals for the patient were to decrease swelling and pain, while improving range of motion, strength, and static and dynamic balance during functional activities. Interventions used were ice as a modality, manual therapy, strength training, over-ground gait training, task specific and functional training of sit-to-stand, kneeling, and ascending and descending stairs. The patient improved the strength in her left lower extremity. She met her goals in decreasing edema, increasing range of motion, improving balance and gait deviations, while gaining independence with functional activities such as sit-to-stand and climbing stairs without the use of an assistive device. She was discharged to continue living at home with a home exercise program.