Therapy, Level 1b.

This report describes the examination, intervention, and outcomes for a patient with Complex Regional Pain Syndrome I (CRPS I) treated with Strain Counterstrain (SCS). The patient was diagnosed with CRPS I following a Grade II ankle sprain. Treatment consisted of SCS once per week for six months with one additional session each week in Months 4 through 6 for strengthening, endurance, and gait training. A re-examination was performed monthly. A clinically signifi cant decrease of 2 points in overall pain as measured with a numeric pain rating scale (NPRS) occurred as of Month 2; a 2-point decrease in tenderness on 10 of 13 SCS tender points also measured with an NPRS was documented as early as Month 1. Throughout the treatment period, an increase in function was noted by way of patient report and objective tests and measures. Gait improved with regard to cadence, use of an assistive device, and weight-bearing status. Single limb stance on the involved leg increased from 0 (s) to 40 (s) over the course of treatment and ankle active range of motion as measured with a goniometer and muscle strength as measured with manual muscle tests both returned to normal values. CRPS I remains a poorly understood and diffi cult-to-treat chronic syndrome. By way of its proposed effects on the neuromuscular system and facilitated segments, SCS may be an additional effective treatment tool in the management of some patients diagnosed with CRPS I.

No abstract

Objectives: To determine the reliability and validity of the Saliba Postural Classification System (SPCS). Methods: Two physical therapists classified pictures of 100 volunteer participants standing in their habitual posture for inter and intra-tester reliability. For validity, 54 participants stood on a force plate in a habitual and a corrected posture, while a vertical force was applied through the shoulders until the clinician felt a postural give. Data were extracted at the time the give was felt and at a time in the corrected posture that matched the peak vertical ground reaction force (VGRF) in the habitual posture. Results: Inter-tester reliability demonstrated 75% agreement with a Kappa = 0.64 (95% CI = 0.524-0.756, SE = 0.059). Intra-tester reliability demonstrated 87% agreement with a Kappa = 0.8, (95% CI = 0.702-0.898, SE = 0.05) and 80% agreement with a Kappa = 0.706, (95% CI = 0.594-0818, SE = 0.057). The examiner applied a significantly higher (p < 0.001) peak vertical force in the corrected posture prior to a postural give when compared to the habitual posture. Within the corrected posture, the %VGRF was higher when the test was ongoing vs. when a postural give was felt (p < 0.001). The %VGRF was not different between the two postures when comparing the peaks (p = 0.214). Discussion: The SPCS has substantial agreement for inter-and intra-tester reliability and is largely a valid postural classification system as determined by the larger vertical forces in the corrected postures. Further studies on the correlation between the SPCS and diagnostic classifications are indicated.

Background: Individuals with proximal femoral focal deficiency (PFFD) present with a shortened femur. This report highlights the process used to determine prosthetic candidacy, a novel use of the International Committee of the Red Cross (ICRC) prosthetic materials, and subsequent rehabilitation when treating in rural Haiti. Case Description and Methods: An eight-year-old boy with PFFD whose goal was to walk 'normally' presented with a shortened right leg and typical foot/ankle. Concerns regarding ability to safely load the leg were mitigated after finding he could fully load his right limb, control motion, and had no fractures. Findings and Outcomes: A unique prosthosis incorporating a donated hinged ankle-foot orthosis, ICRC materials and a SACH foot was fabricated. Physical therapy followed for two weeks, progressing from static weight-bearing and gait training to dynamic balance activities. At discharge, the patient walked independently using the prosthosis and one forearm crutch. Conclusion: Through collaboration and innovation rehabilitation goals can be realized even when presented with limited resources. Clinical relevanceThrough collaboration and innovation novel prosthetic designs incorporating materials from the International Committee of the Red Cross can be created and rehabilitation goals can be realized even when presented with limited resources.