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Purpose] The purposes of this case study are to: (1) report the immediate effects of knee flexion range of motion following manual therapy (MT) and self-stretching/AROM following a total knee arthroplasty (TKA).(2) contribute empirical evidence to the literature through reports within this case study. [Participant and Methods] For 6 days, the authors utilized a different MT technique and 1 day of self-stretching and active range of motion for an 85-year-old male who was 3 days status post right TKA.[Results] The greatest gains for AROM/PROM for knee flexion were achieved while performing typical arthrokinematic motion joint mobilizations, for AROM and PROM, resulting in a gain of 10 degrees and 10 degrees, respectfully. [Conclusion] We theorize that performing typical arthrokinematic motion joint mobilizations stimulates a greater response from the mechanoreceptors and therefore a greater stimulation response to the central and peripheral nervous systems. This greater stimulation may explain the greatest immediate gain in knee flexion range of motion being performed by typical arthrokinematic motion joint mobilizations. The outcomes of this study demonstrate the start of some empirical evidence while exploring the immediate effects of knee flexion range of motion following manual therapy and self-stretching/AROM following a TKA.

Objective: To identify trends of provoked dysautonomia signs and symptoms during the Buffalo Concussion Treadmill Test (BCTT). Subjects: This is a retrospective cohort study of 101 patient charts post-concussion who were screened for suspected dysautonomia. Methods: Patients with suspected dysautonomia were assessed for exercise intolerance using a BCTT. Symptoms and rate of perceived exertion were recorded on a standardized form. Digital pulse oximetry was used to collect heart rate (HR) and oxygen saturation. Descriptive analyses were conducted on BCTT results. Results: Of 101 patient charts, 57 were excluded from analysis, including four patients who completed the BCTT by asymptomatically reaching the target HR zone for their estimated HR max. The remaining 44 patients demonstrated: 35 (79.5%) poor HR stabilization defined as a drop or plateau in HR during exercise, 28 (63.8%) exacerbated concussion symptoms, 13 (29.5%) autonomic nervous system response such as hot flushed sensation, 12 (27.3%) rebound symptoms during recovery phases, and 8 (18.2%) desaturation of 90% or below. The mean delta (80% expected HR max – 80% achieved HR max) on the initial test was 80.66 (± 23.08) beats per minute. Conclusions: This study is the first to identify trends of signs and symptoms during the BCTT in an expanded population with suspected dysautonomia after concussion. Future studies are indicated to validate these findings and contribute to development of modified termination criteria for the BCTT in individuals with suspected dysautonomia associated with protracted concussion recovery.

Background: Physical Therapy management of Postural Orthostatic Tachycardia Syndrome (POTS) symptoms is not currently well established. Purpose: To report the outcomes of a multimodal exercise program for a patient with POTS. Methods: The patient was a 25 year old female with a primary diagnosis of POTS. The patient attended 30 physical therapy sessions, approximately 60 minutes each, over 12 weeks. The patient participated in a multimodal exercise program (aerobic, functional, and strength) that utilized patient-controlled and therapist-controlled rest intervals. Outcomes were measured every 4 weeks. Outcomes: Using the SF-36 outcomes, the patient reported the largest improvements between sessions 23-30. These changes in Physical Functioning, Role limitations due to Physical Health, and Pain were 15%, 50%, and 22.5% respectfully. The largest improvements were in average subjective reports of lightheadedness, dizziness, and chest palpitations occurring between visits 1-13 and 14-22, a change of 26.2%. Conclusion: This was the first study that has investigated a multimodal exercise program (aerobic, functional, strength) that utilized rest interval management as a strategy for exercise progression in a patient diagnosed with POTS. The incorporation of multimodal training methods (aerobic, functional, strength) stimulated positive effects to the parasympathetic nervous system and thus improved average subjective reports of lightheadedness, dizziness, chest palpitations and quality of life in this patient diagnosed with POTS

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