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Thereaputic Exercise and Treatment

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Each treatment session began with ASTYM provided by the certified physical therapist to both anterior lower extremities with the patient seated in order to break up fibrotic tissue and regenerate new healthy tissue. Each treatment session for the first four weeks ended with the patient lying supine with Normatec compression boots on both lower extremities at level three for 15 minutes to decrease edema. For the first two weeks manual therapy included medial to lateral glides of bilateral tibias with PROM knee flexion x six reps each with the patient supine. Bilateral patellas were mobilized superiorly and inferiorly using a grade IV mobilization x six reps each every treatment session. Manual stretching with the patient in supine was performed next with PROM knee flexion to both lower extremities x 6 reps. During the third week of treatment, the manual therapy progressed to grade III bilateral posterior tibia glides and bilateral PROM knee flexion in prone x 6 reps each. Also during the third week of treatment, high speed vibration therapy using Rapid Release Technology was introduced to the patient and applied to both medial and lateral knees moving one inch/per second in all directions for approximately four minutes to decrease scar tissue. At the next treatment session, the vibration therapy was performed with the Vibracussor tool for four minutes at level eight in all directions to both IT bands and lateral knees to decrease myofascial restrictions. These mobilizations along with vibration therapy continued for the rest of the time the student therapist worked with the patient.

Each week PROM bilateral knee flexion was measured after manual therapy. During the second week of treatment, PROM bilateral knee flexion was measured...

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...her research studies need to be done that focus on a couple of specific interventions and their outcomes on patients who have undergone bilateral total knee arthroplasty. For example, further research could be done to see which intervention has the most success with increasing bilateral knee flexion in patients who are status post bilateral total knee arthroplasty.

Conclusion
This case report highlights the physical therapy plan of care for a 64 year old patient who underwent a bilateral total knee arthroplasty. The plan of care was administered by a physical therapy student under the close supervision of a licensed physical therapist. This case report describes the patient’s treatment, tests and measures, exercises, and progress while being seen at the outpatient clinic from the initial evaluation until the end of the physical therapy student’s clinical rotation.
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