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Acute rehabilitation of a patient with total knee arthroplasty in the setting of bipolar disorder
A patient with a complex history of mental illness received a right total knee arthroplasty during the summer of 2016 and was seen for physical therapy treatment for 5 sessions in an acute care hospital setting. Treatment was provided by a student physical therapist (SPT) under the guidance and supervision of a licensed physical therapist. The patient was evaluated with manual muscle testing, goniometry, numeric pain rating scale, two-minute walk test, and levels of assistance. The results of these assessments were evaluated and a plan of care was established to address the patient’s specific impairments and activity limitations. The plan of care addressed the patient’s reduced right knee range of motion, weakness of bilateral hips and right knee, pain while resting and with movement, limited endurance, and impaired bed mobility, transfers and gait. The main goals set for this patient were to improve range of motion in the surgical knee and gain independence in transfers, bed mobility, and gait. Interventions included range of motion exercises, functional mobility training, and cryotherapy. The patient improved independence with all functional mobility activities, increased right knee range of motion, and experienced a reduction in pain with movement by the time of discharge. The patient was safe to discharge home with assistance of a caregiver, and was discharged with a progressive, individualized home exercise program, continuous passive movement device, and orders for home health physical therapy.