Patient Profile: Trauma
Browse resources on patients with traumatic conditions that are commonly observed in the acute inpatient rehab setting.
Please click on a topic or see what catches your interest down below.
Trauma Collection
Conditions
From the authors: "High-energy, open fractures are often associated with other life-threatening conditions secondary to poly-trauma and pose other risks such as neurovascular injuries, soft tissue crushing, wound contamination and skin degloving which makes them more likely to have complications."
+ Sop JL, Sop A. Open Fracture Management. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448083/
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From the authors: "For patients themselves, sustaining a hip fracture is a potentially catastrophic event. Approximately 30% will die during the first year following this injury3 and those who survive will have an appreciable ongoing burden of illness affecting their quality of life."
+ Hip fracture: management. London: National Institute for Health and Care Excellence (NICE); 2023 Jan 6. (NICE Clinical Guidelines, No. 124.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK553768/
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From the authors: "The most severe complications related to rib fractures are the flail chest and damage to the underlying structures. Solid organ injuries associated with rib fractures include liver injuries and splenic injuries. Typically, the higher the rib fracture is within the thoracic cage, the more likely it is to cause a liver or splenic injury. Particular attention needs to be paid for the patient's respiratory status, as rib fractures may cause the patients to go on and develop acute respiratory failure due to poor respiratory efforts and may need mechanical ventilation and surgical stabilization."
+ Kuo K, Kim AM. Rib Fracture. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541020/
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From the authors: "The majority of lower limb amputations occur secondary to ischemia, while trauma is the leading cause of amputation of the upper extremity. Regardless of etiology, surgical technique focuses on salvaging tissue to maximize postsurgical mechanical function. A variety of general surgical principles are followed such as gentle handling of soft tissues, clean transection of nerves, and appropriate engagement of muscular tissue through myodesis or myoplasty. A clean and proximal nerve transection is of great importance. Without retraction of the nerve into muscle tissue, patients may experience an increased risk of a sensitized neuroma at the interface of the distal stump and the prosthesis."
+ Michael L. Kent, Hung-Lun John Hsia, Thomas J. Van de Ven, Thomas E. Buchheit, Perioperative Pain Management Strategies for Amputation: A Topical Review, Pain Medicine, Volume 18, Issue 3, March 2017, Pages 504–519, https://doi.org/10.1093/pm/pnw110
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From the authors: "Specifically, severe postoperative pain has been associated with serious complications including ischemic cardiac events and myocardiac insufficiency that result from increased stress on the cardiovascular system. In addition, immobilization caused by pain may increase the risk of decreased pulmonary function, gastrointestinal complications, such as ileus, and thrombus formation that are related to surgical stress. An increase in stress hormone and sleep disorder due to severe pain can worsen the already decreased immunity, which leads to higher risk of infection. In particular, this may affect the mental status of elderly patients, causing delirium or anxiety disorder. Uncontrolled severe immediate postoperative pain can develop into chronic pain due to the sensitization of the nerve system. Accordingly, early rehabilitation and recovery can be delayed, resulting in longer hospitalization, higher medical costs, and more burden on the health care provider."
+ Korean Knee Society. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res. 2012;24(4):201-207. doi:10.5792/ksrr.2012.24.4.201
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From the authors: "Recent reviews on burns have focused on intensive care-related wound management, the metabolic response, hypertrophic scarring,15 smoke inhalation, anesthetic and hemodynamic considerations, and developments in surgical techniques; however, to our knowledge, this is the first review in recent years encompassing surgical, perioperative, anesthetic, and intensive care management."
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+ Lang TC, Zhao R, Kim A, et al. A Critical Update of the Assessment and Acute Management of Patients with Severe Burns. Adv Wound Care (New Rochelle). 2019;8(12):607-633. doi:10.1089/wound.2019.0963
Rehabilitation
Regaining Functional Independence in the Acute Setting Following Hip Fracture
From the author: "Patients who ambulated independently prior to their hip fracture and patients who on average received more than one physical therapy treatment per day had increased odds of independence in performing supine-to-sit, sit-to-supine, and sit-to-stand transfers and ambulating with a walker prior to discharge from the acute care setting. Patients who achieved independence in these four functional mobility activities, patients who did not experience postoperative complications, and patients who on average received more than one physical therapy treatment per day had improved odds of discharge directly to the home from the acute care setting."
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+ Andrew A Guccione, Timothy L Fagerson, Jennifer J Anderson, Regaining Functional Independence in the Acute Care Setting Following Hip Fracture, Physical Therapy, Volume 76, Issue 8, 1 August 1996, Pages 818–826, https://doi.org/10.1093/ptj/76.8.818
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Assessing Mobility & Physical Function in Patients With Traumatic Injury in the Acute Setting
From the authors: "Clinical utility was demonstrated for the “6 Clicks” short forms, mILOA, and ACIF regarding time taken, with all quick to administer (from 30 seconds to 1 minute extra each), whereas the FIM required a median of 5 minutes extra. None of the measures had any floor effects, but ceiling effects were present for all measures except the FIM in the final physical therapy session (18%–33% of participants). All measures had excellent interrater reliability (ICC = 0.79–0.94) and strong known groups validity. All were responsive to change in mobility and physical function during the acute hospital admission."
+ Sara Calthorpe, Lara A Kimmel, Mark C Fitzgerald, Melissa J Webb, Anne E Holland, Reliability, Validity, Clinical Utility, and Responsiveness of Measures for Assessing Mobility and Physical Function in Patients With Traumatic Injury in the Acute Care Hospital Setting: A Prospective Study, Physical Therapy, Volume 101, Issue 11, November 2021, pzab183, https://doi.org/10.1093/ptj/pzab183
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TUG Test as a Predictor of Falls Within 6 Months After Hip Fracture Surgery
From the authors: "The analyses of all predictors were examined, and the categorical outcome of 1 or more falls versus no falls showed that only the TUG performed at discharge with a cutoff point of 30 seconds was significantly (P=.02) associated with falls. All subjects used walking aids when performing the TUG, and a progressive tendency toward falls was seen with the use of more assistive aids."
+ Morten T Kristensen, Nicolai B Foss, Henrik Kehlet, Timed “Up & Go” Test as a Predictor of Falls Within 6 Months After Hip Fracture Surgery, Physical Therapy, Volume 87, Issue 1, 1 January 2007, Pages 24–30, https://doi.org/10.2522/ptj.20050271
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Lower Extremity Amputee Rehabilitation Protocol: A nationwide, 123-year experience
From the authors: "In this [early] period, surgical wound care, pain, edema, positioning and preventing contracture and exercises are the main steps of rehabilitation program. In addition, joint ROM and muscle strength should be maintained, stump should be shaped, and early mobilization should be applied.[8] Education for daily living activities and psychosocial support should be provided to the individual and his family."
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+ Demir Y, Aydemir K. Gülhane lower extremity amputee rehabilitation protocol: A nationwide, 123-year experience. Turk J Phys Med Rehabil. 2020;66(4):373-382. Published 2020 Nov 9. doi:10.5606/tftrd.2020.7637
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PT Management of Total Knee Arthroplasty
From the authors: "Physical therapist management should start within 24 hours of surgery and prior to discharge for patients who have undergone TKA."
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+ Diane U Jette, Stephen J Hunter, Lynn Burkett, Bud Langham, David S Logerstedt, Nicolas S Piuzzi, Noreen M Poirier, Linda J L Radach, Jennifer E Ritter, David A Scalzitti, Jennifer E Stevens-Lapsley, James Tompkins, Joseph Zeni Jr, for the American Physical Therapy Association, Physical Therapist Management of Total Knee Arthroplasty, Physical Therapy, Volume 100, Issue 9, September 2020, Pages 1603–1631, https://doi.org/10.1093/ptj/pzaa099
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Determining Current Physical Therapist Management of Hip Fracture in an Acute Care Hospital
From the authors: "...focusing on walking and transfer training, which can be combined with daily functional tasks, including showering and toileting, can be a faster means of administering some form of therapy compared with supervising a patient through an individualized exercise program."
+ Susie Thomas, Shylie Mackintosh, Julie Halbert, Determining Current Physical Therapist Management of Hip Fracture in an Acute Care Hospital and Physical Therapists' Rationale for This Management, Physical Therapy, Volume 91, Issue 10, 1 October 2011, Pages 1490–1502, https://doi.org/10.2522/ptj.20100310
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Physiotherapy Management of Patients with Trunk Trauma: A State-of-the-Art Review
From the authors: "Body function and structure impairments (ICF) that patients with trunk trauma present with clinically include impairments in active shoulder joint and trunk range of motion (ROM) (pain from rib fractures, presence of ICD tubing and distention of the abdomen); temporary weakness of the arm on the affected side of the thorax (because of compression of ICD tubing on the first thoracic nerve of which the superior part joins the brachial plexus or compression on the third to sixth intercostal nerves which affects serratus posterior muscle action); protective side-flexed trunk posture towards the affected side of the thorax (pain from rib fractures, ICD or postoperative); protective flexed trunk posture (postoperative abdominal pain); and generalised muscle wasting and weakness and poor cardiorespiratory exercise endurance in those who suffer more severe injury."
+ van Aswegen H. Physiotherapy management of patients with trunk trauma: A state-of-the-art review. S Afr J Physiother. 2020;76(1):1406. Published 2020 Jun 11. doi:10.4102/sajp.v76i1.1406
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Acute Inpatient Rehabilitation Interventions and Outcomes for a Person With Amputation
From the authors: "The ability to functionally ambulate was Jane's initial hope and goal. A component of her progress toward meeting that goal was participating in a focused, directed treatment plan that took into account not only her mobility impairments, but also her musculoskeletal and cardiovascular needs. This case report describes a treatment plan that went beyond standard preprosthetic care and documents significant changes in this patient's functional abilities."
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+ Sharon L. Kimble, Acute Inpatient Rehabilitation Interventions and Outcomes for a Person With Quadrilateral Amputation, Physical Therapy, Volume 97, Issue 2, February 2017, Pages 161–166, https://doi.org/10.2522/ptj.20160044
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Rehabilitation of the Burn Patient
From the authors: "Patients may want to delay their rehabilitation until they feel better; however, every day without burn therapy intervention will make the eventual rehabilitation process more difficult and painful and may result in a poorer outcome. If windows are missed, they cannot be regained easily, since the inevitable sequelae of ever-increasing joint stiffness and tethered soft-tissue glide become more and more devastating with the passage of time. Patients may try to refuse treatment as they are in pain and may not understand fully the impact of not participating in their rehabilitation; they therefore need the support and encouragement of the burn care professionals to help them through this difficult experience with the knowledge of how different their quality of life can be."
+ Procter F. Rehabilitation of the burn patient. Indian J Plast Surg. 2010;43(Suppl):S101-S113. doi:10.4103/0970-0358.70730