CASE: 02

Knee osteoArthritis
Ghulam Mustafa , a 77 -year-old male came to OPD with the complaint of pain , swelling and
stiffness predominantly in the both knees anterior and posterior and difficulty in walking since
2015 with no history of trauma or injury. According to the patient, he worked in private
company but retired now . He is married and lives in a nuclear family at safoora. . He is
financially stable. He was diagnosed with hypertension and Diabetes, for which he uses
Glucopage ,tenormin and Advil Table. His mother was also diabetic .
ASSESSMENT: On assessment, we see that patient has slouch posture with movement limited
including both flexion and extension in both knees . Patient uses crane to walk with the help of
Assistant. His sensory status was intact while have short sightedness. It is also observed that
patient had lost his 3 teeth out of 32 .his BP was high that is 140/90 in lying .
Coordination Assessment:

● Finger- to- Nose= Good

Balance Assessment:

● Push test = positive while standing. Unable to balance himself .

Scales Scoring:
1) MINI-COG SCALE:
Is used for screening dementia. As our patient scored 2 points which means he is
cognitively un stable and positive screened for dementia.

2) KATZ INDEX of Independence, Activities of Daily Living (ADLs):

His total score was 5/6 which shows he was independent in other activities but needed
assistance in physical ambulation .

3) (LAWTON- BRODY) Instrumental Activities of Daily Livings (IADLs):

His total score was 3/5 which suggests that he was not fully independed .
 4) (TINETTI) Performance Oriented Mobility Assessment (POMA):
His balance score was 9/16 .

5) POMA GAIT SECTION:

He scored 9/12 in the gait section

Total Gait Score = (9+9) = 18, 18/28 which means he has high risk of falling.

REHABILITATION PROTOCOL:
SESSION: 01

● Cold pack to reduce swelling for 10 minutes

● Ultrasound for 10 minutes

● AP glides grade 1 and 2 for pain (3 sets of 10 reps)

● Patellar glides (3 sets of 10 reps)

● Quad Drills for the strengthening of quadriceps (2 kg on each side, 15 times each leg)

● Heel press for strengthening of hamstring

● Static quads for strengthening (10-reps each knee)

● Ankle pumping (10 reps each)

● Reciprocal Pattern (For the development of Arm Swing) Training first Right hand and left
foot then Left hand and right foot (10 times each side)
● Heel Raise for the strengthening of calf muscles (Functional exercise for ankle mobility
and stability) (10-sec hold, 10 reps)
● Toe Raise for the strengthening of tibialis anterior (Functional exercise for ankle mobility
and stability) (10-sec hold, 10 reps)
● Side Walk / Lateral Walk for strengthening of Gluteus and Hip Abductors (It improves
flexibility, stability and prevents from injuries) (10 mins)
● Gait training with Parallel bars (Tandem Walk) (To improve balance and mobility) (10
mins)
● Unilateral Bridging (for strengthening of core muscles, muscles of back and helps to
stabilize the spine) (10 reps)
 ● Retraction of shoulder with chin tuck in (To improve slouch posture) (10 reps)

Home Exercise Plan: cold pack , Reciprocal Pattern, Bridging, Heel raise, Toe raise
SESSION: 02

● Cold pack to reduce swelling for 10 minutes

● Ultrasound for 10 minutes

● AP glides grade 1 and 2 for pain (3 sets of 10 reps)

● Patellar glides (3 sets of 10 reps)

● Quad Drills for the strengthening of quadriceps (2 kg on each side, 15 times each leg)

● Heel press for strengthening of hamstring

● Static quads for strengthening (15-reps each knee)

● Ankle pumping (15reps each)

● Reciprocal Pattern (For the development of Arm Swing) Training first Right hand and left
foot then Left hand and right foot (10 times each side)
● Heel Raise for the strengthening of calf muscles (Functional exercise for ankle mobility
and stability) (10-sec hold, 10 reps)
● Toe Raise for the strengthening of tibialis anterior (Functional exercise for ankle mobility
and stability) (10-sec hold, 10 reps)
● Side Walk / Lateral Walk for strengthening of Gluteus and Hip Abductors (It improves
flexibility, stability and prevents from injuries) (10 mins)
● Unilateral Bridging (for strengthening of core muscles, muscles of back and helps to
stabilize the spine) (10 reps)
● Gait training with Parallel bars (Tandem Walk) (To improve balance and mobility) (10
mins)
● Retraction of shoulder with chin tuck in (To improve slouch posture) (10 reps)

HEP: As given before.