• A Knee Blowout Complicated by Fibular Nerve Damage and the COVID-19 Pandemic: A Case Report

      Dieckmann, Ansley; Ebert, Jeffrey (2021)
      While an anterior cruciate ligament (ACL) injury is the most common knee injury, it typically does not occur in isolation. Increased age and contact injuries have been associated with a higher incidence of concomitant damage. The impact of traumatic nerve injury on rehabilitation of the knee is not widely discussed in current literature and optimal timing of ACL reconstruction surgery is not largely agreed upon. Prehabilitation and rehabilitation are provided for patients who undergo knee reconstructive surgery. The purpose of this study is to examine the rehabilitation of a patient status post knee reconstruction when complicated by COVID-19 and fibular nerve damage. This study examines the rehabilitation of a 23-year-old male s/p ACL and LCL reconstruction. The patient presented to a physical therapy (PT) clinic following surgery and revealed that the initial injury occurred 3 months prior, but intervention was delayed due to the COVID-19 pandemic. The nerve damage and delay in intervention altered his rehabilitation and current functional ability. Outcome measures used include the Lower Extremity Functional Scale, ranges of motion of involved joints, and manual muscle testing. This report details a case complicated by fibular nerve damage and delayed intervention after a severe knee injury. The complications led to impaired safety and function prior to surgery and interfered with PT. The patient may have had minimal difficulties when recovering without these complications.
    • Acute Pancreatitis: Evaluation and Management Recommendations in a Critical Care Setting

      Adeyeye, Yomi; Martinelli, LeAnne (2021)
      Acute pancreatitis (AP) is the most common cause of gastrointestinal hospitalizations in the United States. Gallstones and alcohol abuse are its most common underlying etiologies. With AP consistently adding to the hospital burden across America every year, initial management and prompt recognition of a severe AP presentation have become cornerstones for decreasing morbidity and mortality in AP patients. The introduction of severity scoring to the evaluation of AP patients has been essential for drastically decreasing morbidity and mortality. However, with so many severity scores to choose from, along with the controversies with management, how can we ensure that we are providing the best care for AP patients? It is crucial to understand the principles of evaluating and managing AP in order to provide excellent care for patients with this common disease. My capstone project looks to compare and contrast severity scoring systems while also providing evidence for the best diagnostic and management modalities for AP patients.
    • Addressing Fear-Avoidance Beliefs in a Veteran with Sub-Acute Low Back Pain Who Is Non-Ambulatory

      Ferrari, Sofia; Taylor, Leslie F. (2021)
      Purpose: The aim of this case report is to discuss physical therapy management of a 59-year-old male veteran with sub-acute low back pain and elevated fear-avoidance beliefs about walking. Case Description: The patient is a 59-year-old male who was referred to physical therapy for evaluation and treatment of "Sciatica, right side." The patient was non-ambulatory for one month preceding his first physical therapy visit. His primary impairments on initial evaluation were elevated fear-avoidance beliefs, lower quarter weakness, and impaired gait mechanics. Interventions: Physical therapy management included strategies to address fear-avoidance beliefs in combination with gait training and lower quarter strengthening. Strategies used to manage fear-avoidance beliefs included patient education with cognitive restructuring, graded exposure in vivo, one-on-one patient care, and development of a therapeutic relationship. Outcomes: Fear-avoidance beliefs, disability, and gait were assessed at initial evaluation, 5 weeks, and 8 weeks (discharge). All outcome measures exceeded a minimal clinically important difference from initial evaluation to discharge. Conclusions: The patient demonstrated improvements in all functional outcome measures and was ambulating independently after eight weeks of physical therapy interventions aimed at reducing fear-avoidance behaviors.
    • An Update on Nonalcoholic Fatty Liver Disease (NAFLD)

      Kang, Anna; Dickerson, Lisa (2021)
      Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease with a prevalence of 25% worldwide. NAFLD is categorized into nonalcoholic fatty liver (NAFL), or simple steatosis, and the more severe form, nonalcoholic steatohepatitis (NASH), a combination of fatty liver plus liver inflammation and injury. Up to 30% of Americans have NAFLD, 20% of whom have NASH. NASH can progress to life-threatening cirrhosis and is a risk factor for developing hepatocellular carcinoma. Considering NAFLD and understanding risk factors is paramount to helping at-risk patients receive timely screening and diagnosis before liver damage is irreversible. The gold standard for diagnosis is liver biopsy, but emerging studies show that noninvasive serum biomarkers and scores as well as novel imaging techniques are acceptable alternatives for the diagnosis and staging of fatty liver. In the absence of approved drug therapy, the gold standard treatment for NAFLD is lifestyle intervention, namely weight loss as a result of diet and exercise. This article will review the epidemiology, pathophysiology, clinical features, diagnostic approach, and treatment recommendations for patients with NAFLD.
    • Analysis of Student Roles in COVID-19 Contact Tracing and Case Investigation Efforts

      Hernandez, Arlette; Batten, Ashley; Thomas, Joy (2021)
      In December of 2019, Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China and would be marked as the beginning of the COVID-19 pandemic. COVID-19 is caused by the SARS-CoV-2 virus, and is most commonly transmitted via person to person through exposure to respiratory droplets. The Center for Disease Control and Prevention issued an agency-wide response that involved several guidelines for local Health Departments to implement disease tracking strategies to mitigate the spread of the virus. The practice of contact tracing has been continuously supported as a procedure for the control of low-prevalence infectious diseases by identifying individuals who may have been exposed to a person with suspected or confirmed infection of a pathogen. In the COVID-19 response, the "contacts" of confirmed COVID-19 cases were referred by public health authorities to isolate or quarantine themselves during their possible infectious period. In April of 2020, Mercer University's Department of Public Health informed their Master of Public Health student body of their partnership with the Georgia Department of Public Health. Since then, 18 students have participated in contact tracing across Georgia. Some students have used these opportunities for practicum completion, and some as part-time positions. Students were given the opportunity to highlight their experiences as a Contact Tracer and lend their perspective about its effectiveness in controlling the spread of COVID-19.
    • Catheter Directed Thrombolytics: Best Therapy for Pulmonary Emboli?

      Hill, Jonathan; Baeten, Robert (2021)
      Pulmonary emboli are blood clots in the pulmonary arterial vasculature that can lead to right ventricular strain, obstructive shock, and even death. Current treatment options for pulmonary emboli include anticoagulants, systemic thrombolytics, and/or surgical embolectomy. Although these therapies are usually effective, they are associated with side effects such as increased risk of bleeding, surgical site infections, and intracranial hemorrhages. Additionally, there are contraindications to these treatments that limit which patients are eligible. In the past 10 years, the use of catheter directed thrombolytics has emerged and appears to be a promising alternative to traditional therapies. This therapy has been shown to have similar efficacy to anticoagulation or systemic thrombolytics with a much lower risk of severe complications.
    • Chemotherapy Induced Cardiotoxicity

      Proto, Gabrielle Elizabeth; Salmon, Arlene (2021)
      Cancer affects approximately 38.4% of the population and is the second leading cause of death in America. Treatment for cancer has improved and the number of cancer survivors is expected to increase from about 11.7 million in 2007 to 18 million by 2020. However, chemotherapy and radiation therapies for cancer can have long lasting effects for patients. One notable side effect is cardiotoxicity, most commonly caused by anthracycline chemotherapeutic agents. There are several detection methods for anthracycline induced cardiotoxicity and treatment options to manage and prevent heart failure. The most promising diagnostic procedure has been tracking the decline of Left Ventricular Ejection Fraction (LVEF). The only approved treatment by the FDA is Dexrazoxane, though it is only approved for patients under 16. Adult patients are treated prophylactically with organic heart failure medications. Efficient detection and rapid treatment have become a high priority due to the increasing number of cancer survivors and therefore increased number of patients who will experience cardiotoxicity from their treatments.
    • Chiari Malformation Stage 1 in a Female High School Soccer and Wrestling Athlete

      Kathryn Curtin; Emily Gabriel; Amanda Windon; Bill Holcomb
      Case Study of a high school athlete presenting a neurological condition without a known etiology. A discussion course of action, rehabilitation, and education of healthcare professionals for early recognition.
    • Clinical Reasoning in the Management of a Patient with Low Back Pain in Multiple Classification Categories: A Case Report

      Orton, Nicholas; Moran, Kristen Doolittle; Lucado, Ann (2021)
      Low back pain is one of the most common reasons for individuals to seek physical therapy. While prevalent, low back pain can be difficult to classify and treat. Multiple evidence-based classification systems exist with varying approaches to treatment. Case Description: This case report explores the clinical reasoning in the treatment of a patient falling into multiple low back pain classification categories based on the impairment/functional-based classification system. The patient is an otherwise healthy female presenting to physical therapy with a chief complaint of an acute flare-up of persistent low back pain. The rationale behind the sequence in which classification categories were addressed, the decisions behind when to change categories based on emerging data, and the intervention strategies implemented to successfully manage this patient are illustrated. Outcomes: The patient was seen for a total of 13 visits over a span of two months. At discharge, the Revised Oswestry Disability Index for low back pain and the numeric pain rating scale demonstrated improvement with achievement of all patient goals, return of function, and ability to manage symptoms independently. Conclusion: Use of the impairment/functional-based classification system approach to low back pain management proved beneficial and effective. This classification-based approach may assist in clinical decision making when treating individuals with acute flare-ups of persistent low back pain.
    • Contraception in Adolescent Women: Helping Your Patient Choose and Use

      Cook, Ivy; Dickerson, Lisa (2021)
      There are numerous contraceptive methods on the market, yet rates of unplanned pregnancy continue to be problematic among adolescent female patients in the United States. This reality poses the question “What are we missing?” It is imperative that clinicians have a good understanding of the unique social, economic, physical, and psychologic factors that influence adolescent females’ contraceptive choices. This poster outlines some of those variables and influences, including attributes of contraceptive methods, economic considerations, cultural influences, relationship with both sexual partners and parents, sexual education, confidentiality concerns, and social media influences. It is important that providers are able to incorporate this knowledge into their conversations about reproductive health, so this poster also lists effective interview questions and strategies for discussing contraceptive options and expectations with adolescent patients.
    • Counseling Lebanese Americans: A Culturally Sensitive Approach

      Hafsa Ahmed; Colin Freeland; Sara Moe
      Cursory evidence shows that this population, Lebanese Americans, is inordinately impacted by elevated rates of affective and anxiety disorders, acculturative stress, intergenerational trauma, and a wide range of other psychosocial stressors.
    • Current Treatment for Hepatitis C Patients: A Review

      Purcell, Anna Lydia; Heard, Henry (2021)
      Hepatitis C is an RNA virus that affects millions in the United States and globally, but with recent pharmacological achievements, the cure rate of hepatitis C has increased greatly. Hepatitis C is transmitted by blood, with the main infections in the US being cause by IV drug use and blood transfusions prior to 1992. Hepatitis C has six genotypes, but the overwhelming majority of cases in America are genotypes 1, 2, and 3. Diagnosis of hepatitis C is difficult due to the lack of symptoms on presentation. Screening in high risk populations has shown to be efficacious in diagnosing the disease. Previous treatment norms consisted of interferon, but cure rates were very low. In 2011, direct-acting antivirals were introduced and revolutionized the treatment of hepatitis C. Response rates have increased exponentially to over 95%, and the medications are much more tolerable.
    • Dry needling with electrical stimulation in the post-ACL reconstruction management of a female basketball athlete with persistent quadriceps palsy: A case report

      Pyle, Rebecca; Lucado, Ann (2021)
      Background and Purpose: Anterior Cruciate Ligament (ACL) injury is common in sports.1 Well-developed protocols on post-surgical management do not address all potential complications. Our purpose is to determine the effectiveness of dry needling with electrical stimulation (DNES) to address persistent quadriceps palsy (PQP) post ACL reconstruction (ACLR). Methods: A 16-year-old female basketball athlete post-ACLR with quadriceps tendon graft followed the Baylor ACLR Accelerated Protocol with appropriate modifications. DNES to the quadriceps began at post-op week 15 for PQP. Findings: The Lower Extremity Functional Scale (LEFS), knee ROM, MMTs, and circumferential measurements were tracked. All surpassed significant values. Clinical Relevance: When neuromuscular electrical stimulation (NMES) is ineffective for PQP, DNES offers an alternative intervention strategy for increasing maximal voluntary contraction. Conclusion: Data suggest improvement in outcome measures and may promote voluntary muscle contraction of the quadriceps. Further research is required for optimal protocols. Keywords: Neuromuscular control, voluntary contraction
    • ED Treatment of Acute Ischemic Strokes: The Future of the Brain Cath Lab

      Crider, Allie; Bedoya, Damien (2021)
      Acute ischemic strokes are defined as a sudden cessation of blood flow to an area of the brain, resulting in hypoxic death of brain tissue and subsequent loss of neurologic function. They are a leading cause of serious disability worldwide and cost the US healthcare system roughly $3.2 billion per year.1 Historically, first-line treatment for acute ischemic strokes has been thrombolytic therapy with Tissue-Type Plasminogen Activation (tPA), which works by systemically altering the blood�s clotting cascade. tPA is a very effective therapy, however, it carries with it a significant risk of life-threatening bleeding events. Because of the wide array of contraindications to tPA, many patients with prior history of bleeding, anticoagulation use, or prolonged presentation of symptoms are ineligible for this therapy. Mechanical thrombectomy (MT) is an alternative treatment which involves placing catheter-guided stents directly at the site of intravascular blockages in the brain. This method has primarily been reserved for patients in which systemic anticoagulation is contraindicated and was considered a second-line treatment for years. During the early 2010�s, several studies supported the consideration of mechanical thrombectomy as an additional first-line treatment choice in certain patient populations, rather than strictly as an alternative to tPA. This research is essential in determining the safest, most effective treatment for stroke patients on an individual level. It may also lead to expedited triage protocols in the emergency department and faster time to treatment.
    • Emerging Migraine Treatment Monoclonal Antibodies: Pathophysiology, Efficacy, and Recommendations

      Oliver, Hannah; Salmon, Arlene (2021)
      Migraines cause immobilizing headaches and are amongst the top causes of disability worldwide. In the past, migraines were understood as a vascular disorder, but in recent years researchers have attributed the cause of migraines to be a series of neurovascular events. This cascade of events causes a release of peptides, most notably, calcitonin gene-related peptide (CGRP) which triggers pain signals to be released from the trigeminal neurons in the brain. This development in comprehension has led to the production of a new treatment, monoclonal antibodies targeting CGRP, to treat migraines. Since 2018, four new drugs of monoclonal antibodies have been approved by the FDA and each drug has shown significant decrease in monthly migraine days when compared to placebo in people who suffer from episodic and chronic migraines. Today these medications are recommended in patients with migraines who have failed simple abortive therapy.
    • How to save a life: Esketamine as a potential rapid pharmacological suicide intervention

      Montgomery, Kevin; Bedoya, Damian (2021)
      Suicide prevention and intervention efforts have been launched with hopeful results; however, research rarely focuses on pharmacological treatment for the acutely suicidal patient. Correlation between mental health diagnosis and suicide drives recommendations to tailor treatment to the mental health diagnosis rather than the acute life-threatening symptom. This article proposes treatment for the acutely suicidal patient should be intentionally directed at the suicidal ideation instead of the mental health diagnosis. Esketamine has been approved by the FDA, and randomized controlled trials show some evidence that this treatment is worth continued study as a method to rapidly reduce suicidal thoughts in at-risk patients.
    • It takes two quad tendons to tango: A case report about dancing to recovery post spontaneous bilateral quad tendon rupture and repair

      Iskhakov, Vladislav; McMahon, Tim J. (2021)
      Abstract: Spontaneous quad tendon ruptures and resulting surgical repairs have shown to be disabling. Instances of bilateral quadriceps tendon ruptures (BQTR), although a rare occurrence, is more debilitating for the patient, making it harder to treat. Despite its rare occurrence, contemporary research shows a steady increase in incidences of all tendon ruptures, including BQTR, hypothesized to stem from more active lifestyles in the adult population as life expectancy increases. Purpose: This case report focuses on ballroom dance specific intervention strategies used to achieve a full return to amateur ballroom dancing. This case features a non-simultaneous instance of BQTR, which required surgery on a 69 year old, relatively healthy male patient with a strong desire to return to ballroom dance activities. Outcomes: Outcomes used to measure patient’s progress includes lower extremity functional scale, patient specific functional scale, and global rating of change scale Discussion: BQTR is an extremely rare occurrence, providing a unique feature to this case. The therapeutic approach used to reach the patient’s goals is also unique in that it allowed for challenges in strength, proprioception, balance, and ROM, with dance specific activities throughout the protected phased approach which considered HOAC model of healing. Dance specific activity, as well as therapeutic alliance, have been shown to have great benefits with regards to functional outcomes as well as fall risk.
    • Management of Crohn's Disease: Early and Aggressive Treatment Using Biologics and Immunomodulators

      Martin, Erin; Sadowski, Catherine (2021)
      Crohn's Disease (CD) is an incurable type of inflammatory bowel disease (IBD), in which the intestines are chronically inflamed, causing intestinal and extra-intestinal symptoms. CD patients experience a cycle of remission and relapse of symptoms as the disease progresses to serious complications, including small bowel obstructions, malnutrition, and decreased quality of life. Since CD is incurable, medical management is the mainstay of treatment to obtain and maintain remission. Traditional treatment relies on anti-inflammatories. New management strategies focuses on early and aggressive therapy with immunomodulators and biologics to reduce the rate of mucosal and intestinal damage early in the disease course.
    • Pen Pal Project to Write Away Isolation: An IRB-approved Project Aimed at Decreasing Isolation During a Global Pandemic

      Barfield, Kailey; de la Cruz, Jennifer; Lepp, Erin F. (2021)
      As the COVID-19 pandemic radically upended the daily lives and routines of many people, those considered vulnerable faced increased physical isolation due to efforts of increased protection. While interventions such as social distancing have been appropriate to maintain physical health, mental health has taken the brunt of the pandemic. To create connections while maintaining safe physical distance, a letter writing project was created between Mercer Physician Assistant Students and volunteers in the community. This project was created for the Paul Ambrose Scholars Program in which students in medical professions are selected to design a community health project focusing on one of the Leading Health Indicators (LHI) of Healthy People 2020. Suicide was the LHI chosen for this project. As depression increases among elderly, isolated individuals during the pandemic, the risk of suicide increases as well. Letter writing is a cheap, easy way to maintain emotional connections with others despite social distancing guidelines. This project has been IRB approved and included nineteen Mercer Physician Assistant (PA) students and nineteen volunteer letter recipients throughout the United States. A screening tool was used to assess depression levels of volunteer letter recipients both prior to and after receiving letters from PA students over the course of 4-5 months. This poster is a summary of the research project.
    • Physical Therapy Evaluation and Management of a Patient with Acute Anterior Cruciate Ligament and Meniscal Tears Complicated by Hereditary Multiple Osteochondromas in the Occupational Health Setting: A Case Report

      Pendergrast, Sarah; Ebert, Jeffrey (2021)
      Background: Hereditary Multiple Osteochondromas (HMO) is a disease that primarily affects the musculoskeletal system. Sequelae of the disease are often treated via outpatient orthopedic physical therapy. There is a lack of literature on HMO in physical therapy. The purpose of this report is to discuss management of a man with HMO and an acute orthopedic injury. Description: A 44-year-old male with HMO and acute knee injury presented with instability and structural abnormalities as well as impaired range of motion, gait, and muscle performance. MRI confirmed anterior cruciate ligament rupture, meniscal tear, and nondisplaced fibular fracture. The examination and plan of care for this patient included special considerations due to the presence of HMO and nuances of the occupational health setting and insurance. Outcomes: The lower extremity functional scale was used to assess the patient�s functional abilities related to his injury, and objective tests and measures were used to assess the impairments. Discussion: Clinicians should treat within the individual context of each patient, including all comorbidities and patient specific findings in order to make effective clinical decisions. Evaluating and treating a patient in the occupational health setting with HMO that has sustained an acute orthopedic injury requires a combination of disease knowledge, clinical reasoning, collaboration with other healthcare providers, and diagnostic imaging.