Lower Extremity Fracture Case Study | Virtual Reality Improves strength and walking independence

ABSTRACT

Open fractures of long bones occur  approximately 11.5 per 100,000 people, with 40% occurring in the lower limb. This may lead to required open reduction internal fixation (ORIF) to place your bones back into their proper configuration. While uncommon, complications can occur such as misalignment, nerve damage, and irritation of overlying tissue from hardware. After ORIF, patients are typically required to keep the limb immobile for several weeks followed by physical therapy to work towards attaining their prior level of function(1). This case study involves a patient who had sustained a left tibia and fibula fracture as well as lateral fractures at the ankle due to slipping on black ice which required ORIF. This patient received virtual reality exercises using Neuro Rehab VR’s XR Therapy System 8 weeks post op.

INTRODUCTION

The patient is a 50 year old male with ORIF due to a left tibia and fibula fracture as well as lateral fractures at the ankle from slipping and falling on black ice. Due to a lack of insurance and not living near a physical therapy clinic, the patient performed a HEP prescribed by his physician consisting of light ankle/knee stretching and ambulation with weight bearing as tolerated using a rolling walker 8 weeks post op. This patient, in an effort to find exercises to add to his current home rehab program, got in contact with Neuro Rehab VR and accepted a 6 week free trial of Virtual Reality exercises using Neuro Rehab VR’s XR Therapy System. The patient’s exercises were directed and created by a trained health coach from Neuro Rehab VR.

CLIENT CHARACTERISTICS

At 8 weeks post op, the patient utilized a rolling walker for home mobility and required help from family members to safely ambulate and complete activities of daily living. The patient was weight bearing as tolerated with noted slow gait speed and limited wt shift due to weight bearing restrictions. His active range of motion for knee flexion was at 70 degrees with 6/10 pain noted when nearing 75 degrees; he lived in 2/10 pain due to nerve pain on the bottom of his foot. The patient reports that he wants to improve his ability to safely walk and perform activities without needing assistance from his family. Patient’s physician recommended physical therapy be performed if possible.

EXAMINATION FINDINGS

Patient was tested 4/20/21 for knee flexion/extension strength, ankle dorsiflexion/plantarflexion strength and timed up and go test. His knee and ankle strength at 8 weeks post op was recorded as 4-/5, his timed up and go was recorded as 12 seconds, and he was limited to 50% weight bearing per physicians orders.

INTERVENTIONS

The administered exercises included Fowl Play, Retail Therapy, Leg Day, and Lokosprint. These activities required the patient to weight shift, perform kicks, functional reach outside of base of support, and ambulate at progressively increased time/speeds for 30 minutes a minimum of 3 x per week and not exceeding 5x a week per patient's discretion. Exercises were steadily increased under the supervision of a trained health coach over the course of the 6 week trial period.

OUTCOME

On May 27th at the end of the 6 week trial period, the patient demonstrated 5/5 knee/ankle strength, was able to achieve 105 degree knee flexion pain free, and was at 100% weight bearing without an assistive device for at home ambulation. His timed up and go score had increased to 2.3 seconds. The patient reported that he “only occasionally” notices pain in the bottom of his foot or at the incision.

DISCUSSION/CLOSING

Through the use of Virtual Reality exercises using Neuro Rehab VR’s XR Therapy System, the patient showed greatly improved functional mobility without an assistive device, a grade and a half increase in ankle and knee strength, and no longer required assistance for performing his activities of daily living. These gains were made in a 6 week period showcasing that Virtual Reality exercises could be used as an effective home rehab routine in patients who are 8 weeks post op ORIF and lower extremity fracture if physical therapy is deemed appropriate.



1.Hopkins Medicine. “Tibia and Fibula Fracture Open Reduction and Internal Fixation.” Hopkins Medicine,https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tibiafibula-fracture-open-reduction-and-internal-fixation. Accessed Thursday June 10th 2021.