title: Functional and biomechanical outcomes after using biofeedback for retraining symmetrical movement patterns after total knee arthroplasty: a case report.
abstract: METHODS
  Case report.
  
  
  BACKGROUND
  Rehabilitation that includes progressive quadriceps strengthening after total knee arthroplasty (TKA) leads to superior outcomes. Though patients with TKA show marked functional improvement after outpatient physical therapy, they continue to adopt movement asymmetries characterized by reduced knee excursion on the operated limb and excessive loading on the contralateral limb. The purpose of this case report was to describe the functional and biomechanical improvements in a patient who, after TKA, participated in a novel physical therapy protocol that included retraining of symmetrical movement patterns.
  
  
  METHODS
  A 57-year-old female with unilateral knee osteoarthritis was evaluated prior to TKA and at 3 and 10 weeks after surgery. Postoperative rehabilitation included progressive quadriceps strengthening and movement retraining that consisted of visual, verbal, and tactile feedback to promote symmetrical weight bearing during strengthening exercises and functional activities. Outcomes were compared to a historical cohort of patients with TKA.
  
  
  RESULTS
  Prior to TKA, the patient scored below average on all functional measures and walked with knee biomechanics that were abnormal and asymmetrical. After symmetry retraining, her knee motion and moments were restored to normal levels. The patient also walked with greater magnitude and more symmetrical knee excursion compared to a cohort of similar patients.
  
  
  CONCLUSIONS
  This case report describes the use of a novel rehabilitation protocol intended to improve walking biomechanics and functional outcomes after TKA. Restoration of symmetrical movement patterns could improve long-term outcomes of TKA. Further research is needed to evaluate the effectiveness and implementation of similar rehabilitation strategies in a wide range of patients after TKA.
  
  
  METHODS
  Therapy, level 4.
authors.affiliation: Department of Physical Therapy, University of Delaware, Newark, DE, USA.
authors.forename: Jodie
authors.initials: J
authors.lastname: McClelland
authors.forename: Joseph
authors.initials: J
authors.lastname: Zeni
authors.forename: Ross M
authors.initials: RM
authors.lastname: Haley
authors.forename: Lynn
authors.initials: L
authors.lastname: Snyder-Mackler
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D001676:Biofeedback, Psychology; D001696:Biomechanical Phenomena; D005260:Female; D006306:Health Surveys; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities