Non-Weight Bearing due to a Wound

The patient is a 75 yo female who was admitted to a the hospital due to a wound on her left ankle.

In 2007, the patient sustained a left ankle fracture and underwent an ORIF. During that time, she required a wound vac for wound healing. She ended up with a deformity of the left ankle, but has repeatedly experienced onset of wounds on the left ankle at different times. In the past, she has been treating these wounds homeopathically with success. Her current wound has not healed, has become necrotic with the hardware from the old ORIF exposed. Wound culture was positive for Proteus mirabilis, Pseudomonas aeruginosa, Enterococcus faecalis, Enterococcus casseliflavus, Streptococcus anginosus and Corynebacterium ulcerans. While in the hospital, she also tested positive for Klebsiella pneumoniae. A week later, she was infected with COVID-19. She was discharged with a NON-WEIGHT BEARING restriction.

I treated her a day after she was evaluated by another PT who did not ambulate with her. To gain objective information in her ability to activate her anti-gravity hip muscles,  I started with assisted priming in supine (APS). The video above was one of the exercises I had her perform. After determining that she was sufficiently activating her lower extremity anti-gravity muscles concentrically and eccentrically, I had her stand up and she was able to maintain standing with touching assistance using a front-wheeled walker with the left lower extremity non-weight bearing. She required moderate assistance to transfer from sit-to-stand. 

ASSUMPTIONS

1. APS exercises can be used for muscle activation of non-weight bearing lower extremities.

2. APS exercises  allow for self-initiated and volitional movements, eliminating the need for the therapist to lift / move the affected limb. The number of repetitions and sets are not limited by therapist fatigue. The therapist  can focus on the more "skilled" service of correcting movement impairments as they observe the patient move.

LINKS TO RELATED LITERATURE:

1. Submaximal elastic resistance band tests to estimate upper and lower extremity maximal muscle strength