Table Of ContentDavid Ip
Casebook of Orthopedic Rehabilitation
David Ip
Casebook
of Orthopedic
Rehabilitation
Including Virtual Reality
With 74 Figures and 1 Table
123
Dr. David Ip
MBBS (HKU), FRCS (Ed) Orth, FHKCOS,
FHKAM (Orthopedic Surg), FIBA (UK), FABI (USA)
Deputy Governor,
American Biographical Institute Research Association (USA)
Hon Director General (Asia)
of International Biographical Association of Cambridge (UK)
ISBN 978-3-540-74426-9 e-ISBN 978-3-540-74427-6
DOI 10.1007/978-3-540-74427-6
Library of Congress Control Number: 2007933703
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About the Author
Dr. David Ip is a fellow of various professional organizations, including
the Royal College of Surgeons and the Hong Kong College of Orthope-
dic Surgeons, and is a member of the American Academy of Orthopedic
Surgeons and the American Association of Academic Physiatrists,
among many others, such as the International Association for the Study
of Pain and various Gait Analysis societies. His biography is included in
Marquis Who’s Who in Science & Engineering, Who’s Who in Medicine
and Healthcare, Sterling’s Who’s Who in NY, and the International Who’s
Who Historical Society. In his capacity as Director General (Asia) of the
International Biographical Association of the UK and as Clinical Gov-
ernor of the American Biographical Institute he has contributed signifi-
cantly to peer-reviewed journal articles and has written several books on
orthopedics, which have received positive reviews from the Royal Col-
lege of Surgeons and the Journal of Bone and Joint Surgery. He is also the
reviewer of selected orthopedic journals published in Europe, and holds
honorary consultancy positions for various companies like the Lehrman
Gerson group, Brand’s Institute, Medacorp, among many others.
Preface
As the name implies, this “casebook” contains a series of clinical cases on
various topics in orthopedic rehabilitation that the author encountered
over his 23 years of practice ranging from the extremely common con-
ditions like knee arthritis, to newer technologies evolved in the recent
years including the use of smart materials in orthopedics, hypergravity
stimulation therapy, and virtual reality.
Many of us must have encountered difficult real life hurdles to re-
habilitation in real clinical practice in which patients have difficulty in
coming back for rehabilitation either because they live very far away,
or they do not really have adequate time, or they simply only agree for
home-based rehabilitation for various reasons. In these case scenarios,
no matter how good a “protocol” one has on hand, it will be difficult to
achieve the expected result. When the author was still young, he made
the common mistake of accepting lesser outcomes from these patients
saying to myself that it is a question of compliance. However, with large
strides in computer engineering, even rural district patients can have
acceptable rehabilitation as long as they have a telephone line and the
right computer hardware and software and input-output devices to ef-
fect tele-rehabilitation via the aid of virtual reality rather than just rely-
ing on video conferencing alone.
Although this book is a close companion of its fellow, “Orthopedic
Rehabilitation, Assessment, and Enablement” which is very well received
in many parts of the world, it can however be used alone as all the clini-
cal cases stand alone and are self-contained. Each case scenario is based
on real clinical situation (except the one on space travel*) seen by the
author during his clinical practice or during his visits to overseas cen-
ters although the names and some fine details of patients were changed
VIII Preface
to protect their privacy. Finally, a wide readership is expected of this
book including primary care physicians, fellow orthopedic surgeons,
physiatrists, therapists, orthopedic nurses and senior medical students.
Happy Reading!
David Ip
Hong Kong, October 2007
* To enhance protection of privacy of SARS patients, the MRI Knee of Case number 28 was se-
lected from a Non-SARS patient but with extremely similar pattern of involvement as the original
patient
Contents
Section I
Case 1 New Dual-energy X-ray Absorptiometry Machines
(iDXA) and Vertebral Fracture Assessment (VFA) ....... 3
Case 2 Hyper-gravity Stimulation Therapy ..................... 11
Case 3 Lady Having Difficulty in Controlling
the Computer Mouse .................................. 17
Case 4 Whiplash-associated Neck Disabilities .................. 21
Case 5 Sizable Cartilage Defect in a Professional Footballer .... 31
Case 6 Functional Knee Complaints
in a Child with Cerebral Palsy .......................... 37
Case 7 Hamstrings Injuries in a Professional Sprinter .......... 41
Case 8 Was it Simply Tachycardia or Something More Sinister? 49
Case 9 A Lady with Intractable Heel Pain ...................... 53
Case 10 Hip Swelling after Combined TBI and SCI .............. 59
Case 11 Consultation for a Third Opinion on Bone Health ....... 67
Case 12 Was It Really Another Case of “Tennis Elbow”? ......... 71
Case 13 A Patient Requesting an “Oxford Uni” for his knee OA .. 75
Case 14 Bisphosphonates and Peri-prosthetic Osteolysis ......... 79
Case 15 A Young Engineer with Disabling Sciatic Pain ........... 85
Case 16 The “Wonder Drug” Glucosamine ...................... 93
Case 17 Hyaluronan for Knee OA, Facts Vs. Myths .............. 99
Case 18 High Heels Woes ...................................... 103
Case 19 Silent Bone Loss and Vitamin D Insufficiency ........... 111
Case 20 A Professor Suffering from OA Knee Pain .............. 119
Case 21 New Physical Sign in Carpal Tunnel Syndrome .......... 129
Case 22 Kinesiophobia ........................................ 133
Contents
Case 23 Breakthrough Fracture While on Bisphosphonates ...... 139
Case 24 Can Back Pain Be Predicted? ........................... 149
Case 25 Enthusiasm for “Non-fusion Technology”
for Discogenic Back Pain .............................. 153
Case 26 Extra Busy Banker Troubled by Subacute Back Pain,
Yet No Time for Physiotherapy ......................... 163
Case 27 Metal-on-Metal Hip Surface Replacement .............. 171
Case 28 A Young Lady with AVN after SARS .................... 177
Case 29 An Athlete Going for Anterior Cruciate Ligament
Reconstruction with Little Time for Rehabilitation ...... 183
Case 30 The Office Lady with Neck, Shoulder, Arm, and Back Pain 191
Case 31 Bone Health and Space Travel .......................... 197
Case 32 Crouch Gait .......................................... 201
Case 33 Non-healing Diabetes Mellitus Heel Ulcer .............. 209
Case 34 Cervical Disc Replacement ............................ 215
Case 35 Intractable Lateral Epicondylitis ........................ 221
Case 36 Chronic LBP in a Laborer Whose Job
Requires Repeated Lifting ............................. 229
Case 37 Stiffness after Flexor Tendon Repair .................... 237
Case 38 Postpartum Sacroiliac Joint Pain ....................... 243
Case 39 Use of Smart Materials in Orthopedics ................. 249
Section II
General Introduction ........................................... 257
Uses of the Computer in Orthopedics ............................ 258
Emerging Importance of Data Storage and Retrieval .............. 260
Why Develop Virtual Reality? ................................... 260
Summarizing the Four Main Advantages of Virtual Reality ........ 261
Key Components of a Virtual Reality Platform .................... 262
Evolution ....................................................... 262
Forms of Virtual Reality ......................................... 262
Modifications to Suit Training in Surgery and Rehabilitation:
Concept of Mixed or Augmented Reality ...................... 263
Contents I
Uses of Virtual Reality in Orthopedic Surgery and Rehabilitation .. 263
Advances in Hardware .......................................... 264
Advances in Software ........................................... 265
The Process of Pipeline Synchronization .......................... 266
Advances in Input-output Devices ............................... 266
Improving Visual Effects and Depth Perception ............... 266
Quick Scanning of 3D Objects Subsequently
Used in the Virtual World ................................ 267
Virtual 3D Sound Effects Vs. Stereo Sound Effects ............. 268
Importance of the Use of Haptic and Force Feedbacks
in Orthopedic Rehabilitation ............................. 268
Other Modalities Besides Vision, Hearing, and Force Feedbacks 271
Way Finding in Virtual Environments ............................ 271
Different Types of Trackers ...................................... 271
Real Life Applications .......................................... 275
Preoperative Training of Surgeons ............................... 275
Preoperative Planning ........................................... 275
Intraoperative Virtual Model .................................... 277
Intra- or Perioperative Stability/Impingement Testing
in Other Fields of Orthopedic Surgery ........................ 277
An Intraoperative Aid to the Surgeon Combined with Robotics .... 279
Use of Virtual Reality in Postoperative Orthopedic Rehabilitation .. 279
Use of Virtual Reality in Non-operative Orthopedic Rehabilitation 281
Example 1: Pain Management ................................ 281
Practical Case Illustration (Case 40):
Virtual Reality in Burns Care for a Child .................. 283
Example 2: Ankle Rehabilitation ............................. 286
Example 3: Training the Patient in the Use
of Assistive Technology .................................. 288
Example 4: Improving Quality of Life Through the Use of Music 290
Tele-rehabilitation .............................................. 293
Literature Support of the Use of Tele-rehabilitation
with a VR Platform in Hand Rehabilitation ................ 294
