The Implementation of Therapeutic Alliance in the Rehabilitation of an Elite Pediatric Athlete with Salter-Harris Fracture: A Case Report

# Background/Purpose Although research on the value of therapeutic alliance is prominent in other areas of health care, physical therapy research is limited. The purpose is to describe the incorporation of therapeutic alliance concepts throughout the rehabilitation of an elite pediatric athlete with a complicated recovery following a fracture to the distal femoral epiphysis. # Case Description A 14-year-old male was referred to physical therapy following an open reduction and internal fixation to address a type IV Salter-Harris fracture of the right distal femoral epiphysis. Post-operative care included immobilization in a brace for six weeks and he initiated physical therapy for four weeks (post-op weeks 6-10). At 10-weeks post-injury his range of motion and strength were severely limited compared to expected post-operative milestones. Due to these deficits an arthroscopic debridement of the subject’s right knee, hardware removal, and manipulation under anesthesia was performed. The subject then reported to the physical therapist on post-operative day three for evaluation and treatment without bracing or weight-bearing restrictions. # Outcomes The episode of care spanned 17 weeks and included 25 physical therapy sessions. To facilitate therapeutic alliance with the subject, clear communication and easily measurable goals were established and connected to the subject’s relevant needs as an athlete. The plan of care was divided into three phases using “chunking” techniques to establish the rehabilitation priorities. The subject demonstrated improved range of motion, strength and was able to return to hydroplane racing and won a national championship in his age group. # Discussion The unique aspect of this case was the incorporation of therapeutic alliance concepts and techniques into the rehabilitative management of a subject with a complicated fracture to the distal femoral epiphysis. The physical therapist built trust with the subject and facilitated a successful return to elite hydroplane boat racing. # Level of Evidence 4 # Study Design Case Repor

Coronal Heating as Determined by the Solar Flare Frequency Distribution Obtained by Aggregating Case Studies

Flare frequency distributions represent a key approach to addressing one of the largest problems in solar and stellar physics: determining the mechanism that counter-intuitively heats coronae to temperatures that are orders of magnitude hotter than the corresponding photospheres. It is widely accepted that the magnetic field is responsible for the heating, but there are two competing mechanisms that could explain it: nanoflares or Alfv\'en waves. To date, neither can be directly observed. Nanoflares are, by definition, extremely small, but their aggregate energy release could represent a substantial heating mechanism, presuming they are sufficiently abundant. One way to test this presumption is via the flare frequency distribution, which describes how often flares of various energies occur. If the slope of the power law fitting the flare frequency distribution is above a critical threshold, $\alpha=2$ as established in prior literature, then there should be a sufficient abundance of nanoflares to explain coronal heating. We performed $>$600 case studies of solar flares, made possible by an unprecedented number of data analysts via three semesters of an undergraduate physics laboratory course. This allowed us to include two crucial, but nontrivial, analysis methods: pre-flare baseline subtraction and computation of the flare energy, which requires determining flare start and stop times. We aggregated the results of these analyses into a statistical study to determine that $\alpha = 1.63 \pm 0.03$. This is below the critical threshold, suggesting that Alfv\'en waves are an important driver of coronal heating.Comment: 1,002 authors, 14 pages, 4 figures, 3 tables, published by The Astrophysical Journal on 2023-05-09, volume 948, page 7