Case Studies
At an ALF, we received a new admission, a gentleman who was planning for a short stay was in need of our rehabilitation services to recover and move back to an independent living community. Family was very involved and concerned for the patient’s safety and well being while living alone. Throughout his short stay, he was able to become independent with mobility with or without a walker with no/low risk of falling and was able to complete all ADL tasks with no issue. This patient began to look like a visitor within the facility, getting around safely and independently. He was able to move to an ILF near his hometown and had a plan in place to move back to his farm.
In March, an 80-year-old male resident was in a wheelchair 75% of his day after falling and fracturing his pelvis. When he began therapy, he could partially weight bear on the affected side and could only walk 50ft. The therapists worked with him for just shy of 6 months on improving endurance and strength in his lower extremities. He also had a prounounced fear of falling again which was holding his progress back. Strengthening and endurance training were focuses at each session as was working on his confidence to alleviate his residual fear of falling. At discharge from therapy, he was walking anywhere between 500 and 800 ft and had overcome his fear of a repeat fall. As the end of his therapy approached, he confided in the therapists that he really wanted to be able to drive a car again. He stated that he loved to take his wife for drives and he would love to be able to do that again. He and the therapists devised a program and worked hard practicing car transfers to enable him to safely drive again. He is now able to get his walker into the car independently and drive whenever and wherever he wants. He continues to stop in to the Therapy department to say hi and says to everyone that “therapy is the best thing I ever could have done.”
Transfers were also presenting difficulty in an ALF. Several patients needed assistance with showers. Due to the increased cost associated with this need, many of these patients only wanted to shower 2x/week. Therapy and the facility staff worked together to develop transfer skills. The residents were brought to therapy to help them gain the ability to transfer independently and were trained on the use of additional adaptive equipment. All of these residents are now able to shower independently every day.
A female resident was Ax1 with ADLs and mobility in room and facility. Both our PT and OT therapy teams worked with her to develop strength, balance, and endurance and she is now independent with ADLs and independent in the facility with only caregiver assistance with TED hose needed.
Therapy has been working with a female who is currently receiving therapy to build upper extremity range of motion using electrical stimulation, pulleys system, and dowel exercises. She has increased her strength and range of motion and is now able to comb her hair and complete upper body dressing independently without discomfort.
A 92-year-old female resident was seen by PT and OT after a fall in her room, general decline in strength, endurance and balance as well as an injury to her right hand. She had difficulty walking to and from meals and required the use of a wheelchair. She and her family were considering purchasing a wheelchair, however, this resident wanted to avoid that if possible. She was assessed by both Physical and Occupational Therapy trams and a care plan was implemented.
Occupational Therapy: Her right hand was injured, and she had decreased function, particularly her index finger that she was unable to completely flex, resulting in her difficulty gripping objects such as toothbrush, buttons, utensils. OT incorporated the use of ESTIM, massage, kinesiotape which allowed the patient to recover her full range of motion and improved strength in her right hand. Her activity tolerance was low. At evaluation, she was able to stand with her 4-wheeled walker for only 3 minutes. OT worked with her standing, balance, and safety skills. At discharge, she was able to stand for over 10 minutes which allows her to now complete multiple daily tasks independently. OT recommended a room change that would be closer to the dining room. OT worked with the family and with maintenance to enable her to have the same exact size room but much closer to the dining room. Both she and her family were very appreciative of the assistance from therapy
Physical Therapy – Ambulation: At the time of evaluation, she was utilizing a wheelchair to get to and from all meals causing her to become more deconditioned and weaker. At discharge from PT, she was independent with her 4-wheeled walker to and from all meals and activities. She continues to move about the facility independently using the walker.
Physical Therapy – Transfers: She was unable to get out of a chair with arms on her own and needed assistance to get into a standing position. At the PT evaluation a sit-to-stand-to-sit test was given to determine how many sit to stand transfers she was able to do in 30 seconds. She was able to complete only 3 during that evaluation. At the time of discharge, she was able to complete 8 site to stands without assistance.
Physical Therapy – Strength: PT utilized the NuStep, seated/standing exercises, and balance exercises to help her increase her strength from a 3+ (meaning she could hold a position against minimal resistance) to a 4+ (meaning she could hold a position against moderate resistance) at the time of discharge.
Her overall therapy experience has been very beneficial and positive for her. It has allowed her to stay at the facility rather than needing to transition to a higher level of care at a SNF facility. She was and is a pleasure to work with, and she has made great strides to remain as independent as possible