VASCULAR DEMENTIA

Case Study #1

 

Episode of Care:

Diagnoses: Vascular Dementia; Difficulty in walking; Lack of coordination 

Medical History: 12 cardiac stents implanted over the past several years

PT Start Date: 10/25/2016

PT End Date: 1/10/2017

Number of PT Visits: 13

Initial Evaluation:

Status: Patient’s balance had been deteriorating over the last several months and he was becoming a fall risk

Prognosis:

  1.  Declining mobility and coordination skills

  2.  increasing risk of falls

  3.  progressive decline activity and mobility levels

Treatment Plan:

  1.  Physical therapy episode of care incorporating Treadwell System protocols for neuromuscular re-education, improved ankle range of motion, and lower extremity coordination

Result(s):

  1.  After four weeks the patient had made significant progress towards his goals for strength, range of motion, and lower extremity coordination

  2.  His overall level of awareness was improved

  3.  resumed prior activities, notably playing in an adult volleyball game weekly

Addendum: This episode was discontinued following a referral to an outpatient physical therapist for right shoulder pain following a visit to an orthopedic surgeon for shoulder pain. A subsequent Treadwell System addition to his plan of care was initiated.

Conclusion(s): 

In my professional opinion, the significance of inclusion of the Treadwell System in this patient’s episode of care and improved outcomes was threefold.

  1.  The patient’s ability to perform multiple therapy modalities unattainable without Treadwell System protocol inclusion during each session.

  2.  The intensity level of the multiple therapy modalities would have been prohibitive without the Treadwell System protocols inclusion for 5-6 minute intervals between therapy modalities during each session

  3.  the patient’s ability to improve his lower extremity coordination was enhanced by engaging Treadwell System protocols for foot and leg coordination during his sessions

  4.  his observed improved ability to concentrate and communicate during his therapy sessions most likely resulted from improved cerebral blood flow achieved during the Treadwell System protocols use periods.

 

Richard Hand, PT

Case Study #2

 

Episode of Care:

Diagnoses: Vascular dementia; Symptoms and signs involving the musculoskeletal system; Abnormalities of gait and mobility

Medical History: Previously admitted to home health. An athletic individual with a low BMI and history of long distance running for decades. Recent pacemaker implant.

PT Start Date: 2/22/2017

PT End Date: 6/27/2017

Number of PT Visits: 18

Initial Evaluation:

Status:

  1.  Health status unchanged from time of previous episode of care discharge

  2.  decreased performance of home exercise routine

  3.  dissatisfaction with out patient PT experience

Prognosis: excellent potential to achieve therapy goals

Treatment Plan: Physical therapy episode of care utilizing Treadwell System combined with physical therapy best practices interventions for coordination, balance, and gait. Patient also modified his daily walk routine and daily time management following Treadwell System protocols as directed by therapist. Patient left to spend summer at his camp in Maine, and was comfortable with his routine for continuing exercise program.

Result(s):

  1.  Progress accelerated after two weeks plan of care inclusion of Treadwell System protocols

  2.  improved home exercise routine participation by patient

  3.  improved coordination

  4.  improved balance

  5.  improved cognition noted.

Addendum: This patient was a regular distance runner for most of his life, averaging 35 miles of running per week. Despite this exercise regimen, a low BMI, and participation in other physically demanding sports, he developed heart disease requiring multiple stent implants and a recent pacemaker implant. Progress moved from static to improved with his daily walk routine began after altering protocols to include the Treadwell System.

Conclusion(s):

It is my professional opinion traditional interventions alone would not have provided the results achieved by this patient through inclusion of the Treadwell System in his physical therapy plan. The outcome is a better than expected outcome and a higher quality of life for the patient. 

It is my professional opinion that a reduction in risk for a more serious and more costly future health event results from continued use of the Treadwell System in the patient’s continuing exercise plan.

It is my professional opinion that inclusion of the Treadwell System in care plans of therapy patients with similar health profiles will create savings in the health care system totaling millions of dollars annually.

 

Richard Hand, PT

Case Study #3

 

Episode of Care:

Diagnoses: Dementia; Abnormality of gait; Difficulty in walking

Medical History: Fell out of wheelchair at memory care facility and was admitted to hospital. She experienced an over medicated event during this hospitalization. Degenerative joint changes noted in joints of hands as the result of arthritis 

PT Start Date: 7/30/2015

PT End Date: 9/18/2015

Number of PT Visits: 28

Initial Evaluation:

Status: 

  1.  very weak

  2.  did not communicate

  3.  required minimal assistance or contact guarding during ambulation

  4.  after ambulating 20 feet or less she required a rest due to shortness of breath.

Prognosis: Doubtful  to Fair due to dementia and extreme mobility compromise

Treatment Plan:

Daily physical therapy tapering progressively with Treadwell System and best practices physical therapy interventions for weakness and gait issues

Result(s):

  1.  after two weeks of commonly accepted physical therapy protocols, augmented by Treadwell System protocols, the patient had improved significantly

  2.  able to ambulate more than 150 feet before requiring a rest to regain her breath. This improvement was achieved without respiratory interventions, as she was not able to remember and recall instructions

  3.  decrease in lower extremity edema, from plus 4 to plus 3

  4.  improved body mass index due to decreased fluid retention

  5.  improved alertness and communication skills

  6.  after three weeks of therapy ambulatory distance increased to 400 feet before she required a short rest

  7.  no longer required the minimal assistance and/or contact guarding initially required for safety during ambulation

  8.  Addendum: After three weeks of therapy she presented without wearing shoes or stockings. An ulceration of 8 centimeters was noted in the nail bed of her left great toe

  9.  at the fifth week of her physical therapy sessions the wound on her left great toe had completely healed. Note: No other wound healing intervention was engaged during this episode of care

  10. improvement in mental clarity, physical endurance, leg edema reduction, and decreasing body mass index were continuing

  11. patient was discharged 8 weeks following her initial evaluation

  12. lower extremity edema had decreased by two grades, from plus 4 to plus 2

  13. ambulating distances greater than 500 feet without shortness of breath achieved

  14. the ulcer on her left great toe was healed

  15. body mass index had improved significantly with the loss of more than 12 pounds

  16. much more alert

  17. recognized the therapist and the purpose for his arrival

  18. called the therapist by name on more than one occasion. 

Addendum:

The patient’s initial goals had been achieved when discharge was precipitated by her being relocated to another facility in New Bern, NC to be closer to family.

 Conclusion(s): It is my professional opinion the improvements in edema and body mass index would have been unlikely without including Treadwell System protocols supporting increased ambulation distances. 

It is my professional opinion the improved alertness and communication skills observed would not have been expected with only commonly accepted best practice physical therapy modalities included in this patient’s therapy.

It is my professional opinion reversal of edema would have been unachievable without the Treadwell System.

It is my professional opinion rapid healing of her toe ulceration would have been unachievable without the Treadwell System.

It is my professional opinion the rapidity of gait improvement would have been unachievable without the Treadwell System. It is my professional opinion her improved mental status would have been unachievable without the Treadwell System.

It is my professional opinion she was capable of further progress, unachievable without the Treadwell System, had she remained in this facility and Treadwell System protocols continued to be included in her physical therapy plan.

 

Richard Hand, PT

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