FALLS RISK

Case Study

 

Episode of Care:

Diagnoses: Heart transplant; Difficulty walking; Weakness

Medical History: Patient had onset of heart failure more than one year previously, and received a heart transplant three months previously. Her kidneys failed during her heart transplant.

PT Start Date: 1/5/2017

PT End Date: 5/10/207

Number of PT Visits: 35

Initial Evaluation:

Status: Weakness and limited mobility with poor balance and limited endurance.

Prognosis: Guarded due to organ transplant risk and kidney failure

Treatment Plan: Physical therapy episode of care including Treadwell System and best practice physical therapy interventions for strengthening, balance, endurance, and gait improvement

Result(s):

  1.  patient began to make progress after first week.

  2.  progress was slowed by a fall resulting in significant bleeding from her head (she was taking anticoagulant to prevent blood clotting from surgery, and from many days of post dialysis sickness).

  3.  at end of seven month episode she had achieved all goals and exhibited functional independence. 

Addendum: Kidney failure is experienced at a significant level a during heart transplant procedure. This patient was a high risk candidate for blood clotting following surgery and immobilization. Therefore, she was taking anticoagulants for the prevention of blood clots forming. When she fell and struck her head she bled profusely as a result of this pharmacological intervention. The Treadwell System accelerates the rate of blood flow (see Published Research page ). The writer postulates the risk of blood clot formation following immobilization and surgery would be reduced by including the Treadwell System in post surgical care plans.

Conclusion(s): In my professional opinion, achieving her goals would have required more interventional time, 4-6 weeks is estimated, if the Treadwell System had not been part of her treatment regime. Inclusion of Treadwell System enabled the patient to perform activity that increased blood flow on many days when she was unable to walk or perform other therapeutic activities due to post dialysis nausea and or fatigue. In my professional opinion the Treadwell System is a safe intervention with negligible risk of harm following a significant surgery. 

 

Richard HandPT

Case Study

 

Episode of Care:

Diagnoses: Muscle weakness; Difficulty in walking 

Medical History: Arthritic involvement that had caused joint destruction in her hands, shoulders, and knees. She also suffered from anxiety

PT Start Date: 1/12/2016

PT End Date: 7/27/2016

Number of PT Visits: 30

Initial Evaluation:

Status: 

  1.  profound edema in her lower legs

  2.  unable to stand without significant assistance by another person

  3.  relied upon an electric lift chair for position changes

  4.  sleeping in her lift/recliner chair. 

Prognosis: Guarded

Treatment Plan: Physical therapy utilizing Treadwell System protocols in addition to physical therapy best practices interventions for strengthening, transfers, and endurance. Gait training if warranted by progress.

Result(s):

  1.  able to use the Treadwell System as part of her home therapy regimen despite her immobility and inability to independently perform other commonly prescribed physical therapy exercises

  2.  able to engage Treadwell System protocols from her chair independently

  3.  decreased her leg edema significantly (from grade 3 to grade 1)

  4.  improved her tolerance to additional physical therapy exercises

  5.  regained ability to stand from her chair with much less assistance (minimal from another person as compared to maximal)

  6.  improved quality of life as significantly less assistance required for  toileting and dressing

Addendum: Her course of treatment was interrupted by her husband’s hospitalization and death. A two month hiatus in her therapeutic regimen resulted. Depression was an additional issue following his death. Despite these hardships, she was adamant in her desire to stay in her home as opposed to institutionalization, and she believed that if she  were able to get enough assistance she would be able to remain at home.

Conclusion(s): I know of no other physical therapy modality that she could have performed independently or with assistance that would have yielded similar results. In my professional opinion, a physical therapy intervention without the Treadwell system would fail at achieving comparable gains.

 

Richard Hand, PT

Case Study

 

Episode of Care:

Diagnoses: Difficulty walking; Other symptoms and signs involving the musculoskeletal system; Right hip contusion

Medical History: Previous physical therapy episode of care with goals achieved. A fall which injured his right hip. History of circulatory involvement and lower leg edema

PT Start Date: 1/5/2017

PT End Date: 5/10/207

Number of PT Visits: 35

Initial Evaluation:

Status:

  1.  92 year old male was admitted to physical therapy as the result deteriorating mobility resulting from a fall which did not result in a fracture

  2.  the fall caused pain in his right hip when he put weight on his right leg to take a step

  3.  the pain remained unchanged for more than a month

  4.  functional status declined progressively during that time

  5.  patient had an episode of care which had ended sucessfully five months previously

  6.  lower extremity edema

  7.  limited mobility

  8.  mental confusion with respect to both time and place

  9.  care provider (granddaughter) acknowledged that the home routine established for the patient following his previous episode of care had not been followed as recommended, primarily due to complicated family dynamics

  10. his legs had begun to swell again and he had progressively weakened prior to falling.

Prognosis: Good based upon results from previous episode of care

Treatment Plan:

  1.  physical therapy plan of care incorporating Treadwell System along with physical therapy best practices for strengthening, balance and gait improvement.

Result(s):

  1.  progress noted within two weeks of the beginning of this episode of care

  2.  continued steady progress throughout this episode of care

  3.  achieved a functional level comparable to functional level at the end of his previous episode of care nearly one year prior.

Observations:

  1.  the continued pain in his right hip did not respond to applications of heat and cold, which limited his mobility

  2.  pain began to abate when  the Treadwell System protocol re-engagement commenced.

  3.  lower extremity edema and shortness of breath also improved once therapy with the re-engagement of the Treadwell System.

Conclusion(s): In my professional opinion the patient’s failure to continue to perform his home exercise routine, centered around a Treadwell System protocol, contributed to his declining functional levels and ultimately his fall.

In my professional opinion, including the Treadwell System in the care plan enabled success that would not have been achieved without the system.

In my professional opinion the rapid improvement of hip pain, the resolution of lower extremity edema and alleviation of shortness of breath would have been difficult to achieve. If achievable, the time to achieve would have been weeks and maybe months longer. Furthermore, this patient’s age and prior history would have made a return to a similar level of function very unlikely His  functional level would have a lower expected ceiling following his medical complications.

In my professional opinion his functional ceiling was not lowered by including the Treadwell System in his care plan.

Anecdotally, I saw this gentleman and his granddaughter in a social setting two months following his discharge from physical therapy and his functional status remained unchanged, with no evidence of lower extremity edema. The granddaughter related that the home exercise routine, including the Treadwell System, was being followed as directed. She related her belief is the Treadwell System plays an irreplaceable role in keeping her grandfather healthy and mobile.

 

Richard Hand, PT

Case Study

 

Episode of Care:

Diagnoses: Difficulty walking; Muscle weakness

Medical History: History of circulatory issues causing lower extremity edema

PT Start Date: 2/9/2016

PT End Date: 7/21/2016

Number of PT Visits: 41

Initial Evaluation:

Status: 92 yo male was admitted for physical therapy due to mobility issues and a recent history of falls. He presented with significant lower extremity dependent edema, breathlessness with minimal exertion, and lower extremity weakness.

Prognosis: Good

Treatment Plan: Plan of care including Treadwell System and physical therapy best practices interventions for weakness, balance, and gait improvement

Result(s):

  1.  the first week physical therapy sessions evidenced progress in house mobility

  2.  increasing his ambulation from 15 feet to 25 feet before requiring a rest to regain his breath

  3.  lower extremity edema reduction of ½ grade

  4. After two weeks:

    1. his left lower extremity edema was completely resolved

    2. edema and discoloration of his right lower extremity was significantly reduced

    3. mobility skills improved rapidly - he no longer used a cane for in house ambulation an increase in his endurance while performing activities of daily living due primarily to his improved respiratory profile

    4. Exertional shortness of breath had lessened significantly

    5. time to regain his normal breathing pattern was much shorter.

Addendum: Progress continued throughout his episode of care, and at the time of his discharge, 16 weeks later, he was ambulating safely and independently in the house without an assistive device, was transferring in and out of the house independently and ambulating out of doors independently using a rollator.

Conclusion(s): It is my professional opinion the lower extremity edema and discoloration in an adult of this age would have been unattainable without inclusion of the Treadwell System in the plan of care. Lower extremity edema and discoloration in an adult of this age is usually addressed by frequent periods of elevation and the use of compression hose. These interventions require a significant taxing effort for both the patient and care provider(s). Neither of these interventions were necessary.

It is my professional opinion the functional improvement would have been unattainable without inclusion of the Treadwell System in the plan of care. The expectation of improvement in an adult of this age and functional deficit is normally poor, or at best, a questionable outlook.

In my professional opinion the reduction in breathlessness associated with lower extremity fluid retention would have been unattainable without inclusions of the Treadwell System in the plan of care. Exertional breathlessness associated with fluid retention and lower extremity edema would have a poor to questionable outlook prognosis for improvement without the Treadwell System. The use of oxygen would often be prescribed for ongoing therapy. This would address the symptoms without treating the cause. It is my professional opinion the Treadwell System addresses the cause.

In my professional opinion, without the Treadwell System inclusion in the care plan, the probability of this patient achieving his health improvement goals and the functional independence that he regained would have been very unlikely.

 

Richard Hand, PT

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