Case Study

 

Episode of Care:

Diagnoses: Dementia; Abnormality of gait; Difficulty in walking; Wound healing

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