DEMENTIA CLINICAL RESULT #1

(From Electronic Medical Record)

Episode of Care:

Diagnoses: Arterial insufficiency; Gangrene right foot; Dementia

Medical History: Left below the knee amputation

PT Start Date: 8/31/2016

PT End Date: 10/28/2016

Number of PT Visits: 24

Initial Evaluation:

Status:

  1. family had opted not to follow the advice of his vascular surgeon, who recommended a below knee amputation of his right leg to stop the progression of gangrene.

  2. the patient had previously had a below the knee amputation of his left leg due to circulatory insufficiency

Prognosis:

  1. extremely poor based upon his history and present status

  2. best practices wound care would not stop the gangrenous progression

  3. septicemia and death

Treatment Plan:

  1. his primary care nurse practitioner opted to try a physical therapy  intervention which incorporated the Treadwell™ System

Result(s):

  1. signs of progress within the second week

    1. edema reduction

    2. discoloration improved

    3. Induration lessened

    4. improved range of motion of right ankle and toes

    5. observable healing at the gangrenous site

  2. healing was continuous and progressive

  3. odor from the patient’s distal 3rd toe (gangrenous segment) prompted another referral to the vascular surgeon, who no longer recommended surgery

  4. spontaneous amputation of the distal two phalanges of the right 3rd toe occurred

  5. circulation in his right lower leg and foot had returned to normal including healing of his right 3rd toe

 

Addendum:

I have seen this patient in the facility recently, which is 9 months after this episode of care, and his right  lower leg and foot still appear normal with respect to swelling, coloration and induration.

 

Conclusion(s):

In my professional opinion, had the episode of care utilizing the Treadwell System not been engaged, progression of the gangrenous infection would likely have led to sepsis and death.

 

Estimates of the cost of a below the knee amputation surgery  and subsequent medical interventions begin at $100,000. Had this occurred and the patient survived, he would have had to go to a (more expensive) skilled facility to receive the level of care required for a bilateral amputee.

 

The total cost of the episode of care delivered utilizing Treadwell™ technology, which was delivered at the facility (no transportation required for the patient to go to an outside facility for treatments) was approximately $3,000, 3% or less of what the surgical alternative would have cost the healthcare system.

 

Richard Hand, PT

 

An 83 year old female who resides in a memory care facility diagnosed as having dementia. Prior to beginning her therapeutic intervention using the Treadwell System, an evaluation provided the following data:

1. Very limited response to questions; no initiation of conversation or questions

2. Edematous lower extremities (+2 right lower leg and +3  left lower leg).

3. A 1 x 0.35 cm ulceration on the lower/lateral third of her left leg

4. Random blistering of both lower legs

5. A venous clinical severity score of 17

6. The 6 min walk test = distance of 100 feet, with rests intervals every 20 feet

 

Her one month re-evaluation (31 days) provided the following data:

1. Patient initiated conversation 2 times during session; responded to questions appropriatedly

2. Lower extremity edema decreased by one grade on the right, and two grades on the left

3. Her ulceration was healed

4. Blistering of her legs no longer present

5. A venous Clinical Severity Score decreased to 4

6. The 6 minute walk test = 600 feet without interval rests

Conclusion: Therapy with the Treadwell System provided better than expected outcomes in cognitive conversational quality, ulceration healing, lower extremity skin condition, improvement in Clinical Severity Score and 6 minute walk test in the opinion of the writer.

 

Richard Hand, PT

Treadwell Corporation

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RTP, NC 27709

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Ellsworth, ME 04605

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