We all know it’s true: There’s no place like home. That’s exactly what our 70-year-old female patient expressed upon 
admission at Olympia Transitional Care and Rehabilitation.
The patient experienced a cardiovascular accident at home resulting in a fall, with left distal femur shaft fracture. Upon admission, her level of function was as follows:
- Hoyer transfer
- NWB in LLE for eight weeks
- 9/10 pain in LLE, TD for toileting and dressing ADLs
- Mild-mod swallow impairment with mechanical soft and thin liquids
- Mild dysarthria
- Mild-mod cognitive communication deficit
The patient lived at home with her spouse with multiple myeloma in a supportive, social community. She was independent with gait in her home and over short community distances; with swallow function, motor speech, functional cognition for her living environment; and with ADLs and IADLs, including cooking and cleaning.
This patient had one simple goal: “To get back to the way it was.” More specifically, she wanted to return home to her spouse and her cats, return to ambulation at household distances, and decrease the level of caregiver assistance for ADLs.
Treatment Approach
Taking an interdisciplinary approach, we developed a treatment plan combining physical, occupational and speech therapy. COTA and PTA created a “Passport to Home” document to visually track patient goals and progress:
- Goals are checked off as they are achieved
- The patient has an active role in goal-setting and completion
- Extrinsic motivator for compliance over a lengthy rehab stay
Physical Therapy
- Pain management — manual therapy
- Transfer training — progressive strengthening, slide board transfers
- Gait training — parallel bars, bariatric FWW
- Balance training
- Stair training
Occupational Therapy
- Toileting — Q2 hour toileting schedule, nursing staff in-service for compliance
- Dressing — adaptive equipment education, timed trials for improved function
- Tub transfers — tub transfer bench
- UE resistance to fatigue
Speech Therapy
- Oropharyngeal dysphasia — OMEX, compensatory strategy training
- Dysarthria — OMEX, breath support training, compensatory strategy training
- Cognitive communication deficit — external memory aid training, attention processing strategies
Additionally, we collaborated with nursing staff to ensure:
- Safe swallow strategy and positioning training (ST, PT)
- Compliance with toileting schedule with use of external memory aid (ST, OT)
- Transfer recommendations set up (PT, OT)
Conclusions
Using an interdisciplinary approach with complex patients is essential to realizing the highest level of performance success. The use of standardized testing allowed us to develop a personalized plan of treatment for this patient’s needs and improve the chances of a positive outcome.
Although this patient was quite discouraged at the onset of rehabilitation and did not have high expectations for success, we were able to encourage her along the way and improve her outlook. With a team approach, were developed a detailed treatment plan that ultimately allowed her to return home near her prior level of function.
By Scott Hollander, PT, PDT; Sarah Koning, MSOT, OTR/L; and Megan Bennett, MS, CCC-SLP, Olympia Transitional Care and Rehabilitation, Olympia, WA