Upon admission at La Villa Rehabilitation & Healthcare Center three years ago, one 92-year-old Spanish-speaking patient came to us with a history of dementia, heart disease and renal failure. She had undergone prior hospice care as well as multiple episodes of skilled therapy intervention.
On admission, she would walk a short distance of 20 to 30 feet with a flexed trunk and knees. Having experienced a recent decline in function secondary to a hospital stay, she avoided socializing and disliked therapy. She has a history of not participating in therapy and tends to leave her sessions if she feels she has to do too much activity.
Interventions
Therapy evaluation revealed decreased ROM to B knees secondary to arthritic changes and hamstring tightness. Due to her long periods of sitting and the fact that she keeps her knees flexed during WC mobility and primarily uses her UEs for propelling, she presents with tight hamstrings and hip flexors.
With skilled therapy services, the focus was to increase BLE ROM with hamstring stretches and hip flexor stretches. However, the patient was not interested in these interventions. Family then expressed that she would like a new WC. The therapy team discussed with her that if she would help more with transfers and other mobility and allow us to stretch her out, then a new WC would benefit her much more.
The patient worked on the Sci Fit to increase her ROM and strength, with a focus on sit-to-stands on the parallel bars with max A and transfers with max A. The patient would help to stand, but once in standing, she would flex her knees again and would not bear weight.
During this time, we brought in the Barihab Table and encouraged her to let us try using the table with her for transfers, with assistance from the L side bar. This allowed her to feel more secure after the first try. Within a couple of days, the patient was gradually able to utilize the table for hamstring stretches.
We also used the back support to progressively lower her from sitting to a more supine position to obtain a hip flexor stretch. The patient began to perform crutches to increase trunk control, and she was beginning to like the outcomes of the treatment sessions.
We then introduced her to the seat lift for lower body support to move into standing. She was able to gain strength and trust, and she allowed herself to stand with one-handed support and slowly progressed to releasing both hands. She will now play catch with the ball and is helping with transfers as she stands up taller and takes steps to stand and pivot.
Conclusion
We are amazed at the progress we’ve made with a patient who previously disliked therapy and now knows to come to therapy on her own. She has a new custom WC, and even though she still keeps her knees flexed, she is stretching them out on her own and performs stand-pivot transfers with mod A with nursing. The patient’s initial smile when she could stand was priceless, and we continue to gain her trust with each therapy session.