The Pulse

Increasing emphasis on the value of care over the volume of care provides opportunity to incorporate different therapy delivery modes. Therapy delivered in a group format offers benefits over traditional one-on-one therapy that include increased socialization, independence with exercise, and improved transference of learning.

Patient Information: Female, Age 86

Diagnosis: Right Shoulder Fracture / Shoulder Pain

History: This woman fell at her home in an assisted living facility, resulting in a fracture of her
right shoulder. She was evaluated and treated in the emergency room and returned home with an immobilizer to limit the movement of her shoulder. After six weeks of right shoulder immobilization, she was referred to outpatient therapy. Prior to her fall she lived in an assisted living facility and was independent with dressing, eating, and bathing.

This is the third and final installment of our “Exercise in Swallowing Therapy” series. This article will examine some commonly used interventions in light of exercise principles. But first, a quick review. In order to be considered an exercise the activity must meet certain criteria (for more information refer to the two previous articles).

Gersten’s 1955 article on the effect of ultrasound on tendon extensibility began six decades of continuous published research, which has demonstrated the tried and true benefits of ultrasound. ¹ These benefits include pain reduction, a high degree of patient comfort and acceptability, increased cellular microcirculation, relaxation of trigger points and improved collagen extensibility. All of these physiological benefits are dependent on proper dosage and application technique. Ultrasound can provide both mechanical and thermal effects. An effective, skilled ultrasound treatment requires the use of high-quality ultrasound equipment, evidence-based patient-specific parameters, the appropriate treatment area, proper transducer movement speed, and optimal incorporation of the treatment with other therapy procedures.

Patient Information: Male, Age 86

Diagnosis: Stroke / Oropharyngeal Dysphagia / Dysarthria

History: This gentleman was admitted to a skilled nursing facility for rehabilitation services due to oropharyngeal dysphagia (difficulty swallowing) and difficulty managing saliva after hospitalization due to a stroke. He was only consuming 0-25% of his meals. Prior to his stroke, he lived at home with family, worked two days a week, and ate a regular diet.

Patient Information: Male, Age 72

Diagnosis: Spinal Stenosis / Muscle Weakness / Low Back Pain

History: This gentleman went to the emergency room (ER) due to increased pain from spinal stenosis. He received pain medication and was sent home. He fell and returned to the ER and was referred to a skilled nursing facility due to his inability to bear weight on his right leg, walk, or return home. Previously he lived independently in a single story home with three steps at the entry.

Shoulder range of motion, strength, and function are vital to self-care and everyday activities such as dressing, bathing, lifting and carrying items, and putting away groceries. With advanced age individuals may experience a variety of shoulder impairments including arthritis, rotator cuff tears, impingement, and fractures. These issues can result in pain, decreased motion, impaired strength, and reduced function.

In the first installment of “Exercise in Swallowing Therapy” the roles of overload and adequate
duration of therapy were discussed. In this second installment, additional exercise principles of intensity progression and repetition are described.