The Pulse

This 80-year-old woman experienced severe debility following hospitalization for COVID-19 with pneumonia. She was referred to a skilled nursing facility for rehabilitation services including speech therapy to address poor voice quality, and difficulty breathing while eating. She also required 3 liters per minute of supplemental oxygen. Prior to hospitalization, she had no limitations in speaking and eating.

This 82-year-old woman was unable to get up after falling at home. As a result of laying on her left side for more than 24 hours after the fall, she experienced tissue injury on her right hip that progressed over time to a non-healing unstageable (depth not visible) pressure wound. She was referred to outpatient physical therapy for wound healing and fall prevention. Prior to her fall, this woman lived alone and walked with a walker.

Individuals with cardiopulmonary conditions often present with dyspnea, severe weakness, poor endurance, limited mobility, and decreased activity tolerance. As their disease state progresses, their ability to perform activities of daily living (ADLs) declines, ultimately leading to a loss of independence. A therapy plan of care that includes breathing exercises, energy conservation techniques (e.g., paced activity, assistive device, task planning), and ventilatory strategies may improve the individual’s breathing and functional performance as well as help maintain independence.

Dysphagia Research Summaries:

This 78-year-old woman (a left below knee amputee for 30-years) suffered a stroke and received four weeks of inpatient rehabilitation. Due to severe hip pain and inability to perform self-care, she was then referred to a skilled nursing facility for rehabilitation services. Prior to her stroke, this woman lived alone and was independent with self-care and mobility while wearing her prosthesis.

Focused Clinical Application
Synchrony: Skill-Based Typical Swallow Interventions

Improving Speech and Swallowing Using sEMG and Breathing Therapy Biofeedback

Patient Information: Male, Age 73

Diagnosis: Chronic Obstructive Pulmonary Disease (COPD) exacerbation.

History: This gentleman was referred to a skilled nursing facility for rehabilitation services to address significant weakness and functional decline after an exacerbation of COPD.

Patient Information: Female, Age 64

Diagnosis: Cellulitis / Venous Insufficiency Ulcer / DJD Bilateral Knees

History:
This woman was referred to a skilled nursing facility for rehabilitation services following hospitalization due to cellulitis of her left lower leg. Thirty years ago, she fell and injured her left ankle and developed a venous insufficiency ulcer, which has never fully healed and recently has gotten worse due to the cellulitis. Prior to her hospitalization, she required maximal (> 75%) assistance from her husband for activities of daily living (dressing and bathing) and transfers due to a prior stroke and bilateral knee degenerative joint disease causing knee pain, weakness, and limited range of motion.