The Pulse

Patient Information: Female, Age 78

Diagnosis: Stroke / Oropharyngeal Dysphagia

History: This woman with a history of several strokes had a subsequent stroke that resulted in severe oropharyngeal dysphagia (difficulty swallowing). She had weakness in her lips, tongue, and muscles involved in her swallow, and required a feeding tube for all nutrition and hydration. She was admitted to a skilled nursing facility after discharge from the hospital. Prior to her most recent stroke she ate a normal diet with thin liquids.

Patient Information: Female, Age 85

Diagnosis: Falls / Back Pain

History: This woman, a long-term skilled nursing facility resident, was referred to therapy by the
nursing staff due to a recent fall in her room, decreased safety awareness, unsafe transfers,
and increased pain in her back and legs. Prior to the fall this woman required supervision to safely get in and out of bed and maximal assistance to walk.

Patient Information: Female, Age 92

Diagnosis: Osteoarthritis / Dementia / Anxiety

History: This woman, a long-term skilled nursing facility resident, was referred to therapy for right hip pain due to osteoarthritis which resulted in a functional decline with transfers in and out of bed and her ability to walk. Previously, this woman required minimal (<25%) assistance with bed mobility and transfers and she walked throughout the facility using a rolling walker and guiding contact of a caregiver for steadying assistance.

Recently I was engaged in a conversation related to the ability of a speech pathologist to clinically determine swallowing pathophysiology. A therapist responded she had paid a great deal of money for her degree and if she could not rely on her “clinical judgement” to accurately diagnose patients with dysphagia she had wasted her money.  I was not sure how to respond. However, after some reflection, here is my thoughtful response.

What do you do in your free time?
I love playing sports and spend a lot of time playing soccer in a competitive travel league, as well as a recreational league. Both of my sons play competitive travel soccer as well. The soccer field is our second home. I also enjoy reading and deep sea fishing. Fun fact:  I caught a personal record snapper this year at around 75-80 pounds.

How long have you been with ACP?  6 years

Patient Information: Male, Age 67

Diagnosis: Stroke

History: This gentleman was referred to a skilled nursing facility for rehabilitation services after hospitalization due to a second stroke which resulted in lower extremity weakness and decreased balance. Prior to this stroke, he lived at home with his wife and walked with a hemi-walker.

Patient Information: Female, Age 95

Diagnosis: Left Femur Fracture

History: This woman was admitted to a skilled nursing facility for rehabilitation services after hospitalization due to a fall at home, resulting in a femur (leg) fracture. Prior to her fall she
lived at home with family support and walked with a rolling walker and assistance.

The ability of an individual to maintain balance while performing everyday activities is necessary to prevent falls. Therapists treating patients with balance impairments may use a variety of techniques to address identified deficits in strength, range of motion, and/or coordination.

Ankle range of motion, strength, and coordination are critical in standing balance and gait. Patients with a wide range of diagnoses (CVA, PD, MS, COPD, TKA, THA, generalized weakness, etc.) have impaired ankle balance strategies and diminished walking ability. The use of functional electrical stimulation combines targeted e-stim with functional activity to improve strength and coordination. The studies below illustrate some of the benefits.

Patient Information: Female, Age 76

Diagnosis: Acute Hypoxic Respiratory Failure / Acute Bronchitis

History: This woman was referred to a skilled nursing facility for rehabilitation services after hospitalization for acute hypoxic respiratory failure and acute bronchitis. After an eight day stay at the facility, she was re-hospitalized with pneumonia for two weeks and then readmitted to the skilled nursing facility for therapy due to a decline in strength, endurance, balance and overall functional mobility. She also had extensive bruising, swelling, and pain in the right forearm and hand. Prior to hospitalization she lived at home and used a wheelchair throughout her home for mobility.