The Pulse

Patient Information: Female, Age 75

Diagnosis: Supraglottic Cancer / Oropharyngeal Dysphagia / Chronic Obstructive Pulmonary Disease

History: This woman was referred to a skilled nursing facility for rehabilitation services due to progressively worsening swallow function following completion of radiation therapy for supraglottic (throat) cancer. During hospitalization, a video fluoroscopic swallow study (VFSS) was conducted due to dysphagia (difficulty swallowing) indicating aspiration (material entering the lungs), and a feeding tube was placed for all nutritional needs. Prior to the onset of throat cancer, she ate a regular diet.

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.

Patient Information: Female, Age 78

According to the CDC, dementia affects one’s ability to remember, think, and make decisions that impact daily activities and safety. Alzheimer’s disease (AD) is the most common type of dementia accounting for 60-80% of cases. As dementia progresses to increased levels of memory loss and confusion, the individual becomes more sedentary and frail. Rehabilitation in this population should be tailored to patient needs addressing cognition, strength, gait, balance, endurance, and function.

Patient Information: Female, Age 64

Diagnosis: Acute Respiratory Failure / COVID-19 / Chronic Obstructive Pulmonary Disease (COPD)

History:
This woman was referred to a skilled nursing facility due to severe debility following a seven week hospitalization due to COVID-19. Her condition was complicated by diabetes, COPD, and pulmonary fibrosis. At the time of hospital discharge, she required 8 liters per minute of supplemental oxygen to maintain oxygen saturation level. Prior to hospitalization she lived with her family in a 2-story home, was independent with walking and all self-care, and worked as a construction supervisor.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder often requiring therapy to address motor symptoms such as bradykinesia, rigidity, tremors, shuffling and freezing gait, poor postural control, and impaired balance. Exercise plays a key role in rehabilitation for this population with additional benefits being achieved by incorporating biophysical agents and advanced technologies. Research demonstrates that exercise improves motor skill performance, which may be enhanced with cognitive engagement through feedback, cueing, dual-tasking training, and motivation (Petzinger, et al., 2013).

According to the CDC, more than one in four older adults fall each year. Falls may lead to fear of falling, decreased mobility, dependence, increased risk of future falls, and even death. The goal of a fall prevention and balance program is to decrease future falls and improve functional mobility, safety, and quality of life. Rehabilitation for those at risk of falling may include training for static and dynamic balance, gait, dual-task (DT) activity, and cognition which may be accomplished with virtual reality.

Pain*
Is your resident experiencing pain?
• Always assess pain level
• If resident is in pain, report immediately

Patient Information: Female, Age 80

Diagnosis: Subluxed Humerus / Pain

History:
This woman, a long-term care resident of a skilled nursing facility, was referred for rehabilitation services to address pain, decreased strength, and impaired motion of the left shoulder after experiencing a fall which caused her left shoulder to become partially dislocated (subluxed). Prior to her fall, she was able to dress independently.

Patient Information: Female, Age 64

Diagnosis: Acute Respiratory Failure / COVID-19 / Chronic Obstructive Pulmonary Disease (COPD)