Patient Information: Female, Age 76
Diagnosis: Chronic Obstructive Pulmonary Disease (COPD) / Chronic Heart Failure (CHF) / Diabetic Neuropathy
History: This woman was referred to home health therapy services due to numerous falls, poor balance, and a decline in functional mobility. Over several months she became wheelchair-dependent in part due to fear of falling. Prior to this decline, she was independent with transfers and able to walk with a rolling walker to the dining room for meals in her assisted living facility.
Pre-Therapy Status:
•Strength: Fair minus (3-/5) throughout both legs.
•Transfers: Moderate (50%) assistance.
•Balance: Tinetti Gait and Balance Assessment score of 12/28, indicating a high risk of falls.
•Ambulation: 20 feet with a rolling walker and moderate (50%) assistance for walker management with oxygen saturation (O2 sat) dropping below 90% and requiring three minutes to recover. Modified Borg Dyspnea Scale (used to assess symptoms of shortness of breath) score 4/10, indicating somewhat severe breathlessness.
Therapy Information:
•Modality: Omnistim® FX2 Portable Muscle Stimulator.
•Frequency: 2x per week.
•Protocol Specifics: Lower extremity triphasic patterned electrical neuromuscular stimulation (PENS) to both legs for improved neuromuscular recruitment and strength. Initially the electrical stimulation was barely perceptible and a contraction was not obtained. At four weeks sensation improved and muscular contraction was visible.
•Duration: 8 weeks.
•Other Therapy Services Provided: Therapeutic exercise, standing static and dynamic balance exercise, energy conservation education, and fall prevention education.
Outcome:
•Strength: Good minus (4-/5) throughout both legs.
•Transfers: Independent.
•Balance: Significantly improved; Tinetti Gait and Balance Assessment score 22/28, indicating a moderate risk for falls.
•Ambulation: 350 feet with a rolling walker and one rest break due to fatigue with oxygen saturation staying above 90%. Modified Borg Dyspnea Scale score 2/10, indicating slight breathlessness.
This woman feels confident walking to the dining room for two meals a day and has the ability to self-assess when she needs a rest. She reports the electrical stimulation was instrumental in getting her better. The therapist reports she would not have gotten the muscle recruitment due to the severity of COPD and breathlessness without incorporating PENS. As a result, she could participate and progress to a much higher level.
