The Pulse

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)

Strength training and repetition of motor activity alone is not thought to result in functional recovery where impaired motor performance is the baseline. We know this to be true in movements required for both speech and swallowing in our patients who experience ataxia, apraxia, and other motor disruptions. Encouraging a patient with dysphagia to simply “practice” a dysphagic swallow with no modification to this task, is unlikely to produce a desired effect (Huckabee & McCrae, 2014).

Patient Information: Male, Age 71

Diagnosis: Subdural Hematoma / Oropharyngeal Dysphagia

History:
This gentleman was admitted to a skilled nursing facility for rehabilitation services following hospitalization due to a fall, which resulted in a traumatic subdural hematoma (bleeding between the skull and brain). He was then diagnosed with encephalopathy (damage to the brain) and oropharyngeal dysphagia (difficulty swallowing), with a feeding tube placed during his hospitalization to provide nutrition and hydration. Prior to his accident, this gentleman consumed a regular diet and drank thin liquids.

According to the CDC, in the U.S. there have been more than 33.9 million cases since January 2020. As many as 1 in 10 of those who develop COVID-19 exhibit new and prolonged symptoms lasting 12 weeks or longer. This is known as long COVID and occurs regardless of the severity of the acute illness. These individuals may have multisystem involvement with the most common symptoms after 6 months being fatigue, post-exertional symptom exacerbation (PESE), and problems with memory and concentration (brain fog). Therapists should screen for PESE, a worsening of symptoms typically 12 to 48 hours following even minimal cognitive, physical, emotional, or social activity that may last for days or weeks. (World Physiotherapy, 2021)

In a recent CDC Morbidity and Mortality Weekly Report, Moreland & Lee (2021) analyzed 2018 U.S. data which revealed individuals 65 and older had 2.4 million emergency department visits and more than 700,000 hospitalizations due to unintentional injuries. Greater than 90% of these injuries were related to falls. This shows the importance of an effective interdisciplinary fall prevention and balance program for the geriatric population.

Patient Information: Female, Age 78

Diagnosis: Oral Cancer / Dysarthria / Oropharyngeal Dysphagia

History: This woman, a long-term care resident of a skilled nursing facility, has a history of oral cancer four years ago. At that time, she underwent removal of 50% of her tongue, tissue grafting for her palate, and has resultant decreased jaw movement, oropharyngeal dysphagia (difficulty swallowing), and dysarthria (difficulty with speech production). Additionally, she underwent a tracheostomy (tube inserted into the trachea to assist with breathing) and a feeding tube was placed to provide nutrition due to her inability to eat and drink by mouth. She has received intermittent speech-language pathology services over the four years. Prior to her cancer, this woman had no limitations in eating, drinking, and speaking.

Patient Information: Female, Age 66

Diagnosis: Hemorrhagic Stroke / Oropharyngeal Dysphagia

History: This woman was admitted to a skilled nursing facility for rehabilitation services following hospitalization due to suffering a hemorrhagic stroke. As a result, she was diagnosed with altered mental status and oropharyngeal dysphagia (difficulty swallowing) and a feeding tube was placed to provide nutrition and hydration. Prior to her stroke, this woman ate a regular diet and drank thin liquids.

According to the CDC, each year in the United States more than 795,000 people suffer a stroke and it is the leading cause of serious long-term disability. Individuals who suffer a stroke may have muscle weakness throughout the body including muscles of respiration and swallowing. They also may have compromised endurance, poor balance, and increased dependency with mobility and activities of daily living which greatly impact their quality of life.