The Pulse

Patient Information: Female, Age 68

Diagnosis: Respiratory Failure

History: This woman was referred to a skilled nursing facility due to severe deconditioning following a two-month hospitalization for pneumonia, during which she experienced respiratory arrest and required ventilation by tracheostomy intubation (surgical procedure inserting a breathing tube through the trachea to restore breathing).

Diaphragmatic breathing helps individuals use their diaphragm correctly while breathing and enhances oxygen exchange (Cleveland Clinic, 2020). With age, stress, poor posture, and illness breathing changes and becomes shallow with increased reliance on accessory muscles. Implementing diaphragmatic breathing may help improve oxygen delivery throughout the body, use less effort and energy to breathe, and decrease overall oxygen demand.

Patient Information: Male, Age 69

Diagnosis: Chronic Heart Failure / Muscle Weakness / Kidney Failure

History: This man was admitted to a skilled nursing facility after a seven day hospital stay due to a decline in his ability to care for himself and his wife. He was referred to occupational and physical therapy to improve his strength and function, with the goal to return home and resume his role as the primary caregiver for his wife.

Primary respiratory muscles during normal quiet breathing include the diaphragm and external intercostals. Accessory muscles of respiration assist the primary muscles when the chest is not expanding or contracting effectively to meet ventilation demands. Increased age, stress, poor posture, COPD, pneumonia, and illness are conditions that negatively impact proper oxygen and carbon dioxide exchange in the lungs.

Individuals who present with a compromised pulmonary system, are acutely ill, or hospitalized for extended periods may become deconditioned or develop hospital-acquired muscle weakness, among other deleterious effects. Even healthy individuals may become deconditioned and frail if they decrease their activity level due to social distancing and limiting time outside their room or home.

Approximately 6.5 million adults in the United States have heart failure. Heart failure (previously referred to as chronic heart failure or CHF) occurs when the heart cannot pump enough blood throughout the body to meet the requirements of other organs and muscles. This results in a wide variety of symptoms and functional impairments which may result in hospitalization, re-hospitalization, and death. In 2017, heart failure contributed to 1 in 8 deaths. (CDC, 2020)

Over the past several years, the body of evidence on the effectiveness of virtual reality (VR) in rehabilitation has significantly expanded. VR has been studied for a variety of diagnoses including stroke, Parkinson’s disease, multiple sclerosis, dementia, burns, pain, and total knee arthroplasty. VR helps enhance patient involvement and motivation while increasing the repetitions and duration of exercise. Benefits addressing ADL performance, balance, gait, pain, and cognition have been reported.

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 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.

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.