The Pulse

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.

Proper trunk positioning is an essential component of optimal aerobic capacity training. Poor positioning of the head, neck, shoulders, trunk, and pelvis during aerobic exercise may compromise an individual’s ability to reach optimal functional outcomes.

Patient Information: Female, Age 85

Diagnosis: Fractured ribs / CHF / Generalized weakness

History: This woman was hospitalized after falling and fracturing seven ribs. During her
hospitalization, she began having complications from chronic heart failure which resulted in an
extended stay of almost a month. By the time she was discharged from the hospital, her function had declined as a result of generalized weakness and pain in her low back and upper shoulders. She was referred to therapy to recover her function, treat her pain, and improve her activities of daily living.

According to the CDC, heart disease is the leading cause of death in the United States, while chronic lower respiratory disease, primarily COPD, is the third leading cause of death.¹ With advancing age, an individual undergoes cardiovascular and pulmonary changes resulting in the fundamental physiological problem of reduced oxygen delivery to skeletal muscle.

The Centers for Medicare and Medicaid Services (CMS) states that to be covered, skilled therapy services must meet the following conditions:
     • Ordered by a physician
     • Be related to an active written treatment plan
     • Be of a level of complexity and sophistication requiring the judgment, knowledge, and skills             of a therapist
     • Accepted under standards of medical practice
     • Are reasonable and necessary