The Pulse

Patient Information: Female, Age 83

Diagnosis: Acute Encephalopathy / Chronic Heart Failure / Morbid Obesity

History: This woman was referred to a skilled nursing facility due to declining health, functional mobility, and ability to care for herself. Thirteen months prior, she was hospitalized due to encephalopathy and complications from chronic heart disease, she was then referred to a skilled nursing facility for rehabilitation. She had poor adherence and participation in therapy. At that time, her son and daughter-in-law took her home despite requiring assistance for all transfers, mobility, and most daily living activities. Once home, her activity level and health further declined and she was re-admitted to the hospital and subsequently back to the skilled nursing facility. Prior to initial hospitalization, she was able to propel herself in her wheelchair up to 100 feet and was able to assist with transfers and self-care.

ACP’s MFAC Hand Control protocol provides for electrical stimulation-assisted muscle contraction to assist with the development of functional movement of superficial and deep muscles. To maximize the therapeutic effect of the intervention, the electrical stimulation delivered by the MFAC Hand Control protocol should be set to elicit a grade 3-5 muscle contraction and should be administered along with a strong volitional contraction by the patient.

Patient Information: Female, Age 91

Diagnosis: Left Hip Pain / Spinal Stenosis / Difficulty Walking

History: This woman, a long-term skilled nursing facility resident, was referred to therapy due to a significant decline in functional mobility including bed mobility, transfers and walking. The decline was preceded by a fall while getting out of the car with her daughter, after which
she experienced increased pain in her left hip and back. Prior to this incident, she required minimal assistance with most functional tasks.

Patient Information: Male, Age 80

Diagnosis: Muscle Weakness / Falls

History: This gentleman, a long-term skilled nursing facility resident, was referred to therapy by nursing due to generalized weakness, risk of falls, and a significant decline in his ability to bathe, dress himself and use the bathroom independently over the previous few weeks. Prior to this decline he was able to walk 100 feet with a rolling walker with close supervision and required minimal (25%) assistance for toileting.

According to the CDC, falls are not only a serious health risk, they carry a high economic burden as well. For older adults in the US, fall mortality rates have increased by 30% from 2007 to 2016. In 2015, the total medical cost for falls was more than $50 billion with Medicare and Medicaid accounting for 75% of these costs. The statistics related to falls are astounding. Each year:¹

• Three million older adults are treated in emergency departments for fall injuries
• 800,000+ patients are hospitalized due to a fall-related injury, most often head injury or hip fracture
• A typical nursing home with 100 residents reports about 100-200 falls
         – 35% of injuries due to falls occur in residents who do not ambulate
• 24% (most common cause) of falls among elderly nursing home residents are due to muscle weakness and gait problems, whereas 16-27%, on average, are due to environmental hazards

Patient Information: Male, Age 66

Diagnosis: Fall-Related Trauma / Multiple Fractures

History: This gentleman was admitted to a skilled nursing facility for rehabilitation services after being hospitalized for two and a half months due to a fall at home while climbing a ladder, resulting in multiple fractures to the left side of his body. While in the hospital he suffered respiratory failure due to a pneumothorax (collapsed lung). Prior to his fall he was living at home, independent with all activities, and worked full-time in the field of construction.

Patient Information: Female, Age 86

Diagnosis: Right Shoulder Fracture / Shoulder Pain

History: This woman fell at her home in an assisted living facility, resulting in a fracture of her
right shoulder. She was evaluated and treated in the emergency room and returned home with an immobilizer to limit the movement of her shoulder. After six weeks of right shoulder immobilization, she was referred to outpatient therapy. Prior to her fall she lived in an assisted living facility and was independent with dressing, eating, and bathing.

Patient Information: Male, Age 72

Diagnosis: Spinal Stenosis / Muscle Weakness / Low Back Pain

History: This gentleman went to the emergency room (ER) due to increased pain from spinal stenosis. He received pain medication and was sent home. He fell and returned to the ER and was referred to a skilled nursing facility due to his inability to bear weight on his right leg, walk, or return home. Previously he lived independently in a single story home with three steps at the entry.

Patient Information: Female, Age 82

Diagnosis: Right Hip Open Reduction Internal Fixation (ORIF) / Right Hip Pain / Falls

History: This woman was referred to a skilled nursing facility for rehabilitation services after hospitalization due to a fall which resulted in a hip fracture requiring surgery. Prior to her fall she lived independently at home.

Patient Information: Male, Age 62

Diagnosis: Muscle Weakness / Falls / Dementia

History: This gentleman, a long-term skilled nursing facility resident, experienced several falls from his wheelchair and was referred to therapy by nursing to maximize his overall functional mobility in an effort to reduce his fall risk.