The Pulse

Patient Information: Male, Age 96

Diagnosis: Fall / Compression Fracture

History: This gentleman was referred to a skilled nursing facility following hospitalization due to a fall in his garage which resulted in a thoracic compression fracture of the spine. Prior to the fall, he lived at home and was independent with ambulation, driving and mowing his yard.

Patient Information: Female, Age 77

Diagnosis: Esophageal Cancer / Muscle Weakness

History: This woman was referred to a skilled nursing facility for rehabilitation services due to weakness and a decline in functional mobility after hospitalization due to esophageal cancer and feeding tube placement. Prior to her hospitalization she was living alone in a senior living apartment with an elevator and was independent for transfers and activities of daily living with her manual wheelchair due to prior bilateral below knee amputation.

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: Female, Age 70

Diagnosis: Left Femur Open Reduction Internal Fixation (ORIF) / Pain

History: This woman was admitted to a skilled nursing facility for rehabilitation services following hospitalization due to a fall at home resulting in a left femur fracture requiring surgical repair. Prior to her fall, she lived in a 2-story home with her husband and was independent with walking and all activities of daily living.

Patient Information: Female, Age 81

Diagnosis: Distal Femur Fracture / Fall Risk / Dementia

History: This woman was hospitalized for a surgical repair of her right femur, which she fractured in a fall. Following hospitalization, she was referred to a skilled nursing facility for rehabilitation to address decreased functional mobility and safety. Previously, she also had a hip and knee replacement on the same side. Prior to her fall she lived at home with her spouse and walked independently, including up and down four steps at the entrance of the home.

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