The Pulse

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.

Patient Information: Male, Age 75

Physical and occupational therapists treat many individuals who present with impaired coordination, motor control, balance and tone. These individuals may have a wide range of diagnoses, from neurologically involved, such as cerebral vascular accident (CVA) and Parkinson’s disease, to orthopedic involvement such as post-total knee replacement (TKR). The common goal of improving functional mobility and outcomes may be achieved by the addition of research-supported cycling and biophysical agents.

Patient Information: Male, Age 79

Diagnosis: Right Ankle Fracture / Gastrointestinal (GI) bleed

History: This gentleman was referred to a skilled nursing facility for rehabilitation services due to weakness and reduced functional mobility after hospitalization for a right ankle fracture (from a fall) and a GI bleed. Prior to hospitalization, he used a rolling walker to ambulate and lived in a 2-story home with a roommate who helped with household tasks.

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.

Hypertonia is defined as excessive muscle tone which leads to stiffness with movement or inability to move a joint and often occurs with neurological conditions such as upper motor neuron lesions (CP, CVA, TBI, SCI, MS) and basal ganglia disorders (PD, Huntington
disease, Dystonia). While the terms spasticity and hypertonia are often used interchangeably, spasticity is actually a subtype of hypertonia in which muscle tone is increased by the speed of joint movement. (NIH, 2019)

Patient Information: Male, Age 49

Diagnosis: Pneumonia / Neuropathy

History: This gentleman was found by EMS unable to get out of bed and covered in soiled bedding with insect infestation, and reported he hasn’t been out of bed for “quite some time.” He
was admitted to the hospital with pneumonia, then transferred to a skilled nursing facility
for rehabilitation services.

Range of motion (ROM) deficits may affect an individual’s ability to move, care for themselves, or perform typical daily activities including self-feeding, walking, and dressing. Decreased ROM is a common deficit addressed regularly by rehab professionals in all settings. Contractures arise from shortened muscle or other joint structure restrictions, leading to reduction in mobility and deformity with resultant reduced function.
• Prevalence of contractures in nursing homes is estimated at 55% with significant functional and medical consequences. (Offenbächer, 2014)
• Patients who are immobilized for a prolonged period are at risk of developing joint contractures, which often affect functional outcomes. (Born, 2017)

The use of outcome measures has become the standard of care to objectively assess changes in function, quantify clinical observations, enhance interdisciplinary communication, and examine intervention effectiveness at the patient and practice levels. Inconsistent use of outcome measures remains an issue due to difficulty identifying the most suitable measures based on patient diagnosis, acuity of condition, or practice setting.

Patient Information: Male, Age 57

Diagnosis: Cognitive Communication Deficit / Chronic Obstructive Pulmonary Disease /
Chronic Heart Failure

History: This gentleman was admitted to a skilled nursing facility and referred to speech therapy for decreased cognitive function and failure to thrive following bilateral above knee amputations. Previously, the gentleman lived at home.