The Pulse

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.

Opioids are commonly prescribed for acute and chronic pain, including after surgeries such as THR, TKR, and ORIF. Opioids have numerous side effects and a high potential for misuse. Over-reliance on opioids for acute and chronic pain management has led to alarming trends across the United States, including a record number of people developing opioid use disorders, overdosing on opioids, and dying from overdoses. From 2015 to 2017, the annual number of opioid-related deaths rose 44% from 33,000 to 47,600.¹

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 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.

Patient Information: Female, Age 72

Diagnosis: Multiple Sclerosis / Chronic Left Leg Pain / Fibromyalgia

History: This woman, a long-term skilled nursing facility resident, was referred to therapy due to an increase in chronic left leg pain and decreased safety with functional mobility. Prior to this decline she was independent with transfers and walking.

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.

Gersten’s 1955 article on the effect of ultrasound on tendon extensibility began six decades of continuous published research, which has demonstrated the tried and true benefits of ultrasound. ¹ These benefits include pain reduction, a high degree of patient comfort and acceptability, increased cellular microcirculation, relaxation of trigger points and improved collagen extensibility. All of these physiological benefits are dependent on proper dosage and application technique. Ultrasound can provide both mechanical and thermal effects. An effective, skilled ultrasound treatment requires the use of high-quality ultrasound equipment, evidence-based patient-specific parameters, the appropriate treatment area, proper transducer movement speed, and optimal incorporation of the treatment with other therapy procedures.

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.

Shoulder range of motion, strength, and function are vital to self-care and everyday activities such as dressing, bathing, lifting and carrying items, and putting away groceries. With advanced age individuals may experience a variety of shoulder impairments including arthritis, rotator cuff tears, impingement, and fractures. These issues can result in pain, decreased motion, impaired strength, and reduced function.