The Pulse

This 80-year-old woman experienced severe debility following hospitalization for COVID-19 with pneumonia. She was referred to a skilled nursing facility for rehabilitation services including speech therapy to address poor voice quality, and difficulty breathing while eating. She also required 3 liters per minute of supplemental oxygen. Prior to hospitalization, she had no limitations in speaking and eating.

This 82-year-old woman was unable to get up after falling at home. As a result of laying on her left side for more than 24 hours after the fall, she experienced tissue injury on her right hip that progressed over time to a non-healing unstageable (depth not visible) pressure wound. She was referred to outpatient physical therapy for wound healing and fall prevention. Prior to her fall, this woman lived alone and walked with a walker.

This 78-year-old woman (a left below knee amputee for 30-years) suffered a stroke and received four weeks of inpatient rehabilitation. Due to severe hip pain and inability to perform self-care, she was then referred to a skilled nursing facility for rehabilitation services. Prior to her stroke, this woman lived alone and was independent with self-care and mobility while wearing her prosthesis.

Improving Speech and Swallowing Using sEMG and Breathing Therapy Biofeedback

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 64

Diagnosis: Cellulitis / Venous Insufficiency Ulcer / DJD Bilateral Knees

History:
This woman was referred to a skilled nursing facility for rehabilitation services following hospitalization due to cellulitis of her left lower leg. Thirty years ago, she fell and injured her left ankle and developed a venous insufficiency ulcer, which has never fully healed and recently has gotten worse due to the cellulitis. Prior to her hospitalization, she required maximal (> 75%) assistance from her husband for activities of daily living (dressing and bathing) and transfers due to a prior stroke and bilateral knee degenerative joint disease causing knee pain, weakness, and limited range of motion.

Patient Information: Female, Age 75

Diagnosis: Supraglottic Cancer / Oropharyngeal Dysphagia / Chronic Obstructive Pulmonary Disease

History: This woman was referred to a skilled nursing facility for rehabilitation services due to progressively worsening swallow function following completion of radiation therapy for supraglottic (throat) cancer. During hospitalization, a video fluoroscopic swallow study (VFSS) was conducted due to dysphagia (difficulty swallowing) indicating aspiration (material entering the lungs), and a feeding tube was placed for all nutritional needs. Prior to the onset of throat cancer, she ate a regular diet.

Patient Information: Female, Age 78

Patient Information: Female, Age 64

Diagnosis: Acute Respiratory Failure / COVID-19 / Chronic Obstructive Pulmonary Disease (COPD)

History:
This woman was referred to a skilled nursing facility due to severe debility following a seven week hospitalization due to COVID-19. Her condition was complicated by diabetes, COPD, and pulmonary fibrosis. At the time of hospital discharge, she required 8 liters per minute of supplemental oxygen to maintain oxygen saturation level. Prior to hospitalization she lived with her family in a 2-story home, was independent with walking and all self-care, and worked as a construction supervisor.

Patient Information: Female, Age 80

Diagnosis: Subluxed Humerus / Pain

History:
This woman, a long-term care resident of a skilled nursing facility, was referred for rehabilitation services to address pain, decreased strength, and impaired motion of the left shoulder after experiencing a fall which caused her left shoulder to become partially dislocated (subluxed). Prior to her fall, she was able to dress independently.