Excellence in Action! – Encouragement, Perseverance and Clinical Programs

We had a resident admitted from a local specialty hospital with a status of total dependence. He had failed extubation attempts on file with his admitting diagnosis consisting of acute hypoxic respiratory failure, status post LLE amputation, peripheral arterial disease, and sepsis.

We evaluated using TMC’s Specialty Programs focused on Fall Prevention, Functional Mobility and Dysphagia. Through a four-month length of stay (LOS), he exhausted his Part A benefits, receiving services from all three disciplines.

Physical therapy (PT) and occupational therapy (OT) carried over to his Part B benefits to continue to address prosthetic needs and training before reintegrating into his home environment. Daily treatments included training with donning/doffing prosthesis and bed mobility tasks. The parallel bars were also used for balancing tasks and weight shifts to aid with prosthesis balance and body mechanics, along with proprioception tasks with prosthetic, trunk control exercises, and progressive resistive activities. Education regarding pressure relief and skin integrity with prosthesis was also provided, as well as wheelchair safety and transfer training. They also used motor imagery with mirror therapy to impact phantom limb sensation and coordinated and attended prosthesis visits.

Speech Therapy (ST) focused on improving the patient’s ability to tolerate an oral diet, as his primary means of nutrition was via percutaneous endoscopic gastrostomy (PEG), with a pleasure tray consisting of puree/nectar, which he often refused. The Breather, a Respiratory Muscle Training (RMT) device, was used for resistive breathing exercises, while neuromuscular electric stimulator (NMES) treatment was also implemented. Two comprehensive swallow assessments, in addition to traditional methods for improving swallow function were used as well. ST also included cognitive-linguistic treatment to address memory and attention tasks, money and medicine management tasks in conjunction with memory strategies, and patient and caregiver education regarding safety in the home environment and safety at meals.

In the beginning, he required maximum encouragement for participation. He wanted to return home but, understandably, just did not have the “get-up and go” to make it happen. Our team made every effort to be positive and encouraging to help him achieve his goals, including sacrificing their own sweat and tears throughout his journey.

He has now discharged home with independent/modified independent (I/MOD I) status in all areas. He also achieved the ability to tolerate a mechanical soft diet with thin liquids. When he left the facility, he wrote a letter to our therapy team thanking them for all their help and encouragement and left with a huge smile on his face and a thankful heart.

“I feel like rehab more or less saved my life…I would like to thank the entire rehab staff, such as the man that helped me pass my swallowing test so I could eat real food so I could get stronger and participate in PT and OT.”