Excellence in Action: Persevering to Achieve Goals Across the Continuum of Care!

A 69 year-old female admitted to our Chaffee, MO, facility following a recent hospitalization caused by a syncopal episode, resulting in a fall with significant injuries.  Prior to her fall, she lived at home, and had been independent with all ADLs and Instrumental Activities of Daily Living (IADLs), including community mobility, driving, and cooking.

Upon arrival at the hospital, she had zero sensation/movement in the left upper extremity/right lower extremity, and minimal movement without sensation in the right upper extremity/left lower extremity. An MRI showed an interspinous ligamentous injury starting at the C2-C6 vertebrae, as well as spinal stenosis with associated spinal cord edema. She underwent surgery for a Posterior Decompression and Posterior Spinal Fusion of the C3-C7 vertebrae. After surgery she was left with little to no movement in her bilateral upper and lower extremities and was dependent for all Activities of Daily Living (ADLs) and transfers. 

She completed a couple of weeks of inpatient rehab at the hospital with minimal improvement. Then, based on a friend’s recommendation, she chose to transfer to our Chaffee facility to begin her skilled Rehab.  Abi, PT, and Jennie, OT, began developing her personalized plan of care, utilizing the Neuro Connections program for both PT and OT, with a touch of the PRIDE program to impact bowel and bladder incontinence. PTA, Kathy, and Ashley, COTA, worked to address these goals as well.  Through their care, the patient began to show improvement after the first week. She celebrated with our rehab team after each little goal she met, including regaining the ability to brush her teeth!  Once she was able to obtain solid core strength and good sitting balance, our therapists began to train the patient using a sliding board for transfers.

By the time she achieved a status of “Stand-By Assist” with the sliding board and was “Modified Independent” with some of her ADLs, her Managed Care insurance decided to end her stay. With some caregiver training, the patient and her husband decided to go home and see how it went.  After 5 days the patient returned to facility, stating that she and her husband were so impressed with the therapy she received at Chaffee, that they had decided to continue to pay privately for her stay in the facility to continue her recovery. 

At that point, our Therapy team decided to include Restorative Nursing to take over the patient’s basic exercise regimen, allowing our therapists to focus heavily on the patient’s functional abilities and neuromuscular development.  After 3.5 months of intense therapy and a consistent restorative exercise program, the patient was able to achieve Independence with her ADLs and transfers and could ambulate long distances with a walker. She was also completely continent of her bowel and bladder, thanks to the implementation of TMC’s PRIDE Program and our OT team, who addressed the patient’s abilities associated with toileting early on.

This patient continues to celebrate her successes and is receiving home health therapy with TMC therapists through Inspire Home Health, to regain her abilities for full ADL/IADL independence at home. She reports that she is doing great and is so grateful for all her therapists.  She and her husband rave about the therapy staff and the nursing staff at Chaffee, as well as the TMC Therapists providing her Home Health care.  

In Chaffee, MO, we are ALL IN for helping our patients achieve their goals of returning to their prior levels of function, and we don’t give up until we do!