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.
• Low Back and Shoulder Pain: Severe (9/10).
• Bed Mobility: Maximum (75%) assistance to move to sit at the side of the bed.
• Transfers: Total (100%) assistance from two therapists to move from the bed to the wheelchair.
• Gait: Unable.
• Sitting Tolerance: 15 minutes; limited by pain.
• General Muscle Strength: Fair (2/5).
• Modality: Megapulse® II Shortwave Diathermy, Omnistim® FX2 Pro Patterned Electrical Neuromuscular Stimulation (PENS), Omnicycle® Elite Motorized Therapeutic Exercise System.Outcome:
• Frequency: 3-5x per week.
• Protocol: Weeks 1-4: LE Triphasic PENS to the lower trunk 3/wk x 4 weeks; LE Triphasic PENS to the bilateral quads and hamstrings 3/wk x 4 weeks. Weeks 5-12: Diathermy (delta 2 protocol) to bilateral shoulders and lumbar areas 5x/wk and 15 minute Omnicycle sessions to both the upper and lower extremities on the "Neuro" setting with increasing resistance as tolerated, 5x/wk.
• Duration: 12 weeks.
• Other Therapy Services Provided: Bed mobility, balance training, gait training, therapeutic exercise.
• Low Back and Shoulder Pain: Mild (1/10).
• Bed Mobility: Independent to move to sit at the edge of the bed.
• Transfers: Independent.
• Gait: Walks 300 feet independently with a rolling walker.
• Sitting Tolerance: 1 hour.
• General Muscle Strength: Normal (5/5).
This woman is thrilled to be back at home and the rehab director reports, "The use of e-stim when the patient was too weak to tolerate sitting up for traditional therapy in the gym prevented her from weakening and allowed for her to progress at a faster rate."
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