A Dream Come True at Lake Village Nursing & Rehabilitation

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Polly Bee2
Our patient Polly Bee had not walked in 20 years, but our therapy team did not let that stop them from helping Polly follow her dream of walking again. Some of the approaches used by Lake Village therapists with Polly Bee included:

  • Barihab utilized for balance, proprioception and standing tolerance
  • Mobilization techniques to facilitate muscle flexibility for knee
  • Muscle energy
  • Joint mobility
  • Standing activity tolerance
  • Custom shoe for leg-length discrepancy
  • Adaptive equipment for ADls/self-care training
  • Postural alignment
  • Home evaluation for environment modifications

Here, in her own words, is Polly Bee’s story.

It was a cold, wet morning 23 years ago when my life ended, as it was, in an accident that kept me in a wheelchair from then on. While riding in my mobile home, I was forced off the road by a tractor trailer. This broke my left femur in half, and my right foot yanked completely off by getting hung between the door and the step of my mobile home. Before we could get the wheels of the mobile home back on the road, we hit a 6-foot ditch, nose down, making it into an accordion.

The accident happened at 4:30 a.m., and I was taken to the emergency room, where I waited until 2:30 p.m. before I was operated on. Infection took over my left femur during that waiting time, and 32 surgeries later, I had lost not only my femur, but my whole left leg bone. My last surgery left me with a titanium bone from my left ankle to my pelvis. My knee cap was left on top of my internal prosthesis, floating and getting caught in the hinge of my knee, causing very severe pain. Ever since then, I have been in a wheelchair suffering with this pain, living life the best I could.

Two months ago, at 9:30 p.m., I fell off the bed and landed on my left knee, causing me to end up in the hospital for pain control. After getting my pain under control, I was forced to come to Lake Village Nursing & Rehabilitation Center in Lewisville, Texas, because I had no one to care for me at home. My only consolation of coming to Lake Village was that it was very close to my youngest daughter’s home.

At Lake Village, they have an excellent therapy department! I started off exercising my legs, which I had done many times in several rehab centers. But this time, one of my therapists, Addie, actually listened to me and addressed the problem that was causing the pain. She mobilized my kneecap to its proper position with use of slight pressure and used Biofreeze to massage my leg muscles to increase flexibility and facilitate joint movement.

I started to practice standing from there, because my pain was finally under control. I realized that I needed a built-up shoe that would lengthen my internal prosthesis leg to match the length of the normal leg. Once I received my custom shoe, I had overcome all the barriers. Before I knew it, I was walking over 100 feet on my walker! This was the first time I had walked or even taken a single step in 23 years!

This was not only a huge accomplishment for me, but also for Addie, Chris, Ellen and Eric. Hats off to the greatest therapists in the United States! This is the eighth rehab that I have been in since my accident. They all helped me make many accomplishments, but none as great as Lake Village. I always had a dream to walk again, but 10 years ago, I gave up on it and had no hope of ever standing on my own two feet, much less walking. Now I see some light at the end of the tunnel. I will be moving to my daughter’s home soon, and as I get stronger, my long-term goal is to be able to go back to my home in Colorado. All of this is due to the great therapists at Lake Village Nursing & Rehabilitation Center.

Combining Technology and Rehab at Palm Terrace Healthcare & Rehabilitation

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As therapists, we face many daily challenges, including weekly notes, recertifications, orders, schedules and so on. As we provide skilled services, we must justify services via documentation, making it essential to have the equipment necessary to do so.

With technology and the correct devices, we are able to accomplish our daily tasks with reduced legwork. We no longer have to chase down a chart; we can access all of the pertinent information at our fingertips. In our industry, regulations change frequently, and with the use of technology, we are able to stay ahead of the curve and incorporate the changes to ensure compliance.

For example, we use systems such as Rehab Optima, PCC, RO5, in conjunction with devices such as COWs (computers on wheels), laptops and iPads. In Rehab Optima, we have access to reports that allow therapists and nurses to see which patient is being seen by which therapist and what room number the patient is in, as well as weekly reports, recertification, upcoming discharges and productivity/efficiency.

Challenges

Change is not always welcome. Our therapists first had to get used to switching from paper documentation to computer documentation. Many of them were not accustomed to typing, often taking longer to type up notes rather than write them, and lacked education on how to use various technologies.

Progress

Therapists and assistants are getting used to providing accurate, effective point of service documentation. We are seeing increased productivity as therapists no longer have to search for charts and have patient information readily available, such as goals, PLOF, precautions and notes.

Today, we’re seeing enhanced communication among therapists, standardized assessments with less paper involved, and a greater ability to track outcomes. Our team has made big strides forward as we combine technology and rehab for the benefit of patients and therapists alike.

By Scott Dagenais DOR, Palm Terrace Healthcare & Rehabilitation, Laguna Hills, CA

Laminectomy with Post-Surgical Complications at The Courtyard Rehab

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One of our patients, a 61-year-old African-American man, came to The Courtyard Rehab following a laminectomy. A retired cook, the patient had lived independently in the community with PRN assistance from family before surgery and admission to rehab. One week after admission, the client complained of chest pain with SOB and was sent to the hospital. A CT scan revealed multiple pulmonary embolisms in the bilateral lungs. The patient was receiving daily Heparin injections prior to hospital readmission. Our approach to treating the patient included the following:

  • Patient education on signs, symptoms and risk factors of SOB
  • Rated Perceived Exertion Scale, rated 0 to 10 to measure exercise intensity
  • Continuous monitoring with pulse oximeter
  • Energy conservation techniques
  • Low-weight and high-repetition exercises
  • Use of Biodex for seated exercise
  • Gait training

We observed the following results:

Courtyard Graph

Conclusion

Pulmonary embolism can account for 15 percent of all post-operative deaths, with greater risks associated with those undergoing lower extremity procedures, limb amputations and spinal surgery. Risk factors for PE include prolonged immobilization, status of pre-op blood coagulation, age, gender (males are higher risk) and ethnicity (African-Americans have a 50 percent higher risk.)

As illustrated with our patient, therapists must remain vigilant in monitoring S/Sx and vital signs during therapy of post-surgical patients. It is critical that therapists are aware of risk factors and demonstrate good communication with doctors and nursing regarding any potential change of condition. Due to good interdisciplinary communication and aggressive skilled therapy, this man recovered to his prior level of function and was able to return home.

By Justine de la Fuente MOTR/L

Solo Step Fall Protection and Balance System at Park Manor Rehabilitation

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For those of you unfamiliar with the Solo Step, it’s a device designed to prevent patients from falling while also aiding and encouraging their balance. Consisting of an overhead aluminum track and trolley mounted to the ceiling with an attached harness, the Solo Step offers numerous benefits in addition to fall prevention:

  • It instills confidence in patients facilitate maximum recovery from neurological and musculoskeletal deficits
  • It protects patients from injuries as well as the therapists providing care
  • It provides support during all aspects of therapy, including sit-to-stand, ambulation, balance training and climbing stairs
  • It only requires one therapist when used on mid- to high-level patients

After performing a series of standardized tests and interventions with the Solo Step among a selection of low-, mid- and high-level patients, we observed the following results:

[include graph from Park Manor Solo Step poster showing results]

By Sonya Taylor OTR/L, DOR, Crystal Eno DPT and Kelsey Kellar SPT

The Use of AlterG for a Patient Limited by Pain

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Richland Hills Alter GAt Richland Hills Rehabilitation & Healthcare, we have been pleased with the results of using the AlterG Anti-Gravity Treadmill. We had one client who presented with a history of COPD and HTN and was greatly limited by pain. As a former athlete, he was eager to participate in rehabilitation, but he struggled due to his comorbidities. The rehab team determined that he would be a great candidate for use of the AlterG.

Intervention

The AlterG allowed us to target strengthening and conditioning in a fall-safe environment. Our client regained mobility and increased range of motion, all while minimizing stress and pain. Although skeptical at first, after his first time on the AlterG, he was ecstatic that he was able to be mobile and have no pain afterward. The therapists were able to monitor his weight-bearing status and easily track his progress.

Added Challenge

Another limitation for our client was that he came to us without shoes. He wears a 16 wide! Staff members of Richland Hills pooled money together and searched for the perfect shoes for him. He loves his new shoes as well as the rehab department, and he will be staying with us as a long-term care resident.

Richland Hills graph

Stages of Recovery at Sloan’s Lake Rehabilitation Center

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Oftentimes, patients undergo various setbacks on the road to recovery. For instance, one of our patients, a 77-year-old woman with history of post-polio syndrome, had sustained a pathologic hip fracture related to osteoarthritis in January 2014. She underwent a L THA and was sent to a rehab center. A few days later, she developed a marked increase in pain and shortening of her leg. She had significant bruising on her entire leg and up into her back.

Our client was sent back to the hospital, where X-rays revealed the hip socket had dislodged into her pelvis. Over the next month, she changed surgeons and underwent additional surgeries to reconstruct her hip joint, including an impaction bone graft of her left acetabulum. She did not return to the previous rehab facility, but instead chose Sloan’s Lake Rehab.

Despite her history of polio as a child, our client had been fully independent and living alone in a duplex. She was able to walk without a device, drive and lead an active lifestyle as a senior in her community.

Intervention

When our client arrived at Sloan’s Lake, she was non-weight-bearing on her left lower extremity and totally dependent with all of her self-care tasks and mobility. She was limited by severe pain and weakness, and her family was extremely concerned about her care due to the complications she had sustained.

As the patient began her recovery, she slowly improved in all aspects of ADL tasks and mobility. Because she was not able to rely on her stronger left side, she began gaining strength in her weaker right side.

Our client was able to use adaptive equipment to dress, and she improved in her ability to transfer. After several weeks, her surgeon, Dr. Hugate, upgraded our client to 25 percent weight bearing, and she was able to take her first steps in the Alter G. Over time, our client gained confidence in addition to strength. The patient returned home at wheelchair level, and her son was able to take care of her until her next follow-up appointment.

When Dr. Hugate increased our client’s weight-bearing status to 50 percent, she again used the AlterG to walk and gain strength. One of her therapists accompanied her to the follow-up appointment, where she received full weight-bearing status. After tears of joy and hugs all around — six months after her original injury — our client returned to Sloan’s Lake to continue rehab. She was able to gradually work up to 100 percent weight bearing using the AlterG, and she began walking with a walker.

Results

Our client returned home for the last time — after a total of four inpatient admissions and two outpatient stints over the course of eight months — walking with a cane and able to complete all of her basic self-care tasks with modified independence. Her loss of independence was devastating to her, but she was somehow able to keep an amazingly positive attitude throughout her eight-month rehab process.

One of the revelations she had during rehabilitation was discovering that she had been compensating for her post-polio condition since childhood and had developed many strategies to offset her imbalances over several decades. Working with our client to achieve better balance, bilateral integration and strength and provide techniques for her to complete tasks without compensation allowed our client to return home stronger and more capable than she had been in years.

The Mobile Kitchen at Rose Villa

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Mobile Kitchen-use-Rose VillaRecently, Rose Villa purchased a mobile kitchen as an additional tool for our facility. Gym space in our building is so limited, we believed that this would be valuable in providing excellent care to our residents. We have been getting high-level patients, and this has great potential in helping our patients to return to the community.

Our occupational therapist Lorena Penulear thought of this mobile kitchen. Our patients love it, as we are able to do IADL acts such as cooking and meal prep. Lorena can move the mobile kitchen to the back patio as well, where patients and family can watch how they perform some ADLs.

As If by Magic: The Use of Magic as a Therapeutic Intervention at PVPA

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Hands of magician holding cards. Wearing black suit. Studio shot against black.
Hands of magician holding cards. Wearing black suit. Studio shot against black.

I have found that the use of sleight-of-hand magic as a therapeutic intervention has yielded great success and positive outcomes throughout my occupational therapy career. It provides a wonderful opportunity to facilitate functional gains with occupational skills, including pincer grasp, hand-eye coordination, in-hand manipulation, sequencing, problem solving, short-term memory, crossing the midline, activity engagement, concentration, decision making, among many others.

The use of sleight-of-hand magic as a therapeutic intervention also enhances the psychosocial aspects of our clients’ lives. Learning a magic trick that incorporates skill and technique, and then sharing it with friends, family, or other patients, encourages a social component that is vital to support a healthy quality of life. A patient’s self-efficacy immediately rises after successfully showing a magic trick to a family member who comes to visit.

Additionally, the use of magic as a therapeutic intervention breaks up the monotony that may come with a skilled nursing facility stay. It allows for a creative outlet to attempt something new or experience something novel. The use of sleight-of-hand magic as a therapeutic intervention is evidenced-based, dynamic and client-centered. I have found it essential to include magic in my therapeutic “bag of tricks”!

I was working with a gentleman who had a CABG x 3, as well as middle-stage dementia-related decreased short-term memory. He loved magic and the idea of magic tricks but doubted his ability to perform one himself. Some barriers to his ability to perform included cognitive declines and decreased short-term memory.

I graded down a simple magic trick to reflect the patient’s skill level and to compensate for his short-term memory decline. The patient successfully learned the magic trick! After successfully performing this trick, my patient was overjoyed, stating, “It actually worked, and I did it!” He looked forward to showing it to his grandson who was coming to visit later that day!

By Max Zweig, Occupational Therapist, Park View Post Acute Care, Sonoma, CA

 

A Happy Ending at Lake Village Nursing & Rehabilitation

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Johnny Johnson, age 71, has been here at Lake Village Nursing & Rehabilitation Center for about five or six months. He is one of our star patients who has come a long way.

Initially, Johnny would not participate in therapy services, until therapy was presented as an elite exercise club not offered to everyone, with a membership card that was marked off after each exercise session. Once the card was completed, then he moved up to the next level. He chose his membership gift, a steak dinner, and Therapy took him to a local diner for chicken-fried steak with his daughter.

Some of the approaches used by Lake Village therapists included:

  • Barihab to increase standing tolerance/weight bearing
  • SciFit for endurance and total body conditioning
  • Safety awareness
  • Functional activity tolerance
  • Gait training
  • Strength training

We would like to share Johnny’s story, because everyone loves a happy ending! Here is a summary in his own words of his experience at Lake Village.

Back in January, at my country house in Arkansas, I was out hunting for deer on a cool, crisp morning. I fell out of an 18-foot metal deer stand. As I was falling, I remember, I was face-first, but somehow I made myself turn over in the air and land on my back. I laid on the ground for about an hour because I just couldn’t get up. Slowly, I crawled to my four-wheeler and drove home.

I could hardly walk because of the pain, so my wife took me to the Wadley Hospital in Texarkana. It turned out I had trouble with my vertebrae and a head injury. I knew I needed rehab, so my wife asked around and heard great things about Lake Village in Lewisville. It was a good option because my daughter lived here.

I don’t remember much about this time at the Wadley Hospital or even my first few weeks at Lake Village. I was extremely sick and partly crazy. I was cursing more than a sailor, wouldn’t take my medication and wouldn’t do anything they wanted me to. They were needling me all the time with a bunch of pain meds, so I just was out of it.

When I finally felt better, I joined the rehab exercises with a Basic membership. I finally started to walk, build strength and work my mind. I was upgraded to the Gold membership, which focused on even more walking. Now, I’m almost done with Gold, so I’ll be getting a steak dinner. Next, I’ll do the Platinum and Diamond until I’m ready to go home.

The staff here are just wonderful, especially the ones in the fitness center. It’s a nice facility; everybody works with you and gets along with you. I’ve been real satisfied with this place.

Pet Therapy at Willow Bend

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Another facility incorporating pet therapy is Willow Bend Nursing & Rehabilitation, which has similar guidelines and training requirements for its therapy dogs. At Willow Bend, pet therapy consists of supervised visitations in rooms, in hallways and in the gym. The goal of this animal-assisted therapy is to improve residents’ social, emotional, physical and cognitive functioning. The handler’s course for AAT must be completed by at least one staff member, who in turn trains additional staff.

Advocates of the program indicate that AAT can be useful for increasing motivation among participants. Therapists who approach patients with a dog may be viewed as less threatening, thereby increasing rapport between patients and therapists.