Sub-Acute Rehabilitation Outcome Data

Sub-Acute Rehabilitation > Sub-Acute Rehabilitation Outcome Data

Background/History

Mr. X was involved in a motor vehicle accident at the age of 38.  He required prolonged extraction and was intubated at the scene.  He was transported to the emergency department where he displayed posturing of his extremities and at times, presented with tonic/clonic movements.  He had a Glasgow Coma Score of 5.  He had evidence of scalp lacerations to the left side and CT of the brain revealed bilateral contusions.  X-ray of his left leg revealed a comminuted femur fracture.  Mr. X remained on a ventilator and made slow neurologic improvements.  He underwent a tracheostomy and placement of a gastrostomy tube for nutritional support.

Presentation

Mr. X admitted to the Skilled Medical Rehabilitation Center (SMRC) one month after his accident.  Mr. X was awake and alert, vocal, and able to make simple needs known.  He had a tracheostomy in place for continued airway support.  He continued to experience swallowing difficulties and required tube feedings to maintain adequate nutrition.  He had a Foley catheter in place and a PICC line to his right upper extremity.  A deep vein thrombosis was identified in his right lower extremity shortly after admission.

Mr. X presented with functional limitations in areas of physical mobility, activities of daily living and cognition. He was nonambulatory and was dependent for all transfers from the bed to a chair.  He required moderate assistance with bed mobility and rolling with maximum assistance for sit to lying transitions.  Mr. X demonstrated minimal to limited movement of both upper extremities, as well as decreased range of motion with increased muscle tone, and was totally dependent for bathing, dressing, toileting, and grooming tasks.  His right foot and ankle were pointed and inverted (plantar flexion) presenting challenges with being able to stand or ambulate. Additionally, Mr. X presented with moderate deficits in the areas of attention, thought organization, problem solving and reasoning, and short term memory skills.  He demonstrated periods of fluctuating alertness and orientation, with inconsistencies in accurately responding to questions pertaining to person, place, time, or situation.

Rehabilitative Interventions

Mr. X received ongoing medical management by the Interdisciplinary Team of physicians, nurses, respiratory therapists, dietitians, and certified nurse’s aides.  He received aggressive physical, occupational, and speech therapies on a daily basis by our team of licensed therapists specializing in Traumatic Brain and Spinal Cord injuries.

The Respiratory therapy team aggressively focused on speaking valve and capping trials to promote tracheal decannulation.  A bowel and bladder regimen was initiated by nursing to assist Mr. X in regaining continence. Endoscopic swallow studies were conducted by Speech therapy to assess his swallowing skills.  Dysphagia therapy was implemented including, strengthening exercises, safe swallowing techniques, and oral feeding trials of varied consistencies.  In addition to swallowing, Speech therapy’s focus was on improving Mr. X’s cognitive-linguistic skills, targeting areas of attention, memory, thought organization, and problem solving and reasoning which were primary areas of deficit.  Physical and Occupational therapy focused on increasing strength and range of motion in both upper and lower extremities. Promoting independence in functional mobility and activities of daily living through improved balance, coordination, endurance, and motor control was a primary goal for Mr. X.

During his rehabilitation at the SMRC, Mr. X had the immense support of his family and friends and was highly motivated and actively participated in all therapeutic modalities.  His ultimate goal was to return home to his wife and children, and return to work managing the family business.

Outcomes

Within the first 30 days of his rehab, Mr. X’s tracheostomy was removed and he had begun oral feedings of modified consistency foods.  He had regained continence of his bowel and bladder, and by discharge, he was able to perform grooming, upper body dressing, and feeding tasks with set up/supervision only.  His gastrostomy tube was removed and he was consuming a regular diet with thin liquids.  He was able to perform transfers with minimal to no assistance and was independent in propelling his wheelchair. Mr. X’s abilities in all areas of cognitive linguistic skills increased significantly and he was able to demonstrate higher level problem solving, reasoning, and thinking.

Mr. X was discharged home to his family following 10 weeks of rehabilitation at SMRC with outpatient therapy services in place.  Shortly after returning home, Mr. X returned to work and is successfully managing the family business. He is now able to ambulate and perform all activities of daily living independently.

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