Volume 8:2
Clinical Decision-Making for Discharge Recommendations for a 63-Year Old Male with Foot Drop Status Post Great Toe Amputation: A Case Report
Sigmund Ku, SPT
Governors State University – University Park, IL
Abstract
Background and Purpose: Making a discharge recommendation from an acute care setting involves many factors and a coordinated team effort, and discharging a patient to an inappropriate setting can have adverse effects. Physical therapists have shown to be able to make appropriate and accurate discharge recommendations. The purpose of this case report is to apply a model of discharge decision-making and analyze the results in the case of an older adult male with foot drop status post great toe amputation. This model is not only meant to improve decision- making efficiency for physical therapists and other health care professionals, but it also focuses on the patient’s desires and aids in allowing everyone involved to reach a consensus.
Case Description: SF was a 63-year old male with a history of Type II diabetes mellitus, alcohol abuse, and cerebrovascular attack. He was seen in acute care status post left great toe amputation.
Approach: Clinical decision-making in discharge planning was based on four constructs within the model: his function and disability, wants and needs, ability to participate, and life context. Information was analyzed in light of therapist experience, health care regulations, and opinions of medical team members. SF was recommended to be discharged to a subacute rehabilitation facility.
Discussion: Although the patient’s personal wants were not consistent with the other three constructs, the physical therapists were able to exercise skilled clinical reasoning to recommend the appropriate discharge setting through the use of the implemented model of discharge decision making. Further studies are needed to establish the model’s validity and reliability.
Treatment of a 65 Year Old Deconditioned Female Admitted with Complications Resulting from Morbid Obesity: A Case Report
David Sarvin, SPT
Governors State University – University Park, IL
Abstract
Background: Obesity is a medical diagnosis in which excess body fat has accumulated to the extent where it may have an adverse effect on health. Obesity is a growing concern among the population of adults and children living in the United States. It costs the medical industry a great deal of money each year treating these patients, especially in those individuals classified as morbidly obese1(those who possess a BMI greater than 40). With unhealthy lifestyle choices more accessible than ever, it is important to understand the risk factors involved. In many cases, obesity poses serious threats to the cardiovascular system, such as hyperlipidemia, hypertension, and congestive heart failure. If untreated, these risk factors can result in stroke, heart attack, or possibly death. In severe cases, the obesity can be classified as morbid, and may require hospitalization. In this setting, the patient can be monitored, diet can be controlled, and physical therapy can try and decrease body fat and improve level of conditioning.
Purpose: The most widely used instrument to measure obesity is the Body Mass Index, or BMI. The BMI is an evidence based classification system used to categorize level of obesity. The BMI classifications are divided as follows: greater or equal to 35 indicates severe obesity, greater or equal to 40 indicates morbid obesity, and greater or equal to 50 indicates super obesity. “In the present case study, the patient had a BMI of 48 and would be classified as morbidly obese”- 18 The purpose of this study is to assess effectiveness of a primarily cardiovascular based treatment plan which includes elements of functional activity training on a deconditioned subject who suffers from complications resulting from morbid obesity.
Overview: In this manuscript, the history and systems review include an overview and introduction of the patient’s initial condition and function. Clinical impressions outline the opinions of the treating physical therapist, including anticipated treatment outcomes based on research. The sections on diagnoses, prognosis, and goals include the patients’ treatment outlook, and milestones to be achieved by the patient based on PLOF and minimal functional independence. The interventions and outcomes portions of this manuscript illustrate the treatment interventions, performance on certain tests and measures, and the positive effects on the patient. The discussion and conclusion sections describe the overall treatment summary, including limitations to this study and ways to improve.
The Effects of a Ten-Week Multifaceted Exercise Program on Muscle Strength and Aerobic Capacity in Women with Breast Cancer
Kristina Reesman, SPT; Leah Rust, DPT; Emilee Bohde, DPT; Deb Doherty, PT, Phd, CEAS; Jacqueline S. Drouin, PT, Phd
Oakland University – Rochester, MI
Abstract
Objectives: The objective of this pilot study was to determine the benefits of participation in a multifaceted exercise program for women in breast cancer survivorship and then to assess physical adaptations to training. Background: Inactivity in the breast cancer population has been shown to have potentially negative consequences. Evidence suggests regular participation in exercise promotes improved cardiopulmonary function, strength, and flexibility among women in breast cancer survivorship. However, previous studies of exercise programs often reflect only one regimen of exercise for subjects to complete.
Methods and Measures: A quasi-experimental research design, using a pre-test and post-test, was utilized for this ten-week study. Twelve females diagnosed with breast cancer within the last eight years met the inclusion criteria for enrollment in a bi-weekly multifaceted exercise intervention program. This program consisted of aerobic (i.e. bike, treadmill, elliptical, walking track, stair climbing); flexibility (i.e. yoga, active joint motion stretching, foam roller); and strengthening (i.e. free weights, pilates, tai chi, stability ball, BOSU ball, circuit training, theraband routine) The study, in part, assessed aerobic capacity and upper extremity muscle strength. Measurement tools used included the YMCA bike protocol and manual muscle testing. The means and standard deviations were used to determine the descriptive analysis of all data collected. Inferential statistics were analyzed using Wilcoxon Sign Rank test for pre-test and post-test measures due to a small sample size. Statistical significance was determined at p <0.05. SPSS version 11.5 was used to analyze the data.
Results: Nine of the twelve participants completed the testing for analyses. Upon study completion, two participants improved aerobically, two aerobically decreased, and five participants had no change in their aerobic capacity. All participants experienced muscle strength gains of a minimum of 1/3 grade in at least one muscle group. An increase in lower trapezius muscle strength was achieved by all subjects. The two participants with improved aerobic capacity experienced strength gains in every muscle category.
Conclusion: A multifaceted exercise program has the potential to increase scapular muscle strength and is a consideration for increasing activity levels in women one to eight years post breast cancer diagnosis.
