A lady contacted Nordic Rehab to ask if we were able to help her mother, Mrs W. Mrs W had just been discharged home after a stay in a nursing home, following a fall and a fractured hip. She was awaiting community physio, but there was an 8 week waiting list. We had a chat and agreed to arrange some private physio in the interim.

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Physio Kate went to see Mrs W at her home. She found Mrs W globally weak, but alert and able to communicate well.

Mrs W’s goals were:

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• To transfer independently form bed to chair (using a frame)

• To be able to walk (using a frame)

• To return to sleeping in the bedroom (currently in the living room)

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Physio Kate was unable to guarantee any of these, but they certainly had something to work towards. Mrs W lived with her husband and had carers coming in several times a day. She had been able to stand with assistance and using a hoist but was now struggling to do this. It is always alarming and distressing for people to feel that they are ‘losing progress’. She had intermittent swelling in her feet and legs and was globally very weak. Her hip was also causing distress and difficulty.

During the first session physio Kate concentrated on exercises for Mrs W that she could complete while in the chair or the bed. Mrs W’s torso balance was unsteady and she would slowly start to lean to the right side when sitting in a chair. With prompting she was able to correct herself. Physio Kate found that this was symptomatic for Mrs W, she was also struggling with general lapses of focus and needed gentle reminders to bring her concentration back.

Mrs W and Mr W were both pleased with the first session, although it was extremely tiring. Physio Kate left some exercises for Mrs W to carry on with

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• Bilateral Shoulder flexion (x5 reps)

• Alternate knee extension in sitting with x3 second hold (x 5 reps)

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She also had a chat with Mr W and their daughter about some ways they could help Mrs W in her rehabilitation – such as prompting her with her exercises and helping to keep her focussed. They decided to go for two sessions a week and see how it went.

In this scenario, physio Kate explained to Mrs W that her current level of function and muscle strength, meant that her rehabilitation would need to be graded and for now, focus on work in the bed and the chair. This type of conversation can be difficult because our clients are so keen to progress and their family just want their loved one to be ‘well’ again. At this point Mrs W’s functional prognosis was difficult to establish, but it was definite that for Mrs W to regain her optimum strength and mobility, her best chance lay with completing her exercises thoroughly, with concentration and on a daily basis.

 

By the next session, physio Kate found Mrs W had had a good go at completing her exercises. Mr W confirmed that he had needed to push Mrs W, but with encouragement, she had managed to do a bit every day. Brilliant!

 

This time the therapy involved:

• A ball and a theraband to add additional resistance for (upper limb movements).

• Trunk and abdominal exercises – to aid stability.

• Leg exercises. Assistance was needed for left leg, but Mrs W was able to complete exercises on the right leg herself.

 

Physio Kate left Mrs W with some different exercises to carry out every day till her next session. She reminded Mrs W that any movements or activity that she could do would optimise her therapy sessions and improve her chances of functional improvement.

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Mrs W’s next couple of sessions passed by. Mrs W was carrying out her exercises but needed input to keep her focussed.

Physio Kate reported that Mrs W’s mobility is restricted. She is unable to bridge and is suffering significant global de-conditioning. However there are pockets of progress - she is now again able to transfer from bed to chair (using a standing hoist and with the assistance of carers) and Mrs W’s ability to maintain static sitting at the edge of the bed, her static balance and her pain levels are all significantly improved.

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A couple more sessions passed by, Mrs W needed to stay on a graded exercise programme, but there was great improvement in Mrs W’s sitting tolerance, core strength and upper body mobility and strength. This is very cheering for Mrs W and Mr W to see. Mrs W still has lapses of concentration, but in herself was brighter, chattier and more positive.

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During the next session, Mr and Mrs W informed physio Kate that the NHS physiotherapist had been in touch and was able to add Mrs W to their case load. This was fantastic news. Nordic Rehab physios often bridge a vital gap between hospital discharge and community NHS physio. It is impossible to overstate the need for the client to be kept moving and their programme evolving after discharge, but in these austere times, it is not so simple.

We were delighted to have been able to help Mrs W, we hope her successes continue and she achieves all her goals (and then starts on the next ones!).

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