Topic 2 -Assessment

S – My patient was a 88yo female who was admitted with decreased mobility & functional decline. She had a long history of falls with no significant injuries but the frequency of falls had increased markedly in the 2/52 prior to admission. Upon initial Ax she was noted to have very poor balance, hypotension and rapidly fatigued.

T – From this it was determined that her treatment should focus on improvement of her balance and fitness whilst still keeping in mind her poor tolerance to exercise.

A – Treatment involved balance exercises to improve her standing balance and ability to adjust to internal & external perturbations. Her protective reactions, especially stepping, would need to be refined for occasions when she cannot maintain her CoG within her BoS. Her tolerance to exercise was also a focus as this would enable her to be more functionally capable upon discharge.

R – Initially the patient showed improvement but after only 3 days her condition began fluctuating and her tolerance to activity decreased. Simply getting up for the shower in the am meant she was unable to complete a physio session for the rest of the am. The quality of her balance had actually improved from a subjective point of view but it appeared that other factors were at play.

E – After approximately 7 days of Rx I noticed that she would lean to the right and almost collapse in the same direction (which she did during one session). This could possibly have been the cause for her decreased exercise tolerance throughout but as I recognized early on this patient tends to under-report symptoms since she just wanted to get home. I pushed her for a reason for the collapsing and she then told me that her right leg just gives way. Upon a repeated investigation it was found that her R leg (mainly hip flexors) were much weaker than the L.

S – In future I will learn to interpret what a patient is telling me and determine if it is in fact the truth and if they may be concealing something in an effort to escape from the hospital sooner. I learnt how valuable Re-Ax can be since during the initial Ax this irregularity was not picked up. Not only for physio purposes but for other health professionals as well since it could suggest more complex medical issues…which luckily in this case it didn’t.