The inspiring lady is one of Total Health Physio’s long-term clients and her work with us has been a great success.
We first met the lady in October 2018. Her family contacted us asking for support in helping her to regain mobility after a significant fall.
Assessment in an aged care facility
At 90 years old, the lady lives in a residential care facility in East Melbourne.
She was already being well cared for in the facility, so we consulted her file notes to gain a comprehensive understanding of her situation.
Her fall had resulted in a fractured pelvis, and for months following the fall she had been immobile, living in what is known as a ‘princess chair’. A princess chair is very comfortable but allows for very limited mobility.
The lady had previously been independently mobile, and her family’s primary goal was for her to be able to walk again.
A holistic approach – the Total Health Physio way
We value a holistic approach to patient care.
Whenever we engage with a new patient, we really take our time to connect with them so we can complete a thorough initial assessment.
This helps to build trust, which in turn plays a big role in achieving the desired rehabilitation and clinical outcomes.
In the lady’s case, there were a number of factors to consider when developing her treatment plan and delivering her therapy.
The lady also lives with dementia.
This meant that clear communication and a calming, patient approach were very important. A more functional approach to rehabilitation is sometimes required for people who have dementia as it can be harder for them to follow instructions.
The lady is a high falls risk.
Her dementia meant that she didn’t always stay cognisant of the risks around her. For example, if a walker was left nearby, she would attempt to walk with it even though she wasn’t yet physically capable.
The case presents mental health considerations.
It was important to be respectful of the challenges that both the lady and her family faced after such a long time of her being immobile.
Setting mobility-related goals
The primary goal for the lady was to be able to walk again; she and her family were optimistic about getting her back on her feet.
While this was the primary goal, there were also three significant sub-goals when we started treatment with her:
- To be able to transfer into a wheelchair
- To be able to transfer easily when needing the bathroom
- To have improved enough to safely attend the family Christmas celebration in two months’ time (something that would not be possible if she was still in a princess chair)
Starting a Physio & OT treatment plan
Our treatment plan involved a combination of Physiotherapy and Occupational Therapy.
Prior to any significant rehabilitation efforts, we needed to ensure that the lady’s fracture was stable enough to start weight-bearing. Treatment began with some chair-based exercises to develop strength, and within a month the lady was able to commence putting some weight on her legs.
This enabled us to start a more comprehensive rehabilitation process which included:
- Building lower limb strength (to reverse the deconditioning that had occurred from lack of use)
- Upper limb work (to strengthen arm and shoulder muscles)
- Trunk and core strength (critical for dynamic balance control during a return to walking)
- Finding the right walking aid to safely support her mobility.
Re-building the lady’s confidence was also important. After such a significant period of inactivity she needed to re-learn to trust her body and believe that she could put weight on her legs again.
Success – enjoying family Christmas!
We have been working with the lady for eighteen months now and across that time we have had many significant successes:
- Two months after we started treatment the lady was able to attend her family Christmas in a wheelchair
- Importantly, she was able to transfer independently into her wheelchair, and also access the bathroom when needed
- The following year, she succeeded in being able to walk using a gutter frame walking aid
- She then successfully transitioned to a four-wheel walker within a few months and is now ambulating independently with the walker
When we reflect on the lady’s initial condition and her overarching goals, it is incredibly heartening to see the progress she has made, and continues to make.
To have helped her to walk, and become strong enough to attend important family events, is a great success. the lady remains determined, and our focus now is on improving her balance and maintaining her mobility well into the future.