Making Progress in a Complex Case

July 20, 2020
Happy nurse caregiver laughing with Asian elderly woman outdoor

In 2018, we met a lovely lady who’s kidneys and other vital organs shut down following an adverse reaction to hormone replacement therapy.

Numerous surgeries later plus an extended stay in ICU and hospital resulted in debilitating loss of physical function – she was lucky to survive the ordeal.

She was not yet 60 years old, but the deconditioning she experienced left her struggling with simple tasks such as getting up from the couch or walking upstairs. She was also dealing with ongoing medical complications, including the need for regular dialysis treatments.

Back view of nurse caregiver support walking with elderly woman outdoor

Upon leaving the hospital and after a period at rehab, the lady engaged Total Health Physio for in-home Physiotherapy treatment because she wanted expert support without having to travel to appointments.

Initial Assessment Tools

Our initial Physiotherapy assessment involved establishing her current level of function and identifying the limitations that she was experiencing.

A range of tests was carried out, including:

  • BERG balance test to objectively assess her ability (or inability) to safely balance during a series of predetermined tasks
  • A timed up-and-go test using her walker to assist
  • A walking assessment covering a 20-metre distance

Goal Setting – Travelling Overseas

Initial assessments always involve getting to know the client and gaining an understanding of what they want to achieve.

It was clear that the lady was very driven; she had a strong intrinsic motivation and was highly focussed on returning to her pre-morbid capabilities.

She was currently very dependent on her walker and wanted to be able to walk independently.

She wanted to increase her functionality and regain her independence so that she could ultimately travel again to visit her daughter overseas.


This was clearly a complicated case from the outset, with many different factors to consider.

A range of medical professionals was involved and there was a significant amount of information to absorb, all of which helped us to fully understand the client’s situation and needs.

Patients are often emotional, understandably, following a life-threatening illness.

They are often very relieved to be alive but also very emotional from what they have been through.

Some people who have suffered a significant injury are scared to get out and get moving again. Part of our role is to educate them about how important it is to be active and to keep moving forward. We always carefully assess pain and capability, but we also want to help the patient to work through their limitations rather than to feel permanently bound by them.

The Role of Total Health Physio

We established a plan which involved twice-weekly visits from our Physiotherapist. The lady understood that progress would probably be slow, but that every week we would challenge her a little bit more.

Initially, we started doing basic activities to improve function. This included:

  • Sitting to standing exercises to build leg strength
  • Building strength in her arms, taking into account that regular dialysis needles were causing some pain and limitation
  • Walking to build up endurance and resistance to fatigue

Making Progress

The lady has been very focussed on her goals and very adherent to the program.

Over the course of the last two years, she has achieved immense improvements. For example, she progressed from being able to walk twenty metres with a walking frame to be able to walk 2km with only a walking stick.

Regularly repeating her initial walking tests has helped us to ensure that her pace and balance were improving as well as her endurance, which has been very heartening to see.

She is also now able to get up from the floor which is something she was unable to do for a very long time. This has allowed her to get down on the floor and play with her grandson which gives her so much joy.

In the past two years, the lady has also faced setbacks in the form of repetitive infections. This can be challenging because it can impact the progress that has been achieved.

Our current goal is to improve the lady’s health enough to have her placed on the kidney transplant list. This is something that we did previously achieve, but severe infection caused a deterioration that meant the lady had to be taken off the list. Our focus now is getting her physically strong enough to be back on the transplant list.


Outcomes and Achievements

We know that the lady and her family are very happy with the service Total Health Physio has provided.

Despite her setbacks, she has achieved some very significant goals. This included flying overseas to visit her daughter, who lives in Israel.

We see the lady weekly now and are dedicated to helping her achieve her goals. We are working together not just to get her back on the kidney transplant list, but also back to an independent and fulfilling life. We want to reach a point where she can enjoy travelling and seeing family and friends, without having to worry so much about health setbacks.

Our clinicians really admire the lady for the strength and courage she has shown. She has remained determined to move forward, continuously overcoming the setbacks she has had to face.