Grandpa: Enviornmental Impact on Recovery

On Friday afternoon post treatment and after dinner, my grandfather complained about dizziness. This is not a new problem for him as episodes have occurred for years now and the doctor's that he has visited have said that nothing is wrong. (I too have evaluated him in the past to find no evidence of a vestibular cause).

What I did observe was that just prior to our afternoon treatment, he was eating quite a few M & M's, during dinner he had a Sangria and after dinner he had chocolate chip cookies and ice cream.

The next morning, yesterday, I heard him get up in the early morning to go to the bathroom (something that hasn't happened since he has been here) and woke up feeling poorly and observably sluggish. I discovered after it was too late that he choose to have Trix cereal for breakfast.

Our treatment Saturday was productive in gaining range of motion to pelvic extension, his mechanics at the hip and pelvis are normal with the exception of left hip extension. His gait markedly improved post treatment and he walked about 15 steps without and assistive device.

The remainder of the day, he did not indulge in alcohol or sweets and there were no episodes of dizziness.

I hope that today will be more productive.

Treatment Day 5

For today's session I have made sure that the mechanics at his hip pelvis and sacrum are working as they should and we are reinforcing glut medius and minimus strengthening in supine with hip abduction. To reinforce hip extension we are performing bilateral bridging.

To work on proper use of the rolling walker, I have bound his arms so that the walker is within a forearms distance to reinforce advancing the walker with his legs and not his arms. I have also used Mc Connell tape to his right quad to reinforce extension.

I positioned him at the corner of our deck at home and had him hold onto each side rail with the walker in front of him to reinforce an upright rather than forward flexed posture. With my facilitating left knee extension and resisting at the outer left heel maintain a neutral foot we worked on taking a step with the right foot.

We are all able to notice progress in my grandfather's level of independence. He is walking further, 1/4 of a city block independently. He is able to go up and down stairs with supervision and even tried taking a few steps with a straight cane.

Tomorrow, I hope to work in prone and continue to get him weight bearing with proper mechanics on his left leg.

Grandpa treatment Day 1

When I got him in supine for treatment, I noticed again a leg length discrepency of about 1.5 inches and attributed it to the prolonged sitting in the car. I also summized that it is a major contributor to his left knee flexion and his shaking. I suspect that he is flexing his left knee to compensate for the difference in his leg's length since his pelvis is unable to drop on the right to compensate. I also observed and palpated a restriction in his left hamstring and sciatic nerve that prevented him from obtaining knee extension in sitting with out leaning back.

With treatment of the tissues around the pelvis and legs the leg length discrepancy resolved. I also treated the left hamstring/sciatic nerved via functional mobilization with stabilization to his pelvis and left lower extremity. His gait improved and his home program the same, stand every 15 minutes getting both knees straight and weight shift.

I also worked on depressing of the right lower extremity in sitting so that he would not need to bend his left knee in order to properly heel strike.

We also worked step ups on the stairs using 1 handrail and cane (to mimic his home environment) 5 times each.

Throughout the day, I assess the leg length in supine and it manged to be okay, in spite of his sitting most of the day.

Grandpa s/p 4 hour car ride

In spite of hourly stops on the road for a standing session, my grandfather arrived at my home physically compromised.

At the house we opted to keep him outdoors, and practice standing and walking until he literally stabilized and would be safe to perform stairs.

During his first few initial standing and walking bouts he was shaking quite a bit. The shaking subsided with subsequent tries and was gone after about 1 hour and 4 bouts of walking.

My manual treatment consisted of work to his left foot to increase dorsiflexion with the foot in a neutral position. He tendency in walking is to externally rotate it and ambulate with a very narrow base of support (his heels almost touching).

We later worked on step ups on the steps 5 times leading with each leg and after a rest went up the 5 steps using handrails on both sides. He made with a min assist and facilitation to his stepping foot's buttock to elicit depression of the pelvis.

I was not optimistic about his recovery and independence after today.

Grandpa coming home

Upon our return from the rehab facility, we were faced with 5 steps from the outside of his house in. It wasn't pretty but we managed.

Based upon observation and subjective history/complaints our goals for the week as follows:

1. Able to obtain 0 degrees knee extension with standing ADL's, walking, and right lower extremity heel strike.

2. Able to go up and down stairs using both legs for ascending and descending.

3. Progress from rolling walker to straight leg cane.

4. Increase walking distance to 1 city block.

Day 1

I decided to start treatment and when I got him supine noticed that there was about 1.5 inch leg length discrepancy.

Upon functional mobilization with stability to the L. LE and pelvis, they became even. We worked on L. pelvis abduction and extension.

Treatment lasted about 45 minutes and home program was to stand every 15 minutes, with both knees straight and weight shift side to side.

Note that we had adapted his recliner chair to be about 3 inches higher on blocks and provided support behind the his back to get him over his pelvic floor.

Patient tolerated treatment well.

Grandpa

After almost 2 months of rehab status post hip replacement, my family has decided, against the advice of the facility, to discharge my grandfather. We will all be traveling to my home so that I can provide services with home health to try to restore his functioning.

His status has deteriorated slowly with him choosing to use a cane last fall and then came the fall on ice at his home in Vermont which led to his hip replacement surgery 4/29/2010. His recovery has been slow, but he is now walking 100 to 120 feet using a rolling walker, stairs are a min to mod assist with 1 handrail and cane. Sit to stand transfers are independent, bed mobility and transfers, not pretty but independent as well. Medically he is in good health for his 82 years, he had a right THR about 12 years ago and has a 30 year history of Low Back pathology including stenosis.

His chief complaints are as follows:

1. Shaking occasionally with standing, walking and stairs.

2. Decreased ability to ambulate distances.

3. Decreased ability to negotiate stairs.

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I hope to post video of his treatment and progress, so stay tuned.

Wish me good luck!!