Case Study: The Paramount at Somers Rehabilitation and Nursing Center (December 2018)

Patients Age: 71-years-old
Admission Date: October 28, 2018
Admitted From: Putnam Hospital Center
Discharge Date: December 14, 2018
Discharge To: Home
Length of Stay: 49 days
Reason for Stay: Muscle weakness, abnormality of gait and mobility
How did this patient hear about The Paramount at Somers? Referred by Hospital

Day 1 Mr. Marsek:

Mr. Theodore Marsek, (Teddy) is a 71-year-old man who was admitted to Putnam Hospital with admitting diagnoses of muscle weakness, abnormality of gait and mobility, confusion. Previous to infection, patient was living at home with wife, was self- ambulating and functioning independently and oriented. Patient was referred and admitted to The Paramount at Somers Rehabilitation and Nursing Center for rehabilitation therapy for muscle weakness to regain his strength and functioning and return home.

Overall Clinical Observation: Patient progressed through three distinct stages of treatment and intervention. He reacted adversely to medication administered from nursing while the psychiatrist continued to follow up and eventually taper patient off specific medications allowing patient to improve his overall alertness and orientation. In conjunction with continuous and persistent rehabilitation intervention to promote well-being, strength, endurance, activity tolerance, improve his overall independence with Activities of Daily Living (ADL’s), safety and functional mobility. (from baseline: Moderate Assistance to Modified Independence-Discharge to home with spouse)

Week- 1:

Teddy was alert and oriented at times and confused and delusional at other times. He exhibited hallucinations, was combative, easily agitated, had aggressive behaviors toward staff and would have periods of lethargy throughout the day. When he was initially assessed, he was able to follow only simple 1-step commands and directions with some attention-procession difficulties noted. He was able to only make basic needs known to staff. During this time he was at a high risk for falls. Patient was unable to walk or self-ambulate in his wheelchair. He had a poor tolerance for treatment and was able to maintain a 30-45% carryover from his therapy. He required tactile and verbal cueing with Moderate to Contact Guard Assistance for Activities of Daily Living, functional mobility using wheelchair and rolling walker and transitional movement. Teddy required ongoing encouragement and motivation to engage in treatment sessions. Patient was provided attention processing techniques to engage in meaningful tabletop activities. His therapist was able to get him to manipulate nuts and bolts for fine motor coordination. He was provided basic Activities of Daily Living, retraining which included: upper body dressing, hygiene and grooming, toileting with transfers. His therapist also worked on task segmentation, sequencing, and exercise to improve his overall strength and endurance and activity tolerance.

Weeks 2-4:

Mr. Marsek had a decrease in his confusion; he was no longer hallucinating and was less agitated. He had improvements in cooperation; he became more energetic and less fatigued. He progressed to following multi-step commands to remain on tasks in therapist without cueing. He uses his wheelchair for functional mobility and rolling walker during rehabilitation session. He was able to better tolerate treatment and progressed to having 50-75% carryover on skills in therapy. Teddy continued to receive training for Activities of Daily Living, dressing, hygiene toileting and grooming. He received further training with safety techniques and strategies to reduce risk of injuries and falls. He also worked with his therapists on neuro reeducation on basic proprioceptive awareness, grasp release, static/ dynamic/ sitting and standing. He improved his fine motor skills with therapists by zipping and fastening his clothing. Lastly, he participated in range of motion exercises, bending and strengthening techniques to improve functional task performance.

Weeks 5-9:

Teddy was more cooperative, motivated and pleasant. He tolerated treatment and interventions well with 80-100% carryover. He has progressed to supervision to moderate independence. He trained with therapists on functional activities to increase strength, range of motion, flexibility, core strengthening and endurance exercises. To prepare for discharge, Teddy and his spouse were provided education on proper bracing, body mechanics, compensatory techniques, energy conservation and safety to ensure a smooth transition home.

3 days from Discharge:

On Friday, December 14, Mr. Teddy was discharged home to celebrate his return with his wife and family. His ambulation status progressed from non-ambulatory to walking with moderate independence upon discharge. His cognition has improved to being fully aware of person, place and time. Of skills learned in therapy upon discharge, he was retaining 80-100% carryover. He progressed to no falls upon discharge. Lastly, he has had a complete turnaround with his mood and behaviors. He progressed from agitation and aggression to being cooperative, motivated and pleasant. Teddy has truly experienced a complete transformation from when he admitted to the Paramount to now. He has improved in nearly every domain physically, cognitively emotionally and spiritually. Teddy is a prime example of how hard work, committed staff, perseverance and a positive attitude can accomplish amazing things! It is at the core of our mission to provide and foster unprecedented levels of Rehabilitation and Nursing needs to our patients. All made possible by our caring and committed healthcare professionals to get our patients back to their fullest potential.