Case Study: The Paramount at Somers Rehabilitation and Nursing Center (December 2020)

Patient’s Age: 66-years-old
Admission Date: 05/27/20
Admitted From: Putnam Hospital Center
Discharge Date: 12/20
Length of Stay: 6.5 months
Discharged To: Home
Reason for Stay: Respiratory failure and Pneumonia due to COVID-19
How did this patient hear about The Paramount at Somers? Hospital Referral

Details of Experience:
Susan A. is a 66-year-old female who was admitted to The Paramount at Somers Rehabilitation on May 27th, 2020, from Putnam Hospital, following an acute stay secondary to respiratory failure and pneumonia due to COVID 19. Susan was independent before hospitalization, and she lived with her husband and daughter.

Upon admission, Susan presented with decreased strength, endurance, inability to move upper and lower extremities, decreased sitting tolerance, decreased sitting balance, and was dependent in all activities of daily living, (ADLs).

Upon evaluation by occupational therapy, speech therapy, and physical therapy her functional levels were completely dependent on caregivers for dressing, grooming, self-feeding, bathing, toileting, bed mobility, transfers, and ambulation. She had no active muscle movement noted in bilateral upper extremities or lower extremities. Flaccid muscle tone was noted. She was unable to perform a sit-to-stand transfer, was completely dependent regarding bed mobility, and unable to stand.

During the timeframe of May 28th through June 24th, Susan demonstrated the ability to sit in a Geri chair with a Roho cushion for one hour. She was noted to have active movement in bilateral hands, but trace muscle movements in elbow and shoulder joints. Electrical stimulation was used daily for neuromuscular re-education to bilateral upper extremities, as well as passive range of motion, (PROM). Pelvic pain limited her sitting tolerance in a wheelchair.

From June 24th through July 21st, Susan began to feed herself with minimal assistance and the use of built-up utensils, due to her weak grasp. The patient began trial sitting in a standard wheelchair with an arm trough for supports. She began demonstrating improvement in sitting balance. While seated in her wheelchair, Susan required verbal cues to remain sitting upright in her chair. She began to feed herself with buildup utensils with supervision.

From August 16th through September 11th, Susan began to use regular utensils with setup, as well as to display improved standing ability. She was also able to stand with a two-person assist to use the rolling walker. She demonstrated increased sitting tolerance in the regular wheelchair. She was able to perform hygiene and grooming while seated with contact guard assistance.

From September 12th through October 7th, Susan was able to perform upper body (UB) dressing with moderate assist using compensatory strategies, Susan was trained on hemiplegic dressing techniques. She was able to perform lower body (LB) dressing with the use of an assistive device (AD) for LB dressing she was able to perform with maximum assistance.

From October 7th to November 12th, Susan was able to perform UB dressing with min assist, better carryover of hemiplegic techniques. Increased right upper extremity strengthening was noted. She continued to have weakness in her left hand and elbow. Electrical stimulation was continued, with an active-assisted range of motion (AAROM), passive range of motion (PROM), and strengthening exercises. LB dressing with use of Reacher while seated EOB with moderate assistance, Carry giver completes in standing, while Susan was holding the rolling walker (RW). Susan continued to display anxiety in standing.

From November 2nd to November 28th, while performing UB dressing, Susan was able to perform with contact guard assistance (CGA) to complete this task over her head. With LB dressing she was able to perform seated on the edge of the bed with good sitting balance and using AD to don clothing. She was able to stand and assist with pulling up her pants. Susan requires a caregiver to assist in completing secondary to left-side hemiplegia(weakness). She began standing for 1-3 minutes. She required moderate assistance for hygiene and clothing management. Begin toileting schedule, as well as increasing Kegel exercises to assist with continence training.

As she was approaching discharge, from November 29th to December 25th, Susan continued her successes with upper body dressing at stand by assistance (SBA), no cues needed but extended time to complete while seated EOB. She showed increased trunk control and trunk flexion when reaching forward to retrieve clothing while seated. At times Susan can lace her feet through pants without the use of AD. She continues to be limited in her standing endurance. Beginning to perform standing activities to increase endurance. She showed Improvements in toilet transfer with the use of RW.

Susan was discharged from the facility in much better shape than she had been admitted. She only required supervision for upper body dressing, minimum assistance for LB dressing, modified independent propelling wheelchair, and performing functional mobility. Toilet transfer is performed walking into a toilet with RW with CGA. Susan can perform hygiene management with CGA, and minimum assistance for clothing management. Susan continued to have hemiplegia in her left upper extremity and ambulates with an RW and the use of a left articulating foot orthotic device (AFO). Susan demonstrates good sitting balance and fair standing balance. She continues to be limited to 3 minutes of standing activity tolerance at this time.

Susan was admitted to The Paramount at Somers on May 27th, 2020 after a month-long battle with COVID that resulted in her being admitted to the ICU for intubation. Before the time in the ICU, Susan had enjoyed her independence. Upon her admission to the Paramount, Susan was barely able to move any of her extremities and was covered in pressure injuries obtained during hospitalization. With great care and dedication, the staff at The Paramount began to work hard towards Susan’s goal of walking out of our facility. Over many months of hard work, Susan began to regain motion in her extremities and slowly increased her independence. She went from a Hoyer lift to a 1 person assist for transfers and slowly worked her way from being bed-bound to ambulating independently in her wheelchair. These past couple of months, Susan made amazing progress and worked her way up to ambulating with a walker. Susan has shown determination and spirit the entire way. On December 14th, 2020, Susan met her goal, before a crowd of applauding therapists, the whole leadership team, nurses, CNAs, and well-wishers, Susan walked out of the Ambulance Entrance of The Paramount at Somers to her loving family as a true champion. Though the team will miss Susan’s kindness and unshakable spirit, the team is immensely proud of her progress and wish her and her family all the best!

Good luck Susan! Your journey is an inspiration!