Perspective from Physical Therapy
Photo from: @iStock.com/AdamGregor
enjoy doing this. In fact, I think I assessed
half the people in Walmart today. Most of the
problems are usually related to weight-bearing
difficulty, with pain, instability, or both. Gravity
finds everyone eventually.
Most common pathologies of the lower extremity
center on the usual suspects: hips, knees, ankles
and feet. Almost every patient in most nursing
homes has a problem with at least one of these
joints, if not all three. I have several people with
what I’ve termed a “spiral-down” dysfunction.
The hip internally rotates, shifting the knee into a
valgus position, with completely dropped arches.
Not sure of exact percentages, but I can say 75%
have one or more of these. These are prospects
for pedorthic interventions as well.
One of the limiting co-morbidities in any
nursing facility is dementia of any type.
Dementia severely limits the capacity to learn
new activities or compensations to overcome
them. Number One with a bullet as a challenge
for me. Most challenging for the patients is
in maintaining status quo physically, and
maintaining established routines – their last
outpost in control of the world around them.
The return to home is always the goal of STR.
Recently, I had a patient with a good prior level
of function, but who was in the hospital for
months, then went to a specialty care center for a
month, then came to us. We very slowly watched
her progress back to her PLOF (Prior Level of
Function). It took her nearly six months to recover
enough to go home. Then, we saw her for a
month of home health care. Now she is happily
living at home with her husband and is very
pleased with her functional capacity.
The average age of the patients in my facility
is probably about 80. I have someone who is 55,
"Most common
pathologies
of the lower
extremity
center on the
usual suspects:
hips, knees,
ankles and
feet."
Current Pedorthics January/February 2016
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