Date of Award

2015

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Thomas Mohr

Keywords

Accidental Falls; Conservative Treatment; Fractures, Multiple -- rehabilitation; Case Reports

Abstract

Background and Purpose: Falls are prevalent in adults over the age of sixty-five due to lack of balance and decreased lower extremity strength. Non-occupational falls are reported to have an increasing prevalence with age and one-fifth of these types of falls results in hospitalization. The hospitalization of patients who sustain injuries following falls most often results in skeletal fractures. The cost to treat these patients is projected to reach $54.9 billion by the year 2020. The objective of this case report is to demonstrate the outcomes of a patient who sustained multiple fractures following a nonoccupational fall.

Case Description: A sixty-five year old female presents to physical therapy within a rural Transitional Care Unit (TCU) following a twelve foot fall through her garage attic ceiling to the ground which resulted in fractures at three joints and a sprained right ankle. She received an external fixation of a left tibial fracture and open reduction internal fixation of the left thumb and right proximal humerus. An examination and evaluation revealed the patient in an immobilizer of the right upper extremity, left thumb splinted and a cast and splint on the left lower extremity. In addition to pain, the patient had weight bearing precautions which involved non-weight bearing on the left lower extremity, right upper extremity and left hand, and limitations in functional movement. A good prognosis was anticipated based on patient motivation.

Intervention: Strength training of the lower extremity was targeted at the uninvolved joints to initially build strength that was lost over the preceding period of bed rest and then focused on endurance to return the patient to independence. Transfer training was also included. Education to the patient and spouse as well as a home exercise program were also provided.

Outcomes: Following a twenty-three day stay in TCU with physical therapy intervention, the patient was able to complete all sliding board transfers independently and stand with contact guard assist. She was discharged home with her husband and the necessary adaptive equipment.

Discussion: The combination of increased lower extremity strength and endurance allowed the patient to be discharged from the TCU to her home with her husband and modified independence. While the patient's response to this intervention plan was positive, the need for further research to determine the long term effects specifically to gait training exists.

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