Brooke Rehm

Date of Award


Document Type


First Advisor

Susan Jeno


Background and Purpose: Physical therapy management of older adults following hospitalization is common. Patients tend to show impairments such as generalized weakness, decreased endurance, impaired mobility and gait, and an increase in dependence on others to complete activities of daily living. The purpose of this case study is to examine the physical therapy implications of treating patients with hospital acquired disability. This paper outlines the management of a patient who was newly admitted to skilled nursing facility, following a proximal humeral fracture.

Description: Following her stay at the hospital, the patient was discharged to the skilled nursing facility for short term rehabilitation. She presented with decreased strength, impaired mobility, impaired balance, decreased ROM, and a decreased desire to participate in rehabilitation. On evaluation, she was argumentative and did not want to participate in the examination.

Intervention: Treatments for this patient included therapeutic exercise, therapeutic activities, gait training, and neuromuscular re-education. A series of supine strengthening exercises and transfer training were initiated to improve and progress strength and function. Occupational therapy completed care for her upper extremities.

Outcomes: Following physical therapy intervention, the patient improved her function, increased strength, motion, and distance ambulated, decreased assist in transferring, and a positive attitude towards rehabilitation.

Discussion: Treatment was based on the facility’s protocol on new admissions, clinical based articles, and the patient’s presenting symptoms. Interventions were altered based on the patient’s daily response to therapy and health status. The patient was able to progress from almost fully dependent, to needing supervision with transfers. Due to an orthopedic appointment to clear her for weight-bearing status being delayed, the patient was not discharged as soon as expected from short-term rehabilitation. Due to this, the full extent of the patient’s discharge status was unknown. The patient and the family planned on returning home on discharge.