What Physical Therapy Can Do: One Patient's Story
By Jo Reeder, PT, MCSP
Mr. J, in his early 60s, came to physical therapy in April 1998. A hemodialysis patient for nearly 12 years, he had been in a wheelchair for 10 months with significant leg weakness and muscle spasms. Although many specialists had blamed renal disease for his symptoms, his condition may have been caused by the lack of activity or exercise.
Mr. J became increasingly depressed. Because he was obese, it often took three staff members to transfer him to the dialysis chair. He received home health physical therapy, but was discharged due to lack of progress. Apart from a few weekend minutes spent standing in a frame built by his home care physical therapist, Mr. J passed all of his waking hours in his wheelchair. Life at home was becoming increasingly difficult.
Starting Physical Therapy
I started Mr. J on a physical therapy program, to try and prevent further degeneration of his condition and depression. I assessed Mr. J, and found that he had reduced sensation in both legs and went into a flexor spasm at the hips and knees with minimal exertion.
I customized a program for him that involved exercise and functional training. He was unable to keep his feet in the pedals of the exercise bike, so I adapted a bike by fixing shoes onto the pedals. Initially, he could not complete one revolution without assistance, but with warm-up exercises and stretching, he started to bike. I slowly increased his exercise time, and gave him exercises to increase his strength and flexibility.
After a month of exercise, I started to work with Mr. J. on transfers, sit-to-stand, and gait. At first, it took three people to help Mr. J walk three feet with the walker, and a knee brace to prevent his left knee from buckling.
Over time, he was able to increase the distance walked and build his independence. The Orthopedics Department provided him with an orthoses (custom-made brace) to replace the temporary knee brace he previously used.
A Changed Life
Today, Mr. J walks unaided into the Kidney Center. At home, he leaves his wheelchair at the front door, uses his walker in the house, and even walks upstairs. He has resumed deep-sea fishing (his passion), which he had not been able to do for 4 years. His wife, who doesn't drive, is also thrilled with the improvement—he can now drive her to the grocery store!
He also rides the exercise bike at each dialysis treatment for at least 1 hour. His muscle spasms have disappeared and he no longer requires the orthoses. As for psychological well being—Mr. J. is the life and soul of his dialysis pod.
Mr. J's success was the result of a team effort by the nursing staff, physical therapy, and the patient himself. We have noticed a "domino effect" at the center as other patients, encouraged by his progress, have participated in exercise programs. Many patients have been referred to physical therapy and have gained greater functional independence after participating in exercise.
For information on coverage of PT services, and where patients can go to receive treatment, see the Showcase Tip entitled Getting PT Services for Your Patients.
Name: Jo Reeder, PT, MCSP
Title: Physical Therapist
Organization: Renal Services, UVA Health Systems
Address: Box 800405
Charlottesville, VA 22908
Phone: (434) 243-6218
Fax: (434) 924-2973
Willing to reply to readers' questions? Yes
Date: November 2001