Respiratory Rehab Using EStim

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Submitted by Cory Robertson, Therapy Resource, Idaho

Did you know that electrical stimulation can be used for more than a really fun demonstration in high school physiology class? Yes, it is great for that, but the evidence-based applications of electrical stimulation are myriad. A recent meta-analysis (yes, a meta-analysis, the king of the hierarchy of scientific evidence) concluded that e-stim effectually strengthens quadriceps and enhances exercise capacity in moderate to severe COPD patients.

A large barrier to therapy for those with respiratory conditions is their tolerance. They fatigue quickly and get short of breath and struggle with dyspnea. That is in part due to the changes in muscles when the ability to deliver oxygen to them decreases. There is an increased reliance on less fatigue-resistant muscle fibers. One method to address that barrier is the use of neuromuscular electrical stimulation to activate those muscles most important to functional activities. But how do you do it?

Like most therapeutic interventions, there is skill involved, and if done incorrectly, at best it is a placebo. The goal is to use the NMES effectively to get the best outcomes as evidenced by the meta-analysis and many more research articles. Please check out article for Respiratory Rehabilitation EStim from the portal for a refresher on how electrical stimulation works and some best practices. It will help to get the therapeutic dose to the target tissue, leading to great outcomes, while enhancing the tools in your therapy tool bag.

Let’s use the tools available to us, supported by evidence, to best treat those who rely on us to improve their function and quality of life. Electrical stimulation can be more than a last resort, or why Mr. Wilson gets the best reviews in his physiology class.

 

To The Lifters

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Submitted by Tiffany Bishop, DOR/Therapy Resource, Legend Healthcare & Rehabilitation, Greenville, TX

Our amazing ADOR George Palin and his wife have been working tirelessly to provide the entire building (and a few to our sister buildings) with cloth masks, and they are now working on gowns to keep us all safe. Today the team wanted to say a special thank-you to him. One of our other amazing PTAs, Heidi Carmichael, thanked George for providing her with a more comfortable mask (pictured — you gotta laugh sometimes, right?) and read the following poem as a thank-you. I thought this is so true of George and so many others who are going above and beyond to take care of each other and our residents.

There are just two kinds of people on earth today,
Just two kinds of people, no more, I say.
Not the rich and the poor, for to count a man’s wealth
You must first know the state of his conscience and health.
Not the humble and proud, for, in life’s little span,
Who puts on airs is not counted a man.
Not the happy and sad, for the swift counting years
Bring each man his laughter and each man his tears.
No, the two kinds of people on earth I mean
Are the people who lift and the people who lean.
Wherever you go you will find the world’s masses
Are always divided in just these two classes.
And oddly enough you will find, too, I ween,
There’s only one lifter to twenty who lean.
In which class are you? Are you easing the load
Of overtaxed lifters who toil down the road?
Or are you a leaner who lets others bear
Your portion of labour and worry and care?
by Ella Wheeler Wilcox

Broadway Villa’s Patient Success Story

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Submitted by Jennifer Raymond, Therapy Resource – Northern CA

Shell was first admitted to BWV on Nov. 29, 2019, following a devastating CVA. At that time, she was nonverbal due to severe expressive aphasia, NPO on a feeding tube and had significant sensory disturbances. She was unable to follow a very simple command, required max to total assist to perform basic self-care and was unable to ambulate at all.

Prior to the stroke, Shell had been independent with all of her mobility, ADLs and communication and lived with her daughter. She had an extensive course of skilled care with all three disciplines and made impressive gains. However, she did not acquire the level of independence necessary to return home, so she was discharged from therapy to RNA and considered a long-term care placement at Broadway Villa.

As a true advocate, DOR Shobha Neupane-Gautam is always looking for ways that therapy can make a difference. During her daily rounds in April, she interacted with Shell and saw positive changes in her and the potential for her to do more. OT re-evaluated and began to see marked improvements during their treatments such that PT and ST also started new courses of care a month later.

Shobha writes:
“Due to our persistent/compassionate care and comprehensive approach, this resident is singing, dancing with rehab folks. She is able to perform functional transfer/ambulation/ADLs requiring supervision to modified independence. She is very interactive and demonstrates happy expression. Rehab folks have coordinated with IDT/family members, based on her progress. Family is ready to take her home and enjoy her life.”

Shobha’s approach demonstrates an ability to not simply interact with our long-term care patients every day, but to really “see” them as individuals who can change and grow and thrive. Thank you, Shobha, and all the Broadway Villa therapists for your commitment to facilitating the “Can Do” in the residents you serve, for never giving up on human potential and always believing in the power of therapy to change lives.

Update from City Creek

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By Jared MacDonald, Operations Manager, City Creek Post Acute Care, Salt Lake City, UT

May 15 marked our one-month mark of becoming a COVID-only building. We are excited at where we’ve been and where we are going.

First off, thank you! Thank you for all the calls, the messages, the food, the signs, the support, the staff, the prayers, and most of all thank you for helping us see what it truly means to love one another. We know it sounds cheesy but honestly, there have been many things in the past month that have brought us to tears of gratitude for your help and support. We could not be where we are today without your help, so thank you.

In the past month, we have admitted 55 patients and discharged 21. Thanks to our remarkable clinical team, both those on site and those from other buildings, we have a live to date hospital readmission rate of 3.63% and a mortality rate of 3.63%. Those numbers are remarkable in comparison to both the state and national average. This truly shows that on the clinical front, we are succeeding. This plan is making a difference, and we thank you for your support in helping us be what and where we are today.

We’ve started a tradition of ringing bells and cheering as our residents are brought down the hall and sent outside to meet family and friends. We will never forget holding the hands of an 87-year-old as we cheered for her successful discharge back home. Tears streamed down her face as she thanked each one of us for helping her fully recover. We hope you know, especially all you DONs, that you were just as much a part of that successful discharge. Thank you!

Thank you to all of you who have rallied your staff, conducted interviews, and spoken with your friends and families.

Today we had a call with members of the state and local task force. They expressed their appreciation for what we are doing. Dr. Spaulding from Intermountain Health said that this was one of the best teams he has ever worked with. We have and we will continue to attribute our success to the support we’ve received from the market. They know of your greatness and of the countless hours you’ve spent in helping make City Creek what it is. Thank you from the bottom of our hearts!

COVID Update from Victoria PARC

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by Dawn Thompson, DOR, Victoria Post Acute Care, El Cajon, CA

Victoria Post Acute (VPAC) is one of the few skilled nursing facilities accepting COVID-19-positive residents from hospitals in San Diego and El Centro. Like other buildings with positive COVID cases, the beginning stage was certainly an upheaval from “normal” daily routines, as we were thrown into a world of unknowns with ever-changing directions and recommendations, coupled with fear. Schedules were slim, admissions were down, and stress was high. The rehab gym became a room with social distancing markers and a storage room. Hallways turned into PPE stations.

During this time, the rehab staff jumped into every and all support roles necessary (maintenance, dietary, CNA, etc.). They did this without asking and without hesitation, day in and day out, and continue to be heroes to this day. During this time, multiple rehab staff members were out sick, testing positive for COVID. As a team, we focused on “scared is what you’re feeling, brave is what you’re doing” and really went out of our way to emotionally support one another. We had daily emotional check-ins, both as group and individually.

This was a time of great loss in the building, where almost all sense of “normalcy” at VPAC and in the rehab department was absent. Grasping to maintain some normalcy and trying to keep our well patients well, we were able to work with Kaiser to evaluate and treat all appropriate Kaiser LTC residents in the non-COVID unit to maintain strength, activity tolerance and functional status. As our in-house COVID-19-positive patients stabilized medically, rehab jumped in and worked side by side with our new respiratory therapist. We were able to assist in positioning for postural drainage and help her hear true lung sounds of our ill patients.

We have learned a tremendous amount from our experiences treating COVID-positive patients (pay attention to those vital signs!) and have grown in confidence. The fear has dissipated and has been replaced with pride. This transformation was one of the most rewarding experiences we’ve had together as a team. I believe this shift was guided by transparent and efficient communication between IDT members and floor staff. While we seem to have our footing right now, this is an ever-changing process and we are continuously learning, growing and adapting.

As the days and weeks pass, admissions are starting to return, PPE requirements are changing, and barrier placements are being removed. Through it all, VPAC has remained resilient and together. Despite the loss and havoc of the first few weeks, we’ve found reasons (many, many, many reasons) to smile and celebrate. We have celebrated resident successes/discharges, birthdays, a retirement (DON), bridal shower, nurses week/nursing home week, Tuesdays and each other. We have been able to celebrate a COVID-19-positive patient (the husband of one of our charge nurses) being discharged home, walking out hand in hand with his wife after a month of hospitalization/rehabilitation including intubation.

Thank you all for the support, friendship and love over the last several weeks. It was needed and is much appreciated. I continue to be the proudest team leader.

Stay safe, wash your hands and keep your hands off your face!

With much love and gratitude,
Dawn ☺