Care
Fully

Jane is an 87 year old lady who fell and sustained a periprosthetic fracture to her distal femur, she moved into a nursing home until she could potentially return to her own home. She had to wait over 4 weeks for the NHS physiotherapist due to waiting lists. We were called in by her family and assessed her the same week.

She was to be managed conservatively with a full leg brace and non weight bearing, she required hoisting for transfers and was able to sit independently. Her treatment plan was to build her tolerance to sit out daily using the hoist with the care team, strengthening exercises to hip flexors, quadriceps and ankles as well as clot prevention and pressure relieving exercises. Jane progressed to standing with stand aid, we taught the care staff how to safely remove brace and clean leg and brace and how to hoist with straight leg brace in situ. She progressed to a hinge brace and was allowed specific range of motion every 2 weeks, we supported the staff to perform this safely. We handed over to the NHS team who could continue her care.

6 months later we were contacted again as she was now mobile with a frame in her supported living apartment but very nervous and continuing to fall. Jane would like to gain more independence but her NHS physio has discharged her so we returned and were able to progress her mobility, increase her confidence, reduced her number of falls as well as her falls risk. We continue to support this lady with regular input due to her frailty.

Donald is a 78 year old man with dementia, the care home were struggling to mobilise him. On assessment he was able to follow prompts but did not have the mental capacity to make decisions. We worked with the team to ensure a capacity assessment was undertaken and that physiotherapy was in his best interests. We determined the best way to engage Donald to stand and gave him and the care team the tools to assist him safely. This included practising weight transfer forwards, placing the frame much further in front of him to allow him to transfer his weight and guiding him with appropriate handling. Once stood Donald was able to walk in a straight line with his frame around the care home, he needed a lot of help with turning as this is a much more complex procedure.

As he gradually went off his feet as is the nature of dementia we supported the care staff with appropriate positioning to avoid him developing the well recognised tenting foetal position and losing his ability to swallow due to loss of sensory and proprioceptive control. We were able to support him to die in dignity with dementia and provide excellent care and support.