We had the opportunity to shadow at physical therapist (PT) located at the Whetstone Rehabilitation Center near Riverside Hospital. This being a nursing home, all of the patients were geriatric and had limited strength/freedom of movement which presented a wealth of problems and constraints to their physical therapy. During our visit we observed the therapist treat two separate patients as well as helping them move through the building.
Problems:
Staff injuries
-Through talking with the PT, it was found that many of the injuries incurred by the staff (PTs, OTs, Aides) were back or neck injuries due to awkward bending/twisting motions required to adjust wheelchairs and other equipment.
Improper standing technique
-It was noted during our visit that the patients frequently needed help transferring from a bed or wheelchair to a walker. The process consists of pushing up and standing before gripping the walker. If the patient pulls on the walker to stand it can tip and cause a fall and risk additional injuries. Every patient we observed would inherently reach to the walker initially and attempt to pull themselves up before being reminded they needed to push up first.
Too many tasks at once
-The PT had the patients walk as much as possible to get them more exercise. Many patients do not have reliable strength though and could potentially collapse before finding a place to rest. A Gait belt was wrapped around the patients waist to provide a place for the PT to catch them in case they do collapse. In addition to holding the gait belt, the PT had to pull a wheel chair behind them in case the patient needed to sit down suddenly. These, along with opening doors for patients, caused many problems as the PT can only perform so many tasks at once.
Constraints:
-Insurance companies want more for cheaper
-Must do lots of paperwork, but that doesn’t count towards productivity or billable time
-Patients often have limited motion range