After missed sessions, stay at rehab center, more work to do in therapy
Catch-up work needed to address soreness and improve mobility in SMA patient
Michael, our patient who has spinal muscular atrophy, recently stayed at a local rehab center while his caregivers were out of town instead of having someone come stay with him like he has previously. His reasoning for this was he would have care whenever he needed it instead of someone who comes and goes during the day while taking care of other patients.
When Michael returned to physical therapy after missing two weeks, we had some catch-up work to perform. Michael wasn’t able to get comfortable on his mattress while there and had to wait before someone was available to help him change positions to improve his comfort. Also while at the center, Michael lost some weight due to lack of appetite.
Weight loss increases the pressure on Michael’s hip bones which increases the risk for pressure ulcers. A skin check was performed, and he did have a small red spot on the back of his right hip, along his anterior superior iliac spine, a bony prominence above the glutes. He was informed of the spot and the condition and told to have his caregivers follow-up with skin checks until his next appointment.
Michael wasn’t able to change positions as frequently as usual and experienced increased stiffness and soreness throughout his body, mostly his neck, upper back, and lower extremities. When he returned to physical therapy, we transferred him onto the therapy table and performed some gentle stretching and massage to improve his mobility and reduce his pain. He wasn’t able to tolerate aggressive stretching, although light stretching and massaging helped to reduce his discomfort.
Michael exhibited reduced hip flexor length in both legs as well as reduced knee extension and increased sensitivity in his feet and cervical region. We will continue to work through these regressions to improve his comfort and reduce any lasting effects. The main goal for the next few sessions will be to assess his pressure ulcer until that has cleared and focus on his comfort before returning to any balance or other activities he would like to improve on.
Patient perspective
When my caregivers went on vacation for 10 days, I decided to check myself into a rehab facility instead of hiring a caregiver to come to my home for several hours each day. This is the type of facility doctors would send their patients before sending them home, to make sure that they get the proper physical therapy and other help needed.
Since returning home, my physical therapy has been slow. I lost a lot of strength in my arms and hands, and when I came home, my doctors put me on antibiotics because my breathing became labored. It’s that time of year when I typically catch a cold, usually when summer turns to fall. Antibiotics have helped, but when a patient with SMA gets a lung infection, they tend to last quite a while. Deep breathing exercises have helped, and I’m taking an expectorant to help loosen the mucus and phlegm in my lungs.
I had to miss a few of my physical therapy sessions, but my recovery is going well. Hopefully in the next few weeks, I’ll be back to my normal, obnoxious self.
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