I have a bit of an interesting patient. She was 2/52 post TKR when she first came to outpt PT with a d/c knee AROM reported at 8° to 80° with no quads lag and an extensive pre-op falls history. Unfortunately this lady had suffered post op dementia and had no recollection of having any PT or being taught any exercises. At first assessment in outpts she had an knee range AROM of 16° extn to 65° flxn with a quads lag of 5°. She returned early the next week after falling onto her operated knee with an active range of 20° to 45° and a huge increase in swelling. Her GP examined the knee and said there was no damage to the replacement but in the meantime she hadnt done her exercises. She returned again today after having 2 more falls over the weekend with an active knee range of 10° to 72° .
When asked to demonstrate her exercises she couldnt remember any. All the falls she has had have been because she can't slow down on her crutches and twice she fell when she wasn't using them. Today she came to the appointment with only one crutch because she forgot the other one! I have demonstrated all the exercises, drawn pictures and given written instructions but even immediately after doing the exercises she cant follow the written/drawn HEP. I have given her a grid to tick when she has done her exercises but I don't know this will help. So I have booked her in for hydrotherapy and PT 3x a week. But what I am not sure of is how much improvement I can expect. Realistically I can only do her exercises with her maybe 2 sets of 10 reps 3x a week...will this be enough to make a difference? what else can I do?
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Considering the her extensive background of falls pre and post surgery, is she actually safe on crutches? have you assessed her balance with crutches? maybe a Wheely ZF will be more appropriate in her case? just think her fall issue is a priority here. will be worthwhile to talk to the ward physio who gave her the crutches in the first place too.
Second on the list is her dementia. No matter how you try on her, man, her mind is gone. However, who is her primary carer and any chance you can invite him/her to your physio appointment or even just speak to him/her on the phone about how to make sure this lady does the exercise you gave her? Things like that.
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