Personal Narrative: My Experience With Mr. Rasak

May 18th 2014 Mr. Beaird fell and broke his hip. This followed hip surgery performed by Dr. Baker and 21 day rehabilitation form Cordova NH. Before his 21 days was up Mr. Beaird tried to break out of NH by running his scooter though the front door at the NH. When the scooter hit the door, the door opened and Mr. Beaird rolled onto the front porch during this altercation, his foot was injured and the ambulance was called. Mr. Beaird was admitted to Senior Care and diagnosed with a

I spoke with Mr. Rasak on 8/14/17. He reports he has had the AFO since 7/26/17. He wears it about 10 to 12 hours a day and has not noticed any improvement with his pain. He said the biggest thing is the pain and that it has affected his life dramatically. He said that he wonders how much longer he has to live and doesn’t want to live with the pain. I suggested again that he speak with his PCP regarding medications. He is taking Tylenol. He is extremely sensitive to pain medications and is very limited. I suggested his PCP since he knows his history and what he may be able to take.

Jesus Aleman is a 31 year old Hispanic male with Moderate IDD, Intermittent Explosive disorder, birth complications and Infantile Cerebral Palsy with minimal right hemiparesis. He is verbal and able to make his wants and needs known. His preferred language is Spanish, however he also understand and speaks English. Jesus has unequal leg length and abnormal gait. As a child he underwent right ankle surgery for equinus deformity and in 2014 he had a Right proximal tibia & right distal fibula corticotomy. He has history of fracture to right 4th finger. Despite client’s gait, he ambulates independently around the campus. To aid with mobility PT recommended a brace for his right lower extremity and two pair of shoes which he acquired this past year.

Cesar Sanchez is a 61 year old Hispanic male that was admitted to RGSC on 07/12/1982. He has speech and gait disturbance, hearing and vision impairment; he is non-verbal but appears to understand English. He can communicate his needs with body gestures and pointing to items. He is dependent for all ADL’s and ambulation he is at high risk for falls; his adaptive equipment consist of Lift vest to assist with ambulation; wears an elastic knee brace and AFO brace to left leg, shower chair, bed sensor, chair sensor and wheelchair for long distances.; Cesar has history of patellar (left) and L2 fractures.

Respondent came to Department's attention by way of a Northridge Hospital Medical Rehab Center Report.

July 24, 2015 – July 29, 2015 – Physical Therapy: Mr. Rascon presented to Movement Dynamics three (3) more times during this period. Mr. Rascon’s complaints remained the same, however, his upper and lower back were his primary complaint. He continued to have functional limitations

Leo is thirty- seven- years- old (he is in the life stage adulthood), he has not long slipped on some ice and has broken his leg. He has had his leg into a cast for two months now. Is now allowed to have it off. So he went to his appointment at the hospital to get his cast removed. Due to the reason that hasn’t been able to walk for two months, he had been on crutches and in a wheelchair, he isn’t used to walking anymore due to his accident. So the doctor at the hospital has told him to stay on the crutches until he has got used to in again. The doctor has also told him to stay on the crutches also so that Leo doesn’t cause any fever injury to himself. To help Leo walk again the doctor has referred him to a physiologist. This is someone that

House has to walk with a cane due to an motorcycle accident. He has trouble voluntarily controlling his right leg. He accident has left him with ataxia in his leg and the muscle is also beginning to atrophy.

The resident on 1:1 physiotherapy to improve his dynamic standing balance, strength and endurance. Resident

On 5/4/17 I spoke with Dave Thibodeau physical therapist. This was a long call waiting then speaking directly with the therapist. He reports that Mr. Sutter has been attending physical therapy but making little progress at this point. Mr. Sutter has other health issues that have impacted his progress. I spoke at length with Mr. Sutter. He is hard of hearing and you need to speak slowly. He reports he is doing okay. Weather does affect his ankle. He continues to use the bone stimulator and do home exercises.

Mr. Duszynski was non weight bearing initially and made progress with transfers. Mr. Duszynski required stand by assistance and was non weight bearing to his left lower extremity and weight bearing in CAM boot to his right lower extremity using a walker His sutures where removed. He was eventually transferred to skilled nursing facility Tender care in Munising, Michigan for further care and rehabilitation on June 14. Kalie Bianco met with the staff and Mr. Duszynski on June 15, 2017 and coordinated a team meeting for June 22, 2017.

Self Care: Client participated in five sit to stand transfers on the 3-in-1 commode with moderate assistance in the rehab bathroom within 30 minutes. Client did this to increase independence with sit to stand transfers for toileting.

My interaction with R.P. on a weekly basis started out as being consistent, until became as a conflict to maintain the weekly visits, due to him obtaining employment. When he became my client to be assisted with services in the community, he was very engaging and attentive when working together to obtain services that are of importance to him. As a request from R.P., he seeks out guidance on what to do in order to take care of personal. He is informative when seeking information about his mental and physical well-being that is important for me to keep record of to prevent him from being hospitalized. The interaction between the client and I is on professional level where a rapport have been developed allowing the client to be able to express himself about positive and negative outcomes relating to personal and societal matters.

Patient would come in for weekly checkup and progress was going as expected. On Dr. Nash’s Wife contacted us asking for your services but hung up abruptly. Mrs. Nash sounded troubled with an urgency in her tone.

For him to progress with these goals also meant balance and spasticity would have to be addressed. The treatment plan consisted of making his home his own rehabilitation clinic creating and performing activities in all aspects of the home in hope of creating independence and adherence in home exercise program. Integrating exercises into the patient’s daily routine is important for compliance and management of fatigue and heat sensitivity.6 Physical therapy services were provided for the patient two times per week with 30 minutes dedicated to aerobic and strengthening plus an additional 30 minutes for stretching and transfer training. At the patient’s request, visits were made in the morning hours when he was rested and more energetic. He would work on his endurance and aerobic conditioning using a restorator, a simple, portable pedal exerciser but an effective way to increase circulation, starting at 2 to 3 minutes, 2 times per day with the goal of being able to perform 15 to 20 minutes at one time without rest breaks. Aerobic exercise has been shown to reduce fatigue, not only physical but also psychological, and improve walking ability and walking speed.16 Patient would also engage in standing with support for 1 minute initially gradually