1. Home Health Services EVIDENCED BASED THERAPY AND FUNCTIONAL OUTCOMES PRESENTED BY: Christopher Brian Skrypski, MSPT Director of Rehabilitation Services Main Office 718 South State Street Clarks Summit, PA 18411 Phone: 570-586-2222 Fax: 570-585-1321 Stroudsburg Branch 930 North 9 th Street Stroudsburg, PA 18360 Phone: 570-421-6600 Fax: 570-585-1321 Berwick Branch 500 Fowler Ave Ste 104 Berwick, PA 18603 Phone: 570-759-2000 Fax: 570-585-1321

2. Information Regarding the Importance of Utilizing Evidence Based Physical Therapy (EBT) with Timeline of Patient History

3. History of Present Illness: 85 year old female who was status post 8 falls at home over the past year (01/06 – 12/06) with the last fall resulting in multiple fractures to both sides of the pelvis, 4 ribs, toes and hairline fracture to hip not requiring surgical intervention, Patient was discharged home from inpatient rehab on 02/22/07 and a home care agency was ordered (nursing, physical and occupational therapy) to follow through with patient care (not CareGivers America) PMHx: ESRD with dialysis 3x/wk, A-fib, Osteoporsis

4. BERG BALANCE ASSESSMENT 3-13-074-17-075-10-07 36/5642/5644/56

5. INTERPRETATION OF RESULTS Berg Balance Score (BBS) is able to discriminate between elderly people’s needs for ambulatory assistive devices based on their mean BBS with standard deviations Walker: 33.1 +/- 8.4 Cane Indoors: 45.3 +/-3.4 BBS < 45 = increased risk for falls Cane outdoors only: 48.3 +/- 3.2 BBS> = decreased risk for falls No assistive device: 49.6 +/- 5.6 _ 1 2

6. Scoring: (Podsiadlo and Richardson) SecondsRating <10Freely independent/mobile <20All were independent with basic chair and toilet transfers, most independent with tub and shower transfers, usually able to climb stairs and go outside alone 20-29Variable mobility >30Decreased independence (most needed assistance with chair and tub/shower transfers help with climbing stairs) Unable to go outside alone. 1

7. Shumway-Cook et.al found adults who took longer than 14 seconds were at high risk for falls. Carmeli et al. found significant decreases in TUG scores in residents receiving 12 – week exercise program versus control group. TUG scores are less for people returning to the community following hip fracture when compared with age and gender matched cohorts 6-12 months post fracture. 2 4 3

8. Information Regarding the Importance of Utilizing Evidence Based Therapy with Timeline of Patient History (The Outcome) DateTrial 1 (sec) Trial 2 (sec) Trial 3 (sec) Average (sec) Fall risk based on reference data Observation Of transitions 5-10-07SPC 14 SPC 14 SPC 13 14 Fall risk Minimized TUG performed for first time on this date on discharge

9. Information Regarding the Importance of Utilizing Evidence Based Therapy with Timeline of Patient History (The Outcome continued) DateTrial 1 (sec) Trial 2 (sec) Trial 3 (sec) Avg (sec) Fall risk based on reference data Observations of transitions 1/20/08SPC 23 SPC 24 SPC 23 Reports fear of falling and at high fall risk Difficulty with step initiation- poor power with sit-stand 3/11/08SPC 18 SPC 21 SPC 22 20High fall risk Slow turning but safe, power improving with sit to stand 4/09/08SPC 15 SPC 14 SPC 12 14 Fall risk minimized No verbal reports of fear of falling Normalized power with sit to stand and no hesitation with stepping

10. Information Regarding the Importance of Utilizing Evidence Based Therapy with Timeline of Patient History (The Outcome continued) DateTrial 1 (sec) Trial 2 (sec) Trial 3 (sec) Avg (sec) Fall Risk based on reference data Observation of transitions 7/22/08RW 29 RW 30 RW 26 28 High Fall Risk Significant reports of fear of falling with transfers Multiple rocks to stand up with loss of balance backwards at times 9/11/08RW 23 RW 21 RW 21 22 Fall Risk DecreasingMarked improvement with power with one rock forward to stand 10/9/08RW 15 RW 17 RW 17 16 Fall Risk continues to decrease and no loss of balance backwards Normal power when transferring from sit to stand for condition 11/13/08RW 16 RW 14 RW 16 Pt will remain at high fall risk as per research by Carmeli et al. Demonstrates heel strike to tow off, looses time with turns, but safe