Phit Phorum: PT Transforms Dilly, Phit’s Grandmother

phit grandmother dillyPhil’s grandma, Dilly, is an 87-year-old pickle who lives with her daughter’s family. Her daughter has brought her to a physical therapist because her physical activity level and mobility are declining. The physical therapist conducts an evaluation and learns that Dilly had ovarian cancer 20 years ago and currently has atrial fibrillation, high blood pressure, and urinary incontinence. She is taking 8 medications, which increases her risk of falling, and has fallen twice in the past year without a fracture. She feels exhausted, has lost 10% of her bodyweight in the past year, and sits or lies down for almost the whole day. She isn’t able to rise from a chair without assistance, walks very slowly, and can’t walk more than 30 feet before sitting down. Balance tests show that she has trouble keeping her balance.

A high-intensity exercise program (2 or 3 times per week for 8 weeks) to strengthen her leg muscles doesn’t improve Dilly’s ability to get around in her community, but she does begin to walk longer distances. The physical therapist decides to develop a “circuit training program” of activities important to Dilly, such as folding towels, setting a table, walking to answer the phone, dressing, making a bed, emptying small trash cans, and sweeping. The first time Dilly attempts the circuit program, she is constantly on the move for a half hour, never asking to sit down. Her daughter incorporates household activities at home that quickly result in Dilly cooking, getting herself out of bed in the morning, dressing herself, and having a more positive mood.

After 18 weeks of physical therapy once per week, Dilly’s walking speed and walking distance and and her ability to get up from a chair have improved dramatically, and balance testing indicates that her risk of falling has decreased. Dilly’s physical activity has improved from 380 steps per week to 11,000 steps per week—and she was able to attend her grandson’s birthday party.

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