Case Study: The Enclave at Port Chester Rehabilitation and Nursing Center (May 2017)

Patients Age: 60
Admission Date: 2/28/17
Admitted From: Greenwich Hospital
Discharge Date: 5/16/17
Discharged To: Home
Length of Stay: 2.5 months
Reason for Stay: Rehabilitate from ORIF malleolus and Right tibial and fibular fracture
How did this patient hear about the Enclave? Greenwich Hospital

Details of Experience:

Anthony arrived at The Enclave Rehabilitation and Nursing Center on February 28, 2017 following an inpatient hospitalization at Greenwich hospital due to a fracture of his right tibia, fibula, and malleolus, affecting his overall functional independence. Additionally, he had a history of polymyositis requiring use of ankle foot orthosis (AFO) to left foot for foot drop. Upon admission, Anthony was greeted by the members of the interdisciplinary team who would oversee his care during his time at The Enclave, including the doctor, clinicians, social worker and administrative staff.

After undergoing an evaluation by his therapist, Catherine, Anthony was assessed as non-ambulatory. He required Contact Guard Assist with bed mobility, maximum assist of two with transfers, and required a wheelchair with footrests, for his non-weight bearing right leg, which was in a cast. After sharing of pain to the surgical site, the nursing staff created a pain management plan to prevent the pain from limiting Anthony’s progress.

Catherine began a therapy regimen aimed at increasing Anthony’s upper body, trunk and overall strength, which would allow him increased mobility. Three weeks into his stay, he had a follow up visit with the orthopedist, which resulted in the removal of the cast and placement of a CAM boot on the right foot/ankle, with the ability to perform passive range of motion exercises. Shortly thereafter, he could transfer with moderate assist of one.

Seeing noticeable progress, Anthony felt encouraged to extend himself in order to gain the most from his productive therapy sessions. Four weeks later, a second consultation with the orthopedist informed the team that his right leg was now fifty percent weight bearing at which point he began walking with a walker up to 50 ft. The CAM boot would now be used exclusively while walking. Two additional weeks of therapy improved the leg to being one hundred percent weight bearing at which point he began ambulating in the room and in therapy up to ~150 ft utilizing a rollator walker and could perform transfers with stand by assistance . Cassandra, the social worker, began coordinating the discharge plan.

In preparation for the upcoming discharge, the rehab team recommended Anthony be seen by an orthotist for a custom-made ankle foot orthosis for the left foot and knee braces for both knees, which would give him added support. These were provided as the wheelchair and CAM boot were discontinued. He was now able to ambulate with full weight-bearing without pain.

After two and a half months, Anthony returned back to his community fully independent with ADLs, including dressing, hygiene, and the ability to walk independently with a cane. Cassandra arranged continued therapy for him with the Visiting Nurses’ Services of Westchester. The entire team was thrilled that Anthony reached his potential and could go back to everyday life at home!