As I walked in the door, with my brother leaning on my arm for support, I noticed that the answering machine was blinking. However, I didn't have time to check it. I had to get him settled into the bedroom as comfortably as possible after returning home with him from his serious back operation and hospital stay. The half hour drive had been tiring but now we could relax. He was on the mend and we were relieved and grateful.
Finally, I went to check the answering machine and found a message that our mother had been taken to the same hospital we had just come from. She had fallen and broken her hip at the nursing home she lived in. She was undergoing surgery.
The top part of her leg bone that fits into the pelvis was completely sheared off and detached. I believe it is called an oblique, comminuted fracture of the trochanter. An orthopedic surgeon repaired the break by inserting a pin in the shaft of the femur and attached it to the trochanter. The head of the trochanter was inserted at an angle so that her leg was rotated toward the midline with her knee facing inward. According to the doctor this was done to fix it more solidly in the muscle. This awkward positioning would prove to make it very difficult for my mother to walk.
After a period of convalescence, my mother was returned to the nursing home and evaluated for physical therapy. It was determined that she was physically capable of walking. However she did not respond favorably to the therapist's verbal instructions to stand up. To me, this was understandable. She was ninety years old and had dementia. The recent surgery and lingering effects of anesthesia left her obviously confused and in pain, making communication with her very difficult.
The therapist explained that, since my mother did not show any initial progress, Medicare would not pay for continued therapy. It looked like my ninety year old mother would never walk again. She was assigned to a non-mobile ward where she would lie in bed all day.
When I heard this, my heart felt like it was about to burst with sorrow. Prior to the accident, my mother walked all day in the corridors of the nursing home. In addition, family members would come and walk her outside. Walking was one of the few things that still gave her joy. It kept her alive. I knew that if she did not get up and move that she would probably waste away and die. People of her age who break their hips and remain immobilized typically have their bones thin out and their muscles atrophy. They develop bed sores and, within a year or so, die. My brother and I were horrified. We were determined not to let this happen.
I took my mothers hands in mine and said, "Ma, let's go for a walk." I gently pulled her up from the wheel chair and guided her to the parallel bars. She proceeded to walk, slowly and painfully, along the bars. My crazy brother, still recuperating from his back operation, tried to help. I ordered him to sit down. Often the care giver ends up straining himself and ending up worse than the one he is trying to help.
Every day, I came in and continued the therapy. I bought a support (gait) belt for her to wear and was given a walker. Within a week, my mother had progressed to the point that she was able to walk short distances with the walker. I was always present to assist her. Her mind cleared up and she was able to respond to verbal cues.
This was sufficient improvement for the physical therapy department to justify continuing therapy. However, the short time that the physical therapist could devote to her was not sufficient to get her walking by herself. A half hour a day would not result in recovery. When she was returned to her ward she remained immobile in a wheel chair. The attendants' focus was to prevent falls rather than to facilitate mobility, they therefore did not, to any appreciable extent, walk her.
My brother and I resolved to pick up the slack. He eventually recovered to the point where he could participate. We came in every day. We eventually got a rolling walker type of device, which had a seat and wheels, so that my mother could support herself when walking and sit when she needed to.
There were setbacks from the beginning. For example, early on she developed ugly bedsores on her foot. After a bit of detective work we determined that this was because her leg was put in at an odd angle and put abnormal pressure on her foot when she walked or even lay down. A wonderful physical therapist got a special boot that allowed her to walk while keeping the pressure off the sores. This same physical therapist donated two weeks of her own time to walk my mother when my brother and I both had to be out of town.
When we walked my mother we talked to her, sang and played musical instruments. It obviously had a great effect in motivating her. Here we are, two years later. My mother is able to walk long distances, for several hours, completely unaided. She likes to dance and often smiles.
When we are not around, she spends her time in the rolling walker. She is able to get up, walk and sit down completely on her own. The staff is delighted. They call her "miracle lady."
I have written this in the hope that something useful can be learned to help others. Many elderly people who have had a broken hip have similar problems. In the initial evaluation by physical therapy or in the ensuing treatment, they are unable to respond sufficiently to merit continued treatment. They are then consigned to an immobility ward and eventually waste away and die. I believe that their lack of, or negative, response is often due pain, fear of falling and the lingering effects of anesthesia rather than just dementia.
I propose that a simple solution would be to use a mechanical Body Weight Support device (BWS) to gently lift and support the patient. Such devices are available and have been used for gait and locomotion therapy for spinal cord injury and strokes. I am currently trying to locate sources of funding to test this concept out with elderly patients with hip fracture. Considering that there are approximately 350,000 new cases of hip fracture a year, there is an obvious need.
It looked like my ninety year old mother would never walk again. But she did.
A scholarly article on my mother's recovery was published in the Annals of Long-term Care. The reference is: Hip Fracture Rehabilitation in Persons with Dementia: How Much Should We Invest? Elliot Davis, PhD, James Biddison, and Jiska Cohen-Mansfield, PhD Annals of Long-Term Care - ISSN: 1524-7929 - Volume 15 - Issue 3 - March 2007 - Pages: 19 - 21
It can be found on the Internet at: http://www.annalsoflongtermcare.com/article/6903
Thank you.
Elliot Davis, Ph.D.
