Rehabilitation following an injury, illness, or surgery commonly involves some combination of physical, occupational, and speech therapy to overcome multiple functional deficits. For Joan Akers, 83, who recently went to The Laurels of Toledo for rehab following a hospital stay, those deficits included both difficulty swallowing and impaired balance—challenges that called upon the expertise of several members of the Laurels rehab team.
Akers, a resident of Pelham Manor in Toledo, wound up in the hospital last January after she experienced a severe allergic reaction to penicillin and then developed pneumonia. “The reaction caused my hands to peel and my tongue and throat to swell up,” she recalls. “I couldn’t eat anything, not even ice chips, and I was on IVs for eight days.”
When Akers came to The Laurels, she continued on IVs for approximately another week. Also, she was initially limited to pureed foods and thickened liquids due to her impaired swallowing reflex, or dysphagia—a difficult predicament for a woman who enjoys cooking and has a passion for Wendy’s cheeseburgers and Frosties. But that would gradually change with the help of Laurels speech therapist Emily Russell. With guidance from Russell, Akers worked hard to regain the muscle strength necessary to resume effective swallowing without the risk of aspirating food or liquid into her lungs, which could lead to another bout with pneumonia.
Among the tools Russell used to help Akers was an innovative therapy device called the AccuTuck. The AccuTuck, which looks rather like a small beach ball with a wrist strap, is used to perform a specific form of exercise called Chin Tuck Against Resistance, or CTAR, which is very effective in strengthening the muscles necessary for swallowing.
Russell couldn’t be more pleased with Akers’ progress. “Joan has made such drastic improvement since she came here. With the exception of water, she still needs to have her liquids thickened, but she’s eating regular foods now, and her latest modified barium swallow study showed very good function with just a little ‘penetration,’ which means a small amount of fluid is reaching the vocal cords, the entrance to the airway. But she’s able to cough and clear that liquid with no problem, so it won’t enter the lungs and cause aspiration pneumonia,” she explains.
Once Akers was upgraded to regular foods, the rehab staff surprised her with a special treat—a cheeseburger and Frosty from Wendy’s.
However, dysphagia wasn’t the only rehab challenge Akers faced. She had issues with her balance as well. According to Laurels Physical Therapy Assistant Matt Snyder, “When people come here as inpatients, one of our primary goals is to get them back on their feet and walking. Joan was able to walk independently very quickly, but she noticed she was having problems with her balance, which created some interesting opportunities for us from a physical therapy perspective.”
Snyder explains that our bodies use three different strategies in progression to recover from loss of balance—the ankle, hip, and stepping strategies. He observed that Akers tended to walk with her feet shuffling, indicating weakness or lack of coordination in the muscles of the ankle. To help her overcome this deficit, he had her walk on and maintain different stances on an uneven foam surface. “This technique creates an instability that challenges the balance and strengthens the ankles because the small muscles around the ankle must continually fire to adapt,” he says.
Like Russell, Snyder is very pleased with Akers’ progress. “I feel her balanced has improved considerably,” he says. “She’s getting more and more confident in her movements and requiring less and less assistance from me.”
Having transitioned back to independent living at Pelham Manor, Akers currently comes to The Laurels on an outpatient basis to continue building on her gains as an inpatient. To get to The Laurels and back home, she takes advantage of the facility’s shuttle van service, which is available free of charge to clients who qualify. Commenting on the Laurels rehab team, which she holds in the highest regard, she states “The people here are just wonderful, and I would recommend this facility to anyone in need of rehab services.”❦