I worked in a SNF as a PRN PT for one day, and I was assigned to a patient, who was a pharmacist in his 50's, with long COVID. He had been in and out of the hospital for 4 months after initially getting infected with COVID-19, and had acquired a sacral pressure ulcer.. When I treated him in the SNF, he required maximum assistance to transfer from supine-to-sit. I asked him if I could try to stand him up. He told me that he did not think this was possible because the last time he stood up was 4 weeks prior to this treatment session, before he was taken back to the hospital and readmitted back to the SNF. At that time, he required 2 people to assist to get him to standing momentarily. I explained that I was planning to use elastic potential to assist him into the standing position.

I used the same technique as the video below to get him into the standing position from the edge of his bed.

He was able to complete sit-to-stand 3 times, maintaining the position for a minute each time without requiring physical assistance. Although he had little strength in both lower extremities and both upper extremities, this was augmented by the elastic potential, enough to allow him to maintain standing without the physical support of another person.

After his third attempt, he indicated he could not stand up again, but was wondering when I will come back to perform the treatment. He said that this provided him the optimism that he will be able to stand up and walk again soon. I told him that I was a PRN therapist and that I will tell his supervising PT about the treatment. I also told him to tell his treating therapist about the treatment, and that he wanted to do it again.

I went back to the SNF 2 weeks later, and the social worker stopped me in the hallway to let me know that the patient told him that he was offering to pay "a thousand dollars" to have the same treatment repeated. Apparently, no one had done the treatment again. Because the patient was adamant about doing the same exercise, his treating PTA sought me out and requested for me to demonstrate the treatment.

I went back to the SNF after 3 or 4 weeks and the patient was ambulating with a front-wheeled walker with touching assistance.

The title of one of the studies below is interesting in that it specifically cites "increasing independence, confidence, and energy" in addressing fear of falling (FOF). In a lot of patients with FOF (or after prolonged immobility), a major source of their fear / apprehension is their perception that their lower extremities do not have sufficient strength to hold their body in the standing position. Using ELASTIC POTENTIAL to facilitate the standing position facilitates patient independence, engenders confidence, and minimizes energy expenditure to assume and maintain the standing position. Their success in performing the task is important to their psyche and contributes to their perseverance to progress.

RELATED ARTICLES:

1. Cognitive-behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial - the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

2. The anatomy of choice: active inference and agency