To Funding Agency,
Martha is a 78-year-old female who has suffered a
cerebral vascular accident (CVA) with resultant right hemiplegia and aphasia. Martha
presents with decreased tone in all muscle groups and her RUE is nonfunctional.
She has deficits in motor planning, poor endurance, and poor safety awareness. Her
static sitting balance is fair. Her dynamic sitting balance and static standing
balance are poor. Martha is unable to express herself verbally, however, she is
able to shake and nod her head to answer yes/no questions.
Martha is currently receiving occupational therapy,
physical therapy, and speech therapy services at The Rehabilitation Hospital. She
also receives support from her 80-year-old spouse and primary caregiver, Jack, who
reports that he wants to care for her at their home. In the last two months at
the hospital her progress has been minimal.
Martha is a homemaker. Until recently, she was
independent in dressing, feeding, and mobility. She is unable to ambulate at
this time and is totally dependent on transfers and wheelchair mobility. She
requires maximal assistance with sit to stand transfers and maximal assistance
from the wheelchair to the bed as well as bedside commode transfers.
In addition, she requires moderate to maximal assistance
with upper body dressing and maximal assistance with lower body dressing. She
is dependent in gathering ADL supplies and all homemaker activities. She requires
maximal assistance for lower body bathing and with toilet hygiene.
Martha spends the majority of the day sitting in a
wheelchair, which puts her at an increased risk for pressure ulcers and contractures,
and an overall decline in health. She is able to bear 25% of her own weight,
however, she does not have much support for continued practice of ambulation
skills. As Martha and her spouse prepare to make the transition from the hospital
to their home, transfers and mobility are major concerns. Without the appropriate
support and equipment Martha and her spouse will experience great difficulty in
the home environment, especially with regards to safety. Martha’s muscle
weakness and body weight make it risky for her spouse to manually assist her with
transfers to and from the wheelchair. As a result, both Martha and her spouse
are at risk for injury. It is critical that they adopt a durable device to prevent
any adverse health effects and to aid in the recovery of Martha’s condition.
I am strongly suggesting the Rifton TRAM for Martha. The
Rifton TRAM is a multifunctional therapeutic modality device that will
accommodate Martha with
transfers, standing, and gait training. A built-in scale and thigh straps are included
in the standard frame; however, Martha also requires the optional forearm
supports, pelvic support, and swivel locks.
The scale on the Rifton TRAM will serve to be an
important tool for Martha, as it can be used to show her progress in weight
bearing ability. The forearm supports are required to help stabilize her head
and trunk during transfers, standing, and gait practice. The pelvic support is
required to aid with comfortable standing and walking. It can be adjusted to
support the full weight of the user and it has the option of gradually
diminishing this support as the user improves, allowing them to become more
independent in weight bearing and gait.
Due to Martha’s motor planning deficits and poor safety
awareness, the swivel locks on the Rifton TRAM are necessary to guide movement in
a linear course and avoid any collisions. The swivel locks will allow for better
control of the device during transfers and ambulation and ensure safety.
The Rifton TRAM is a medical necessity for Martha as it
will promote overall health, especially with regards to strengthening and
maintaining joint, muscle, bone, and skin health. Not only will the Rifton TRAM
significantly enhance Martha in achieving independence and adequate occupational
performance, but caregiver
injury will be significantly reduced with the as the
device is battery operable and there is no lifting necessary on the part of the
caregiver. Both Martha and Jack have confirmed their eagerness
to adopt the Rifton TRAM in assisting them in the home environment.
Long term goals for Martha
are to bear 30% of her weight during transfers in order to assist with dressing
and hygiene; however, she is unable to achieve this goal with her dependence on
the wheelchair. Her functional mobility and participation are very important to
her overall well-being, and she urgently needs access to the Rifton TRAM within
the home environment. A less durable device is too risky and could potentially lead
to a costly hospital visit.
The Rifton TRAM is less costly
than the potential health risks. A pair of small sized forearm supports will
cost $450. The cost of a small sized pelvic support strap is $230. The total cost of the Riftton TRAM is $5,246
and it can be purchased online at www.medicaleshop.com.
Based on the evaluations
and assessments of Martha, we believe that the most effective option would be
the Rifton TRAM. The Rifton for safe and effective transfers
and gait practice, as well as ease with dressing and hygiene care.