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CASE STUDY

CASE STUDY

S.R. is a 66-year-old retired man who has been participating in a conditioning program at a wellness center for 2 months without incident. The program includes walking on a treadmill, upper extremity resistance exercises, and abdominal exercises. During the summer, the wellness center provides an area for clients to exchange produce from their gardens. S.R. has atrial fibrillation and stable angina pectoris and is currently taking warfarin in addition to antianginal drugs. S.R. participates in the conditioning program 4 days per week. A physical therapist reviews his status and modifies the exercise prescription every other week. Last week, S.R. was absent. This week, he participated on Monday and Tuesday, and the therapist reviewed his status on Wednesday. During the initial discussion, S.R. stated he was out of town visiting his grandchildren and he kept up with his medications but not his conditioning program. He also mentioned that he missed the fresh vegetables last week while away. Today, he complains of pain in his shoulders and knees. He figures it was the result of not keeping up with his exercise program last week and getting started again. The therapist notices a circumferential bruise around the right wrist that appears several days old. When questioned, S.R. states that the bruise must have been due to his grandchildren leading him by the wrist last week. The therapist asks the client whether he knows his current INR level. When S.R. responds that he has not had his INR level checked for the past few weeks, the therapist advises him to discontinue the conditioning program until he is certain that his anticoagulation level is within a safe therapeutic range.

REHABILITATION FOCUS

A considerable number of patients undergoing rehabilitation are treated with drugs that affect the blood and these medications have significant impacts on rehabilitation outcomes. Anemia is a problem experienced by many patients, especially those receiving cancer chemotherapy and those with renal or heart failure. Exercise programs combined with drug therapy improve quality of life in these patients and reduce morbidity and mortality. However, when patients are being treated with hematopoietic factors, aerobic capacity and immune responses may be depressed. Consistent review of hematocrit, hemoglobin, and blood cell counts prior to therapy interventions is warranted to determine the appropriateness and intensity of mobilization and exercise.

Anticlotting drugs are used to treat individuals with a variety of conditions including neurologic, cardiac, and post-surgical. Anticlotting medications may include anticoagulants and/or antiplatelet drugs. When available, clinicians should carefully monitor coagulation lab test results prior to beginning a treatment session, especially if interventions involve wound care, intense aerobic or resistance exercises, or significant joint mobilizations. This will ensure that the treatment session is appropriately scaled to the patient’s level of medication. If patients are over-medicated, myalgia or arthralgia associated with bleeding into tissues may occur 1 or 2 days following a rehabilitation session involving impact-related physical activities.

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