Brian T. Swanson
© 2015 Matthew Kraft
Background and Purpose: On any given day there are over 600,000 homeless persons in the United States. Many homeless people sustain injuries directly resultant of their living situations and are treated at local hospitals. Following medical stabilization, many times hospitals encounter difficulties with discharging homeless patients. This case report examines the role of Physical Therapy in one such case in the context of direct patient care and collaboration with the interdisciplinary team for safe patient discharge. Case Description: The patient was a 77 year old homeless male who sustained compression fractures to his T12 and L1 vertebrae after falling from a 4 foot height. The decision was made to treat the fractures non-surgically using a Thoracic Lumbar Sacral Orthotic (TLSO). The patient presented with deficient range of motion (ROM) in his bilateral lower extremities limited by pain, and good strength and coordination throughout both his upper and lower extremities. The patient initially presented as a high fall risk, per the Tinetti Balance and Gait Assessment, and scored within normal cognitive functioning per the Montreal Cognitive Assessment (MoCA). Outcomes: The patient's self-reported pain levels decreased, his bilateral lower extremity range of motion increased, and he scored as a low fall risk per the Tinetti. Following treatment at the hospital, the patient was discharged to an inpatient rehab facility for further recovery because he could not return safely to his current living situation. Discussion: Hospitals often run into difficulties when discharging homeless patients. A major obstacle is lack of patient compliance. Successful outcomes for homeless patients require constant, open communication among the interdisciplinary healthcare team, and between the healthcare providers and the patient.
Kraft, Matthew, "The Role Of Physical Therapy In The Treatment And Discharge Of An Elderly Homeless Patient With Fractures Of The T12-L1 Vertebrae: A Case Report" (2015). Case Report Papers. 50.