Treatment Plan

RUNNING HEAD: TREATMENT PLAN

RTH 352:PHASE 1
BETHANY WASHBURN

1
Case Study
Abstract:
This case study is being completed on a 74 year old male veteran in
long term care in the W.G. (Bill) Hefner VA Medical Center in Salisbury,
NC. To protect the veterans identity we will call him Mr. Veteran. This
case study will explore many aspects of the veterans health care at
this facility. Also this case study will include a focused emphasis on the
veterans recreational therapy participation.
Demographic Information/Social History:
Mr. Veteran is a 74 year old white male. Mr. Veteran served in the
Unites States Air Force during the Korean Era as a jet engine mechanic.
Mr. Veteran is married and has one son. Mr. Veterans was born and
raised in West Virginia but currently resides in Charlotte, NC with his
wife and son. He completed up through the 11 th grade and worked as
a shipping and receiving clerk after serving 2 years in the Air Force. He
affiliates himself as a Baptist Christian. He is very spiritual and often
enjoys listening to gospel music. Mr. Veteran at one time enjoyed
fishing and hunting.

He currently enjoys bingo, baseball, country

western music, listening to the radio, and reading books by the Rev
Billy Graham. He once played the guitar.
Admission Information:
Admitting Diagnosis:

2
Mr. Veteran was admitted to this facility following a fall which fractured
his right hip. He was acutely seen at Wake Forest Baptist Medical
Center post fall and received right hip hemiarthroplasty before being
discharge to this facility for rehabilitation.
Other Current Diagnoses:
Mr. Veteran has many other diagnoses he is receiving treatment for at
this time. They include : Hyperlipidemia, COPD, Urinary Incontinence,
Vascular

Dementia,

Hypothyroidism,

Peripheral

Nerve

Disease,

Osteoporosis, Cardiomyopathy, Schizophrenia (paranoid type), Edema,

Gastroesophageal

Reflux

Disorder,

Vitamin

Deficiency,

and

Hypertension. Mr. Veteran also experiences muscle weakness.

Medications:
Mr. Veteran currently is prescribed 17 medications.

They are listed

below along with what each medicine is currently prescribed to treat or

prevent.

ACETAMINOPHEN- for pain and fever

ARIPIPRAZOLE- For mood
ASPIRIN- for cardiovascular prevention
BUPROPION- for mood
CALCIUM 500MG/VITAMIN D- for osteoporosis prevention
CARBOXYMETHYLCELLULOSE- for dry eyes
DONEPEZIL- treatment unlisted
GABAPENTIN- for foot pain
LEVOTHYROXINE- for thyroid dysfunction
LITHIUM CARBONATE- for mood
METOPROLOL- for elevated blood pressure
NITROGLYCERIN- daily for prevention of chest pain
NITROGLYCERIN- for emergency use for chest pain
OMEPRAZOLE- for acid reflux

SIMVASTATIN- for diabetes

clonAZEPAM- for mood
oxyBUTYNIN- treatment unlisted

Assessment Information:
Recreation Therapy Assessment:
Completed by: DeMarcus Steele LRT/CTRS
Strengths: Veteran can state his own wishes. Veteran has a strong
family support system. Veteran has a strong religious belief system.
Goals:
A:

I enjoy watching TV.

I like attending religious services that are being offered.
I enjoy working on various crafts.
I would like listen to music from time to time.

To demonstrate continued interest for participation in leisure

B:

activity pursuits/recreation therapy programs during the desired

time frame.
Objectives:
Veteran will take part in a variety of activities which include but not
limited to self-directed leisure pursuits (i.e. Reading, writing, drawing),
recreation therapy programs (i.e. Community outings, special events),
and Spiritual programs weekly during review period.

To provide an opportunity to experience fun and enjoyment

To provide an opportunity to participate in a passive leisure

activity
To provide an opportunity to socialize with peers

SOCIAL INTERACTION:
Pleasant, Interacts with peers, Talkative, Interacts w/ staff, Participates
in groups , Eye Contact
LEISURE SUMMARY:
Limited Resources, Participation condition, Limited socialization
LEISURE INTERESTS AND PREFERENCE:
Individual, Group/Team, Crafts, Music, Passive, Religious, Indoor, Social
PLAN/INTERVENTION:

CTRS will offer various leisure activities such as but not limited to
groups, games, social events, movies, fishing, gardening (when
offered, outdoor outings, table top activities/crafts, Tai' Chi ( when
offered) and community outings. CTRS will provide one on one visits
with patient for discussion of his leisure. CTRS will monitor patient
independent leisure activity and needs. CTRS will remind patient to
look at the monthly calendar of recreation therapy programs posted on
the unit so he can keep informed of programs taking place of possible
interest to him to include spiritual programs offered.

5
OTHER

ASSESSMENT

INFORMATION

AND

EXTENDED

CARE/GERIATRICS MASTER TREATMENT PLAN

Date of Admission: NOV 21,2011 16:19
Care Plan Meeting held: 12/7/11
Treating Specialty: Long Stay Psych
[X] Service Connected
PSYCHOSIS, SCHIZ PARA - 100% Service Connected
DIAGNOSES:
Axis I:

Dementia, Vascular
Paranoid Schizophrenia with mood disorder mania

Axis II:

None

Axis III:

Congestive Heart Failure, Cardiomyopathy with EF 30-35%

Hypothyroidism
Osteoporosis, s/p compression fractures of L1,4 and 5
Chronic Obstructive Pulmonary Disease
Dyslipidemia
Peripheral Vascular Disease
Urinary Incontinence
Presbycusis
Falls
Bilateral Inguinal hernia repairs 2009
Gastroesophageal Reflux Disease

AXIS IV:

problems related to the social environment, declining health

6
Axis V

GAF=55

Cognitive Abilities:
DECISION

MAKING

decision making

CAPACITY:

Mr.

Veteran

demonstrates

capacity in regard to his health care.

limited

He would

benefit from support in complex circumstances.

WANDER/ELOPEMENT RISK: He is not a wander or elopement risk.
Orientation: Mr. Veteran is orientated to person, place, time, and event
Physical Abilities:
Veteran is non-ambulatory and requires the use of a wheel chair.
Veteran is identified with a high fall risk with a Morse score of 60.
Veteran does not currently show signs or admit to being currently in
pain.
CRITERIA FOR TERMINATION OF TREATMENT
[x] Medical Stability
[x] Completion of Arrangements for Post-Discharge Care
[x] Psychiatric/Behavioral Manageability
[x] Achievement of Optimal Functional Level
PATIENT STRENGTHS: [x]
[x]

Alert [x]

Oriented [x]

Able to Communicate Needs [x]

Verbally Expressive

Supportive Family/Friends [x]

Cooperative [x] Motivated

Hip Fracture

7
1. Definition
This case study is on a 74 year old man named Mr. Veteran. He
is currently in long term care at the W.G Hefner VA Medical Center in
Salisbury, NC. He was admitted to the Medical Center following a fall
where he fractured his right hip. A fracture is a break in the bone (U.S.
National Library of Medicine, 2014a). There are different types of
fractures, for example a compound or open fracture is one in which
the skin is punctured (U.S. National Library of Medicine, 2014a).
Several events can lead to a bone fracture such as car accidents, falls
or sports accidents. More than 95 percent of hip fractures are caused
by falling, usually on the side of their hip (Centers for Disease Control
[CDC], 2014). In Mr. Veterans case he has weakening of the bones
which has to do with his low bone density and osteoporosis (U.S.
National Library of Medicine, 2014a). Symptoms that are associated
with a fracture are an out of place limb or joint, swelling, bruising,
bleeding, severe pain, numbness, tingling as well as limited to no
mobility in a limb (U.S. National Library of Medicine, 2014a).
Mr. Veteran was then seen at Wake Forest Baptist Medical
Center where he received a right hip hemiarthroplasty. The hip joint is
made up of two major parts. During a surgery both parts could be
replaced or just one depending on the injury (U.S. National Library of
Medicine, 2014b). You have the hip socket and the upper end of the
thighbone known as the femoral head. Depending on what part of your
hip was broken will determine how they go about repairing the hip

8
(U.S. National Library of Medicine, 2014b). A few examples of parts
that they can use to repair a hip are a socket that is usually made of a
strong metal, a liner that goes inside the socket. Plastic has
traditionally been used but some experimentation is going on with
using ceramic and other materials that allow for smoother hip
movement (National Institutes of Health, September 8). One of two
anesthesias is used during a hip replacement to ensure the patient
feels no pain. The first type of anesthesia that the doctors could use for
surgery is a general anesthesia. A general anesthesia will put you to
sleep during the surgery. The doctors can also use a regional
anesthesia which is a spinal or epidural anesthesia (U.S. National
Library of Medicine, 2014). This anesthesia is inserted into your back to
numb you below the waist. Along with this type of anesthesia you
would also receive medicine to make you sleepy even medicine to
make you forget the surgery. With the regional surgery even though
you may not remember the surgery you will not be fully asleep through
the surgery. The typical stay in the hospital after a hip replacement is
two to three days. Hip replacements usually last 15 to 20 years
(National Institutes of Health, September 8). Most complications occur
after a hip fracture, about 1/5 die within a year following their hip
fracture (CDC, 2014). Some patients have trouble living independently
following surgery. About 1/3 of those who live independently before a
hip fracture will stay at least a year in a nursing home following a hip

9
fracture (CDC, 2014). After Mr. Veterans surgery he was then
discharged to the Medical Center for rehabilitation.
2. Demographic Information
According to the International Journal of General Medicine, hip
fractures are One of the most serious health care problems affecting
older people (Marks, 2010, p. 1). It has been noted the number one
cause in premature death among older adults (Marks, 2010). Hip
fractures have also been linked to a severe reduction in quality of life
(Marks, 2010). The chance of getting a hip fracture increases with age
for men and women (CDC, 2014). Adults who are 85 years of age and
up are ten to fifteen times more likely to get a hip fracture than sixty to
sixty five year olds (CDC, 2014). White women are more likely to have
a hip fracture than African American or Asian women (CDC, 2014).

3. Strengths of your Client

Mr. Veteran has many strengths that will assist in a healthy
recovery following his right hip hemiarthroplasty. The most influential
strength he has is strong family support. He is married with one son
and they live together in Charlotte, North Carolina. Family support is
crucial because it lowers the chances of being admitted to a nursing
home, continuous injuries, and even death following surgery. Mr.
Veteran is also non-ambulatory and requires the use of a wheelchair
which could make some situations difficult during his recovery if he did
not have the support of his family. Mr. Veteran also has strong religious

10
beliefs. He is a Baptist Christian and tries to attend any church function
he can. This just like the family is another great support system to
have.
Outside of his great support systems he has many more
strengths that will assist him in his recovery. Mr. Veteran is alert and
person, place, time and event oriented. He is verbally expressive, can
state his own wishes and interacts with peers and staff. He has the
ability to communicate all his needs and is a pleasant person. He
participates in activities making good eye contact and tends to be
talkative as well as cooperative. Another vital strength he has is
motivation. When it comes to rehabilitation internal motivation is
imperative to a successful and long lasting recovery.
4. Needs of your Client
o Schizophrenia is a secondary diagnosis that Mr. Veteran also has.
Postural support is a major concern with patients who have
schizophrenia. This postural instability puts these individuals at a
greater risk for falls, which may lead to fractures or even death.
Even the medicine that these patients take can decrease their
postural support. This is not a typical barrier of those with hip
fractures, but fractures are typical of patients with schizophrenia
due to the lack of their postural support (Ikai, et al., 2013).
o Mr. Veteran is non-ambulatory and requires the use of a wheelchair
at all times. There can be several complications with this but one of
the most concerning is pressure ulcers. According to the National
Pressure Ulcer Advisory Panel, a pressure ulcer is a localized injury

11
to the skin and/or underlying tissue usually over a bony prominence
as a result of pressure, or pressure in combination with shear and/or
friction. Edema is a factor that can make someone more prone to
develop pressure ulcers. Edema is when a tissue has reduced
circulation and has poor nutrition. Mr. Veteran has Edema, putting
him at risk for these pressure ulcers. This is typical for hip fracture
patients because post-surgery may be using a wheel chair to assist
in mobility but putting them at risk for pressure ulcers (Agrawal &
Chauhan, 2012).
o Osteoporosis, which is a secondary diagnosis for Mr. Veteran, is a
barrier that many older adults face and the chances of developing
osteoporosis only increases the older you get. From ages 70 to 79,
nine percent of males have osteoporosis while 35 percent of women
have it. This increases dramatically when you go up to the 80+ age
group. Men are at 19 percent while women rise to 51 percent with
osteoporosis. Osteoporosis goes hand in hand with hip fractures. In
58 countries the total number of new hip fractures was 2.32 million.
Preventive strategies focused towards osteoporosis could have
prevented up to 50% of all hip fractures. This is obviously a very
common occurrence and is something that should not be taken
lightly for older adults in order to prevent injuries (Oden, McCloskey,
Johansson & Kanis, 2013).
o Morse fall scales are used to identify risk factors for patients who
are at risk for falling. Mr. Veteran has a 60 on the Morse scale which

12
is extremely high. This is common among patients who have fallen
before or who have had a previous hip fracture injury (Agency for
Healthcare Research and Quality [AHRQ], n.d.).
5. Environmental Barriers
o Assuming the wheelchair that Mr. Veteran is using is a hand
pushed wheel chair you have to worry about sidewalk availability
as well as having enough resting places. Mr. Veteran is from the
Charlotte area so if he plans on ambulating through the town he
will need sidewalks in good condition. With it being a hand
pushed wheel chair he will also need good resting spots such as
bus stops or benches (Portegijs et al., 2013).
o Accessibility to community opportunities for those with hip
fractures or any ambulatory difficulties. Studies have shown that
hip fracture patients can complete task such as walking down the
sidewalk or up the street but they do not have the confidence to
complete these task successfully. With access to programs like
these the community can build these individuals confidence and
be aware that there are people who may have difficulty
ambulating from place to place. This would provide a safer
environment for everyone (Dennett, Taylor & Mulrain, 2012).
o Wheel chair accessibility is probably the number

one

environmental barrier that hip fracture patients face. Despite the

fact that there are laws and regulations being enforced there are
still no studies showing 100% wheelchair accessible places. In
order for these people to be full members of the community there

13
needs to be an extreme change in the way we look at accessibility.
This is something that prevents those who use a wheelchair from
going to eat where they want, shop where they want, the list goes
on and on. In order to improve their quality of life this barrier
needs to be addressed (Welage & Liu, 2011).
6. Cultural Information
o 74 year old
o White
o Male
o Baptist Christian
o Military
o City Resident
Mr. Veteran is around the baby boomer age which researchers
expect the rate of hip fractures to increase as this generation of
people get older. There is a lot more focus going into the research of
older adults and hip fractures because most the time it leads to
disability or even death. The main goal in treating older adults is to
make sure they return to the level of functioning that they were at
before the fall. For an older adult this could vary so you need to talk
to them and be aware of the activities that they were involved with
before. For example Mr. Veteran participated in activities such as
watching tv, religious services, crafting and listening to music. The
level of functioning he needs to get to will not be as difficult as a 32
year old who ran cross country and hiked their entire life (Heaton,
2013).

14
Mr. Veteran is a Baptist Christian, which means his spirituality or
religion is very important to him. This is something that people take
very seriously and could be included in treatment. During hard
times, such as recovering from a hip fracture people cling to what
they know, for Mr. Veteran and many other adults this is religion or
spirituality. The idea of spiritual coping is an idea that people use it
to rebuild meaning in life when an event threatens that meaning.
When people are using spiritual methods of healing they tend to
turn within and depending on what spirituality they connect with
they may meditate, pray or any other spiritual ritual they may do.
This could create some internal motivation that the patient may
need to push through therapy. It could be very beneficial to be
aware of these cultural characteristics in a patient (Gockel, 2009).

15
Efficacy Research
Ikai, S., Uchida, H., Suzuki, T., Tsunoda, K., Mimura, M., & Fujii, Y. (2013).
Effects of yoga therapy on postural stability in patients with
schizophrenia-spectrum

disorders:

A single-blind

randomized

controlled trial. Journal of Psychiatric Research, 47, 1744-1750.

doi:10.1016/j.jpsychires.2013.07.017

1. Summary
This study was conducted to effectively identify the outcomes of
yoga therapy on patients postural stability and flexibility of the body
of those with schizophrenia. Postural instability is an aspect of serious
concern in patients with schizophrenia spectrum disorders. Postural
instability is suggested to increase the risk of falls in these patients
and potentially leading to fractures or more fatal outcomes. The
postural instability could be due to the psychotropic medications or
possibly the disease itself. Therefore it is important to focus attention
on improving and maintaining postural stability in these patients to
prevent unnecessary injuries.
The reason there was a particular interest on postural stability
and flexibility in those with schizophrenia is because to the best of the
researchers knowledge, there have not been previous explorations of
physical outcomes of yoga when used in a therapeutic setting for
schizophrenic patients. There have been other controlled trials for the

16
efficacy of yoga therapy that confirmed yoga therapy in combination
with their regular pharmacological intervention has the potential to
reduce the positive and negative symptoms of schizophrenia along
with improving the quality of life in these patients. Now yoga is being
seen as a good complimentary treatment with psychiatric disorders.
Yoga has been practiced for several millennia. Yoga consists of
several components that help produce a better quality of life. These
components are ethical lifestyle, spiritual practice, physical exercise
and the practice of meditation. Yoga uses a plethora of movements
and poses to focus on the pivot of the body. You practice this while
also focusing on breath control, meditation and lifestyle. Yoga has
always been seen as a practice that improves the balance of your
body. Clinical trials have validated the effectiveness of yoga improving
the gait, balance and flexibility of the body in older adults. The
researchers believe that yoga has the potential to improve postural
stability and flexibility of the body of schizophrenia patients.
2. Subjects and Methods
The subjects in this study were all outpatients who had been
diagnosed with schizophrenia or a related psychotic disorder. There
were 49 participants and all were eighteen years of age or older. All
subjects have been receiving the same medications eight weeks prior
to the study. All subjects were registered in the day-care center that
the chosen hospital for this study provided. Only few subjects were
turned away from this study to ensure the representation was a

17
sample in the real-world clinical setting (P.2). Those excluded were
patients with current substance or alcohol abuse or dependence and
those who could not provide consent to be included in the study.
This study was an eight-week single-blind random control trial.
There was also a follow up of another eight weeks. These studies took
place at the Department of Neuropsychiatry, Yamanashi Prefectural
Kita Hospital. This hospital is in Yamanashi, Japan. This study was
conducted from June to October in 2012. The institutional review
board of the Yamanashi Prefectural Kita Hospital approved the study.
All subjects were provided detailed information about the protocol and
then provided researchers written consent.
Participants were randomly assigned to one of two different
groups. They were put in the yoga therapy group or in the regular daycare group. The randomization was done by doctors at the Yamanashi
Prefectural Kita Hospital who were not a part of the study. They used a
computer system to randomize the groups after the baseline
assessment. Once put into the groups they started participating in the
groups.
If put into the yoga group you went into a weekly, one-hour yoga
class from 9:30 to 10:00 am on Mondays in the gymnasium of the
hospital. Each patient received eight sessions. The administrator of
the yoga group was an investigator and obtained a masters degree in
yoga. Each yoga session was the same and included gentle yoga
stretches and simple movements in coordination with breathing. They
did warm-ups at the beginning which included gentle movements of

18
the major muscle groups through joint rotations and self massage.
They preformed asana which is twisting poses, standing poses and
sun salutation. They also participated in deep relaxation and breathing
exercises. Following the eight week intervention they only received
regular day-care programs. Another assessment was performed at
week sixteen involving yoga therapy.
The control group was the group who did not receive yoga
therapy. In return they participated in a weekly regular day-care
program. Activities performed in this group included social skills
training and psycho-education. After the eight-week observation the
participants were offered the chance to attend yoga sessions outside
of the trial if they wanted too. All participants continued to take their
regular medications as prescribed throughout the trial.
Postural sway was the primary outcome measured. The Clinical
Stabilometric Platform was used to measure this at the baseline
testing and at week eight. They performed the test with eyes open
and eyes closed. A smaller range would indicate better stability.
3. Findings and Implications
Two patients out of the yoga group and three out of the control
group withdrew before the study was completed. The CSP test found
significant reduction, about 20%, in the postural sway in the yoga
therapy group at the eight-week check. At the sixteen-week check up
the improvements were not sustained. Changes in quality of life and
body flexibility were also observed with the overall favorability
towards the yoga therapy. The potential clinical effectiveness of yoga

19
therapy was shown in this study enhancing postural stability. This
suggests that yoga therapy could reduce the risk of falls and fractures
in patients with schizophrenia-spectrum disorders. Because the results
did not last until week sixteen it suggests that there should be a
longer duration of therapy or reminder sessions to maintain the
clinical benefits.
4. Applications for this Case
Mr. Veteran is a 74-year-old male who has schizophrenia and
fractured his right hip and received a right hip hemiarthroplasty.
Patients with schizophrenia, such as Mr. Veteran, present more
postural instability than those without schizophrenia. The psychotropic
medications prescribed for schizophrenia can also cause a lack of
postural stability, which Mr. Veteran takes these medications. Previous
studies mentioned within the data findings show that risk of falling is
increased tremendously for those with poor postural support due to
schizophrenia and the psychotropic medications used to treat it. There
is an increased risk and concern for older adults due to their
sensitivity to medications because of their age. It is extremely
important that these patients receive continuous treatment to
maintain and improve postural support.
Taking note of all the risk factors Mr. Veteran possess such as
Schizophrenia, being an older adult, osteoporosis, being on so many
medications as well as having a previous hip fracture suggests that it
is critically important that he take immediate action to gain and

20
maintain the best postural stability as possible. I believe that yoga
would be the best option for him. According to the IDEA Fitness
Journal, about 20% of the 16 million Americans who practice yoga are
over age 55 (Krucoff & Carson 2011). 80% of these older adults have
at least on chronic condition while 50% of those with one chronic
condition have two chronic conditions (Krucoff & Carson, 2011). This
shows you that older adults are already greatly involved in yoga and
there are trained professionals who can provide the right modifications
for these older adults to fully participate in yoga without obtaining an
unnecessary injury.
I think that Mr. Veteran should participate in a yoga therapy
group consistently. As the study shows eight weeks was not long
enough to maintain long lasting effects so continued treatment should
be provided. Mr. Veteran is good with interacting among his peers,
participating in groups and seems to be pleasant. He also enjoys
passive and indoor activities so yoga would be something that I
believe he would enjoy. I think that participating in a group yoga
therapy class would benefit him the most.

21

Treatment Plan
Strengths:
-Alert and oriented
-Cooperative
-Motivated
Needs:
-Increase trunk stability
-Prevent falls
-Interest in wider variety of activities
Goal List
-Increase trunk stability through balance and strength training using
yoga.
- Prevent falls by learning yoga positions that increase trunk stability.
- Develop an interest in yoga through socialization in yoga group.

The facility where Mr. Veteran will be receiving treatment is W.G.

(Bill) Hefner VA Medical Center in Salisbury, North Carolina. It is a long-

22
term care facility that Mr. Veteran will probably stay in for the rest of his
life. The services provided are home based, outpatient and acute
treatment. Their goal is to improve functioning and enhance
independence (US Department of Veteran Affairs).

The intervention that will be used for Mr. Veteran is group yoga. Mr.
Veteran will meet Monday and Thursday mornings in the recreation room
from 9:30 to 10:30 AM for sixteen weeks. Each yoga session will be lead
by a trained professional and consist of the same routine. The routine will
contain gentle yoga stretches and simple movements in coordination
with breathing. At the beginning of each session there will be a warm-up
where Mr. Veteran will warm up the major muscle groups through joint
rotations and self massage. Next they will preform asana. Asana involves
twisting poses, standing poses and sun salutation. There will be deep
relaxation and breathing exercises throughout each yoga session.

Behavioral Objective #1
- During a yoga class with CTRS for one hour twice a week for
sixteen weeks, Pt. will practice yoga with moderate physical and verbal
prompting from CTRS for the entire session with no more than ten
minutes of break time, to increase trunk stability. (Skill
practice/Acquisition)

23
Behavioral Objective #2
-Patient successfully performs two yoga poses of his choice that
increase trunk stability once a week outside of class with recreational
therapist.

Progress Notes
Subjective- I enjoy yoga even though at times I get frustrated because I
am still learning and I get tired after about 45 minutes, I have never done
yoga before I like the people in my yoga class Mr. Veteran is engaged
with his peers and participates throughout the whole class. Mr. Veteran
asks for help when he needs it.

Objective- Mr. Veteran attempts all yoga poses throughout the class. Mr.
Veteran interacts with all four of the other members in the yoga class. Mr.
Veteran takes two five-minute breaks during the duration of the class. He
had three verbal prompts per class. He attended all of the yoga sessions.

Analysis- Mr. Veteran is participating in class and exhibiting good social

skills. There has been improvement in the accuracy at which he
demonstrates his yoga poses indicating an increase in trunk stability. He
gets tired after about 45 minutes of yoga. I believe that this intervention
will continue to benefit Mr. Veteran.

24
Plan- Continue with the one-hour yoga classes twice a week for sixteen
weeks. Give Mr. Veteran three five minute breaks to increase social time
he has with peers as well as allowing him to rest to increase performance
in class.

Discharge Plan
1. Client Major Problems/goals.
Client had poor trunk stability due to the medicine taken for his
schizophrenia and he had surgery to correct a hip fracture. The goal
was to increase his trunk stability through yoga to decrease future
falls.
2. Services Patient received in RT
Patient received sixteen weeks of yoga. There were two, one-hour
sessions per week. He attended all of the yoga session.
3. Response to treatment
Mr. Veteran has had a slight increase in trunk stability but informs
us that he gets tired after about 45 minutes. He continues to
participate in each yoga session. Mr. Veteran asks questions when
he needs help and continues to stay engaged with peers.
4. Remaining Problems and Concerns
He gets tired after about 45 minutes of yoga decreasing his accuracy
and increasing the risk of him falling in class.
5. Plan for post discharge and referrals
Client agrees that he will continue practicing yoga at least once a
week. Mr. Veteran also believes that being referred to a personal
trainer to work on fitness to help maintain progress with trunk

25
stability is a good idea and intends to follow through with the
discharge plan. Since Mr. Veteran is not leaving this facility written
permission is not required to refer him to a personal trainer.

References
Agrawal, K., & Chauhan, N. (2012). Pressure ulcers: Back to the basics.
Indian Journal of Plastic Surgery, 45(2), 244-254.
Centers for Disease Control and Prevention. (September 18,2014). Hip
fractures among older adults. Home and Recreational Safety.
Retrieved

September

10,

2014

from

http://www.cdc.gov/HomeandRecreational
Safety/Falls/adulthipfx.html
Dennett, A. M., Taylor, N. F., & Mulrain, K. (2012). Community
ambulation after hip fracture: Completing tasks to enable access
to common community venues. Disability & Rehabilitation, 34(9),
707-714.

26
Gockel, A. (2009). Spirituality and the process of healing: A Narrative
Study. International Journal for The Psychology Of Religion, 19(4),
217-230. doi:10.1080/10508610903143248
Heaton, M. (2013). Hip Fractures in the older patient. Hughston Health
Alert, 25(3), 4-5.
Ikai, S., Uchida, H., Suzuki, T., Tsunoda, K., Mimura, M., & Fujii, Y.
(2013). Effects of yoga therapy on postural stability in patients
with schizophrenia-spectrum disorders: A single-blind randomized
controlled trial. Journal Of Psychiatric Research, 471744-1750.
doi:10.1016/j.jpsychires.2013.07.017
Krucoff, C., & Carson, K. (2011). Therapeutic Yoga for Seniors: Safely
adapting the practice to older bodies, minds and spirits. IDEA
Fitness Journal, 8(3), 78-80.
Marks, R., (2010). Hip Fracture Epidemiological trends, outcomes, and
Risk

Factors

1970-2009.

International

Journal

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