Abstract
A patient with gross hematuria with mild anemia was seen for physical therapy treatment for 23 sessions from 7/3/15 to 8/6/15 at a skilled nursing facility. Treatment was provided by a student physical therapist under the supervision of a licensed physical therapist. The patient was evaluated at the initial encounter with Manual Muscle Test, Borg fatigue scale, 10 Meter Walk Test, Berg Balance Scale, 6 Minute Walk Test, and Fatigue Severity Scale. A plan of care was established based on patient report and the findings from these tests. Main goals for the patient were to improve fatigue, strength, endurance, activity tolerance, and functional mobility and independence. Main interventions used were over-ground gait training, restorative training, task-specific training, and functional training. The patient made moderate improvements in fatigue, strength, endurance, functional mobility and independence, due to complications from contracting Clostridium difficile. The patient was self-discharged to home with a home exercise program and recommendation for use of a front wheeled walker and follow-up from home health physical therapy.