A story from Harbor Healthcare
“I wanted to talk with my friend out there."”
Patient statement shared by Noelle Leighty, PT, DPT, Harbor Healthcare
B.S. had tried to get herself out of bed to reach a co-resident in the hallway. That was one of eight falls documented over five months. Some happened at her bed. Some on the way to the bathroom. One from her wheelchair, while she reached down to fix her shoe.
Nothing in her chart explained the pattern. She fell in her room without her walker, and she fell in the hallway with the walker right beside her. Her walking had been better in March than it was in July. A decline like that at her age is easy to accept as permanent. Then she fell again in late July. She said she had slipped, and she told staff nothing hurt. If that was right, there was nothing to treat.
The next day her care team captured a walk on OneStep. The numbers came back worse than anything else in her record. Her right step measured 35 cm and her left measured 26 cm. That 9 cm gap was the widest asymmetry she had ever recorded. Her velocity and cadence bottomed out on the same walk. A difference that size appearing right after a fall is what a protected limb looks like. The nursing note had recorded no complaint of pain.
By her next assessment, her step length asymmetry had dropped from 14.3% to 2.4%. Her PT recertified her for continued skilled therapy. The target came from her own record: the 0.82 m/s she walked in March. Not a generic goal for her age. A number she had already proved she could reach. Her PT also raised something no gait metric could show: a suspected depth perception problem. After a conversation with nursing, she was added to the list for an eye exam. Her therapy continued, and her care team could see what her walking was telling them. Eight falls in five months, and none since the OneStep walk that flagged her asymmetry.
Her best walk was already in her record. Now it is the target.