For the purpose of this narrative the patient discussed will be referred to as KB.

KB is a 62 year old Caucasian female who underwent a single lung transplant on

4/4/16. Due to some complications post-transplant, she remained at MGH for a
extended period of time before going to Spaulding Rehab where she remained for a few
weeks before this current readmission. KB reported subjective heartburn, increased
cough and congestion, fatigue, and dyspnea on exertion for three days which lead to
her readmission to MGH. Her post-transplant oxygen requirement baseline was 3L at
rest and 5L during activity. She was highly knowledgeable about her care and remained
motivated throughout her admission. Prior to the transplant KB was completely
independent with ADLs, IADLs, and mobility.
When I saw KB for the first time, she required a rolling walker, a wheelchair
follow for breaks, and 6L of oxygen (because there is no 5L setting on most portable
tanks) during ambulation. KB seemed to be very well aware of her body and the signs/
symptoms it was giving her. She was able to identify shortness of breath and
generalized fatigue as the reasons for her endpoints. Francie explained to me that the
early fatigue KB experienced was primarily due to the steroids she was taking. The
steroids had also caused proximal and extensor muscle weakness. This weakness
caused KB to almost immediately begin her walk once standing up from the chair and
immediately sitting down once she needed a rest break during ambulation; she was
unable to stand still for prolonged periods of time and experienced a lot of difficulty with
repeated sit to stand transfers.
KB looked forward to working with physical therapy each day, asking her nurses
frequently when we would be stopping in to work with her. She also had a supportive
family and she wanted to be able to get home to them and return to her normal
everyday life. No matter how tired she was or if she was not feeling well, she would
always say that she would give it her best shot. The first day that I worked with her, KB
was able to ambulate roughly 12 meters before taking a seated rest break and then
continuing for another shorter distance before being wheeled back in the wheelchair to
her room. Even though she wasnt ambulating as far as she had been able to at rehab,
the look on her face proved that she was happy to have gotten up and moving. As the
sessions continued, so did her progress. It was slow and steady, but it was evident that
she was making progress. After each session, KB would ask us to measure out how far
she went before taking a rest break and how far she was able to go after the break.
She also liked to know how fast she had walked, comparing it to prior sessions. KB was
able to go a little bit further before requiring a seated break and rested for shorter
periods of time each day.
At one point during her stay, she reached a plateau. Francie explained how
varying her exercise program was necessary for KB to continue improving. We began
to use the restorator, therabands, and seated therapy exercises to create program
variation. Each of these were especially good on the days that KB was so physically
tired that she felt like she could not walk, but wanted to be active. At this point, I saw
the importance of education. Francie was able to educate KB so that she had the
knowledge and ability to properly perform her exercises throughout her entire day, not

just limited to the time allotted during the physical therapy session. This allowed for
greater progress to be achieved.
During our last session together, she was able to ambulate 54.6 meters with one
seated rest break about halfway through. A couple of goals that KB was working
towards were: self-pacing and self-feedback for a diaphragmatic breathing pattern. It
was recommended that she continued working towards these goals as well as focusing
on strength training and her respiratory reserve. I predict that KB will continue working
hard upon her return to rehab. I see her being able to ambulate much further distances
prior to requiring a rest break, especially if she masters the concept of self-pacing and
feedback. If she continues to use the therabands to resistance train, I foresee her
muscles becoming stronger and in turn that she will be able to take standing rest breaks
and experience less early fatigue caused by the steroids.
Working with KB gave me a new perspective on inpatient physical therapy. I was
able to witness first-hand, someone taking full advantage of a new opportunity at life
presented to her via a single lung transplant. While working in an inpatient setting, a lot
of the time we see patients who are lacking motivation and in turn they do not give forth
the effort physical therapists would like to see. When we have a patient that is
unmotivated or is refusing physical therapy, I have found that it is important to educate
the patient on the risks of not exercising along with the benefits of participating in the
treatment. I have seen that it is better to keep a positive attitude and find ways to relate
to the patient. Sometimes it makes it easier if you take their mind off the fact that they
are exercising by talking to them about something that interests them. If we are able to
break down the walls between the patient and whatever they have against physical
therapy, then the sessions tend to be more successful. KB is evidence of the important
role that self-motivation plays in the recovery process.