Open Access. Powered by Scholars. Published by Universities.®
- Keyword
-
- Case Reports (105)
- Muscles -- physiology (53)
- Electromyography (41)
- Postural Balance (39)
- Aged (24)
-
- Risk Factors (23)
- Risk Assessment (17)
- Accidental Falls -- prevention & control (16)
- Low Back Pain -- therapy (15)
- Biomechanics (14)
- Exercise (13)
- Exercise Therapy (13)
- Joint Instability (13)
- Physical Therapy Modalities (12)
- Conservative Treatment (11)
- Sacroiliac Joint (10)
- Anterior Cruciate Ligament -- surgery (9)
- Child (9)
- Exercise -- physiology (9)
- Low Back Pain (9)
- Shoes (9)
- Walking (9)
- Anterior Cruciate Ligament Injuries -- etiology (8)
- Exercise Therapy -- methods (8)
- Gait (8)
- Physical Therapy (8)
- Physical Therapy -- methods (8)
- Quality of Life (8)
- Range of Motion, Articular (8)
- Running (8)
- Publication Year
Articles 1 - 30 of 776
Full-Text Articles in Entire DC Network
Treatment Of Posterior Tibial Tendon Dysfunction: A Case Study, Baylee Ann Reiser
Treatment Of Posterior Tibial Tendon Dysfunction: A Case Study, Baylee Ann Reiser
Physical Therapy Scholarly Projects
Background and Purpose. Posterior tibial tendon dysfunction (PTTD) is a progressive and debilitating disease that can lead to bony involvement or deformity. Common symptoms of PTTD include medial ankle and foot pain and acquired flat foot deformity. The purpose of this case study is to examine physical therapy interventions in a patient with chronic PTTD.
Case Description. This case study describes the 15-week physical therapy management in an outpatient clinic for a 34-year-old female with unstaged PTTD presenting with pain, decreased range of motion, strength deficits and muscle imbalance, impaired balance, and impaired gait. The patient lived a …
Physical Therapy Management Of Lower Exteremity Weakness And Balance Dysfunction Due To Sarcopenia And Frailty: A Case Report, Carla J. Maurstad
Physical Therapy Management Of Lower Exteremity Weakness And Balance Dysfunction Due To Sarcopenia And Frailty: A Case Report, Carla J. Maurstad
Physical Therapy Scholarly Projects
Introduction: The aging population is on the rise and is expected to increase from 8.5% to 16.5% for those aged sixty-five years and older by 2050. With the expected rise comes the increased prevalence of frailty that leads to a decline in physiological function placing individuals at risk for sarcopenia, disability, falls, hospitalization, and death. The purpose of this case study is on lower extremity muscle weakness (sarcopenia) and frailty and the effectiveness of physical therapy to improve muscle strength, balance, proprioception, and functional mobility to decrease the risk of falls, improve performance with daily activities, and improve …
The Effects Of Physical Therapy For Acute Knee Pain With Meniscuc Involvement: A Case Report, Courtney R. Hornung
The Effects Of Physical Therapy For Acute Knee Pain With Meniscuc Involvement: A Case Report, Courtney R. Hornung
Physical Therapy Scholarly Projects
Introduction: Cartilage tears and osteoarthritis are upon the most common sources of knee pain. The peak incidence for degenerative meniscal tears in women are from ages 61-70. The meniscus acts as a cushion within the knee and if this becomes damaged or degenerates over time, osteoarthritis is likely to become a factor as well. The purpose of this study is to find whether or not physical therapy is an appropriate treatment option for a patient with knee pain with indications of osteoarthritis and a meniscal involvement.
Case Description: The patient is an 82 year old female who came …
Physical Therapy Clinical Instructor's Viewpoints On Entry-Level Performance Of Physical Therapy Students And New Graduates, Elhana Selimovie
Physical Therapy Clinical Instructor's Viewpoints On Entry-Level Performance Of Physical Therapy Students And New Graduates, Elhana Selimovie
Physical Therapy Scholarly Projects
Purpose: The purpose of this study was to gain perspective on how physical therapy clinical instructors (CI) define entry-level in relation to the field of physical therapy. The research question asked CIs was whether or not there was a difference in how CIs defined entry-level physical therapists. Entry level is defined as “a student who is capable of functioning without guidance or supervision while managing simple or complex conditions, with proficiency in skilled examinations, interventions, and clinical reasoning, and is able to maintain 100% of a full-time therapist’s caseload in a cost-effective manner.”
Methods: A survey was sent …
Conservative Outpatient Physical Therapy Management Of Patient With Atraumatic Anterior Sternoclavicular Joint Subluxation: A Case Report, Fallon N. Hill
Conservative Outpatient Physical Therapy Management Of Patient With Atraumatic Anterior Sternoclavicular Joint Subluxation: A Case Report, Fallon N. Hill
Physical Therapy Scholarly Projects
Introduction: Atraumatic Anterior Subluxations of the Sternoclavicular Joint (SCJ) are a rare upper extremity injury that may cause range of motion (ROM) and strength deficits to the shoulder joint due to pain and feelings of instability. There are a variety of approaches for management as with SCJ subluxations, but atraumatic anterior displacements respond mostly to conservative management or masterly neglect.
Case Description: The patient was a 63-year-old female with an atraumatic anterior subluxation of her right side. The patient did not qualify for surgical or physician intervention and was referred to physical therapy for conservative treatment and pain …
Case Report Of A 42-Year-Old Male Affected By Plantar Fasciitis, Jenna Baumgartner
Case Report Of A 42-Year-Old Male Affected By Plantar Fasciitis, Jenna Baumgartner
Physical Therapy Scholarly Projects
Background and Purpose: Plantar fasciitis is an irritation of the plantar fascia that causes increased pain and inflammation of the area. Plantar fasciitis affects nearly 1 in 10 people in their lifetime with a high likelihood of reoccurrence. There can be multiple causes but physical therapy (PT) can be crucial for the reduction of pain and return of function. Due to high likelihood of reoccurrence, it is the goal to give patients the tools that they need to self-treat when they experience another bout of plantar fasciitis.
Case Description: The patient was a 42-year-old male who had pain in …
Outpatient Physical Therapy Management Of A Patient Presenting With Double Crush Syndrome: A Case Study., Nicholas G. Hatfield
Outpatient Physical Therapy Management Of A Patient Presenting With Double Crush Syndrome: A Case Study., Nicholas G. Hatfield
Physical Therapy Scholarly Projects
Background and Purpose. This case study evaluates the effectiveness of physical therapy interventions in the treatment of a patient presenting with a potential Double Crush Syndrome.
Case Description. This patient was a 59-year-old male with reports of right shoulder pain and right upper extremity paresthesia, numbness, and tingling affecting his ability to perform daily tasks at work and at home.
Interventions. The physical therapy interventions given were all based on findings from the initial evaluation and included a mixture of manual therapy techniques such as shoulder mobilizations, therapeutic exercises/activities such as stretching, resistance training, and carries, and …
Outpatient Physical Therapy Treatment Of Patient With Spondylosis: A Case Study, Paige B. Kropuenske
Outpatient Physical Therapy Treatment Of Patient With Spondylosis: A Case Study, Paige B. Kropuenske
Physical Therapy Scholarly Projects
Background and Purpose: In the United States low back pain (LBP) is one of the leading causes for individuals to reach out to health care professionals. LBP is often associated with a diagnosis of spondylosis. Spondylosis is present in about 80% of peoples in the United States. The prevalence of spondylosis continues to increase without a definite cure or form of treatment. Overall, exercise and intervention have proven to decrease symptoms of pain of those with spondylosis. However, success of treatment may see large variables in success. Further research into specific treatment interventions may be warranted to decrease chronic …
The Effects Of Blood Flow Restriction On Electromyography Activity Of Proximal And Distal Upper Extremity Musculature, Nicole Mazour
The Effects Of Blood Flow Restriction On Electromyography Activity Of Proximal And Distal Upper Extremity Musculature, Nicole Mazour
Physical Therapy Scholarly Projects
Purpose/Hypothesis: Blood flow restriction therapy (BFR) has become a popular means of strength training and intervention used by physical therapists, athletic trainers and body builders. BFR allows for high intensity resistance training at a low intensity training level. It has been shown that BFR increases muscular hypertrophy and strength due to the vascular occlusion that occurs during BFR application. When performing BFR a pressurized tourniquet cuff is applied to the proximal portion of the selected limb. Individuals complete exercise between 20-40% of their 1 repetition maximum (RM) while utilizing the BFR cuff for improvements in muscular strength. Most BFR …
The Correlation Between The Season Of Birth And Early Child Development In Healthy Children: Evidence From The Midwestern Region Of The United States: A Pilot Study, Elizabeth G. Bodensteiner
The Correlation Between The Season Of Birth And Early Child Development In Healthy Children: Evidence From The Midwestern Region Of The United States: A Pilot Study, Elizabeth G. Bodensteiner
Physical Therapy Scholarly Projects
Background and Purpose: Research has been conducted in countries like Japan and China assessing the impact of various factors on gross motor development. One variable that has been researched and discussed within studies in other countries is the relationship between gross motor development and birth season. This study aimed to address the impact of birth season on gross motor development, specifically within the Midwestern region of the United States. There is limited research regarding this topic within the Midwestern region of the United States.
Materials and Methods: Parents of 114 children completed self-reports on their children’s gross and …
Inpatient Physical Therapy Management Of Patient With Post-Operative Quadriparesis Following Posterior Cervical Lamenectomy And Fusion: A Case Report, Kayla A. Christopherson
Inpatient Physical Therapy Management Of Patient With Post-Operative Quadriparesis Following Posterior Cervical Lamenectomy And Fusion: A Case Report, Kayla A. Christopherson
Physical Therapy Scholarly Projects
Background and Purpose: Spinal hemangioblastoma are benign tumors that compress the surface of the spinal cord. Surgical resection of the hemangioblastoma with a posterior cervical laminectomy and fusion technique is one treatment option. This form of treatment can lead to poor outcomes such as post-operative quadriparesis although rare. The following case study depicts physical therapy interventions use to treat a patient with post-operative quadriparesis for posterior laminectomy and fusion of C6-T2.
Case Description: The patient was a 77-year-old female with complex past medical history and multiple comorbidities. She received inpatient physical therapy for 31 days before transferring to …
Outpatient Physical Therapy Management Of Patient With Torn Right Anterior Collateral Ligament Prior To Surgical Repair: A Case Study, Isaac Scott
Physical Therapy Scholarly Projects
Background and Purpose: Anterior cruciate ligament injuries are one of the most common in sports medicine. This structure provides stability to the knee joint. Depending on the level of ligament injury, this injury can be treated conservatively or surgically. The purpose of this case study is to explore a preoperative treatment plan for a patient looking to have a future ACL surgical repair.
Case Description: This case study describes the 13-week treatment plan for a 21-year-old patient that had plans for a future surgical repair. This was the second time this patient tore the ACL in that extremity …
Association Of Generalized Joint Hypermobility And Occurrence Of Musculoskeletal Injury In Physical Therapy And Occupational Therapy Students, Katie A. Harris
Association Of Generalized Joint Hypermobility And Occurrence Of Musculoskeletal Injury In Physical Therapy And Occupational Therapy Students, Katie A. Harris
Physical Therapy Scholarly Projects
Background: Previous studies have found a higher rate of hypermobility among physical and occupational therapy students compared to the rate of hypermobility within the general public. Hypermobility has been linked to increased injury rates. This raises the question of the influence hypermobility has on injury type and recurrence.
Purpose: The goal of this study was to examine the rate of hypermobility and injury history among physical and occupational therapy students. The injury type and frequency of those with hypermobility was compared to those without hypermobility to determine if there was a relationship. The Foot Posture Index was used …
Outpatient Physical Therapy Management Of A Patient With Right Hamstring Strain Injury: A Case Report, Tina M. Belgarde
Outpatient Physical Therapy Management Of A Patient With Right Hamstring Strain Injury: A Case Report, Tina M. Belgarde
Physical Therapy Scholarly Projects
Background and Purpose: Hamstring injuries are the most common muscle strains in competitive sports. Insufficient rehabilitation may be attributed to a high occurrence of recurrent hamstring injuries in athletes. This case study evaluates the effectiveness of physical therapy following a Grade 2 right hamstring injury and discusses the outcomes experienced by the patient.
Case Description: The patient was a 51-year-old Caucasian female athlete who received 6 outpatient physical therapy treatments. She presented with a Grade 2 right hamstring injury after hearing a pop while competing in a tennis tournament.
Interventions: The therapy provided emphasized the use of …
A Golf Fitness Program To Develop Clinical Skills In Student Physical Therapists: A Program Proposal, Development And Recommendations For Implementation., Derek Ferebee
Physical Therapy Scholarly Projects
PROBLEM: Golf is a fast-growing sport that is played by people all around the world of all ages and skill levels. The complexity of the golf swing and varying skill levels of participants leads to increased risk for injury. Acute and chronic musculoskeletal injuries can occur to the lumbar spine, shoulders, wrists, and elbows. The injuries are common among amateur, intermediate, and professional golfers. Studies show that the overall rate of injury in golfers is 15-20%. This is a surprisingly high amount of injuries for a low-impact sport. Physical therapists are an important healthcare provider for individuals with musculoskeletal injuries. …
A Case Report Of Guillain-Barre Syndrome, Jonathan Tyre
A Case Report Of Guillain-Barre Syndrome, Jonathan Tyre
Physical Therapy Scholarly Projects
Background and Purpose: Guillain-Barre Syndrome is a medical condition with no known cause. Incidence of this condition is 1 to 2 per 100 000 people in the United States. Guillain-Barre Syndrome is a condition in which a person’s immune system attacks the person’s nervous system and demyelinates nerves in a person’s body.
Case Description: The patient is a 64-year-old male who received physical therapy services following a diagnosis of Guillain-Barre Syndrome. The condition came on with insidious onset and the patient had no signs or symptoms prior to his diagnosis. The patient was evaluated and treated by my clinical …
Functional Movement Screen: Exploring Interrater Reliability Between Students, Austin Weisz
Functional Movement Screen: Exploring Interrater Reliability Between Students, Austin Weisz
Physical Therapy Scholarly Projects
Purpose: The purpose of this study was to assess the interrater reliability of the most recent Functional Movement Screen (FMS), between four second-year physical therapy students. The most recent FMS has added the ankle clearing test (pain and mobility categories) after the inline lunge and modified the rotary stability movement pattern and criteria for scoring. To our knowledge, there has not been a reliability study completed with the most recent additions and modifications of the FMS.
Methods: Forty-five physical therapy students participated and were videotaped completing the Functional Movement Screen (FMS) and were rated by four current second-year physical …
Rehabilitation Of A Patient Diagnosed With Dermatomyositis In A Skilled Nursing Facilty: A Case Report, Chance D. Halvorson
Rehabilitation Of A Patient Diagnosed With Dermatomyositis In A Skilled Nursing Facilty: A Case Report, Chance D. Halvorson
Physical Therapy Scholarly Projects
Background and Purpose: Dermatomyositis is a disease of unknown origin that results in skin rashes and muscle wasting that can lead to significant respiratory issues and loss of function. This case report describes the response following functional training in a bedridden patient who recently reported to a skilled nursing facility.
Case Description: The patient was a 78-year-old male who was previously diagnosed with dermatomyositis that rapidly progressed after being hospitalized for over 4 months. The patient had a complicated past medical history and a difficult socioeconomic background.
Intervention: The plan of care was focused around promoting independence …
The Effect Of Physical Therapy Intervention On Fatigue, Balance, Depression And Quality Of Life In Clients Following Medical Treatment For Cancer: A Pilot Study, Mckenna N. Johnson
The Effect Of Physical Therapy Intervention On Fatigue, Balance, Depression And Quality Of Life In Clients Following Medical Treatment For Cancer: A Pilot Study, Mckenna N. Johnson
Physical Therapy Scholarly Projects
People who are diagnosed with cancer and undergo radiation or chemotherapy treatment are at great risk for developing long-term side effects such as fatigue, balance deficits, depression, and decreased quality of life months and even years following treatment. With approximately 16.9 million people in the United States with a history of invasive cancer, and an expected steady increase in this number in the coming years, a better understanding of these side effects and how they can be treated would be instrumental for health care professionals. The purpose of this study was to test the effect of exercise intervention on fatigue, …
The Effects Of Palmar Cooling On Power, Strength, And Endurance: An Investigative Study, Madison Kramer
The Effects Of Palmar Cooling On Power, Strength, And Endurance: An Investigative Study, Madison Kramer
Physical Therapy Scholarly Projects
Purpose/Hypothesis: For many athletes and active individuals, the ability to improve endurance, strength, and power is a common goal. Millions of people around the world engage in sporting events and other physical activities every day. While each sport has differing physical requirements, each sport requires varying degrees of endurance, strength, and power. During sporting events or exercise routines, body temperature increases and eventually begins to have a negative impact on performance. Research on palmar cooling has shown endurance benefits. The palm is an area of the body with abundant anastomoses, or cross-connections of blood vessels. These areas transfer heat …
Outpatient Physical Therapy Management Of Symptoms Associated With A Brainstem Arteriovenous Malformation: A Case Report, Michell Hall
Outpatient Physical Therapy Management Of Symptoms Associated With A Brainstem Arteriovenous Malformation: A Case Report, Michell Hall
Physical Therapy Scholarly Projects
BACKGROUND AND PURPOSE: Arteriovenous malformations are irregular connections between arteries and veins, while they can occur anywhere in the body, they are the most common in the brain and the spinal cord. The purpose of this case study is to describe the interventions, treatments, and results of conservative physical therapy for a patient diagnosed with an arteriovenous malformation located in the brainstem.
CASE DESCRIPTION: Descriptive case study of a patient scheduled two times a week for a 6-week episode of care. Conservative physical therapy interventions and treatments included lower extremity strengthening, static and dynamic balance training, gait training …
The Progression, Treatment, And Rehabilitation Of Guillain Barré Syndrome: Case Report, Hannah M. Shaffer
The Progression, Treatment, And Rehabilitation Of Guillain Barré Syndrome: Case Report, Hannah M. Shaffer
Physical Therapy Scholarly Projects
Background and Purpose: Guillain Barré Syndrome (GBS) is an acute demyelinating disease of the peripheral nervous system. It is characterized by sudden progressive weakness and paraesthesias of the limbs. This case study evaluates the effectiveness of physical therapy (PT) and the use of body-weight support gait training (BWST) in the return to function in GBS patients.
Case Description: The patient was a 42-year-old female who presented to the acute care hospital with sudden onset paresthesias and weakness causing sudden loss of ambulation and functional mobility.
Interventions: Due to decreased activity tolerance, initial PT treatment consisted of passive …
Periacetabular Osteotomy With Tibial Derotation And Fai Repairs As A Treatment For Symptomatic Hip Dysplasia In An Athlete: A Case Study, Marlie M. Maanum
Periacetabular Osteotomy With Tibial Derotation And Fai Repairs As A Treatment For Symptomatic Hip Dysplasia In An Athlete: A Case Study, Marlie M. Maanum
Physical Therapy Scholarly Projects
Background and Purpose: This case study details a 16-year-old patient following periacetabular osteotomy surgery with labral repair and tibial derotation. In reading this case, you will learn about interventions performed and ideas to consider for any patient hoping to return to sports following orthopedic procedures.
Case Description: Throughout the rehabilitation there was a large focus on the patient returning to sports, specifically basketball. The physical therapy prescription focused on mobility and strengthening of the entire lower extremity due to this surgery’s aggressive nature at the ankle and hip joint. It is accepted throughout the orthopedic world that there …
Functional Rehabilitation And Strength Training-Focused Interventions For An Achilles Tendon Rupture And Repair: A Case Report, Anna Murphy
Physical Therapy Scholarly Projects
Background and Purpose. Current literature identifies a lack of consensus regarding specific rehabilitation protocols following acute Achilles tendon ruptures. This case report highlights the rehabilitation of a patient following an Achilles rupture and surgical repair, who underwent a physical therapy treatment program, focusing on interventions to increase function, strength, and return to activity.
Description. The patient is a 64-year-old male, evaluated in the clinic four weeks following a status-post left Achilles tendon repair surgery, and presented with left ankle pain, decreased left ankle range of motion and decreased left ankle strength. The treatments and interventions used for this …
Left Medullary Stroke And The Effects Of Physical Therapy In The Acute Rehabilitation Setting: A Case Study, Alissa Dahle-Koch
Left Medullary Stroke And The Effects Of Physical Therapy In The Acute Rehabilitation Setting: A Case Study, Alissa Dahle-Koch
Physical Therapy Scholarly Projects
Background and Purpose. Approximately 800,000 strokes occur each year in the United States, either resulting in death or mild to moderate functional deficits. This case study examines the effectiveness of physical therapy treatment of a patient following a left medullary stroke in the acute rehabilitation setting.
Case Description. The patient was a 72-year-old male with a complex medical history who presented to the acute rehabilitation unit with right-sided weakness, diminished postural control, impaired muscle tone, and paresthesia. His admission was complicated by the onset of delirium during the second week of treatment.
Intervention. Physical therapy treatment provided …
Thoracic Outlet Syndrome Decompression And The Effect Of Physical Therapy In The Outpatient Setting: A Case Study, Kaiann Arellano
Thoracic Outlet Syndrome Decompression And The Effect Of Physical Therapy In The Outpatient Setting: A Case Study, Kaiann Arellano
Physical Therapy Scholarly Projects
Background and Purpose: Thoracic outlet syndrome (TOS) includes the signs and symptoms in the upper extremity caused by a compression of the brachial plexus, subclavian vein and/or subclavian artery at the thoracic outlet. The thoracic outlet symptoms may present as pain, weakness, numbness, tingling, and early fatigue or heaviness of the arm. Severe and unrelenting symptoms may lead to individuals considering surgical treatment. The purpose of this case report is to present an evidence based strengthening and stretching program for the post-operative care of TOS.
Case Description: This article describes the 10 - week outpatient physical therapy treatment …
Outpatient Physical Therapy Management Of A Patient Following Rotator Cuff Repair, Brianna Erickson
Outpatient Physical Therapy Management Of A Patient Following Rotator Cuff Repair, Brianna Erickson
Physical Therapy Scholarly Projects
This case report describes a 12-week physical therapy treatment of a patient that arrived to physical therapy following a rotator cuff repair of the right shoulder. The patient was a 43-year-old male who had a torn rotator cuff of the right shoulder following a farming accident.
Purpose: The purpose of this report is to describe the presentation, intervention, and outcomes of the 12-week treatment.
Description: Treatment for this patient included soft tissue mobilizations, joint mobilizations, stretching, and strengthening.
Outcomes. Following treatment, the patient gained strength and range of motion, but he was unable to reach full range …
Acute Care Physical Therapy Rehabilitation Of An 85-Year-Old Male With Three Lower Extremity Amputations: A Case Study, Ashley Bergerson
Acute Care Physical Therapy Rehabilitation Of An 85-Year-Old Male With Three Lower Extremity Amputations: A Case Study, Ashley Bergerson
Physical Therapy Scholarly Projects
Background and Purpose. This case report describes the acute care management of an 85-year-old male with three consecutive lower extremity amputations and one associated revascularization procedure at attempt of limb salvage. The purpose of this report is to describe the effects of chronic conditions on various body systems and how they relate to physical therapy rehabilitation post-amputation since limited research is present in this area of physical therapy practice.
Case Description. The patient had a very extensive and complicated medical history which included type Il diabetes mellites, chronic kidney disease and peripheral artery disease. His primary goal was …
Conservative Treatment And Management Of A Patient With Thoracic Spine Pain And Radiating Symptoms: A Case Report, Brian Illing
Conservative Treatment And Management Of A Patient With Thoracic Spine Pain And Radiating Symptoms: A Case Report, Brian Illing
Physical Therapy Scholarly Projects
Background and Purpose: Back pain can occur for several reasons. With the increasing prevalence of smart-device use today coupled with sedentary lifestyles, there is an increasing incidence of back pain related to postural deficits associated with device use and extended periods of sitting or inactivity. The purpose of this case study is to investigate the effects of posture and ergonomics and their role in back pain for an office worker.
Case Description: This case study follows the treatment of a 45-year old male over his 4-week episode of care. The chief complaint of the patient was an acute …
Hospital Acquired Deconditioning In A 78-Yeaar Old Individual: A Case Study, Brooke Rehm
Hospital Acquired Deconditioning In A 78-Yeaar Old Individual: A Case Study, Brooke Rehm
Physical Therapy Scholarly Projects
Background and Purpose: Physical therapy management of older adults following hospitalization is common. Patients tend to show impairments such as generalized weakness, decreased endurance, impaired mobility and gait, and an increase in dependence on others to complete activities of daily living. The purpose of this case study is to examine the physical therapy implications of treating patients with hospital acquired disability. This paper outlines the management of a patient who was newly admitted to skilled nursing facility, following a proximal humeral fracture.
Description: Following her stay at the hospital, the patient was discharged to the skilled nursing facility for …