Rehab patients master varied terrain in mobility courtyards

June 1, 2013


As 88-year-old Vernon Ohrt recovers after surgery to place a pacemaker, he's working on improving his endurance, strength and balance in a mobility courtyard at St. Mary's Care Center in Winsted, Minn.

It's one of three outdoor therapy courtyards Benedictine Health System opened in

Minnesota in the fall, creating innovative rehabilitation space which therapists hope will reduce the fall risk for patients once they return home. The courtyards are used by a variety of patients undergoing therapy to regain or build skills for daily living, including outpatients and those in short-stay or long-term care.

At St. Mary's, therapy patients practice walking on different uneven surfaces, including flagstones and gravel, grass and mulch, sand and steps. Working with therapists, patients navigate up inclines, down ramps and around obstacles. Ohrt, who also had a hip operation in 2004 and uses a walker, says of the mobility courtyard, "It helps with strength and balance, so when I get out, I can handle it."

While the walled courtyards are landscaped and welcoming, the garden features are practical, not ornamental. A car body located under a sun shade in the St. Mary's courtyard allows patients to practice getting in and out of all four doors and loading and unloading items from the trunk, says occupational therapist Trisha Schauer, St. Mary's director of rehabilitation. Family caregivers may practice folding up and stowing a wheelchair in the trunk of the "transfer training" car. Elsewhere in the courtyard, therapy patients practice retrieving items from a mailbox, setting up a clothes line, spraying a garden hose or playing horseshoes.

Reality check
The hands-on practice with routine tasks of independent living gives recuperating patients a real sense of new challenges they may face. Schauer may say to a patient, "'It sounds like it will be easy to get in and out of a car, but let's go try it.' It can be an eye-opener for them."

Patients practice the same skills repeatedly with a therapist, with the goal that they'll improve as they do. "Some older adults are so afraid of falling that they give up doing what they enjoy. We have people who gain a lot of confidence when they're able to do these things," she says.

At least a handful of mobility courtyards have been around for decades. The outdoor mobility courtyard attached to the 346-bed, acute care Bon Secours' Maryview Medical Center in Portsmouth, Va., dates from 1999. It was designed for in-patient rehabilitation and has a variety of surfaces and grades, a small bridge to walk over, ramps and curb cuts.

"Usually a patient's goal is to get home," says John DaVanzo, Maryview's director of rehabilitation services. Mobility courtyards allow patients to practice ways they can be safe in their home environment, or how adaptive devices or new techniques and skills can be used to compensate in the case of permanent disability. When learning a skill, "it takes a lot of practice to get it into muscle memory," DaVanzo says.

Garry Woessner, regional director of rehabilitation in the Benedictine Health System, has seen a number of mobility courtyards in the South, where warm weather is a natural fit for therapy outside. However, at the Minnesota courtyards this past winter, staff found benefits to taking patients outdoors in wintery weather, too. Patients benefit from physical and occupational therapy exercises as they put on coats, hats and mittens before venturing outside. "Donning and doffing" of clothes, common skills that many people take for granted, are needed to maintain independence. "Our philosophy is to simulate real-life skills as much as possible. We call it 'reality rehab,'" he says.

Fall prevention
Benedictine plans to follow up with patients who have undergone therapy in the mobility courtyards to determine if it's an effective tool in keeping people from falling once they leave a rehabilitation facility. Benedictine facilities with the mobility courtyards have a goal of a 5 percent reduction in the numbers of patients discharged from those skilled nursing facilities who later have a fall resulting in an emergency room visit, hospital stay, readmission to a skilled nursing facility, or death.

The Minnesota Department of Human Services Performance-Based Incentive Payment Program has awarded $270,000 to Benedictine to support baseline data collection, the construction and landscaping of the three mobility courtyards, and for follow-up data gathering on discharged rehab patients. Under the program, the centers could lose 20 percent of the state award, or $54,000, if they fail to achieve measurable outcomes. The three centers will follow up with patients at 60 days, six months and a year after they leave one of the centers with a mobility courtyard. The other new mobility courtyards are at Benedictine Health Center at Innsbruck, a skilled nursing facility in New Brighton with long term and short-term care; and St. Gertrude's Health and Rehabilitation Center in Shakopee, which has a short-stay rehabilitation unit, skilled nursing and an assisted living facility.

Benedictine staff have started the regular follow-ups with 24 people who received therapy in the courtyards before returning to their homes. "None have fallen so far," Woessner notes.

Copyright © 2013 by the Catholic Health Association of the United States
For reprint permission, contact
Betty Crosby or call (314) 253-3477.

Copyright © 2013 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.