Acute Rehabilitation of a 27-Year-Old Man With Failure to Thrive

Abstract

Background and Purpose: Failure to thrive is a complex medical diagnosis that does not describe a single disease process, but rather a variety of symptoms associated with one or more possible underlying diseases or conditions. It is a diagnosis that is not well-documented outside pediatric or geriatric populations. The purpose of this case report is to present the physical therapy examination and treatment of a 27-year-old Hispanic man with a diagnosis of failure to thrive, a history of superior mesenteric artery syndrome, chronic malnutrition, type 1 diabetes mellitus, and osteopenia. Case Description: A 27-year-old Hispanic man, BMI of 12, admitted to the hospital for acute hypothermia, urinary tract infection, generalized weakness, hypotension, and failure to thrive. The complexity of his medical condition required nearly 2 weeks to stabilize general health prior to initiating physical therapy services. Personal and environmental factors contributed to progressive decline in physical activity prior to this hospital admission and led to increased dependence and support. Outcomes: Blood pressure increased by 18 mm Hg systolic and 20 mm Hg diastolic and stabilized within normal range; 5 repetitions in the 30-second sit-to-stand; functional balance composite score of 35 seconds; 20% reduction in subjective Numeric Pain Rating Scale; supervised bed mobility; maximum assistance stand-pivot transfer; and family to support caregiver needs upon return home. The patient was discharged home with recommendation for continued services through home health care referral. Discussion: Evidence-based literature regarding failure to thrive in the young adult or middle-aged adult population is limited. Therefore, the physical therapy plan of care necessitates the application of interventions shown to be effective in addressing the physical structure and function limitation upon examination generally applied to the geriatric and/or pediatric population. Clinical decision-making focused on improving physical activity and participation are imperative across clinical settings. Manual therapy interventions applied in this case may prove beneficial in the acute care setting to maximize muscle activation within available range of motion elicited through patterns of functional movements emphasizing existing abilities.