She is 86-years-old and is the widow of a meat-cutter with no formal education beyond a high school diploma.
The physician responsible for her care at discharge from the hospital (after a 2 day stay with edema in her legs) had ordered home care that included skilled nursing, physical therapy and occupational therapy.
During her physical therapy evaluation she demonstrated an ability to maneuver throughout her home slowly, but without difficulty and she was “tested” to have good strength. I asked her how she maintains her strength:
You see, every day I stand at this window with my hands on the sill and I watch people out my window. Sometimes they are walking on the sidewalk, sometimes they are going to church, and sometimes they are going into that funeral home. While I watch them I do 30 of these [standing hip flexion], and 30 of these [standing hip abduction], and 30 of these [standing hip extension], and 30 of these [mini-squats], and 30 of these [heel/toe raises], and 30 of these [Shoulder pendulums], and 30 of these [shoulder elevation in the plane of scaption].
And where had she learned these activities?
Geez, it’s just common sense, ain’t it? I figured I have to move like this [standing hip flexion] to step up on a curb, that my leg moves like this [standing hip extension] when I walk and I figured if those were gonna be good, than this direction [standing hip abduction] would probably be a good idea too. I figured that I do this [mini-squats] when I get out of the chair, and this one [heel/toe raises] just feels good; it makes me feel taller. I thought the arms should move too, so I just move them to keep them moving and to keep them strong. Why?
I did not have the heart to tell her that what she accepts as common sense is mistaken for care by most of my colleagues. I was happy, however, to inform her that she did not need physical therapy.