Rehabilitation Beyond The Therapy Sessions
[ photo by Kampus Production ]
Rehabilitation happens during the therapy session and at home.
The majority of my medical career has been spent on the clinical side of medicine working directly with patients. Recently, I have also spent time on the non-clinical side, reviewing patient charts and helping determine the appropriateness of continued outpatient physical, occupational, and/or speech therapy.
This side of medicine has brought to light what I have suspected for the majority of my time spent in rehabilitation medicine, and that is the importance of the home exercise program. The home exercise program is important from the side of getting better and on the side of getting more therapy when it is recommended by the therapist or physician.
Why the home exercise program is important.
Before I go on, let me explain the home exercise program. This should be short because it is exactly as it is named. This is the set of exercises a therapist provides to her patients to perform on the days the patient does not have a scheduled therapy session. The exercises usually take 15 to 30 minutes in total to complete. Sometimes, it is even less time than that. I have gone through several rounds of physical therapy personally after various injuries. I have never worked with a therapist who did not begin to provide me with a set of exercises to do on my own time. I would hesitate to go to a therapist who did not provide a list of exercises to be done on one’s own time.
The last statement of the above paragraph might seem a bit strongly worded, I know, but I believe it to be true. Part of an outpatient therapy session often involves direct treatments for the injury or weakness, such as massage, ultrasound, or cold therapy. Another portion of the session, however, is meant to train the patient how to continue to work the areas of weakness on his own time in order to facilitate the healing of the injury and help to prevent the injury from reoccurring.
The majority of outpatient therapy sessions are two times a week. Occasionally they are once, and rarely, they are three times per week. Each session is usually 30 to 60 minutes. Over the course of a week, this really is not a lot of time. Just as you would not expect your child to master a new concept in school just by hearing his teacher go over the lesson a couple of times and not studying any on his own, a person is not likely to make a good recovery from an illness or injury by just attending a couple of sessions of therapy each week without doing additional work on his own time.
Facilitate performance of home rehab exercises.
Many of you reading this are caring for an aging parent who is undergoing outpatient therapy. Can I encourage you to attend some of the therapy sessions to be able to learn directly from the therapist exactly what exercises are being recommended and how to do those exercises?
As many of you know personally, it can be hard to motivate yourself to do those prescribed exercises. Know that it is hard, also, for the aging parent you are caring for to do those exercises. I have found it to be beneficial for family members to assist their loved one with the home exercise program each day. It might start out as being physically present to encourage and assist the person through the exercise. As your aging parent gets more comfortable with the program, it can transition to a FaceTime or voice call to talk your loved one through it. It can then possibly even transition to just a phone call reminder to get the exercises completed. I understand this can be quite a time commitment, but I have found that my most successful patients are the ones who actually did their exercise programs on a regular basis.
Performing home exercise program allows one to continue with rehab.
Now, I want to briefly move on to the other aspect of why the home exercise program is important. When the chart of a patient requesting additional therapy services (physical, occupational, or speech therapy) is reviewed by a clinical reviewer, be it a therapist or a physician like myself, one of the things the reviewer is looking for is if the patient is compliant with his home exercise program.
The therapists do document this information into the note. In addition to compliance with a home exercise program, the reviewer is also looking to see if there is an improvement in the pain, improvement in the person’s function as well as looking at measurable improvements, such as strength and range of motion.
If a person continues to report pain and minimal functional and measurable improvements, that is going to give the reviewer pause as to whether additional therapy should be approved. If a reviewer wants to know why a patient is not getting better with therapy, the documents are further reviewed to see if the patient is compliant with his home exercise program. Additional therapy is not likely to be approved if it is documented that the patient does not do the home exercise program on a regular basis.
For those of you undergoing outpatient therapies, do the exercises as prescribed by your therapist in order to get better. For those of you providing care for an aging parent going through outpatient therapies, encourage her to do her exercises so that she can get better!
(Related blog posts: Taking Care Of Elderly Parents At Home)
Feeling overwhelmed with the process?
Afraid you may not make the right decision at the right time? This stage of life for you and your aging parent often brings more questions than answers. Reading information from a trusted source like me can help guide you in the process. However, if you still feel overwhelmed, don’t hesitate to reach out to me. I am happy to help with a personalized plan for your unique situation.
© 2022 Jessica Kluetz, DO