Thursday, June 1, 2017

Make the Home Exercise Program AWESOME!!

Years after stroke survivors have been discharged form therapy, recovery can continue.

Of course, the speed of recovery diminishes over time. There is no time that is quite as fertile as the period of natural recovery in the first few months after stroke. 

But recovery can continue. Stroke survivors should be encouraged to see discharge from therapy not as the beginning of the end, but as the end of the beginning. The baton of the conductor of the grand symphony of recovery is passed from therapists to survivor. 

Most of the time therapists will leave stroke survivors with little guidance for further recovery. Some therapists think “HEP” stands for “Hand ‘em photocopies.” Too often the HEP reflects nothing more than a watered down version of the exercises that were done in the clinic. 

Irony: The survivor is left with the same exercises that caused the very plateau that caused the discharge! 
A good home exercise program will help the survivor to continue making progress if it is started the day the therapist meets the survivor. Therapy itself can be part of the HEP. If the survivor and caregivers can see what goes into the basic concepts that therapists use all the time, they will be able to direct their own recovery long after they’ve forgotten your name. 

The HEP should explain:
--progression of exercise, 
--measuring and documenting progress, 
--tips on equipment needed for a home gym. 

Therapists: Your job is done. You would have liked more time with them, but this is all manged care has allowed. At least, you’ve helped them to be functional, safe and return home. 

Survivors: Your job has just doubled. Not only do survivors have to continue the quest towards recovery through their own efforts, but they have to do it without therapist's guidance. Leaving stroke survivors with the tools they need to continue the quest is critical helping them to be in the best position to reach the highest level of potential recovery.

5 comments:

John Short ad sinorazum said...

I thought this would be an ad for the fitmi

Peter G Levine said...

Hey John, I did look at fitmi... not quite sure what the point is with it. The video they have up misses the mark by... a lot. Weird. Thanks.

John Short ad sinorazum said...

Whats wrong with the fitmi then? I thought it allows you to create exercise programs increasing in difficulty, thus breaking through that plateau you mention? I assumed youd be excited by it.

Geoff Wenker said...

I am sure this describes the typical experience, but after reading your book and checking Deans posts daily for info that might apply to me, I have learned how to continue getting professional therapy and my experience is slow steady improvement. You are totally right about doing it yourself, and you have to be the CEO of your own health, but it is difficult & complicated to keep progressing without some expert advice.

It has been 4 years since stroke caused by a bacterial infection called Whipple’s, which caused me to lose 40 pounds in 4 months & put me in the hospital for 56 days. In the sub-acute phase, I got a measly 8 days inpatient paid by insurance, then sent home in a wheel chair, and allowed a poultry 8 weeks of a combined 4 PT, OT, & speech sessions a week at home. 4 months after the stroke I could barely walk with a cane & AFO, needed an arm sling, and no hand movement. Then I was discharged to outpatient care limited to a maximum of 20 sessions. Then I found in the policy fine print, that more is allowed for neurological conditions. I am now on Medicare and find it also allows more if shown medically necessary. I now see my OT every 3 weeks and my PT monthly. That is 140 sessions so far.

I come to every session with written agenda listing my questions, concerns, progress I have noticed to maximize my benefit from the sessions. The therapist make measurements and document progress so insurance or Medicare continues to pay. They help me figure out what to work on next and how to exercise & stretch. Of course you have to do what they say and work at it as much as you can each day. I spend 2-4 hours a day exercising & stretching. Recovering from hemiparesis & spasticity is complicated and you need neuro therapist not the typical, who only deals with orthotic issues, because nothing is wrong with my muscles, joints & nerves. It is a brain problem!

Peter G Levine said...

Great advice in your comment Mr. Wenker... thanks!

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