out patient therapy

[givincare]

I am curious about the out patient therapy everyone received. I understand that patients will stop receiving the treatments if the therapists/physiatrist feel the patient is no longer benefiting from them. (or if they can't get paid )

 

I would like to get an idea (time wise) from the members here, how long post-stroke did you receive therapy? Did you feel it was ended at the appropriate time? If you're still going, how has the frequency and duration of the therapies changed over time?

 

Just wondering about Patrick receiving therapy over the long haul, and what I can anticipate. He currently has PT 5 days a week, ST 4 days, and OT 3-4 days a week. Not to mention acupuncture 2 days a week. I am thrilled he gets this much, more would be even better. But I know this won't last forever...

 

Thanks for sharing!

Kristen

[arogers]

Hi Kristin,

 

I can only speak from our experience. The duration of my husband's therapy was related to the insurance company's guidelines. When he was evaluated short and long-term goals were developed by the therapists. His therapy stopped when the therapists indicated he had reached the "long-term" goals they had put in place. He is by no means rehabilitated - however, due to his inability to "perform" as the therapists would like, he is no longer involved in outpatient therapy.

 

His short-term memory was greatly affected, so he is unable to perform the exercises without much prompting. He still forgets which foot to use going up steps and down steps - BUT - this week-end he asked me before going up steps which foot he should use. That was a huge milestone.

 

He was not successful at OT because of the pain he was experiencing. Finally, he received BOTOX injections last week and I'm hoping he will be able to resume once he gets some relief. In the meantime, we will work gently at home so that we might be able to regain more use of his arm.

 

His speech therapy ended because of his memory issues as well. The therapist felt that since we can communicate that was all that she really expected.....Since I communicate with him on adult terms, she decided everything is fine. He still has alot of problems coming up with the words he wants to use, but we do OK because I can usually use a process of elimination. I have discovered that he says, "I don't care" because he can't come up with the words he wants to communicate. Many times if I give him choices he identifies what he wants.

 

Anyway, my husband's last stroke was 3/21/05 and his therapy ended 7/23/05.

The OT did tell me they found it frustrating that they could not do what they wanted because of his memory limitations and the spasticity in his arm, althgouh I was the one who pushed to have that addressed AFTER therapy ended and with no suggestion from the therapists that spasticity may be the problem. We MUST advocate for ourselves and the survivors for whom we care.

[pprovost]

Outpatient was a blessing because I was very homesick and as soon as I no longer need 24 hour care. I was ready to go home. I went to our local hospital for the rehab sessions. I would go twice a week for PT,OT and neuropsychology. after about 10 months I graduated to phase 3 ( returning to the real world of independance) They refered me to a rehab centre for OT and psychological councelling for post-stroke depression and also had me join an art therapy group. I got a little bit of PT at my insistance because I needed a home program to use at home .

I think everyone feels they can use more therapy than they get but I have come to understand that I gave it my best shot from day 1 and I have no regrets. My quality of life is quite good and things get easier all the time.

 

Good luck

Pat

[2ndChance]

I too went to outpatient 5 days a week, 6 hours a day for 4 months. I was then burned out - I took 6 months off and went back for 4 months, then took another few months off and then returned again - that is how you play the insurance game.

 

Rene

[fking]

Kristen,

Here is my experience in what you asked. I'm 18 months out now, just restarted PT therapy again for 14 visits in July. So I go twice a week for 7 weeks. Its the same one I used after discharge from hospital.

I reached what they call a plateau a year ago. I went for about 3 months

I learned to climb stairs at that time and to walk.

 

My PCP felt I needed more therapy so she got the 14 visits approved thru my insurance. I imagine after this time, later on if she feels I need more she would request again. I don't know if the insurance will approve at that time or not.

 

Since this is my second time since rehab in hospital stay; I don't know how long they will keep approving rehab. Since you are using up to 5 days a week its hard to say or tell how long your insurance will pay time wise. Hope this helps from my case with rehab so far. Good luck and you are right it won't last forever I'm sure.

 

My frequency(twice a week) and duration(14 visits) are considerable less than my first time around. How long or how many visits next time is unknown for now.

[marlen]

KRISTEN,

 

FIRST RULE. GET A THERAPIST WHO KNOWS SOMETHING ABOUT STROKES.

SECOND RULE. MAKE SURE THE THERAPIST SPENDS THE ENTIRE TIME GUIDING HIM THROUGH THERAPY AND NOT FILLING OUT FORMS.

 

I HAD OUTPATIENT THERAPY TWICE A WEEK FOR SIX WEEKS BEFORE MY INSURANCE RAN OUT. THE PLACE WAS AN AXILLARY SERVICE CONNECTED TO THE HOSPITAL, SO I THOUGHT IT WOULD BE OK. FOOLISH ME. THE RECEPTIONIST WAS MISERABLE (CONTINUAL PMS), THE GAL WHO RAN THE SHOW HAD ONE HELL OF A LIBIDO AND WE ALL HEARD ABOUT IT, AND THE PT AND OT WERE SO IMMERSED IN THEIR PAPERWORK, I WOULD GO IN AND DO THE EXERCISES BY MYSELF.

 

AFTER MY INSURANCE RAN OUT, I JOINED THE YMCA. YOU CAN READ ABOUT MY WATER THERAPY EXPERIENCE IN THE AUGUST NEWSLETTER. (HOW'S THAT FOR A PLUG?) I CONTINUE TO DO A LOT OF EXERCISING ON MY OWN.

 

GOOD LUCK.

 

MARTY

[Guest PERRYS]

My Pt & Ot got cut out first, they concluded that I wasn't improving enough to continue. I'm still in out-patient speech therapy. My insurance will pay as long as I show some improvement, my stroke was in 2000 so my speech therapy has gone on since I have been able. My others lasted about a year to a year and a half, my OT was cut off first.

[tom71]

Kristen,

I went to ot & pt for about 6 months 3 times a week an hour per day for each one,then my insurance changed, due to my wife switching jobs, so I talked with my doctor and got a new prescription for more therapy, so I was able to go back for 14 more visits!

Good luck and God Bless,

Tom

[Phyllis4732]

Because I'm old (in years not in spirit) - 73, I am on Medicare. It is they who decided just how much therapy I would get. The first week I spent 5 days in ICU, and then was put in a regular hospital room for 2 days, mainly because I was having a test taken. During those 2 days I had about 1/4 hour being dragged around the hall just outside the room with a walker and at least 2 therapists. This was horrible. After the 2 days as soon as the 24 hour test was over I was sent to an acute rehab. Therapy (OP, PT, SP and a little RT was from 9-3:30 7 days a week. Two weeks was all Medicare allowed. I still was unable to walk with a walker.

 

Then I went to a step down which is a nursing home with therapy facilities for 4 weeks and it was here that I learned to walk using a rollator. It was also there that I could ask to be taught to do certain things such as clean up after my dog when we walked, do the 14 steps that I had to be able to do up and down so that I could sleep in a room on the second floor, get up after sitting on the floor after "working" on flower beds etc. At one point they started to give me tests required by medicare to evaluate my condition. Some were timed tests, one was standing next to a walk and reaching out as far as I could. The length was measured.

 

After the 4 weels I went to out patient therapy twice a week- 1 hr. PT and 1 hr. OT. Since I was using the rollator, on my own, I would push it a little ahead and walk the 2 or 3 steps up to it and push it again. The halls that I had to walk to get to the gym and when I'd visit my ex-roomate were grat for this. In the house I would hold onto counters and start walkling with out the rollator and only use it when I took the dog for her walk or when I left the house. PT was about 4 weeks and OT a few weeks more. They simulated the work I used to do since I said I wanted to go back to work.

 

In all, I stroked May 23 and was determined to walk unaided at the yearly rehab reunion in September. At the end of September, I started to drive and in November, I went back to work, on a part-time basis.

 

My rehab was geared to what I had to do to be able to do what I wanted. It is your insurance that makes the decision how much and for how long. I suppose if you want to stretch it out, you could fake your ability............Also as others have said, if you need to do something that you can't, you can go back for a length of time determined. I have not tried to walk up a ladder yet - but don't think I would want to anymore.

 

Sorry for the length of this.

[janiem]

My therapy followed a list of goals the therapists felt I should be able to reach, ending with my return to work full days. As long as I continued to make progress, the insurance covered it.

 

I had a heavy program with ST, OT & PT in the hospital; each was 6 days a week (about 5 hours each day) for 3 weeks. I completed speech while I was at the hospital, but continued with my occupational and physical therapies as an outpatient - 3 days a week (about 2 hours each day) for 3.5 months at our local hospital. I had to take a neuropsychological test in order to be released to return to work. Then I worked half days and continued my physical therapy for another 6 weeks.

 

When I was working full days, I had therapy after work, in order to set up a program I could continue on my own. As much as everyone complains about costs of insurance these days, I was happy to have good coverage and wonderful therapists, who tried to cram as much as possible into every day.

Janie

[givincare]

I am finding everyones replies fascinating.Extremely varied, aren't they? I thought the amount of therapy Patrick is scheduled to be good, but I now wish he could spend more time per day there. I have tried to no avail. PT and OT are 45 minute sessions and they are unable to bill the insurance company for, lets say, 2 PT sessions in one day (in an effort to increase the duration of each session). We are maxing out what the availability of OT and ST are and some staff are even coming in for 1/2 days just to give Patrick more therapy. My isnurance will cover 80% as long as needed, I just wish we could make the sessions longer! I had no idea some places you could recieve 4 or 5 hours out patient therapy a day.

Kristen

[janiem]

I don't know what kind of program Patrick is receiving right now, and it's of course possible that this wouldn't work for him, but perhaps there are some parts that you could work with him on? When I reached the point where I was doing strengthening exercises, and needed less direct assistance, they taught me the exercises that I could do at home (some of them required that I had someone with me to be sure I didn't fall, but I was to do the exercise without help otherwise), and we used the class time for the things I needed therapist supervision with.

Janie

[Guest lwisman]

Kristen,

 

As you stated above individual experience varies. Unfortunately the decision of how much therapy is most often in the hands of the insurance company (at least in the US). Find out what yours allows and work with therapists and doctors to get the most possible.

 

It is also true that survivors do reach a plateau. That is usually the point at which outpatient therapy is discontinued. I have never heard of anyone who who did not experience improvement after this plateau. The body may at times take a rest from healing but it usually picks up where it left off at a future date. As time goes by recovery takes longer. But, I have never actually heard from a survivor who said it completely stopped. But, there are usually deficits the survivor is not able to overcome.

 

Marty makes a good point above. When Patrick gets to the point of no longer receiving out patient therapy, look around for other options. Marty uses a water aerobics class. These are usually available and not costly. Look for classes designed for arthritis. Jean Riva's husband attends speech classes at a local college. He is five years out from his stroke. At the very least Patrick should continue with exercises given by therapists.

 

Stroke recovery is a years long process. Outpatient therapy is extremely important, but therapy should not end there.

 

Good luck!