Could the Person You Support Benefit from Physical or Occupational Therapy? It’s Not a Far Stretch.

As HCQU staff, we are often times asked to come in and provide insight as to how best to support an individual and their team that may be struggling with medical, behavioral, emotional, and physical complications. These are called Intensive Technical Assists or ITAs. As we try to sleuth our way through medical and psychiatric records along with input from individuals, staff, families, and Supports Coordinators, many times we will suggest that the team request an evaluation by an Occupational or Physical therapist.  But what exactly are these disciplines responsible for and why do we suggest the evaluations? In addition to these therapies, what is the role of a Physiatrist?  In this blog, I’ll break down the ways that each can help to increase strength, mobility, and independence, thereby providing a better quality of life for the people that we support.

October is Physical Therapy Month. You may be more familiar with a Physical Therapist if you, or the person you support, ever sustained an injury or surgery that required rehabilitation. Physical Therapists work to provide treatment plans that include exercises and patient education as well as hands on assistance to improve quality of life. This can include helping to improve mobility, managing pain and chronic conditions or, as mentioned above, assisting with recovery from injury or surgery. The Physical Therapist (PT) also works with the Physical Therapy Assistant (PTA).  The PTA will help with carrying out the exercises that are individualized, assisting with patient education, as well as measuring results to see what progress has been achieved during rehabilitation. The PT and PTA also want to ensure that the individual receiving services is actively involved in developing the treatment plan and this usually includes working with a team of other health professionals to ensure a comprehensive recovery and treatment plan.

The responsibilities of a physical therapist include:

• Consulting with patients to learn about their physical condition and symptoms
• Diagnosing movement dysfunction and developing a treatment plan
• Teaching patients how to properly use therapeutic exercise techniques
• Providing stimulation or massage to promote healing
• Assisting patients with the use of equipment such as wheelchairs or walkers
• Maintaining patient records and keeping track of goals and progress
• Advising the patient and family about in-home treatment options and exercises

This link is a database for Physical Therapists called Find a PT http://aptaapps.apta.org/APTAPTDirectory/FindAPTDirectory.aspx

The following are tips from the American Physical Therapy Association on “How to Choose a Physical Therapist”.

How to Choose a Physical Therapist

1. Use the Find a PT database to locate a physical therapist near you.
You can narrow your search results by practice area or find a board-certified specialist in one of nine areas. All physical therapists listed in Find a PT are members of the American Physical Therapy Association.

2. Contact the physical therapist’s clinic to determine the services offered.
All physical therapists have extensive training and experience. Some PTs treat specific patient groups (pediatrics, geriatrics, sports, women’s health, etc.) or practice in specific settings (home health, outpatient, etc.).

3. Ask if the physical therapist’s clinic participates with your insurance company.
Receiving care from a participating physical therapist should minimize your financial responsibility. Some physical therapists accept cash payments.

4. Ask whether the physical therapist’s clinic will submit claims on your behalf to your insurance company.
Some policies require copayments for services, and the amount of the copayment may depend on whether the physical therapist is part of the insurer’s provider network. You also will have to meet your deductible, which is the portion of medical costs you will need to pay before the insurance benefit begins. The physical therapy clinic should be able to help you calculate an estimate of your financial responsibilities, but it is recommended you contact the insurance company directly prior to initiating treatment to verify out-of-pocket costs. See additional information regarding the deductible and other insurance terms.

5. If referred for treatment, verify that your “physical therapy” is being delivered by a licensed physical therapist.
“Physical therapy” is treatment provided by or under the supervision of a licensed physical therapist. Physical therapists use the designation PT (physical therapist) and/or DPT (doctor of physical therapy). Read an explanation of physical therapist education and credentials (PT, DPT, FAPTA, etc) in Adobe PDF.

Choose PT is a website  https://www.choosept.com/Default.aspx sponsored by the American Physical Therapy Association.  There are a number of resources available there, including podcasts, interactive tools to understand the benefits of PT, and several patient success stories. Sometimes a person may benefit from only a PT consult and treatment.  Other times they may benefit from both at PT and OT consult. Let’s take a look at what treatment an Occupational Therapist can provide.

The American Occupational Therapy Association INC (AOTA, Inc.) notes that ‘the Occupational Therapist works with the individual to develop a comprehensive understanding of his or her skills and abilities to perform daily activities in the home, at the workplace, at school, or in the community. Daily activities demand the integration and use of sensory, motor, cognitive, perceptual, emotional, and social skills and abilities. Occupational therapists (OT) evaluate and provide interventions for these skill areas.’

The OT will take a look at home, school, workplace, community, any place the person will be functioning, and the interaction of these environments as it relates to the individual’s ability to perform daily activities. They will evaluate the individual and the environment and provide adaptations to promote that person’s participation. The OT  can help educate the individual on developing new skills, modifying or adapting the activity, or modifying the environment to optimize the situation and best suit it for that person’s needs. Some of these needs may be based on effects due to aging processes, accidents, illness, injury, or disease that can change the ability to participate in daily activities.  But occupational therapy can help the individual maintain an active lifestyle and live well despite limitations. For some recovering from a joint replacement, or injury, they may need new ways to dress, bathe, and prepare meals. Pain from arthritis and other conditions can make it difficult to work safely, walk through a grocery store, or maintain favorite hobbies.  A few examples could be someone who has difficulty brushing teeth, buttoning clothes, or using eating utensils.  An OT evaluation can determine which adaptive equipment, such as a built up spoon or toothbrush, can assist with the difficulties in fine gross motor control. Or if someone has mobility issues, the OT evaluation may suggest modifications to the home environment such as handrails.

The Occupational Therapist also works alongside of the Occupational Therapist Assistant.  They look at the relationships among the person, the environment, and the ways to support health and well-being through everyday activities no matter your health condition, disability, or risk factors. The AOTA, INC. lists the roles of the Occupational Therapist to include:

• Providing customized treatment programs to improve one’s ability to perform daily activities
• Comprehensive home and job site evaluations with adaptation recommendations
• Performance skills assessments and treatment
• Adaptive equipment recommendations and usage training
• Guidance to family members and caregivers. 

Both the PT and OT can assist by providing services in many places, including outpatient clinics, hospitals, personal homes, schools, work settings, nursing homes, and group homes.  For more information on Occupational Therapy and what it entails, click on the link to the AOTA, Inc. site.  www.aota.org

Finally, let’s take a look at what a Physiatrist, also known as Physical Medicine and Rehabilitative Physician, does. You may have only recently heard of this field of medicine but this excerpt from AAPMR-American Association of Physical Medicine and Rehabilitation states “physical medicine and rehabilitation (PM&R) began in the 1930s to address musculoskeletal and neurological problems, but broadened its scope considerably after World War II. As thousands of veterans came back to the United States with serious disabilities, the task of helping to restore them to productive lives became a new direction for the field. The American Board of Medical Specialties granted PM&R its approval as a specialty of medicine in 1947.”

A Physiatrist must complete 4 years of medical school and additional training in physical medicine and rehabilitation for their residency.  They can diagnose and treat medical conditions associated with disabilities, including cognitive problems, orthopedic issues, mobility concerns, bowel and bladder issues, gait disorders, feeding and swallowing problems, communication difficulties, pain, and muscle stiffness or hypotonia (poor muscle tone).  They can prescribe medications for nerve and muscle problems, bowel and bladder issues, sleep pain, or behavioral issues, just to name a few.  They also specialize in spasticity management, such as in the case of someone with Cerebral Palsy. In addition to those services, they also have training to help prescribe splints, braces, and adaptive equipment, such as wheelchairs and walkers. They work together with a team of health professionals such as neurologists, orthopedists, neurosurgeons, physical therapists, occupational therapists, speech therapists, and primary care physicians.  The Physiatrist also looks at caregiving, mobility, daily living skills, like dressing, bathing, and eating, as well as lifespan issues. This way the individual has a comprehensive support team to improve their functional ability to participate in activities of daily living, as well as improving their quality of life.

Physiatrists can provide services in rehabilitation centers, hospitals, and in private offices.  There is a database available at this link to search for accredited Physiatrist in the area. https://members.aapmr.org/AAPMR/AAPMR_FINDER.aspx

Many of the people we support have complex medical concerns, including impaired mobility and/or fine/gross motor issues. As they age the need for more assistance can increase and the manner in which they need to be supported changes as well. It may mean that a PT/OT evaluation is appropriate to provide some insight into how to best manage those changes.  Utilizing valuable resources such as PT and OT may assist in maintaining an individual’s level of independence and promote the best quality of life as possible. Keep in mind that each therapy program will be individualized. It is important to encourage the person receiving therapy to take part in the care planning as much as possible, helping to ensure it is tailored specifically to their needs. For more information on any of the disciplines listed above you can visit the links for the websites provided within this blog. Remember if you don’t use it you lose it!