When do you stop rx for an individual with CVA?

neuro

2 Posts
 
Posted - 02/22/2006 :  11:39:32  Show Profile  Reply with Quote
I have been seeing a 66 y/o male for the past 4 months who has had a R sided CVA. When I initially saw him he was ambulating with a walker and was utilizing an AFO. He did have PT in a nursing home for a month following discharge from the hospital. He had signicant weakness in his L LE and no AROM at his L ankle. He is now able to ambulate with a standard cane and is independent with all ADL's. He grades 3+ to 4-/5 throughout his L LE. He is a very motivated individual. The problem I am having is that he has plateaued and has been at this level for the past month now. In accordance to Medicare guidelines he should be discharged. I work for a hospital system so we are exempt from the Medicare cap. However, I am unsure how much he will improve if I were to see him for another month. I have enocuraged him to work out on his own and even obtain a gym membership but he wants PT. Just wondering if others have been in a similiar situation and how they handled it? Also if you continued to see your patient did he/she improve?

apt

7 Posts
 
Posted - 02/24/2006 :  09:44:30  Show Profile  Reply with Quote
I work for a hospital system as well in both inpatient and outpatient departments. There isn't too much problems in regards to this issue in the inpatient realm butI have been in situations similiar to yours as well with some of my patients that have suffered a stroke. I encourage the patients to work out on their own and I really search other areas that I think the patient can improve on and write new goals to address these areas. Thay way they can continue with therapy. Otherwise, if I am not successful with this we offer an aftercare program where patients pay a small fee out of their own pockets to come to therapy and work out in a group with one therapist supervising. This has worked pretty well as the patient can continue their rehab in a familiar setting and still be able to have their concerns and questions adressed by a PT.
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D.R.

USA
6 Posts
 
Posted - 10/20/2006 :  17:30:10  Show Profile  Reply with Quote
This is a fundamentally important physical therapy issue. It seems we must be able to describe in detail to patients, family, community, indeed our society, the distinction between activity that can be accomplished in many forums other than Physical Therapy, and how the true character of physical therapy is initiation of change that cannot be achieved in other venues for exercise and activity. This is our fundamental distinction, and if we do not make that clear, then others who do not understand this, continue to define and control the definition of physical therapy. Acceptance of plateau, and helping a person understand themselves as now, in this example, an indivdual who has had a stoke, which now includes some aspect of deficit; not accepting that is not only a physical therapy issue, but the persons own understanding of themselves issue.

I think it could be a sub-category of the now often stated important professional characteristic for our greater autonomy function, to know when to refer to another service if we see a symptom that we cannot or should not address....well so too on the higher functional level end of the scale, when we see someone can move to activity levels beyond our perspective, then they could be referred to other resources for exercise.
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