Rehabilitation: What is its role?


Rehabilitation: The Benefits

A person who has experienced a significant change in their physical abilities can benefit from rehabilitation. Many people know the importance of rehabilitation after a stroke, injury, or surgery. The medical community is now more aware of the immense value of ongoing rehabilitation for patients with chronic illnesses, especially MS. MS can have a variety of symptoms that can cause changes in movement and function.

Many of the challenges and issues that MS patients face are addressed through rehabilitation. Spasticity, weakness, and associated movement problems are some of the symptoms that can be treated. Also, balance, dizziness and coordination difficulties, as well as changes to speech, swallowing and cognition, may all be addressed. However, treating these symptoms is just the beginning. The different therapies available through rehabilitation can help you regain or compensate for any limitations in movement or other abilities. Rehabilitation also promotes safety precautions and prevention of pressure sores.

MS symptoms can impact one’s ability to work at home and at work. They can affect your ability to drive and participate in outdoor activities. They can also impact one’s self-image and how he or she interacts with others. Social, psychological, or emotional changes are often associated with physical symptoms.
Rehabilitation is a unique concept that takes into consideration the whole person’s situation. It also considers how physical changes might impact one’s emotions and well-being. A team of specialists works together to treat all aspects of a person’s disability. They aim to improve the quality of life for people with disabilities, as well as preserve independence and safety.

Rehabilitation Terms, Facilities and Insurance Coverage

Individuals are often referred for rehabilitation after experiencing an exacerbation of symptoms or a flare-up. This is to assist with regaining lost function. This is a chance to slowly get your muscles moving again, and to start an exercise program to help you return to your normal activities and lifestyle as quickly as possible. Any symptoms that do not resolve are dealt with immediately. Assistive devices and therapies may be recommended to assist the person. The participant can learn “compensatory strategies” to help him or her accomplish tasks differently, in order to replace any lost abilities.

Rehabilitation can also be very beneficial for people who do not have a flare up but are still experiencing symptoms. MS patients can benefit from physical therapy, occupational therapy and speech therapy. These therapies can help relieve symptoms and increase function.

Because it is intended to bring an individual to their highest functional potential, initial rehabilitation is called “restorative.” This type of rehabilitation is often covered by insurance. Specific goals are established. Once a person has achieved their full potential for improvement, “maintenance” rehab is offered. This is designed to prevent any loss of function. This type of therapy is vital for maintaining a person’s progress, but insurance companies may not be as willing to cover maintenance rehabilitation.

“Preventative” rehabilitation refers to maintaining function. Because specific goals are established, it is seen as a dynamic process that encourages insurance companies to approve funding.

A physician may prescribe inpatient rehabilitation. The individual will be admitted to an acute or subacute rehabilitation center. A subacute facility, in contrast to acute care is more conservative and cheaper. Subacute care, often associated with acute care facilities, is a good intermediate care option that makes it easier to transition from the hospital to home. Subacute care sessions are usually three hours long. Medicare typically covers two to three weeks’ worth of therapy. Other insurance might cover a stay for seven to ten days.

Outpatient rehabilitation has many advantages and is becoming more popular. Clients can enjoy the benefits of rehabilitation while staying at home for as little as a week. Although they provide the same equipment and staff as larger acute and subacute care facilities and may be closer to the patient’s residence, outpatient rehabilitation centers can also offer many of the same services. You may feel more at ease if they are smaller, more personal and less formal. These facilities are designed to help participants reinforce and improve skills they have learned in an inpatient setting.
Outpatients often attend sessions twice to three times per week.

Outpatient care is generally less costly than subacute and acute care. Insurance usually covers a limited number of visits per annum. There are many therapies available, and each one takes approximately one hour. Outpatient rehab facilities will schedule multiple therapy sessions at the same time on the same day so that clients don’t have to travel to different therapists.

Insurance companies consider each hour with a therapist to be a separate visit. This means that clients could be seeing three different therapists over three days. A representative from the center will work with the therapists and determine how many visits are covered before they begin therapy. Members of the healthcare team might request additional visits if the limit has been reached.

Clients can also be their own advocate and request additional coverage from their insurance company. People who are interested in continuing their therapy after all other options have ended should speak to their facility. Individuals who are not covered by insurance may be able to continue therapy at many outpatient centers that offer lower rates and payment plans.

Therapists sometimes offer home visits. If an individual is unable to travel or lives too far away from an outpatient rehabilitation facility, this may be an option. This can be convenient for clients and provide therapy that is needed. However, it does not allow them to have access to the entire facility’s staff and equipment. Also, they miss out on the social aspect that comes with going to a center. Therapists can also visit your home or work place to suggest strategies and assistive equipment that will make it safer, more comfortable, more productive, and more energy-efficient.

Linda A. Lucuski MPT, rehab center administrator, and physical therapist, says that there are several steps to follow before a patient receives their first evaluation at a comprehensive rehabilitation center. While most states don’t require a referral or prescription for therapy, many insurance companies won’t pay for it unless it is prescribed by a doctor. A prescription may be written by a primary care physician, neurologist or another licensed physician. Together, the physician and the therapist can decide the frequency and length of therapy sessions as well as the goals.

To ensure that the center is covered by the patient’s insurance, it is important to contact the representative of the chosen therapy facility. Dependent on the plan benefits and insurance company, co-pays,deductibles or co-insurances may need to be paid. A person must verify that the center offers MS therapy. Some rehab centers are geared towards sports injuries, but may not be suitable for someone with MS. A person, a family member or care partner can tour the facility to determine if there is a positive, motivating atmosphere and if they have experience with MS treatment.

Exercise and rehabilitation can help people with MS

After an exacerbation has subsided, rehabilitation is often recommended. This can help someone regain their function and gradually return them to their previous activity level. Rehabilitation may be recommended if the MS is stable. One or more therapies may be beneficial to someone with MS.

 Participants may be educated about MS, how to manage symptoms, exercise properly, dietary suggestions, and overall health. Moderate MS requires more aggressive therapy. This includes assistance with daily activities (ADL), ambulatory aids (such a cane or walker), exercises for mobility, balance and coordination, assistive devices (such a hand brace or leg brace), and speech or cognition exercises. Other adaptive equipment may be recommended for more advanced MS patients. In these cases, much of the attention should be paid to how long the wheelchair is used. It is important to tailor the wheelchair fit and avoid any complications like pressure sores.

Sometimes, rehabilitation can help with symptoms like weakness or spasticity. This can lead to an imbalance. This can lead to an individual overusing certain muscles, while others become weaker due to disuse. Even those with only a few symptoms might not be aware that their gait has changed. Problems with walking, such as pain or numbness, can also be caused by a change in sensation.

Vestibular rehabilitation can be used to treat balance and coordination issues, as well as dizziness. “Proprioception” refers to the ability to sense where a joint or limb is at any time. It allows someone to see with their eyes closed and determine where limbs, hands, feet, and fingers are. Therapy uses sensory input to help individuals become more aware of their feet and hands. There are many ways to reduce tremor, such as adding weights or using a splint. Individuals with visual impairments may be offered therapy at some facilities.

Rehabilitation can help someone who has difficulty doing daily household chores. Sometimes, this may include the use of a brace, or another assistive device. This is also true for grooming, dressing, and bathing. To avoid fatigue, rehabilitation facilities are designed to teach and assist individuals in learning new ways to do “activities of daily life” (ADL).

MS patients may be assisted by exercise and getting more fit. If a person does not exercise, they will “decondition” their condition. This is a syndrome that reduces muscle strength, vital capacity (volume exhaled air) and adrenocortical reserves (storage hormone needed for stress reactions). Deconditioning can also increase neuromuscular tension, resting pulse rates, fatigue, anxiety and depression.

Aerobic exercise has many benefits, including increased flexibility and lean muscle mass, as well as a decrease in body fat. Aerobic exercise improves heart function and blood circulation. Aerobic exercise can also reduce anxiety, depression, fatigue, and other symptoms. Aerobic exercise improves self-esteem and sleep quality. It also increases one’s ability focus and academic performance.

Participants should warm up before starting any exercise program and then cool down after they are done. Aim to exercise three to four times per week. Exercise can also be done by family members, which is good for everyone’s health.

Anybody who plans to start an exercise program or change his/her current level of activity should do so under the supervision of a qualified doctor. MS patients should be careful about starting and increasing their physical activity.

MS therapists must be aware of the limitations when working with MS patients. MS patients can quickly become tired or hot. Temperature and the time of day can have a significant impact on a person’s ability perform. Exercise machines and weights are designed to increase your ability to perform at your best.

Although many MS symptoms can be managed with rehabilitation, there is another advantage to participating in such programs. Many people with MS find that physical therapy and other forms of therapy at a rehabilitation facility can greatly lift their spirits.

Being active can improve your mental and physical health. It can also help you feel more confident. Individuals can also learn new methods to do ADLs such as bathing, housework, and other daily activities. This increases their self-worth and confidence.

The Rehabilitation Team Members

Rehabilitation employs a team approach in order to resolve the many problems that MS presents. One patient may receive therapy from several medical professionals. This is an “interdisciplinary team approach” – where all members of different specialties collaborate and discuss the patient’s treatment. It is different from a multidisciplinary team that includes multiple specialists.
You can treat the same person independently.

A person who is going to rehab for the first time meets with different therapists and other professionals. Specialists meet with clients individually to assess their needs and then perform various tests. This baseline assessment will give a measurement of function and can be used to set goals or track progress.

After an in-depth evaluation, the rehabilitation team meets with the client to determine the goals that can be achieved for them in various areas of functioning. The team develops a plan to achieve these goals and meets with the client, their family members and/or care partner to discuss it.
Some of the team members who work in a rehabilitation facility include:

Rehab nurse – This role is to act as a patient advocate and help the client and their family understand their choices, create problem-solving strategies, set goals, and make decisions. They may assist with assessment and coordination of therapies.

Physical therapist – The PT’s role is to help individuals reach their full potential in terms strength, mobility, function, and function. The PT focuses on posture, movement, and lower extremities. They also pay attention to safety and energy conservation. This specialist can also assist with the fitting and selection of wheelchairs.

Occupational therapist – This specialist focuses on the way someone is “occupied” and how they do ADL (activities in daily living). This specialist focuses mainly on the upper extremities, fine-motor control, as well as cognitive status. They also assist with energy conservation, fatigue management, safety, and safety.

Speech-language pathologist or speech therapist A speech specialist deals with speech, communication and swallowing disorders. Cognitive issues may also be treated by the SLP. Therapy may also include assistive technology and computers. This therapy can help people function at their full potential.

Recreational therapist – An RT uses recreation to improve one’s social, emotional and/or physical behavior.

Social worker This person examines a client’s entire living situation, including their family dynamics and home environment. Social workers may be able to help with financial arrangements and case management.

A physiatrist, who is trained to assess functional problems and manage symptoms, may also serve as a team leader; a psychologist to support, counsel and prepare clients and their families for active participation in rehabilitation; and a vocational rehab counselor to help the client set realistic goals and create strategies to assist them in the workplace or in other vocations.

Additional professionals may be required depending on the individual’s symptoms. They could include an orthotist or a respiratory therapist, urologist and chaplain.

(The information about team members was taken largely from the second edition Comprehensive Nursing Care in Multiple Sclerosis. For more information, please see the list of resources.

Different types of therapy, exercise, and equipment

Physical Therapy may be the first thing you think of when it comes to rehabilitation. This covers a wide range of abilities and functions, including exercises for people who use a wheelchair or have a slight gait problem. This area may be the largest in a rehabilitation facility. It is packed with exercise equipment that can increase strength, tone and flexibility. There are also special products and equipment that can help retrain someone to balance better and control their movements. The physical therapist (PT), as the name implies, is concerned with posture, movement and lower extremities. They also pay attention to safety and energy conservation.

Spasticity, a sign of MS, is common. Stretching exercises can help to reduce this condition. They should be done once daily. A printed copy of the client’s exercise program and daily homework is sent home to the participant. To correct abnormal postures, the therapist will use movement patterns. This may also help to prevent spasticity or spasms.

There are many tools that can be used to reduce dizziness, balance, coordination problems. The therapist should work with the client gradually, moving from a low to a high gravity center and then back down. For a support base, the same applies. It should be narrower than wide.

Giant physioballs, originally from Europe, can be used to help people develop balance. They sit on the ball and lean in different directions. To help improve balance, a tilt board can also be used. This is a flat piece made of wood that has a curved section underneath. It causes it to tip to one side when someone stands on top.
Sometimes, small orange cones are placed in a grid pattern. Participants must navigate around them. This simulates walking around a shop or a crowd. The therapist will hold a belt around the waist of the participant and may push or bump into them to help them regain their balance in crowded places.

Wooden steps are set at different heights to allow individuals to practice safely going up and down different stairs or curbs. For those who use public transport, a separate step simulates how high a step is to get onto a bus. The therapist will instruct the person how to use the assistive equipment, such as a crutch, cane or walker, if necessary.
Two “foot plates” connected to a laptop computer measure how evenly an individual’s weight is distributed. This can also be used with your hands to determine if someone favors one side or the other.

Low mats may be placed on wooden frames and are approximately the same height as a bed in some facilities. These can be used to exercise, practice getting in and going out of a bed or moving to and fro from a chair. This area may also contain treatment tables. Clients may be offered massage, light therapy, electric stimulation, or ultrasound.

Individuals who want to regain their strength and balance to walk can use parallel bars. You can also use them to lift yourself in and out of a chair.

 The physical therapy area offers a variety of equipment to increase strength and condition. You can find stationary bikes, treadmills, rowing machines and stair climbers. Many of these machines have therapy features. A treadmill might have longer bars at the sides and slower speeds. Bicycles have foot pedals and hand pedals. Individuals with weakness in their legs can attach a special boot to the bike. Therabands (r) elastic bands help improve shoulder range and strengthen weaker muscles.

Overuse of exercise equipment should not be done without the supervision of a PT. A lot of people who return to exercise want to go back to their previous levels of activity (before they develop MS symptoms). This can lead to overexertion and tired muscles. A PT will create a plan that allows participants to increase their activity without causing discomfort or harm.

 If any type of ambulatory aid such as a cane or crutches is required, the physical therapist ensures that the right device is chosen, fitted properly and used correctly. To avoid injury and maximize the effectiveness of assistive devices, anyone who needs them should see a PT. A PT can also make custom braces for the lower extremities. This includes an ankle-foot orthoses, which can be used to treat symptoms like foot drop, toe drag and poor knee control.

Individuals in wheelchairs can also be assisted by a PT. It is both an art as well as a science to select and fit a wheelchair. Many factors, including the person’s posture, strength, and symptoms, must be taken into consideration. To ensure maximum comfort and protection against pressure sores, there are many types of cushions, supports, pads, and wedges (all which can be filled with air foam or gel), and contoured seating systems.

Skin breakdown prevention is crucial. Patients are classified into three groups: low (can transfer without assistance and can shift weight easily), medium and high-risk (needs help to perform pressure relief exercise). The individual and the care partner are trained in different pressure relief techniques. These may include sitting up in a chair periodically, tilting the chair and leaning to one side.

Linda Lucuski, Physical Therapist, says, “A physical therapist evaluates an individual’s posture and range of motion in all extremities and the trunk; and as well as strength, proprioception and balance; and coordination and function. The therapist will assess the individual’s gait and ability to walk with or without assistive devices. A wheelchair evaluation will be done to ensure that it is comfortable, fit, and easy to use. After the evaluation, the therapist will discuss the individual’s goals and formulate a treatment plan.

“Follow up treatment sessions will be scheduled taking into consideration the individual’s best time of day and transportation needs. Sessions will include individualized exercises and activities that meet the goals. For people suffering from neck or back pain, loss in joint mobility, balance, coordination, and other issues, there are special treatment plans.

Occupational Therapy
An occupational therapist (OT), is concerned about how people use their time and their ability to perform their daily activities. The OT mainly works with the upper extremities, fine motor skills, eye-hand coordination, and high-motor skills.

 Hand-strengthening devices for grasping and squeeze are available to help develop strength. You can use Putty to roll, grip, and practice cutting.

Individuals can regain their coordination by using a variety of peg boards in various sizes and complexity levels. If needed, the OT can provide finger and hand support for writing (dues to weakness or tremor), as well as a splint that supports a contracture. For those who need additional support, an OT can make arm braces. You can also use other devices to help you type on the computer keyboard.

A rehab facility’s occupational therapy section is especially interesting. This area may have working kitchens, laundry areas, and bathrooms. It is designed to help people learn and practice skills for everyday tasks. Individuals are taught how to do common household chores like washing dishes, folding laundry, drying and folding laundry, and cooking. To help people learn how to move from one seat to the next, bathrooms have special toilet seats, grab rails and tub seats.

 An occupational therapist will show individuals how to conserve energy and improve safety in each area. Assistive devices include long-handled sponges to wash; dressing aids that help with buttons, zippers and socks; and specially designed plates and cups.

Sometimes, the OT can also assist with workplace intervention. The OT may visit a person’s workplace to assess safety, comfort, efficiency, and other factors. An occupational therapist will recommend ways to improve these areas, including rearranging furniture and moving someone’s office closer the exit and toilets. To help MS symptoms, an OT may suggest a flexible work schedule and a longer lunch break. They may also recommend keeping the office comfortable.

Linda Lucuski explained, “An occupational therapy will evaluate an individual diagnosed with MS for range and motion, strength, sensation, tone, and tone in the upper extremities. Functional activities like dressing, feeding, bathing and other daily activities will be evaluated by the occupational therapist. An individual’s physical
The environment at work or home may also be assessed and discussed.

The therapist will suggest the appropriate adaptations to allow for ease of movement and function. One example of this would be an adaptive writing tool to stabilize the wrist and hand during handwriting activities like checking and paying bills. An occupational therapist will examine the upper extremity and create a splint in order to reduce contractures, protect the joints, or allow for better movement and function.

Functional Vision Rehabilitation

Functional Vision Rehabilitation is a specialty program in occupational therapy. The program is prescribed by an optometrist or ophthalmologist. It addresses the common visual dysfunction symptoms that MS patients experience. These include blurred vision or double vision, loss in visual field and low vision. Although this type of therapy can only be offered in a few centers, it can prove very beneficial for those who are able to access it.

The therapist might offer suggestions and techniques for compensatory methods to improve your eyes’ ability to function at work, home, or in leisure activities. To increase visibility, one example would be to use contrast colors in the home. There are also low-vision aids that can be used to help visually impaired people. These include a device that can identify the size and color of a medication so they know if it is the correct prescription.

Speech Therapy

MS can cause voice and articulation issues. Dysarthria is a condition that causes abnormal muscle movement and can affect strength, range and accuracy of speech movements.

Speech-language pathologist (SLP), is a therapist who has been trained in the treatment and evaluation of speech, language and swallowing problems. An oral-motor exam may be performed by the SLP to determine the strength, range, timing, accuracy, timing, and precision of the jaw, mouth, and surrounding muscles. The therapist will evaluate the intensity, speed and endurance of an individual’s vocal use. Also, the therapist will assess your ability to properly use your breath and respiration.

After the evaluation is complete, the SLP will create a comprehensive rehabilitation program. This may include oral motor exercises to maintain muscle strength and coordination; pausing or pacing techniques for those whose speech has become slurred or rapid. Nonverbal techniques may be used in severe speech cases.

MS patients may also have dysphagia or difficulty swallowing. A diagnosis of dysphagia involves examining the tongue and swallowing muscles, as well as observing how different foods and liquids are swallowed. A therapist might recommend an assistive device, such as a special cup, dietary modifications and exercises to improve swallowing.

Cognitive changes may occur in people with MS. Cognitive changes are a person’s ability to understand and process what has been heard, seen, smelled and tasted. Attention, learning, memory, organization, comprehension, reasoning and problem solving are all possible components of cognition. Cognitive impairments can also be caused by stress, anxiety, fatigue, depression, and other factors.

SLPs may be able to help with cognitive function and teaching techniques to correct the problem. It is possible to introduce cognitive devices, such as calendar planners or voice recorders. In the treatment of cognitive disorders, special software and workbooks may be used.

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