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JNPT Discussions
Current research in neurologic physical therapy and its impact on clinical practice.
Wednesday, July 24, 2013
Prevention and wellness in clinical practice
Neurologic PTs are trained to understand that sedentary behavior is not an inevitable consequence of most neurological conditions. PTs are uniquely positioned to intervene at the primary and secondary prevention levels to those living with neurologic conditions. Unfortunately, we allow the structure of our third party payor system and the facilities at which we work dictate the type of care that we provide. Many of our clients are discharged from insurance-reimbursed care and left to fend for themselves in search for health, reduction of disability, and options for physical activity and exercise. Rather than leading the charge to be part of the solution to this problem, the PT community appears willing to tacitly accept as inevitable the pervasiveness of the sedentary lifestyle due to neurologic dysfunction and its deleterious consequences. Do you provide prevention and wellness services in your practice area? If so, please respond and tell the group what group you work with (diagnosis?), where your care is delivered, how participants are referred to you, and how the services are funded. What have been your successes and failures and what are the barriers to this kind of care in your community? How do you advocate for prevention and wellness care? Are you involved with non-profit patient advocacy groups or do you serve on local, state, or federal government institutions that fund this type of care?
Dr. Christine M. Brussock said:
I have been working toward the establishment of a non-profit organization to fulfill this very gap of care so necessary for those with neurologic disease. It has been very difficult 1)despite verbal support from my colleagues, few remember to refer clients to the group exercise/education programs, & revert to a few hand-outs following formal PT. Many are kept busy meeting the needs of their individual clients that "fit" into the schedule. 2) Payment is a huge barrier, Despite having a small fee ($35 for 8 1x/week classes), people expect their insurance to cover this. One contract was supported by the housing corporation where I provided the group classes & was thus open to ALL members of the community, some who needed supervised programs & others who could do so on their own.We are working on alternatives & I hope to garner the support of PT Practices for referral of individualized needs--perhaps who can financially support continuation of these programs- a Future ACC!! Open to ideas
Ms. Kristin McNealus said:
I was frustrated by discharging patients from inpatient rehabilitation and seeing them come back to visit much heavier. The payment system means the limited time we get not only needs to be used to make the greatest impact in functional recovery, but also is not nearly enough weekly exercise to ward off secondary complications, and yet is often the most exercise people are getting... Then there is the issue of transportation. So I started an online adapted exercise program. Users can access 3 seated workout routines at any time, and workout as often as they want to at home. They just follow along, and can use weights to add challenge. I change the 3 routines weekly, so users don't get bored. There is an affordable monthly subscription. I'm trying to take away barriers to adequate exercise. My website is
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This blog features JNPT editors who will discuss and comment on recent articles and important, current issues related to neurologic physical therapy. JNPT editors have clinical and research expertise in a wide range of patient health conditions.

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