One of the things I wish my medical staff had mentioned to me was the difference between compensation and recovery. Compensation being doing whatever is necessary to accomplish a goal. Recovery is using the muscles as intended to accomplish the same goal. Insurance wants you to use compensation whenever possible because it is faster and cheaper. The best example I can give is I had a substitute OT and she asked for what my next goal was, I told her I wanted to be able to read a newspaper. She immediately proceded to place a sticky material(Dycem) on the table and put the newspaper on top of that to help with holding it in place as the pages were turned. This was compensating for my inability to open my left hand, keep my left wrist straight and hold my left arm up in the air. I didn't want to compensate, I wanted to figure out how to hold the paper and read it with two hands. She took the easy way out and marked it as accomplished. 4 years later I still can't do this the proper way but I have at least mapped out the necessary steps to finally accomplish this.
Peter Levine has a great blog post on this. What happens to your brain if you compensate.
http://recoverfromstroke.blogspot.com/2010/11/make-them-walk-funny-and-look-lousy-in.html
This is the great divide in what survivors want vs. what the therapists can work on because of insurance/HMO guidelines. Most survivors want complete recovery while therapists need to work on ADLs to be able to get paid. Insurance guidelines require that functional ability be able to be created/maintained within 4-6 weeks. If progress is not made then the dirty word - plateau - is brought up. Plateau is not a medical term, it is just used to deny further therapy. My workaround when I was still getting therapy was to set as a goal something I was already able to do. One goal was to be able to get on/off an escalator. I could already do it because I needed it at work. A goal my OT set for me was to use my left arm/hand to open the refrigerator at home. 4 years later I still can't do this because I can't open my fingers. So I compensate and use my right hand. The main one is the use of AFOs to compensate for the lack of dorsiflexon. By using most compensation strategies you are actually preventing recovery from taking place. So you need to make a decision on which route you want to go.
So who plateaued? You or the therapist.
ReplyDeleteYou noted 4-6 weeks of rehab. Of course that was in the past, now it's about 2-3 weeks depending on HMO or Medicare coverage.
Now, only 30% of rehab patients go to Rehab Centers, 65% are referred to SNFs - nursing facilities with therapy. Some of the better programs figured out that patients need more actual therapy time. Unfortunately, they stand out statistically and are being investigated.
Ah yes, the Plateau! Where's the fiscal cliff?