Rehabilitation or rehab can consist of physical, occupational or speech therapies, or any combination of all of the above.  Therapies need to prescribed by a physician to address some type of deficit or difficulty in performing certain functions, often due to a medical condition or surgery. 

Once treatment is prescribed, the therapist will perform an extensive evaluation in order to identify the actual problems, the patient's current and prior abilities, as well as addressing the patient's goals.  A treatment plan is developed with goals and a timeline to reach them, which can be equated to a map.  For example, here you are at point A, you want to get to point B and then you have to figure out the route to get there, without too many detours!

In order to better understand which therapist provides which type of service, it is necessary to clarify their functions.  A physical therapist, or P.T., generally will work on a person's ability to ambulate, or their mobility, which may include using a wheelchair, walker or even crutches.  The P.T. will work on strengthening, retraining or re-educating various muscles to do new functions. For example, someone who has had a stroke with resulting weakness on one side of their body, may have difficulty with walking and balance.  At the same time, they have problems dressing themselves as well as performing bathing and grooming activities. 

In this situation the P.T. will address the function of mobility and an O.T. or occupational therapist will work with the patient on dressing and grooming.  An O.T. will focus more on the upper body functions and normal daily activities, which also includes planning the specific tasks.  In the case of this particular patient, they will help the patient gather all of the "tools" needed for bathing - fresh clothes, soap, toothpaste, toothbrush etc.  It won't do much good for the patient to be able to get into the bathroom without his supplies.

A speech therapist, or S.T., works with the function of language.   It is not merely the ability to speak words, but language includes comprehending verbal information from others, from written information, as well as non-verbal language.  Higher level functions such as balancing a checkbook or counting back change in a financial transaction, may also be addressed.

 
As a patient transitions through the multiple areas of care, a case manager may be involved in the various settings to assist with the coordination of care.  The primary role of the case manager is patient advocacy with the goal of avoiding any issues "falling through the cracks", educating the patient/family, facilitating communication amongst the care team as well as with the insurance carrier.  There may be case management services available through the health plan to allow for greater continuity along the road to recovery, but again, there may not be.  Medicare has been slow to get these services in place and the patient may have to rely on other family members to act as an advocate.  Another option is to locate an independent case or care manager who will be able to continue with you through all levels of care, again, assuring continuity.

 
Rehab may occur in an acute rehab "facility" which may be a separate building, or even a floor within a hospital.  This level usually requires the patient be able to participate in a total of 3 hours of therapy per day, often receiving a combination of two or more types of therapy i.e. P.T. and O.T.  Skilled nursing/rehabilitation facilities provide the same type of services, however, the patient does not have to meet the same amount of time criteria, and may only need one type of therapy.  The key admission mandate for skilled nursing/rehab, however, is that the patient must have had a three day stay in an acute hospital in order for Medicare and often some insurances to pay for this level of care.

 
As the recovery continues, a patient may then transition to home, receiving home health care and possibly then onto out-patient therapies.  Continued therapy needs will depend on the patient's ability to make progress and gains, and not just maintaining their current level of function.  The majority of insurances, including Medicare, use this guideline in order to reimburse for therapy services.

 
Overall, therapy can have far reaching results and is a far more complicated process than merely doing some exercises, and the role of therapists is more valuable than many anticipate.  So on your road to recovery after an illness or injury, be very involved with all of your healthcare providers.  This will allow you to have a better understanding of your role. as well as that of the therapists, in order to maximize your outcome and minimize any detours.

Cheryl A. Acres RN, CCM
Owner
Comprehensive Care Management LLC
www.txcasemanager.com