Age, disease, or injury can make simple movements like walking, using the stairs, and getting out of bed very difficult. However, the right therapy can bring back a great deal of functional independence within the home and in the community.
Alex Greenspan, MSPT, is the founder of Outreach Rehabilitation, which specializes in in-home physical, occupational, and speech rehabilitation therapy for older adults throughout New York City. He explains how therapy can help older adults regain the ability to perform daily tasks after an injury or illness. Answers have been edited for clarity and brevity.
Epoch Times: What misconceptions do people have about regaining functional movement?
Mr. Alex Greenspan: In general, adults, specifically the older adult population, think they cannot regain what was lost after an injury, surgery, or life-changing diagnosis. Functional movement can potentially be regained or modified in order to accomplish a specific task.
Epoch Times: Can you give an example of modified movement?
Mr. Greenspan: For example, if a patient has pain in their right knee when they get up from a chair, we would teach them to move the right leg slightly further away from the chair than the left leg. This will take some of the pressure off the right knee as they get up allowing for a smooth, safer transfer.
If they’re having difficulty getting up from a chair due to weakness, we may prop something between them and the chair or have them practice sitting on a higher surface and then standing up again, or give them assistance as they sit and stand until the task becomes easier, ultimately leading to a greater ability to get up from the chair. A functional task that’s difficult can be most effectively improved if a similar task is practiced.
Epoch Times: What can you do if patients have trouble with stairs?
Mr. Greenspan: We first assess how they negotiate stairs: Are they having trouble due to fear, pain, decreased sensation, or loss of motion or strength? Are they favoring a stronger side or compensating for something that has diminished or weakened?
Knowing these factors will help establish the appropriate plan to make it safer and easier for them. For example, if we found that a patient is no longer going down stairs due to pain or weakness in the left leg, we would have them walk down the stairs leading each step with that left leg so there is more weight or stress on the non-affected right leg. This will allow them to feel more secure on the stairs, allowing them to slowly regain confidence in this functional task.
We would decrease the modification as the pain and weakness lessen.
Epoch Times: How do you help patients who are afraid of falling?
Mr. Greenspan: We would identify what activities a client is most fearful about doing and why they are afraid.
For example, if a patient has fallen in the kitchen or bathroom or is fearful and withdrawing from entering these areas, we would assess these environments and make them more accessible and safe. We would make sure they have grab bars or railings where they need them, that the tub and toilet are the appropriate height, and that the doors are wide enough for them and their assistive devices. We also look at doorway saddles—raised pieces of wood across the doorway, clutter, lighting, flooring, and make sure there is a clear path from room to room.
We would also help them practice specific tasks that they have difficulty with like getting up from the floor or a chair, reaching across their body for their coat or an item in a cabinet, multitasking, or stepping off a curb or onto a bus.
Are there grab bars on the side of the toilet at the right height or angle? How high is the tub lip? Are there mats on floor in and out of tub along with a grab bar in the shower? Do they have a removable showerhead they can hold? An elevated toilet seat or a three-in-one commode?
Do they “furniture walk” or grab onto things within the home that are not stable and secure because they feel unstable?
In the kitchen, we look at whether there are any mats or rugs acting as an obstacle, whether the lighting is good enough for the patient’s vision, and whether the items most used in the kitchen are the most accessible ones. If not, we put them in an area where the patient is less vulnerable.
Epoch Times: Besides the risks posed by furniture, you also address the mental and medical factors that raise the risk of falling. What do you do about these?
Mr. Greenspan: We look at whether they have had prior falls, how sharp their cognition is, and whether they have a false sense of what they are capable of. We also find out if their vision or sensation is impaired and what medications they are taking, which may affect their balance.
We work within our scope of practice as rehabilitation professionals and educate our patients on what other factors may be contributing to their increased risk and what steps they can take to address them. They key is educating them about what they can to maximize their safety and independence.
Epoch Times: What are some of the things that prevent people from being able to get out of bed after they have been injured or ill?
Mr. Greenspan: Fear, lack of motivation, hopelessness, pain, weakness, decreased sitting or standing tolerance, lack of help or support, the type of bed or mattress.
Epoch Times: How can you help people get out of bed if they are having trouble with this?
Mr. Greenspan: A person may need a rail by the head of the bed or along the side, so they can grab it when they transfer from a lying to a sitting position.
We would also look at whether the mattress is firm, soft, gel or air; whether their bed inclines or declines, and if it is a manual or mechanical bed. These factors play a part in making it easier for people to transfer and decrease other potential complications that occur post injury or illness.
Epoch Times: What are some of the daily life activities your occupational therapists help people with?
Mr. Greenspan: Dressing, bathing, feeding, and grooming, as well as the ability to return to doing laundry, preparing meals and medicines, shopping, and managing their money and finances.
Epoch Times: Do insurance companies cover the in-home therapy that Outreach offers?
Mr. Greenspan: Mainly Medicare part B. Medicare along with some private insurance companies will pay if an individual has out-of-network benefits. We are a private group, not an agency, so the way we bill is different from that of a home-care agency.
Epoch Times: How is what you do different from other care agencies?
Mr. Greenspan: We bridge the gap between a home-care agency and an out-patient clinic.
To be eligible for therapy through a home-care agency, one has to meet certain criteria. An individual has to be homebound, and services must be received or limited to the confines of their own home. With Outreach, a patient does not have to be homebound, and we can take a patient outside and into the community if appropriate.
Our therapists bring all necessary equipment and provide every detail of care. We typically bring in resistive bands, cuff weights, blood pressure cuff, goniometer to measure range of motion, massage cream, pulse oximeters, portable electrical stimulation and ultra-sound units. We also order lots of adaptive equipment based on patients’ needs within the home and surrounding environment.
Outreach Physical and Occupational Therapy and Speech Rehabilitation
147 West 35th Street, Suite 407
New York, NY 10001
*Image of “male therapist and patient” via Shutterstock