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Integrating Home Exercise into PN Treatment

Posted by mandlfoxworth on October 29, 2018 at 4:45 PM

Customizing effective exercise for your HOME environment is not well integrated into normal PN treatment. Because PN saps strength, Physical Therapy (PT) prescriptions for strengthening and balance exercise are common, even if the central role of exercise in PN is rarely stressed. But I think home PT visits to setup an exercise program should be part of normal treatment. Can it be?


I'm a big advocate of exercise. Why? Because I've seen it work for me. Puzzled by the connection between PN and muscle weakness, I worked many months, going through several versions, to create a layman-level presentation to the group on the logic behind it. (The write up on the details page about the March 2018 meeting has link to a PDF with speaker notes. Original PowerPoint version available on request.)


Nevertheless, I'm NOT a big exerciser. I try and sort of succeed. I think "I do more than most”. (I’ve heard that most people rate themselves as "above average" on ANY "good" personal characteristic, including exercise. Ain't math great!)


When I exercise, all the good things happen (I feel better, I'm proud of myself, etc., etc.). BUT, like most people I don't "have" to do exercise "right now". I don't have a job that requires it. Honey-dos and the dog might demand to be fed or let out, but that's about it. I have an exercise schedule and goals. BUT. But. But. Yes, the pattern is clear.


Developing a Custom Exercise Plan with a PT Specialist in My Home


I asked my doctor if I could get someone to come to my home to help with my Physical Therapy effort and review my home for safety features. Last year (early 2017) our PT specialist came to our house for a series of visits and we worked up an aggressive exercise program that led to dramatic improvements. Really, it did!


Nothing Lasts Forever


Now, almost 2 years later, life and PN is eroding my exercise plan. My other goals elbow in. Shopping, eating, sleeping (especially napping). Church. Doing my PN support group bit. All those things are getting harder as my body weakens and balance degrades. This morning the alarm went off, as usual, at 6:30 so we could get to exercise class. I'd been up late, as usual. But, for the first time in about 5 years, I stopped, sat on the bed and felt too tired to go. More precisely, too tired to make myself go. Life being complicated (as usual), I dropped my gym membership early this year and moved my focus to exercise at home. I have a vigorous "stomping" exercise with the dog. I can't walk the dog on a lease and can't stand without moving my feet, but dancing to the music while tossing around bits of dog food to a hustling dog is fun. But it's getting harder and its associated fall risk is beginning to concern me. My daily stair climbing, core exercises, and other routines seem harder & I find myself "forgetting" to do them. Arthritis is yelling at me louder.


My "plan" needs a reboot. My short-run focus needs a sharp rap on the head. Probably both.


Why I Think Home PT Visits should be the First Step


I'll ask my doctor to get the PT specialist return and we'll update my PT exercise plan. But what can a web site like this one or any web site or YouTube do for you, the reader, the patient and the caregiver? Realistically, exercise information from the Internet is a nearly incomprehensible fire hose.


1. Without personal help by a human looking at your activity and status it's extremely difficult (probably impossible) to correctly customize exercise plans. A PT person needs to touch you, physically guide you, for you to really understand what is required and correct poor execution. Websites and algorithms cannot provide the physical interaction needed to reflect your personal and home issues/assets. Without that human help, a web site and its included docs, videos, interactive data-gathering and machine learning systems, or books will be limited in what they can demonstrate or describe. Any set of multiple websites or material places a stiff data integration problem on the consumer's shoulder.


2. PT evaluations and training are usually done in a traditional PT clinic. Visits in a PT clinic are good and less expensive. They have their place, especially for follow up, status evaluations and coaching. I went to clinics for 3 years before my home visits. The clinic-based PT personal were top notch, the sessions about the same length and exercises were helpful. But the clinic-base specialist is really restricted in seeing what is needed and adapting the plans. Only a visit to your home can allow the PT specialist to integrate your capabilities, needs and required exercise elements with your physical surroundings. In my experience with home visits, the difference in effectiveness was night and day. I think including an early set of home visits is the best way to get you started in the right direction. Yet such personal attention in the home is expensive in terms of specialist time. The relevant question is the tradeoff between expense and effectiveness.


3. Commercial gyms often have the all the facilities needed for PT evaluation and/or treatment. Personal trainers are routinely used by their clients for advice and trainers are trained to know what is needed for physical health. It seems to me that gyms could host certified PT Specialists But there seems to be little integration of such service providers with the health services sector. There are some programs like Silver Sneakers and some gym memberships are subsidized, but even these programs seem like afterthoughts.


4. After a PT visit, follow-on guidance often consists of printed handouts. The significance of subtle aspects can be lost. Once you have a plan, the internet may help. The available web material, perhaps supplemented with books and pamphlets, then becomes relevant, especially if the PT specialist can help guide you. But such integration with web material seems scarce. Personalized follow on can be efficiently provided by single home visits, PT clinic visits, tele-medicine or, possibly, gym personnel.


5. When we had PT specialists come to our support group meeting, discussions made it clear that doctors and insurance companies do not generally appreciate the critical role of exercise and PT in the management of PN. Only YOU can get home visits by PT – doctors will rarely suggest it and insurance may fight you. Despite lip service, integration is the weakest aspect of specialist-dominated American medical practice.


It seems to me that a standardized approach to home based PT evaluations supplemented with all other tools (clinic visits, tele-medicine follow-ons exams, printed materials, videos, follow-on phone calls, case management conferences between relevant specialists, gym support personnel) is needed.


Does any one know of programs like that?


Mike Foxworth


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