2012-12 Issue: The Road that Needs to be Built - Connecting Rehab to Physical Activity

Connecting Rehab to Physical Activity

By Dr. Jim Rimmer

One evening in April 2008 I received one of those dreadful calls from my mother’s best friend. After repeatedly calling my mother during the day and getting no response, Phyllis decided to walk over to my mother’s apartment to check on her. It was unlike my mother to not pick up one of Phyllis’s phone calls during the day. They had a regular routine of checking in on one another. After several loud knocks on her apartment door with no response, she walked over to a neighbor’s apartment to get my mother’s extra key. What she and the neighbor found was a woman lying on the floor in her nightgown next to her bed for close to 20 hours. She had awakened in the middle of the night to go to the bathroom and somehow ended up on the floor (which I later found out was the result of a fall-related hip fracture). My response to Phyllis’s phone call that evening from 1,000 miles away marked the beginning of a new journey caring for an 86-year-old woman who had previously been independent all her life.

After a couple of days in the hospital recovering from hip surgery, my mother was transported to a rehabilitation center where she spent the next four weeks undergoing rehabilitation twice a day. Her physical therapy sessions included learning to walk safely with a walker; performing upper and lower body strength and balance exercises (standing and sitting); and using an arm cycle ergometer.

After she was discharged, she moved in with my wife and I and was eligible (through Medicare) to receive five or six sessions of outpatient physical therapy. After the first few sessions, I could see that the exercises the therapist was having her perform would do little in the way of improving her overall health and function. I asked him if we could move the last couple of sessions to a local YMCA a few miles from my home so that she could have access to a host of exercise equipment and a personal trainer that I would pay for after his services ended. He indicated that Medicare coverage only allowed him to treat my mother at home and that he would be unable to accommodate my request. My mother performed the exercises two or three times after he ended his services and never did them again.  

The majority of patients hospitalized after an accident, injury or exacerbation of a chronic health condition are transferred as early as possible to a rehabilitation center or skilled nursing facility to receive their rehabilitation. In much the same way as my mother, these patients will return home with few, if any, options to continue their recovery.  The adjustment to life after disability typically does not match the community’s receptivity in facilitating reintegration, and connections to community-based health/wellness programs are often not considered or unavailable.

It’s time for a new model in healthcare that provides people with newly acquired disability a membership to a fitness center where they can continue to recover and then begin a new road to improving their health and fitness. Rehabilitation without fitness only gets the individual to the halfway point on where they need to be after acquiring a disability.

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