The 3 main options for physical rehabilitation

Have shoulder pain? Recovering from traumatic illness, surgery, or a bad fall? Your doctor may well recommend physical rehabilitation or physical therapy to get you back to your daily routine and the activities you love. There are several options available, depending on your needs.

1. Inpatient rehab

Inpatient rehab is prescribed after a hospital stay, when you’re not well enough to go home. It offers comprehensive care from doctors, nurses, therapists, and other health professionals. There are two types of this rehab.

Acute rehab. This highest level of rehab is prescribed after a traumatic medical problem, such as a stroke. The facility may be located in a hospital or a stand-alone building. Each day you’ll see doctors, physical therapists (who help restore your physical function), occupational therapists (who help restore your ability to perform daily activities), speech therapists (who help restore your communication and swallowing skills), and other types of health professionals (such as respiratory therapists), depending on your illness.

“This level of rehab is intense. You must be able to do at least 15 hours of therapy per week, or at least three hours per day for five of the seven days in a week,” notes Bob McCall, senior vice president of network development and inpatient rehabilitation services at the Harvard-affiliated Spaulding Rehabilitation Network.

Subacute care (also called skilled nursing). This type of rehab is often located within a nursing home. Doctors will visit only periodically, and you’ll spend less time with physical, occupational, and speech therapists (perhaps up to two hours daily).

For both types of care: Stays may last for a few months (such as after a spinal cord injury) or a few weeks (such as after a stroke or joint surgery). Medicare and supplemental insurance pay for the majority of care for about three months after you’re discharged from the hospital. Insurance deductibles and copays apply.

To make the most of it: “The medical team will guide and support you, but ultimately success is based on you taking control of your recovery. Having family and friends support you during your stay and your transfer home also makes a big difference,” McCall says.

2. At-home rehab

Rehab at home (home health care) sends skilled professionals — including nurses and therapists (physical, occupational, or speech) — to your door. You might be a candidate for this after a hospital stay or an inpatient rehab stay, if you’re not yet fully recovered. For example, you may need physical and occupational therapy after a knee replacement.

What can physical therapists accomplish in your living room, without large exercise machines? “Therapists may guide you through exercises with resistance bands or small weights, body-weight exercises, or muscle contraction exercises. Therapists may also use small pieces of equipment to stimulate muscle contractions or apply hands-on techniques to achieve improved motion and strength,” McCall says.

Home health care is a temporary service — about two to six weeks, depending on your needs — with therapists visiting a few times per week. Medicare pays for the service. To qualify, your doctor must certify that you need the therapy, and you must be homebound (although you’re still eligible if a caregiver lives with you).

To make the most of it: “Be as prepared as possible when the therapists arrive: wear loose clothing so you can exercise, keep a list of your questions handy, and be ready to work hard and keep it up if you’re assigned exercises in between visits,” McCall advises.

3. Outpatient rehab

Outpatient rehab is for people well enough to get to a facility throughout the week. For example, you might be recuperating at home after surgery. Or you might have knee pain from arthritis and want to reduce the pain and increase your level of activity.

Medicare pays for the rehab (copays apply), which typically lasts about eight weeks, with several visits per week. During that time, you’ll work with a physical therapist who guides you through exercises (sometimes on large gym equipment) or performs hands-on muscle and joint therapy.

You’ll also be expected to continue workouts at home, in between visits. “If we identify a muscle that’s weak, we may recommend strengthening four to six times per week to rebuild it and regain strength. Once that’s back to normal, you may not need the same frequency,” explains David Nolan, a physical therapist at Harvard-affiliated Massachusetts General Hospital.

To make the most of it: “Make sure everyone is on the same page about your goals, such as being able to dance at your daughter’s wedding,” Nolan says. “That’s in addition to complying with the treatment plan at home and then living an active lifestyle to maintain strength and prevent injuries.”

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Acts 4:18-31 And when they had summoned them, they commanded them not to speak or teach at all in the name of Jesus. But Peter and John answered and said to them, “Whether it is right in the sight of God to give heed to you rather than to God, you be the judge; for we cannot stop speaking about what we have seen and heard.”     

2 Chronicles 25:19 “You said, ‘Behold, you have defeated Edom.’ And your heart has become proud in boasting. Now stay at home; for why should you provoke trouble so that you, even you, would fall and Judah with you?”

1 Samuel 2:3 “Boast no more so very proudly, Do not let arrogance come out of your mouth; For the LORD is a God of knowledge, And with Him actions are weighed.

Proverbs 11:2 When pride comes, then comes dishonor, But with the humble is wisdom.

Proverbs 16:5 Everyone who is proud in heart is an abomination to the LORD; Assuredly, he will not be unpunished.

Micah 2:3 Therefore thus says the LORD, “Behold, I am planning against this family a calamity From which you cannot remove your necks; And you will not walk haughtily, For it will be an evil time.

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