Beyond Stretching: How Outpatient Rehabilitation Can Benefit You

This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You're listening to Weekly Dose of Wellness, brought to you by MemorialCare Health system. I'm Deborah Howell, and today's guest is John Fenger, physical therapist and manager of outpatient rehabilitation services at Orange Coast Memorial Medical Center. John received his bachelor's in exercise science from Northern Arizona University. He then earned his master's in physical therapy at MGH Institute of Health Professions in Boston. John has continued his academic and clinical pursuits by earning both his doctorate in physical therapy and specialty certifications in sports and orthopedic rehabilitation. Welcome, John!

John Fenger, PT: Hi, how are you doing?

Deborah Howell (Host): Good! Today's show is called Beyond Stretching, How Outpatient Rehabilitation Can Benefit You. So let's begin at the beginning. What is outpatient rehabilitation?

John Fenger, PT: Well, outpatient rehabilitation is a form of therapy where patients travel to a clinic or a hospital and attend sessions of therapy and then return home on the same day.

Deborah Howell (Host): So what different types of therapy might they receive when they go to these places?

John Fenger, PT: So typically outpatient rehab will include speech, physical, or occupational therapy.

Deborah Howell (Host): Okay. Okay, or all of the above, huh?

John Fenger, PT: Or all of the above. At our clinic we have speech therapy and physical therapy. And that usually can include multiple specialties, such as orthopedic therapy, neurologic therapy, aquatic therapy, hand therapy, cancer therapy, pain therapy. So at our clinic, we specialize in orthopedics, primarily a little bit of neuro and speech.

Deborah Howell (Host): Okay, let's talk specifically about each one of those. Orthopedic, what kind of treatments do you perform or therapy?

John Fenger, PT: Well, we'll typically see patients with headaches, dizziness, poor posture, sprains, strains, any kind of walking or ambulation problem from any surgery like a total knee replacement or total hip replacement, pain and swelling after a surgery. Those are some of the ailments that we would treat in that population. Occasionally with our neuro population, we'll see folks with increased or decreased tone after a stroke. And then all of the problems that may come with that particular diagnosis, like poor balance, poor functional mobility.

Deborah Howell (Host): And then speech, of course.

John Fenger, PT: With speech, occasionally after a stroke, individuals might have a problem comprehending or actually producing speech. So our speech therapist will help them with that. Individuals just might have a problem with stuttering or articulating. So the speech therapist can handle that.

Deborah Howell (Host): It's really retraining the body to do what it's innately meant to do.

John Fenger, PT: Absolutely. Very, very natural, normal process. Very, very important.

Deborah Howell (Host): I remember when I had my ACL replaced, I literally had to learn how to walk again. It's just helping the muscles remember how to do that.

John Fenger, PT: Yeah. No matter what is ailing an individual, whether it's... sprain or a strain, whether they received surgery, could be anything. Outpatient rehab or physical therapy, if in your case an ACL reconstruction, has to be part of the treatment process. On that pie chart of options, it might make up a certain percentage, but it has to be on there simply because it's, as you said, just retraining the body to do what it should be doing. Very conservative, very normal modalities.

Deborah Howell (Host): And you work on people that have progressive diseases as well as just recovering from a single incident. So you work from, you know, from anybody with Parkinson's disease, for example, to someone who's maybe been in a car crash that is, you know, having trouble walking or other kinds of movements.

John Fenger, PT: Absolutely. So an individual with Parkinson's disease, they present with very specific impairments. They have a lot of rigidity. Their posture is poor. They have some tone, resting tremors. Their postural reactions are a bit delayed. They demonstrate slowness of movement. So these are all impairments that we can work on. While the disease is progressive, Just like, you know, aging is progressive, but it doesn't mean that we can't address some of the impairments that are inherent to either the aging process or to Parkinson's disease and maybe facilitate enhanced function as the disease progresses or as we get older. So it's, in other words, just basically, can we make the person stronger? Can we fix their posture for an increased amount of time and delay what might be the inevitable. But in the process at least enhance the function while it's happening.

Deborah Howell (Host): And that also would give them, I would think, a mental boost as well.

John Fenger, PT: Well, they're engaged in their own treatment process, and they have support. And, of course, there's the realization that if they become weak, they can get strong, period. And that has to benefit them, plain and simple. So that does, it is very motivating. And we see it just subjectively, just pure observation in our patients, We have a couple of Parkinson's disease programs here, and they are fully and totally engaged in the process, attend consistently, and it's created a, there's this little kind of culture that's been created around the program where it's, it's, everyone supports one another. They get together after class, and it's just created a buzz around the program.

Deborah Howell (Host): It's like a community.

John Fenger, PT: Absolutely. Very community-oriented.

Deborah Howell (Host): That is wonderful, and that cannot hurt. And, you know, the more mentally fit you are, that certainly helps the physical part as well.

John Fenger, PT: Absolutely. They feed off one another. So if you're motivated, you're going to perform better physically. You're going to be more apt to attend the sessions. And then just by being involved, just by participating, your body will respond. It's impossible for it not to. If you're strengthening something or if you're working on your balance or if you're walking to the class, that's going to result in an increased fitness level, more posture, more strength. And so that hopefully would translate into function. And then, as you mentioned, the sense of community will bolster the outcome.

Deborah Howell (Host): I think it all feeds into each other. That's a good thing. So how does someone request a certain therapy program from their doctor?

John Fenger, PT: Very simple. If they simply state the desire to attend therapy, their doctor should write an order. Or could write an order for therapy, not should, but could write an order for therapy. And it's as simple as that. The patient would have to present with some therapy-oriented diagnosis, which pretty much covers most diagnoses out there. We mentioned them earlier. It could be any neurological process like stroke, Parkinson's disease, it could be any orthopedic issue, any post-surgical orthopedic issue, ACL reconstruction, rotator cuff repair. It could be a sprain, strain, dizziness, headaches. These are all things that PTs treat. So if you have any of those issues, you can receive therapy. You could get an order for therapy.

Deborah Howell (Host): Now, a lot of insurance companies do cover outpatient rehab. Is that correct?

John Fenger, PT: Absolutely. Probably all of them.

Deborah Howell (Host): For at least a certain amount of time, anyway.

John Fenger, PT: For at least a certain amount of time. Some might put restrictions on that, but generally speaking, insurance companies don't typically, in my experience, give us a hard time when requesting visits. So if the therapist feels that more therapy could help the patient and we can demonstrate that, we could prove that with our documentation and the outcomes, we'll typically get more that are covered. So in other words, there are limitations, but you rarely see them if the need is there.

Deborah Howell (Host): Okay. Now, for your basic knee patients or, you know, surgery, if they don't go to PT, what are the dangers there?

John Fenger, PT: Okay. Well, if they don't, for like a knee patient, did you ask?

Deborah Howell (Host): Yeah, I'm just taking an example.

John Fenger, PT: Yeah, if they don't attend therapy, in my opinion, you lose that engagement. You lose the structured conservative care that would guide your progress. So you might delay progress. You might, if you have, let's say, a knee or a shoulder surgery, you could develop contractures in that area. And that would basically be the soft tissue would constrict, become hardened, scarred, fibrotic, and that could decrease your range of movement that might require some kind of manipulation under anesthesia. So basically physical therapy allows us to fully exhaust the conservative, the entire conservative spectrum of care quickly, immediately, and without any kind of obstacle or barrier so that you could have a nice trajectory of improvement over time. If you delay that or if you choose not to go, you are subject to just continued weakness, decreased range of motion, the contractures that I spoke of. And not to mention that PTs are a nice conduit to the physician. Like I said, you exhaust all the conservative aspects of care. We're in communication with the physician, so you stay part of the rehab medical treatment cycle.

Deborah Howell (Host): Thank you so much, John. I'm so afraid that we are out of time, but we really appreciate you talking to us today about the benefits of outpatient rehab. Do your rehab, everybody. It's very beneficial! It's been a real pleasure to have you, John. I'm Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Have a wonderful, wonderful day.