Rehab tries CI therapy with lower intensity
Results are promising, especially in pediatrics
Rehab facilities wanting to try a constraint-induced (CI) movement therapy program but hesitant to commit to a labor-intensive new treatment without full payer backing might try a less intense model developed by Brooks Rehab Hospital in Jacksonville, FL.
Brooks Rehab began trying CI therapy after therapists began reading about its positive results in a variety of clinical trials and heard about it at educational conferences.
"I wouldn’t say we’ve used it on a widespread basis because you have to look at all the factors involved with patient care before you can use it," says Donni Welch-Rawls, MS-PT, manager of physical therapy.
Nonetheless, therapists provide the therapy to stroke patients in an inpatient setting. The therapy typically begins a few weeks post-stroke and involves three hours a day of therapy, five days a week, plus a few hours on weekends. All the care is fully reimbursable.
Brooks’ program has worked well, particularly for pediatric patients, says Lori-Ann Pietruski, OTR/L, an occupational therapist who has been providing the CI therapy. With children, the hospital obtains permission from parents and an order from a physician to place the unaffected arm in a cast that can be taken on and off easily.
Two patients returned to 90% function in their affected arms after undergoing the therapy, Pietruski says. "I did this with one pediatric patient, and she went from having minimal shoulder movement to within a couple of days of putting the cast on to having every muscle work in her arm."
Patients have to be chosen carefully because of psychological as well as physical barriers to effective outcomes, Welch-Rawls says. "This is especially true with the older person who now can’t move that one side, and then to take away their ability to do functional activities that maybe they could have done, even for a brief period of time and for a very good reason, can be a problem," she explains.
Because the patients are admitted to an inpatient setting and many have Medicare coverage, reimbursement has not been a problem for the hospital, Welch-Rawls says. If the therapy intensity were raised, some creative solutions might be needed to preventing a prohibitive cost. For instance, physical therapists and occupational therapists might be involved with starting the CI therapy and then supervise less-skilled therapists.
Before the facility would set up a more extensive CI therapy program, a hospital manager should explore how CI therapy used on an outpatient basis might affect requirements regarding restraints, such as the new standards by the Joint Commission on Accreditation of Healthcare Organizations, Welch-Rawls says.
"There would have to be some dialogue with the Joint Commission to make sure they didn’t regard this as a restraint," she adds. "Hopefully, they’d regard it as a therapeutic modality type of thing."
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