This page was designed to show how I, a Home Health Physical Therapist, address balance problems, leg muscle weakness, and coordination deficits. I recommend watching the video (it’s a little over 11 minutes) and learning the reasons I use the methods in the video to challenge my patient’s balance, strength, and coordination required for safe standing and walking in the home as well as going up/down ramps, steps or curbs.
Maintaining strength, decreasing falls and improving independence are probably the most common reasons for Home Health Physical Therapy. Following a hospitalization, my patients seem to be overwhelmed and face numerous obstacles from general weakness of the legs, difficulty breathing (sometimes from pneumonia), bone-cold chilliness, appetite changes, and swelling to depression, poor endurance, and healing surgical incisions.
This is a video of an actual Physical Therapy home therapy treatment. Please, DO NOT attempt this or any new home exercise program without seeking the advice/supervision of a medical professional first!
Most patients are discharged home from either a hospital where they have had no therapy, or an inpatient rehabilitation facility (Skilled Nursing & Rehab aka SNF) where they had varying degrees of therapy. Most of a patient’s therapy at this stage is focused on promoting initial healing processes without complications such as infection, pneumonia, and blood clots through very low-level walking (slow paced on even surfaces), exercises (usually sitting down), basic transfer training (standing up, getting in/out of bed, going from a wheelchair to/from the bed, toilet and chair), and bed mobility (rolling, scooting, and sometimes bridging).
In the home setting, patients are still trying to conquer the healing process, but they have advanced beyond the initial therapeutic exercises mentioned above. In the home, patients face different challenges and therapy needs to be different (look different and feel different) compared to the therapy he/she received in both the hospital and inpatient rehab. For example, in the home, they have soft, cushy recliners, couches, and often beds that are more difficult to stand up from compared to the hospital bed, the medically equipped bathroom facilities, and the chairs with armrests. Stairs, steps, and carpet can even be challenging after a recent hospitalization.
RATIONAL BEHIND MY TREATMENT METHODS
As an experienced Home Health Physical Therapist, I have several beliefs/treatment practices (some of these beliefs were mentioned in the video) to address and improve my patient’s level of independence, safety, and quality of life in the home setting.
Belief #1: You are only going to get good at what you practice, so you need to PRACTICE what you want or need to get better at while you have the skilled therapist available to assist with problem-solving and fall risk management.
If you are safe and functional in sitting, but lose your balance, get really tired, or stagger around during standing and walking activities, THEN therapy needs to be 90% completed in STANDING and not sitting down peddling a floor bike, kicking your legs, etc….
Belief #2: Everything changes once you are home!
If you were in therapy at an inpatient rehab facility and discharged home, THEN you obviously met your goals and successfully completed the initial stages of rehabilitation appropriate for either going home or continuing rehab in an outpatient rehab setting.
Therefore, therapy in the home SHOULD look, feel and be different from the therapy received in the hospital or inpatient rehab setting. Furthermore, therapy should look, feel and be different for different goals and problems. In other words, therapy after a total knee replacement should look, feel, and be different to therapy after a stroke, heart attack, fall with significant injury, etc…
Belief #3: During therapy, especially in the home, there needs to be a goal (FUNCTION-al reason for doing an exercise) behind EVERY exercise/intervention.
I encourage and sometimes prompt my patients to ask questions! For example, “What FUNCTION-al goal is being addressed with riding a floor bike for 20 minutes in the home?” Experience has taught me that being able to pedal a floor bike for 20 minutes primarily promotes circulation when someone is not able to/not suppose to put weight on his/her leg and to decrease stiffness using the pedaling motion. I DO NOT believe the floor bike is an effective treatment method for strengthening because to build strength, you need the proper amount of resistance applied in a specific/appropriate position. I personally do not ride a bike through my house and neither do my patients. Therefore, I DO NOT have my patients PRACTICE riding a bike during therapy because riding a bike does not make walking or standing easier.
On the contrary, in the video, I explain why I have every one of my patients with balance problems and increased fall risks complete standing heel and toe raises WITHOUT holding onto a walker! The foot and ankle are the 1st things to contact with the ground. When walking UP a ramp, the ankle is in the “TOE UP” position of toe raises. When walking DOWN a ramp, the ankle is in the “TOE DOWN” position of heel raises. If my patients don’t want or need to remain on a walker, THEN they need to practice all standing exercises and walking (UNDER MY SKILLED SUPERVISION AS A PT) without using a walker or holding onto something (I have not seen a kitchen countertop in the middle of a parking lot for someone to hold onto). This goes back to my 1st Rule–You are only going to get better at what you PRACTICE!
No one enjoys wasting their time! If you understand the “Why” behind certain exercises, then you do not feel like you’re wasting your time, and you are more likely to do your home exercise program because it makes sense. In previous videos and posts, I explain why I DO NOT use a floor bike, theraband or leg weights during home therapy treatments. The primary reason I DO NOT use these therapy methods is: I have never observed someone walk better, stand up easier, or keep their balance because he/she can peddle a bike for 20 minutes in sitting or sit and move their legs 20 times against the resistance of a red theraband or with 5 pounds on their legs.
Remember: These are my OPINIONS and I treat home therapy differently because I believe rehab in the home IS different from rehabilitation in the hospital or inpatient facility.
If you have any questions or would like to share your own experience with Physical Therapy, please leave a comment below. I hope this video and post were helpful. I am available for any questions, suggestions or comments because I am dedicated to making care in the home easier and safer!
Until Next Time,
Hey Shawna. As a certified EMT, I definitely have an appreciation for the type of work you do. I know it can be very challenging, but also very rewarding. I wonder if you could help me out, since my wife and I have tried just about everything. Even though she gave birth to our daughter almost 9 years ago, she still suffers from chronic lower back pain, which we believe was caused by the epidural she received pre-labor. Could you recommend some type of therapy that would help?
Chronic low back pain is such a common problem. One of the key components to chronic back pain especially following a pregnancy is due to the weakening of the abdominal muscles through the stretching of the muscles. We have 3 pillars of stability: muscles, bones, ligaments/tendons. When one of the three is weak, the other two need to step up! Ironically, to build stronger bones you have to build muscle strength because bones react to the forces placed on them–with increased force comes increased strength. I recommend doing REVERSE ABDOMINAL CURLS–lying down so the back is supported, you raise your knees toward your shoulders, with your knees bent. In a traditional abdominal curl you are raising your or the shoulders toward your knees–this is very uncomfortable and takes longer to get results including pain relief. I have my patients squeeze the exercise ball in between their legs while completing the reverse abdominal curls. Another great stability exercise for the back–for someone just starting back stabilization is a hamstring curl while lying on the back. Again, using the ball, she would place both ankles on the ball, tighten her stomach muscles, elevate her buttocks slightly off the floor, and then bend/straighten the knees doing a hamcurl. If she can’t tolerate having both her legs on the ball initially, then she would bend one leg, place that foot flat on the floor next to the ball, and then do a hamcurl with the other leg on the ball. She can start doing about 8-10 reps and then increase to her tolerance. Finish with what is called NONWEIGHT BEARING LOW BACK MASSAGE: Lying on the back, both knees bent and shoulder-width apart–using pillows between the knees helps to keep the knees shoulder-width apart–she will gently rotate both knees side-to-side. This should not hurt at all–if she has pain, she is rotating her knees too far over to the side. Always walk–it’s the best type of exercise to warmup and cool down the body. Text me with any questions or clarification needs. One final note: Be sure she replaces her bra and her shoes regularly. Just like a car needs proper alignment and tire tread to run efficiently, our shoes are our tires–over time they wear out and throw off our alignment. If you add the effects of compromised breast support, overall alignment is thrown off even more dramatically and the result is increased pain. I know this is long winded, but these tips have helped my patients struggling with chronic low back pain.