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    Functional PT goals

    I need to formulate functional goals to justify the treatments I would like to get. I was hospitalized and lost about 20% my body weight. Evidently insurance companies do not care about my regaining weight in the form of muscle and bone rather than fat. I would like to justify standing, and E ? stim on my quads.

    Also, only my PT does E ? stim, so I need PT goals to justify stim that is really helping with my upper extremity/OT goals: my forearms for my fingers and wrists, biceps and triceps, deltoids I guess (or whatever I need to raise my arms).

    Any ideas?

    #2
    What the insurance company is looking for is just that...functional goals. Not strengthening, not endurance. They want to see that you are going to improve your independence in such things as transfers, manual wheelchair mobility, turning in bed, self care (ADLs), etc. Unless there is an activity that you have to do standing (such as for your job) they are unlikely to pay for standing, and as far as E-stim, both PTs and OTs do this, but again, they would need to write it up as a step to increasing functional independence for activities such as those above, not just for generalized strengthening or muscle bulk building. Talk to your physiatrist and PT about writing up the justification if you have functional goals that require these things to achieve.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #3
      Thanks for the advice. It still just tortures me: standing makes me so much better in so many systemic ways, and my heart aches and my spirit flags when I look down and see just sticks with flab hanging off of them where my quads were in September, and I remember being able to stand for whatever was the length of the movie I watched.

      I understand the limitations of their professional guidelines, but it still really irritates me when on an attitudinal level my therapists insist that I can’t really improve and that there is no point to my retaining as much “non-functional” (at the moment) bodily integrity as I can. They clearly think that I am being just delusional trying.

      So I was looking for a Wise paper to update them on the status of things, but that place on the site seems to have only dated articles. Does anyone know of a more recent paper I could share? Or does anyone know where is the thread I remember where Wise advises how to maintain while waiting for cure?


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        #4
        I realize I got to only half the story last night. I do have a lot of functional OT goals. I was making progress toward a lot of them using electrical stimulation on my upper extremities. The problem is that none of the OTs here perform electrical stimulation. So I don’t even know what to ask. I particularly need to improve my finger dexterity and strength, elbow flexion and extension, and whatever I need to get my hands to my head and face (deltoid tone reduction and strength?). So could any of the following be considered a PT goal: feeding myself, washing, grooming, brushing my teeth, dialing the phone, operating a TV remote, staying upright in bed or chair, reaching for things, operating my bed control, sitting stably in bed – staying upright and not falling out – maintaining sufficient neck posture to keep your head where you can eat, be

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          #5
          Random, my opinion, absolutely each and every one of those things are and should be considered the types of goals you are trying to achieve. If you can improve all of these things, there will be countless other things that are improved at the same time you are not even aware of.

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            #6
            From Medicare's standpoint:

            These are functional activities:
            feeding myself
            washing
            grooming
            brushing my teeth
            dialing the phone
            operating my bed control

            These are not
            operating a TV remote (not seen as medically necessary)
            staying upright in bed or chair (would have to be tied to some type of self care function)
            reaching for things (this would need to be spelled out...what things, for what activities)
            sitting stably in bed (would have to be tied to some type of self care function)
            staying upright and not falling out (would have to be tied to some type of self care function)
            maintaining sufficient neck posture to keep your head where you can eat (would have to be tied to some type of self care function)
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

            Comment


              #7
              So it my insurance mimics Medicare, I am just screwed. How are you supposed to perform any of these ADLs without being upright and stable, let alone alive because they don’t care if you fall on the floor? They want me to spend my next 50+ years just surviving in bed?

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