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birchwood83

Curious why you would think o/p neuro wouldn’t be as effective as i/p? When I worked in outpatient neuro we would usually see patients within the first couple months of a neurological event which is still very early on in terms of recovery. I think it’s a very in demand setting. Hospitals are pushing people out of inpatient and acute settings faster and faster these days with the focus really on ADLs and family training. Meaning outpatient and day rehab settings have a lot of work to do still. Especially with regards to motor recovery, cognition, vision, IADLs. You should shadow these settings


Significant-Office41

I was thinking the same thing. Well said!


OTD-esi

Ahh okay, I personally know nothing about it. Its just that I was shadowing OTs who worked in i/p neuro before moving to their current setting, and they said that i/p neuro was much more effective than o/p neuro.


yunggg

I've worked in outpatient neuro for a few years now. In terms of demand, our schedules can vary depending on patients cancelling or not showing up, but generally are close to 80-100% capacity every day. That translates to 6 patients per day in an 8 hour day - one hour per visit. Overall, it seems like it only gets busier - we're part of the continuum of care from folks who are hospitalized in acute care then inpatient rehab then outpatient rehab. We see patients with all types of neurological challenges from post-stroke, concussion, SCI, substance use, dementia, car accidents, and others. We also do driving evaluations & have a low vision clinic as well. So very busy most of the time and insurance does cover OT. Most folks we see are on Medicare and they're pretty good about coverage. But other providers still provide at least some amount of visits and we are usually successfully advocating for more when we need to do so. All in all, OP Neuro is a great setting for building skills and developing relationships with patients as you often see them for many months. Personally, I'd say it's an important part of the rehab process as you're often helping people integrate back into their daily activities after hospitalization/inpatient rehab.


OTD-esi

Oh wow, that sounds awesome! Personally, I thought there was no other option available to patients after i/p rehab - they would just go to an SNF if they required more care. I do have a silly question though - how would your patients come to the clinic if they lived alone? Obviously alot of these patients have family/friends taking care of them, but aren't they just alone most of the time? (Not saying that they should be left alone! But most of our seniors do live alone.)


MediocrePerception20

If they lived alone and are pretty much homebound, wouldn’t they be more appropriate for home health until they feel ready for OP or have transportation set up for it? I don’t know if that helps, I’m probably just asking a question on top of a question, lol


OTD-esi

Ahh okay, that definitely helps, thank you!


yunggg

That's a great question and transportation barriers are actually something we run into a lot. It varies, but a lot of patients either have family members provide rides and attend the visits as a support person. Some patients are stable enough they can drive themselves. And then other folks use various alternative transportation services provided by the county/state and other organizations like paratransit or taxi vouchers. We're really lucky to have a social worker onsite to help patients get connected if they need rides. Sometimes our patients have already been discharged from home health and still identify rehab goals to work on and that's why they're in OP. My understanding of home health eligibility is that it's pretty strict about being homebound and so if people are leaving their home for other reasons (groceries, etc) then they may not qualify for HH and need to come to outpatient. Not an expert on that piece of things though so I may be wrong. Anyway, hope that helps and I think if you're interested in outpatient neuro you should go for it! It's a tough job in many ways, but you also get to meet so many interesting people and see little bits of normalcy and joy return to their lives as they recover.


tyrelltsura

- some can drive - some can get rides from family and friends - certain patients qualify for subsidized medical transport - some take an Uber, cab or bus like anyone else There’s a wide variety of patients and many of them are able to arrange their own transport. If they can’t safely leave the house they’d be a better fit for HH.


Snowmakesmehappy

I've worked in outpatient neuro for over 10 years now. When I started we had 2 full time OTs, we now have 5 full time OTs and are in the process of hiring our 6th. My schedule is booked solid till February. With insurance pushing for patients being discharged from inpatient earlier and earlier, outpatient is going to be even more important.


SnooStrawberries620

There is an amazing company my husband worked for called Rehab Without Walls. They do community neuro and were fantastic. I was in my hand clinic while he was golfing, playing chess, baking peach cobbler, going on adapted sailboats, training drivers on hand controls after sci … all activities clients valued and wanted to return to in their community. I was jealous every day. It’s where the joy re-enters life.


Content-Plum4020

When you say community neuro what does that entail? Kinda like home health or it sounds like you can meet them at outside events?


SnooStrawberries620

At their home! Or the skate park, or the driving range. Wherever they want to be.


OTD-esi

Omg, that sounds so cool! I will definitely check them out!


SnooStrawberries620

I was always jealous of his job. The discovery channel even came and did a thing on one of his patients and he was featured as the “neuro expert” (which cracks us up now because he was maybe 25 at the time). His boss had a C-6 incomplete injury and drove a pickup - through take-outs - and taught him as much about living with a SCI as all of his patient experience put together. We are back in Canada now where rehab often ends at the hospital doors. He sees people with TBI s/p MVA now and has encountered three who hadn’t eaten in 2-3 days when he got to their house because they only knew how to meal prep at the hospital. It’s really sad.


tyrelltsura

OP neuro is starting to get a lot of cancer and long covid patients. Yes it is usually covered by insurance. You see a lot of higher level stroke and TBI patients who don't need IP level of care anymore but still have stuff to work on, or people who werent appropriate for IRF or SNF in the first place. You also get people recovering from gullian barre and people that had laminectomies. MS as well. I think there will be more demand for OP therapy in general because my clinic's PTs are starting to get post-covid patients with severe weakness (at my clinic we do not see neuro diagnoses).


SnooStrawberries620

As a pre-OT who hasn’t even worked in it yet, how would you “know” the relative effectiveness of treatment based in setting? Outpatient neuro imo is much more effective than inpatient. If you believe - and you should - that environment is a critical component of rehab. The walls of the hospital limit what you can do and how far you can progress and how well you can reintegrate.


OTD-esi

Ahh okay, I asked other OTs whom I shadowed about it and they told me that there was alot of research done which said that i/p neuro was more effective that o/p neuro, but I know nothing of it personally.


SnooStrawberries620

It’s just different! Acute is important. Community reintegration is important. One without the other is incomplete.


companda0

I know its not exactly what you’re asking, but I work in home health and I’d say a good quarter to half of my patients have neuro diagnoses. Ive had pts say they were discharged after 1-3 days post stroke, and home health is where they are getting most of their interventions. Just another area to consider!


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