Is this what physical therapy is like?

[NiteNicole]

So my daughter is on new meds and responding really well. In the past week she's gone to not really walking unassisted to walking without help. She still bobbles a bit but I think she's getting ahead of herself. She can finally move faster than a snails pace and not fall and she's excited. I hope going forward, she'll just keep getting better.

We took her in for an occupational and physical therapy eval. First, our insurance does not pay for OT and it's $300 per HALF hour. Our insurance does not pay for physical therapy, they "negotiate a rate" for us.

We had our OT eval first. The OT explained that she understood it's expensive and if it's nothing really profound, she can make recommendations based on the eval and the PT can work on that with her. DD had a slight tremor in her hands and low grip. She was somewhat nervous and she's just a kind of "soft" kid. She is like me, she doesn't slam things. If something is new, she approaches with a soft touch. The OT said some kids are just like that, whereas some kids are off the charts in the other direction because they're just like that. Ok. Also, the tremor did not interfer with her stacking all the blocks straight up.

During the eval, the OT had to leave twice to find materials. She checked her pager a few times, the student with her had to go gather materials. People were in and out the whole time. The OT kept scribbling things down on scraps of paper and misplacing them. This did not make a great impression on me.

Then the PT. Nice guy, good with kids. During his eval, the OT was back in and yammering away at us while the PT is doing his thing. I'm trying to hear what I need to hear from both as well as watch what my daughter is doing. He says she has some weakness in her trunk and some other stuff. Two neurologists, a orthopedist, and her ped have all said...at least she doesn't have any weakness. I don't think he knows how to account for the fact that three year olds don't always follow directions well, especially when five adults are standing over them conversing loudly and she's unsure of what's going on.

Then he takes her out into the work room or whatever. There's one kid sitting on the floor sorting blue things into a box with a very impatient tech. There are three thechs standing over one child who is in a chair playing with a car. They were gossiping about coworkers when we came in, and still doing it when we went out. There's another kid in a room with one tech, another kid who must be like 16 with someone else...in general, it didn't look like a whole lot of anything was going on. AND they don't like the parents watching. The waiting room was chaos, the work room was chaos, the eval was a mess.

In the end, the PT recommended 30 minutes a week for a year. WHAT is she supposed to get from 30 minutes a week for a year? It would be one thing if he did some things with her and said ok, Mom, you go home and do this every day but...come on? It looks like a huge insurance scam to me.

Also, I don't have a whole lot of faith in these techs. My cousin just stopped working in this facility two days ago. She was a tech. She has a degree in criminal justice and no background in PT/OT at all. What the heck? $300 per HALF hour for that?

I am not saying PT and OT are useless, I just think that unless my child is getting some serious one on one time - it is going to be a waste. What I want to know is - are all facilities like this? This place is supposed to be "the best" around here. They're attached to the major hospital in our area and it looks like a whole not of nothing is going on.

I don't want to skip it if it could help my daughter but I will be honest, we have taken some HUGE financial hits. It has been a hard year. I don't know what services I can get for her through public school in our county, but I'm not hopeful there's much. I hate the idea of not taking her to PT because we "can't afford" it but chances are, we can't. I don't know if I can scrape together the money for something that doesn't look like it's going to help.

We have bikes, we have a mini trampoline. When the weather is nice, I make sure I drive her (yes, drive, there are none close by) to a park at least once a week so she gets climbing and play time. We have a swingset, slide, something to climb outside. When the weather is nice, we have a pool. If I am making sure she gets plenty of exercise, what good will 30 minutes of PT do for her?

[pixiepunk]

i'm sure the laws vary by state, but where I live very little is allowed to be done by what you are calling a "tech" (in the field they are generally called aides, I'm assuming that's what you mean since aides don't require specific education, and just on the job training). In my state most everything needs to be done by at least an OTA or PTA (these are degreed people who pass state licensing exams and have specific education and clinical training in their fields, though they are associates degrees vs. masters+ that OT's and PT's have), they tend to do most of the hands-on daily work with the patients, and the PT's and OT's do the evaluations and review the notes with the OTA's and PTA's regularly to discuss options for treatment and progress.

There are places that are good, with lots of oversight and dedicated staff and then places that aren't. it sounds like this place isn't. I especially do not like that they require parents to wait outside during treatment - that is totally counter-productive, the parent needs to see what is going on so they can follow-up at home. I've never met a PT who doesn't require "home work" in an out-patient situation like that. Yes, they might only see you once a week, but in between you are supposed to be doing stuff on your own. For example, when DD1 had a mild torticollis and tight hip, we did PT once a week for a few months. i was with her the entire time, helping the PTA in some instances (ie, encouraging DD1 to climb the stairs by standing at the top and calling for her), and she gave us stuff to work on through the week (in our case mostly stretching).

just for reference, my mom is a PT and i'm in school to become a PTA. I think PT can work wonders but it has to be a progressive approach and they have to know what they're doing and have the kind of dedicated staff that can make it happen. you only learn so much in school, and continuing education is really important. plus, pawning off all the patient care to aides is not cool. where i live it isn't even legal. aides can do stuff like walk a patient or help them get out of bed, but they are not allowed to actually do treatment like gait training or exercises or the like. that needs to be done by at least a PTA. AFAIK the same is true for OT work - it needs to be done by at least an OTA.

what about your local school system? is there a birth-to-3 or head start program where you live? you might actually be able to get most if not all of her treatment free through the school system.

[NiteNicole]

Aid. Thank you. I just couldn't spit out the word.

From what I understand, they have one occupational therapist and two physical therapists for the peds area and a whole lot of aids.

I guess I will see what this is going to cost and then make a decision. Obviously if we can afford it, we'll try it and see what happens. I do know that they are not in any way doing anything where I'm not "allowed" to watch. That's BS.

My daughter is four and she's not in pre-school. The PT facility we went to is in a different state. We're going to contact the school system and see what we can find out here.

[preemiemamarach]

Originally Posted by NiteNicole

My daughter is four and she's not in pre-school. The PT facility we went to is in a different state. We're going to contact the school system and see what we can find out here.

I think it's great idea to go through the school system. I know it varies from state to state, but here in CO I will be able to get services for my son (he's in birth to three now) at home, since his health issues make preschool hazardous to him to attend full-time.

I would look into your state's parent-to-parent organization. I've gotten a wealth of info from ours, and even found a local contact to advocate for us when we are developing my son's preschool IEP.

Also, FWIW, I think that center does sound very poorly run. Perhaps there was a lot of work being monitored by students the day you were there? We've always done therapies at home because of my son's immune issues, but I've been to a few outpatient centers, and I hope you're able to find a better solution than the one you just went to.

[karne]

I'm also going to say that eval, and possibly service, through your school district can be a really good thing. One of my kids has OT, and is quite a bit older than yours, but I am happy with the services. One of the biggest bonuses for us is that the providers have contact with other school personel, and I find that this helps enormously with classroom accomodations. I know that you're not there yet, but I just thought I'd share our experience.

[jennabean]

My son receives PT and they come to the house. The facility they have is nothing like you describe though, we've been there 2x at my request... It was/is all one on one. The PT said that they've recently switched the whole gestalt of PT to in-home b/c parents need to be able to recreate the therapies used with the resources around them.

Personally, for that kind of $ I would not use them. We recently dropped our OT for a similar reason... she was OK, but just OK and our insurance co-pay doubled and she just didn't seem worth the $ for what she was doing for us.

Its hard b/c I sorta felt like a neglectful mom when I canceled the OT services but no one but me knows what our finances are like so I just did it anyway

Best of luck to you, it sounds like your daughter is doing well with what you're providing her

[logan&jordansmommy]

It sounds like that is a poor run facility to me. We have been doing different therapies for 4 years and I can tell you that it varies so much from facility to facility and therapist to therapist. Even a great therapist might not be a right fit. In the short amount of time the therapist actually works with the child, it should be more about yes, working with the child but mostly showing you what to do. I don't like places that don't welcome you back. Now if the parent doesn't want to go back because they have other children to watch or their child works better without them then I can see that. And in that case, the therapist should spend 10-15 minutes with you explaining what they worked on and how you can help.

I didn't get to read all the replies so you may have said, but are there any other facilities to go to?

The part about low tone in the trunk could be true. If it is something you question though I would ask them to show you what they mean then you can get a better idea if it is weakness or just not following directions. The reason I say this is because when doctors see my son they see him as healthy, jumping all over, climbing etc and they have all told me he is SO strong. Then our OT (once we got a good one) showed me why he actually has low tone in his upper extremities.

Good luck! We have been hit hard financially too so I do understand the frustration of not being able to get your children all you feel they need, not a good feeling

[NiteNicole]

Thanks for all the info. I'm pretty much lost in this process. We live in a very rural area (and in the past week I think we have talked ourselves into trying to sell our house and move because there is just NOTHING. HERE.), and there just aren't many resources. We only moved here recently and we don't know anyone except my parents and older people. We live in one state in a town of 400 people, our ped is an hour away in another city and state, the neuro is two hours away in another state, the pt and ot that's closest to us is about half an hour away...in the other state.

We are going to have to try to deal with this through the school system, I think. We are just so so close to just making our bills right now (honestly, since we bought this house it's just been one thing after another. Obviously I'm not "blaming" the house but it's been a rough few years).

Also, we're always kind of hoping...maybe the meds will just clear this up. In the first month she was on the first med, she was walking fine by the end of the month. She's only been on the new meds for a week and she's so SO much better already (actually, I guess a week and a half) so...maybe?

And thanks for the advice about checking out the services in the school systems before we move. That is certainly something for us to focus on.

All this and I just remembered I have a cousin who does pt. He mostly works with sports injuries and adults, but *light bulb goes on* I should really be talking to him about this and getting his advice and perspective. Duh.

Thanks so much for all your replies. I am going to reread the thread and take some notes.

[KatWrangler]

I am sorry to hear the trouble you are having. Even when we lived in Bozeman, Montana we had great PT services. I mean awesome service! Now it was more of a pain for my daughter's specialists (they were quite a drive away and NOT ped specialists) but still we had pretty good care. Except Urologist. Which we were looking at switching to a Doc in Spokane.

[NiteNicole]

We've contacted someone from the local school something or another and they've told us to come get a form to fill in. We're doing that tomorrow as it's in another town. The lady we spoke to said to do it as soon as possible and she'll be on the lookout for our application.

Obviously I am still hoping the meds will take care of her gait issues, which her neuro says is possible, and this won't be so pressing. If there are any services she needs or that we can get for her, we want to do that, but it would be nice if I didn't have to feel like a deadbeat because I can't afford $300/30 minute OT session and we still don't know what PT will cost.

And if one more person says, "at least her college will be paid for" I. will. scream. First, what is that? Who even knows if that's true? And as if that's some kind of fair trade or I'll be getting one over on the state. I want my child to WALK and RUN and have a normal life. I will worry about college some other time.

[anj_rn]

In Texas, the initial assessment must be done by an OT or PT, and then the patient must be assessed monthly by the same OT or PT. The OTA and PTA then carry out the plan outlined in the OT or PTs assessment. Our clinic also has "techs" that clean the equipment, help move patients, assist the licensed therapists and aides during therapy, etc.

We currently see an OT (2/wk), a ST(2/wk), and a PTA(3/wk), and have homework to do for each of them. We love them all, but we had to go through a few to find the ones we liked.

((((Hugs)))) to you as you start this journey.

-ap