Clinical Programming

Exercise isn’t just for young people. We believe rehabilitation providers don’t push older adults hard enough. Research shows that exercise is effective in older adults with little risk of adverse events. FOX bases interventions on guidelines grounded in literature by The American Heart Association and the America College of Sports Medicine. Highly trained clinicians use their skills to prescribe the optimal intensity based on the patients’ presentation. The result is superior functional outcomes in a shorter time frame.

Did you know there’s a 10% decline in strength per decade after age 30? So people in their 80s or 90s will lose 50-60% of their strength without intervention. That can lead to reduced quality of life, higher healthcare costs, and even death from falls and other consequences of poor or limited movement. Literature suggests that exercise should be prescribed 60-80% of the patient’s maximal ability.

FOX therapeutic exercise addresses specific impairments. These impairments may be related to the reduction or loss of:

• muscular endurance
• muscular power
• range of motion

We, at FOX Rehabilitation, use the most current evidence to provide patient-specific and skillfully-dosed exercise to maximize positive outcomes.

A big part of treating balance and reducing falls risk is related to strength. So, when we dose therapeutic exercise properly, we reduce balance-related issues and falls. FOX proactively screens patients and gathers information on changes including overall balance, and how pathology, impairments, functional limitations, behavioral patterns, and environmental factors affect the ability to move in space. If the individual demonstrates signs outside normative values, we request physician’s orders for a tailored treatment program before an adverse event occurs.

Differential diagnosis means “distinguishing a particular disease or condition from others that present with similar symptoms.” Since we see patients in their home setting, this is a critical skill sharpened with frequent education from our Quality Assurance and Professional Development Division.

FOX clinicians intensely study the functional impairment, and then following Medicare guidelines, send their differential diagnoses, evaluation, and plan of care to a physician for sign off. We do not diagnose medical disease. So when “red flags” indicate a condition that falls outside our scope, we refer to the appropriate medical professional to ensure patient safety and improvement.

For physiological monitoring, FOX monitors vital signs including respiratory rate, heart rate, lung sounds, blood pressure, and oxygen saturation throughout sessions, treatments, and interventions to ensure that the therapeutic plan of care is properly dosed, and risk of adverse events are mitigated.

FOX clinicians are empowered to provide skilled treatment to a Medicare Part B patient as long as is medically necessary. Our documentation standards are extraordinarily high. Among other things, our rigorous documentation is the means for our clinicians to provide clinically-excellent interventions according to the clinician’s plan of care that is skilled in nature and is medically necessary for the patient to achieve optimal results.

At FOX we believe that a patient with cognitive impairment can achieve equal, if not better, outcomes if they are pushed, dosed, and effectively treated. We assess patients on an objective, evidence-based scale in order to tailor treatment to impact their functional abilities and allow them to age in place effectively.

Cognitive impairments include deficits related to particular processes and systems (i.e., attention, perception, memory, organization, executive function). Areas of function affected include behavioral self-regulation, social interaction, activities of daily living, learning and academic performance, and vocational performance.

The cause of cognitive impairments may be stroke, brain tumor, traumatic brain injury, anoxic or toxic encephalopathy, and non-degenerative and degenerative neurologic diseases (including Alzheimer’s and other dementias). Restorative treatments can help to improve the cognitive functioning related to a wide variety of activities, whereas compensatory treatments can teach and train strategies related to specific problem areas.

FOX clinical team members (PTs, OTs, and SLPs) assume a variety of roles when working with individuals who have cognitive impairment:

• identify needs
• provide assessments
• develop interventions
• counsel
• collaborate
• educate
• advocate

Because there is such a high incidence of cognitive impairments with serious consequences, proven preventative efforts, assessment, diagnosis, and management are critical.