Maintaining and Improving Mobility at Home

Abstract

Even today, no one can say with certainty for how long patients with hemiplegia will continue to recover or regain useful motor function. Many hypotheses as to the probable outcome of rehabilitation have been put forward, but all provide only a statistical probability which has nothing to do with individual possibility, and there have been many surprising exceptions to the prognostic results. It is certainly not true that after 3 months, or 6 months or even a year no further improvement in a patient’s condition is possible. Improvement continues far longer, with recovery of function occurring more than 5 years after the onset of hemiplegia (Bach-y-Rita 1981b; Kaste 1995). Because of the present-day financial limitations in health insurance, many patients will have to stop receiving treatment before they have achieved their full potential or even regained independence in activities of daily life. For some patients cessation of treatment means that they will not have the chance to achieve what might otherwise have been possible, such as being able to walk, to go out and about with others and to enjoy life more fully. It would be a great pity to stop too soon after spending so much time, effort and money on expensive diagnostic measures such as magnetic resonance imaging (MRI) or positron emission tomography (PET) and on the costly, comprehensive treatment during the intensive care and rehabilitation stages. With regard to how long treatment should continue, the same principles as for other medical, surgical and traumatic conditions should be followed and the same reasons considered valid. Treatment should certainly not be curtailed on the grounds that it is taking too long or is considered to be too expensive. If a patient with hemiplegia is still making progress because of the treatment, it should definitely be continued, just as a patient with tuberculosis who requires 2 years of hospital care with expensive medication before he is cured has the necessary treatment financed without question. Similarly, a patient with a fractured femur that has failed to unite would not be denied prolonged treatment on the grounds that it was taking longer than expected or that surgery to make walking possible would be too expensive.