The neurological program is appropriate for individuals recovering from stroke, traumatic brain injury, or neurodegenerative conditions such as Parkinson's Disease.
Initial Evaluation may include:
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Patient/Caregiver Interview & Review of relevant medical documents
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Cognitive Screening
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Formal Balance Assessment
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Joint Range of Motion/Strength/Muscle Tone Exam
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Ocular Motor/Vestibular Screening
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Sensation Exam
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Functional Activity Analysis
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Fine Motor Coordination Assessment
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Standardized Visual-Perceptual Assessment
Treatment Sessions:
Treatment sessions are tailored your unique goals and are based on the results of thorough evaluation. The focus on any specific deficits (e.g. improving strength, balance, cognitive skills), modifying the environment or task using adaptive equipment or techniques.
I find it helpful to use a 2 prong approach to meeting goals with neuro patients & often draw a diagram like the one below to help patients & families better understand what to expect in a quality therapy program:
Remediation - Improve physical/mental performance
Compensation - Alter the task/setting to facilitate success
Goal Achievement
For individuals who experienced initial onset many years ago or for individuals with degenerative conditions, sometimes the focus is more about maintaining function rather than seeing massive changes. These are all concepts which can and should be explored.
The vestibular program is for patients suffering from unexplained dizziness, disequilibrium, or motion sensitivity. Benign Paroxysmal Positional Vertigo (BPPV) is relatively common and tends to recur frequently. For patients with a history of BPPV, a brief evaluation/treatment is appropriate. For patients with concussions or other more complex vertigo, a more in-depth evaluation may be necessary.
Brief BPPV Eval/Treat
Initial Evaluation may include:
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Ocular-Motor Screening
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Symptom Review
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Balance Screening
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Testing & Treatment Maneuvers
Concussion/Complex Vertigo Evaluation
Initial Evaluation may include:
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Ocular-Motor Screening
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Motion Sensitivity Analysis
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Balance Assessment
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In-depth symptom review
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Testing & Treatment Maneuvers
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Cognitive Exam if needed
Treatment Sessions:
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An open discussion about symptoms is vital when dealing with vertigo. Re-checking for BPPV and completing any necessary maneuvers should be done regularly.
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Complex vertigo include conditions such as Vestibular Neuritis, Labyrinthitis, Vestibular Migraine, Meniere's Disease, and many others. Concussions, Strokes, and other neurological conditions can disrupt the way the brain interprets visual stimuli and body movement. These cases are complex but in almost all situations, some graded systematic desensitization with vestibular exercises is needed.
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Concussions can bring on cognitive changes which many describe as "brain fog," as well as changes in emotional control/self-regulation. These are areas that can be worked through systematically during treatment.
Cognitive rehabilitation can be appropriate for patient with any level of impairment. For patients with mild cognitive impairments, formal standardized tests can be used. For patients with progressive conditions or more advanced dementia, it is often more appropriate to focus more on quality of life.
Initial Evaluation may include:
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Patient/Caregiver Interview, Review of relevant medical documents
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Formal Cognitive Assessment or Qualitative Screening
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Speech-Language Screening
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Leisure Exploration
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Environment & Quality of life Review
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Analysis of tasks/Goals of patient
Treatment Sessions:
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Cognitive treatments can target high-level, return to work activities or other more challenging skills such as financial management, medication management, or skills necessary for return to driving. This can include working on attention/concentration, short-term memory, processing speed, and executive function skills like planning, organization, decision making, etc.
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Sessions for individuals with beginning to moderate level dementia may target training compensatory strategies like checking a wall calendar for the answer to a recurring question, creating memory books or reminiscence therapy, or spaced retrieval therapy to recall a few high priority items.
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Sessions for advanced dementia focus more on maintaining quality of life. The emphasis is on functional use of basic objects, Montessori style exploration, and gentle movement.
Speech-Pathology Program
A thorough SLP evaluation involves careful standardized testing of speech, expressive language, receptive language, and cognition. Swallowing dysfunction can also be address but requires a Modified Barium Swallow Study (MBS) and/or FEES study to be completed prior to beginning treatment for clear picture of the problem.
Speech-Language Evaluation
Initial Evaluation may include:
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Patient/Caregiver Interview, Review of relevant medical documents
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Speech Intelligibility Assessment
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Standardized Aphasia Examination
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Standardized Memory/Cognitive Exam if possible
Swallowing Function Evaluation
Initial Evaluation may include:
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Patient/Caregiver Interview, Review of relevant medical documents & instrumental exam
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Food trials and strategy trials
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Begin training in exercise program
Treatment Sessions:
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Treatment for speech intelligibility often requires a lot of drilling to re-write the motor plan.
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Treatment for language disorders also involves a great deal of practice at the "just right" level of challenge as determined by the evaluation.
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Swallowing therapy also involves a lot drills on specific swallowing exercises to improve strength and coordination of the swallowing mechanism. Both VitalStim therapy (electrical stimulation to swallow muscles) and the McNeill Dysphagia Therapy Program (MDTP) are available at Evolve.
Treatment
After evaluation, recommendations for the number and frequency of sessions will be provided. Recommendations are estimates and depend greatly on carryover of strategies at home & individual adherence to home exercises. Patients are welcome to request an increase or decrease in frequency of visits based on their unique needs and situation. Sessions are 50 minutes in length with final 5 minutes reserved for final debrief on home program and questions.
Individual Evaluation session $250/hr
Individual 50 minutes session $150/session
Virtual Therapy is available upon request
*A $50 no-show fee does apply for cancellations made with less than 24 hour notice.
