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The Following Tips utilize compensatory pathways (or "neural detours") to achieve your goal. Check out this article for more information.


Disclaimer: Below, you'll find my 3 most frequently offered tips for those with Parkinson's Disease. This is NOT a substitute for evaluation and skilled physical therapy treatment. Any exercise comes with risks such as loss of balance or muscle soreness. Please make sure you have safety precautions in place if you try these things, in case you lose your balance.


If you have any concerns about your balance, or using these techniques, please reach out to your PT. If you need help finding one near you, please reach out and I'll try to help :)


#1 When you are “stuck” or “frozen” try this!


If you get frozen while walking, and you feel like your feet are stuck to the floor, do NOT try to push through it. This will just make you tired, increase your risk of falling forward, and probably won't help. Freezing is often caused by having too much weight on the leg you’re trying to move. To fix this and get “unfrozen”, pause for a moment and try “The Four S’s”.

  1. Stop where you are and find your balance

  2. Stand up straight

  3. Shift your weight all the way over one leg

  4. Take a step with the opposite leg

This process allows your brain to give attention to the movement and addresses the reason most people freeze while walking. It also uses the Purposeful Movement Detour.


#2 When you feel like your steps are getting small, Count your Steps.

Really, you should try counting your steps out loud. Here are 2 separate techniques you might use.


“Cadence Counting”


For this one, you’re going to count a rhythm as you step. Say out loud: “1, 2, 3, 4, 1, 2, 3, …” No need to count to 100 or anything like that. Think of it like a marching cadence. In fact, some people prefer to use a metronome or a song with a strong beat to walk with. You step in time to the beat and you try to keep your steps at an even tempo. This technique takes advantage of the auditory cuing detour.



"Predict the Future"


This option, which may work better if you can't keep a steady beat, will use the purposeful movement detour. In this technique, you locate your target location, (the front door, the kitchen table, the front entrance of the store) and make a prediction. “How many steps will it take me to get to the target location?”

To make this work, you need a real prediction, so let’s say you said “It’ll take me 6 steps to get to the door.” Next, you get to test your prediction. Count your steps (out loud is better) between your starting point and the target. Being correct isn’t vital, you’ll improve your predictions with time, but trying to meet the prediction will help your brain use the purposeful movement pathway to walk more efficiently.


#3 If you feel it's impossible to get out of a chair

Similar to #1, this one starts with a Pause. Relax back into your seat and assess your setup.



  1. Are you far enough forward in your chair? Scoot forward if needed

  2. Are your feet too far out in front of you? Tuck them under

  3. When you’ve assessed your setup, and are ready to try again, make sure to do a BIG lean forward to get your weight over your feet as you stand up.


What If I was just diagnosed and don’t have many motor symptoms yet?

Fabulous! At this point, your focus should be on slowing the progression of the disease. The single BEST way to do that is through exercise. Need to know what exercise is best for you? Check the Resources linked below or send me an email. I’d love to help!


Resources:


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Move Free Physical Therapy has partnered with Reimbursify to make it easy for you to submit your claims for out-of-network health insurance reimbursement using your smartphone. Download the app and get your first claim free (future claims are less than $3 each):


How does my Insurance Work?


First off, let's define a few terms.

  1. Premium: This is the amount you pay each month in order to say "I have insurance"

  2. Deductible: This is the amount of money you must pay in a year before the cost sharing of insurance kicks in. Usually there is an "in-network" and "out-of-network" deductible

  3. Co-Insurance: Once you've met the deductible, this is the amount of your bill you're responsible to pay. In an 70/30 plan, once you've met the deductible, the insurance will pay 70% of the allowed amount, and you will be responsible for the 30%

  4. Balance Billing: What you get billed an amount after the insurance gets pays its part

  5. Prompt Pay Discount: What you pay at time of service


OK I see, how do I get this information?


In an out of network situation, (where you want to see a provider who isn't in network with your insurance company), you should call the number on the back your insurance card and ask:


What are my out of network benefits for ____? (Physical Therapy, Mental Health services, Specialist visits, etc)

Write down your: Out of Network (OON) Deductible; Amount of OON Deductible Met; Co-insurance percentage


With this information you can now make an informed choice with your chosen provider regarding Prompt Pay Discounts, or Balance Billing of the full charge rate


How does a Prompt Pay Discount work?

  1. You pay a discounted rate at time of service

  2. You take a "superbill" and submit it to your insurance

  3. You receive reimbursement of the insurance's portion of the discounted rate (say 70% in our example above), once you have met your deductible

What about Balance Billing?

  1. You ask the provider to bill OON to your insurance provider (who will be billed at the full charge rate)

  2. Your insurance provider will pay the provider their portion of an "Allowed Amount" (an amount less than the charge rate) after you have met your deductible

  3. You will then be responsible for the difference between the charge rate and allowed amount + your co-insurance (the 30% in the example above); or the full charge rate if you have not yet met your deductible

In most scenarios, especially with high deductible plans, you will come out ahead with paying at time of service and submitting your own claim to insurance for reimbursement. You will know what to expect, and you will not have any surprise bills months down the line.


Also, please remember, your provider is NOT obligated to bill your insurance for you and may do so as a courtesy. But you can feel free to ask about a "Prompt Pay Discount" and for the "superbill" so you can submit toward your own insurance.



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Updated: Nov 4, 2022



If you or a loved one is currently hospitalized, you've probably heard people discussing if they need rehab before going home. The rehab process is a bit complex, but is a vital part in many people's return to normal life. Below I'll explain the process in a bit more detail. Please comment or email me with any questions.


1. Who needs it?

People who are sick enough for hospitalization, who have developed weakness or experienced a neurological or musculoskeletal trauma and need help with strengthening and learning how to best use their body before being safe and independent at home.


2. What does it entail?

Depending on the setting, the individual may receive anywhere from 1-3 hours a day of therapy services including speech therapy (working on speech, cognition, and swallowing), occupational therapy (working on activities of daily living such as bathing, dressing, and food preparation), and physical therapy (working on mobility tasks such as getting in and out of bed or chairs, and walking).


3. When will it be over?

There are multiple phases of the rehab process, stays in a rehab facility are usually under a month, and are followed by care in skilled nursing, home health rehab, or outpatient therapy. Rehab will continue until goals are met, progress plateaus, or insurance decides to stop paying (but there are private pay options as well).


4. Where does it occur?

Typically, for those with major changes in mobility related to their hospitalization, the post hospital rehab either happens in an Acute Care Rehab Hospital or a Subacute Rehab Facility (often a skilled nursing facility). These are inpatient facilities where the patient spends a lot of time working with therapies to help get the patients back home.


Acute Care Rehab is more intensive and requires the ability to handle 3 hours of therapy a day with a team-based approach. Subacute Rehab is somewhat less intensive and more appropriate for those with lower activity tolerance. The goals of the inpatient facilities are to maximize patient’s independence to allow for a safe return home.


After Inpatient rehab stays, often patients come home with the services of a Home Health Agency. To qualify for “Home Health”, the patient must be considered homebound. This means the goals of the home health rehab team are to help the patient be independent in their home and progress to a level where they are no longer homebound. This type of therapy is great for adapting for your environment.


Following Home Health, you may not feel that you are back to “normal” yet. At that point, you likely qualify for Outpatient Rehabilitation. These services are generally provided by separate companies for PT/OT/ST, and can be provided in a standalone clinic, telehealth, or by home visits. In the Outpatient setting, your end goals are key. Getting back to work, school, and recreational activities may be addressed in an outpatient setting along with continued work on activities of daily living, balance, and strength.


Move Free Physical Therapy at Home provides virtual and in home Outpatient Physical Therapy services for the convenience of our patients and to reduce the barrier to rehab that is lack of transportation.


5. Why is it needed?

Some physical conditions get better on their own with time, however once your mobility is limited to where it is difficult to get around and do your day-to-day tasks, it becomes much less likely that you will be able to recover by doing “normal life” on your own. The rehab process is designed to help you work through the challenges your condition has brought, and maximize your functional return to a sense of normalcy.


If you have more questions, I’d love to speak with you! Send us an email or give us a call!



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