Expanding the service landscape

[Guest guest]

Greetings,

I have been listening in on the valuable conversations about the PT business and

I am hoping you will humor me with some feedback regarding the questions I am

posing below.

I am a neurotherapist with a specialized practice in Autism Spectrum Disorders,

TBI (including CVA) and chronic neurologically affecting illnesses (like MS,

Parkinsons, CFS, Chronic Lyme, Mold Illness).

For the past 5 years I have been evaluating different neurofeedback (NFB)

technologies (both active and passive) for efficacy with these different

populations as the field has dramatically changed from old school approaches

used for many years. My starting goal for the client is recovery, which for me

means restoring sufficient function and capability that the individual is a

productive contributor to society.

While the NFB is only one part of the puzzle that I address, I have a functional

medicine practitioner involved with every case to address nutrition, metabolic

issues and toxicity, the NFB is almost always a game changer for these difficult

cases. The client must be willing to engage in lifestyle changes as well.

I have observed a dearth of PT/OT/SLP credentialed practitioners in this growing

field. I am wondering why that is and have been speaking to some local PT/OT/SLP

colleagues about this.

The insights I have so far include:

-NFB is completely absent in the scope of education for PT/OT/SLP

-the Neuro & Peds advanced training does not include this body of work

-no CEUs are presently offered for PT/OT/SLP practitioners in NFB classes

The other things I am wondering about include:

-is there reimbursement for these services (particularly CPT codes 90901 and

97152)? Can it be folded in as therapy under traditional 97112 because it is

focused on physiological capabilities (for example in a CVA with spastic limb we

do a specific passive therapy on the homunculus to normalize control and

movement)?

-is there capital to make equipment investments which are required to offer

these modalities?

-if insurance coverage was readily available, would it be more attractive? A

parity bill that went into effect in June 2011 is likely to improve this

situation with insurance.

-is there an issue with the skillset required to offer such servcies?

Maybe what I am really saying is if you follow the money, does it make sense for

these practices financially, not just based on outcome?

Does it make better sense for niche practitioners rather than larger scaled

practices? Is this because of " out-of-network " status or other reasons?

I am trying to make sense out of why such potent approaches are not being

embraced by the rehabilitation community, when they are really the front line to

these populations.

To give an example of what can be accomplished in ASD:

In 18 months, 11YO male echolalic ASD client with aggression and no ability to

learn (self contained babysitting classroom) has no aggression, is now speaking,

reading, writing and is entering LD school to " catch up " .

To give an example of an emerging CVA outcome:

In 6 sessions, a 41YO female with CVA at age 29, very limited verbal expression,

visual field disturbance (only right lower quadrant of vision functioning, far

vision blurry), spastic R arm and ltd use of R leg). Following 6 sessions can

now speak whole sentences, can multitask, can see 50% of visual field and far

vision mostly clear) with spasticity in arm releasing more each session.

I am indebted to you for sharing your thoughts and opinions on these questions.

Thank you and Happy Holidays!

Jackie de Vries, MS