Neurologic PT Clinical Practice Settings

What is Acute Care PT?

Physical therapy provided in the hospital for patients with high medical acuity and complex medical/nursing needs

WHO is treated in Acute Care PT?

Hospitalized patients who are medically complex and have high acuity (more unstable/sick patients)

WHAT is the focus of Acute Care PT?

Functional mobility, including:

- Bed mobility

- Sitting edge of bed

- Sit-to-stand (STS)

- Tolerance to upright position

- Walking and stairs

What interventions are commonly included in Acute Care PT?

Functional mobility training

Strengthening

Balance training

Gait training

What education is provided in Acute Care PT?

Training on assistive devices, such as:

- Canes

- Walkers

- Crutches

- Wheelchairs

What is the role of discharge planning in Acute Care PT?

PT helps decide discharge location with the team:

- Home

- Inpatient rehab (IPR)

- Subacute facility

WHEN is Acute Care PT provided (frequency)?

Varies based on patient acuity:

1-2x/day OR 2-3x/week

What determines Acute Care PT frequency?

How medically stable the patient is

How much therapy they can tolerate

WHERE does Acute Care PT usually occur?

Patient's hospital room (most common)

Hallway (walking/stairs)

Hospital gym (sometimes)

Tell-tale signs of Acute Care PT setting

Patient is in the hospital

Medically unstable or complex

Focus on basic functional mobility (bed → standing → walking)

Short, frequent sessions

Strong emphasis on discharge planning + safety

May require assistive device training

What is Inpatient Rehabilitation (IPR)?

PT for patients who are not safe to go home yet, but are medically stable enough for intensive rehab

WHO receives care in Inpatient Rehab?

Patients who:

- Cannot safely return home

- Are not highly medically complex (more stable than acute care)

- Still need medical + nursing support

WHAT is the main goal of IPR PT?

Maximize functional independence so the patient can safely go home

WHAT is the PT focus in IPR?

Functional mobility

Wheelchair mobility (if needed)

Strengthening

Flexibility

Balance

How does IPR differ from Acute Care PT?

Less medically complex than acute care

More focus on rehab training (strength, balance, function)

Longer, more intensive sessions

WHAT determines discharge planning in IPR?

PT and interdisciplinary team decide if patient can safely:

- Go home

- Or needs subacute rehab

WHEN does IPR therapy occur (frequency + intensity)?

At least 5 days/week

Must tolerate 3 hours of therapy/day

Therapy may be split between PT, OT, SLP

Typical length of stay in IPR

Usually 1-2 weeks

Can be shorter or longer depending on progress

WHERE is Inpatient Rehab provided?

In an IPR facility

May be attached to a hospital or freestanding

Therapy usually in a rehab gym

Tell-tale signs of Inpatient Rehabilitation (IPR)

Patient is medically stable but not safe to go home

Needs intensive therapy (3 hrs/day, 5 days/week)

Focus on function, strength, balance, independence

Has access to rehab gym + multidisciplinary team

Goal is return home safely

What is Subacute Rehab?

PT for patients who are too weak/sick to go home or go to IPR, but are more stable than acute care patients

WHO is treated in Subacute Rehab?

Patients who:

- Are not safe for home discharge

- Are not strong/independent enough for IPR

- Still require medical + nursing care

WHAT is the main focus of Subacute Rehab PT?

Functional mobility

Independence in daily tasks

Preparing patient for discharge home safely

WHAT is the overall goal of Subacute Rehab?

Help the patient become safe and independent enough to go home

HOW does Subacute Rehab differ from IPR?

Less intense than IPR

Shorter/less frequent therapy sessions

Patients are generally weaker or less able to tolerate intensive rehab

WHAT is discharge planning in Subacute Rehab?

PT and team decide if patient can go home safely or needs:

- Assisted living

- Long-term care facility

- Continued PT (home health or outpatient)

WHEN does Subacute Rehab occur (frequency)?

Typically 3-5 days/week

Sessions range from 30 minutes to 1-2 hours/day

Depends on facility

Typical length of stay in Subacute Rehab

Usually 1-3 weeks

May be shorter or longer depending on progress and needs

WHERE is Subacute Rehab provided?

Rehab facility (often same setting type as IPR)

May be attached to hospital or freestanding

Usually includes a therapy gym

Tell-tale signs of Subacute Rehab

Patient is not safe for home, but too weak for IPR

Needs moderate therapy intensity (3-5 days/week)

Focus on functional independence + safety for discharge

May still need ongoing therapy after discharge

Longer recovery time than IPR

What is Home Health PT?

PT provided to patients who are living at home but are homebound and cannot safely leave the home for outpatient therapy

WHO receives Home Health PT?

Patients who are homebound due to:

- Weakness or fatigue

- Difficulty managing stairs or mobility

- Lack of transportation

- Safety concerns leaving the home

WHAT is the main focus of Home Health PT?

Safety and independence at home

Returning to prior level of function (PLOF)

Reducing fall risk

Improving ability to manage home environment

WHAT unique PT role is important in Home Health?

Home safety assessments

Environmental modifications (fall prevention, accessibility)

Recommendations to improve mobility and safety in the home

HOW is the Home Health PT plan of care determined?

PT creates individualized plan based on patient needs, safety, and home environment

WHEN does Home Health PT occur (frequency & duration)?

1-3x/week (1 more common)

Sessions usually 30-60 minutes

Plan of care may last:

- 1-4 weeks

- 6-8 weeks

- or longer depending on needs

WHERE does Home Health PT take place?

In the patient's home

Tell-tale signs of Home Health PT

Patient is at home but cannot safely leave it

Needs therapy in real-life environment (home-based function)

Focus on safety, mobility, and fall prevention in the home

Short visits (30-60 min), 1-3x/week

Goal is return to independence and PLOF

What is Outpatient PT?

PT for patients who are medically stable and able to travel to a clinic for therapy services

WHO receives Outpatient PT?

Patients who:

- Are no longer homebound

- Are not receiving home health or nursing services

- Are medically and physically able to travel to a clinic

WHAT is the main goal of Outpatient PT?

Return to prior level of function (PLOF), including:

- Work

- Sport

- Daily activity performance

WHAT interventions are common in Outpatient PT?

Higher-level rehab including:

- Strength training

- Flexibility work

- Balance training

- Gait training

- Functional mobility training

HOW does Outpatient PT differ in intensity?

Higher-level, more progressive exercise program

Less medically complex than inpatient settings

Focus on performance, function, and return to activity

HOW is the Outpatient PT plan of care determined?

PT creates individualized plan based on patient goals, impairments, and functional limitations

WHEN does Outpatient PT occur (frequency & duration)?

1-3x/week or sometimes 1x every 2 weeks

Sessions: 30-60 minutes

Plan of care:

- 1-4 weeks

- 6-8 weeks

- 12+ weeks (depending on condition/goals)

WHERE is Outpatient PT provided?

Outpatient PT clinic or gym setting

Tell-tale signs of Outpatient PT

Patient is fully medically stable

Can travel to clinic independently or with help

Focus on return to work, sport, and high-level function

Uses progressive strengthening and advanced rehab

No longer requires home health or inpatient services