There’s no place like home and that motivation can help you and your therapists get you back there after a medical issue. (For Spectrum Health Beat)

Among the first questions asked most often by a recovering patient is, “When can I go home?”

This is understandable. Many suffered a sudden health calamity such as a stroke, car crash or heart attack, and the time spent in the hospital was both unexpected and shifted the axis of their lives. They want to return to what was, and as quickly as possible.

Rest assured, your therapy team wants to help you re-integrate into your community, back to doing the activities you enjoyed, just as much as you yearn to be there. Their focus will be on helping you regain what you lost due to illness or injury as much as possible with current and future safety top of mind.

As partners in your care, your therapy team wants to get you to your highest functional capacity, and use a variety of therapeutic techniques and exercises to get you there.

What this may look like will be custom-tailored to your individual needs and goals.

Various therapy methods, based on goals

PT in Motion recently featured an article highlighting the efforts of physical and occupational therapists in helping patients as they reintegrate into their communities and how that may present in different settings.

The article discussed how rehabilitation teams work with spinal cord injury, brain injury, and stroke patients to help them do everyday tasks such as shop at a store or how to facilitate even more difficult and complex activities such as navigating an airport.

Next, the article examined how physical and occupational therapists address maintaining function after periods of immobility.

Finally, the article considers what physical therapists working with military service members and veterans do to help injured service members or veterans get back to military service or civilian life.

To illustrate how the journey home may start, the writers shared a salesman’s story about community reintegration after a fall that caused him to have a paraplegic-level injury.

Drew Oswald, DPT, with The Shepherd Center, shared that when the salesman we will call Joe arrived at the center, the patient felt so depressed and unmotivated that he thought he would never work again.

But Oswald encouraged Joe to set aside his feelings of hopelessness and put his willpower into getting better. Physical therapists working on reintegration teams helped Joe and many others like him accept the challenge.

They showed their patients how they can achieve their goals and return home by providing social-physiological support.

Oswald discussed in the article the deep emotions patients feel about what their return to the community will ultimately look like upon discharge. The center is committed to integrating their patients back to an environment that is as close to home as possible, with an emphasis on independence and quality of life.

Oswald shared, “One of the best moments as a physical therapist is when someone comes in and just looks challenged. But when that patient goes home, he or she is really excited about returning to his or her life.”

In Joe’s case, he far exceeded his expectations and is back working as a salesman at his same company.

At another organization, the Kessler Institute for Rehabilitation, the patient population includes people who have experienced issues such as a stroke or spinal cord injury.

Jenna Tucker, DPT, wrote in the article that “in the initial stages of rehabilitation from a life altering injury, it’s crucial to gather proper information to plan for a safe discharge to home.”

Tucker and her team work hard to reduce any cognitive impairments before it is time to discharge the patient home. This is all in an attempt to remove as many barriers to returning home as possible.

The institute also takes additional steps, such as taking their patients out into the environments in which they live and helping them through problems they might face in everyday living.

These trips also include going to the airport to acclimate the patient to busy areas and help them problem solve areas of concern.

As a test of community reintegration, the institute uses a Modified Multiple Errand Test, sending patients out to find the gift shop or cafeteria.

Lyndsey Vanderberg, DPT, therapy supervisor of acute practice at the Mayo Clinic describes a different element of community reintegration: keeping the patient as strong as possible in the first days of injury.

Vanderberg said “the goal when patients come into the hospital is to help them try to maintain their functional status. So many times, patients experience functional decline that leads to dismissal to a setting other than home.”

But by addressing the negative effects of immobility on the body, she and her team work to limit discharge to settings “other than home.”

A key component at the clinic is to keep the patients up and moving with an emphasis on having the patient function at the highest level possible.

“We want to ensure that they don’t lose ground while they’re here,” Vanderberg said. The clinic keeps the negative effects of immobility to a minimum so they can help patients get back home more quickly and effectively.

Similarly, injured service members receive a helping hand from The Department of Defense as they work to get back to active service or to return to civilian life.

Ret. Col. Rebecca Hooper, MD, is the program manager of The Center of the Intrepid at Walter Reed and is in charge of helping injured soldiers—be it from a car accident or wounds suffered in combat—get back to living life like before the injury.

“It’s our responsibility to try to maximize their performance, return them to duty if that is their desire, or return them to a very active civilian life,” Dr. Hooper said.

Through the use of technology and the latest in prosthetics, soldiers are empowered to return to life.

Motivation means everything

As the saying goes, home is where the heart is, and through the use of rehabilitation, therapy teams are working to help people get to their desired location—home.

One of the biggest contributors to gains made in therapy is motivation.

The more the patient is determined to do the exercises, the stretches, the activities, and the more they are invested in reaching their goals, the more success and gains they will experience.

Success is a mixture of this intrinsic motivation and drive along with the therapeutic techniques the therapy team is able to deploy in a patient’s treatment plan.

In a recent study completed earlier this year, a direct correlation was found between both intrinsic and extrinsic motivation and functional progress in therapy, as well as reduced pain and improved cognitive function.

Optimism and self-efficacy, in particular, go hand-in-hand with a patient’s willingness to push themselves during treatment sessions, and also to complete home exercise programs to continue to make gains.

“If patients have a more optimistic view of their situation and rehabilitation process, they are typically able to progress through their rehabilitation faster,” the study author wrote. “If the patient has low outcome expectancies and value beliefs, these can serve as demotivating factors which can prolong the rehabilitation process.”

While the approach might be different from therapist to therapist, the goal is the same—returning as much function and independence as possible to the patient.

And returning to where the heart is—home—can be a powerful and motivating tool.