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Raising the Bar in Rehab

Is Detox the Same as Skilled Therapy?

Published October 1, 2009 9:26 AM by Lisa West
The hospital I work at is in urban Milwaukee.  It is located a little south-west of actual downtown Milwaukee, but it is by no means a "suburban"-type establishment.   The Milwaukee Journal Sentinel published an article in today's paper citing Milwaukee as the 11th poorest city in the nation.  (Poston, B.  City is 11th Poorest in Nation. Milwaukee Journal Sentinel.  28 Sept 2009.)  Needless to say, we see it all.

On my schedule today I had three patients admitted for alcohol withdrawal, one of which was accompanied by a police escort for his hospitalization.  It is obvious these patients are not safe with mobility. Withdrawal tremors, unsteadiness, and significant balance deficits make these patients fall risks.  I have no problem with treating these patients, even considering they will likely be readmitted in the near future with a similar diagnosis. 

However, with the temperatures dropping and warnings for frost on the weather, we are seeing more and more of these patients.  Many are homeless, and many realize that being admitted to the hospital means a warm place to stay and food to eat. 

What's the right way to help these patients?  How can you participate in discharge planning for a patient with no home?  With such limited resources, it's hard not to feel helpless. 

2 comments

Great post! I remember similar situations when I was a student at Bellevue Hospital in New York City. As a PT you evaluate; are they safe and ready for treatment or are they still actively detoxing? If detoxing, say treatment not appropriate at this time please refer again when detox is complete. Are there real neuro issues going on such as the peripheral neuropathies that accompany long term alcohol abuse or CNS changes that come with some substance abuse? Then treat those.

Christiedf made a very clear and valid point above, get to know your social work team well and refer to them as needed. No, it isn't your profession to solve someone's homelessness, however it is your responsibility to get them to someone who can. If you don't, then you are correct, they will be readmitted very quickly for similar issues.

Dean Metz October 6, 2009 4:57 AM

This is where good team work with your social worker will come in handy.  

Here's the other issue with treating patients who are detoxing.  Once detox is complete, how many of them really still display the gait deficits?  While they are detoxing, add in confusion and combativeness and sometimes gait training is really an accident waiting to happen.  I've always said, give them a couple days to detox and them reassess...in the meantime, let them get to the chair with assistance, but I dont' necessarily consider gait training with someone who is actively detoxing a course of "skilled PT."  

Christiedf, PT October 4, 2009 1:50 PM
IL

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