Daily Rehabilitation for Seniors: Is It Safe and Necessary?

Rehabilitation issues

I would like to ask if my father, given his age, can continue to go to rehabilitation every day.
The lumbar traction sessions were on August 30 and 31, 2021; September 2, 6, 7, and 13.
(Cervical and lumbar traction from September 14-17, September 20, 23-24, September 27-30, and October 1.) Initially, in 2020, a female physician at the rehabilitation department requested that we first go to a major hospital for an MRI of the area operated on in 2018 before she would agree to perform traction, as she was concerned about potential slippage.
After our visit to the major hospital on March 11, 2021, the doctor indicated that the cervical spine was more urgent, which is why an MRI was performed, and they also retrieved the MRI data from 2018, revealing that the lamina at lumbar L4-5 had been removed.
In 2021, my father independently sought rehabilitation from a male physician who advised him to go every day and undergo traction, increasing the weight each time.
I found that his health insurance records show he has been visiting this clinic almost daily, which raises my concerns.
Is it really necessary to attend rehabilitation every day? Can my father undergo traction without an MRI of his lumbar spine? Not only has he had surgery on his lumbar spine, but the lamina has also been removed.
Now, when I palpate his lumbar spine at L4-5, I cannot feel anything; it is completely sunken towards the belly button.
I often check my father's spine, so when I cannot feel his L4-5, I wonder if the doctors have reviewed his imaging and deemed this treatment appropriate.
Why was the female physician unwilling to assist us while the male physician felt it was acceptable? I also asked my father, and he said that while the process feels comfortable, there has been no improvement afterward, and he struggles to climb onto the bed, experiencing pain and needing to use his arms to pull himself up.
I have seen related questions on your website indicating that traction can affect slippage, so it should be carefully evaluated.
I am not very clear on the rehabilitation process, so I would like to ask how to proceed in my father's case.
I am currently planning to take him to a government-registered institution for proper posture management training.
As for rehabilitation, I am unsure if my father's situation warrants the daily visits as suggested by the male physician for a full two months.
I am genuinely afraid that continuing this may worsen his slippage, leading to the need for a second surgery! My father is not young anymore.
Thank you for your hard work, doctor.

Niming, 60~69 year old female. Ask Date: 2021/10/04

Dr. Li Yanheng reply Rehabilitation

Traction may lead to an exacerbation of the patient's symptoms, which can occur during or after the procedure, resulting in increased pain or neurological symptoms.
However, based on the information provided, it seems that such situations have not arisen.
The relative comfort experienced during the process may be attributed to muscle relaxation induced by traction or heat therapy, suggesting that the patient may have had pre-existing muscle tightness.
Therefore, it is understandable why the physician continues to recommend traction (temporarily alleviating symptoms and improving quality of life).
Nonetheless, it is essential to monitor and assess the patient's neurological symptoms during and after traction.
Additionally, if there are any concerns regarding the treatment, it is advisable to discuss them directly with the physician.

Reply Date: 2021/10/04

More Info

When considering daily rehabilitation for seniors, especially for someone like your father who has a history of spinal surgery and specific concerns regarding his lumbar and cervical spine, it is essential to approach the situation with caution and informed decision-making. Rehabilitation can be beneficial, but it must be tailored to the individual's health status, medical history, and specific needs.

Safety and Necessity of Daily Rehabilitation
1. Individual Assessment: Before engaging in daily rehabilitation, it is crucial to have a thorough assessment by a qualified healthcare professional. This assessment should include a review of your father's medical history, current physical condition, and any imaging studies (like MRI) that may provide insight into his spinal health. Given that he has undergone surgery and has had changes in his lumbar spine (such as the removal of the lamina at L4-5), understanding the structural integrity of his spine is vital.

2. Type of Rehabilitation: Rehabilitation can encompass a variety of therapies, including physical therapy, occupational therapy, and specific exercises aimed at improving mobility, strength, and function. However, not all forms of rehabilitation are appropriate for every individual. For someone with a history of spinal issues, particularly with surgical interventions, certain activities (like traction) may pose risks if not carefully monitored.

3. Frequency of Rehabilitation: While some patients may benefit from daily rehabilitation, it is not universally necessary or safe. The frequency should be determined based on the individual's response to therapy, their overall health, and the specific goals of rehabilitation. In your father's case, if he is experiencing discomfort or no improvement from daily sessions, it may be worth reconsidering the frequency and type of rehabilitation he is receiving.

4. Monitoring and Adjustments: Continuous monitoring of your father's condition during rehabilitation is essential. If he reports discomfort or if there are physical signs of worsening (such as increased pain or difficulty with mobility), these should be addressed immediately. It may be necessary to adjust the rehabilitation plan, including the frequency of sessions, the types of exercises performed, and the intensity of treatments like traction.

5. Consulting Specialists: Given the conflicting opinions between the two physicians your father consulted, it may be beneficial to seek a second opinion from a specialist in spinal rehabilitation or a physical medicine and rehabilitation (PM&R) physician. They can provide a comprehensive evaluation and recommend a rehabilitation plan that considers your father's unique circumstances.

6. Alternative Approaches: If daily traction is deemed inappropriate or risky, consider alternative rehabilitation strategies that focus on strengthening, flexibility, and proper body mechanics. These may include supervised physical therapy sessions that emphasize safe movements, posture training, and exercises that can be done at home.

7. Education and Support: Educating yourself and your father about safe practices and the goals of rehabilitation can empower both of you in this process. Engaging with a physical therapist who can teach proper techniques and exercises tailored to his condition can be invaluable.

Conclusion
In summary, while rehabilitation can be beneficial for seniors, especially those with a history of spinal issues, it must be approached with caution. Daily rehabilitation may not be necessary or safe for your father, particularly given his medical history. A thorough assessment, careful monitoring, and possibly seeking a second opinion from a specialist will help ensure that he receives the most appropriate care. Your proactive approach in seeking the best rehabilitation strategies for your father is commendable, and with the right guidance, you can help him achieve better health outcomes while minimizing risks.

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