Life on Wheels Read Online Free PDF Page B

condition. Cynthia Bishop of Shepherd’s MS center notes:
     
    Neurologists may have a very small percentage of patients with MS. The patient might be getting good medical treatment from her neurologist, but the doctor is not able to be completely current in the many developments happening in MS and its treatments. We might see patients and notice that they’re starting to experience foot drop and will refer them to our brace clinic and help them with their gait in therapy. A neurologist might not notice that. A person with MS commonly has issues with bladder or bowels. A neurologist is not an expert in that type of thing. You really need someone who knows rehab.
    Transition from Childhood Disability
     
    The rehab system discussed in this chapter is largely targeted to adults, many of whom already work or are educated. Many disabilities are work related; conditions such as MS typically occur in adulthood. Children with disabilities such as cerebral palsy, spina bifida, or muscular dystrophy are serviced under a different system.
    With the passage of the Individuals with Disabilities Education Act in 1975, children began to be integrated into public schools, and those systems were required to provide services to those children. In effect, rehab for children gets delivered through the school system—although parents and schools sometimes find themselves in conflict over the extent and nature of these services. Physical therapists work with children with disabilities at the schools. Equipment and medical services continue to be supplied by charitable organizations.
    The difficulty with this delivery system is what happens when children become adults. For some, the transition is not smooth. This man with muscular dystrophy is angry about what happened once he became an adult:
     
    Throughout my childhood and adolescence, these agencies were very good about providing various things I needed such as wheelchairs, orthopedic shoes, braces, clinics, etc. Unfortunately, when I became an adult, they forgot I existed. I no longer fit their marketable, “dying child” image.
    Once children with disabilities leave the school system where they were receiving medical and therapeutic services, they need to establish a relationship with physicians and facilities qualified and equipped to address their needs. New issues also appear in adulthood, such as weight gain, the start of sexual activity, living independently, driving, or alcohol use. People in such transition need a specialized set of services, and the family doctor is not in a position to provide them. As Stanford Hospital’s Jody Greenhalgh describes the transition:
     
    When they turn 18, where do they go? Hopefully the children’s services doctors refer them to a rehab doctor, but it doesn’t always happen. If they get a job and go on an HMO program, they get assigned a primary physician who may not know much about their disability. The physician may not know their equipment needs or that they need ongoing therapy.
    Dealing with Insurance
     
    Many medical professionals believe that insurance companies have gained excessive control of medical treatment. Spending limits tie the hands of physicians, whether limits are set by a health maintenance organization, private insurance, or government programs like Medicare. Medical professionals chafe at decisionmaking control being out of their hands. Insurers complain of cost pressures, rising prices, shrinking profits, and a healthcare system too expensive for many people to afford. Business owners trying to provide coverage with minimal employee contributions to premiums also add pressure to insurers. Because the insurers are demanding lower costs, we, as a result, receive less coverage. The issue is too complex to simply demonize insurers.
    Alex Barchuk of the Kentfield Rehabilitation Hospital in northern California states:
     
    All these new products coming out are great, but no one can afford to buy them. Insurance doesn’t pay