Neurological FAQ

During your first visit you can expect the following:

• Arrive at your appointment with your paperwork completed (you can download it from our website – see the paperwork or forms link).
• You will provide us with your referral for physical therapy if you have one. If you don’t have a referral, let us know when you schedule your first visit with us (note – a referral is not always needed).
• We will copy your insurance card.
• You will be seen for the initial evaluation by the therapist.
• The therapist will discuss the following:
  1. Your medical history.
  2. Your current problems/complaints.
  3. Pain intensity, what aggravates and eases the problem.
  4. How this is impacting your daily activities or your functional limitations.
  5. Your goals with physical therapy.
  6. Medications, tests, and procedures related to your health.
  7. Medications, tests, and procedures related to your health.
• The therapist will then perform the objective evaluation which may include some of the following:
1. Palpation – Touching around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inflammation, etc.
2. Range of Motion (ROM) – the therapist will move the joint(s) to check for the quality of movement and any restrictions.
3. Muscle Testing – The therapist may check for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.
4. Neurological Screening – The therapist may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reflexes may be assessed as well.
5. Mental Status Assessment – A mental status assessment provided by a physical therapist evaluates a patient’s cognitive functions, such as memory, attention, orientation, and problem-solving abilities. This assessment helps the therapist determine the patient’s cognitive capacity to participate in rehabilitation, follow instructions, and engage in therapeutic activities safely and effectively. It is especially important for patients with neurological conditions or cognitive impairments.
6. Special Tests – The therapist may perform special tests to confirm/rule out the presence of additional problems. Some examples of these tests include:
7. Dix-Hallpike Test – This test is used to diagnose benign paroxysmal positional vertigo (BPPV). The therapist moves the patient from sitting to lying down with the head tilted at an angle, assessing for symptoms of vertigo and nystagmus (involuntary eye movements) that indicate inner ear issues.
8. Romberg Test – The Romberg test evaluates balance and proprioception. The patient stands with feet together, eyes closed, and arms by their side while the therapist observes their ability to maintain balance without visual input, identifying issues related to sensory or neurological deficits.
9. Head Impulse Test (HIT) – This test assesses the function of the vestibulo-ocular reflex (VOR), which stabilizes vision during head movements. The therapist quickly turns the patient’s head to the side while the patient focuses on a stationary target, watching for corrective eye movements that indicate vestibular dysfunction.
10. Timed Up and Go (TUG) Test – The TUG test measures mobility, balance, and fall risk. The patient is timed as they rise from a chair, walk three meters, turn around, and return to the chair. Prolonged time or instability during the test suggests issues with balance or neurological impairments.
11. Fukuda Stepping Test – This test checks for asymmetrical vestibular function. The patient steps in place with eyes closed for about 50 steps, and the therapist observes for significant rotation or deviation, which may indicate a vestibular imbalance affecting one side of the body.
12. Posture Assessment – The positions of joints relative to ideal and each other may be assessed.
    The therapist will then formulate a list of problems you are having, and how to treat those problems. A plan is subsequently developed with the patient’s input. This includes how many times you should see the therapist per week, how many weeks you will need therapy, home programs, patient education, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created with input from you, your therapist, and your doctor.

Make sure you bring your physical therapy referral (provided to you by your doctor) and your payment information. If your insurance is covering the cost of physical therapy, bring your insurance card. If you are covered by Workers’ Compensation, bring your claim number and your case manager’s contact information. If you are covered by auto insurance or an attorney lien, make sure you bring this information.

You should wear loose-fitting clothing to expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice. For low back problems, wear a loose-fitting shirt and pants, again so we can perform a thorough examination.

Treatment sessions typically last 30 to 60 minutes per visit.

This is highly variable. You may need one visit or you may need months of care. It depends on your diagnosis, the severity of your impairments, your past medical history, etc. You will be re-evaluated on a monthly basis and when you see your doctor, we will provide you with a progress report with our recommendations.

More than half of all Americans are suffering from pain. Whether it is a recent episode or chronic, an ABC News/Stanford study revealed that pain in America is a serious problem. However, many do not even know that physical therapists are well equipped to not only treat pain but also its source.

Physical therapists are experts at treating movement and neuro-musculoskeletal disorders. Pain often accompanies a movement disorder, and physical therapists can help correct the disorder and relieve the pain.

People with neurological disorders are referred to physical therapy to improve their mobility, function, and quality of life. Neurological conditions, such as stroke, multiple sclerosis, Parkinson’s disease, vestibular disorders, and traumatic brain injuries, often cause muscle weakness, balance problems, and difficulties with movement. A specialized neurological physical therapist designs individualized treatment plans that focus on retraining the nervous system and muscles to improve coordination, strength, and balance.

Physical therapy for neurological patients can help restore function, reduce pain, and prevent further complications. By focusing on exercises and techniques that improve mobility, balance, and coordination, patients can regain independence in their daily activities and enhance their overall quality of life.

In most cases, health insurance will cover your treatment. Click on our insurance link above for a summary of insurances we accept and make sure you talk to our receptionist so we can help you clarify your insurance coverage.

You will be evaluated by one of our licensed and highly trained physical therapists and he/she will also treat you during subsequent visits. Unlike some clinics, where you see someone different each visit, we feel it is very important to develop a one-on-one relationship with you to maintain continuity of care. Since only one physical therapist knows your problems best, he/she is the one that will be working closely with you to speed your recovery.

Yes, there are physical therapists who specialize in the treatment of balance and neurological disorders. These therapists often pursue advanced certifications in neurological rehabilitation, such as Neuro-Developmental Treatment (NDT), Vestibular Rehabilitation, or Neurologic Clinical Specialist (NCS) certification, which equips them with in-depth knowledge of how the nervous system controls movement, balance, and coordination.

Neurological physical therapists work with individuals affected by conditions like stroke, Parkinson’s disease, multiple sclerosis, brain injuries, and vestibular disorders (e.g., vertigo or dizziness). Their approach includes specific therapies to address muscle weakness, impaired coordination, spasticity, loss of balance, and gait abnormalities.

They also focus on neuroplasticity—the brain’s ability to form new connections and relearn lost functions—by using repetitive, task-oriented exercises to help the nervous system recover. For balance disorders, specialized therapists use techniques like gaze stabilization, habituation exercises, and balance retraining to help reduce dizziness, prevent falls, and improve confidence with movement.

These therapists often work in collaboration with other healthcare professionals, including neurologists, occupational therapists, and speech-language pathologists, to provide comprehensive care for individuals facing complex neurological challenges. Their ultimate goal is to help patients maximize their independence, enhance their quality of life, and manage symptoms more effectively.

For many patients, one of the primary objectives is pain relief. This is frequently accomplished with hands-on techniques, modalities such as ultrasound, electrical stimulation, and/or heat or cold therapy. Movement often provides pain relief as well. Your physical therapist will provide you with the appropriate exercises not only for pain relief but to recover range of motion, strength, and endurance.

In some cases, physical therapy techniques can be painful. For example, recovering knee range of motion after total knee replacement or shoulder range of motion after shoulder surgery may be painful. Your physical therapist will utilize a variety of techniques to help maximize your treatment goals. It is important that you communicate the intensity, frequency, and duration of pain to your therapist. Without this information, it is difficult for the therapist to adjust your treatment plan.

Flare ups are not uncommon. If you have a flare up (exacerbation), give us a call. We may suggest you come back to see us, return to your doctor, or simply modify your daily activities or exercise routine.

In most cases, you have the right to choose any physical therapy clinic. Our practice is a provider for many different insurance plans.

The best thing to do is give us a call and we will attempt to answer all of your questions.

All fifty states have some form of direct access. In most cases, if you are not making significant improvement within 30 days, the therapist will refer you to/back to your physician.

Seeing a physical therapist first is safe and could save you hundreds of dollars or even thousands of dollars. Click here for details

Billing for physical therapy services is similar to what happens at your doctor’s office. When you are seen for treatment, the following occurs:

The physical therapist bills your insurance company, Workers’ Comp, or charges you based on Common Procedure Terminology (CPT) codes.

Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer.

The payer processes this information and makes payments according to an agreed upon fee schedule.

An Explanation of Benefits (EOB) is generated and sent to the patient and the physical therapy clinic with a check for payment and a balance due by the patient.

The patient is expected to make the payment on the balance if any.

It is important to understand that there are many small steps (beyond the outline provided above) within the process. Exceptions are common to the above example as well. At any time along the way, information may be missing, miscommunicated, or misunderstood. This can delay the payment process. While it is common for the payment process to be completed in 60 days or less, it is not uncommon for the physical therapy clinic to receive payment as long as six months after the treatment date.

Some patients will need to continue with home exercises. Some may choose to continue with a gym exercise program. Others will complete their rehabilitation and return to normal daily activities. It is important that you communicate your goals to your therapist, so he/she can develop a custom program for you.

Physical therapists (PTs) and physical therapist assistants (PTAs) are licensed by their respective states.

These are some things you may consider when seeking a physical therapy clinic:

The therapist should be licensed in the state.

The first visit should include a thorough medical history and physical examination before any treatment is rendered.

The patient goals should be discussed in detail during the first visit.

Care should include a variety of techniques which might include hands-on techniques, soft tissue work, therapeutic exercises and in some cases heat, cold, electrical stimulation or ultrasound.

Do they have a service that can address your problem?

Do they take your insurance or are they willing to work with you if they are not a preferred provider?

They should be conveniently located. Since sitting and driving often aggravate orthopedic problems, there should be a very good reason for you to drive a long distance for rehabilitation.

What are the hours of operation?

Can they provide satisfaction survey results?

The therapist should provide the treatment.

Can you briefly interview the therapist before the first visit?

Ask your family and friends who they would recommend.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our number on our website for more information.