- The Foundation For Peripheral Neuropathy - https://www.foundationforpn.org -

Promoting Safety and Solutions

Peripheral Neuropathy and the Impact on Safety

Peripheral Neuropathy can impact safety for patients due to the symptoms it causes..  Sarah Boyd, PT, DPT and Sarah Dahlhauser, OTR/L, OTD share with the Foundation for Peripheral Neuropathy tips and suggestions for improving safety and comfort of patients with peripheral neuropathy.

Why Peripheral Neuropathy can Impact Safety for Patients

Peripheral neuropathy is an umbrella term that reflects any condition that damages the peripheral nervous system. Our peripheral nervous system connects our brain and spine to our limbs and organs, thereby allowing us to walk, run, taste, digest, sweat, and more.  The type of peripheral neuropathy a patient has is identified by the type of nerve that is damaged . There are three classifications of nerves in our body: motor, sensory, and autonomic. Below are symptoms that one may experience if that nerve type is damaged(1):

Although each neuropathy has its own features that make it stand out against others, a common denominator between all neuropathies is the impact it has on one’s safety. The emphasis of this article is to broadly discuss safety considerations depending on what you may be experiencing in your peripheral neuropathy and providing simple strategies to assist in maximizing your safety, health, and day to day wellness.

Peripheral Neuropathy Impact on Safety: Methods to Enhance Safety for Weakness

Depending on the type and extent of the weakness you are experiencing, there are several aids that could significantly improve your comfort and safety:

Peripheral Neuropathy Impact on Safety: Methods to Enhance Safety for Sensory Impairments

Sensory impairments can significantly impact your safety, especially if you find it is too painful to walk on your feet or if you are unable to feel where you walk. The  type of sensory impairments you are experiencing will dictate what recommendations are provided. Here are several general recommendations:

Peripheral Neuropathy Impact on Safety: Methods to Enhance Safety for Orthostatic Hypotension

Orthostatic hypotension is a drop in blood pressure when changing positions. This can cause lightheadedness, fainting, weakness, visual changes, and reduce the ability to sit or stand for prolonged periods of time. General recommendations to reduce the severity of orthostatic hypotension are (3):

Falls Prevention and Safety

All of the symptoms above can increase your risk of falling and injury. Furthermore, you may experience a greater fear of falling, which could slowly reduce your participation in activities or leaving the home. Here are general recommendations to improve your safety and falls prevention:

Insurance Coverage

A healthcare provider may recommend a piece of durable medical equipment (DME), such as a cane, walker, or an arm/leg orthotic.  The most common question asked by patients when this happens is: will my insurance cover this?.   Each insurance company is different so it is advised to consult with them for further clarification.  In general, coverage is dependent on a piece of equipment that is deemed medically necessary the patient’s care team.  The patient’s healthcare provider or rehabilitation specialist, specifically a physical and/or occupational therapist, will evaluate which device is the safest and most appropriate for the patient.  The healthcare specialist will then provide a prescription for the DME.

If your DME needs change, insurance coverage may be impacted if you had prior DME equipment covered in the past five years. Furthermore, if you believe a wheelchair or powered scooter is needed, insurance coverage will be dictated as to where you will be using it. If you only require wheeled mobility for outdoors or community use, insurance generally will not provide coverage. If you require wheeled mobility inside of the home, insurance will assist in coverage if you have had a consultation by your primary care provider and a rehabilitation provider who specializes in wheelchair seating and assessment for best assessment of seating and cushioning needs (4).

Consult with Your Rehabilitation Team

If you are experiencing any of the aforementioned symptoms, recommend consulting with your local rehabilitation team, whether physical and/or occupational therapy, to find the best options for you. Request a provider that is neurologic-based versus orthopedic to ensure all needs are met. The American Physical Therapy Association (APTA) has developed a helpful resource to locate physical therapists near you with their “Find a PT” search engine. You can limit your search to only include providers who are neurologic-based. You can access this resource at: https://www.choosept.com [1]. Unfortunately, there is not a search engine to locate an occupational therapist; however, you can ask your primary care provider or physical therapist for additional options.

References:

1. Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke. [2] Modified March 16, 2020. Accessed October 22, 2020.
2. Gibson W, Wand BM, O’Connell NE. Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database Syst Rev. 2017;9(9):CD011976. doi:10.1002/14651858.CD011976.pub2.
3. Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleveland Clinic J Med. 2020;77(5):298-306. doi:10.3949/ccjm.77a.09118.
4. Durable Medical Equipment (DME) Coverage. The Official U.S. Government Site for Medicare [3]. Accessed October 22, 2020.

Written by Sarah Boyd, PT, DPT and Sarah Dahlhauser, OTR/L, OTD for the Foundation for Peripheral Neuropathy.  Other articles written for FPN by Sarah Boyd and Sarah Dahlhauser are Peripheral Neuropathy Devices For Safety and Independence with Daily Activities [4] and Staying Active with Peripheral Neuropathy [5].