Neurology Q&A
We are thrilled to introduce our guest writer, Board-Certified Neurologic Physical Therapist Dr. Ian Lonich to Sentry Aging! Dr. Lonich is the lead primary physical therapist for Allegheny Health Network Neuroscience Institute’s interdisciplinary clinics in Pittsburgh, Pennsylvania. He is an adjunct professor for several Physical Therapy programs within the city as well as a faculty member for the Cleveland NeuroDesign Workshop. Dr. Lonich also sits as the Vice-Chair of the Southwestern District of the Pennsylvania American Physical Therapy Association.
Neurology as a specialty can be an overwhelming field within the healthcare system, leading to many feeling lost on when to seek help. We are happy to share the expertise of a clinical specialist with you in our first edition Q&A!
1. What are some of the most common signs or symptoms that indicate a person should consider seeing a neurologist?
Dr. Lonich: From a statistics standpoint, the most common reasons to see a neurologist is related to headaches/migraines, an acute event like a stroke, or chronic pain. However, some symptoms are generally overlooked and can delay a diagnosis and correct support. This includes changes in cognition and memory, which many people relate to normal aging. While some changes are more typical and not specifically disease-related, others that are disease-related can be better managed if diagnosed early. Things to watch for are short-term memory changes—forgetting something someone just told you, or forgetting about an important event that is upcoming. Having difficulty with executive tasks, such as paying bills and medication management. Emotional or behavioral changes are also signs of possible cognitive changes, especially emotional states that seem amplified from what would be expected. This can be noted especially with situation changes, such as moving, and may also be alongside disorientation or confusion.
Other things that should make someone seek a neurologist are changes in strength or feelings of decreased motor control, especially if it seems to be one-sided. These don’t necessarily have to be overnight changes. From my experience, gradual changes are usually when people bounce around to multiple providers before they end up seeing a neurologist and finally getting a diagnosis.
2. What can a patient expect during their first visit to a neurology clinic like yours?
Dr. Lonich: I work specifically in interdisciplinary clinics. These clinics are set up so that an individual gets a chance to see multiple providers at once. Who that is can vary greatly, but could include a neurologist, physical therapist, occupational therapist, speech therapist, pharmacist, social worker, or other providers from different specialties. This leads to more collaborative care, and the team gets to discuss what is best to help a patient from a medical standpoint. It also includes function and social aspects and has a goal to create patient-centered care instead of care based on a disease or diagnosis. These types of appointments are generally longer, but ultimately the results are better than the sum of its parts. These types of clinics allow us as providers to ensure an individual gets the care they need and want, reduce unnecessary services, and allow for a greater focus on prevention and education.
3. It seems like many people don’t feel they need to see a neurologist and tend to wait a long time before seeing one. What do you recommend when it comes to a timeline of establishing a new patient evaluation with the doctor and when to reach out to see them?
Dr. Lonich: If someone is diagnosed with any neurological problem or has symptoms that can’t be explained easily, they should start seeing a neurologist. Primary care providers are amazing, but they have to cover a lot of different specialties, and because of that, they may not always be up to date on the newest medication or on all aspects of disease. Going to see a neurologist can improve patients’ outcomes long term and allow for a better conversation about some other symptoms that they have that may not be “textbook” but are common with a diagnosis. Even within neurology, there are subspecialists in headache, neuromuscular, and movement disorders.
4. What roles do physical, occupational, and speech therapists play in neurological care?
Dr. Lonich: The biggest thing to remember is that a therapist looks at an individual from a functional standpoint and how a diagnosis or treatment may affect daily participation and quality of life. When you add that lens to someone's care, you get a much more holistic approach to care. For example, someone who has spasticity that affects their ability to walk or use their hand may be recommended to try Botox. A physical or occupational therapist can help assess how those treatments not only affect the spasticity but also affect overall participation and help avoid unwanted decline. We can help with recommendations on appropriate muscle groups to maximize spasticity management, but not negatively impact function. The same is true for speech therapy, which can help a family with appropriate communication of a loved one with cognitive changes or help with aspiration prevention or disease management.
5. In your opinion, what are one or two of the biggest challenges in our healthcare system related to neurological care?
Dr. Lonich: The biggest issue is access to care. Generally, neurologists are a part of larger systems and are located near larger metro areas, leading to difficulty for people in more rural areas receiving more consistent care. This is especially true for specialists within neurology. However, with the increase of telehealth, some of these barriers are being removed, but we aren't completely there yet. When people tell me they are limited by the distance to a neurologist, I suggest utilizing telemedicine and setting it up so they see their neurologist in person every 12-18 months, but all other visits are virtual. This generally improves care but allows for a reduced burden of transportation. Most offices can also switch a visit the same day to a video, which is great for bad weather days.
6. Many people are seeking resources and community support outside of medical appointments. Are there any organizations, websites, or tools you recommend for patients or families who want to learn more and feel more supported?
Dr. Lonich: The first steps should always be a national disease-based organization, such as the Parkinson's Foundation, the Michael J. Fox Foundation, or the National MS Society. Also, nationally recognized health systems such as the Cleveland Clinic and Johns Hopkins. These are usually well-vetted sites supported by nationally recognized clinicians. Be careful of influencers and ads though —they are generally painting the best picture of something that generally doesn't fit a larger population of individuals. A rule of thumb: if it sounds too good to be true, it generally is. Another great resource is https://clinicaltrials.gov/ which shows ongoing clinical trials that people can enroll in.
We are grateful to Dr. Lonich for sharing his expertise with us for this month’s topic. We’d like to take this opportunity to stress the importance of early detection for potentially complex medical conditions with aging and encourage our readers to pursue assessment when presented with signs and symptoms of neurological changes in themselves or their loved ones. At Sentry Aging, we fully believe self-awareness and self-advocacy are critical skills when it comes to aging well.
“I learned a long time ago the wisest thing I can do is be on my own side, be an advocate for myself and others like me.”
- Maya Angelou