Over the last year or more, I have been asked multiple times to comment on the impact of health care reform and the Affordable Care Act (ACA) on physical therapy, and more specifically, neurologic physical therapy practice. Although I don't have a crystal ball, it would seem from many indicators that this will be a time of opportunity for the profession and especially for neurologic physical therapy.

Why, you might ask? Well, first and most obvious, an increased number of individuals should be eligible for our services, as an estimated 21.6 million people who are now uninsured will have some level of coverage for rehabilitation services.1 Yet, we must be vigilant in guaranteeing that physical therapy is included, with appropriate allowances to ensure quality outcomes, in the established delivery models. This requires each practitioner, the profession as a whole, and our national associations (ie, the Neurology Section, the American Physical Therapy Association) to advocate for patients with neurologic conditions to be included in the new models of delivery across the health care continuum.

Notably, there is an emphasis, in the ACA, Part III,2 on quality of care and cost reduction through the bundling of services. For neurologic patients, this will place a greater emphasis on quality outcomes and decreasing readmission occurrences, to avoid financial penalties that will be applied for preventable readmissions. Physical therapists are poised to play a primary role in ensuring that patients are discharged with appropriate skills to the least restrictive environment, in which they can function safely, and to prevent costly preventable readmissions. This will place even greater emphasis on the maximization of function and assurance of safe mobility prior to initial discharge.

In addition, prevention of subsequent readmission should also focus on prevention of the consequences of diminished activity, secondary to neurologic conditions, by promoting physical activity. There has been sufficient research documenting a decline in physical fitness following stroke,3 traumatic brain injury,4 and spinal cord injury5 to suggest that programs for addressing fitness should be developed. Furthermore, enhanced health and fewer complications have been attributed to better physical fitness poststroke6 and post-SCI5 as well as in Parkinson disease.7 Yet, there is a paucity of research aimed at identifying appropriate fitness programs and long-term benefits of such programs postneurologic injury/condition. One such study in people with Parkinson disease found improved walking economy with aerobic exercise training that surpassed functional training.7 This also emphasizes the need for health care reform to change the emphasis from "improvement" to "preventing decline" in those with degenerative conditions. Nonetheless, physical therapists have an exciting opportunity to refocus long-term health care delivery toward the prevention of secondary complications, including those resulting from inactivity, and defining new health care models that will improve the lives of those living with neurologic conditions.

Finally, the aging population and the shortage of primary care physicians available to meet an expanding insured population should open the door for an enhanced role for physical therapists in primary care. Working in alliance with nurse practitioners and physician assistants, as well as primary care physicians, physical therapists should be part of the portal to health care. Ideally, we should be the first to evaluate individuals with balance or vestibular disorders, aging adults with changes in mobility and function, those with emerging neurologic signs, or others experiencing the long-term consequences of living with a neurologic disorder. As the door opens, we need to be ready to take the giant step through it and establish ourselves as the profession of choice for these conditions; furthermore, we need to be ready to evaluate our effectiveness through sound scientific methods.

So, although it is difficult to know how health care reform will be implemented, it is a time of great change and opportunity. We, as neurologic physical therapists, both clinicians and researchers, should be ready to change the future for those with neurologic conditions by helping create the health care models of tomorrow and evaluating our impact as our roles and practice change.

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