The Plateau Paradox 
... and why it can end therapy

Insurance usually provides coverage as long as the patient is showing improvement.  However, if improvement stops, even for a few months, coverage usually ends and never resumes.  That's where therapy usually ends.   Patients need lots of practice to master the new skills they learn in speech therapy. But patients can't do that practice on their own. They need help. But insurance doesn't pay for that help. Here's why...

Rehabilitation from a brain injury can take many months or years.  Improvement comes in spurts.  Everyone eventually hits a plateau where recovery seems to come to a standstill.  This does not necessarily mean recovery has ended.  It might mean the survivor needs lots of drill practice to break through the plateau.  Here's where it gets interesting...  

Insurance coverage is intended only for skilled medical professional service, i.e., a therapist or doctor.  However, what's needed to overcome the plateau is lots of drill practice, which does not require a medical professional.  So, guess what?  

Insurance does not cover the therapy needed to overcome the plateau.   

And caregivers often cannot get the patient over the plateau alone.   Caregivers are expected to provide therapy practice to get the patient though the plateau.  Unfortunately, most caregivers are just plain busy working, caring for their families and the survivor.  And, while you don't need to be a trained professional to provide drill practice, you do need to have some training or teaching experience.

Therapy practice isn't simply about "testing" or "correcting" the patient.  It's about providing appropriate (and minimal) cues and hints.  It's also about being patient for hours at a time.  That alone is a challenge for anyone.  
So, where does this leave the patient ?