The other challenge is the politics of institutions, like my own, where they try to do as much as possible with very little resources. I've seen a better understanding of the concept of movement, of what goes into reaching overhead for example, or walking down the street. We have more and more ways to evaluate somebody's ability to function in the real world. I've also seen more direction toward nutrition and a little more skepticism for medications. We're now finding some significant limitations to what a pill can do.
Medications are helpful, but the dosages are getting smaller.
Fewer people are on chronic medications these days. We've had some really great success stories. He was crippled from arthritis and not a candidate for surgery. We showed him how to control his shoulder and certain muscle groups, over several months. He regained full function of his arm for overhead movements by learning how to use the muscles again.