Posted on 6/7/2018 by Annette Monaccio, O.T., CHT
Hand Therapy Week is held during the first full week of June and hosted by the American Society of Hand Therapists. Certified hand therapists are dedicated to helping patients with hand and arm injuries and conditions that may be affecting their daily life.
As a certified hand therapist, I’ve had the privilege to meet many people with a wide range of injuries. Watching an individual perform a task or activity that we often take for granted is a proud and exciting moment for both a patient and therapist after an injury.
I met Lexi, a shy and nervous young girl, who had been through a traumatic experience and hospitalization after a bon fire accident left her with severe burns over most of her body. She had spent several months at a local hospital in the intensive care burn unit. Upon beginning treatment, I knew that I needed to address and acknowledge her injuries, expectations of participation in therapy, boundaries for success and goals for recovery and independence.
Lexi had many burns on her face, arms, hands, torso, legs and back. There were many areas to address with her injuries, including:
Managing her wounds
Regaining mobility in her extremities
Performing basic activities of daily living, such as bathing, dressing and returning to school
Processing the psychological impact of others reactions to her appearance
I knew there were many things that we had to address quickly to avoid the loss of motion of her arms, especially her hands which were severely burned and beginning to form contractures/scarring along the fingers. We developed custom splints, “orthoses” made to fit the individual. It required many attempts for success due to Lexi’s injuries, but the key to our success was listening to determine the best splint, proper fit, adjustment and fashion for a preteen. A few color adjustments of splinting materials, a little added “bling” and voila, it was done and Lexi began wearing her orthotic!
The management of her wounds – cleaning, dressing, monitoring and education – were our first steps of trust and understanding, since this was one of the most difficult aspects of intervention. The next process of touching, moving and passively stretching her hands and fingers were the true challenge. Building trust and establishing goals were vital. We were on our way as a team to improve her ability to bend a finger, make a fist and then use her hands to accomplish daily tasks. There was blood, sweat and tears during many sessions, but, most importantly, there was a lot of laughter, too.
LexiLexi’s parents were dedicated to helping her in the center and at home for carryover of the program. As I watched her mom tie her shoes and write out some of the exercises we were reviewing one day, I asked Lexi why she wasn’t doing this on her own. She said, “I can’t do it myself.” This began the educational component with Lexi and her mom of why it was important to allow Lexi some reasonable time to attempt to gain her independence to complete daily tasks on her own. Yes, it was quicker and easier for someone to do this, but what would happen the first day back to school? Within two sessions, Lexi was independently putting on her shoes, tying them and had her first sense of independence since the accident.
Her laughter and smile were infectious with each new success. Next, Lexi was writing with adapting pens and pencils and back to writing poetry. Putting on her arm and leg compression garments and gloves was a tug of war match and she won each time. Again, another success. There were challenges of zipping a backpack, carrying books and fatigue following walks through the hallways in school, but Lexi overcame them all.
We initiated more challenges with fine motor skills with the purchase of a Barbie head and working on braiding hair. As a preteen, this was a must for Lexi. She now started braiding and had taken the focus of the hypersensitivity of her burns away to a new focus of allowing herself to touch different textures, which previously prevented her from using her hands for any activities. With each new challenge came a new set of frustrations, successes and, ultimately, independence.
Due to the extent of her burns, Lexi has been through several follow-up surgeries. She has returned each time to the center and hand therapy treatment with a new set of goals and motivation to quickly return to her routine. Step-by-step she continued to accomplish her goals, becoming independent with all activities. She now has excellent mobility of her arms, hands and legs.
Lexi has matured into a teen. She drives, attended prom, participates in track and other sports at school and has become a teen counselor at the burn camp she has attended each summer since her accident. I observed Lexi go from a quiet, scared child to an energetic and expressive young lady. She has taught me about determination, hard work and maintaining a positive attitude. She is an inspiration. I was not only the therapist, but the student learning each day from her.
By: Annette Monaccio, O.T., CHT. Annette is an occupational and certified hand therapist with Banner Physical Therapy in Arizona. She has treatment expertise in hand/upper extremity conditions and injuries, pelvic floor health and cancer rehabilitation.
Banner Physical Therapy, NovaCare and NovaCare Rehabilitation are part of the Select Medical Outpatient Division family of brands.
Posted on 4/3/2017 by Cornelia von Lersner Benson, O.T., CHT
Join NovaCare Rehabilitation, NovaCare and our team of dedicated occupational therapists as we celebrate Occupational Therapy Month (OTM)! OTM is hosted by the American Occupational Therapy Association (AOTA) each April to recognize how occupational therapists and occupational therapy assistants help transform society by restoring and improving function in people's lives.
Occupational therapy is celebrating its anniversary! The National Society for the Promotion of Occupational Therapy (now AOTA) was established in 1917, marking 100 years of the profession and evidence-based practice. With more than 200,000 occupational therapists and occupational therapy assistants helping individuals across the lifespan live life to its fullest, this dedicated group of professionals focuses on treatment to help develop, recover and maintain the daily skills of patients.
Occupational therapists offer a unique approach to physical rehabilitation. The focus isn’t just someone’s motion or strength, but how it is used in their life, such as a healthy return to work, getting back to sports or hobbies or helping to braid a child’s hair before school. Occupational therapists also have specialty training in orthoses fabrication and emotional, thinking and reasoning factors that affect physical health and function. It is a service that, side-by-side with physical therapy, can offer a return to health and function in an all-inclusive and progressive way.
This service offering, however, all began for NovaCare Rehabilitation in 1990, prior to joining the Select Medical family, within our Southern New Jersey community when I was hired by our then company president to develop an occupational therapy program. I was hired as the first occupational therapist for the company, likely as an informal pilot study to determine a consumer’s benefit of receiving occupational therapy and its contribution as a service and unique offering for our organization. As we knew it would, occupational therapy was a hit! Occupational therapy allows patients to achieve independence and participate in tasks they want and need to accomplish through therapeutic interventions following trauma or disability. Our local success meant that the occupational therapy service offering quickly grew, adding additional staff members in New Jersey and then Philadelphia, Maryland and Minnesota.
Today, occupational therapy is a national service for NovaCare Rehabilitation, NovaCare and other brands within the Select Medical Outpatient Division family. We employ more than 480 occupational therapists across the country. We continue to treat patients on a daily basis as well as provide education and mentoring to support new occupational therapy graduates who desire to achieve his/her certification in hand therapy. We help to supervise all levels of occupational therapy students, ongoing development for staff and continued service expansion to meet the needs of our community at large.
At NovaCare Rehabilitation and NovaCare, our occupational therapists are everyday heroes and know that each patient is unique and requires an individualized approach to care. Our team finds the right solution for each patient to reach goals and return to function and the things they enjoy doing as soon as possible.
I am proud to work for a company that holds occupational therapy in such high regard and encourages and supports therapists in their growth, their unique contributions and their skills to improve the lives of our patients. This comes as a result of having a company creed that is dedicated to providing an exceptional patient experience in a compassionate environment. It all fits! Happy OTM, everyone!
Cornelia von Lersner Benson By: Cornelia von Lersner Benson, O.T., CHT. Cornelia serves as NovaCare Rehabilitation’s hand and occupational therapy director for the Southern New Jersey community. NovaCare in New Jersey proudly employs 46 occupational and hand therapists within 27 offices, including those who provide in-home care and services within physician offices.
Posted on 3/30/2020
Each March, the National Athletic Trainers’ Association (NATA) celebrates National Athletic Training Month. This year’s slogan is “ATs Impact Health Care Through Action.”
Since I became a certified athletic trainer in 1995, I am often posed the question “Why did you choose this profession?” Many times my answer is not only an expression of my own feelings, but a compilation of answers I have heard from the number of interviews I have conducted through my position as regional coordinator for sports medicine.
As many athletic trainers have, I came from an athletic background. I enjoyed success as a high school athlete, but I was not gifted enough or provided the opportunity to take my talents to the next level. However, my friend invited me to a college career fair at the local university, and a window of opportunity presented itself to me when I learned about athletic training. Following that career fair, I knew this profession would impact me for the rest of my life. I had found a profession that would allow me to maintain my appetite for sports: the competitiveness, the excitement of game day, the ability to be part of a team and, most importantly, the ability to impact every athlete through my actions as a health care provider.
Oftentimes during the interview process, I hear the response from candidates that the reason they became an athletic trainer was because of the effect their athletic trainer had on them. Whether they sustained an injury in high school or college, they were impacted by their athletic trainer and this profession. No matter the response they give, all athletic trainers possess a number of similar traits, including the innate need to help others.
Our ability to walk side-by-side with an athlete through their journey from training, prevention, performance, injury, treatment, recovery and return to play is the most unique in the health care field (though I may be biased). As an athletic trainer, our collaboration with all facets of the health care spectrum are unmatched.
On any given day, we communicate with coaches, parents, school nurses, nurse practitioners, physician assistants, physical therapists, family medical physicians and orthopedic physicians to assist just one athlete. Athletic trainers also impact our workforce community by providing services to industrial athletes in manufacturing, police, fire and rescue, tactical, performing arts, transportation and aerospace, hospital and retail settings. We communicate with their employers, case managers, payers and insurers to help with return to work. In all that we do, our one common goal is to provide quality health care and safety for each athlete, patient and worker we care for.
For the past 25 years, I have been employed as an athletic trainer, 18 of them for NovaCare. As a certified and licensed health care professional, my job encompasses the prevention, examination, diagnosis, treatment and rehabilitation of emergent, acute or chronic injuries and medical conditions. I have been on the sidelines for high school, collegiate and professional sports. I have witnessed state championship games, national championship games and individual titles. I have worked in a major automobile factory providing care for employees responsible for assembling the doors on your car or truck. Most recently, I have been given the opportunity to educate, support and mentor other athletic trainers in the field.
I do what I do because, at the end of each day, I can look back on my work and feel the value and positive effect I have had on an individual’s health, well-being and ability to do what is important to them in that moment – impacting their health care through my actions. What could possibly be better than that?
By: Perry Siegel, M.S., ATC, CSCS, regional sports medicine coordinator for NovaCare in Connecticut. NovaCare and NovaCare Rehabilitation are part of the Select Medical Outpatient Division family of brands.
Posted on 9/11/2018 by Brian Brewer, CPT
School is back in session and fall sports are underway! From the gridiron to the soccer field to the volleyball court, athletes of all levels are hitting the field. With increased play, however, there is also an increased risk for injury.Categories: Physical Therapy
Did you know that there are movement assessments designed to assess ACL injury risk? Within Select Medical’s Outpatient Division*, we provide movement assessments using dorasaVi wireless wearable sensors to measure exactly how individuals move. This technology allows our highly trained clinical team objectively analyze body movement and muscle activation, utilizing a test called the Athletic Movement Index, or AMI. With this testing, we are able to accurately determine an athlete’s ability to safely perform higher level movements, such as cutting, pivoting and deceleration, all of which can lead to ACL injury if not performed efficiently.
The ACL is one of four ligaments in the knee that provide joint stability. Roughly 70 percent of ACL injuries during high-risk sports are non-contact injuries, meaning no collision occurred when the ACL tore. As an athlete begins to tire throughout the course of a game or event, their efficiency in movement begins to suffer, their mechanics become faulty and their risk for injury is heightened. If we can recreate these conditions during movement assessments, we are more able to determine an athletes risk for ACL injury. The AMI is a test that simulates the fatigue factor that plays a role in ACL injuries.
The AMI runs the athlete through a battery of movements, designed to assess core strength and stability, hip strength and mobility and efficiency moving through single-leg movements, such as a single-leg squat and a single-leg hop. The single-leg movements analyze the movement of the knee, whether it is collapsing inward or outward past neutral and the degree of loading, or depth, that the participant is able to go to, both of which are important indicators in assessing ACL injury risk. If the knee is not staying neutral during single-leg movements, then there is weakness in the hip, specifically the gluteus medius muscle, which is leading to inefficient movement. The higher the speed that the knee is moving out of neutral, the higher the risk of ACL injury there is. Similarly, if the athlete is not loading deep enough, and that is coupled with a high speed of displacement, then their risk is increased even more. Through strengthening the hips and core effectively and deliberately, based on the test results, clinicians can help reduce an athlete’s risk of injury dramatically.
Our exclusive ACL Play it Safe Program is an ACL prevention program, designed specifically to go hand-in-hand with the AMI and address the faulty mechanics that lead to ACL injuries. The program consists of a mobile application, with pre- and post-practice exercises and drills to be performed. Additionally, there is an ACL Play it Safe Kit that consists of equipment designed to improve strength and conditioning of the muscles responsible for controlling mechanics during dynamic movements that can cause injuries.
The pre-practice exercises are dynamic warm-ups that should be used to increase flexibility and mobility in the hips, knees and ankles:
High knee with calf raise
These pre-practice exercises should be performed for 15 yards down and back, two times each. This will help to warm-up the hips and knees, and prime them for efficient movement.
The post-practice exercises utilize the TheraBand CLX, TheraBand Ankle Cuff and TheraBand Stability Trainer. These should be done after practice when the athlete is tired. If an athlete can strengthen and train with proper mechanics while they are tired, then it will be that much easier for them to perform efficiently on the field when they reach the same level of fatigue. There is a multitude of post-practice exercises, with some listed below:
CLX spiral technique
TB cuff side stepping with kicks
Single leg toss on stability trainer
CLX plank with kicks
All of the post-practice exercises are designed to help strengthen the core and gluteus medius muscle and prevent a displacement of the knee during dynamic movements. Of course, as with any exercise routine, static stretching and/or foam rolling should also be performed following the completion of the program.
Through objective analysis of muscle activation and subjective observations of movement, clinicians are able to determine ACL injury risk with high accuracy. If we can address poor mechanics of movement through assessment prior to when an athlete takes the field and introduce them to ACL Programs designed to addressed these poor mechanics, we can start to minimize lost time on the field, see an increase in performance and help athletes be more confident in their sport.
*NovaCare Rehabilitation and NovaCare are part of the Select Medial Outpatient Division family of brands.
By: Brian Brewer, CPT, is a strength and conditioning specialist for NovaCare Rehabilitation in Annapolis, Maryland.
Posted on 9/26/2018 by Anne Marie Muto, OTR/L, CHT
Now that students have a few weeks of school under their belts, their backpacks – which were relatively light from a few school supplies – are now filling up. Not only are children feeling the weight of nightly homework, but also the weight of their book, binder and electronic-filled backpacks.
Aside from considering the right cartoon character/super-hero, color and cool factor, the backpack should also be the right fit. In honor of National School Backpack Awareness Day, here are few things to keep in mind when picking out a backpack:
The width should be about the same size as the student; the length should be no longer than the torso (trunk or central part of the body) and not hang more than four inches below the waist. Remember to check the bag each year, especially for younger children who are experiencing growth spurts.
Select a backpack that has a padded back, two padded shoulder straps and a waist strap to help evenly distribute the weight from the shoulders to the body’s core and hips. The extra padding will help protect students’ neck and shoulders which are rich in blood vessels and nerves and when constricted can cause pain and tingling in the neck, arms, and hands.
Finally, choose a backpack that is light-weight and has multiple compartments which can help distribute the weight more evenly. It’s also a good idea to think about picking a backpack with reflective material or adding reflective tape for younger students.
After picking out the perfect backpack, students should also be reminded on how to properly wear and pack their “shoulder shadow.”
Always wear both shoulder straps to distribute the weight evenly. Using one only shoulder strap can cause too much leaning and threaten to curve the spine.
Adjust the shoulder straps so the pack fits snugly across their back. When possible, pack lightly and carry only items that are required for the day.
Never allow a student to carry more than 15 percent of their body weight. For example, if a child weighs 100 pounds, the backpack should not weight more than 15 pounds.
When organizing the content of the backpack, distribute the weight evenly by packing the heaviest items toward to the center and lower portion of the bag to keep the weight off their shoulders.
Finally, here are a few tips to keep in mind to help lighten the load:
Ask if textbooks are available digitally, or if extra books are available to leave at home.
Consider having a “homework box” at home that contains schools supplies (pens, pencils, ruler, markers, highlighters, etc.) to reduce the amount of unwanted weight in a backpack.
Encourage kids to use their locker or desk frequently throughout the day instead of carrying an entire day’s worth of books. Only bring home the books which are truly required for homework or studying each night.
Pick up the backpack using proper lifting techniques, encouraging students to bend at their knees and use both of their hands when lifting the bag to their shoulders. It may not be a bad idea for students to participate in back-strengthening exercises to assist in building up muscles required to carry a backpack.
We hope you have a fun and healthy year at school! Happy learning!
By: Anne Marie Muto, OTR/L, CHT, from NovaCare Rehabilitation’s Broomall and Boothwyn, PA centers. Anne treats patients dealing with upper extremity injuries and is a preferred provider for the Graston Technique.
NovaCare Rehabilitation and NovaCare are part of the Select Medical Outpatient Division family of brands.
Posted on 6/12/2017 by Heather N. Wnorowski, P.T., DPT, OCS
Across the country, baseball and softball season is in full swing. Whether it’s at a backyard barbecue or an official game, athletes of all skill levels are taking part in America’s favorite pastime.
Over the past few years, a large emphasis has been on the youth athlete and overuse injuries in pitchers. We have learned to monitor pitch counts, plan structured rest and encourage multi-sport participation with athletes.
But what about outfielders, catchers and the weekend warriors who enjoy playing in their neighborhood league?
Common injuries aside from the shoulder and elbow exist in youth and adult baseball/softball athletes, such as back pain, knee pain and Achilles injury. Many overhead athletes have concurrent complaints of back pain or contralateral knee pain (knee pain opposite of their throwing arm). Why?
When you think about baseball and softball, a player is doing rotational movements that require the entire body. Unless they switch hit, these rotational patterns are always to the same side. What then happens is they may overdevelop certain muscular groups on one side in comparison to the other. In doing so, this can cause overuse injuries of these groups or we may injure or strain ourselves doing normal daily activities due to this imbalance.
The easiest way to avoid injury at practice or during a game is to develop a proper warm-up routine. An adequate warm-up usually involves a little bit of sweat, which can be hard to get in the dugout. Try performing some of these full body movements to warm-up quickly and efficiently:
Overhead walking lunge
Heather Overhead Lunge
Split squat with one foot on the dugout bench
Heather Split Squat
Lunge with trunk and arm rotation
Heather Lunge Rotation
Shoulder rotation with banded pull aparts
Heather Band Rotation
PNF diagonal pattern with banded pull aparts
Heather PNF Bands
Incorporating a low back and abdominal strengthening routine into your normal strengthening routine is also recommended. To be most efficient, you need a good transfer of force between the upper half and lower half during throwing or batting. Without a solid core, athletes with lose force and become less effective. Abdominal exercises that require rotation in both directions, isometric holds (planks, side planks), and lumbar extension strengthening should all be incorporated into your programming.
Heather Stretch 1 Heather Stretch 2
Having a good balance of strength (right and left sides comparable) and a solid warm up routine will help to prevent injury and enhance performance. Hopefully these tips prepare you for your season and keep you healthy on the field. Best of luck in your upcoming season!
By: Heather N. Wnorowski, P.T., DPT, OCS. Heather is a staff physical therapist at our NovaCare Rehabilitation center in Sewell, NJ. She earned a doctorate of physical therapy from Widener University and is dedicated to developing efficient avenues of treatment to influence superior patient outcomes.
Posted on 5/26/2017 by Aileen Lysaught, M.S., CCC-SLP
Join NovaCare Rehabilitation and NovaCare as we shine a light on Better Hearing and Speech Month (BHSM)! BHSM is hosted each May by the American Speech-Language-Hearing Association which works to make effective communication accessible and achievable for all.
Being a first time mother, you don’t really know what to expect after your child is born. My son Rowan was born unexpectedly at 35 weeks. While I was in labor, the nurses warned me of all the complications that may occur with a premature baby. The neonatologist was present for the delivery, and my son was quickly whisked away before I could hold him. While he was being examined by the doctors, I couldn’t wait to hold him for the first time. I could hear him crying as well as the nurse saying, “It looks like he has a tongue tie; my grandson had one, too.”
It seemed slightly ironic, being a Speech-Language Pathologist (SLP), that my son would have a tongue tie; however, I was too overjoyed with his birth to worry about the consequences of this during our first moments together.
When I looked in Rowan’s mouth, I could see he had what’s called a Class 1 tongue tie (the small fold of membrane that normally extends from the floor of the mouth to the midline of the bottom of the tongue attaches all the way at the tip of the tongue). This would significantly impact his ability to move his tongue for feeding.
Our first attempt at breastfeeding was when things became difficult. Being a preemie, he had some difficulty feeding as the sucking pads are not developed in babies born prior to 37 weeks. The tongue tie also made it difficult for him to coordinate the movements necessary for breast or bottle feeding. So, being an experienced SLP, I knew to ask, “When can we have the ear, nose and throat (ENT) doctor come do the frenectomy?”
A frenectomy is a procedure for children struggling with speech or feeding difficulties related to tongue tie. This procedure would help my son improve his feeding skills and get the adequate nutrition needed. The next day, the ENT arrived and quickly performed the procedure. By our first pediatrician appointment the following week, he was back up to his birth weight and then some.
As time went on, I noticed some symptoms in my son that led me to believe he still had tongue restriction and a potential lip tie. He suffered from reflux, which caused him to arch his back and become fussy after feedings. He was gassy and didn’t sleep very well.
Aileen and RowanI began to research as much as I could about tongue tie in babies and children. I took courses and joined support groups for other parents with tongue tie babies and groups in which SLPs would discuss their experiences with tongue ties. I found that some of the other symptoms my son was experiencing could be related to his tongue tie. I also found that many physicians or dentists who are not specially trained in tongue tie may not perform complete revisions, which may result in the need for a second procedure. By this time my son was six months old.
After a lot of research and careful consideration, I went to see a pediatric dentist who was highly recommended and performed successful frenectomy procedures on many of my patients with great outcomes. I was worried, but I couldn’t help but think about how many times I have recommended a family to have the procedure done. The pediatric dentist we saw was extremely knowledgeable.
After he examined my son, the dentist said Rowan’s initial frenectomy was likely incomplete and he would have to use a laser to perform another revision on Rowan’s tongue as well as revise his lip tie. I trusted his recommendation and the procedure took less than five minutes.
I knew the importance of aftercare procedures, including stretching 10 times per day for 10 days and oral motor exercises to improve Rowan’s tongue’s strength and range of motion. I noticed significant improvements in his feeding abilities, ability to babble and gross motor development. Now that Rowan is a little over a year old, has well over 20 words in his vocabulary and is beginning to eat a variety of foods, I couldn’t be happier that he is able to move his tongue freely.
My situation was quite unique being a practicing pediatric SLP with experience in this area. Many mothers struggle and have to give up their attempts at breastfeeding before they discover what may be impacting their child. Many babies have difficulty with weight gain, suffer from reflux or are diagnosed as colicky when the issue lies in their tongue’s ability to function correctly. Parents may not realize their child has a tongue restriction until they have been diagnosed with a speech delay or struggle with a toddler who refuses to eat.
Tongue ties impact many areas of speech and feeding development, and it is important to find knowledgeable professionals to help with the process. It is essential to work with a SLP who can evaluate and identify if a tongue restriction exists and treat the symptoms (speech and feeding difficulties). It is also important to get referrals to an ENT or pediatric dentist to determine if a frenectomy is advised.
Having experienced these issues first hand, I feel that it not only makes me a better mother, but a better SLP. I am dedicated to helping other families overcome these difficulties so their child’s quality of daily life can improve.
Aileen LysaughtBy: Aileen Lysaught, M.S., CCC-SLP. Aileen is a pediatric SLP and the assistant center manager at NovaCare Kids Pediatric Therapy in LaGrange, IL. She has been a practicing SLP since 2010.
Posted on 3/18/2019 by Martin Ryan, C.P., CFO, FAAOP | Comments
How does a prostheses attach? Great question and one that has a number of possible styles for the below the knee patient.
Suspension systems in prosthetics come in a number of configurations. One system common today is the mechanical pin lock system. A pin is attached to the distal liner and inserted to a lock mechanism that provides the interface for suspension. The system is clinically referred to as the Below Knee Prosthesis with a Pin Locking Liner.
Pin lock suspension can be used with patella tendon bearing (PTB), total surface bearing or hydrostatic socket design. With pin lock liners, a silicone liner is rolled onto the residual limb creating a seal between the skin and the liner. The liner has a pin on the end that locks into the bottom of the prosthetic socket. A prosthetic sock may be worn over the silicone insert in order to allow for volume fluctuations.
PUTTING ON THE PROSTHESIS:
Turn the liner inside out. Make sure the liner is clean and dry and has no dirt on it that will irritate the skin.
Make sure a good portion of the bottom end of the liner is exposed and place it against the limb. (Figure 1) With light pressure, roll it up and over the limb. Make sure no air pockets exist between the liner and the skin.
Roll the liner up the limb. (Figure 2) Do not pull or tug. Be careful not to tear or puncture it with fingernails or jewelry.
Pay close attention to the placement of the pin. In most cases, it should be in line with the limb. Be careful not to pierce the liner with the pin.
When using a liner without a fabric cover, a lubricant may be necessary. Consult with your prosthetist to determine the best lubricant for your use.
Add the appropriate thickness of prosthetic sock over the liner, if necessary.
Push the residual limb into the prosthetic socket. The pin will insert into the lock and click down as the limb goes into the socket. It should take some effort to put on the prosthesis. If it clicks down easily, a thicker prosthetic sock may be needed. (Figure 3)
REMOVAL OF YOUR PROSTHESIS:
Push and hold the lock button in and lift the limb out of the socket.
CLEANING AND MAINTENANCE:
The prosthetic socks and sheaths should be cleaned according to the manufacturer’s directions. The soft insert and the prosthetic socket may be wiped out with warm, soapy water or alcohol as needed. Clean socks should be worn every day.
TIPS AND PROBLEM SOLVING:
One of the most difficult concepts to master is how to determine the correct sock ply to wear. Wearing the correct amount of socks is critical for comfort and safety. Your prosthetist and physical therapist will supply you with general guidelines in wearing socks, but if you have questions do not hesitate to contact or visit your prosthetist.
OH NO, IT’S STUCK:
It can happen. You get stuck and the pin will not release. Many times, the sock has covered the pin and is providing in ability of the pin to release.
Do not panic. In most instances, some consistent pulling will release the pin and free the lock. Ask someone to assist you in this process if necessary.
In extreme cases, pour soaping water into the liner next to the skin breaking suction and allow it to release from the prostheses and work free.
Contact your prosthetist.
For more information on the Below Knee Prosthesis with a Pin Locking Liner, please contact a NovaCare Prosthetics & Orthotics centers near you.
By: Martin Ryan, C.P., CFO, FAAOP, is prosthetist for NovaCare Prosthetics & Orthotics. Marty is certified in advanced prosthetic designs for adults and pediatrics. He received prosthetic training at Northwestern University and the Rehabilitation Institute of Chicago. Marty is certified in prosthetics by the American Board for Certification and works out of NovaCare P&O’s Fond du Lac center in Wisconsin. NovaCare Prosthetics & Orthotics is part of the Select Medical Outpatient Division family of brands.
Posted on 2/9/2017 by Melissa Bloom, P.T., DPT, NCS
One of the many myths pertaining to concussion is that you need a big blow to the head to get one, or that getting your “bell rung” isn’t a big deal. In fact, any impact to the head, neck, or body has the potential to create changes to the neurological function of the brain, or cause a concussion. While you most certainly can get a concussion from a high intensity football game or from a car accident, they often occur after what
may seem like a fairly light bump.
I’ve seen people with significant concussion symptoms from slipping and falling on ice, accidentally hitting their head on a cabinet door, getting elbowed in the head, or having luggage hit their head while unloading it from a plane. Additionally, I see patients from motor vehicle collisions where they never even hit their head and I see athletes where no one can pinpoint a specific hit. However, these individuals may be showing signs of post-concussion symptoms after the accident or game.
Similarly, a common myth is that you need a loss of consciousness or at least will “see stars” in order to have a concussion. In fact, a loss of consciousness is quite rare post-concussion, with occurrences of less than four to 10 percent.
An invisible condition
What makes concussions more complicated is their invisible nature. Unlike a cut or even a broken bone where we can see a bandage or a cast, the symptoms of a concussion often go unseen. The most common symptoms are:
Foggy or difficulty thinking
Blurred or double vision
Sensitivity to light or sound
Changes in sleep patterns
Increases in anxiety and irritability
While the symptoms are real and can significantly impact someone’s ability to function, peers, family, co-workers and friends cannot see them.
Return to sport and return to life
Awareness and education are key to help diagnosis concussions and to help those with persistent symptoms get the proper care they need to recover. An important first step can be recognizing anyone who may be showing any of the symptoms listed above that could be connected to anyphysical impact, no matter how much of “just a bump” it was. Despite how or when someone sustained a concussion, an active rehabilitation program can help. Our concussion management clinicians complete comprehensive examinations to assess the multiple systems that are often involved post-concussion and will develop an individualized plan of care unique to each person and case.
In the past, the primary treatment for concussion was rest; it has even been called “cocoon therapy.” However, current research shows that activity and stimulation is better than excessive rest. That doesn’t mean, though, that you should go full force into your previous activities. Symptoms should be monitored and controlled; this may vary depending on the underlying factors specific to a concussion. As long as you have remaining symptoms post-concussion, having an evaluation and treatment plan set for you can help guide your activity levels and ultimately get you back to your normal symptom-free life. Treatments will depend on your individual test results, but will likely be a combination of visual exercises, vestibular rehabilitation, neck treatments, or a sub-symptom exertion program.
Common rehabilitation components
Visual exercises are provided when symptoms are due in part to your eyes not communicating well with each other and the brain. These exercises tend to involve having your eyes work more efficiently to reduce symptoms and increase visual clarity. This can involve simple eye movements or complicated tasks of watching a busy scene with many moving items.
Vestibular rehabilitation is indicated when the inner ears are somehow involved. These treatments can also be varied, but typically involve some type of head movement. You may initially get dizzier with these exercises, but they are effective in eliminating symptoms in the end.
Neck treatments may involve addressing any neck pain you have post-injury. More often than not, neck pain means that the sensors in the neck are not communicating well with the brain, leading to fogginess, dizziness, imbalance, or headaches. Specific exercises can retrain these receptors and in turn eliminate remaining symptoms.
Sub-symptom exertion training is frequently needed post-concussion. These exercises are designed specifically for you based on your heart rate, and are intended to allow the brain to safely heal and handle the physiologic challenges needed for daily physical and mental activities.
Balance and functional training may be included to make sure you are in tip-top condition to safely get back on the field or get back to work, play, and or life.
Unfortunately, there is not a lot we can do for concussion prevention. A concussion is different than other brain injuries where there is focal damage. The changes we see post-concussion are due to sheering or pulling forces on the nerves of the brain, which in turn changes the effectiveness in how they work. Protective devices, such as helmets or mouth guards, cannot prevent these forces from occurring. They are important in preventing skull or jaw fractures or cerebral bleeding, but their limitation with concussion protection is an all too common misconception. In fact, using equipment that does not protect against concussion while perceiving there is preventative value may lead to more risky behavior and possible paradoxical increase in concussion rates.
The best thing we can possibly do is be vigilant about injuries, symptoms and being sure to take the necessary steps toward recovery. We can help you.
Melissa Bloom By: Melissa Bloom, P.T., DPT, NCS. Melissa is a physical therapist with Physiotherapy Associates in Atlanta, GA. Melissa is a board certified neurology specialist. She specializes in vestibular rehabilitation and concussion management and teaches nationally on both topics.
Physio, NovaCare Rehabilitation and NovaCare are part of the Select Medical Outpatient Division family of brands.
Posted on 10/6/2017 by Melissa Bloom, P.T., DPT, NCS
Cooler temperatures, students returning to school and the start of another football season are all the telltale signs of fall. And with football back, reports of concussion will inevitably follow. While advancements continue to be made in regards to concussion prevention and treatment, the long-term effects of head trauma, specifically chronic trauma encephalopathy (CTE), remains a huge concern.
You may have previously heard of CTE from the movie “Concussion,” or even from recent media reports. CTE is a tough topic for me. My trouble with the conversation is that there are a lot of unknowns and uncertainties. With the potential for serious injuries, there is the chance for panic and decisions made on emotions versus science. Moreover, ignoring the conversation leads to misinformation. So, it’s time we talk about CTE; what is it and what it means for the future of football.
What is CTE?
CTE is a progressive neurodegenerative disease associated with repetitive head trauma. CTE involves cellular pathological changes similar, but different, to Alzheimer’s disease. The buildup of Tau protein in the brain causes cell death, atrophy and abnormal functioning. CTE can currently only be diagnosed after death by examining the brain under a microscope.
Symptoms can be physical, involving gait abnormalities and slowness of speech, or psychiatric and behavioral, including personality changes, depression and aggression. Various cognitive and processing deficits are also common with CTE, including difficulty thinking, concentrating and remembering.
One consistent scientific challenge is understanding the extent to which age-related changes, psychiatric or mental illness, alcohol or drug use, coexisting dementia or other unknown factors play a role in developing CTE. Currently, this is largely unknown and has not been accounted for in research. CTE is more common in contact sports, but other factors in these athletes may also lead to the disease.
Recent Study and Media Interviews
Earlier this year, the Journal of American Medical Association released an article on CTE. The study looked at participation in American football along with multiple physical and psychosocial variables, and they compared these factors to diagnosis of CTE. Results of this study travelled across the media quickly, with the overall conclusion that players of American football may be at increased risk for CTE. Of the 202 individuals in the study, they found 177 were diagnosed with CTE. The researchers further concluded that 99 percent of subjects who played in the National Football League (NFL) were diagnosed with CTE. What a headline.
Not to downplay the severity of CTE and valid concerns that exist about it, but I want to discuss some limitations about what we can take from these results. First, they conducted their study with football players whose brains were donated for research of CTE, creating a significant selection bias. It was known that their brains would be studied regarding a possible connection with CTE and their participation in contact sports. Individuals and their families who participated (i.e., donated their brain) may have noticed symptoms consistent with CTE prior to death, which led to their participation.
What trends did they find?
Beyond the expected motor, cognitive and psychological involvement known to accompany CTE, there were other notable trends. Substance abuse was noted in 67 percent of those diagnosed with mild CTE, and 49 percent in those diagnosed with severe CTE.
The presence of co-morbid neurodegenerative diseases was also common, including Alzheimer’s, Lewy Body Dementia (LBD) and other motor neuron diseases. In fact, more than 19 percent of the subjects with CTE presented with LBD alone. The current study was not designed to determine the impact these factors had on the development of CTE.
Even the authors note that caution must be used in interpreting the high frequency of CTE in their sample. Their results do not allow for estimates of prevalence, due to the lack of comparison groups. Additionally, the sample population was not representative of the overall population of former players of American football. The majority of players only play youth or high school levels, but most individuals in this study played at the college or pro level.
Evidence supports an association between long-term cognitive, neurobehavioral and psychiatric problems with participation in contact sports, such as football, boxing, soccer, etc. While it seems plausible there is a connection between CTE and repetitive impacts seen with American football, it is currently not possible to determine the causality or risk factors with any certainty. We need to proceed cautiously and collect additional research. However, concussion screenings and efforts to minimize concussion can improve the current health of players even if the long-term effects are unknown.
There is an inherent risk with contact sports for concussive and sub-concussive impacts. The challenge now is evaluating the risk given uncertain long-term consequences and the many scientific questions we don't have answered. For now, let’s continue to play smart, wear protective gear, get baseline tested for concussion and, should a concussion occur, thoroughly go through the rehabilitation process for safe return-to-play and activity.
Melissa Bloom By: Melissa Bloom, P.T., DPT, NCS. Melissa is a physical therapist with Physiotherapy Associates in Atlanta, GA. Melissa is a board certified neurology specialist. She specializes in vestibular rehabilitation and concussion management and teaches nationally on both topics.
Physio, NovaCare Rehabilitation and NovaCare are part of the Select Medical Outpatient Division family of brands.