Posted on 4/19/2018 by Inessa Soden, O.T., CHT
Occupational therapy has been an established profession for more than 100 years. Yet, to this day, many people, and even medical professionals, are confused about what this field has to offer. It could be described as one of the disciplines in a rehabilitation team, focusing on restoring people’s ability to perform normal daily activities and resume valued roles in life. Thus, occupational therapy could be applied in general public health and the rehabilitation of many medical diseases.
Cancer diagnosis and treatment is a devastating life event that throws unexpected hurdles on the road of survivorship. Cancer patients may experience:
Weakness and fatigue
Stiffness in joints
Numbness and altered sensation in extremities
Difficulty remembering and performing daily activities
Some of these difficulties occur at the time of diagnosis, while others might become apparent during treatment and long after.
Medicine has been making great strides in treating and curing some cancers and better prognoses for life expectancy. There are currently more than 15 million cancer survivors in the United States, and the projected number is more than 20 million in the next 10 years. However, the courageous victory of beating the disease often comes with paying the price of temporary, residual or lasting side effects from the cancer treatment. Yet, after going through such a hard battle one doesn’t have to succumb to suffering or giving up so many of one’s previously enjoyed activities.
Life might be changed after experiencing cancer, but that means that one needs to learn to adjust and do things differently. This is where occupational therapy and our ReVital Cancer Rehabilitation program can improve quality of life.
ReVitalFor example, pain could be addressed by multiple manual therapy techniques and stretches, sometimes utilizing the application of special tools such as instrument-assisted soft tissue mobilization or cupping. Different physical agent modalities, such as ultrasound, electrical stimulation, and physiological techniques, like deep breathing and sensory reeducation, could be beneficial. Based on the cause of pain, the therapist will choose an appropriate course of treatment.
In cases of weakness and fatigue, an occupational therapist will develop an individualized program focusing on activities to build up strength and eliminate unnecessary strain on the body. The program may consist of exercises and activities as well as learning energy conservation principles and use of adaptations and adaptive techniques. In addition, each person will get an individualized home exercise program that is modified based upon progress.
For altered sensation, such as pins-and-needles, burning or numbness, an occupational therapist can help to control symptoms, which may be temporary due to swelling or nerve compression. The therapist may recommend and fabricate a custom orthosis, incorporate manual therapy to release the bound neve and design an individualized exercise plan. Other modalities, such as therapeutic taping, may be performed as necessary.
Sometimes unexpected difficulties arise in a battle with cancer. Survivors may experience difficulties focusing on a task, forgetting important information or have trouble multitasking everyday schedules. This may become a safety issue or cause severe emotional distress. In this case, a trained occupational therapist will help to set priorities and come up with suggestions and adaptations in order for the person to be as safe and independent as possible.
Teaching family members how they can help their loved ones to cope is part of the education that an occupational therapist provides. Learning how to access some local and national resources, finding support groups and leisure/recreation activities may also be of benefit.
These are just few examples of what occupational therapy can offer to ease the burden on a cancer survivor and promote a happier, healthier life. Working in a close relationship with a team of doctors, nurses, physical/speech therapists and local communities to help establish a strong support system so one does not need to go through this journey alone.
Consultation with your local occupational therapist trained in the ReVital Cancer Rehabilitation program could be requested at any time, be it right after the diagnosis, prior to surgery or during or after cancer treatment throughout the survivor’s lifespan.
By: Inessa Soden, O.T., CHT. Inessa has been a NovaCare Rehabilitation team member in South New Jersey since 2011. She treats patients of varying diagnoses, including orthopaedics and neurological and oncologic conditions. She focuses on building an individualized treatment plan for each of her patients to ensure they achieve their best level of independent participation in every day roles and activities.
Posted on 3/27/2018 by Bryce Vorters, M.S., ATC, LAT
A couple weeks ago, I got the chance to dust off my golf clubs and go to the driving range. I hit 100 golf balls with four different clubs, and all of them went the same distance. I know that isn’t how it’s supposed to work, but hey, I never said I was good at golf. I just have the dream of hitting a hole in one, so I looked up the odds and it is about a one in 3,500 chance. Given that I can’t hit the ball like a pro, or even a good amateur, my dream will probably never happen, but I’m always going to prepare for the day by striking the ball whenever I get a chance.
From an odds standpoint, one in 3,500 is about .02 percent, which is a long shot, but accounts for approximately 100,000 people this year in the United States. These odds are the same as the possibility of tearing your anterior cruciate ligament (ACL). For the same reasons I go out year after year and practice hoping for a par, I’d encourage you to make a small effort to work on lowering your chances of tearing an ACL with an ACL prevention program.
ACL prevention programs have been created and mixed into teams warm-ups, cool downs and off-season lift programs and have been shown to be helpful. Research shows 75 to 85 percent less ACL injuries happen when athletes are on an ACL program. Programs are usually three-times per week and take about 30 to 45 minutes to perform or, in my experience, about 15 to 20 minutes of additional work onto the normal warm-up and cool down of a team sport. It’s no guarantee that you won’t tear your ACL, but if you can practice for your sport to get better, why not make a small investment in making sure you can potentially avoid a nine- to 12-month rehabilitation process, too?
A simple ACL program looks something like this:
Jogging – Two minutes forward, two minutes backward and two minutes of side shuffling
Stretching – Thirty seconds on each of these muscle groups:
This should look similar to a basic high school gym class warm-up.
Agility Drills – During agility drills, look to maintain your balance. Have your knee stay behind your toes and do not allow your knee to sway toward the opposite side of your body.
Bend over and touch a ball on the ground in front of you 10 times.
Balance on one leg in a mini squat for 60 to 90 seconds while dribbling a basketball, playing catch or trying to kicking a soccer ball.
At this point, we added approximately five minutes to your warm-up, and you should be ready to perform your normal practice, pick-up game or workout.
Strength Portion – After your workout, perform strength exercises that reinforce proper mechanics of jumping and landing and help you control your body while you’re tired. Most injuries happen to people when they are tired or near the end of a game because they lose focus on controlling their body.
During this strength portion, you should be looking to stay focused, keep your knees from going toward each other during the landing and land softly and on the balls of your feet.
Squat jumps with two second hold at the landing 10 times
Tuck jumps 20 times
Lateral jumps 10 times each side
Lunge 10 times each side
Plank two times for 30 seconds front and each side
Cool Down – Perform your normal cool down or a nice foam rolling session.
An ACL prevention program doesn’t guarantee you won’t tear your ACL any more than me hitting the driving range three times per week to help fix my golf swing will guarantee me a hole in one, but it doesn’t mean I’m not going to go out and try. I encourage you to take a few extra minutes to help prevent an ACL injury, and I hope your extra work is fruitful to your sports performance and ACL injury prevention.
For more information concerning ACL injury prevention and NovaCare Rehabilitation and Select Physical Therapy’s ACL Play it Safe Program, please click here.
By: Bryce Vorters, M.S., ATC, LAT. Bryce is the head athletic trainer with NovaCare Rehabilitation for Conwell-Egan Catholic High School in Fairless Hills, PA.
Posted on 3/21/2018 by Dorothy Lehr, DPT, OCS, Cert. MDT
Major snowstorms have already hit many parts of the country this winter, and the fourth nor'easter in three weeks is currently battering the East Coast, drowning out any hopes of spring. There is lots of fun to be had with the fluffy white powder, but removing snow from sidewalks and driveways is an unenviable chore and one that can cause a plethora of physical problems.
With that in mind, below are a few tips and stretches to keep you safe and healthy while out in the winter wonderland:
Choose an ergonomically correct shovel, one which has a curved handle and an adjustable handle length. As opposed to a straight line shovel, a shovel which is small, lightweight and curved will allow you to carry a manageable load of snow and keep your back straighter, reducing spinal stress.
Proper shoveling technique is just as important as the correct shovel. Keep your back straight and bend at your hips and knees. When moving the snow to a new location, avoid twisting your body. Instead, turn your whole body by pivoting your legs.
Avoid slipping on slick areas or black ice by wearing shoes or boots with good tread. Applying pet-friendly salt, sand or kitty litter will also increase traction and decrease the risk of slipping.
Snow shoveling can be as physically demanding as a gym workout and should be treated like a day in the gym. Don’t overexert yourself, especially when the snow is wet and heavy. In deep snow, take a few inches off the top and tackle the job by dividing it into thirds, with one-hour rest breaks.
Snow shoveling is a cardiovascular and weight-lifting exercise, and just like you would stretch before working out at the gym, performing the stretches described below before, after and even during snow shoveling can help in preventing an injury.
Lumbar Extension – This stretch will help in balancing any forward bending that may occur during shoveling. While standing or lying on your stomach, bend back as far as is comfortable and hold for three to five seconds. Perform 10-15 repetitions.
Lumbar Extension - Step 1 Lumbar Extension - Step 2
Quadriceps Stretch – While standing, use your right arm to pull your right leg up toward your buttocks. Make sure to keep your trunk straight and use your other arm to hold onto a sturdy object to maintain your balance. Hold each stretch for 20 seconds and perform five reps on each leg. This will help stretch out your quad muscles that you’ll be using to lift while shoveling.
Hip Flexor Stretch – In a half-kneeling position and while maintaining an upright trunk, lunge forward until you feel a stretch in the front of your hip. Hold this position for 20 seconds and perform five repetitions on each leg. This stretch will help to stretch the muscles you’ll be using while moving snow and helps to keep your spine in a neutral position.
Sometimes, there will be a winter storm where a snow shovel simply isn’t enough. While a snow blower can certainly help with snow removal, hand injuries such as burns, lacerations, fractures and even amputations can occur if proper techniques aren’t practiced. Here are a few tips to keep you safe while operating a snow blower:
While it sounds simple, never put your hands down the chute or around the blades of a snow blower.
Use a broom handle, clearing stick or another tool to clear any clogs. Wait 10 seconds after the engine has been turned before you attempt to unclog the chute; blades could still be spinning even though the machine has been turned off.
Generally, keep your hands and feet away from all moving parts of a snow blower.Avoid wearing scarves and loose fitting clothing which could become tangled in the moving parts and pull you into the machine.
Never direct the discharge chute toward you, other people or areas where any damage can occur. The blower can also discharge hard objects, such as salt, sticks and ice further and faster than snow.
If you are feeling some unwanted aches and pains or suffered an injury during your clean-up efforts, we’re here for you. Contact the center nearest you to schedule a complimentary consultation. Stay safe and keep thinking spring – it’s coming!
By: Dorothy Lehr, DPT, OCS, Cert. MDT. Dot is a physical therapist and center manager with NovaCare Rehabilitation in Willingboro, NJ. A treating clinician for 12 years, Dot is a board certified orthopaedic specialist and McKenzie credentialed therapist, specializing in spine treatment.
Posted on 3/16/2018 by Stephanie Wilkins, MSEd, ATC, and Leah Friedland, M.S., ATC
Concussions are a great concern throughout the world of sport and especially in the high school setting. They can impact the student-athlete not only on the field, but also in the classroom and their daily lives. As athletic trainers in the high school setting, when a concussion has occurred, we are involved in the entire process, including:
We help with education, implementation of proper concussion protocols and serve as an advocate for the student-athlete in their sport, classroom and life.
Education – Despite the growing awareness and concern that is present in the media over concussions, we find that coaches, parents and athletes are often still uninformed about the seriousness of concussions and the proper way to handle them. A concussion is a traumatic brain injury that is caused by either a direct force/blow to the head or a force transmitted through the body to the head. As high school athletic trainers, we find ourselves explaining to coaches that “getting your bell rung” is the same as sustaining a concussion, and that it is not something that can be ignored. “This wasn’t a big deal back when I played sports, and I turned out fine,” is not an acceptable way of viewing this issue.
We are seeing now that, decades later, people are experiencing abnormal brain function and lasting damage as a result of previous head trauma that might not have been managed properly. Concussion education is not intended to scare people, but rather to inform and stress that concussions should be handled appropriately and taken seriously.
We must also work to change the team attitude around concussions and urge athletes and coaches to take responsibility for their well-being and the well-being of their teammates. The culture of not reporting concussions for fear of sitting out or being made fun of must not continue. High school athletic trainers are in the unique position of helping create this cultural change within sports programs and we strive to do this by forming relationships with our coaches, parents and student-athletes that are based on trust and compassion.
Baseline Testing – Every concussion is different; even in one person, different concussive episodes can present in different ways. Symptoms of a concussion include:
Appearing dazed or confused
Nausea and vomiting
Imbalance… and more
There are few objective measures available to diagnose concussions, so it’s important to have a baseline evaluation for each athlete to help determine return-to-play.
We perform this evaluation at the beginning of the season to obtain a baseline score, i.e. an athlete’s “normal” level of functionality. If the student-athlete sustains a concussion during that season, a second test will be administered. This second test occurs when they are symptom-free and have completed the return-to-play progression.
In our high school, we implement two different tools for baseline testing. With more than 800 student-athletes, we prioritize the high risk contact sport athletes (like those participating in football or soccer) and administer baseline tests to those sports. The first test is ImPACT®, a computer neurocognitive exam that tests word and image recall, reaction time, motor speed and symptom report. The alternate test we use is C3 Logix. In addition to a neurocognitive exam, C3 Logix includes a balance and vision component. It is more comprehensive and time intensive, whereas the ImPACT® Test is more easily administered to a large team all at once.
We don’t use ImPACT® or C3 Logix to diagnose concussions, but rather as a tool to monitor their healing process and identify any potential problem areas.
Evaluation and Diagnosis – The most important aspect of concussion management in the high school setting is communication. We’ll discuss concussion management with both the student-athlete and parents/guardians to discuss next steps and answer any questions they may have
Next, we communicate with our Concussion Oversight Team (COT). The COT is a multidisciplinary group of individuals who help manage the student-athlete’s post-concussion care. It includes the athletic trainers, team physician, school nurses, athletic director and school counselors. We also email the coach and physical education teacher. This is our opportunity to provide athletic and/or academic accommodations as needed. The counselors and nurses are vital for helping communicate with the student-athlete’s teachers.
Occasionally, a student-athlete will require academic accommodations. These are specific to each individual and can include wearing sunglasses to help with sensitivity to light, postponing quizzes or tests, limiting use of computer work or leaving class early. Most students don’t require academic accommodations, but all are excused from gym class and athletics until their symptoms have resolved and they have completed the return-to-play progression.
Follow-Up – Oftentimes, parents will ask, “Does my son/daughter need to go to the doctor or the emergency room?” The emergency room is rarely indicated unless there are signs and symptoms of a brain bleed. This will be evaluated at the time of the injury and, if there is concern, a referral to the emergency room will be made.
Research shows that most concussions resolve within 7-14 days. Our protocol recommends following up with a physician if the symptoms have not resolved within 7-10 days. And, referral to an appropriate health care provider is essential. When possible, we will refer to a concussion specialist who works with these cases on a normal basis. The average primary care physician will not have expertise in concussion management. We will sometimes recommend following up with an ophthalmologist if the student-athlete is having difficulty with vision or physical therapy due to vestibular problems.
As athletic trainers, we take care to be as best prepared to diagnose and treat concussions as possible. We put a strong emphasis on communication with the athlete, parents, coaches and school in order to return the student-athlete safely to school and sport. Concussion research will continue to evolve over the years to come, just as we will continue to adapt and update our management protocols to keep student-athletes safe and active.
By: Stephanie Wilkins, MSEd, ATC, and Leah Friedland, M.S., ATC. Stephanie and Leah serve certified athletic trainers for NovaCare Rehabilitation in Chicago, Illinois, and currently work at York Community High School. Stephanie also serves as the sports medicine program director and helps manage other sports medicine contracts around the Chicago-land area.