Posted on 3/8/2018 by Joshua Cramer, DAT, LAT, ATC, CES, CSCS
Injuries can happen at any time to anyone. Whether playing your favorite sport, working on the job or living your daily life, it’s important to get the proper treatment when an injury occurs, and that starts with the evaluation process.
During an evaluation, a clinician will discuss a patient’s medical history, discuss goals and specific needs, inspect for abnormalities, tenderness or deformities and test musculoskeletal health. All of these components are essential to making a proper diagnosis, but they rarely provide the whole picture. These evaluative techniques focus on the area of the patient’s chief complaint, but what if the issue is in a different region or system in the body?
To design more effective treatments, it is important to look at the body as a whole – the upper and lower body, the front and back of the body and the limbs. This is where postural and functional assessments come into play.
Functional movements are essentials movements found in activities of daily living. They usually involve multi-joint movements in numerous directions, which place demand on the body's core muscles. Our clinical team frequently include functional movement screens in the evaluation process, which are designed to examine these daily essential movements and help identify limitations and dysfunction, reduce the risk of injury and improve efficiency and performance. Functional movement screens also include a detailed report and customized corrective exercise program.
There are a handful of functional movement tools available to clinicians. Some of the more popular are through the Functional Movement System, which is divided into two main parts: the Functional Movement Screen (FMS) and the Selective Functional Movement Assessment (SFMA). Another popular functional movement tool is Fusionetics.
The FMS is a screening tool which takes the patient through a series of basic movements with the intention of determining if the patient is at risk for injury. Its role is to impose minimum standards on movement patterns. The movements include:
Stepping over a hurdle
Reaching behind the back
Core test – the patient starts on his/her hands and knees and touches the elbow to the knee
The SFMA is a full-body assessment broken down into two parts, the top-tier and the breakouts. The top tier helps determine if movements are functional versus dysfunctional and painful versus non-painful. The breakouts determine the type of dysfunction a patient may suffer from. The movements consist of:
Various neck movements
Reaching behind the back
Hip flexion (bending forward)
Hip extension (arching backward)
Hip rotation (twisting)
Single leg stance
The SFMA will help define what type of dysfunction exists, whether that’s stability and motor control dysfunction, joint mobility dysfunction or tissue extensor dysfunction. Once the clinician determines which dysfunctions exist, he/she will set up an individualized treatment protocol to correct the faulty movement pattern and treat the injury and prevent future occurrences.
Fusionetics is designed in the same manner, but is web-based. It is a series of 10 exercises that determine whether someone is susceptible to certain injuries due to form and body mechanics. At the end of the Fusionetics assessment, the system will provide patients with corrective exercises. Each patient can create a free account with Fusionetics and access the results and corrective exercises from any computer, tablet or smartphone.
These screenings and assessments can be done on both injured and healthy individuals to identify movement and stability deficits. As you continue to play your respective sport or go through your daily routines, keep in mind that proper functional movement is a necessity. It is just as important to treat your body properly when you’re healthy as it is when you’re injured.
By: Joshua Cramer, DAT, LAT, ATC, CES, CSCS. Josh has been with NovaCare Rehabilitation for five years and serves as the head athletic trainer for Germantown Academy and the Philadelphia Freedoms. He is certified in various manual therapy techniques and has treatment expertise in shoulder injuries and concussion.
Posted on 1/24/2018 by Jeff Lambert-Shemo, ATC
Throughout the 2017 NFL regular season, a plethora of superstars saw their seasons cut short due to serious and season-ending injuries. Carson Wentz, Odell Beckham and J.J. Watt were just a few of the headliners bit by the injury bug. Overall, 35 players who had previously been elected to the Pro Bowl or could be considered major contributors to a team sustained a serious or season-ending injury. Many fans were left wondering whether there were key factors that contributed to this increase in sidelined players.
One possibility lies within an increase in physical abilities of the athletes participating in pro football. While an influx of bigger, stronger and faster players may make for a more exciting product, it also increases the opportunity for injuries to occur. Advances in the field of strength and conditioning along with nutrition have allowed these gladiators of the gridiron to reach new peak performance levels in regards to power and speed. With the difference in speed and strength among players becoming negligible, athletes are now relying on different skills to make an impact for their team.
One of the most important skills for the player is the ability to transfer speed and strength into movements, allowing a receiver to get separation, a defensive lineman to get a step on his adversary and a running back to evade a would-be-tackler. This skill allows an athlete to use their other talents to make a big play. So if athletes are more skilled at movement, why are these injuries still occurring?
As the speed of movement increases, control of that movement will naturally decrease, also affecting an athlete’s ability to maintain control. Athletes who are relied upon to change the course of a play, game or season must continuously perform at a level that is tiptoeing between success and failure and that can put their physical safety at risk. Changing direction, stopping, turning and jumping all become less controlled as speed increases. For a player in the NFL, an opportunity to make a great play also increases the opportunity for injury.
With an increase in the number of exceptionally strong and fast athletes in the NFL, the number of players who have the skill to separate themselves from other athletes within a particular position is dwindling. With fewer players who have the skill to make a difference, teams are relying more heavily than ever on a few key individuals to adjust the course of a game, which is also putting those players at a higher risk of injury.
As a point of emphasis, training and practicing athletics at full competition speed is the best way to create appropriate muscle patterns to increase skill in movement while decreasing the risk of injury.
At NovaCare Rehabilitation and Select Physical Therapy, we offer sport-specific programs to help athletes of all performance levels restore function, decrease pain, increase strength and flexibility, optimize performance and gain education on injury prevention. Contact a center near you to speak with a member of our sports medicine team today!
Jeff Lambert-ShemoBy: Jeff Lambert-Shemo, ATC. Jeff is a certified athletic trainer and the director of sports medicine for NovaCare Rehabilitation in Northern Ohio. He has been a NovaCare team member for six years and brings more than 20 years of experience in youth, high school, collegiate and professional athletics, including soccer, lacrosse and football. Most recently, Jeff served as the head athletic trainer for the Cleveland Gladiators of the Arena Football League.
Posted on 1/12/2018 by Laila Hasham, P.T., DPT
Parkinson’s disease is a chronic, progressive movement disorder that affects one in 100 people over the age of 60. While the average age at onset is 60, people have been diagnosed as young as 18. It is the second most common degenerative brain disorder affecting adults (Alzheimer’s disease is the most common). Recent research indicates that at least one million people in the United States and more than five million worldwide have Parkinson’s, and there are around 50,000 new cases diagnosed each year.
Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Some of these dying neurons produce dopamine, a chemical that sends signals to the brain to control movement and coordination. As Parkinson’s progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally. People with Parkinson’s disease are at risk of falling and sustaining injuries due to their movement and balance impairment.
Treatment includes a combination of medication and physical therapy, and in some cases surgery. A physical therapist who has experience treating Parkinson’s can help a person improve mobility, strength and balance.
The universal benefits of exercise in helping everyone feel better and improving overall health are well documented. There is evidence that exercise has specific benefits for people with Parkinson's in staying active and improving balance and coordination. Exercise approaches have long played a role in the management of Parkinson’s disease, to maximize function and minimize secondary complications and inactivity.
For decades, the Lee Silverman Voice Technique (LSVT) has been an effective way to treat the symptoms of impaired voice and swallowing from Parkinson’s called LSVT LOUD®. In 2005, a new approach to therapy called LSVT BIG® was developed. LSVT BIG is a research-based exercise program specifically designed for people with Parkinson’s. It has been shown to improve function with significant improvements noted in trunk rotation, balance and faster walking with larger steps1. LSVT BIG is provided by physical and occupational therapists who have received specific training in this technique.
LSVT programs include the combination of:
An exclusive target on increasing amplitude, or loudness in the speech motor system, and bigger movements in the limb motor system.
A focus on sensory recalibration to help patients recognize that movements with increased amplitude are within normal limits, even if they feel ‘too loud’ or ‘too big.’
Training self-cueing and attention to action to facilitate long-term maintenance of treatment outcomes. In addition, the intensive mode of delivery is consistent with principles that drive activity-dependent neuroplasticity and motor learning2.
The LSVT BIG program includes 16 sessions of therapy over four weeks, at a frequency of four days each week. These sessions are provided in a one-to-one manner and include high intensity, whole body movements. Depending on the nature and severity of the condition, treatment sessions may focus on activities that are important to the patient and education to help transfers, bed mobility and hand movement. While other exercise interventions may focus on external cues and breaking down task components, LSVT BIG focuses on movement amplitude to achieve bigger and faster movements in the attempt to restore normal movement patterns and improve gait speed.
The program is both intensive and fun, and the hard work and dedication of the patient is integral to the success of the program. Find a local Select Physical Therapy center to see if the LSVT BIG program is offered near you.
For more information on Parkinson’s disease and the LSVT BIG program, please visit the LSVT Global website at www.LSVTGlobal.com.
Farley et al (2008) Intensity amplitude-specific therapy for Parkinson’s disease. Topics in Geriatric Rehabilitation 24(2) 99-114.
Cynthia Fox, Georg Ebersbach, Lorraine Ramig, Shimn Sapir. LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease. Parkinson’s disease. 2012;2012.
By: Laila Hasham, P.T., DPT. Laila is a physical therapist with Select Physical Therapy in Austin, TX. Her primary expertise is in orthopaedics, but she is passionate about treating people with Parkinson’s and similar movement disorders in order to improve quality of life and overall function. Laila is pictured above treating a patient.
Posted on 11/28/2017 by Rachel Linden, M.A., CCC-SLP
People tend to choose a career path based on what they enjoy doing or a special skill they possess. I have always enjoyed working with children, so a career like speech language pathology suited me. Once I started my major courses in college, I found that speech language pathology didn’t just suit me, it helped turn my greatest personal weakness into my passion.
Food preferences are a personal choice, but our tastes typically adapt and change as we grow. Eating should be an easy and natural thing, seeing as we eat at least three times a day, but it doesn’t always pan out that way. There’s picky eating and then there’s problem feeding.
As a young child, describing me as a picky eater would be an understatement. At times, I could be a problem feeder. Living on “kid food” such as macaroni and cheese or peanut butter and jelly was just fine with me. It always had to be the same brand, and my sandwiches had to be cut into triangles. No big deal; I was just a kid and would grow out of it, right?
As I got older, these habits stayed with me and food experiences became more difficult. I was anxious about birthday parties, sleepovers, meals with friends and dates, on edge about the available food options. There were some strategies I used to get by, like eating beforehand or stuffing snacks in my bag, but planning my life around food was difficult.
With marriage and family, life is about compromise and working together. My husband and I have had multiple conversations about my eating habits to ensure we can both eat and be happy. I’ve found success personally using some of the same treatment approaches that help my young clients and my son to become better eaters and enjoy less stressful mealtimes.
It took most of my life to realize that feeding contributed to the way I thought of myself, as well as my relationships with others. Through feeding training, I’ve been able to provide children and their families with interventions starting at a young age. Intervention provides a means to increasing skills and looking at foods in a new and more positive way, thus making mealtimes easier.
Feeding therapy using the Sequential Oral Sensory (SOS) approach focuses on developing the necessary skills for self-feeding as well as safe chewing and swallowing. The SOS approach uses a hierarchy to help the feeder gradually move toward their highest level of tolerance. Together, these approaches can expose the feeder to new foods and help him or her to increase their positive experiences with new and non-preferred foods.
Picky eaters are not the only children who can benefit from feeding therapy. Children who have weight gain issues, oral motor deficits, limited oral intake and are transitioning off a feeding tube are candidates for feeding therapy. Children who are highly specific about brands, refuse food and experience difficulty transitioning to new textures are also candidates. Moreover, families who have “power struggles” at mealtimes or children who display bad mealtime behavior may benefit from feeding therapy.
Therapy meals address behaviors, sensory responses to food, oral motor improvements and diet expansion. A meal is set up to remove distractions to allow for a “family style” meal. Each food is presented one at a time to increase tolerance to the offered food. Therapeutic assistance is provided to move a child up the feeding hierarchy to their highest point of tolerance and then the next food is presented. Mealtime rules and positive language about mealtimes and food is an essential part of feeding therapy to build trust and learn expectations.
If you suspect your child might be a picky or problem feeder, ask your NovaCare or Select Kids speech therapist about opportunities to expose them to exciting new food experiences.
Rachel LindenBy: Rachel Linden, M.A., CCC-SLP. Rachel is a speech language pathologist with NovaCare Kids Pediatric Therapy in Crystal Lake, IL. She has been practicing since 2013 and is committed to helping children live their best lives!