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 NovaCare 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 NovaCare 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 4/19/2017 by Rebecca Miles, MSOT, OTR/L
When I tell people I am an occupational therapist, they generally either respond enthusiastically or nod as if they know what I do (when they really don’t!). Upon first hearing the name, most people think occupational therapists are vocational therapists who help people find employment or get back to a certain job. Because of this, the people who do not know what occupational therapy is are even more confused when I say I work with the pediatric population.
Occupational therapists work with people across the lifespan to do what they need to do, want to do and what they are expected to do. For us, an “occupation” refers to activities that support the health, wellbeing and development of an individual (American Occupational Therapy Association, 2014). This can mean helping someone after a stroke learn how to dress themselves again. In my work as a pediatric occupational therapist, it means I work with children and their families to allow participation and independence in their “occupation" of playing, learning and completing activities throughout their daily life.
Pediatric occupational therapists work across many settings, from schools to hospitals to outpatient centers. Here at Select Kids Pediatric Therapy, I have the opportunity to work with infants and toddlers in their homes and natural environments and to work in a pediatric outpatient center treating children from age three to 22.
Pediatric occupational therapists utilize the most current evaluation tools and clinical standards in determining the appropriate treatment for each child. We start by communicating directly with parents/guardians to determine the family’s goals and priorities. Then, through individualized evaluations, we find solutions to help maximize independence and increase participation in daily activities, including self-care, learning and play.
I work with children on reaching their full potential by addressing deficits that challenge performance of developmentally appropriate skills. For instance, I often help children who have challenges with grasp and handwriting, attention span, moving their body to complete a task, responding to information coming from the senses (like becoming overwhelmed and distraught when there is a loud noise), visual perceptual skills (like finding an item in a busy drawer or knowing what an item is when it is not entirely visible) and activities of daily life (like dressing and feeding). I get to address these skills through play and actual performance of the activities, so that children can engage in their “occupations” and learn while having fun.
I empower families through education and guidance to help the children in their lives grow and learn. It is amazing to be able to spend every day helping children to reach their own individual potential.
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain & process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006
Rebecca MilesBy: Rebecca Miles, MSOT, OTR/L, pediatric occupational therapist at our Select Kids Pediatric Therapy center in Virginia Beach, VA.
Select Kids Pediatric Therapy and NovaCare Kids Pediatric Therapy are part of the Select Medical Outpatient Division family of brands. Contact a center near you today for more information on pediatric therapy services.
Posted on 6/18/2018 by Erica Zettlemoyer, P.T., DPT
Multiple Sclerosis (MS) is a progressive disease in which the body’s immune system attacks the central nervous system (CNS). The CNS is composed of the brain, spinal cord and optic nerves. Our nerves are surrounded by a fatty substance called myelin, which allows electrical messages to be delivered quickly from the brain to the correct muscle. In MS, the myelin is damaged, scars are formed and the electrical message from our brain is disrupted. This creates a less efficient movement pattern, as well as pain, weakness, heat sensitivity, fatigue, numbness, vision changes and other impairments.
Multiple Sclerosis and Exercise – Though researchers are making significant advances in treating MS, there is still not a cure. However, there are various treatments which focus on slowing the progression of the disease and managing symptoms. Exercise is considered one of these treatments. In a published study, people with MS who participated in 15 weeks of three 40-minute training sessions per week were shown to demonstrate improved cardiovascular fitness, strength and overall health.¹
Multiple Sclerosis and Physical Therapy – Due to the complexity of MS, it is important to work with a physical therapist who will create a specialized exercise program based on one’s progression and severity of symptoms. Treatments will focus on general conditioning, strengthening, flexibility and balance as well as postural education, positioning and respiratory function. In more severe cases, a therapist will assist in the utilization of equipment, such as bracing, wheelchairs, standing frames. Several of the challenges that must be considered include:
Heat Sensitivity: Many patients with MS report a sensitivity to heat. A rise in core body temperature of as little as 0.5ᵒ C can intensify symptoms. A physical therapist can guide patients through several ideas that will assist in controlling body temperature while exercising. Using a fan, drinking cold water prior, during and after activity as well as utilizing cooling vests and wrist bands are helpful in controlling body temperature. Other ideas include placing a cooler in the car with cold drinks and starting the air conditioning in the car 10 minutes prior to leaving.
Lassitude: Fatigue affects 74 to 89 percent of those diagnosed with MS.² It is the initial symptom for almost half of those diagnosed, even predating diagnosis by as much as 10 years.³ A physical therapist can help patients address modifiable factors that increase fatigue, such as activity, respiratory weakness, thermosensitivity, pain, deconditioning and movement compensation.
Bone Density Loss: When exercising, it is important to focus on strengthening with resistance. Those diagnosed with MS may suffer from bone density loss due to Vitamin D deficiency and increased use of steroids. Participating in a weekly strengthening program while utilizing weights may improve bone health. A physical therapist can guide patients in safely incorporating resistance into an exercise program.
Examples of Appropriate Exercises – It is helpful to know that when exercising with MS, we should look at the total amount of exercise minutes for the day. For example, if someone can participate in riding a stationary bike for five minutes in the morning, five minutes in the afternoon and five minutes in the evening, that will give them 15 minutes of total cardio exercise for the day. Walking on a treadmill, walking inside or standing activities are other examples of exercises that can be modified to one’s functional and physical capabilities.
Strengthening exercises can include bridges, clams, heel raises, sit-to-stand transitions squats, step-ups and rows. Wall push-ups and triceps dips are especially important for fall recovery training. I recommend working on eight to 15 repetitions while using an appropriate resistance level.
Stretching is important and should focus on calf muscles, hamstrings, hip flexors and pectorals. When incorporating balance activities, vary the surface you are practicing on, whether seated or standing. For example, sitting on a wobble board or standing on foam will maximize training.
Beginning an exercise program does not have to be overwhelming or intimidating. Each patient with MS will tolerate exercise differently and a physical therapist can individualize each program to meet the needs of that individual. The MS Society and Multiple Sclerosis Association of America are also valuable resources for those who are seeking information on exercise.
For more information regarding physical therapy for MS, please contact a center near you today!
Petajan J, Gappmaier E, White A, Spencer M, Mino L, Hicks R. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Annals of Neurology. April 1996 39(4):432-41
Murray TJ. Amantadine therapy for multiple sclerosis. Can J Neurol Sci 1985; 12:251-254
Krupp L, Alvarez L, LaRocca N, et al. Arch Neurol. 1988 45(4):435-437
White L, Dressendorfer R. Fitness testing in multiple sclerosis: a case report. Med Sci Sports Exerc 2003;35 (5): S314
By: Erica Zettlemoyer, P.T., DPT, is a licensed physical therapist at Baylor Scott and White Institute for Rehabilitation. She received a doctorate of physical therapy in 2010 from Texas Woman’s University and is a Certified Multiple Sclerosis Specialist.
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!
Posted on 11/10/2017 by NovaCare and NovaCare Rehabilitation
For the management of some types of pain, prescription opioids can certainly help. However, there is not enough evidence to support prolonged opioid use for chronic pain. We sat down with Katie McBee, P.T., DPT, OCS, M.S., CEAS, regional director of our WorkStrategies Program, to ask her a few questions regarding opioid use, chronic pain and the benefits of physical therapy as a safe alternative to prescription medication.
In your opinion, what are the main reasons for the opioid epidemic in the United States?
There is no simple explanation as to what caused the opioid epidemic in the United States. Opiates are not a new drug and have been abused at other time periods in American history, but not nearly to the extent that is happening now. Initial research on opiate medications said they were effective and safe and addiction was rare when used for short-term pain1. The development of FDA approved OxyContin in 1995 had labeling that stated iatrogenic addiction was “very rare,” and a widespread marketing campaign to physicians started to build medical providers’ confidence in prescribing these medications to decrease pain-related suffering2. Add to that the 2001 standards implemented by the Joint Commission on Accreditation of Healthcare Organizations for organizations to improve their care of patients with pain medication and this is probably what catalyzed the beginning of our current opioid epidemic.
With medical providers focused on pain as a vital sign, pain quickly became the enemy and had to be eradicated to show successful management for many conditions with an increased focus on post-operative pain management. As drugs became more widely available, aggressively advertised and culturally acceptable, a three-fold increase in prescription rates for these medications ensued. With the increase in opioid prescription rates, death rates from side effects also increased by three-fold to more 16,000 by 2011.
What is the difference between chronic pain versus pain suffered as a result of an injury?
Pain is a mechanism designed to protect us from harm. Pain is not the enemy. A common misconception about pain is that it is not a simple cause/effect relationship. The amount of injury does not equal the amount of pain we experience. Pain is a complex process based on many areas of the nervous system and the brain communicating together to let us know what we need to prioritize and protect. The more threatening the brain perceives something, the more we potentially feel pain.
Acute pain or pain suffered immediately after an injury or surgery to the body’s tissues is a protection mechanism from the brain to remind you to protect the area so that no further harm is done. As the tissue heals and time passes, there is less threat of injury so the brain stops signaling, the pain eases and you slowly get back to normal activities.
In chronic pain, the tissues are not signaling danger to the brain as much as they are in acute pain. When the brain perceives threat for extended periods, it starts to change the nervous system to become a pain-producing machine. It creates new nerve junctions to make things hurt that wouldn’t normally hurt, like light touch on the skin. It can decrease the amount of pressure needed to create a pain signal. It creates more chemicals along the nervous system so it can create greater pain experiences with fewer stimuli. Research is still trying to figure out why some individuals have pain that goes away as the tissues heal and others have pain that persists despite the fact that the tissue has healed.
Individuals can be at risk of developing chronic or persistent pain for a number of reasons, including unhelpful coping strategies, stress, chronic illness and poor sleep habits. It appears the more emotional or physical stress going on at the time of the injury and/or during the healing process, the more at risk you can be of developing a persistent pain issue. A holistic approach to address some of these drivers of persistent pain is showing promise in being able to reduce the pain and get people with chronic pain back into their normal lives again.
Why is physical therapy important and what are some of the benefits to patients?
Physical therapy is an ideal treatment for many types of acute and chronic pain and should be a part of any single or multidisciplinary treatment plan for pain. The goal of physical therapy is to increase function and keep people in their meaningful life activities while they are healing. Physical therapists are trained to address many of the drivers of chronic pain and can perform testing and screening to see if your pain system is sensitized and adjust treatment to desensitize the pain system as well as address the functional limitations many people often experience when they are in pain.
Physical therapists have many tools they can use to decrease pain and desensitize the pain system. These tools include education on pain to discover what could be driving pain issues. Once the pain drivers are discovered, a physical therapist will develop a holistic plan to address these drivers, including increased activity, sleep hygiene, stress management skills and pacing techniques.
The best thing about physical therapy for pain is that the outcomes for some of the techniques are better than many medications and procedures available; plus, there are no negative side effects. If you or someone you know has an issue with pain, consult with a physical therapist as a component of care.
For more information on physical therapy and its benefits, or to request an appointment today, please contact a Select Medical outpatient physical therapy center near you.
Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980;302:123.
Van Zee A. The promotion and marketing of OxyContin: commercial triumph, public health tragedy. Am J Public Health. 20:99 (2):221-227.
Posted on 10/19/2017 by NovaCare Rehabilitation and NovaCare
Play It SafeOne of the most devastating injuries in sports today is the anterior cruciate ligament (ACL) injury. We sat down with Trent Nessler, P.T., MPT, DPT, national director of sports medicine innovation, to ask him a few questions regarding ACL injuries and his exclusive evidenced-based ACL Play it Safe Program.
What are three measures that can be taken to prevent ACL injury?
If you were going to break it down into three measures, these would be:
Education – Almost 80 percent of ACL injuries are non-contact in orientation. This means there is no contact with another player or structure, but typically result from a rapid change in direction or jumping motion. There are certain movement patterns that put an athlete at greater risk for these non-contact injuries. Using a baseline movement screening process is critical to identifying those at risk. The results should further guide training that can be implemented throughout the season to reduce the athlete’s risk of injury.
It is also imperative for athletes, coaches and parents to understand that when you address movements that are associated with non-contact ACL injuries, they see a significant impact on their on-field athletic performance. The knee abduction that occurs not only puts excessive stress on the ACL and structures of the knee, but also results in a significant loss of kinetic energy transfer from the lower limb, hips to the core. This loss of energy has a direct impact on vertical jump, sprint speed, explosive power and pitching velocities.
Movement Assessments – There are many movement assessments on the market today. Although some have become the standard of practice in our industry, the fact that we are still depending on the eyeball to score the majority of these assessments introduces a tremendous amount of subjectivity into the equation. Three-dimensional technology, complete with cameras and wearable sensors, however, are removing the subjectivity from the equation and allowing for improved reliability.
Training – Many good injury prevention programs out there have been shown to reduce injury rates in athletes. However, the challenge is the adoption of these programs as a standard part of an athletic program or season has been very low. Why is that? If the program takes too long, then teams, coaches and athlete are less likely to do it. Knowing that these programs improve movement and movement efficiency, we should be promoting the impact on sports performance versus injury prevention. Approaching a coach or athlete with an effective and proven 20-minute program that helps to improve their sprint speed and vertical jump will cause the adoption rate to become much higher.
Technology is an ever-changing industry, and ACL injuries are a prevalent occurrence. How do the two go together and benefit patients?
One of the most exciting trends we are seeing today is the adoption of 3D wearable sensor technologies. These can and are having a huge impact on ACL injuries. The technology inside a 3D wearable sensor is what’s called an inertial measurement unit (IMU). An IMU detects and records motion, rotation and acceleration data. We now use these for movement assessments in our athletes to detect degree of knee abduction and the speed at which it occurs within a very high degree of accuracy. In addition, this becomes a much more efficient and reliable way to measure movement that puts athletes at risk for injury and performance issues. This is a huge step in ACL prevention! For the first time ever, we are collecting movement data with technology and combining it with demographic data for every athlete assessed.
Aside from use of IMUs in assessment, it can be used in training. We are in the process of leveraging this same technology to track movement during single limb training. This will not only give the athlete immediate feedback on how they are moving, but will identify those athletes at risk during their training. This information could be used to refer them to a provider for a more extensive movement assessment and treatment. This would expand the scope of ability to identify athletes at risk beyond just those who have a physical or who see a health care provider.
You developed a nationally recognized non-operative ACL program – the ACL Play it Safe Program – to decrease the likelihood of injury and enhance athletic performance. What sets this program apart from others and how can folks learn more about it?
Trent ACL 2As a result of numerous researchers’ hard work and the influence of great mentors, the development of the ACL Play it Safe Program was made possible. The things that set this program apart are:
The ACL Play It Safe program is specifically designed to improve performance on the movements that are assessed with the ViPerform Athletic Movement Index (AMI). So, athletes can be assigned to the level of the program based on an assessment.
The program has four distinct levels of progression; level one for athletes who don’t move very well, all the way up to level IV for athletes who move efficiently.
This program has a pre-practice routine that takes five minutes and a post-practice routine that takes 15 minutes. The post-practice routine is a fatigue-based training routine. This is where fatigue from practice is carried over in the post-practice routine. From a training specificity standpoint, we find that training in a fatigued state has better carry over to later in the game when performance issues are likely to arise and injuries rates increase.
Each athlete is given a kit that has standardized equipment in it. This prevents them from using different types of equipment or variations in resistance from training session to training session, allowing for more consistency in the progression.
The program offers a video instruction of each exercise that can be accessed on the complimentary ACL Play It Safe app. This ensures there is no error or change in interpretation of the exercise from athletic trainer to coach to athlete.
So far, this program has been implemented with more than 3,000 athletes across the country. We are using this as a part of their rehabilitation and return-to-play. When implemented correctly and with the ViPerform AMI, we are seeing an average of 58.2 percent reduction in lower extremity injuries from the spine to the foot and ankle.
For more information on this program, folks can email me directly at [email protected] I look forward to hearing from you!
Posted on 8/23/2018 by Marge Krengel, OTR/L, CHT
Summer activities often mean more upper extremity injuries associated with overuse, poor posture and unconditioned muscles. In the summer, everyone is excited to get outside and work on gardening, lawn improvement and home repair projects. Others are going back to the gym or taking up sports like tennis and golf.
The terms “wear and tear,” overuse injuries, osteoarthritis and degenerative joint disease have been used in the past to describe these types of injuries. More recently, terms such as repetitive motion injury, repetitive strain injury and cumulative trauma disorder (CTD) are used to define and diagnosis musculoskeletal impairments caused by overuse.
An overuse injury can happen when you try to take on too much physical activity too quickly or when you are causing repetitive trauma to a muscle or joint. For example, if you use poor form as you perform strength training exercises or throw a baseball, you may overload certain muscles and cause an overuse injury.
Certified hand therapists are specifically trained in job and activity analysis and to address CTDs. We have many methods to decrease pain, inflammation and recondition the injured area to tolerate normal use again. In addition to eliminating pain, therapists can educate individuals on different ways to perform the same activities and lower re-injury. Our goal is to return patients to the level of activity they are accustomed to.
Here are few ideas shared by the American Society of Hand Therapists for preventative treatment:
A therapist can assess your work, leisure or home repair activities by simulating these in the center or looking at photos or videos of you performing an activity. If you are having problems at work, in some instances the therapist can visit your job site.
Sometimes different tools are needed. If you find you are adding padding or modifying how you are doing something, then the tools being used should be re-evaluated for their effectiveness. Ergonomically designed tools are available.
Take 30-second breaks every 15 to 30 minutes when performing repetitive activities. Use this time to stretch the muscles in the opposite direction from your working pattern.
If possible, break up your day with different activities to avoid over-repetition with one activity.
In addition to these tips, a therapist can design exercises specific to your unique needs to address your upper extremity condition.
Speak with your physician before starting any new activity or ramping up your current routine and contact a hand therapist if you are experiencing pain in your hand, wrist, elbow, arm or shoulder. Regardless of the activity you want to enjoy, make sure you can reach your optimal performance and avoid unnecessary injuries.
Enjoy the remaining weeks of summer and remember to see a certified hand therapist if you need help reaching your goals!
By: Marge Krengel, OTR/L, CHT. Marge is an occupational and certified hand therapist for Emory Rehabilitation Outpatient Center in Marietta, GA.
Emory Rehabilitation, NovaCare and NovaCare Rehabilitation are part of the Select Medical Outpatient Division family of brands.
Posted on 2/7/2019 by Diane Jagelavicius, C.P.
An amputation, whether planned or not, is a physical, mental and emotional loss, one that requires time to adjust. A wide range of emotions occur while undergoing the process of amputation and are completely normal as you begin to process and adjust to this life-changing event. Understanding what you are feeling and why will help you to process the situation and overcome negativity and hurdles.
No matter what circumstances have brought you here, NovaCare Prosthetics & Orthotics can help and is devoted to meeting the special needs of those with all levels of amputation. As you embark on this unique journey, keep these seven tips in mind:
You are not alone.
The Amputee Coalition estimates there are two million amputees in America and 185,000 leg amputations each year. This leads to a challenging period of physical recovery and complex psychological, emotional and social issues. While everyone’s path in life is unique, you should not feel as if you are alone.
Support groups, peer mentors and online forums are all available if you are looking to connect with others in a similar situation as you. In your physical rehabilitation program, you have the potential to form strong bonds with your peers through shared challenges and successes. Your friends, family and caregivers can also provide a tremendous amount of support.
If using a prosthesis will improve your function, then you are considered a candidate for a prosthesis.
At a minimum, you must be able to tolerate standing. It is OK if you need help to stand. A strong desire to walk with a prosthesis will help you overcome any physical challenges along the way. No matter what your physical condition, motivation is the single biggest factor to your prosthetic success.
Your previous lifestyle and abilities are the best indicators of success with a prosthesis.
For below knee amputees, it is expected you will be able to return to all the activities you were participating in prior to the amputation. If you were dealing with sores and infection prior to your amputation, your quality of life will likely improve as an amputee.
Many factors also affect success, like general health and the length of your amputated limb. If you have multiple conditions or injuries, they may limit your potential. Generally, the higher the amputation level, the more energy is required to walk. If your amputated limb is short or above the knee, you can expect to be able to participate in most of the activities you were participating in before your amputation.
Take ownership of your care.
Rehabilitation is a team effort, and your participation is essential to your success. At the core, no one is more invested in the quality of your life than you. Physicians, therapists, prosthetists, patients, family members, friends and caregivers are all part of your team. Spend time picking the right people for your team. It never hurts to do a little research, or seek a second opinion.
Be honest with your team members about your rehabilitation goals. They will work with you to set up small, achievable goals to help you gain momentum, stay motivated and get you back to your best.
Follow instructions and guidelines, and ask plenty of questions. Seek out solutions rather than making excuses. The more informed and proactive you are the better patient you will be, and the better choices you will make about your future care.
It’s OK to smile and have a little fun.
Sometimes life can get too serious, especially when it takes unexpected turns. It’s OK to have fun and let some joy into your life. Laughter is great medicine, too!
Some patients take it a bit further and get creative with the design of their prosthetics. Prints and fun fabrics can be laminated in the socket; patients have chosen designs like butterflies, camouflage, tie-die, lightning and American flag patterns.
Your prosthesis will be custom designed for you. The socket is the most important part.
Each prosthesis is unique and tailored to meet your lifestyle and abilities. Your prosthetist will spend time with you to understand your needs and goals and use that information to design your prosthesis. Many different styles and componentry options are available.
The most important part of your prosthesis is the socket, the portion that interfaces with your body. The socket is the part that translates your body movement to the componentry. To provide the most benefit, the socket must be snug and supportive. Your prosthetist will work with you to come up with the fit for you.
Receiving your prosthesis is a really big milestone, but it is not the end goal.
Learning how to walk or function with your prosthesis, returning to your lifestyle, work, family, home, sports, etc., are all the end goals.
After amputation surgery there is a lot of emphasis placed on receiving the prosthesis. So much so it is easy to mistake the prosthesis itself as the end goal. But really, much of the work begins after you receive the prosthesis.
Participation in a formal gait training program after you receive your prosthesis is an investment in the quality of your life. It takes time and practice to adapt to your new lifestyle and be confident with the prosthesis.
Keep up the hard work and, before you know it, you will reach your goals in no time!
At NovaCare Prosthetics & Orthotics, we consider it part of our job to be your advocate. If you have questions, concerns or would like more information specific to prosthetic devices and/or other organizations and resources that can help you, please contact a NovaCare Prosthetics & Orthotics center near you today. We’re here to be your partner for life.
By: Diane Jagelavicius, C.P., prosthetist for NovaCare Prosthetics & Orthotics. Diane earned a bachelor’s degree in exercise physiology from Rutgers University and post-bachelorette certificate in prosthetics at Northwestern University. She completed residency at POSI prior to becoming an ABC certified prosthetist. Diane is passionate about patient outcomes and specializes in lower limb prosthetics with an emphasis on socket fit. She has extensive experience with microprocessor knees and ankles, suction/ elevated vacuum suspension and various socket designs. NovaCare Prosthetics & Orthotics is part of the Select Medical Outpatient Division family of brands.
Posted on 7/10/2018 by Nicole Tombers, P.T., DPT
In a culture dominated by cell phones, table stand computers, neck pain and headaches are becoming more and more common. Studies show that up to 45 percent of today’s workforce will experience problematic neck pain at some point.1, 2 As a physical therapist, I often find that these problems are associated with muscle tightness and weakness brought on by poor posture. It can be difficult to maintain perfectly straight posture all day, especially when your thoughts are focused on other things, such as the work project you need to finish this week, the heavy traffic on the roads around you or the emails you are answering from your tablet in the evening.
Here are a few tips and tricks that will set you up for success when it comes to maintaining good posture and reducing the strain on your neck in everyday situations.
Set your car mirror
Many people spend up to an hour or more in their car every day – driving to and from work, running errands and shuttling the kids to their many activities. Having poor posture in the car can place extra stress on the joints and muscles of your back and neck. Leave yourself a little reminder to keep good posture by adjusting your rearview mirror.
When you first get in your car, sit in a tall but comfortable posture; not leaning on the door or console, and not slouched low in your seat. Once you are in a good position, adjust your rearview mirror appropriately. Then, as you are driving, if you look in your mirror and realize you do not have the full view, it will be a reminder that you need to adjust your posture back to that good starting position.
Adjust your workspace
If you are one of the millions of people who spend their work day sitting at a desk, it can be a major source of strain on your neck and back. Modifying your workspace may help keep you in a good posture while you work. Here are a few key things to pay attention to:
When sitting, your hips and knees should be at 90 degree angle with your feet flat on the floor or stool.
Your arms should be comfortably supported on armrests with shoulders relaxed and elbows at a 90 degree angle. The keyboard and mouse should be positioned comfortably under your hands; you should not be reaching forward for the keyboard, nor should you be actively holding your shoulders up near your ears.
The monitor should be directly in front of you (if you work with more than one monitor, try to keep them centralized in your field of vision as much as possible) and the top of the monitor should be at your eye level.
Keep work off of your lap
Sitting on a couch or chair with your laptop, tablet or other papers on your lap tends to lead to a hunchbacked posture. Ideally, you should bring your work up to eye level (as discussed above) to reduce strain on your neck. If you must work from the sofa, try to raise it up a little by placing a pillow or folded blanket on your lap and working from that elevated surface.
Set a posture timer
If you know you are going to be focused on a project for a long period of time, try setting a timer on your computer or cell phone to go off every 20 to 30 minutes as a reminder to be conscious of your posture and readjust as needed.
Use a pillow roll
Ideally, you want to have a neutral spine while you sleep so that you can wake up feeling refreshed rather than cramped and stiff. Stomach sleeping is not good for your neck as it requires you to have your head turned to one side for a prolonged period. Back or side sleeping is preferred.
You want to have your head in line with your body and your neck fully supported. You can accomplish this by rolling a hand towel lengthwise and placing it inside your pillow case so that when you lay down it fills and supports the curve of your neck.
Do some self−massage
Place two tennis balls or racquet balls about one inch apart in a tube sock or nylon. You can hold the ends and place one ball on either side of your spine to give the muscles at the base or your head a nice massage.
Take stretch breaks
When you sit at a desk all day, your body grows stiff and your mind grows tired. Take a short break every hour or so. Stand up, look around, go for a short walk, take some nice deep breaths and do a few stretches. Here are a few options that can easily be done at your workstation:
Segmental rolling: Start with a nice tall posture (either sitting or standing) and focus on slowly bringing your chin to your chest one vertebra at a time until your neck and upper back are rounded forward. Hold at the bottom for a few seconds, then slowly return to upright posture one vertebra at a time.
Cat stretch: This is a popular yoga-style stretch that can be done sitting, standin, or on hands and knees. With arms stretched out in front of you, gently round your back, tuck your chin and pull your shoulder blades apart. Hold this pose for five to 10 seconds.
Upper trapezius stretch: Sitting up tall with hands resting in your lap, gently tip your head to one side and turn chin into shoulder until a stretch is felt in your neck. Hold this pose for 30 seconds and repeat on the other side.
Upper trap stretch
Chin tuck: With ears directly over your shoulders, gently tuck your chin as if trying to make a double chin. You should feel a gentle stretch at the base of your skull.
Scapular squeeze: sitting or standing tall with ears directly over your shoulders, gently squeeze your shoulder blades together without pushing your chin forward or raising your shoulders up. Hold this pose for five seconds, relax and repeat five to 10 times.
For persistent neck pain, please consult with your physician or contact one of our outpatient physical therapy centers conveniently located near you to speak with a licensed clinician today. Our highly trained physical therapists will help to alleviate your pain and get you back to work, athletics and daily life!
By: Nicole Tombers, P.T., DPT. Nicole is a physical therapist for NovaCare in Eagle River, AK. She treats a variety of conditions, but specializes in post-surgical rehabilitation and treatment of dizziness and vertigo. Nicole loves helping people improve and providing them with the education they need to have power over their circumstances.
Posted on 1/17/2019 by Sarah Donley, MSOT, CHT
Mother Nature has yet to truly make her presence known in 2019, but that all could change this weekend. Many in the Midwest and Northeast will feel the effects of a storm that’s slated to bring dangerous amounts of snow, wind, ice and rain. With that in mind, we've provided a few snow shoveling and snow blowing tips to practice if your area turns into a winter wonderland!
Remember to wear appropriate layers of light, loose and water resistant clothing for warmth and protection when you go outside in these low temperatures. Layering allows you to accommodate your body’s constantly changing temperature. Switch to mittens if your hands are becoming cold quickly. Mittens trap body heat by keeping your fingers together and reducing evaporative heat loss.
Before you begin to clear snow from your driveway or walkway, remember that snow shoveling is a cardiovascular and weight-lifting exercise. It should be treated like a day in the gym – stretch before exercising and take it slow if you’re not in shape.
Move smaller amounts of snow and tackle the job by dividing it into thirds, with one-hour rest breaks.
Keep your back straight and your knees bent to decrease the pressure to your lower back when lifting. When moving the snow, turn your whole body by pivoting your legs, not just your upper body.
Use an ergonomically correct shovel, one where the rod of the shovel bends in an elbow shape, not the straight line shovel. These shovels help you to keep your back straighter reducing spinal stress.
Sometimes, however, there will be a storm when a snow shovel simply isn't enough. And while a snow blower can certainly help, hand injuries such as burns, lacerations, crushed bones, fractures and even amputations can also occur if proper techniques aren't practiced. Here are some tips on how you can keep your hands safe during these snowy months.
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.
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.
Use proper hearing protection for your ears, and wear glasses or snow goggles for your eyes.
If the ground is icy or slick after you’ve finished shoveling or snow blowing, spread sand or salt over the area to help create foot traction. Be aware of areas that may be uneven which could cause you to slip, trip or fall.
Finally, think spring! Punxsutawney Phil saw his shadow and predicted six more weeks of winter ahead, but here’s to hoping the furry seasonal prognosticator is wrong this year.
By: Sarah Donley, MSOT, CHT. Sarah is an occupational therapist at NovaCare Rehabilitation in Swedesboro, NJ. She focuses on fractures, tendonitis and compression injuries. She is Graston- certified, providing her with an advanced method of soft tissue mobilization.