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.
Segmental rolling

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.
Cat stretch

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.
Chintuck

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.
Scapular squeez

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! 

Resources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489448/
http://www.123chiropractors.com/articles/the-statistics-regarding-neck-pain/
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.

Snow Shoveling

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.

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.
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.

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:

Warm-up
Jogging – Two minutes forward, two minutes backward and two minutes of side shuffling
Stretching – Thirty seconds on each of these muscle groups:
Calf
Quad
Hamstring
Groin
Glute
Hip flexor
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 NovaCare’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 5/4/2018 by Shannon K. Holman, OTR/L, BCP

There are many amazing children and families that will shape your growth and development as a pediatric occupational therapist. As a pediatric therapist you will not go a day without learning something new, that you will learn just as much from your patient as you expect them to learn from you and that play is the hardest thing you will ever do.

Julian and I met in January 2011. He was about 7 years old and had a shy smile that would melt your heart. He was the “typical” child with autism, presenting with some motor skill challenges, social difficulties and underlying sensory processing struggles. Intervention initially incorporated sensory integration to address organizational skills, regulation and modulation of self, tolerance to transitions and changes in routine, fine motor skills, leisure skills and social interactions. As an additional intervention bonus, Julian’s mother was very organized and dedicated to ensuring her son was engaged in activities that facilitated his optimal potential and functional independence. With this energy behind our intervention strategies, Julian continued to demonstrate growth and gains in all areas, most noted in social and self-confidence. Standard and textbook, Julian was making progress.

In October 2012, Julian, his brother and his mother participated in a hiking activity at Red Rock that went unusually and unexpectedly well. Julian had such a good time that he was eager to share the experience with his father. The family decided they would return to the national park on the weekend, and Julian was looking forward to the outing. Unfortunately, they had forgotten to account for the popularity of the park on the weekends. What had been a quiet day on their original mid-week outing was met with a significant increase in the number of people… and their dogs.

It was in this manner that I learned of Julian’s fear of dogs. A fear that had never been discussed in therapy, as tolerance to animals was not something I thought of as affecting developmental skills or level of independence. I was in for a lesson on occupational profile and performance.

The story unfolds as such: a very excited Julian eager to show his dad his success, a family participating in an ordinary outing, an off-leash dog racing past Julian on the trail, Julian frozen in fear and screaming inconsolably. This led to a mother attempting to console her son, a frustrated father, a sad younger brother and a devastated Julian.

Julian had had dogs in his life as a toddler with no concerns or issues. A recent move had the family now living next door to two very large, loud and out-of-control dogs. Julian was terrified. He no longer played outside, would only exit the house to go to the car while it was in the garage with the door closed and would not go to visit friends if they had dogs. Conflict, anxiety, fear and sensory struggles. Julian had worked so hard and was doing so well and now we were losing ground.

My brain scrambled, remembering lessons on activity analysis, occupational profile and performance and what has value to the patient and family. And then, inspiration hit. Without knowing how or having experience, out from my mouth came the words, “Let’s bring a dog into the therapy sessions.” Mom agreed. Now in all honesty, I had no idea what this would look like, how to make it happen and, most of all, how to get Julian to buy into it. I had some basic knowledge of therapy dogs and had experience with a service dog, but this is the type of moment occupational therapy is made for! Inspiration, creativity, foundation of activity analysis, thinking outside the box and relying on our gut; that is the art and science of occupational therapy. Sometimes the best interventions come from the support of families, trusting your therapy instincts and sheer luck. Our luck just so happened to come with four paws and a wet nose.

Love Dog Adventures is an organization that inspires physical and emotional healing by creating custom protocols for therapeutic and educational animal-assisted interactions. They came to us in late November in the form of Kirby, the dog, and owner, Sue. Both Sue and I had no idea what was going to happen. She trusted I knew the therapy part, I trusted she knew the dog part and mom trusted we knew what we were doing. The all-amazing part, Julian trusted all of us.

Sue and Kirby, a Pet Partners-certified therapy dog, became a part of our weekly therapy sessions. On Julian’s time, we worked toward proximity of the dog, activities next to the dog and touching the dog. With time and patience, Julian progressed from Kirby always having to have his tail end toward Julian to Julian touching and holding Kirby. Sadly, Kirby passed unexpectedly. Together, as a team, we carefully explained to Julian what had happened and, true to childhood understanding, he accepted, grieved and picked up with Kirby’s brother, Benny.

Benny and Julian built a strong bond. Kirby was the introduction, Benny became the story. Julian soared through touch and holding with Benny. He began to walk with Benny, dressed and undressed Benny in his service vest and holiday costumes and could tolerate unexpected movements from Benny. We addressed sensory integration, handwriting, reading, fastener manipulations, spatial awareness and all other typical skills that were a part of Julian’s plan of care. With each passing session, Julian’s self-confidence and skill improved. Verbal skills, self-initiation and empowerment grew. With Sue’s knowledge of her volunteers and their dogs, she continued to match us up to amazing volunteers. In the end, Julian would successfully interact with more than 30 dogs of all sizes, breeds and energy levels, as well as a cat.

Julian engaged in play (ball, toy, treat), brushing, dressing, massaging and walking the dogs, as well as tolerating unexpected movement toward or past him, jumping and barking. He could now engage in community outings, walk with his mother around the neighborhood, socialize with friends in their homes regardless of dog, engage in family outings and entertain the thought of a dog joining the family. Tears filled his mother’s eyes on the day Julian let Benny “kiss” him and the day he fed Benny a small treat.

Eighteen months later, Julian participated in an autism walk with dogs present and on-leash with no concerns. The family again hiked at Red Rock. Mother reported she knew that success had been reached and all was going to be fine when an off-leash dog ran past Julian and Julian’s response was that “they aren’t following the rules,” as dogs are supposed to be on-leash in the park. No screams, no tears, no fear.

The inspiration, art and science that takes play to occupation for a child, the ability to take occupational performance and profile and create a treatment plan and intervention strategies, and the ability to learn what a child really needs is both the challenge and most rewarding aspects of pediatric therapy. But what Julian would forever change in my occupational therapy tool box is knowing that you don’t always know immediately what is important to a child and that you should start with the basics. Activity analysis will apply in all scenarios, so you must trust your skills and knowledge. Sometimes in our quest to facilitate optimal level of independence for a child, we learn what truly has value and importance to a family and their child. I am no longer the therapist who just facilitates developmental, executive function or sensory processing skills. I am a therapist who facilitates the skills for living life to its fullest as defined by child and family.

I leave you with this simple quote from Fred Devito that serves as advice for therapists, pediatric patients and their families… “If it doesn’t challenge you, it won’t change you.”

By: Shannon K. Holman, OTR/L, BCP, center manager of Select Kids Pediatric Therapy in Las Vegas, NV. She has treating experience in cerebral palsy, autism, Asperger’s, attention-deficit/hyperactivity disorder, sensory processing disorder and much more, in children birth to 23 years of age. Shannon is board certified in pediatrics by the American Occupational Therapy Association.

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 NovaCare, 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 10/31/2017 by Valerie L. Bobb, P.T., DPT, WCS, ATC

October is Breast Cancer Awareness Month and a time to honor to those who have been affected by the disease. Approximately one in eight (12 percent) women will develop breast cancer in her lifetime, so chances are you have been touched by somebody who has had breast cancer. The good news is breast cancer death rates continue to decrease each year. This leaves women (or men!) free to live a full life once they have recovered from treatment.

Any type of surgery can leave a patient with restriction in their neck, shoulder or arms, fatigue from chemotherapy or radiation and at risk for bone loss. However, physical therapists trained in treating cancer can design a program to regain motion, return to a healthy exercise program and return to all those things you love. That is why you fought so hard to overcome cancer!

Exercise is shown to reduce nausea, pain and stress and maintain a good weight. With your doctor’s permission and a physical therapists help, you can begin a program that focuses on moderate cardiovascular training, light weight training, flexibility and stress reduction.

Specific shoulder range of motion and strength exercises can help recovery from breast surgery, improve function, quality of life and body image and confidence. Resistance training is safe after surgery (once your restrictions have been lifted) and focuses on the muscles affected by the surgical procedure and what muscles you need to get back to your activities. Aerobic exercise is recommended three to five times a week for at least 30 minutes and can consist of walking, swimming or your favorite low impact exercise.

Both aerobic and strength training is vital to counteract bone loss related to chemotherapy. It is especially important if you are post-menopausal when you are diagnosed. Physical therapists can also teach you better ways to move and lift that will reduce chance of injury and excessive pressure on your spine. Fatigue is also another side effect of chemotherapy and radiation. Besides exercise, things such as deep breathing, stress reduction techniques and proper nutrition also help with recovery.

Many risk factors for breast cancers are beyond our control, such as age, family history and other medical conditions. However, you can control others, such as:

Weight: Being overweight, especially in postmenopausal women, is associated with an increased risk of breast cancer. Estrogen is stored in fat and, after menopause, is our body’s main source of estrogen. The more fat tissue you have, the higher your estrogen levels.

Diet: Diet is suspected as a risk factor; however, research is not clear on exactly what foods increase our risk. It is recommended to limit foods high in animal fat and read labels to make sure the source has limited added hormones and soy. A low-fat diet that is rich in fruits and vegetables is generally recommended.

Exercise: There is growing evidence that shows exercise can reduce breast cancer risk. The American Cancer Society recommends engaging in 45 to 60 minutes of physical exercise five or more days a week.

Alcohol and Smoking: Studies show that breast cancer risks increase with regular amounts of alcohol consumption. Smoking in general increases alcohol levels. Please contact your local hospital for a cessation program.

Please contact your local women’s and men’s health physical therapist for guidance on an exercise program for breast cancer recovery and return to your life!

Valerie BobbBy: Valerie L. Bobb, P.T., DPT, WCS, ATC, women’s and men’s heath physical therapist for Baylor Institute for Rehabilitation Outpatient Services in Dallas, TX. Baylor, NovaCare Rehabilitation and NovaCare are part of the Select Medical Outpatient Division family of brands.

Posted on 5/23/2019 by Andrea Pavlik, C.O., Cfm

You just brought your perfect little bundle of joy home and are eagerly looking forward to watching them grow. A few months go by and you notice that their head shape is flat on one side. Why is this? Is it natural? Should you be concerned?

In 1992, the American Association of Pediatrics launched its most successful program ever: the “Back to Sleep” campaign, which served to combat Sudden Infant Death Syndrome (SIDS). SIDS, also known as crib death, is the sudden, unexplained and leading cause of death in children from one moth to one year of age. The campaign encouraged parents to put their babies to sleep on their backs, helping to reduce SIDS by more than 40 percent.

However, the “Back to Sleep” campaign had a now recognized unintended consequence: plagiocephaly, or flat head syndrome. Plagiocephaly is characterized by the development of a flat spot on the back or side of the head. A baby’s head is very soft, and they spend excessive time laying on their backs while in cribs, beds, bouncers, car seats, high chairs, etc. This leads to an increase in the number of infants who acquire skull deformities.

Why do babies’ heads deform?

Plasticity of newborns skull make is susceptible to external pressures
Immobility of newborns
Abnormalities to the skull present at birth
What are contributing risk factors?

Prolonged positioning on their backs and back of head
Lack of tummy time
Multiple birth infants
Neck weakness
Is this serious?

It is perfectly normal for newborns to have abnormal head shapes; however, they should resolve within a few weeks.
If flat spots are still apparent, some help may be needed to correct the problem.
Do a simple test by looking at your baby’s head and comparing to the chart below.
To be sure of the normalcy of your baby’s head shape, consult your physician.
Plagiocephaly Chart

It is fixable? Absolutely! There are several treatment options to help correct the flat spot.

Let nature take her course: Many minor flat spots will resolve on their own as the child ages, but try to keep your baby off their backs as much as possible by engaging in some quality tummy time.
Tummy time: This can be done starting from the day you bring your baby home from the hospital. Tummy time is simply that: placing your child, while supervised, on their tummy or side. This can include while being carried, diapering, feeding and playing. Please check out this tummy time guide.
STARband: By using a plastic helmet that is worn for 23 hours per day, your baby’s head is gently guided into a more normal shape. Please consult your physician and/or orthotist for more detailed information.
NovaCare Prosthetics & Orthotics offers complimentary consultations for cranial remolding helmets in many of our locations, courtesy of our certified cranial remolding specialists and orthotists. Our team will educate you on repositioning techniques, plagiocephaly and protocols for the device your child may use. Over the course of treatment, we can adjust the custom-fit helmet as the baby’s head improves.

For more information or to schedule your complimentary consultation, please contact a NovaCare Prosthetics & Orthotics center near you  

The cutie pictured above is one of our cranial remolding graduates, Arvy Roberts.

By: Andrea Pavlik, C.O., Cfm. Andrea is a certified orthotist with NovaCare Prosthetics & Orthotics in Sheboygan, WI.

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