Posted on 5/16/2018 by Erin Longhurst, P.T., DPT
National Women’s Health Week is hosted each year by the U.S. Department of Health and Human Services’ Office on Women’s Health. The week serves a reminder for all women to be vigilant of their health and wellness and to make healthy habits a priority for life.
During National Women’s Health Week, we are proud to recognize some of the more under-served issues that women deal with regarding their health. At NovaCare Rehabilitation and Select Physical Therapy, some of our physical therapists who treat women’s health issues have received specialty training specific to the pelvis and pregnancy and provide specialized treatment, education and training to help overcome challenges.
If you or a loved one are experiencing any of the below conditions, physical therapy may be able to help you maximize function, minimize pain and improve overall quality of life. Patients are evaluated by a licensed physical therapist and a personalized plan of care is designed to meet individual needs. Together, we will establish clear goals and begin treatment to help the healing begin in a positive and encouraging environment.
Incontinence refers to the accidental loss of urine, gas or stool. This most commonly happens during a cough, sneeze, laugh or force from exercise (stress incontinence) or with a strong urge to urinate or defecate (urge incontinence). Incontinence is generally caused by weakness of the pelvic floor muscles, whose primary functions include supporting the pelvic organs. Our conservative physical therapy approach includes bowel or bladder retraining, an exercise plan to strength the muscles that support the pelvic floor and non-invasive biofeedback or electrical stimulation, as needed.
Pelvic organ prolapse occurs when one or more pelvic organs (bladder, uterus or rectum) moves out of its normal position, usually in a downward direction, because of weakness of the pelvic floor muscles or pressure exerted downward on the pelvis, e.g. long pushing phase of labor. Usually, this causes a sensation of heaviness or pressure in the lower abdomen or vagina. Guided strengthening of the pelvic floor muscles by a pelvic-trained physical therapist can help reverse early stage prolapse and prevent worsening of symptoms.
Pelvic pain is experienced by many women, but it is not considered normal if the pain persists longer than three months or occurs during sexual intercourse. Women experiencing pelvic pain may also complain of pain (or referred pain) in their hips, back or abdomen. Treatment of pelvic pain by a specialized physical therapist may include exercise to stretch or strengthen muscles in the hips, core and pelvis; relaxation and breathing techniques; hands-on soft tissue work; and, biofeedback for muscle retraining.
Studies estimate that 40 to 50 percent of expectant mothers will experience some form of aches and pain during pregnancy. These pains are often caused by the dramatic changes in posture and increased demand that weight gain and weight distribution can place on the woman’s body. Following birth of the baby, mothers then spend a lot of time bent over, which can cause pain in the back, neck and arms. Physical therapy treatment during or after pregnancy includes education in proper posture and body mechanics, soft tissue manual therapy and muscle strengthening to help manage and treat pain.
Normal urinary frequency is between two and four hours, but some women experience urinary urgency that leads them to urinate more than every two hours or that wakes them up at night. Women’s health physical therapy can assist with bladder retraining and help you take back control of your bladder.
Diastasis rectus abdominis is separation of the abdominal muscles and happens frequently during the later stages of pregnancy. This often resolves on its own in the 13 weeks following birth; however, sometimes the abdominal muscles stay separated and can contribute to poor core strength and back pain. A women’s health physical therapist can help to create a targeted exercise program that resolves the diastasis recti and allows for a return to full activity.
Contact a center near you today for more information!
By: Erin Longhurst, P.T., DPT. Erin is an orthopaedic physical therapist with NovaCare Rehabilitation in Washington, D.C. She specializes in treating women's health conditions, with primary focus on pregnant and postpartum women and women struggling with pelvic pain or incontinence.
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 4/19/2018 by Inessa Soden, O.T., CHT
Occupational therapy has been an established profession for more than 100 years. Yet, to this day, many people, and even medical professionals, are confused about what this field has to offer. It could be described as one of the disciplines in a rehabilitation team, focusing on restoring people’s ability to perform normal daily activities and resume valued roles in life. Thus, occupational therapy could be applied in general public health and the rehabilitation of many medical diseases.
Cancer diagnosis and treatment is a devastating life event that throws unexpected hurdles on the road of survivorship. Cancer patients may experience:
Weakness and fatigue
Stiffness in joints
Numbness and altered sensation in extremities
Difficulty remembering and performing daily activities
Some of these difficulties occur at the time of diagnosis, while others might become apparent during treatment and long after.
Medicine has been making great strides in treating and curing some cancers and better prognoses for life expectancy. There are currently more than 15 million cancer survivors in the United States, and the projected number is more than 20 million in the next 10 years. However, the courageous victory of beating the disease often comes with paying the price of temporary, residual or lasting side effects from the cancer treatment. Yet, after going through such a hard battle one doesn’t have to succumb to suffering or giving up so many of one’s previously enjoyed activities.
Life might be changed after experiencing cancer, but that means that one needs to learn to adjust and do things differently. This is where occupational therapy and our ReVital Cancer Rehabilitation program can improve quality of life.
ReVitalFor example, pain could be addressed by multiple manual therapy techniques and stretches, sometimes utilizing the application of special tools such as instrument-assisted soft tissue mobilization or cupping. Different physical agent modalities, such as ultrasound, electrical stimulation, and physiological techniques, like deep breathing and sensory reeducation, could be beneficial. Based on the cause of pain, the therapist will choose an appropriate course of treatment.
In cases of weakness and fatigue, an occupational therapist will develop an individualized program focusing on activities to build up strength and eliminate unnecessary strain on the body. The program may consist of exercises and activities as well as learning energy conservation principles and use of adaptations and adaptive techniques. In addition, each person will get an individualized home exercise program that is modified based upon progress.
For altered sensation, such as pins-and-needles, burning or numbness, an occupational therapist can help to control symptoms, which may be temporary due to swelling or nerve compression. The therapist may recommend and fabricate a custom orthosis, incorporate manual therapy to release the bound neve and design an individualized exercise plan. Other modalities, such as therapeutic taping, may be performed as necessary.
Sometimes unexpected difficulties arise in a battle with cancer. Survivors may experience difficulties focusing on a task, forgetting important information or have trouble multitasking everyday schedules. This may become a safety issue or cause severe emotional distress. In this case, a trained occupational therapist will help to set priorities and come up with suggestions and adaptations in order for the person to be as safe and independent as possible.
Teaching family members how they can help their loved ones to cope is part of the education that an occupational therapist provides. Learning how to access some local and national resources, finding support groups and leisure/recreation activities may also be of benefit.
These are just few examples of what occupational therapy can offer to ease the burden on a cancer survivor and promote a happier, healthier life. Working in a close relationship with a team of doctors, nurses, physical/speech therapists and local communities to help establish a strong support system so one does not need to go through this journey alone.
Consultation with your local occupational therapist trained in the ReVital Cancer Rehabilitation program could be requested at any time, be it right after the diagnosis, prior to surgery or during or after cancer treatment throughout the survivor’s lifespan.
By: Inessa Soden, O.T., CHT. Inessa has been a NovaCare Rehabilitation team member in South New Jersey since 2011. She treats patients of varying diagnoses, including orthopaedics and neurological and oncologic conditions. She focuses on building an individualized treatment plan for each of her patients to ensure they achieve their best level of independent participation in every day roles and activities.
Posted on 3/27/2018 by Bryce Vorters, M.S., ATC, LAT
A couple weeks ago, I got the chance to dust off my golf clubs and go to the driving range. I hit 100 golf balls with four different clubs, and all of them went the same distance. I know that isn’t how it’s supposed to work, but hey, I never said I was good at golf. I just have the dream of hitting a hole in one, so I looked up the odds and it is about a one in 3,500 chance. Given that I can’t hit the ball like a pro, or even a good amateur, my dream will probably never happen, but I’m always going to prepare for the day by striking the ball whenever I get a chance.
From an odds standpoint, one in 3,500 is about .02 percent, which is a long shot, but accounts for approximately 100,000 people this year in the United States. These odds are the same as the possibility of tearing your anterior cruciate ligament (ACL). For the same reasons I go out year after year and practice hoping for a par, I’d encourage you to make a small effort to work on lowering your chances of tearing an ACL with an ACL prevention program.
ACL prevention programs have been created and mixed into teams warm-ups, cool downs and off-season lift programs and have been shown to be helpful. Research shows 75 to 85 percent less ACL injuries happen when athletes are on an ACL program. Programs are usually three-times per week and take about 30 to 45 minutes to perform or, in my experience, about 15 to 20 minutes of additional work onto the normal warm-up and cool down of a team sport. It’s no guarantee that you won’t tear your ACL, but if you can practice for your sport to get better, why not make a small investment in making sure you can potentially avoid a nine- to 12-month rehabilitation process, too?
A simple ACL program looks something like this:
Jogging – Two minutes forward, two minutes backward and two minutes of side shuffling
Stretching – Thirty seconds on each of these muscle groups:
This should look similar to a basic high school gym class warm-up.
Agility Drills – During agility drills, look to maintain your balance. Have your knee stay behind your toes and do not allow your knee to sway toward the opposite side of your body.
Bend over and touch a ball on the ground in front of you 10 times.
Balance on one leg in a mini squat for 60 to 90 seconds while dribbling a basketball, playing catch or trying to kicking a soccer ball.
At this point, we added approximately five minutes to your warm-up, and you should be ready to perform your normal practice, pick-up game or workout.
Strength Portion – After your workout, perform strength exercises that reinforce proper mechanics of jumping and landing and help you control your body while you’re tired. Most injuries happen to people when they are tired or near the end of a game because they lose focus on controlling their body.
During this strength portion, you should be looking to stay focused, keep your knees from going toward each other during the landing and land softly and on the balls of your feet.
Squat jumps with two second hold at the landing 10 times
Tuck jumps 20 times
Lateral jumps 10 times each side
Lunge 10 times each side
Plank two times for 30 seconds front and each side
Cool Down – Perform your normal cool down or a nice foam rolling session.
An ACL prevention program doesn’t guarantee you won’t tear your ACL any more than me hitting the driving range three times per week to help fix my golf swing will guarantee me a hole in one, but it doesn’t mean I’m not going to go out and try. I encourage you to take a few extra minutes to help prevent an ACL injury, and I hope your extra work is fruitful to your sports performance and ACL injury prevention.
For more information concerning ACL injury prevention and NovaCare Rehabilitation and Select Physical Therapy’s ACL Play it Safe Program, please click here.
By: Bryce Vorters, M.S., ATC, LAT. Bryce is the head athletic trainer with NovaCare Rehabilitation for Conwell-Egan Catholic High School in Fairless Hills, PA.