• below knee prosthetic

    Posted on 3/18/2019 by Martin Ryan, C.P., CFO, FAAOP | Comments

     

    How does a prostheses attach? Great question and one that has a number of possible styles for the below the knee patient.

    Suspension systems in prosthetics come in a number of configurations. One system common today is the mechanical pin lock system. A pin is attached to the distal liner and inserted to a lock mechanism that provides the interface for suspension. The system is clinically referred to as the Below Knee Prosthesis with a Pin Locking Liner.

    Pin lock suspension can be used with patella tendon bearing (PTB), total surface bearing or hydrostatic socket design. With pin lock liners, a silicone liner is rolled onto the residual limb creating a seal between the skin and the liner. The liner has a pin on the end that locks into the bottom of the prosthetic socket. A prosthetic sock may be worn over the silicone insert in order to allow for volume fluctuations.

    PUTTING ON THE PROSTHESIS:

    Turn the liner inside out. Make sure the liner is clean and dry and has no dirt on it that will irritate the skin.
    Make sure a good portion of the bottom end of the liner is exposed and place it against the limb. (Figure 1) With light pressure, roll it up and over the limb. Make sure no air pockets exist between the liner and the skin.
    Roll the liner up the limb. (Figure 2) Do not pull or tug. Be careful not to tear or puncture it with fingernails or jewelry.
    Pay close attention to the placement of the pin. In most cases, it should be in line with the limb. Be careful not to pierce the liner with the pin.
    When using a liner without a fabric cover, a lubricant may be necessary. Consult with your prosthetist to determine the best lubricant for your use.
    Add the appropriate thickness of prosthetic sock over the liner, if necessary.
    Push the residual limb into the prosthetic socket. The pin will insert into the lock and click down as the limb goes into the socket. It should take some effort to put on the prosthesis. If it clicks down easily, a thicker prosthetic sock may be needed. (Figure 3) 

    REMOVAL OF YOUR PROSTHESIS:

    Push and hold the lock button in and lift the limb out of the socket.
    CLEANING AND MAINTENANCE:

    The prosthetic socks and sheaths should be cleaned according to the manufacturer’s directions. The soft insert and the prosthetic socket may be wiped out with warm, soapy water or alcohol as needed. Clean socks should be worn every day.
    TIPS AND PROBLEM SOLVING:

    One of the most difficult concepts to master is how to determine the correct sock ply to wear. Wearing the correct amount of socks is critical for comfort and safety. Your prosthetist and physical therapist will supply you with general guidelines in wearing socks, but if you have questions do not hesitate to contact or visit your prosthetist.
    OH NO, IT’S STUCK:

    It can happen. You get stuck and the pin will not release. Many times, the sock has covered the pin and is providing in ability of the pin to release.
    Do not panic. In most instances, some consistent pulling will release the pin and free the lock. Ask someone to assist you in this process if necessary.
    In extreme cases, pour soaping water into the liner next to the skin breaking suction and allow it to release from the prostheses and work free.
    Contact your prosthetist.
    For more information on the Below Knee Prosthesis with a Pin Locking Liner, please contact a NovaCare Prosthetics & Orthotics centers near you.

    By: Martin Ryan, C.P., CFO, FAAOP, is prosthetist for NovaCare Prosthetics & Orthotics. Marty is certified in advanced prosthetic designs for adults and pediatrics. He received prosthetic training at Northwestern University and the Rehabilitation Institute of Chicago. Marty is certified in prosthetics by the American Board for Certification and works out of NovaCare P&O’s Fond du Lac center in Wisconsin. NovaCare Prosthetics & Orthotics is part of the Select Medical Outpatient Division family of brands.

  • heat image of brain

    Posted on 2/9/2017 by Melissa Bloom, P.T., DPT, NCS

     

    One of the many myths pertaining to concussion is that you need a big blow to the head to get one, or that getting your “bell rung” isn’t a big deal. In fact, any impact to the head, neck, or body has the potential to create changes to the neurological function of the brain, or cause a concussion. While you most certainly can get a concussion from a high intensity football game or from a car accident, they often occur after what

    may seem like a fairly light bump.

    I’ve seen people with significant concussion symptoms from slipping and falling on ice, accidentally hitting their head on a cabinet door, getting elbowed in the head, or having luggage hit their head while unloading it from a plane. Additionally, I see patients from motor vehicle collisions where they never even hit their head and I see athletes where no one can pinpoint a specific hit. However, these individuals may be showing signs of post-concussion symptoms after the accident or game.

    Similarly, a common myth is that you need a loss of consciousness or at least will “see stars” in order to have a concussion. In fact, a loss of consciousness is quite rare post-concussion, with occurrences of less than four to 10 percent.

    An invisible condition

    What makes concussions more complicated is their invisible nature. Unlike a cut or even a broken bone where we can see a bandage or a cast, the symptoms of a concussion often go unseen. The most common symptoms are:

    Headaches
    Dizziness
    Foggy or difficulty thinking
    Blurred or double vision
    Sensitivity to light or sound
    Changes in sleep patterns
    Increases in anxiety and irritability
    While the symptoms are real and can significantly impact someone’s ability to function, peers, family, co-workers and friends cannot see them.

    Return to sport and return to life

    Awareness and education are key to help diagnosis concussions and to help those with persistent symptoms get the proper care they need to recover. An important first step can be recognizing anyone who may be showing any of the symptoms listed above that could be connected to anyphysical impact, no matter how much of “just a bump” it was. Despite how or when someone sustained a concussion, an active rehabilitation program can help. Our concussion management clinicians complete comprehensive examinations to assess the multiple systems that are often involved post-concussion and will develop an individualized plan of care unique to each person and case.

    In the past, the primary treatment for concussion was rest; it has even been called “cocoon therapy.” However, current research shows that activity and stimulation is better than excessive rest. That doesn’t mean, though, that you should go full force into your previous activities. Symptoms should be monitored and controlled; this may vary depending on the underlying factors specific to a concussion. As long as you have remaining symptoms post-concussion, having an evaluation and treatment plan set for you can help guide your activity levels and ultimately get you back to your normal symptom-free life. Treatments will depend on your individual test results, but will likely be a combination of visual exercises, vestibular rehabilitation, neck treatments, or a sub-symptom exertion program.

    Common rehabilitation components

    Visual exercises are provided when symptoms are due in part to your eyes not communicating well with each other and the brain. These exercises tend to involve having your eyes work more efficiently to reduce symptoms and increase visual clarity. This can involve simple eye movements or complicated tasks of watching a busy scene with many moving items.

    Vestibular rehabilitation is indicated when the inner ears are somehow involved. These treatments can also be varied, but typically involve some type of head movement. You may initially get dizzier with these exercises, but they are effective in eliminating symptoms in the end.

    Neck treatments may involve addressing any neck pain you have post-injury. More often than not, neck pain means that the sensors in the neck are not communicating well with the brain, leading to fogginess, dizziness, imbalance, or headaches. Specific exercises can retrain these receptors and in turn eliminate remaining symptoms.

    Sub-symptom exertion training is frequently needed post-concussion. These exercises are designed specifically for you based on your heart rate, and are intended to allow the brain to safely heal and handle the physiologic challenges needed for daily physical and mental activities.

    Balance and functional training may be included to make sure you are in tip-top condition to safely get back on the field or get back to work, play, and or life.

    Prevention

    Unfortunately, there is not a lot we can do for concussion prevention. A concussion is different than other brain injuries where there is focal damage. The changes we see post-concussion are due to sheering or pulling forces on the nerves of the brain, which in turn changes the effectiveness in how they work. Protective devices, such as helmets or mouth guards, cannot prevent these forces from occurring. They are important in preventing skull or jaw fractures or cerebral bleeding, but their limitation with concussion protection is an all too common misconception. In fact, using equipment that does not protect against concussion while perceiving there is preventative value may lead to more risky behavior and possible paradoxical increase in concussion rates.

    The best thing we can possibly do is be vigilant about injuries, symptoms and being sure to take the necessary steps toward recovery. We can help you.

    Melissa Bloom By: Melissa Bloom, P.T., DPT, NCS. Melissa is a physical therapist with Physiotherapy Associates in Atlanta, GA. Melissa is a board certified neurology specialist. She specializes in vestibular rehabilitation and concussion management and teaches nationally on both topics.

    Physio, NovaCare Rehabilitation and NovaCare are part of the Select Medical Outpatient Division family of brands.

  • skeleton showing brain

    Posted on 10/6/2017 by Melissa Bloom, P.T., DPT, NCS

     

    Cooler temperatures, students returning to school and the start of another football season are all the telltale signs of fall. And with football back, reports of concussion will inevitably follow. While advancements continue to be made in regards to concussion prevention and treatment, the long-term effects of head trauma, specifically chronic trauma encephalopathy (CTE), remains a huge concern.

    You may have previously heard of CTE from the movie “Concussion,” or even from recent media reports. CTE is a tough topic for me. My trouble with the conversation is that there are a lot of unknowns and uncertainties. With the potential for serious injuries, there is the chance for panic and decisions made on emotions versus science. Moreover, ignoring the conversation leads to misinformation. So, it’s time we talk about CTE; what is it and what it means for the future of football.

    What is CTE?

    CTE is a progressive neurodegenerative disease associated with repetitive head trauma. CTE involves cellular pathological changes similar, but different, to Alzheimer’s disease. The buildup of Tau protein in the brain causes cell death, atrophy and abnormal functioning. CTE can currently only be diagnosed after death by examining the brain under a microscope.

    Symptoms can be physical, involving gait abnormalities and slowness of speech, or psychiatric and behavioral, including personality changes, depression and aggression. Various cognitive and processing deficits are also common with CTE, including difficulty thinking, concentrating and remembering.

    One consistent scientific challenge is understanding the extent to which age-related changes, psychiatric or mental illness, alcohol or drug use, coexisting dementia or other unknown factors play a role in developing CTE. Currently, this is largely unknown and has not been accounted for in research. CTE is more common in contact sports, but other factors in these athletes may also lead to the disease.

    Recent Study and Media Interviews

    Earlier this year, the Journal of American Medical Association released an article on CTE. The study looked at participation in American football along with multiple physical and psychosocial variables, and they compared these factors to diagnosis of CTE. Results of this study travelled across the media quickly, with the overall conclusion that players of American football may be at increased risk for CTE. Of the 202 individuals in the study, they found 177 were diagnosed with CTE. The researchers further concluded that 99 percent of subjects who played in the National Football League (NFL) were diagnosed with CTE. What a headline.

    Not to downplay the severity of CTE and valid concerns that exist about it, but I want to discuss some limitations about what we can take from these results. First, they conducted their study with football players whose brains were donated for research of CTE, creating a significant selection bias. It was known that their brains would be studied regarding a possible connection with CTE and their participation in contact sports. Individuals and their families who participated (i.e., donated their brain) may have noticed symptoms consistent with CTE prior to death, which led to their participation.

    What trends did they find?

    Beyond the expected motor, cognitive and psychological involvement known to accompany CTE, there were other notable trends. Substance abuse was noted in 67 percent of those diagnosed with mild CTE, and 49 percent in those diagnosed with severe CTE.

    The presence of co-morbid neurodegenerative diseases was also common, including Alzheimer’s, Lewy Body Dementia (LBD) and other motor neuron diseases. In fact, more than 19 percent of the subjects with CTE presented with LBD alone. The current study was not designed to determine the impact these factors had on the development of CTE.

    Even the authors note that caution must be used in interpreting the high frequency of CTE in their sample. Their results do not allow for estimates of prevalence, due to the lack of comparison groups. Additionally, the sample population was not representative of the overall population of former players of American football. The majority of players only play youth or high school levels, but most individuals in this study played at the college or pro level.

    What now?

    Evidence supports an association between long-term cognitive, neurobehavioral and psychiatric problems with participation in contact sports, such as football, boxing, soccer, etc. While it seems plausible there is a connection between CTE and repetitive impacts seen with American football, it is currently not possible to determine the causality or risk factors with any certainty. We need to proceed cautiously and collect additional research. However, concussion screenings and efforts to minimize concussion can improve the current health of players even if the long-term effects are unknown.

    There is an inherent risk with contact sports for concussive and sub-concussive impacts. The challenge now is evaluating the risk given uncertain long-term consequences and the many scientific questions we don't have answered. For now, let’s continue to play smart, wear protective gear, get baseline tested for concussion and, should a concussion occur, thoroughly go through the rehabilitation process for safe return-to-play and activity.

    Melissa Bloom By: Melissa Bloom, P.T., DPT, NCS. Melissa is a physical therapist with Physiotherapy Associates in Atlanta, GA. Melissa is a board certified neurology specialist. She specializes in vestibular rehabilitation and concussion management and teaches nationally on both topics.

    Physio, NovaCare Rehabilitation and NovaCare are part of the Select Medical Outpatient Division family of brands.

  • hand with scar getting cup treatment

    Posted on 3/23/2017 by Michael Staino, O.T., CHT, COMT

     

    Negative pressure soft tissue manual therapy, or, in simpler terms

    , cupping, is a mobilization technique used to treat pain, stiffness and swelling of the upper and lower extremities, as well as large soft tissue areas such as the shoulder blade or low back.

    Cupping is the combination of massage movements and negative pressure with the use of a suction device on the skin. A cup is positioned at the treatment area and a vacuum is created within the cup to draw the skin and underlying tissue into the cup. The produced vacuum creates a suction effect that increases blood and lymphatic circulation, relaxes muscle tissue and support, draws stagnation and toxins out of the body and releases a myriad of pain causing factors.

    Cupping for soft tissue stiffness

    Following injury, surgery and prolonged immobilization, patients may experience pain, stiffness and swelling that hinder normal movement patterns. There are numerous methods to treat such soft tissue stiffness. Scar tissue can be hypersensitive to touch, restricting a therapist’s ability to mobilize the visible scar and scar tissue deep within a patient’s recovering region. Using cupping, the therapist able to gently lift and mobilize surrounding pain-free tissue and work toward the targeted region without pain and discomfort. The results are immediate and lasting, with patients gaining range of motion and tolerance to exercise with reduced swelling.

    Additional cupping benefits include:

    Improved muscle performance
    Improved functionality
    Decreased hypersensitivity
    Decreased pain
    Improved scar mobility
    How does cupping work?

    Cupping tissue liftLotion is applied to the skin to improve suction and contact quality of the silicone cups on the skin. Treatment time can range from a few minutes to 10 to 20 minutes depending on the patient and treatment area. The negative pressure works well in a moving technique as our therapists glide the silicone cups across the skin.

    Patients will feel slight pressure during treatment, similar to a massage, and experience little to no pain. Following treatment, small, pin-sized red dots or bruising surrounding the treated area may appear.

    Cupping can help to treat:

    Tightness, stiffness and swelling following healed fractures
    Post-operative carpal tunnel syndrome
    Brachial plexopathy (pain, decreased movement and sensation in the arm and shoulder)
    Tennis/Golfer’s elbow
    Rotator cuff injury
    Shoulder pain and stiffness
    Low back pain
    Neck pain and stiffness
    …And much more!

    For more information on cupping, please contact a center near you today.

    Mike StainoBy: Michael Staino, O.T., CHT, COMT. Michael works in NovaCare Rehabilitation’s South Jersey community and works extensively out of our Manahawkin center. Along with managing hand therapy in his market, Michael specializes in treating patients with hand and upper extremity injuries. He is an occupational therapist, certified hand therapist and certified orthopaedic manual therapist of the upper extremity with more than 24 years of experience.