Posted on 6/7/2018 by Annette Monaccio, O.T., CHT
Hand Therapy Week is held during the first full week of June and hosted by the American Society of Hand Therapists. Certified hand therapists are dedicated to helping patients with hand and arm injuries and conditions that may be affecting their daily life.
As a certified hand therapist, I’ve had the privilege to meet many people with a wide range of injuries. Watching an individual perform a task or activity that we often take for granted is a proud and exciting moment for both a patient and therapist after an injury.
I met Lexi, a shy and nervous young girl, who had been through a traumatic experience and hospitalization after a bon fire accident left her with severe burns over most of her body. She had spent several months at a local hospital in the intensive care burn unit. Upon beginning treatment, I knew that I needed to address and acknowledge her injuries, expectations of participation in therapy, boundaries for success and goals for recovery and independence.
Lexi had many burns on her face, arms, hands, torso, legs and back. There were many areas to address with her injuries, including:
Managing her wounds
Regaining mobility in her extremities
Performing basic activities of daily living, such as bathing, dressing and returning to school
Processing the psychological impact of others reactions to her appearance
I knew there were many things that we had to address quickly to avoid the loss of motion of her arms, especially her hands which were severely burned and beginning to form contractures/scarring along the fingers. We developed custom splints, “orthoses” made to fit the individual. It required many attempts for success due to Lexi’s injuries, but the key to our success was listening to determine the best splint, proper fit, adjustment and fashion for a preteen. A few color adjustments of splinting materials, a little added “bling” and voila, it was done and Lexi began wearing her orthotic!
The management of her wounds – cleaning, dressing, monitoring and education – were our first steps of trust and understanding, since this was one of the most difficult aspects of intervention. The next process of touching, moving and passively stretching her hands and fingers were the true challenge. Building trust and establishing goals were vital. We were on our way as a team to improve her ability to bend a finger, make a fist and then use her hands to accomplish daily tasks. There was blood, sweat and tears during many sessions, but, most importantly, there was a lot of laughter, too.
LexiLexi’s parents were dedicated to helping her in the center and at home for carryover of the program. As I watched her mom tie her shoes and write out some of the exercises we were reviewing one day, I asked Lexi why she wasn’t doing this on her own. She said, “I can’t do it myself.” This began the educational component with Lexi and her mom of why it was important to allow Lexi some reasonable time to attempt to gain her independence to complete daily tasks on her own. Yes, it was quicker and easier for someone to do this, but what would happen the first day back to school? Within two sessions, Lexi was independently putting on her shoes, tying them and had her first sense of independence since the accident.
Her laughter and smile were infectious with each new success. Next, Lexi was writing with adapting pens and pencils and back to writing poetry. Putting on her arm and leg compression garments and gloves was a tug of war match and she won each time. Again, another success. There were challenges of zipping a backpack, carrying books and fatigue following walks through the hallways in school, but Lexi overcame them all.
We initiated more challenges with fine motor skills with the purchase of a Barbie head and working on braiding hair. As a preteen, this was a must for Lexi. She now started braiding and had taken the focus of the hypersensitivity of her burns away to a new focus of allowing herself to touch different textures, which previously prevented her from using her hands for any activities. With each new challenge came a new set of frustrations, successes and, ultimately, independence.
Due to the extent of her burns, Lexi has been through several follow-up surgeries. She has returned each time to the center and hand therapy treatment with a new set of goals and motivation to quickly return to her routine. Step-by-step she continued to accomplish her goals, becoming independent with all activities. She now has excellent mobility of her arms, hands and legs.
Lexi has matured into a teen. She drives, attended prom, participates in track and other sports at school and has become a teen counselor at the burn camp she has attended each summer since her accident. I observed Lexi go from a quiet, scared child to an energetic and expressive young lady. She has taught me about determination, hard work and maintaining a positive attitude. She is an inspiration. I was not only the therapist, but the student learning each day from her.
By: Annette Monaccio, O.T., CHT. Annette is an occupational and certified hand therapist with Banner Physical Therapy in Arizona. She has treatment expertise in hand/upper extremity conditions and injuries, pelvic floor health and cancer rehabilitation.
Banner Physical Therapy, Select Physical Therapy and NovaCare Rehabilitation are part of the Select Medical Outpatient Division family of brands.
Posted on 4/3/2017 by Cornelia von Lersner Benson, O.T., CHT
Join NovaCare Rehabilitation, Select Physical Therapy and our team of dedicated occupational therapists as we celebrate Occupational Therapy Month (OTM)! OTM is hosted by the American Occupational Therapy Association (AOTA) each April to recognize how occupational therapists and occupational therapy assistants help transform society by restoring and improving function in people's lives.
Occupational therapy is celebrating its anniversary! The National Society for the Promotion of Occupational Therapy (now AOTA) was established in 1917, marking 100 years of the profession and evidence-based practice. With more than 200,000 occupational therapists and occupational therapy assistants helping individuals across the lifespan live life to its fullest, this dedicated group of professionals focuses on treatment to help develop, recover and maintain the daily skills of patients.
Occupational therapists offer a unique approach to physical rehabilitation. The focus isn’t just someone’s motion or strength, but how it is used in their life, such as a healthy return to work, getting back to sports or hobbies or helping to braid a child’s hair before school. Occupational therapists also have specialty training in orthoses fabrication and emotional, thinking and reasoning factors that affect physical health and function. It is a service that, side-by-side with physical therapy, can offer a return to health and function in an all-inclusive and progressive way.
This service offering, however, all began for NovaCare Rehabilitation in 1990, prior to joining the Select Medical family, within our Southern New Jersey community when I was hired by our then company president to develop an occupational therapy program. I was hired as the first occupational therapist for the company, likely as an informal pilot study to determine a consumer’s benefit of receiving occupational therapy and its contribution as a service and unique offering for our organization. As we knew it would, occupational therapy was a hit! Occupational therapy allows patients to achieve independence and participate in tasks they want and need to accomplish through therapeutic interventions following trauma or disability. Our local success meant that the occupational therapy service offering quickly grew, adding additional staff members in New Jersey and then Philadelphia, Maryland and Minnesota.
Today, occupational therapy is a national service for NovaCare Rehabilitation, Select Physical Therapy and other brands within the Select Medical Outpatient Division family. We employ more than 480 occupational therapists across the country. We continue to treat patients on a daily basis as well as provide education and mentoring to support new occupational therapy graduates who desire to achieve his/her certification in hand therapy. We help to supervise all levels of occupational therapy students, ongoing development for staff and continued service expansion to meet the needs of our community at large.
At NovaCare Rehabilitation and Select Physical Therapy, our occupational therapists are everyday heroes and know that each patient is unique and requires an individualized approach to care. Our team finds the right solution for each patient to reach goals and return to function and the things they enjoy doing as soon as possible.
I am proud to work for a company that holds occupational therapy in such high regard and encourages and supports therapists in their growth, their unique contributions and their skills to improve the lives of our patients. This comes as a result of having a company creed that is dedicated to providing an exceptional patient experience in a compassionate environment. It all fits! Happy OTM, everyone!
Cornelia von Lersner Benson By: Cornelia von Lersner Benson, O.T., CHT. Cornelia serves as NovaCare Rehabilitation’s hand and occupational therapy director for the Southern New Jersey community. NovaCare in New Jersey proudly employs 46 occupational and hand therapists within 27 offices, including those who provide in-home care and services within physician offices.
Posted on 9/11/2018 by Brian Brewer, CPT
School is back in session and fall sports are underway! From the gridiron to the soccer field to the volleyball court, athletes of all levels are hitting the field. With increased play, however, there is also an increased risk for injury.Categories: Physical Therapy
Did you know that there are movement assessments designed to assess ACL injury risk? Within Select Medical’s Outpatient Division*, we provide movement assessments using dorasaVi wireless wearable sensors to measure exactly how individuals move. This technology allows our highly trained clinical team objectively analyze body movement and muscle activation, utilizing a test called the Athletic Movement Index, or AMI. With this testing, we are able to accurately determine an athlete’s ability to safely perform higher level movements, such as cutting, pivoting and deceleration, all of which can lead to ACL injury if not performed efficiently.
The ACL is one of four ligaments in the knee that provide joint stability. Roughly 70 percent of ACL injuries during high-risk sports are non-contact injuries, meaning no collision occurred when the ACL tore. As an athlete begins to tire throughout the course of a game or event, their efficiency in movement begins to suffer, their mechanics become faulty and their risk for injury is heightened. If we can recreate these conditions during movement assessments, we are more able to determine an athletes risk for ACL injury. The AMI is a test that simulates the fatigue factor that plays a role in ACL injuries.
The AMI runs the athlete through a battery of movements, designed to assess core strength and stability, hip strength and mobility and efficiency moving through single-leg movements, such as a single-leg squat and a single-leg hop. The single-leg movements analyze the movement of the knee, whether it is collapsing inward or outward past neutral and the degree of loading, or depth, that the participant is able to go to, both of which are important indicators in assessing ACL injury risk. If the knee is not staying neutral during single-leg movements, then there is weakness in the hip, specifically the gluteus medius muscle, which is leading to inefficient movement. The higher the speed that the knee is moving out of neutral, the higher the risk of ACL injury there is. Similarly, if the athlete is not loading deep enough, and that is coupled with a high speed of displacement, then their risk is increased even more. Through strengthening the hips and core effectively and deliberately, based on the test results, clinicians can help reduce an athlete’s risk of injury dramatically.
Our exclusive ACL Play it Safe Program is an ACL prevention program, designed specifically to go hand-in-hand with the AMI and address the faulty mechanics that lead to ACL injuries. The program consists of a mobile application, with pre- and post-practice exercises and drills to be performed. Additionally, there is an ACL Play it Safe Kit that consists of equipment designed to improve strength and conditioning of the muscles responsible for controlling mechanics during dynamic movements that can cause injuries.
The pre-practice exercises are dynamic warm-ups that should be used to increase flexibility and mobility in the hips, knees and ankles:
High knee with calf raise
These pre-practice exercises should be performed for 15 yards down and back, two times each. This will help to warm-up the hips and knees, and prime them for efficient movement.
The post-practice exercises utilize the TheraBand CLX, TheraBand Ankle Cuff and TheraBand Stability Trainer. These should be done after practice when the athlete is tired. If an athlete can strengthen and train with proper mechanics while they are tired, then it will be that much easier for them to perform efficiently on the field when they reach the same level of fatigue. There is a multitude of post-practice exercises, with some listed below:
CLX spiral technique
TB cuff side stepping with kicks
Single leg toss on stability trainer
CLX plank with kicks
All of the post-practice exercises are designed to help strengthen the core and gluteus medius muscle and prevent a displacement of the knee during dynamic movements. Of course, as with any exercise routine, static stretching and/or foam rolling should also be performed following the completion of the program.
Through objective analysis of muscle activation and subjective observations of movement, clinicians are able to determine ACL injury risk with high accuracy. If we can address poor mechanics of movement through assessment prior to when an athlete takes the field and introduce them to ACL Programs designed to addressed these poor mechanics, we can start to minimize lost time on the field, see an increase in performance and help athletes be more confident in their sport.
*NovaCare Rehabilitation and Select Physical Therapy are part of the Select Medial Outpatient Division family of brands.
By: Brian Brewer, CPT, is a strength and conditioning specialist for NovaCare Rehabilitation in Annapolis, Maryland.
Posted on 9/26/2018 by Anne Marie Muto, OTR/L, CHT
Now that students have a few weeks of school under their belts, their backpacks – which were relatively light from a few school supplies – are now filling up. Not only are children feeling the weight of nightly homework, but also the weight of their book, binder and electronic-filled backpacks.
Aside from considering the right cartoon character/super-hero, color and cool factor, the backpack should also be the right fit. In honor of National School Backpack Awareness Day, here are few things to keep in mind when picking out a backpack:
The width should be about the same size as the student; the length should be no longer than the torso (trunk or central part of the body) and not hang more than four inches below the waist. Remember to check the bag each year, especially for younger children who are experiencing growth spurts.
Select a backpack that has a padded back, two padded shoulder straps and a waist strap to help evenly distribute the weight from the shoulders to the body’s core and hips. The extra padding will help protect students’ neck and shoulders which are rich in blood vessels and nerves and when constricted can cause pain and tingling in the neck, arms, and hands.
Finally, choose a backpack that is light-weight and has multiple compartments which can help distribute the weight more evenly. It’s also a good idea to think about picking a backpack with reflective material or adding reflective tape for younger students.
After picking out the perfect backpack, students should also be reminded on how to properly wear and pack their “shoulder shadow.”
Always wear both shoulder straps to distribute the weight evenly. Using one only shoulder strap can cause too much leaning and threaten to curve the spine.
Adjust the shoulder straps so the pack fits snugly across their back. When possible, pack lightly and carry only items that are required for the day.
Never allow a student to carry more than 15 percent of their body weight. For example, if a child weighs 100 pounds, the backpack should not weight more than 15 pounds.
When organizing the content of the backpack, distribute the weight evenly by packing the heaviest items toward to the center and lower portion of the bag to keep the weight off their shoulders.
Finally, here are a few tips to keep in mind to help lighten the load:
Ask if textbooks are available digitally, or if extra books are available to leave at home.
Consider having a “homework box” at home that contains schools supplies (pens, pencils, ruler, markers, highlighters, etc.) to reduce the amount of unwanted weight in a backpack.
Encourage kids to use their locker or desk frequently throughout the day instead of carrying an entire day’s worth of books. Only bring home the books which are truly required for homework or studying each night.
Pick up the backpack using proper lifting techniques, encouraging students to bend at their knees and use both of their hands when lifting the bag to their shoulders. It may not be a bad idea for students to participate in back-strengthening exercises to assist in building up muscles required to carry a backpack.
We hope you have a fun and healthy year at school! Happy learning!
By: Anne Marie Muto, OTR/L, CHT, from NovaCare Rehabilitation’s Broomall and Boothwyn, PA centers. Anne treats patients dealing with upper extremity injuries and is a preferred provider for the Graston Technique.
NovaCare Rehabilitation and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands.