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 1/12/2018 by Laila Hasham, P.T., DPT
Parkinson’s disease is a chronic, progressive movement disorder that affects one in 100 people over the age of 60. While the average age at onset is 60, people have been diagnosed as young as 18. It is the second most common degenerative brain disorder affecting adults (Alzheimer’s disease is the most common). Recent research indicates that at least one million people in the United States and more than five million worldwide have Parkinson’s, and there are around 50,000 new cases diagnosed each year.
Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Some of these dying neurons produce dopamine, a chemical that sends signals to the brain to control movement and coordination. As Parkinson’s progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally. People with Parkinson’s disease are at risk of falling and sustaining injuries due to their movement and balance impairment.
Treatment includes a combination of medication and physical therapy, and in some cases surgery. A physical therapist who has experience treating Parkinson’s can help a person improve mobility, strength and balance.
The universal benefits of exercise in helping everyone feel better and improving overall health are well documented. There is evidence that exercise has specific benefits for people with Parkinson's in staying active and improving balance and coordination. Exercise approaches have long played a role in the management of Parkinson’s disease, to maximize function and minimize secondary complications and inactivity.
For decades, the Lee Silverman Voice Technique (LSVT) has been an effective way to treat the symptoms of impaired voice and swallowing from Parkinson’s called LSVT LOUD®. In 2005, a new approach to therapy called LSVT BIG® was developed. LSVT BIG is a research-based exercise program specifically designed for people with Parkinson’s. It has been shown to improve function with significant improvements noted in trunk rotation, balance and faster walking with larger steps1. LSVT BIG is provided by physical and occupational therapists who have received specific training in this technique.
LSVT programs include the combination of:
An exclusive target on increasing amplitude, or loudness in the speech motor system, and bigger movements in the limb motor system.
A focus on sensory recalibration to help patients recognize that movements with increased amplitude are within normal limits, even if they feel ‘too loud’ or ‘too big.’
Training self-cueing and attention to action to facilitate long-term maintenance of treatment outcomes. In addition, the intensive mode of delivery is consistent with principles that drive activity-dependent neuroplasticity and motor learning2.
The LSVT BIG program includes 16 sessions of therapy over four weeks, at a frequency of four days each week. These sessions are provided in a one-to-one manner and include high intensity, whole body movements. Depending on the nature and severity of the condition, treatment sessions may focus on activities that are important to the patient and education to help transfers, bed mobility and hand movement. While other exercise interventions may focus on external cues and breaking down task components, LSVT BIG focuses on movement amplitude to achieve bigger and faster movements in the attempt to restore normal movement patterns and improve gait speed.
The program is both intensive and fun, and the hard work and dedication of the patient is integral to the success of the program. Find a local Select Physical Therapy center to see if the LSVT BIG program is offered near you.
For more information on Parkinson’s disease and the LSVT BIG program, please visit the LSVT Global website at www.LSVTGlobal.com.
Farley et al (2008) Intensity amplitude-specific therapy for Parkinson’s disease. Topics in Geriatric Rehabilitation 24(2) 99-114.
Cynthia Fox, Georg Ebersbach, Lorraine Ramig, Shimn Sapir. LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease. Parkinson’s disease. 2012;2012.
By: Laila Hasham, P.T., DPT. Laila is a physical therapist with Select Physical Therapy in Austin, TX. Her primary expertise is in orthopaedics, but she is passionate about treating people with Parkinson’s and similar movement disorders in order to improve quality of life and overall function. Laila is pictured above treating a patient.
Posted on 4/19/2017 by Rebecca Miles, MSOT, OTR/L
When I tell people I am an occupational therapist, they generally either respond enthusiastically or nod as if they know what I do (when they really don’t!). Upon first hearing the name, most people think occupational therapists are vocational therapists who help people find employment or get back to a certain job. Because of this, the people who do not know what occupational therapy is are even more confused when I say I work with the pediatric population.
Occupational therapists work with people across the lifespan to do what they need to do, want to do and what they are expected to do. For us, an “occupation” refers to activities that support the health, wellbeing and development of an individual (American Occupational Therapy Association, 2014). This can mean helping someone after a stroke learn how to dress themselves again. In my work as a pediatric occupational therapist, it means I work with children and their families to allow participation and independence in their “occupation" of playing, learning and completing activities throughout their daily life.
Pediatric occupational therapists work across many settings, from schools to hospitals to outpatient centers. Here at Select Kids Pediatric Therapy, I have the opportunity to work with infants and toddlers in their homes and natural environments and to work in a pediatric outpatient center treating children from age three to 22.
Pediatric occupational therapists utilize the most current evaluation tools and clinical standards in determining the appropriate treatment for each child. We start by communicating directly with parents/guardians to determine the family’s goals and priorities. Then, through individualized evaluations, we find solutions to help maximize independence and increase participation in daily activities, including self-care, learning and play.
I work with children on reaching their full potential by addressing deficits that challenge performance of developmentally appropriate skills. For instance, I often help children who have challenges with grasp and handwriting, attention span, moving their body to complete a task, responding to information coming from the senses (like becoming overwhelmed and distraught when there is a loud noise), visual perceptual skills (like finding an item in a busy drawer or knowing what an item is when it is not entirely visible) and activities of daily life (like dressing and feeding). I get to address these skills through play and actual performance of the activities, so that children can engage in their “occupations” and learn while having fun.
I empower families through education and guidance to help the children in their lives grow and learn. It is amazing to be able to spend every day helping children to reach their own individual potential.
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain & process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006
Rebecca MilesBy: Rebecca Miles, MSOT, OTR/L, pediatric occupational therapist at our Select Kids Pediatric Therapy center in Virginia Beach, VA.
Select Kids Pediatric Therapy and NovaCare Kids Pediatric Therapy are part of the Select Medical Outpatient Division family of brands. Contact a center near you today for more information on pediatric therapy services.
Posted on 6/18/2018 by Erica Zettlemoyer, P.T., DPT
Multiple Sclerosis (MS) is a progressive disease in which the body’s immune system attacks the central nervous system (CNS). The CNS is composed of the brain, spinal cord and optic nerves. Our nerves are surrounded by a fatty substance called myelin, which allows electrical messages to be delivered quickly from the brain to the correct muscle. In MS, the myelin is damaged, scars are formed and the electrical message from our brain is disrupted. This creates a less efficient movement pattern, as well as pain, weakness, heat sensitivity, fatigue, numbness, vision changes and other impairments.
Multiple Sclerosis and Exercise – Though researchers are making significant advances in treating MS, there is still not a cure. However, there are various treatments which focus on slowing the progression of the disease and managing symptoms. Exercise is considered one of these treatments. In a published study, people with MS who participated in 15 weeks of three 40-minute training sessions per week were shown to demonstrate improved cardiovascular fitness, strength and overall health.¹
Multiple Sclerosis and Physical Therapy – Due to the complexity of MS, it is important to work with a physical therapist who will create a specialized exercise program based on one’s progression and severity of symptoms. Treatments will focus on general conditioning, strengthening, flexibility and balance as well as postural education, positioning and respiratory function. In more severe cases, a therapist will assist in the utilization of equipment, such as bracing, wheelchairs, standing frames. Several of the challenges that must be considered include:
Heat Sensitivity: Many patients with MS report a sensitivity to heat. A rise in core body temperature of as little as 0.5ᵒ C can intensify symptoms. A physical therapist can guide patients through several ideas that will assist in controlling body temperature while exercising. Using a fan, drinking cold water prior, during and after activity as well as utilizing cooling vests and wrist bands are helpful in controlling body temperature. Other ideas include placing a cooler in the car with cold drinks and starting the air conditioning in the car 10 minutes prior to leaving.
Lassitude: Fatigue affects 74 to 89 percent of those diagnosed with MS.² It is the initial symptom for almost half of those diagnosed, even predating diagnosis by as much as 10 years.³ A physical therapist can help patients address modifiable factors that increase fatigue, such as activity, respiratory weakness, thermosensitivity, pain, deconditioning and movement compensation.
Bone Density Loss: When exercising, it is important to focus on strengthening with resistance. Those diagnosed with MS may suffer from bone density loss due to Vitamin D deficiency and increased use of steroids. Participating in a weekly strengthening program while utilizing weights may improve bone health. A physical therapist can guide patients in safely incorporating resistance into an exercise program.
Examples of Appropriate Exercises – It is helpful to know that when exercising with MS, we should look at the total amount of exercise minutes for the day. For example, if someone can participate in riding a stationary bike for five minutes in the morning, five minutes in the afternoon and five minutes in the evening, that will give them 15 minutes of total cardio exercise for the day. Walking on a treadmill, walking inside or standing activities are other examples of exercises that can be modified to one’s functional and physical capabilities.
Strengthening exercises can include bridges, clams, heel raises, sit-to-stand transitions squats, step-ups and rows. Wall push-ups and triceps dips are especially important for fall recovery training. I recommend working on eight to 15 repetitions while using an appropriate resistance level.
Stretching is important and should focus on calf muscles, hamstrings, hip flexors and pectorals. When incorporating balance activities, vary the surface you are practicing on, whether seated or standing. For example, sitting on a wobble board or standing on foam will maximize training.
Beginning an exercise program does not have to be overwhelming or intimidating. Each patient with MS will tolerate exercise differently and a physical therapist can individualize each program to meet the needs of that individual. The MS Society and Multiple Sclerosis Association of America are also valuable resources for those who are seeking information on exercise.
For more information regarding physical therapy for MS, please contact a center near you today!
Petajan J, Gappmaier E, White A, Spencer M, Mino L, Hicks R. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Annals of Neurology. April 1996 39(4):432-41
Murray TJ. Amantadine therapy for multiple sclerosis. Can J Neurol Sci 1985; 12:251-254
Krupp L, Alvarez L, LaRocca N, et al. Arch Neurol. 1988 45(4):435-437
White L, Dressendorfer R. Fitness testing in multiple sclerosis: a case report. Med Sci Sports Exerc 2003;35 (5): S314
By: Erica Zettlemoyer, P.T., DPT, is a licensed physical therapist at Baylor Scott and White Institute for Rehabilitation. She received a doctorate of physical therapy in 2010 from Texas Woman’s University and is a Certified Multiple Sclerosis Specialist.