• girls wearing backpacks

    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.

  • Baseball Pitcher

    Posted on 6/12/2017 by Heather N. Wnorowski, P.T., DPT, OCS

     

    Across the country, baseball and softball season is in full swing. Whether it’s at a backyard barbecue or an official game, athletes of all skill levels are taking part in America’s favorite pastime.

    Over the past few years, a large emphasis has been on the youth athlete and overuse injuries in pitchers. We have learned to monitor pitch counts, plan structured rest and encourage multi-sport participation with athletes.

    But what about outfielders, catchers and the weekend warriors who enjoy playing in their neighborhood league?

    Common injuries aside from the shoulder and elbow exist in youth and adult baseball/softball athletes, such as back pain, knee pain and Achilles injury. Many overhead athletes have concurrent complaints of back pain or contralateral knee pain (knee pain opposite of their throwing arm). Why?

    When you think about baseball and softball, a player is doing rotational movements that require the entire body. Unless they switch hit, these rotational patterns are always to the same side. What then happens is they may overdevelop certain muscular groups on one side in comparison to the other. In doing so, this can cause overuse injuries of these groups or we may injure or strain ourselves doing normal daily activities due to this imbalance.

    The easiest way to avoid injury at practice or during a game is to develop a proper warm-up routine. An adequate warm-up usually involves a little bit of sweat, which can be hard to get in the dugout. Try performing some of these full body movements to warm-up quickly and efficiently:

    Overhead squat
     Heather Squat

    Overhead walking lunge
     Heather Overhead Lunge

    Split squat with one foot on the dugout bench
     Heather Split Squat

    Lunge with trunk and arm rotation
     Heather Lunge Rotation

    Shoulder rotation with banded pull aparts
     Heather Band Rotation

    PNF diagonal pattern with banded pull aparts
     Heather PNF Bands

    Incorporating a low back and abdominal strengthening routine into your normal strengthening routine is also recommended. To be most efficient, you need a good transfer of force between the upper half and lower half during throwing or batting. Without a solid core, athletes with lose force and become less effective. Abdominal exercises that require rotation in both directions, isometric holds (planks, side planks), and lumbar extension strengthening should all be incorporated into your programming.

    Heather Stretch 1 Heather Stretch 2

    Having a good balance of strength (right and left sides comparable) and a solid warm up routine will help to prevent injury and enhance performance. Hopefully these tips prepare you for your season and keep you healthy on the field. Best of luck in your upcoming season!

    By: Heather N. Wnorowski, P.T., DPT, OCS. Heather is a staff physical therapist at our NovaCare Rehabilitation center in Sewell, NJ. She earned a doctorate of physical therapy from Widener University and is dedicated to developing efficient avenues of treatment to influence superior patient outcomes.


  • Posted on 5/26/2017 by Aileen Lysaught, M.S., CCC-SLP

     

    Join NovaCare Rehabilitation and Select Physical Therapy as we shine a light on Better Hearing and Speech Month (BHSM)! BHSM is hosted each May by the American Speech-Language-Hearing Association which works to make effective communication accessible and achievable for all. 

    Being a first time mother, you don’t really know what to expect after your child is born. My son Rowan was born unexpectedly at 35 weeks. While I was in labor, the nurses warned me of all the complications that may occur with a premature baby. The neonatologist was present for the delivery, and my son was quickly whisked away before I could hold him. While he was being examined by the doctors, I couldn’t wait to hold him for the first time. I could hear him crying as well as the nurse saying, “It looks like he has a tongue tie; my grandson had one, too.”

    It seemed slightly ironic, being a Speech-Language Pathologist (SLP), that my son would have a tongue tie; however, I was too overjoyed with his birth to worry about the consequences of this during our first moments together.

    When I looked in Rowan’s mouth, I could see he had what’s called a Class 1 tongue tie (the small fold of membrane that normally extends from the floor of the mouth to the midline of the bottom of the tongue attaches all the way at the tip of the tongue). This would significantly impact his ability to move his tongue for feeding.

    Our first attempt at breastfeeding was when things became difficult. Being a preemie, he had some difficulty feeding as the sucking pads are not developed in babies born prior to 37 weeks. The tongue tie also made it difficult for him to coordinate the movements necessary for breast or bottle feeding.  So, being an experienced SLP, I knew to ask, “When can we have the ear, nose and throat (ENT) doctor come do the frenectomy?”

    A frenectomy is a procedure for children struggling with speech or feeding difficulties related to tongue tie. This procedure would help my son improve his feeding skills and get the adequate nutrition needed. The next day, the ENT arrived and quickly performed the procedure. By our first pediatrician appointment the following week, he was back up to his birth weight and then some.

    As time went on, I noticed some symptoms in my son that led me to believe he still had tongue restriction and a potential lip tie. He suffered from reflux, which caused him to arch his back and become fussy after feedings. He was gassy and didn’t sleep very well.

    Aileen and RowanI began to research as much as I could about tongue tie in babies and children. I took courses and joined support groups for other parents with tongue tie babies and groups in which SLPs would discuss their experiences with tongue ties. I found that some of the other symptoms my son was experiencing could be related to his tongue tie. I also found that many physicians or dentists who are not specially trained in tongue tie may not perform complete revisions, which may result in the need for a second procedure. By this time my son was six months old. 

    After a lot of research and careful consideration, I went to see a pediatric dentist who was highly recommended and performed successful frenectomy procedures on many of my patients with great outcomes. I was worried, but I couldn’t help but think about how many times I have recommended a family to have the procedure done. The pediatric dentist we saw was extremely knowledgeable.

    After he examined my son, the dentist said Rowan’s initial frenectomy was likely incomplete and he would have to use a laser to perform another revision on Rowan’s tongue as well as revise his lip tie. I trusted his recommendation and the procedure took less than five minutes.

    I knew the importance of aftercare procedures, including stretching 10 times per day for 10 days and oral motor exercises to improve Rowan’s tongue’s strength and range of motion. I noticed significant improvements in his feeding abilities, ability to babble and gross motor development. Now that Rowan is a little over a year old, has well over 20 words in his vocabulary and is beginning to eat a variety of foods, I couldn’t be happier that he is able to move his tongue freely.

    My situation was quite unique being a practicing pediatric SLP with experience in this area. Many mothers struggle and have to give up their attempts at breastfeeding before they discover what may be impacting their child. Many babies have difficulty with weight gain, suffer from reflux or are diagnosed as colicky when the issue lies in their tongue’s ability to function correctly. Parents may not realize their child has a tongue restriction until they have been diagnosed with a speech delay or struggle with a toddler who refuses to eat.

    Tongue ties impact many areas of speech and feeding development, and it is important to find knowledgeable professionals to help with the process. It is essential to work with a SLP who can evaluate and identify if a tongue restriction exists and treat the symptoms (speech and feeding difficulties). It is also important to get referrals to an ENT or pediatric dentist to determine if a frenectomy is advised.

    Having experienced these issues first hand, I feel that it not only makes me a better mother, but a better SLP. I am dedicated to helping other families overcome these difficulties so their child’s quality of daily life can improve.

    Aileen LysaughtBy: Aileen Lysaught, M.S., CCC-SLP. Aileen is a pediatric SLP and the assistant center manager at NovaCare Kids Pediatric Therapy in LaGrange, IL. She has been a practicing SLP since 2010.

     

  • 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.