• Snow Shoveling

    Posted on 1/17/2019 by Sarah Donley, MSOT, CHT

     

    Mother Nature has yet to truly make her presence known in 2019, but that all could change this weekend. Many in the Midwest and Northeast will feel the effects of a storm that’s slated to bring dangerous amounts of snow, wind, ice and rain. With that in mind, we've provided a few snow shoveling and snow blowing tips to practice if your area turns into a winter wonderland!

    Remember to wear appropriate layers of light, loose and water resistant clothing for warmth and protection when you go outside in these low temperatures. Layering allows you to accommodate your body’s constantly changing temperature. Switch to mittens if your hands are becoming cold quickly. Mittens trap body heat by keeping your fingers together and reducing evaporative heat loss.

    Snow Shoveling

    Before you begin to clear snow from your driveway or walkway, remember that snow shoveling is a cardiovascular and weight-lifting exercise. It should be treated like a day in the gym – stretch before exercising and take it slow if you’re not in shape.
    Move smaller amounts of snow and tackle the job by dividing it into thirds, with one-hour rest breaks.
    Keep your back straight and your knees bent to decrease the pressure to your lower back when lifting. When moving the snow, turn your whole body by pivoting your legs, not just your upper body.
    Use an ergonomically correct shovel, one where the rod of the shovel bends in an elbow shape, not the straight line shovel. These shovels help you to keep your back straighter reducing spinal stress.
    Sometimes, however, there will be a storm when a snow shovel simply isn't enough. And while a snow blower can certainly help, hand injuries such as burns, lacerations, crushed bones, fractures and even amputations can also occur if proper techniques aren't practiced. Here are some tips on how you can keep your hands safe during these snowy months.

    Snow Blower

    While it sounds simple, never put your hands down the chute or around the blades of a snow blower. Use a broom handle, clearing stick or another tool to clear any clogs. Wait 10 seconds after the engine has been turned before you attempt to unclog the chute; blades could still be spinning even though the machine has been turned off. Generally, keep your hands and feet away from all moving parts.
    Avoid wearing scarves and loose fitting clothing which could become tangled in the moving parts and pull you into the machine.
    Never direct the discharge chute toward you, other people or areas where any damage can occur. The blower can also discharge hard objects, such as salt, sticks and ice further and faster than snow.
    Use proper hearing protection for your ears, and wear glasses or snow goggles for your eyes.
    If the ground is icy or slick after you’ve finished shoveling or snow blowing, spread sand or salt over the area to help create foot traction. Be aware of areas that may be uneven which could cause you to slip, trip or fall.

    Finally, think spring! Punxsutawney Phil saw his shadow and predicted six more weeks of winter ahead, but here’s to hoping the furry seasonal prognosticator is wrong this year.

    By: Sarah Donley, MSOT, CHT. Sarah is an occupational therapist at NovaCare Rehabilitation in Swedesboro, NJ. She focuses on fractures, tendonitis and compression injuries. She is Graston- certified, providing her with an advanced method of soft tissue mobilization.


  • heat map of knee

    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:

    Warm-up
    Jogging – Two minutes forward, two minutes backward and two minutes of side shuffling
    Stretching – Thirty seconds on each of these muscle groups:
    Calf
    Quad
    Hamstring
    Groin
    Glute
    Hip flexor
    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.


  • young boy cuddling with mini poodle

    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.


  • cartoon showing all NFL players all injured together on the field

    Posted on 1/24/2018 by Jeff Lambert-Shemo, ATC

     

    Throughout the 2017 NFL regular season, a plethora of superstars saw their seasons cut short due to serious and season-ending injuries. Carson Wentz, Odell Beckham and J.J. Watt were just a few of the headliners bit by the injury bug. Overall, 35 players who had previously been elected to the Pro Bowl or could be considered major contributors to a team sustained a serious or season-ending injury. Many fans were left wondering whether there were key factors that contributed to this increase in sidelined players.

    One possibility lies within an increase in physical abilities of the athletes participating in pro football. While an influx of bigger, stronger and faster players may make for a more exciting product, it also increases the opportunity for injuries to occur. Advances in the field of strength and conditioning along with nutrition have allowed these gladiators of the gridiron to reach new peak performance levels in regards to power and speed. With the difference in speed and strength among players becoming negligible, athletes are now relying on different skills to make an impact for their team.

    One of the most important skills for the player is the ability to transfer speed and strength into movements, allowing a receiver to get separation, a defensive lineman to get a step on his adversary and a running back to evade a would-be-tackler. This skill allows an athlete to use their other talents to make a big play. So if athletes are more skilled at movement, why are these injuries still occurring?

    As the speed of movement increases, control of that movement will naturally decrease, also affecting an athlete’s ability to maintain control. Athletes who are relied upon to change the course of a play, game or season must continuously perform at a level that is tiptoeing between success and failure and that can put their physical safety at risk. Changing direction, stopping, turning and jumping all become less controlled as speed increases. For a player in the NFL, an opportunity to make a great play also increases the opportunity for injury.

    With an increase in the number of exceptionally strong and fast athletes in the NFL, the number of players who have the skill to separate themselves from other athletes within a particular position is dwindling. With fewer players who have the skill to make a difference, teams are relying more heavily than ever on a few key individuals to adjust the course of a game, which is also putting those players at a higher risk of injury.

    As a point of emphasis, training and practicing athletics at full competition speed is the best way to create appropriate muscle patterns to increase skill in movement while decreasing the risk of injury.

    At NovaCare Rehabilitation and Select Physical Therapy, we offer sport-specific programs to help athletes of all performance levels restore function, decrease pain, increase strength and flexibility, optimize performance and gain education on injury prevention. Contact a center near you to speak with a member of our sports medicine team today!

    Jeff Lambert-ShemoBy: Jeff Lambert-Shemo, ATC. Jeff is a certified athletic trainer and the director of sports medicine for NovaCare Rehabilitation in Northern Ohio. He has been a NovaCare team member for six years and brings more than 20 years of experience in youth, high school, collegiate and professional athletics, including soccer, lacrosse and football. Most recently, Jeff served as the head athletic trainer for the Cleveland Gladiators of the Arena Football League.


  • breast cancer ribbon

    Posted on 10/31/2017 by Valerie L. Bobb, P.T., DPT, WCS, ATC

     

    October is Breast Cancer Awareness Month and a time to honor to those who have been affected by the disease. Approximately one in eight (12 percent) women will develop breast cancer in her lifetime, so chances are you have been touched by somebody who has had breast cancer. The good news is breast cancer death rates continue to decrease each year. This leaves women (or men!) free to live a full life once they have recovered from treatment.

    Any type of surgery can leave a patient with restriction in their neck, shoulder or arms, fatigue from chemotherapy or radiation and at risk for bone loss. However, physical therapists trained in treating cancer can design a program to regain motion, return to a healthy exercise program and return to all those things you love. That is why you fought so hard to overcome cancer!

    Exercise is shown to reduce nausea, pain and stress and maintain a good weight. With your doctor’s permission and a physical therapists help, you can begin a program that focuses on moderate cardiovascular training, light weight training, flexibility and stress reduction.

    Specific shoulder range of motion and strength exercises can help recovery from breast surgery, improve function, quality of life and body image and confidence. Resistance training is safe after surgery (once your restrictions have been lifted) and focuses on the muscles affected by the surgical procedure and what muscles you need to get back to your activities. Aerobic exercise is recommended three to five times a week for at least 30 minutes and can consist of walking, swimming or your favorite low impact exercise.

    Both aerobic and strength training is vital to counteract bone loss related to chemotherapy. It is especially important if you are post-menopausal when you are diagnosed. Physical therapists can also teach you better ways to move and lift that will reduce chance of injury and excessive pressure on your spine. Fatigue is also another side effect of chemotherapy and radiation. Besides exercise, things such as deep breathing, stress reduction techniques and proper nutrition also help with recovery.

    Many risk factors for breast cancers are beyond our control, such as age, family history and other medical conditions. However, you can control others, such as:

    Weight: Being overweight, especially in postmenopausal women, is associated with an increased risk of breast cancer. Estrogen is stored in fat and, after menopause, is our body’s main source of estrogen. The more fat tissue you have, the higher your estrogen levels.

    Diet: Diet is suspected as a risk factor; however, research is not clear on exactly what foods increase our risk. It is recommended to limit foods high in animal fat and read labels to make sure the source has limited added hormones and soy. A low-fat diet that is rich in fruits and vegetables is generally recommended.

    Exercise: There is growing evidence that shows exercise can reduce breast cancer risk. The American Cancer Society recommends engaging in 45 to 60 minutes of physical exercise five or more days a week.

    Alcohol and Smoking: Studies show that breast cancer risks increase with regular amounts of alcohol consumption. Smoking in general increases alcohol levels. Please contact your local hospital for a cessation program.

    Please contact your local women’s and men’s health physical therapist for guidance on an exercise program for breast cancer recovery and return to your life!

    Valerie BobbBy: Valerie L. Bobb, P.T., DPT, WCS, ATC, women’s and men’s heath physical therapist for Baylor Institute for Rehabilitation Outpatient Services in Dallas, TX. Baylor, NovaCare Rehabilitation and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands.


  • baby in graduation cap

    Posted on 5/23/2019 by Andrea Pavlik, C.O., Cfm

     

    You just brought your perfect little bundle of joy home and are eagerly looking forward to watching them grow. A few months go by and you notice that their head shape is flat on one side. Why is this? Is it natural? Should you be concerned?

    In 1992, the American Association of Pediatrics launched its most successful program ever: the “Back to Sleep” campaign, which served to combat Sudden Infant Death Syndrome (SIDS). SIDS, also known as crib death, is the sudden, unexplained and leading cause of death in children from one moth to one year of age. The campaign encouraged parents to put their babies to sleep on their backs, helping to reduce SIDS by more than 40 percent.

    However, the “Back to Sleep” campaign had a now recognized unintended consequence: plagiocephaly, or flat head syndrome. Plagiocephaly is characterized by the development of a flat spot on the back or side of the head. A baby’s head is very soft, and they spend excessive time laying on their backs while in cribs, beds, bouncers, car seats, high chairs, etc. This leads to an increase in the number of infants who acquire skull deformities.

    Why do babies’ heads deform?

    Plasticity of newborns skull make is susceptible to external pressures
    Immobility of newborns
    Abnormalities to the skull present at birth
    What are contributing risk factors?

    Prolonged positioning on their backs and back of head
    Lack of tummy time
    Multiple birth infants
    Neck weakness
    Is this serious?

    It is perfectly normal for newborns to have abnormal head shapes; however, they should resolve within a few weeks.
    If flat spots are still apparent, some help may be needed to correct the problem.
    Do a simple test by looking at your baby’s head and comparing to the chart below.
    To be sure of the normalcy of your baby’s head shape, consult your physician.
    Plagiocephaly Chart

    It is fixable? Absolutely! There are several treatment options to help correct the flat spot.

    Let nature take her course: Many minor flat spots will resolve on their own as the child ages, but try to keep your baby off their backs as much as possible by engaging in some quality tummy time.
    Tummy time: This can be done starting from the day you bring your baby home from the hospital. Tummy time is simply that: placing your child, while supervised, on their tummy or side. This can include while being carried, diapering, feeding and playing. Please check out this tummy time guide.
    STARband: By using a plastic helmet that is worn for 23 hours per day, your baby’s head is gently guided into a more normal shape. Please consult your physician and/or orthotist for more detailed information.
    NovaCare Prosthetics & Orthotics offers complimentary consultations for cranial remolding helmets in many of our locations, courtesy of our certified cranial remolding specialists and orthotists. Our team will educate you on repositioning techniques, plagiocephaly and protocols for the device your child may use. Over the course of treatment, we can adjust the custom-fit helmet as the baby’s head improves.

    For more information or to schedule your complimentary consultation, please contact a NovaCare Prosthetics & Orthotics center near you  

    The cutie pictured above is one of our cranial remolding graduates, Arvy Roberts.

    By: Andrea Pavlik, C.O., Cfm. Andrea is a certified orthotist with NovaCare Prosthetics & Orthotics in Sheboygan, WI.

    We have the same overall goals: obtaining outcomes and delivering exceptional patient experiences. In addition, we have sophisticated platforms to effectively partner with you and share data. Experience our compassionate approach and let us - in partnership with you - help your patients heal and get back to work, athletics and daily life.

    Refer a patient to our therapy team.


  • Family doing laundry

    Posted on 4/15/2019 by Karrianna Gallagher, OTD, OTR/L, CHT

     

    Occupational therapist? I already have a job…

    The term ‘occupation’ is more general than what we typically think. Because a third of our day is spent at work, the word ‘occupation’ has taken on that set meaning. This is interesting given that another one third of our day is spent sleeping. So why isn’t sleeping considered an occupation? This is likely because everyone sleeps, and when you think of your occupation you think of something that is uniquely you. But what is uniquely you is actually a collection of occupations, not just the one that takes up the most time. You could be a mom, teacher, gardener, friend, sculptor, chef, etc. These are the roles that you identify with and the occupations that occupy your time.

    Occupations are how we define ourselves and how we experience life. It’s likely that some occupations take up more of your time than others, but that doesn’t mean you identify with them any less. Each of them is part of who you are.

    We live our most fulfilling life when we are able to participate in all of our valued occupations to the fullest extent. Now, imagine breaking your wrist or tearing your rotator cuff. Suddenly you can’t hold your baby, write a grocery list, chop vegetables, press down piano keys, throw a ball or achieve a full night of pain-free sleep (which we all know was already being interrupted by the baby!). Every part of who you are and the way you define yourself as a person is impacted by this injury.

    There are many members of the health care team who will play a part in helping you heal. One of the team members may be an occupational therapist. Occupational therapists have the knowledge of your injury accompanied by the expertise in analyzing the necessary activities in order to guide your rehabilitation program. Their goal is to ensure your range of motion, strength and endurance are restored in the safest, most efficient way so you can get back to fully engaging in all of the occupations you want and need to live your best life.

    Hand therapist? But I tore my rotator cuff…

    A hand therapist is an occupational or physical therapist who has specialized knowledge in the upper limb - shoulders, arms and hands. The anatomy and mechanics of hands and arms is extremely complex and intricately connected, which is why it requires specialization. Think about all of the various movements you use your arms and hands for – turning a door knob, using a fork, tucking in your shirt, etc. Even seemingly simple tasks will be impacted by an injury to the smallest finger bone.

    What’s the difference in a hand therapist who is an occupational therapist and a physical therapist?

    More than 80 percent of certified hand therapists are occupational therapists, the other 20 percent are physical therapists. Both occupational and physical hand therapists have similar goals in terms of helping you heal from injury. The main premise of occupational therapy is the therapeutic use of meaningful occupation as a form of treatment. The idea here is to motivate a person to bend their elbow so they are able to feed themselves. In addition, occupational therapy has its roots in mental health. They can address not only the physical injury, but the emotional components as well.

    So, now you know… occupational therapists don’t help you find jobs and hand therapists don’t just treat hands. Occupational therapists who specialize in hand therapy are creative and caring shoulder, arm and hand experts. They take you on a rehabilitation journey where your ability to return to your unique collection of meaningful occupations is the finish line.

    By: Karrianna Gallagher, OTD, OTR/L, CHT. Karrianna is an occupational therapist and certified hand therapist with NovaCare Rehabilitation in Minnesota. She has experience in rehabilitation non-surgical and surgical shoulder, arm and hand injuries.