After a person receives acute care in a “regular” hospital for catastrophic illness, traumatic injury or a debilitating chronic condition, the next step in the process of recovery often involves a stay at an inpatient rehabilitation, or rehab, facility.

Patients often have little warning when they’re quickly moved to a rehab facility from acute care. Those who envision a long, leisurely recovery in a hospital or at home may find that the abrupt transition-and new responsibilities in rehab-leaves their heads spinning.

Depending on the type and severity of the patient’s injury- and the mandates of the patient’s insurer or Medicare/Medicaid-recovery time in the community hospital may last only hours or days before the transition to a rehab facility takes place.

Concerns also move from whether someone is going to live-which is paramount in acute care-to how are they going to live under what may be very different circumstances.

Although the doctors and nurses at an inpatient rehab hospital will provide pain medicines and medical attention, just like an acute care hospital, the purpose of inpatient rehab is to help the patient regain functions they’ve lost from injury and illness.

Returning to activities of daily life such as relearning how to walk or feed oneself or talk, and handling changes in mental status and emotional health are all common challenges for patients in a rehab facility.

The change in environment also means changes in daily routines from simple basics like visiting hours, meals, learning names and roles of a new health care team and changes in responsibilities for both patients and families/loved ones.

Twenty-seven-year-old Jeff Miklaszewski entered an inpatient rehab hospital three weeks after a serious motor vehicle accident almost cost him both his legs.

For younger people like Jeff, the abrupt contrast between their prior robust good health and a new significant physical impairment is a dramatic jolt, says Dexanne Clohan, M.D., medical director of HealthSouth, a nationwide network of inpatient rehabilitative hospitals. Issues related to school, career, and sexual relations can be a big worry.

In the short term, adjusting to inpatient rehab often means dealing with roommates, noise, and a lack of personal privacy for toileting, bathing and personal care. In Jeff’s case, his rehab roommate required a ventilator to breathe, and the nurses didn’t always respond immediately to his roommate’s request for assistance, leaving Jeff frustrated and unsure how to help.

“That struck a nerve with me. I had to share a room with this guy, and it was frustrating at times watching that happen,” he says.

Intense Role Shift

In the hospital, you may have felt like you were along for the ride, with your doctors and nurses in the driver’s seat of your medical care. At a rehab facility, you’re definitely behind the wheel, a role change that many patients don’t realize when the hospital doors close behind them.

The patient’s responsibilities involve undergoing several hours of physical and occupational therapy daily, usually five days a week, while at the rehab facility.

Physiatrists -physicians who specialize in rehabilitation medicine-nurses, physical and occupational therapists, and caseworkers coordinate care at the inpatient rehab hospital, designing programs that can be physically and emotionally intense as they push patients to recover lost function and regain independence.

Depending on a patient’s injury or illness, physiatrists may also recommend specialized therapies, such as speech therapy or gait training.

But a successful rehab experience depends heavily on patient participation, and the person’s outlook about the process plays a critical role.

“The person who says, ‘I can’t do this. I’m checking out. I’m never going to get better’ may have a more difficult time than the patient who says, ‘This is the hand I’ve been dealt, and I’m going to do my best. This is not going to stop me.’ Motivation is a huge factor,” as is support from family, says Alain Pierre-Louis, M.D., a New York City physiatrist.

Many patients don’t realize that their continuing participation in rehab is not only desirable, but necessary to stay at these types of facilities, Clohan says.

“If a patient isn’t able to participate consistently in therapy, then they’re really not considered eligible under Medicare law for an inpatient rehab hospital . . . it’s important to match each patient to the right level of care,” Clohan says.

“The whole point of being with us is to get the close level of medical supervision and the intensity of the therapy a rehab hospital provides. There may be moments when they don’t feel like it or they’re tired of it and need rest, but our nurses and therapists can coach them through so they can achieve the best recovery possible. It takes an intense experience to get that result,” Clohan says.

At first that intensity proved overwhelming for 84-year-old retired minister Larry Gruman, who spent five weeks in a rehab hospital in 2008 after a brief hospital stay for spinal surgery.

“The workouts took all the strength out of me. I was physically exhausted and very much on edge. They kept me busy with three or four appointments each day. In between those I went back to bed,” Gruman says.

But Gruman credits the grueling workouts for helping him get back on his feet. Today he stays physically active, swimming regularly and staying mobile with the help of crutches and a scooter.

“I pushed myself always at the edge . . . I believe I progressed because of that determination to advance each day,” Gruman says.

( Note: Larry Gruman is the father of Jessie Gruman, Ph.D., president of the Center for Advancing Health, of which the Health Behavior News Service is a part.)

Down the Road

Inpatient rehab stays generally aren’t long, says Keith Robinson, M.D., a physiatrist based at Philadelphia’s University of Pennsylvania. In fact, even for patients with severe trauma, such as spinal cord injuries, the average rehab stay is only 38 days.

That’s a short span of time for people to make major, long-term adjustments.

A large study on medical rehab trends found that of the five major impairment groups -stroke, brain, spinal cord dysfunction, other neurological conditions and orthopedic conditions, like hip replacement-about 60 percent of patients are female and the average is about 68 years.

For patients of any age, the transition to rehab compels them to come face-to-face with fears and concerns about future disability.

“Any sudden decline in function is never an easy thing to adjust to. We can address issues such as worry, guilt, depression, concerns about their ability to provide for their family. No one is ever prepared to have a stroke. No one’s ever really prepared to lose a limb or go through a trauma or suffer a spinal cord injury,” says Alain Pierre-Louis, M.D., a New York City physiatrist.

The accidents or conditions that lead to a stay in a rehab facility have an impact far wider than just the patient. Family, friends and loved ones may all be called upon to make adjustments in their expectations, provide support and participate in therapeutic goals. The role these family members or caregivers play is a critical component of a successful inpatient rehab experience, especially when it comes to making the transition home.

While the patient is at rehab, caregivers may be expected to fetch comfortable clothing for the patient from home and launder it later. They may need to attend team meetings to assess and monitor their family member’s progress. The health care team also involves caregivers when setting goals for the rehab patient. For example, the patient, health care team, and caregiver may set goals for walking, toileting without assistance and returning to home or work, if possible. If there are neurological problems with the patient, the caregiver may need to make decisions about care along with the doctors.

And for many patients in rehab, caregivers serve as a link to the community and the outside world. “There are times that if you don’t have that connection to outside world, it can be lonely, despite the fact that there are patients you become friends with in rehab,”Jeff says.

Homeward Bound

Once the patient is discharged home, the caregiver’s role expands even more, providing transportation to medical and therapy appointments, picking up and administering prescription medications, helping the patient bathe and toilet, fixing meals and encouraging adherence to the family member’s at-home exercise schedule. Dealing with the complex financial issues associated with rehab-and dealing with insurers- also typically fall to a patient’s family member during the recovery period.

However, family members and friends aren’t patients’ only support system. In addition to the medical team members, case managers at the rehab facility offer assistance with the transition home by helping patients and families manage outpatient therapy appointments, administer medications, and use medical equipment.

Case managers also talk extensively with patients and families about the home environment and how to arrange it so the patient can move about easily after returning home. In Gruman’s case, a caseworker visited his home to offer counseling on exercise and recreational activities, using a catheter and climbing steps.

Paving the Way to Recovery

As part of discharge planning, which starts at admission, “we ask a lot of questions about what’s your house like, what’s your bathroom like, do you have steps, is your bedroom upstairs? We customize our therapy to help an individual patient live as independently and safely as possible. One size doesn’t fit all,” Clohan says.

However, as in all areas of health care, some rehab patients will have less access than others to such thorough, customized discharge planning.

A successful transition from acute care to rehab, and eventually home, means hard work and the realization that you’re learning a new way of living as a disabled person, Robinson says. In many cases, even if there’s a complete recovery, as in the case of a hip or knee replacement, it’s important to keep in mind it doesn’t happen immediately.

For many recovering patients, though, inpatient rehab helps cement their desire to regain as much independence and function as possible.

Thanks to his motivation in rehab and several orthopedic surgeries to repair the bones in his legs, today Miklaszewski is back on his feet with the help of a cane.

“The best thing about being at a rehab facility is that you’re surrounded by people who are in the same spot you are. You can talk to people every day about their progress. You can see them, in the course of a few weeks, go from a wheelchair to a walker to getting their coordination back,” Miklaszewski says. “That in itself is inspiring.”

Source: Health Behavior News Service

The University of Southern California is taking the lead to address rehabilitation therapy and how it can improve the quality of life for stroke survivors. Each year, about 700,000 people in the United States experience first or recurrent attacks of stroke.

About 65 percent of stroke survivors experience significant disability, such as the loss of use of one arm. This can lead to a reduced quality of life and loss of independence, says Carolee Winstein, director of the Motor Behavior and Neurorehabilitation Laboratory at USC.

“More effective rehabilitation treatments could lessen the disability, caregiver burden and economic impact of stroke,” says Winstein, a professor of biokinesiology and physical therapy.

To address the problem, the NIH-National Institute of Neurological Disorders and Stroke and the NIH-National Institute of Child Health and Human Development awarded Winstein $12.4 million for a five-year study of a promising physical therapy program for stroke patients who have lost movement in their upper limbs.

The trial will investigate the effectiveness of the Accelerated Skill Acquisition Program (ASAP), an “intense and focused” outpatient rehabilitation program that emphasizes activities-based training and resistance exercises, and includes 30 hours of one-on-one therapy early in the rehab process, within the first three months of the stroke. The ASAP program also uses motivational techniques to encourage patients to self-manage their therapy.

Patients in the study will be divided into three groups; the ASAP therapy group, an outpatient group receiving a similar amount of PT and a monitoring only out-patient therapy group. The ASAP and outpatient group will attend a one hour therapy session, three times a week for 10 weeks. Meanwhile, the monitoring only group will receive out-patient therapy for a frequency and duration prescribed by their referring physician.

Winstein’s study is named I-CARE, for Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (I-CARE) Stroke Initiative.

The I-CARE trial will link the USC School of Dentistry’s Division of Biokinesiology and Physical Therapy with two other academic clinical research centers in the U.S.: the National Rehabilitation Hospital in Washington, D.C., led by co-principal investigator Alexander Dromerick, and the Emory University Center for Rehabilitation Medicine in Atlanta, Ga., led by co-principal investigator Steven Wolf. USC will serve as the primary project site and data management center.

I-CARE will also involve five Southern California physical rehabilitation sites: Cedars-Sinai Medical Center in Los Angeles, Casa Colina Centers for Rehabilitation in Pomona, Huntington Rehabilitation Medicine Associates in Pasadena, Long Beach Memorial Medical Center in Long Beach and Rancho Los Amigos National Rehabilitation Center in Downey.

The extensive study is expected to generate a wealth of useful data about stroke rehabilitation that “could find use in trials of current and future experimental interventions such as pharmacological agents, gene therapy, stem cell implants and robot-assisted and direct cortical stimulation programs,” Winstein says.

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Source: Angelica Urquijo

University of Southern California

The Magstim Transcranial Magnetic Stimulation (TMS) Summer School 2008 presented pioneering research on the theme of Plasticity and Rehabilitation, when it was held at the Institute of Child Health in London on 30th and 31st May.

Researchers in TMS are exploring the ways in which magnetic stimulation can be utilized in the diagnosis and treatment of a number of neurological conditions.

The Summer School, organised in collaboration with Professor Vincent Walsh of the Institute of Cognitive Neuroscience, University College London (UCL), was attended by over 300 registered delegates. The two-day scientific programme saw presentations from 16 eminent international academics and researchers, and there was an opportunity for the upcoming generation of researchers to pose questions to some of the most prominent pioneers in the field.

The event was sponsored by Magstim, specialists in the field of neuromodulation and nerve monitoring, and included an exhibit by “Magstim Innovations”, a team involved in advance product development.

Magstim also launched its new tDCS (Transcranial Direct Current Stimulation) device at the event, and previewed new equipment that will be introduced in the coming months.

As part of an ongoing commitment to research, Magstim sponsored two academic prizes at the event. Dr. Marco Davare of UCL won the Magstim Young Investigator Award 2008 for his research into how the brain precisely controls hand movements. The Poster Prize was won by PhD student Niamh Kennedy of Queen’s University Belfast for her work on the effect of simultaneous contractions of ipsilateral muscles on changes in corticospinal excitability induced by paired associative stimulation. Both prizes were judged by a panel of leading experts connected with the Summer School, with Dr. Davare and Ms Kennedy winning ВЈ500 and ВЈ250 respectively.

“The TMS Summer School was a great opportunity to learn the very new techniques for stimulating the brain. It is also an important place in which we can meet and discuss with people directly involved in the same research field,” commented Dr Marco Davare after being awarded. “It is also a way for us ‘young scientists’ to be better known by the research community.”

About Magstim

Magstim provides clinicians and researchers with state-of-the-art stimulation and monitoring equipment to facilitate the assessment, protection and improvement in function of the human nervous system, with our expertise focused on applications related to magnetic neurological stimulation and intra-operative nerve monitoring.

Magstim has a reputation for the development, manufacture and distribution of electronic medical devices and has long standing contacts with key opinion leaders within the academic sector. The company has expert knowledge of research techniques; electronics design and production; mechanical design and production, assembly, marketing and sales distribution networks.

Magstim

Only 40 per cent of patients with a fragility fracture are aware of their osteoporosis risk – a level that is likely to remain a barrier to patients seeking medical review and managing their risk, according to research published in the Medical Journal of Australia.

Dr Charles Inderjeeth, Geriatrician and Rheumatologist at the North Metropolitan Area
Health Service, Perth, and co-authors implemented and evaluated a multimodal intervention
to improve osteoporosis treatment in patients discharged from an emergency department
(ED) after presentation with a fragility fracture.

Dr Inderjeeth said that, after implementation of the intervention, the rate of bone mineral
densitometry investigations improved from three per cent to 45 per cent, the number of
patients receiving calcium and vitamin D supplementation increased from 12 per cent to 33
per cent and from 12 per cent to 37 per cent, respectively, and initiation of specific
osteoporosis treatments increased from six per cent to 30 per cent.

But despite improvements in these outcome measures, Dr Inderjeeth said that only a minority
of patients were aware of osteoporosis, although most GPs and hospital clinicians accepted
that it was their responsibility to assess and treat their patients and inform them of their
osteoporosis risk.

“The persistent low level of awareness of osteoporosis remains a significant concern and is
likely to remain a barrier to patients seeking medical review and accepting and complying
with preventive treatment,” he said.

“Most ED and orthopaedic clinicians in our institution claimed that time and resources were
the main barriers to improving the quality of osteoporosis care in their settings.

“It is possible that the ED may not be the best setting for giving patients educational
information about fracture prevention and osteoporosis, given that they are preoccupied at the
time with more acute issues of pain, comorbidity and anxiety in an overwhelming
environment.”

Dr Inderjeeth said that 84 per cent of patients referred to the Fragile Bone Clinic presented
for osteoporosis review at the clinic after being contacted by a fracture liaison nurse.

This suggests that a multimodal strategy involving a dedicated fracture liaison nurse may
offer the greatest potential for improving education and patient follow-up and treatment.

The Medical Journal of Australia is a publication of the Australian Medical Association.

Source:
Dr Charles Inderjeeth
Australian Medical Association

The aging process often forces older adults to give up things they value and enjoy, including their independence and the ability to exercise and participate in physical activities. Researchers at the University of Missouri Center for Eldercare and Rehabilitation Technology (CERT) are working to help older adults live better lives by developing and evaluating motion-capture technology that monitors the physical functioning of older adults while preserving their privacy.

“Frequent assessment of physical function is a key indicator for detecting initial decline of health in older adults,” said Marge Skubic, director of CERT and associate professor of electrical and computer engineering in the MU College of Engineering. “The technology we are developing will help health care providers identify potential health problems, which provides a window of opportunity for interventions and treatments to alleviate the problems before they become worse.”

Skubic recently received a $900,000 grant from the National Science Foundation to work with an interdisciplinary team of researchers at MU and the University of Washington to advance CERT’s current projects, which include an exercise feedback system and a fall recognition system.

Using existing motion capture methods, CERT researchers developed an exercise feedback system to increase exercise effectiveness and safety for older adults. The automated system uses standard Web cams to capture the silhouette sequences of participants while they exercise, and provides feedback about posture and gait, including stride, balance and body position.

“This information will help older adults understand more about their posture and movement during exercise, and lead to improved effectiveness and safety of exercise regimens,” said Greg Alexander, assistant professor in the MU Sinclair School of Nursing and lead researcher of the project.

In another project, CERT’s researchers completed an evaluation of a video-based fall recognition system for elders. The system preserves privacy by extracting silhouettes acquired from multiple cameras viewing the same scene. The silhouettes are used to build a 3-D object, and the object’s activity is analyzed by the system. The system generates summaries and distinguishes between fall and non-fall activities.

Using the results of these projects, the researchers will study vision-based detection methods designed to capture continuous and automated assessments of older adults’ physical functioning in multiple-person environments.

The studies, “Markerless Human Motion Capture-Based Exercise Feedback System to Increase Efficacy and Safety of Elder Exercise Routines,” (Alexander GL, Havens TC, Skubic M, Rantz M, Keller JM, and Abbott C ) and “Evaluation of a Video Based Fall Recognition System for Elders Using Voxel Space,” (Anderson D, Luke R, Skubic M, Keller JM, Rantz M, and Aud M) were presented at the 6th International Conference of the International Society for Gerontechnology in Pisa, Italy, June 4-7, 2008.

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Source: Emily Smith

University of Missouri-Columbia

The Child Nutrition and WIC Reauthorization Act, 2004, requires that all school districts have a Wellness Policy if they participate in federal school meal programs. As part of the Wellness Policy, schools are mandated to include nutrition education activities which promote student wellness. A study in the July/August issue of the Journal of Nutrition Education and Behavior evaluates elementary teachers’ overall acceptance and implementation of nutrition competencies in the classroom as part of their School Wellness Policy.

Earlier studies have reported that the majority of school wellness policies include written goals for nutrition education. In the new study, researchers at The University of Mississippi begin development of an instrument to identify the extent of implementation and/or compliance with nutrition education goals. To measure this, Lewin’s Organizational Change Model was used to determine elementary school teachers’ progression as it relates to the School Wellness Policy. By using this Model, researchers were able to develop an online survey to evaluate whether teachers were in one of the following stages: unfreezing (individuals become dissatisfied with the status quo and believe that change is needed), moving (change comes when individuals have input, allowing them to take ownership), or refreezing (change is complete and has become standard organizational protocol and/or culture).

To ensure that teachers were informed about their School Wellness Policy, only those who answered “Yes” to two items, ”My school has a School Wellness Policy” and ”I am informed and understand the School Wellness Policy in my school,” were included. Of the 321 Mississippi teachers surveyed, only 69% (221 teachers) of the teachers’ answered “Yes”, allowing the researchers to evaluate their stage for implementing change in nutrition education. However, of the 221 teachers informed of the School Wellness Policy, 86% supported it and 81% believed it will allow students’ opportunities to practice healthful living (unfreezing stage).

Involvement and commitment to a project plays a large role when determining whether teachers are in the moving stage. This study found that 58% of the teachers surveyed thought they did not have adequate classroom time to include nutrition competencies and only 26% thought they would be given time to attend an in-service on strategies to incorporating nutrition education into their lessons. When determining if nutrition education can become a standard of practice for teachers (refreezing stage), the researchers found that the majority of teachers (64%) thought they had the skills to incorporate it into their curriculum, however, fewer than one third of teachers (30%) are actually including nutrition competencies into their lesson plans.

So what seems to be the problem? The researchers found that teachers feel little involvement in implementation of the school wellness policies and therefore “teachers may not view inclusion of nutrition competencies into classroom instruction as a part of the SWP [School Wellness Policy]. A lack of involvement in the SWP development may have led teachers to believe that the role of implementing it is not their responsibility but that of other school staff such as physical education instructors, school nurses, and school food-service staff” says lead author Dr. Laurel Lambert, Associate Professor of Dietetics and Nutrition, University of Mississippi.

Successful implementation of new policies cannot and should not be the sole responsibility of school administration. New policies must also have the support of a well-rounded team which includes teachers (including physical education), food-service employees, and school nurses. This study documents that teachers need to participate in the development and implementation of School Wellness Policies in order to move out of the unfreezing stage (and out of the “Ice Age”).

Within the article, the researchers give recommendations that could support teachers’ progression out of the moving and into the refreezing stage. The recommendations to incorporate nutrition competencies into the classroom include, ” Involve[ing] teachers in the development of an evaluation tool that can be used to assess how the nutrition competencies are being presented in the classroom. Use results obtained with this tool to recognize those teachers who have demonstrated effective ways to incorporate nutrition competencies within limited classroom time. Inform[ing] teachers of the numerous resources, including credible Internet links that provide nutrition education information and classroom materials. Many resources are available at minimal or no cost from federal government agencies, state extension services, and nonprofit health organizations. Conduct[ing] specific focused in-services on strategies for incorporating state-mandated nutrition competencies into lesson plans. Require addressing nutrition competencies in terms of time (minutes) for scheduled classroom instruction… Create a nutrition education coordinator position within the Mississippi Department of Education [recommendations could be used in other states] to assist school districts on current and effective practices for implementation of nutrition education programs.”

The article is “Mississippi Elementary School Teachers’ Perspectives on Providing Nutrition Competencies under the Framework of Their School Wellness Policy” by Laurel G. Lambert, PhD, RD, LD; Ann Monroe, EdD; Lori Wolff, PhD, JD. It appears in the Journal of Nutrition Education and Behavior, Volume 42, Issue 4 (July/August 2010) published by Elsevier.

Source:
Lynelle Korte
Elsevier Health Sciences

Rehabilitation is essential for patients with disabling symptoms of dizziness, vertigo, and unsteadiness caused by disorders of the vestibular system. A special issue of The Journal of Neurologic Physical Therapy (JNPT) presents an update on new and emerging vestibular rehabilitation techniques, highlighting the physical therapist’s role on the multidisciplinary teams providing patient care and research. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

The special issue provides physical therapists and other professionals with an update on new developments in vestibular rehabilitation. “We hope that this Special Issue will help clinicians explore some new innovations and discoveries in physical therapist examination and treatment of persons with vestibular disorders,” according to guest editors Michael C., Schubert, P.T., Ph.D., and Susan L. Whitney, P.T., Ph.D. “This issue of JNPT is unique,” commented Special Issue Editor Kathleen M. Gill-Body, DPT, PT, NCS who also serves as an Associate Editor of JNPT. “Emerging data is reported for specific components of vestibular rehabilitation, and for some specialized patient populations, reflecting the more sophisticated research questions that are being asked now that the overall efficacy of vestibular rehabilitation has been established by prior studies. What was particularly exciting to me was to see preliminary data reported by several authors, and to review the authors’ interpretation of the meaning and clinical relevance of their findings.”

New Technologies and Emerging Techniques for Vestibular Rehabilitation

The supplement includes nine research papers and reviews, authored by an invited panel of international experts at the forefront of research and practice in vestibular rehabilitation. “The topics covered are diverse and so is the authors’ expertise,” Drs. Schubert and Whitney write. “The authors include physical therapists, engineers, and physicians who work to enhance the care of persons with vestibular disorders.”

The original mainstay of treatment for people with vestibular disorders was developed in the 1950s and included a set of simple, progressive exercises called Cawthorne-Cooksey exercises designed to manage dizziness and improve balance following damage to the inner ear. More recently, techniques have been developed to address specific problems with gaze and postural instability, motion sensitivity, and vertigo in patients with a variety of different vestibular disorders such as benign paroxysmal positional vertigo, Meniere’s disease, brain injury, and others.

Several papers report on the use of advanced technologies, such as a “balance vest” that provides patients with vibrotactile feedback to help them relearn balance function. Other topics include computerized techniques to help restore steady vision during head movements (gaze stability) and to document improvements in the ability to focus on tasks in the presence of distractions (perceptual and motor inhibition).

One study uses a device similar to a mirrored “disco ball” to provide optokinetic stimulation for patients with vestibular disorders. All of these techniques “involve some degree of innovative technology to assess treatment effectiveness, measurement of vestibular function, or reveal behavior in people with vestibular dysfunction,” Drs. Schubert and Ryan write.

Physical Therapists Play Key Roles in Research and Treatment

Other articles in the special issue document the benefits of vestibular rehabilitation for specific groups of patients. One study shows that gaze stability exercises can reduce the risk of falling in older adults with vestibular disorders. Another paper is one of the first reports on the effectiveness of vestibular rehabilitation on vestibular-visual-cognitive function following blast-induced head trauma sustained by soldiers in Iraq or Afghanistan.

Similarly, a third study reports improvements in dizziness, walking and balance after participation in a customized vestibular physical therapy program in children and adults with concussion. Other articles included in the special issue evaluate the comparative benefits of different types of vestibular rehabilitation exercises (habituation exercises versus gaze stability exercises) to reduce dizziness and improve gaze stability, as well as the influence of damage to the otolith organs of the inner ear on outcomes following vestibular rehabilitation. Such studies are essential to document the effectiveness of specific rehabilitation techniques for specific groups of patients with different types of vestibular disorders.

Physical therapists play a central role in vestibular rehabilitation not only as care providers, but also in helping to advance new research in the field. The next wave of vestibular rehabilitation approaches could include virtual reality feedback and training, vestibular prostheses (implants), and even stem cell techniques, according to Drs. Schubert and Whitney. They encourage physical therapists to collaborate with researchers in evaluating these new techniques as well as in pointing out patient problems in need of new rehabilitation approaches and helping to maximize the value of new technologies.

Source: Wolters Kluwer Health

Many Americans, even Medicare beneficiaries, may not be aware that Congress is working hard on revisions to the Medicare law. It’s a tough job and a huge challenge to assure that this is done fairly in its impact on patients. While the major impetus is to try to avoid an across-the-board cut to Medicare physician fee payments slated to take effect as of July 1, among the other proposals being considered is the possibility of delaying Medicare’s ongoing process to implement a competitive bidding program for durable medical equipment (DME). Under the Congressional rules, all costs to Medicare involved in delaying competitive bidding on the selling of medical equipment like hospital beds, wheelchairs, and oxygen, will have to come from elsewhere in the Medicare system. A spokesperson for DME suggested in Congressional testimony that there be a broad cut to the Medicare DME fee schedule to pay for the delay on competitive bidding – in essence that DME suppliers, being those who will benefit from the delay in competitive bidding, ought to be the ones to pay for it.

Recently, however, the discussions have taken an alarming turn. DME suppliers are the only ones who would benefit from a delay in competitive bidding, but some are suggesting that other Medicare suppliers should help cover the costs through reductions in their fee schedule, including the orthotic and prosthetic (O&P) field. The consequence of such a proposal would mean fee cuts to patient care facilities that provide care to America’s amputees and other disabled individuals. This has prompted grave concerns about access to those O&P facilities providing care and restoring mobility to these patients, many of whom are Medicare beneficiaries.

“Americans have been heartened to see that veterans returning from Iraq and Afghanistan are benefiting from the tremendous improvements that are now available for those who have lost a limb, or have impaired mobility due to limb injuries,” said Brad Ruhl, President of the American Orthotic and Prosthetic Association. “This proposed change is incomprehensible… prosthetics and orthotics are NOT included in competitive bidding, and it would be profoundly unfair for Congress to pay for a delay in competitive bidding by reducing Medicare payments to amputees and other disabled seniors, including disabled veterans and disabled children who are well-served under the current O&P fee schedule.”**

Ironically, this week hundreds of amputees converge on Washington for an annual legislative day conducted by the Amputee Coalition of America (ACA), and plan to ask members of Congress to enact a prosthetic parity bill to assure that all insurers provide the identical coverage for amputee care that is provided for all other medical and surgical conditions. Some insurers have limited coverage to one replacement limb per life, or very meager amounts on how much they will spend for replacement limbs. It is an anomaly to have some in Congress talking about balancing the budget for what they wish to do to help DME, on the backs of these amputees.

“Orthotics and prosthetics have already gotten the short end in prior fee cuts and freezes, so we have lost significant ground to inflation in recent years,” says James Kaiser, CP, LP, of Scheck and Siress, a chain of prosthetic and orthotic patient care facilities in the Midwest. “If there is a new round of Medicare cuts to help pay for this totally unrelated DME competitive bidding delay, the approximately 20% of O&P patient care facilities that are already on the edge will close, severely damaging patient access and choice, and assuring longer delays for these Medicare amputees and other disabled patients at the fewer, more crowded facilities that would remain open to serve them.”

AOPA, based in Alexandria, Virginia, is the largest non-profit organization dedicated to helping orthotic and prosthetic businesses and professionals navigate the multitude of issues surrounding the delivery of quality patient care. The association was founded when needs of returning veterans in the aftermath of World War I required a national organization to address the educational and research requirements of the industry.

**This refers to veterans with non-service connected injuries who are covered by Medicare and disabled children covered under Medicare and Medicaid. In addition, it would affect all private managed care contracts that pay based upon a percentage of the Medicare fee schedule.

American Orthotic and Prosthetic Association (AOPA)

Hand therapy is one of the most vital treatment steps in recovery from hand injury surgery, according to a literature review published in the August 2010 issue of The Journal of the American Academy of Orthopaedic Surgeons (JAAOS). In fact, many patients spend more time with the hand therapist than the orthopaedic surgeon in the effort to ensure the best results and long-term recovery.

“Hand therapy is the critical link between certain surgeries on the hand and a good outcome,” said Erik Dorf, M.D., an orthopaedic surgeon and upper extremity specialist at Vail Summit Orthopaedics in Vail, and Frisco, Colorado, and a co-author of the review. “Collaboration and cooperation between the patient, the therapist, and the orthopaedic surgeon is critical.”

Dr. Dorf added that not all hand injuries need surgery or intense therapy; but typically, injuries like tendon lacerations, or hand, wrist or finger fractures have a better long-term recovery following hand therapy.

The review found that hand therapy addresses important factors in any hand injury recovery. Some include:
swelling control;
wound management;
range of motion;
strengthening of the hand;
and work conditioning.

These goals are not necessarily sequential; some factors may be addressed simultaneously, depending on the injury and treatment plan. In addition, treatment may also include some combination of splinting, taping, or wrapping the hand to provide support and/or prevent swelling.

To ensure the best result after a hand injury, Dr. Dorf recommends finding a therapist who is both qualified and convenient. It is important for both the patient and treating physician to be confident in the therapist. After a qualified therapist has been agreed upon, the patient should participate in a structured therapy program and perform at-home exercises as instructed.

“If therapy is not part of the overall treatment plan, the long-term consequences can include ongoing pain, decreased range of motion, decreased strength, and difficulty with fine motor tasks,” added Dr. Dorf. “The activities of daily life can become very difficult.”

The article describes different modalities used by hand therapists to improve results, including:
Fluidotherapy (a dry heat treatment that helps range of motion)
Paraffin therapy (a warm paraffin wax bath that helps range of motion)
Cryotherapy (application of cold water to reduce swelling)
Various modes of electrical stimulation (to decrease fluid in the hand and accelerate wound healing)
Phonophoresis and iontophoresis (instillation of low dose medications into the tissues of the hand using an electrical charge or ultrasound).

Dr. Dorf also notes that persistence is important. “People want to get better quickly, but recovery from hand injuries and subsequent surgery can take a long time. Working with a hand therapist encourages patients to get involved in their own recovery by enabling them to follow the small but significant changes that occur over time.”

Source:
Lauren Pearson
American Academy of Orthopaedic Surgeons

Secretary of Health and Human Services Kathleen Sebelius launched the Let’s Move Cities and Towns component of the Let’s Move! campaign at the U.S. Conference of Mayors Annual Meeting in Oklahoma City, OK. Addressing an audience of more than 400 mayors and municipal staffs, Secretary Sebelius encouraged local officials to adopt a long-term, sustainable and holistic approach to fight child obesity in their communities.

Let’s Move Cities and Towns reaffirms the commitment First Lady Michelle Obama made to the U.S. Conference of Mayors in January to work in partnership with local leaders to tackle the challenge of child obesity.

“You occupy a unique position in your community,” the First Lady told the Conference of Mayors via video. “You can bring communities together around great challenges, you know how to develop effective solutions, and you can spur action at the grassroots unlike anyone else.”

Let’s Move Cities and Let’s Move Towns asks local communities support the Let’s Move Initiative and its four pillars: helping parents make healthy choices, creating healthy schools, providing access to healthy and affordable food, and promoting physical activity.

“Mayors and local leaders are critical to the Let’s Move! campaign” said Secretary Sebelius. “We recognize that every community is different, and every town requires a distinct approach. We designed Let’s Move Cities and Towns to empower local leaders to take steps that will have a real impact on their own unique communities, whether that’s building sidewalks and parks, supporting local farmers markets or bringing healthier food into schools.”

Over the past three decades, childhood obesity rates in America have tripled, and today, nearly one in three children in America are overweight or obese. The First Lady launched the Let’s Move! campaign in February to solve the problem of childhood obesity within a generation.

Source
HHS