Human Performance and Rehabilitation Centers, Inc.

Speech Therapy After Stroke

Stroke Overview

Strokes are caused either by a blockage of the blood vessels in the brain or by bleeding in or around the brain, and they can happen to anyone of any age at any time. Patients have the best shot at recovering from the effects of a stroke when they are evaluated quickly and thoroughly by a team of medical professionals, including a Speech-Language Pathologist (SLP). A stroke can cause cognitive communication and swallowing deficits, and an SLP will diagnose and treat these specific conditions.

Speech Therapy After Stroke

An SLP creates a tailored treatment plan for each patient that focuses on improving the skills that the stroke has diminished. The brain is organized such that an injury to one side of the brain affects the opposite side of the body. Depending on what areas are affected, an SLP will deploy certain therapies and strategies. The SLP’s goal is to:

    • Improve the patient’s ability to understand and/or produce language;
    • Improve speech production if there is difficulty due to weakness or motor planning;
    • Determine whether there is a need for an alternative/augmentative device to supplement a patient’s verbal communication;
    • Increase awareness of deficits in order to help self-monitoring in the hospital, home and community;
    • Implement compensatory strategies or modify the patients work/school environment to meet their needs;
    • Make recommendations that involve positioning issues, feeding techniques, specific therapeutic techniques and diet consistency changes; and,
    • Educate the patient, their family members or caregivers about the therapy path forward.

The recovery and rehabilitation process is different for each patient. An SLP will work with a team of other health care professionals to help a patient transition back into the community and to reclaim the skills to live as independently as possible. Everyone’s common goal should be restoring a patient’s quality of life.

Remember, there is life after stroke, and early therapy increases the chance that life will be as fulfilling as possible.

Additional resources:

National Stroke Association – www.stroke.org
American Speech Language Hearing Association (ASHA) – www.asha.org
National Institute of Health – www.stroke.nih.gov

As the World Turns: Using Therapy to Resolve Vertigo

Overview

The sensation of spinning, or vertigo, can be a common problem especially among older adults. Vertigo is usually a condition called Benign Paroxysmal Positional Vertigo, (BPPV), an inner ear malfunction treated in a therapy setting. Vertigo is not detected in an MRI.

BPPV, the most common form of vertigo, is a mechanical failure of the inner ear. Calcium carbonate crystals (otoconia) that are embedded in a part of the ear called the utricle dislodge and float to places where they cause problems. When enough of these crystals settle in the fluid of the ear canals, they trick the brain into thinking the head is moving when it isn’t. That’s where the sensation of spinning comes from.

Treating Vertigo

Our first step is to determine if a patient has BPPV. We do this by performing a Dix-Hallpike Test in which we ask the patient to lie in a supine position while we carefully roll the head until it triggers vertigo. If a patient has BPPV, a bout of vertigo will create a detectable “error message” in the eye movement. Both eyes will turn rapidly in a torsional fashion which also intensifies the sensation of spinning.

Ultimately, the eye movements are the key to a BPPV diagnosis and helps us pinpoint exactly where the crystals have migrated. Our next step is to gently maneuver the head using specific protocols. Your therapist should be well-trained in this intervention, which uses gravity to naturally guide the crystals from their offending location back to the utricle. The most common type of maneuver is called an Epley Maneuver, and it can take less than five minutes to perform. Many patients will feel instant relief, and others will see progress in a day or two.

Patients who suffer from BPPV have often spent months or years trying to get a clear diagnosis. Seeing a therapist first can bring an end to both frustration and discomfort.

Front of knee pain: How to treat Patellofemoral Pain Syndrome

If you’ve experienced pain in the front of your knee around the kneecap, it’s probably a condition called Patellofemoral Pain Syndrome. Known also as “runner’s knee” or “jumper’s knee,” this condition can occur at any age, but it’s most common in teenagers, young adults, athletes and those who have recently hit puberty.

Patellofemoral Pain Syndrome is typically not caused by trauma; instead, it can seem to just appear. Because no single incident is the culprit, a person experiencing it may be inclined to work through the pain, or keep participating in sports or activities. When the pain doesn’t resolve, and, in fact, it gets worse, everyday knee flexion and extension can become intolerable.

Younger athletes are particularly vulnerable to Patellofemoral Pain Syndrome. During puberty, a young person’s bones grow fast –  outpacing the growth rate of ligaments, tendons and muscles and putting more stress on the joints. In addition, females have wider hips compared to their male counterparts and this can change the alignment of the knee and impact the patella’s movement in the trochlear groove. Athletes who engage in running, soccer, volleyball, cheerleading and dancing could experience this kind of knee pain.

Other causes for Patellofemoral Pain Syndrome include muscle weakness, stiffness, fatigue, improper shoe wear and poor movement patterns. Other contributing factors include overtraining or poor training techniques. And, prolonged sitting behind a desk during the week coupled with extreme “weekend warrior” activities can create an opening for Patellofemoral Pain Syndrome.

Patients should avoid irritable activities and apply ice two-to-three times daily to decrease inflammation. Physical therapy plays a big part in getting back to normal. In PT sessions, we work with patients on improving flexibility, stretching the hamstrings and strengthening the quads and hips by using very specific exercises. I usually like to see patients with this condition twice a week for four to six weeks.

Because of the multitude of contributing factors for each individual experiencing Patellofemoral Pain Syndrome, it’s important to let an experienced PT evaluate your case and develop a therapy plan that fits.

Achilles Tendon Injury

The Achilles tendon is an essential part of daily life. Spanning from your heel bone to your calf muscle, this band of tissue allows you to participate in everything from competitive sports to recreational activities, or just simply getting around. While the Achilles is the strongest and thickest tendon in the body, it can also be vulnerable to injury.

How Achilles tendon injuries happen

Athletes certainly experience their fair share of Achilles tendon injuries, but so can the average person. A variety of issues can cause the tendon to partially tear or even rupture. These include an abrupt and incorrect stepping down movement, wearing high-heeled shoes over the long-term, contact injuries or overuse. A tear can occur anywhere along the tendon from the heel to the calf. Injuries are more common in middle-aged individuals, and generally effect men more often than women.

How to recognize a tear

Partial tears, which are vertically or horizontally oriented along the tendon, are much more common than ruptures, or complete tears. You can usually feel a tear when it happens. It will cause the area around the Achilles to feel sore, tender and it may cause swelling. When a patient experiences a complete tear, normal walking is instantly compromised since the tendon is severed and essentially rolls up like a Roman shade. A rupture will require surgery and follow-up physical therapy.

Treating a partial tear or a post-op rupture

A full recovery from an Achilles injury demands patience. Rest is key. If surgery is not indicated, some patients benefit from wearing a boot to keep the tendon in a neutral position. If surgery is indicated, the patient will be referred to physical therapy typically around the 6th post-operative week, but will remain in a boot until 12 weeks post-op, on average.

During therapy sessions, a PT will manually stretch the tendon to bolster blood flow and to improve the relationship between the tendon and the heel bone and/or the calf muscle. The PT will also issue home exercises to encourage healing while minimizing inflammation. When the patient is ready, the PT will introduce gentle exercises like seated calf raises and exercises using therapy bands to increase blood flow. Next, the therapist will guide the patient through a progression of walking activities and dynamic stretching like lunges and standing calf raises with the goal of an eventual return to the individual’s desired level of activity. Another important part of therapy is restoring – or improving – a patient’s sense of balance, so a therapist may also deploy exercises that improve biomechanics. As the patient builds strength and flexibility, it will be possible to once again run and jump.

Continued maintenance

A home exercise program is a key part of helping a torn Achilles tendon heal throughout therapy. Wearing proper footwear is also important. While active adults are always eager to jump back into their former routines, it’s crucial that they practice patience and allow the Achilles tendon to heal fully to prevent re-injury.

Cupping and Taping: Not Just for Elite Athletes

The 2016 Summer Olympics in Rio made folks aware of a couple of different physical therapy techniques popular among elite athletes. Remember the round bruises around the shoulders of five-time Olympian Michael Phelps? Those were from a process called “cupping.” And beach volleyball guru Kerri Walsh Jennings routinely competed with a pattern of tape on her shoulder. Not just for elite athletes, cupping and kinesio-taping are effective strategies for everyday PT patients experiencing a range of issues. Here’s what you need to know.

Cupping

This is an aggressive manual therapy technique meant to enhance range of motion and optimize muscle function. A physical therapist places a special plastic suction cup on the surface of the skin to effectively pull skin and fascial tissue away from the muscle. This releases adhesions that may have formed from a collagen fiber build-up. Over years of use and stress, a patient can develop scar tissue and adhesions within the muscle that limit range of motion, making the muscle feel tight and sometimes causing pain.

Cups come in different sizes for use on different areas of the body. A therapist will identify the proper placement of the cup by examining the skin for tautness and testing the muscle’s range of motion. While the process leaves a circular bruise, it actually invites more blood flow to the area and helps trigger healing. Avoid any kind of cupping that also includes skin laceration techniques because this can introduce infection. Cupping should not be used on patients with blood clots or those taking blood thinners.

Taping

The kind of tape you’ve seen on elite athletes is different from the common tape or bandage that holds a sprained ankle in place. Instead, this is a special type of stretchy tape meant to promote muscle function and guide the muscle into proper movement. A physical therapist places the tape in a deliberate pattern. As it guides the joint through motion, it sparks kinesthetic and proprioceptive feedback. In other words, it’s coaxing better function out of a muscle or joint because it’s showing it how to move correctly. This provides stability and helps prevent injury or re-injury. It also helps teach the muscles to contract properly.

Because they both show good results, cupping and taping are becoming popular therapy techniques for treating everyday patients.

My aching back: Using physical therapy to address low back pain

If you’ve experienced low back pain, you’re not alone. According to the National Institute of Neurological Disorders and Strokes, about 80% of American adults – both men and women – will experience low back pain at some point in their lives. For many patients, physical therapy is an effective tool in improving low back pain and restoring strength and function.

The low back, or lumbar region, is an incredibly important part of the body. Comprised of five vertebrae, the low back supports the weight of the upper body as we go about our daily lives. Multiple components have to work together for the low back to function properly. Soft cushions or discs between the vertebrae act like shock absorbers as we walk, lift, run and jump. Ligaments hold the vertebrae in place. Tendons attach the muscles to the spinal column. Finally, dozens of pairs of nerves are embedded in the spinal cord. Each of these parts works in tandem, so when something is compromised, we feel pain.

No two patients experiencing lower back pain are built exactly the same, which is why a physical therapy setting can be so effective in addressing a patient’s issues and body mechanics. Our goal is to restore normal physiological motion in the low back through tested hands-on therapy techniques that zero in on each joint. In many cases, this mechanical approach is a much more effective – and certainly less invasive – than surgery.

Some of the patients we see experience pain due to spinal stenosis, or the narrowing of spaces in the spine. This is usually caused by age, normal wear-and-tear or arthritis. As joints grow harder and more narrow over time, they can encroach on the nerves that are rooted there. When that happens, the nerves become compressed. We use techniques including traction modalities, manual therapy, joint manipulations and extension exercises both in the clinic and at home.  These therapies help give the nerves more room to function and can help reduce pain in our patients.

PT First: You can see a physical therapist without a doctor referral

Physical therapists are experts in movement, trained to eliminate pain through non-invasive, evidenced-based clinical approaches. For the growing number of Americans suffering from situational or chronic pain, the fastest road to recovery may be to see a physical therapist directly. All states offer some degree of direct access, meaning you don’t need a referral from your doctor to make an appointment. [read more]

Having direct access to a physical therapist is a game changer for many patients. It’s a trend that first began in 1957 but really caught fire around the late nineties. The level of direct access depends on state law, but it generally allows patients a greater degree of control in addressing injury recovery or pain. This streamlined experience is truly a progressive approach to health care. It can cut out wait time, unnecessary testing and long-term pain medication.

When a physical therapist sees any patient, he or she begins by performing a methodical one-on-one clinical evaluation. We listen carefully to our patient’s description of symptoms. We observe and measure their mobility and record their neuromuscular function. We diagnose the site of the pain as well as its underlying source.

Once we complete an evaluation of patients who come to us without a referral, one of three things will occur.

  1. Treatment begins immediately. We determine that physical therapy will achieve the desired results, and we proceed right away with a tailored treatment plan. The patient is instantly on the road to recovery without having to wait for further x-rays or MRIs.
  2. We refer the patient to a physician. If, after our clinical assessment, we determine the patient’s issue is not related to neuromuscular or musculoskeletal function, we recommend the patient see a doctor.
  3. We treat and refer. In some cases, we treat the patient using physical therapy techniques, and we also recommend they see their doctor to address an ancillary issue that is also present.

Physicians and hospitals will continue to be an important partner to physical therapists, but many patients can achieve their therapy and pain management goals far faster and cheaper by taking advantage of direct access and seeing their physical therapist first for aches, pains, injuries and other neuromuscular and musculoskeletal dysfunctions.

View American Physical Therapy Association Direct Access by State

 

Author:

Dr. Chris Wilson, PT, DPT, CHES
Director, Physical Therapy
HPRC, Mount Pleasant, South Carolina

Shoulder pain: Addressing rotator cuff issues early pays off

The shoulder is a key player in everyday life. When it’s not functioning properly you can feel pain while carrying out basic functions, including putting on a jacket, or reaching into the back seat of the car. These are hallmark signs of a rotator cuff issue. Untreated, this condition can become a much bigger problem.

The rotator cuff is the group of muscles and tendons that hold the shoulder joint in place and allow the arm and shoulder to move. Age, injury and overuse are all causes for rotator cuff disease. The muscles or tendons can become inflamed, frayed or torn resulting in pain and limited mobility and strength. If this sounds familiar, it’s important to be evaluated by your doctor early. Physical therapy is an effective way to improve low grade rotator cuff injury and avoid surgery.

When a patient comes in with a low-grade rotator cuff injury, we begin by using manual evaluation techniques on the shoulder joint to discover the level of strength and flexibility. There are four main muscles in the rotator cuff that act as a cohesive unit. When one is injured, others get out of balance. A patient has probably developed a habit of avoiding certain movements without even realizing it, while overcompensating with other muscles. Part of our strategy is to find out where these imbalances are so we can rebuild strength and flexibility in muscles experiencing pain or weakness.

Once we determine this, we can begin appropriate stretching and strengthening exercises. We also develop a tailored home program so that a patient can continue therapy daily. Multiple studies have shown that a quality home program is a big factor in helping patients achieve good results.

We educate patients thoroughly about the frequency and duration of the home exercises we want them to accomplish. We send home diagrams with written instructions and we can email videos of exercises to reinforce what we’ve done in the clinic. Usually, patients with low-grade rotator cuff injury see results in four to six weeks.

 

 

Untying the knot: Myofascial trigger point therapy an effective tool for resolving tension

We’ve all felt them — those tight spots in the neck, shoulders and back that make you feel sore and stiff. You might call them knots, but they’re referred to as myofascial trigger points, and they require a specific type of physical therapy. Performed correctly, myofascial trigger point therapy can help inactivate the trigger point, relax the hardened bands of muscle tissue, and restore strength and flexibility.

Normal muscle contractions operate through a series of events involving nerve conduction and the sliding of protein filaments (myosin and actin) that contract the muscle cells and change the length and shape of the muscle cells. The message to contract a muscle is relayed from the brain to the spinal cord and then out into the muscle cells. The muscle cell is composed of many fibers, fibrils and filaments. Trigger points form when the protein filaments are unable to slide past each other and allow the muscle to return to its normal resting length. These hardened bands can compress the underlying tissue, blood vessels and nerves, leading to pain, weakness, and stiffness

The weakness results because the muscle fibers are already too busy being knotted up they cannot overlap any further to generate more power.  A therapist with good palpation skills will palpate the body in search of the trigger point, based on the client’s complaints of pain reported in the initial exam. The tissue will feel like a hardened knot (rock) or taut band(rope). The spot will be painful on compression and can cause referred pain, or pain that shows up in the body in a distant location.

Trigger points are brought on by a number of factors. While they can be caused by injury or trauma, most often, they build gradually over time.

Culprits include:

  • Static postures, such as sitting behind a desk all day
  • Repetitive motion, including working behind a computer or on an assembly line
  • High velocity movements associated with sports like swimming, golf, tennis or baseball
  • Muscle overload or strain resulting from lifting something too heavy or an abrupt increase in exercise
  • “Weekend Warrior” activities or extreme exercise on weekends
  • Past sports injuries

A physical therapist trained in myofascial trigger point therapy will palpate the muscle until he or she locates the tight muscular band. The therapist should also use the location of the referred pain to help trace the origin, since the body contains a network of established referred pain patterns. Then, using a variety of manual therapy techniques, the therapist will help each trigger point release its contracted state. Dry needling (link to HPRC blog) may also be used to release the taut bands.

The length of time it takes to ease a trigger point depends on a number of factors. The therapist will address any factors (mechanical, medical, psychological) that led to the pain initially or are continuing to make the trigger points worse during the course of rehabilitation. Patients can continue the work we accomplish in therapy sessions through at home exercises, including applying pressure with tennis or racquet balls or Foam Rollers, and frequent stretching of the affected muscles following pressure release work.  Trigger points can be successfully resolved with adequate Myofascial release, proper stretching, muscular retraining and activity modification. It is wise to seek out a physical therapist who specializes in manual therapy, specifically Myofascial Release and/or dry needling techniques to help untie those knots.trigger-point-culprits

My aching back: Using physical therapy to address low back

If you’ve experienced low back pain, you’re not alone. According to the National Institute of Neurological Disorders and Strokes, about 80% of American adults – both men and women – will experience low back pain at some point in their lives. For many patients, physical therapy is an effective tool in improving low back pain and restoring strength and function.

The low back, or lumbar region, is an incredibly important part of the body. Comprised of five vertebrae, the low back supports the weight of the upper body as we go about our daily lives. Multiple components have to work together for the low back to function properly. Soft cushions or discs between the vertebrae act like shock absorbers as we walk, lift, run and jump. Ligaments hold the vertebrae in place. Tendons attach the muscles to the spinal column. Finally, dozens of pairs of nerves are embedded in the spinal cord. Each of these parts works in tandem, so when something is compromised, we feel pain.

No two patients experiencing lower back pain are the built exactly the same, which is why a physical therapy setting can be so effective in addressing a patient’s issues and body mechanics. Our goal is to restore normal physiological motion in the low back through tested hands-on therapy technques that zero in on each joint. In many cases, this mechanical approach is a much more effective – and certainly less invasive – than surgery.

Some of the patients we see experience pain due to spinal stenosis, or the narrowing of spaces in the spine. This is usually caused by age, normal wear-and-tear or arthritis. As joints harder and narrow over time, they can encroach on the nerves that are rooted there. When that happens, the nerves become compressed. We use techniques including traction modalities, manual therapy, joint manipulations and extension exercises both in the clinic and at home.  These therapies help give the nerves more room to function and can help reduce pain in our patients.

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