Human Performance and Rehabilitation Centers, Inc.

Parkinson’s Disease

Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.peerymoran

Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in the area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.
The specific group of symptoms that an individual experiences varies from person to person.

Primary motor (movement) signs of Parkinson’s disease include the following:
tremor of the hands, arms, legs, jaw and face
bradykinesia or slowness of movement
rigidity or stiffness of the limbs and trunk
postural instability or impaired balance and coordination

Each person with Parkinson’s will experience symptoms differently. For example, many people experience tremor as their primary symptom, while others may not have tremors, but may have problems with balance. Also, for some people the disease progresses quickly, and in others it does not. By definition, Parkinson’s is a progressive disease. Although some people with Parkinson’s only have symptoms on one side of the body for many years, eventually the symptoms begin on the other side. Symptoms on the other side of the body often do not become as severe as symptoms on the initial side.

The progression of Parkinson’s disease varies among different individuals. Parkinson’s is chronic and slowly progressive, meaning that symptoms continue and worsen over a period of years, but is not considered a fatal disease. Movement symptoms vary from person to person, and so does the rate at which they progress. Some are more bothersome than others depending on what a person normally does during the day. Some people with Parkinson’s live with mild symptoms for many years, whereas others develop movement difficulties more quickly.

Non-motor symptoms also are very individualized, and they affect most people with Parkinson’s at all stages of disease. Some people with Parkinson’s find that symptoms such as depression or fatigue interfere more with daily life than do problems with movement.

Since Parkinson’s disease (PD) is a chronic condition, it is important to develop and maintain a solid PD management plan. Research has shown that those who take an active role in their care see an improvement in their Parkinson’s symptoms.

Managing your care means not only finding the right doctor, but ensuring you are prepared for your visit and talking to your doctors about the right issues. It means, not just taking your medications, but keeping track of when you need to take them. People with Parkinson’s are best served by a multi-disciplinary approach that provides not only the expertise of a PD specialist, but also the help of a physical therapist, occupational therapist, speech therapist, nutritionist and social worker. Some people also require medical consultants in areas such as psychiatry and neurosurgery. It is important that these healthcare professionals are aware of each other and communicate regularly, and that they all know the full list of treatments and medications that each is prescribing.
Physical and Occupational therapy focus upon restoring the ability to move effectively and safely by instructing and facilitating normal movement patterns and providing safety education and adaptive equipment to facilitate a person’s ability to maximize independence with mobility, self-care and activities of daily living.

Speech therapy focuses upon restoring swallowing, speech and language production and understanding and cognitive (thinking/memory) functions.

National HelpLine:
Ask the experts at PDF your questions
Are you looking for a support group? Call us at (800) 457-6676 or email info@pdf.org to find a group in your area

The toll-free HelpLine/email service – staffed by a team of information specialists – can:
Answer your questions about Parkinson’s disease: symptoms, treatments, complementary and alternative therapies and the latest scientific studies reported by the media.

Identify financial, legal and other resources to help you live well with Parkinson’s.
Provide access to an interpreter for non-English speaking callers.

Knee Osteoarthritis

I was diagnosed with osteoarthritis in my knee. What caused this and how can physical therapy help me?

Knee osteoarthritis is a very common condition causing pain, stiffness, and limited mobility. It occurs when the cartilage or padding in a joint deteriorates and wears away. Arthritis is a degenerative condition and joint damage progresses or worsens over time. Arthritic joints can be quite painful, stiff, and sometimes swollen. Many people with osteoarthritis report that their knee is the most stiff in the morning.

There are a variety of factors which increase your risk of developing knee osteoarthritis. Arthritis is much more common in older adults. There is also a genetic component to developing arthritis, so you are more likely to develop arthritis if others in your family have it. People who are overweight are more susceptible to developing osteoarthritis and the joint damage can progress more quickly in heavy individuals. Also, if you have injured your knee in the past you are more likely to develop knee osteoarthritis as you age.

If you have the misfortune of developing painful knee arthritis, a physical therapist can evaluate you and develop an appropriate treatment program. Your physical therapist should assess your strength, range of motion, balance, and the alignment of your body while you move. People with arthritis often benefit from strengthening, stretching, and instruction on how to move correctly to minimize further joint wear and tear. As your strength, flexibility, and alignment improve, you should find that it is easier for you to walk, move around, and participate in your desired activities.

Congratulations to the 2014 George M. McCluskey, Jr. and Viney C. McCluskey Award Winners!

Congratulations to the 2014 George M. McCluskey, Jr. and Viney C. McCluskey Award Winners!
Jeffery Fraser, PT, MS, ECS, CNIM was the recipient of the George M. McCluskey, Jr. Award.
This award is given to one employee annually in recognition of their truly outstanding performance as it relates to the rehabilitation profession.
Candy McAllister was the recipient of the Viney C. McCluskey Award.
This award is given to one non-clinician employee annually in recognition of their truly outstanding support and contribution to the success of HPRC.
Congratulations to both of these very well deserved team members and all past recipients!
gmccluskey1

Temporomandibular Disorder (TMD)

It’s been a long day, the pounding of a headache I woke up with and a crazy schedule I’m ready to escape from. A great movie is on the television and a perfect night of relaxation is complete with a warm bag of popcorn. As I settle in and the movie begins, I take the highly anticipated first bite and… OUCH! What was that? It’s from my mouth but not a normal toothache. The pain in my face and jaw travels up to the temple and ear. My headache has not only returned, but intensified! I’m experiencing signs and symptoms of TMD, temporomandibular disorder. Can you relate? The National Institute of Dental and Craniofacial Research estimates over 10 million Americans are affected by TMD. This disorder impacts many within our own community and HPRC is here to help inform, educate and treat to restore a healthy and desired lifestyle.

Background: Anatomy and Function

Temporomandibular disorder involves the temporomandibular joint (TMJ) and/or the surrounding musculature. The TMJ is a hinge joint that connects the jaw to the skull, just in front of the ear on both sides of the head. Movement at the TMJ allows for up and down and side to side motions of the jaw for talking, chewing and yawning. The cervical spine and surrounding musculature influence the position and control of the joint.

What Are the Signs and Symptoms of TMD?

Common signs and symptoms are typically, but not limited to:

  • Pain in the jaw, face, temple region, neck, shoulder and/or ear at rest or during movement
  • Limited jaw motion opening, closing and/or side-to-side
  • A “stuck” or “locking” feeling in the jaw, “clicking” or “popping” when opening and closing the mouth that may or may not be painful
  • Headaches
  • Fatigue in the jaw, head and/or neck region.

These symptoms may be temporary, reoccurring or chronic.

What Causes TMD?

The exact cause of TMD is not clear, but clinicians do believe signs and symptoms arise from problems in the surrounding muscles, the joint itself, stiffness in the cervical spine and poor ergonomics/posture. A rapid onset may occur after an injury, such as a blunt force to the face or whiplash. Other contributing factors include:

  • Grinding/clinching at night
  • Osteoarthritis or rheumatoid arthritis in the TMJ
  • Dislocation of the disc in the TMJ
  • Work, home or emotional stress
  • Recent prolong and/or high-level dental work
  • Recent cervical injury or surgery
  • Diet (i.e., nuts, ice, tough meats)
  • Overuse/habits (i.e., bubble gum, biting nails, chewing the end of a pen/pencil)

Treatment Options

The most effective treatment for TMD typically involves a collaborative team effort between the patient, a physician or dentist and a physical therapist. As the patient, the following steps may be help in easing symptoms:

  • A soft diet
  • Ice applied outside (ice packs, frozen vegetables) and inside (popsicles, pieces of ice) the jaw
  • Avoid extreme jaw motions that hurt and/or create popping
  • Reduce stress and learn relaxation techniques
  • Keep your teeth slightly apart and jaw relaxed during daily activities

A physician or dentist will evaluate you for TMD, as well as for other possible issues in the teeth, jaw, head and neck. X-rays or an MRI may be performed if found necessary to further examine hard and soft tissues. Medication may be prescribed to help with inflammation. Dentist and oral surgeons can prescribe a helpful tool to reduce the effects of grinding at night called a night guard or splint. These custom made appliances prevent the upper and lower teeth from coming together while sleeping, thus reducing the grinding forces that contribute to TMD.

Physical therapists play a key role in the collaborative effort to get you back to a healthy, desired lifestyle. A licensed PT at HPRC will evaluate and treat all factors contributing to your TMD to reduce symptoms today and to prevent recurrences in the future. Treatments include:

  • Manual techniques (i.e., stretching, mobilizations and manipulation of the TMJ and cervical spine)
  • Exercise instruction (stretching and strengthening of the musculature surrounding the TMJ and cervical spine)
  • Patient education (detailed activity modifications, postural instruction and relaxation techniques)
  • Modalities that help reduce pain and improve tissue health.

 

Welcome Back Patrick!

HPRC, Inc. is having a good day.

Patrick Graham returns to work.
Patrick D. Graham, PT, MBA (pictured centered and seated), our President and COO, returned to work this morning after more than a year’s absence due to illness. Patrick is six months post liver transplant and is obviously doing remarkably well. His journey and story is one that miracles are made of. Needless to say, we are thrilled he has returned to us.

The past year has been challenging. Other than Patrick, HPRC lost two senior leaders and executives to retirement. Henry McRae and Joyce Duncan retired in June 2014 and February 2015, respectively, after remarkable careers and contributions to HPRC. Patrick’s return today marks a new beginning for our company, a new chapter.

As I reflect on the past year and what Patrick and the company have been through, I am reminded of several important lessons:

1) Failure is nothing to be feared. I don’t know who performed the first successful liver transplant, but I know one thing about them – they were not afraid to fail. You simply cannot achieve anything great in this life without failing first. As HPRC faces its future in the difficult landscape of healthcare, we must take strong and confident steps forward.

2) Live today. As I understand Patrick’s disease, the day he was born his liver began dying. He was destined to have a liver transplant at some point in his life. We often have our eyes focused so far in front of us that we forget to enjoy today. Our planning for tomorrow trumps the possibilities today offers. Patrick was born with a diseased liver, he was never promised a second one. He was fortunate. Enjoy the people in your life today.

3) Miracles happen. Patrick’s story is the story of a miracle. My theology is far too amateurish to explain his healing. I just know that legions of faithful people were prayerfully thinking of Patrick every day. His work is not complete.

Welcome back, Patrick Graham! Even in your absence, you taught us all.

Brian S. McCluskey, Ph.D.
Chairman/CEO
HPRC, Inc.

Student Blog

Upon entering the HPRC main office, I was bombarded with joy, excitement, and warmth, mostly my own, but I knew that I was in good hands. This is my first long-term rotation, building relationships with patients, seeing their growth, and facing their challenges. I have been nothing but thankful to my patients, my Clinical Instructor, and the organization for the experiences I’ve had thus far and those that are yet to come.

The training and education that I’ve received has proven to be valuable every day. I have been trained to view each person differently, evaluating their symptoms and impairments, and using the findings to reach their personal goals. Even after such a short period of time in clinic, I’ve grown to love this profession even more (which is reassuring after dedicating so many resources to my education).

So what makes a PT’s education and training unique? Physical therapy school is a professional program that focuses on human anatomy and ultimately how the body moves. We consider ourselves the experts in human movement, recognizing abnormalities that are either contributing to an injury or inhibiting a person’s function. This includes three years of continuous learning divided between the classroom and clinic. There, we are subjected to a combination of written and practical exams testing our knowledge and competency in skills. You grow to rely on your PT family, a group of adults gathered with the same passion of bettering people’s lives by utilizing our extensive knowledge of human anatomy, kinesiology, and proper motion.

It should also be known that all physical therapy students graduate with a DPT, or a doctorate of physical therapy degree. The emphasis on higher education has come to light by including differential diagnosis (acknowledging other causes with similar symptoms), pharmacology, among other courses. This is all in preparation of treating patients directly, without the gate of a physician. Every state has some form of direct access of offering services to patients. This assists in cost savings through the elimination of an extra co-payment.   In addition, direct access allows patients the opportunity to have an individualized exercise plan, addressing muscle imbalances, and to provide relief from injury.

While we like to think we are ready to practice right at the start of school, we need guidance and practice to develop our skills, exercise progressions, and patient handling skills. If you ever have the pleasure to work with a student, make sure to maintain open communication. If something is uncomfortable, doesn’t seem to be improving your overall function, or you have a question about your condition or therapy, express your concern. You will improve your therapy as well as future experiences for other patients who are too timid to express their concerns.

Just remember, you are helping to mold the newest member of the healthcare team. Every therapist has memories from their clinical experiences that will affect how they treat and in what specialty they will dedicate their time. Be patient and open. But, most importantly, be an advocate for yourself. This will lead to better overall care for our future patients.

 

Frozen Shoulder

I just found out that I have a frozen shoulder. My friend said that therapy for this is very painful. Is that true?brycegaunt

Frozen shoulder is a painful condition in which the shoulder loses the ability to move normally.  Often, patients’ shoulders can be painful at night and also hurt when reaching overhead, behind their back, or in other extremes of motion such as putting on a jacket.  Some therapists do take a “no pain, no gain approach”. However, at the St. Francis Rehabilitation Center, in helping patients with this condition, we prefer the slogan “you don’t get a sore thumb better by hitting it with a hammer”.  While you will need to do exercises that gently move the shoulder, we carefully choose exercises that are friendly to your shoulder and teach you to perform them in a very comfortable manner that is NOT painful.  This gradually improves the movement in your shoulder while decreasing pain and inflammation.  Frozen shoulder can typically get better with exercises done primarily at home – only a few visits to see a therapist are usually necessary.  This approach is supported by multiple studies published in medical journals demonstrating that home based comfortable stretching guided by skilled therapists provides superior results compared to highly painful stretching.

Balance

I’ve been sent to Physical Therapy to receive help with my balance. What do I need to know?JulieKing

Many times, doctors will send a patient to physical therapy if he/she has experienced a fall, been ill, or just felt unsteady while walking. There are several different components to increasing and maintaining balance and mobility.

When you arrive for your appointment, there will be paperwork to complete, most importantly a past medical history form, including a list of your medications. This information is needed to see if you have any conditions or take any medication that could contribute to your symptoms.

During the evaluation, the therapist will test the muscle strength in your legs and assess your balance. These tests are done in an effort to determine which system of balance needs to be addressed. There are three primary systems of balance: vestibular, visual, and proprioceptive. The vestibular system is located in your inner ear and is sensitive to head movements and can create dizziness if there is a dysfunction. The visual system plays a role in your balance by interpreting what you see and making adjustments to obstacles that are ahead, such as a curb. Proprioception is the feedback that you receive from your feet being in contact with a surface. This is important if you are walking on an unstable surface, such as grass or gravel. These three systems help maintain your balance, and your legs have to be strong enough to help hold you up!

The PT will analyze how you walk and determine if you need an assistive device, such as a cane or walker, for safety. Your balance may be tested by your performing tasks such as balancing on one leg and standing with your eyes closed and by performing tasks that involve putting your feet close together or in front of each other. Some of these tests may seem silly, but they give the therapist information about your ability to perform daily activities safely.

Often, your therapist will want to see you once or twice a week to work on increasing strength and balance. One thing to remember with balance is that repetition helps the body re-learn the correct way to perform daily activities. More than likely, the PT will send you home with exercises to perform on your own. Performing these exercises will help maintain your mobility and strength between PT visits. Working on balance is a time-consuming process; you will need to be patient with yourself as your symptoms improve. Most importantly, therapists want patients to remain safe with their mobility and prevent future falls. By improving strength and balance, you will be on the right track to stay injury free!

Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome (CTS)brooketeaster

By Brooke Teaster Schwoebel MHS, OTR/L, CHT

Do you wake up at night finding yourself having to shake out your hand because it falls asleep? Do your fingers go numb while you are typing at work? If you answer yes to either or both of these questions, you may have Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome is a condition in which the median nerve is compressed as it passes through an opening from the wrist to the hand called the carpal tunnel. It is formed by the carpal bones on the bottom of the wrist and a ligament structure on top (transverse carpal ligament) that runs across the wrist. The Median nerve, is just below this ligament, and provides sensory and motor functions to the thumb, index finger, middle finger and ½ of the ring finger.

Carpal Tunnel Syndrome is a repetitive use injury/Cumulative Trauma Disorder and can begin with numbness and tingling that comes and goes in above specific fingers; however, it can become constant, causing an increase in discomfort in the hand and even forearm. This can be caused from poor positioning while sleeping allowing wrist(s) to stay bent for long periods, using tools that vibrate for long periods of time, poor ergonomics while sitting and typing or even while standing at a work bench with repetitive use of hand(s). Other symptoms include weakness with gripping objects, dropping items with affected hand, swollen feeling in fingers, and/or awakening at night due to discomfort in thumb, index and middle fingers.

It’s important for you, with these symptoms, to seek medical attention quickly as compression on the nerve will continue and can eventually lead to nerve damage.

How to treat it?

Treatment will be based on your age, past medical history and the extent of the syndrome. To begin relieving compression on the nerve at the wrist and prevent wrist motion, wrist splints are beneficial to wear during the time the symptoms are more prevalent. Other treatments can include anti-inflammatory medication, phonophoresis/iontophoresis, median nerve glides, ASTYM (Augmented soft tissue mobilization), changing positions of work station (ergonomics), or surgery to relieve the compression of the nerve in the carpal tunnel.

If your symptoms are not improving with conservative treatment above, a nerve study (EMG) can be ordered to determine the location of the compression and its severity. As a result, this will allow the surgeon to determine if surgical intervention is warranted or to continue with conservative treatment to alleviate the symptoms.

If you have surgery, what to expect:

Surgery is a scary thought and there are risks involved; however, this surgery is performed using a scope and a small incision and recovery is pretty quick as long as you follow instructions via the doctor and your therapist. If you are non compliant, the recovery can be long and make you question why you had surgery.

In general, the surgery for CTS is performed under local or regional anesthesia and is an outpatient procedure allowing you to go home the same day after surgery. For endoscopic approach, there is a small incision made at your wrist area, and the tissue that is pressing on the nerve will be cut to decrease the pressure.   After the surgery, a bulky dressing will be used to immobilize your wrist, but your fingers are free allowing you to move them immediately after surgery. You will follow up in therapy 3-5 days after surgery. The bulky dressing will be removed, incision cleaned and your home exercise program will be initiated. A smaller dressing will be reapplied after therapy for ease of daily dressing changes at home. Approximately 10-12 days from surgery, stitches will be removed either by doctor or therapist and will continue to progress your movement and activities, as tolerated. The length of recovery can vary with each person especially if the nerve has been compressed for a long time, return of your sensation may take longer. Typically, four weeks from surgery, strengthening activities will begin under the supervision of a therapist to ensure you are progressing well without pain or discomfort. Weekly progression of resistance’s/weight limits are issued via your therapist and this methodical succession will return you to your prior level of function pre-Carpal Tunnel symptoms. Full recovery of the nerve is said to be approximately 18 months, but most people’s sensation returns well before that time frame.

 

Knee Pain

Suffering from knee pain? Here are some reasons why…

Jo Barker PTjobarker

Knee pain is something nearly every person experiences at one point or another, usually related to a particular injury or provocative activity, such as lots of kneeling for spring planting in the yard or playing the occasional game of basketball. How do you know the difference in a serious injury versus simple overuse? The causes of knee pain typically fall into one of three categories: traumatic, overuse, and degenerative.

Traumatic is self-explanatory; a fall, collision, twist, or awkward landing can create enough force to damage the structures inside the joint. When this type of damage occurs, the person may experience severe and immediate swelling, severe pain, a loss of ability to move the joint, and an inability to bear weight through the limb; a safe bet is when two of the three exist, the person should seek medical attention from a physician and/or physical therapist immediately. Attempting to “walk it off” is not recommended.

An overuse injury can be a little tougher to recognize. Starting a fitness program or a dramatic change in a person’s activity level (more or less) can provoke this type of pain. So can rapid increases in body weight, such as pregnancy. Adolescents who are going through growth spurts will often have pain in the knees because of changes in the way the muscles and joint function together. The pain may show up immediately or gradually, appearing more and more frequently until it is constant. Swelling may appear but it is typically not severe, and disappears overnight. Depending on the structure inside the knee that is taking the abuse, surgery may be needed, but many times this is treated quickly and effectively with a short course of rest, stretching and strengthening.

“Degenerative” describes the normal changes our joints experience with aging, specifically thinning of the articular cartilage and the loss of quality in the soft tissue of the joint. Knee pain from degenerative changes generally does not produce swelling, and is provoked by remaining in one position for a great deal of time.

Besides pain, a problem within the knee (or any joint) will also cause the muscles around the joint to stop working effectively. Over time this will produce a loss of muscle size as well as a loss of control of the joint. The longer the joint remains untreated, the more severe the muscle atrophy and loss in function will become. Other joints may become painful as a result, particularly the areas above and below the injured joint or the opposite side. Medical treatment should begin before the body learns bad movement patterns.

Unless severe structural damage is present, a course of physical therapy will often be successful in getting rid of pain and restoring a person’s usual activity level. Any physician can refer to physical therapy; in most cases, the therapist can make an accurate assessment of the problem and begin treatment immediately. If the problem be severe enough that a specialist should be involved, the therapist can facilitate the referral and also make recommendations for any diagnostic testing.