Human Performance and Rehabilitation Centers, Inc.

Functional Capacity Evaluations

Functional Capacity Evaluations (FCE) are full body assessments that are performed to determine an individual’s ability to safely return to work at pre-injury status or to determine if work modifications are necessary to allow the employee to safely resume their job. FCE’s are commonly used for:
– employees that have suffered musculoskeletal work related injuries and an evaluation is requested to determine their physical abilities in comparison to the demands of a target job
– establishing disability
– a generic test to assess an individual’s current physical ability when the job goal is unknown
A job description is requested and reviewed to assure all job demands are evaluated. The results of the FCE are then compared to the job description. If the client does not meet all the job demands, the evaluator will determine if the employee is a candidate for a work reconditioning program and recommendations will be made to the physician ordering the exam.
The length of the test and the number of days required to complete testing will vary depending on the injured body part. Hand, elbow, and shoulder exams are performed on one day and take approximately 4 hours to complete. Spine, hip, knee, foot, and ankle exams are performed over two separate days, taking approximately a total of 6-8 hours to complete. Clients are asked to dress in clothing and shoes that permit them to safely perform the presented tasks, and that information is provided prior to the day of testing.
The test may be executed by a physical therapist, occupational therapist, athletic trainer, or a kinesiologist. The test items are designed to determine cardiovascular fitness, lifting capabilities, strength, balance, and hand coordination. In order to perform the test, the individual must be medically stable and have met maximum medical improvement as determined by their physician.

The Things We Take for Granted

Dr. Oz brought women’s health into the limelight in April 2014 with an episode about Pelvic Floor Dysfunction (PFD). His segment introduced a very well-known pelvic floor physical therapist, Amy Stein MPT, from Manhattan. If you viewed or missed his segment you might be asking, “I need a physical therapist for my what?” Don’t fret, let me explain. The pelvic floor is a group of muscles, nerves, and soft tissue that attach from the pubic bone in the front of your body to the tailbone behind, similar to a hammock.

Physical therapists are well known and effective in treating all types of muscle problems. We treat muscle strain, spasm, weakness, and tightness. We treat muscles after injury and especially after surgery to regain their best function. Are you still asking, “Do I need a pelvic floor physical therapist?” The answer may very well be yes. The Massachusetts General Hospital website states one in three women will develop a pelvic disorder in her lifetime.

Physical therapists are teaming with doctors to effectively and conservatively treat many types of pelvic floor disorders.

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The muscles of the pelvic floor serve the important function of supporting the organs in the pelvis, and assist in stabilizing and supporting the spine. They also play a role in sexual function and pleasure, indeed important muscles! It is these muscles that help keep us dry or continent and must relax in order for us to empty the bladder or rectum, and stretch to deliver a baby. We take for granted that these muscles will function throughout our lifetime, but sometimes they just need help.

In May 2014, Moore Magazine had an article highlighting all the treatment options for one type of PFD, stress incontinence. A physical stress from above the bladder pushes down on the organs in the pelvis and the muscles just do not have enough oomph to push back. This is a muscle problem. The pelvic organs are not well supported due to muscle weakness. Does your bladder leak with sneezing, coughing, laughing or lifting things? Think again about that physical therapist.

In 1948 Dr. Arnold Kegel developed exercises for women to reduce bladder leakage, assist in vaginal laxity, and support mild pelvic organ prolapse. Pelvic floor muscles can be strengthened just like any other muscle with properly prescribed Kegel exercises. But, one size does not fit all! So, if you were ever told to practice Kegel exercises, you were on the beginning of the right path…possibly. I hear many women state, “Oh, I tried Kegel exercise and they didn’t work for me.” Unfortunately, up to 51% of women are not able to perform Kegel exercises through verbal instruction alone (Bump et all 1991). Properly prescribed, instructed (squeeze and lift) and practiced (repetitions determined by your ability to produce and hold a contraction) Kegel exercises do work. You don’t have to squeeze your thighs or hold your breath or clench your buttocks, but you do need to learn to isolate the hammock of muscles in your pelvic floor. You can learn to exercise these muscles with your regular gym workout, and no one will know the difference, except you. You will be more comfortable, dry and less anxious about finding a bathroom. Take a look at www.totalcontrolprogram.com or www.nafc.org for more info.

Kegel exercises are NOT all we do. Not all women or men need or should even try to do Kegel exercises. For various reasons, pelvic floor muscles can also become short and tight, and lose their ability to relax. Symptoms of tight muscles might be pelvic and low back pain, constipation, finding it hard to empty the bladder or bowel, or experiencing pain with intercourse. Physical therapy can help with that too. Manual techniques to soften and lengthen muscle tissue and reverse Kegel exercises help to restore function and reduce pain.

The muscles of the pelvic floor are especially vulnerable in women due to pregnancy and delivery, but are important in men’s health as well. Dysfunction has multiple causes and affects all ages. The National Association for Continence (NAFC) website reports it takes an average of 7 years before a woman will discuss her bladder problems with her physician. Ignorance is not bliss. Your doctor can guide your treatment. The GOOD news is pelvic floor dysfunction is treatable, and a physical therapist that specializes in the pelvic floor can offer conservative options.

In September 2014, The American College of Physicians released guidelines for non-surgical solutions for uncomplicated stress incontinence. These guidelines include pelvic floor muscle exercises, bladder training and weight loss as effective options, and recommended conservative options as a first choice of treatment.

A pelvic floor physical therapist specializes in understanding and treating the multiple problems of the pelvic floor muscles. We can help you find your muscles in your pelvis and learn to control them. We can help that got-to-go feeling with a bladder training program. A pelvic therapist will complete a comprehensive pelvic floor muscle exam, digitally examine the pelvic floor muscles, evaluate posture and examine the joints of the low back and pelvis and prescribe appropriate treatment options.

There is HELP and HOPE for your pelvic health problems! You will be grateful for those hidden muscles once they are no longer hiding from you!

The HPRC Brand, Competence, Service, Culture

HPRC celebrates its 60th anniversary in 2015! The company has not only witnessed change but has endured and survived change. Medicare did not exist when HPRC was founded. About the only thing that hasn’t changed in our 60 years is our brand. In fact, we believe the reason we have survived for so long and through so many changes in the healthcare landscape is because of our brand. The HPRC brand is about EXCELLENCE – excellence in the level of care we provide, excellence in the delivery of that care, and excellence in our culture and how we treat each other and present ourselves to those we serve.

The founder of our company, George M. McCluskey Jr., PT is singularly responsible for establishing HPRC’s brand of excellence. He founded our company with one idea in mind – to improve life, one patient at a time. One of his favorite quotes is from St. Francis of Assissi: “If you work with your hands you are a laborer. If you work with your hands and your head you are a craftsman. If you work with your hands, your head, and your heart you are an artist.” He encouraged all of us to be artists.

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Mr. McCluskey, or “Coach” as we called him, challenged and inspired us to grow professionally and advance our knowledge. He taught us to then use our success to make a difference in the lives of others. He taught us about relationships – the importance of treating everyone with respect and dignity regardless of their situation. He had very high expectations of all of us, and gave us the means to accomplish anything we dared. He eliminated our fear of failure and replaced it with a spirit that wasn’t afraid to dream. And we loved him for it.

At HPRC, as we plan for our future, we plan together. Whatever the climate may be, we know we can count on each other. We know who we are, what we do, and why we are here. We are about excellence – excellence in our competence, our service, and our culture. An African proverb says if you want to go fast, go alone; if you want to go far, go together. We vow to keep alive the lessons we learned from our founder, and advance our brand of excellence.

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

Why am I dizzy with certain activities?

Why am I dizzy with certain activities?

Dizziness can be caused by many things: side effects of medication, low blood pressure, low blood sugar, and anxiety. Dizziness following bending over to tie shoes, lying down in bed, looking in the blind spot, and walking down a grocery aisle are all frequent causes of dizziness related to a vestibular disorder. Vestibular dizziness symptoms may include everything from the room spinning to a feeling of off balance or unsteadiness.

There are three major systems in the body that help you maintain your balance. Vision helps to locate the horizon and objects in a person’s path. Sensory mechanics in the feet and legs help identify the type of ground underneath a person’s feet. The last system is the vestibular system which is located in the inner ear behind the ear drum. The vestibular system is what causes motion sickness, makes the stomach turn on a roller coaster, and what jolts a person awake when dreaming of falling.

balance1The vestibular system has three main functions: stabilization of visual images (keeping eyes on a target), maintaining postural stability (especially with head movement), and providing spatial orientation. These three functions are controlled by coordination of the central vestibular system (brain and brain stem) and the peripheral vestibular system (shown to the left). There are two main parts of the peripheral vestibular system. The three fluid filled semicircular canals that detect angular head movement such as shaking your head to say “yes” and “no”. The vestibule contains the otolith organs which detect vertical and horizontal acceleration, like riding in a car and an elevator. If either of these systems are disrupted in any way it can cause dizziness. Two of the most common vestibular issues are benign paroxysmal positional vertigo (BPPV) and unilateral vestibular hypofunction (UVH).

BPPV is caused when otoconia (calcium carbonate crystals) from the vestibule fall into the semicircular canals. This causes movement of the fluid in the canals, which in turn moves the hair or ampulla, which triggers the sensation of movement. When someone with BPPV lies flat, bends forward, or looks up, this movement causes the crystals in the canal to move, moving the fluid, and then the hair, which triggers the sensation of spinning in the brain. This can be fixed by moving the crystals out of the canal by performing specifically sequenced positions which can treated by a medical professional familiar with vestibular rehabilitation in as little as 1-2 visits.

Unilateral vestibular hypofunction usually occurs following a viral illness, head trauma, or a vascular incident, such as a stroke or blockage, that decreases or eliminates the receptor input of the vestibular system to the brain. This causes less intense sensation of dizziness, more commonly characterized as feeling off balance. Common complaints of UVH are off balance or slight dizziness when turning a corner, picking something up from the floor, walking in the grocery store, or driving. Rehabilitation for UVH can take between 6-8 weeks with therapy to improve gaze stabilization (maintaining vision on a target), postural stability (maintaining standing balance), and decrease motion sensitivity.

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!
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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.