Human Performance and Rehabilitation Centers, Inc.

Still Working from Home? Here’s How to Stay Healthy

Nearly overnight, COVID-19 created a remote American workforce, and many folks are still working from home at least some of the time. Companies and workers both report positive results from the great telework experiment, but it does come with certain downsides, including the possibility of a sore neck, shoulder or back pain from hunkering down in an “office” that looks more like the living room couch. Remote workers also may face feelings of isolation, poor eating habits and not enough exercise as the lines get blurred between their professional and personal spaces.

It’s important to take steps to ensure your work-from-home experience is productive and healthy. Keep the following tips in mind, and if you’re experiencing neck, shoulder, back or joint pain, reach out to your physical therapist.

Establish an appropriate work station

The most important thing you can do to foster wellness while working from home is to establish a work station that’s as ergonomically correct as possible. Don’t be tempted to work from your sofa, or worse yet, your bed. This is especially hard or working parents, who have had kids home during the spring quarantine and throughout the summer. But no matter what your home life is like, find a spot that allows you to focus and sit up straight, comfortably.

Protect your posture

Whether it’s the kitchen table or a proper desk, your home work station should allow you to place your feet flat on the floor in front of you. Your knees should be at the same level as your hips, creating a 90-degree angle with your planted feet. Similarly, your arms should form a 90-degree angle at the elbows. Your elbows should be positioned close to your trunk and your forearms should be straight in front of you, working at a flat, not raised, keyboard. Your spine should be straight. If you need them, place cushions or rolled bath towels between the chair and your lower back. Ideally, your computer screen is half the distance between your eyes and your keyboard, which can be hard when working on a laptop. Consider adding an external keyboard, so you can elevate your laptop. In the absence of that, be careful not to crane your neck down as you look at your screen.

Move frequently throughout the day

No matter where you work, don’t remain sitting for too long. There’s no question that regular movement fosters well-being. Every hour, take a short break, stand up, stretch and get moving, even it’s for a short period. Walk the dog, complete a chore, toss the Frisbee to your kids, or just stand and stretch. If you’re back at work, regular movement is equally important. It doesn’t take much; just a few minutes of movement between long period of sitting can be very effective at increasing wellness.

Eat well and stay hydrated

With the home kitchen close by, it may be tempting to tank up on snacks. Create a schedule for eating breakfast, lunch and snacks. Stock the fridge and pantry with healthy items. And be sure to drink plenty of water. As temperatures rise, it’s important to stay hydrated not just when going outside, but throughout the day. Keeping the body hydrated helps the heart pump blood throughout the body more easily, enabling the organs and muscles work more efficiently.

Exercise and Stretch

When you work from home, it’s important to integrate an appropriate exercise routine into your day. The advantage of telework is that it eliminates the commute, freeing up extra time to walk, run or go to the gym. In addition, there’s more fitness content online than ever, so break up the day with a virtual stretching session, Pilates or yoga class.


What to Expect During OT after an Amputation

Whether it is a wound that has refused to heal or you got too close to the table saw, when an amputation of a finger occurs it can be a traumatic experience. After your doctor or surgeon has deemed you appropriate for therapy, you will be set up for an evaluation. At the evaluation, your therapist will assess your affected finger(s) in several different ways: the amount of swelling, range of motion of the unaffected joints, how well your incision is healing, and if you have any involvement of the nerves in the other parts of your hand.

Usually, the first few therapy visits focus on how to take care of your incision, range of motion exercises to prevent stiffness or increase flexibility of the other joints of your hand, controlling swelling, and shaping the stump by wrapping using a certain technique.

After the incision(s) is well healed, scar massage is started. This will help the area not only normalize in appearance but prevents the scar tissue from adhering to underlying structures. Scar tissue can also interfere with achieving desired motion and cause the area to become itchy, painful, sensitive, or even raised. If you are experiencing numbness or sensitivity of the stump, a sensory program is started to retrain those nerves to communicate with the brain in a normal way instead of over- or under-reacting.

The last phase of therapy after an amputation consists of activity modifications or adaptive equipment training to safely return to doing the things that are important to you.  Whether it’s playing baseball, shuffling a deck of cards, returning to work, or making a cup of coffee, what is important to you is important to your therapist.

If you experience an amputation, please talk to your surgeon or doctor about seeing an occupational therapist for best possible outcomes from a less than ideal situation.

Learn more about Katherine Branch, OTR-L.

Am I Sore or Am I Hurt?

Starting a new exercise routine can be uncomfortable.  However, the long-term payoffs are greater than the initial aggravation of getting up early, changes to your normal “comfortable” routine, and soreness of muscles you have not used in a long time.  The rewards of exercise are great.  Starting an exercise routine can provide some immediate results: improved flexibility, increased mental clarity, and weight management effects can be seen shortly after starting a new routine.  But the long-term effects are even more powerful.  The American Cancer Society published a study that shows that too much time sitting and being sedentary is associated with an increased risk of death from various health conditions, including type 2 diabetes, high cholesterol, high blood pressure, and heart disease.  The good news is that exercise of any type will help reverse the effects of a sedentary lifestyle and it does not matter what type of exercise you do; the main thing is to get up and get moving.

So, now that you are moving and starting to use those muscles that you have not used in a while, what can you expect.  Soreness is more than likely going to happen.  Think about doing yard work.  You may be used to cutting the grass with your push mower and weed-eating the edges, but say you go to the nursery and buy 10 new bushes to plant along the front of your house.  Now you are lifting, bending, digging, planting, moving dirt, and watering for an entire day.  You are tired at the end of the day, but you feel great and your house looks amazing.  But the next morning, well that is a different story, is it not?  The same thing can be true for starting a new routine, soreness is expected, pain is not.  But how do you know the difference?


Soreness after or during activities can be completely normal.  Typically, soreness sets in the day after activity and will usually resolve in a few days.  Soreness occurs from muscle exertion that causes micro tears in the muscle fibers. This micro tearing forces your muscles to adapt and remodel to handle the increased stress from the exertion.  This is what allows your muscles to get stronger and have greater endurance to complete various activities.  Therefore, soreness is a normal response that your body has to doing exercise and a normal process of adapting the body to handle increased activity levels.

Soreness will typically present in the following ways:

  • Onset: During exercise but can be 24-72 hours after exercise before soreness starts.
    • Lasts 2-3 days.
  • Presents in the muscles only.
    • During exercise: tender to touch, tires easily, and a burning feeling.
    • At rest: tight with a dull achy feeling
    • Gets better with stretching, movement, and appropriate amounts of rest.
    • Gets worse with inactivity.
  • You should continue to move after appropriate amounts of rest and recover.
    • Activities should be different than the activities that you did to cause the soreness


If discomfort persists and does not improve beyond the 3-4 days that is typical for soreness, then it may be time to be concerned about an injury.  Delayed onset muscle soreness (DOMS) will typically present in 1-2 days post workout and resolve in another 2-4 days.  Any pain, tenderness, achiness, discomfort, etc. that persists beyond 1 week needs to be looked at further.  Also, soreness will always be in a muscle, if discomfort is noted in a joint, then always suspect an injury.  If an injury is suspected, then you can start using ice immediately, especially if you see swelling.  Ice should be used exclusively for 7-12 days.  Heat should be reserved for old, chronic injuries.  When using ice, make sure to leave the ice one for 15-20 minutes but no longer.  Any longer than 20 minutes and you run the risk of injuring tissue from the prolonged cold.  Also, if you are using a chemical cold pack (other than ice) you need to put a layer of some type (i.e. towel, pillowcase, etc.) between you and the cold pack.  Most chemical cold packs get extremely cold and stay at the extreme temperatures longer than ice does and cause skin and tissue damage much faster than ice.  If swelling is present or an injury is acute remember RICES (Rest, Ice, Compression, Elevation, and Support).  For an injury such as a sprained ankle:  rest can be decreasing activity and staying off the injured ankle as much as possible, using ice for 15-20 minutes every hour, for compression use an ACE wrap or sleeve to apply compression, for elevation you can lie on your back with your ankle above your heart, it is best to do this every time you ice, and support would be the use of an ankle brace during activity to allow the injured ligaments to heal.

Pain will typically present in the following ways:

  • Onset: During exercise or up to 24 hours following activity.
    • Typically, does not resolve on its own and becomes a linger issue.
  • Presents in the muscles and/or joints.
    • Gets better with ice, rest, and gentle/pain free movements.
    • Gets worse with return to activity after recovery and appropriate time off/rest.
    • During exercise: Sharp ache to pain.
    • At rest: Sharp Ache
  • You should seek the advice of a medical professional (i.e. family doctor, orthopedic surgeon, and/or physical therapist) if pain persists >1-2 weeks or comes back with resuming activity.

Similarities exist between soreness and pain, which is why people have some confusion as to what they may have going on.  It is always best to listen to your body and back off the exercise routine for a few days.  If your discomfort subsides in a few days, more than likely, you just over did it and you had a bad case of muscle soreness.  But, if your discomfort persists for a week or more, comes back when you resume exercise after rest,  is a sharp instead of a dull ache, and/or is in a joint and not just in a muscle; then you need to seek out the advice and expertise of a medical profession such as a physician or physical therapist to further evaluate your condition and help you manage your condition appropriately.

Learn more about the author of this article, Paul L. Padgett, PT, ATC, CSCS.


Tips To Avoid Injury For Runners

Running is a great way to improve your cardiovascular fitness and get some fresh air! Unfortunately, injuries such as shin splints, runner’s knee, muscle strains, plantar fasciitis, and stress fractures can plague runners. Whether you are just starting out or you are an experienced runner, you want to do all you can to prevent an injury which could interrupt your training and your daily life. Here are some tips to help you achieve healthy running.

Wear proper footwear

It is important to wear shoes that were meant for running, fit you well, and are designed for your foot type. Runners who overpronate when running need a shoe with more stability and support, while runners who supinate require a shoe with more cushioning. If you are not sure what type of shoe you need, a physical therapist or knowledgeable shoe salesperson will be able to help. It is important to keep track of the miles on your running shoes and replace them regularly. Even if there are no visible signs of wear, you should retire your running shoes after a maximum of 500 miles.

Do a dynamic warm-up

Warming-up is important in order to get your muscles and joints ready for a run. You can walk or jog for a few minutes to get your muscles warm. You can also do some high knee marching and some exercises bringing your heel to your bottom (“butt-kicks”) to stretch the backs and fronts of your legs. Long duration static stretches are better to do after your run.

Vary your running surface

Paved roads are a very convenient running surface, but they are not very forgiving. If you are running a lot of miles, you may not want to log all of them on concrete. Doing some of your miles on a track or dirt surface results in less of a pounding on your legs. A treadmill is another great option, especially on days with poor weather. If you are running on the road, running on the left side of the road facing traffic is typically the safest way to run to avoid being hit by a car. If you are in an area where you can easily be seen, you may consider alternating between the right and left sides of the road due to the beveling of roads.

Increase distance gradually

Runners who are trying to increase their distance should do so gradually. An increase of about 10% per week is a good guideline. For example, if you currently average 10 miles per week, try for 11 miles next week. If you are training for a specific event or distance, be sure to plan ahead and give yourself ample time to ramp up your mileage safely.

Listen to your body

Perhaps the most important advice to avoid injury is to listen to your body. If you are developing a nagging ache or pain with running, respect it. It is better to take a few days off than to let a little nagging pain turn into a serious injury. You can cross train by biking or swimming to give your body a break from running while maintaining your fitness. It is also a good idea to seek a physical therapy evaluation to address any muscle imbalances or mechanical issues that you can correct to resume pain-free running.


Brittany McLeod, PT, DPT, is a licensed Physical Therapist with HPRC St. Francis Main Campus since 2013. She received her Doctorate in Physical Therapy degree in 2012 at Upstate Medical University in New York and her BS degree in Heath Science at SUNY Brockport New York in 2009. Brittany is a member of the American Physical Therapy Association, Orthopedic Section.

Constipation: Understanding it and finding relief

Constipation is the most common digestive complaint presented to doctors, estimated to affect more than 4 million people in the U.S. While common — and perhaps a little difficult to discuss – it can be treated.  The good news is a pelvic physical therapist can help.  Pelvic Physical Therapy is a specialty that focuses on the muscles of the pelvis that relate to the bladder, bowel and sexual dysfunction. A Pelvic PT will take a thorough history of your problem and perform a clinical exam of the musculature of the pelvic floor for tone, tenderness, contraction and relaxation. There are a number of techniques employed in the practice to help you regain control. The first and most important is basic education.

Let’s define constipation. Having a BM three times a day to three times a week is considered normal. If you are having a BM less than three times week, you have met one of the criteria for constipation. Do you strain to pass a BM more than 25% of the time? Are your stools hard or lumpy more than 25% of the time? Do you feel that your stool is blocked, or that your BM is incomplete 25 % of the time? Do you have to manually assist to complete a BM? If you answered yes to two or more of the above questions, you are constipated.

A number of different issues can cause constipation, including:

Poor diet

The American diet is generally low on fiber. The USDA recommends 25 grams of fiber for women, and 38 grams for men under the age of 50. Over the age of 50, the recommendation is 21 grams for women and 30 grams for men. Some fibers add bulk to your stool, which helps to regulate a BM. Adding other fibers helps to prevent heart disease, lower cholesterol, and even helps to regulate blood sugars. These are definite benefits for us all. Keeping a food diary for two to three days can help you track the amount of fiber you are consuming. Fiber is best obtained with food but supplements are available and helpful. It’s important to increase fiber slowly, and to increase your water intake at the same time. Generally, your water intake should be close to ½ your body weight in ounces, depending on how active you are. Fiber-rich foods to incorporate into your diet include cooked beans, bran, whole grains, fruits, vegetables and high fiber nuts.


Some medications, including opioid pain medications, antidepressants, urinary incontinence meds and others can cause constipation. When taking these drugs, it’s important to increase your intake of fiber-rich foods and water. Talk to your doctor if you think your medication is contributing to your constipation.

Dyssynergic Defecation

In about 50% of chronic constipation cases, the cause is a condition called dyssynergic defecation, or the inability to coordinate the diaphragm pelvic floor and the abdominal muscles. If your symptoms include a feeling of incomplete evacuation, straining and bloating your pelvic floor muscle, it may be what we term “non relaxing.” It might seem odd to tell you that you must learn how to have a BM, but long-term straining leads to poor coordination of the ability to evacuate the bowel. Dyssynergia occurs when your pelvic floor muscles contract instead of relax and lengthen to pass a BM.  Biofeedback and neuro-muscular education will help get you back on track. One of the simple solutions here is to use a foot stool. A well-known one is called the Squatty Potty. It’s a foot stool that brings your knee into a position that is higher than your hip (the squat position), and it creates relaxation in the pelvic floor musculature.


A rectocele is one type of pelvic organ prolapse. A rectocele can occur in women secondary to pregnancy and childbirth. The risk of rectocele increases with age. It is generally caused by a weakening of the support structures (muscles and ligaments), and it can become worse with chronic straining during a BM, and even heavy lifting.  A pelvic physical therapist can assess for prolapse. A large rectocele and inability to empty the bowel may require surgery. Surgery restores the anatomy, but it does not correct the dysfunctional strategy that occurred to manage the rectocele. Physical therapy is appropriate 4-6 weeks after surgery to improve defecatory function.

Rules to Poop By:

While each cause of constipation requires its own therapeutic strategy, there are several good rules to follow to improve constipation and to keep it from returning.

  • Don’t push for a bowel movement if there is no urge to push.
  • Don’t ignore the urge to have a bowel movement when you feel it.
  • Create a regular time to have a bowel movement, preferably first thing the morning, or 20 –30 minutes after a large meal.
  • MiraLAX is best taken just after your evening meal, so that it can help to produce a morning BM.
  • Four ounces of prune juice with pulp taken at bed time, also helps to produce a morning BM.
  • Elevate your knees when sitting on the toilet. Use a footstool preferably at least seven inches high so that your knees are higher than your hips. This places you in a squatting position and allows the posterior pelvic floor muscles to relax.
  • Use diaphragmatic breathing throughout your day.
  • Learn how to coordinate the diaphragm, abdominal and pelvic floor muscles in order to eliminate straining.
  • Exercise regularly.


Constipation is a frustrating condition. Pelvic physical therapists may use neuromuscular education myofascial release, biofeedback, relaxation/strengthening exercises, joint mobilization, abdominal massage and pelvic floor muscle massage amongst their many tools to help you regain control.

Joanne O’Connor PT, PRPC is a licensed physical therapist employed with HPRC since 2001. She is a certified Pelvic Rehab Practitioner through the Herman and Wallace Institute since 2016. Joanne received her Bachelor of Science degree in Physical Therapy from the University of Connecticut in 1978.  Her clinical interests include the Spine and Women’s Health. She welcomes all diagnoses related to the spine and women’s health inclusive of pregnancy, postpartum urinary and fecal incontinence, constipation and pelvic pain. She is a member of the American Physical Therapy Association Women’s Health Section. Joanne is also a member of Pelvic Guru and the Global Pelvic Health Alliance

Importance of Tummy Time

The Back to Sleep program was initiated in 1992, in order to decrease the occurrence of SIDS. Since then, there has been a decline in parents/caregivers placing their infants on their tummy.  Additionally, many do not think about tummy time for play and caregivers are generally not provided with information on recommended play positions.

As a result of less time spent on their tummies, there has been an increase in the number of infants with developmental delays, This means that infants are taking longer to develop the muscles they need to achieve developmental milestones in a timely manner, such as holding their heads upright and rolling. There has also been an increase in infants with misshapen heads, such as plagiocephaly.

Parents and caregivers need to know the importance of awake, supervised tummy time, and how they can safely incorporate it into their day to day lifestyle.

What is Tummy Time?

Tummy time is the time that an infant spends on their belly/tummy. They are not sitting up, laying on their backs or even vertically held against their parent’s/caregiver’s chest.

For tummy time to count, they need to be awake and supervised. Being awake is important, because as they move, wiggle and even get upset, they are working their muscles that are needed for development, such as rolling and crawling.

Why Do We Not Put Our Infants on Their Tummies?

  • Fear – some may feel that their infants could hurt themselves, or stop breathing.
  • The infant does not like tummy time – They cry as soon as they are put on their tummies so we avoid it.
  • Some are unsure as to when they can do tummy time, are they old enough?
  • Use of devices, such as swings, bouncy seats and jumpers to vary an infants position instead of their tummy.

Why is Tummy Time Important?

Tummy time works babies muscles that are needed for development.

Awake, tummy time play has been shown to promote gross motor skill development. It allows for strengthening of antigravity extensor muscles that are needed for motor skills, such as rolling, crawling and pulling to stand. It also allows for movement exploration, thus increasing the infant’s opportunities to learn new motor skills.

Tummy time also helps alleviate gas pain and assists with preventing misshapen heads (plagiocephaly).

When Should You Begin Tummy Time?

  • Immediately
  • A newborn baby can begin right away.
  • Always do tummy time supervised.
  • Newborns sleep most of the time, so a great way to begin tummy time, with a newborn, is having them lay on your chest.

How Long Do I Do Tummy Time For?

Recommendations on the amount of time in a day an infant should spend on their tummy varies greatly.

Studies range from a minimum recommendation of 20 minutes a day to at least 80 minutes a day for a 16 week old infant.  What is consistent is that the higher the duration of tummy time, the better development of gross motor skills.

So, recommend begin slowly, and immediately. Try to aim for at least 10 minutes a day for up to 1 month of age, then keep adding 10 minutes for each month, until your baby rolls independently. So at 6 months of age, they should be on their tummy for at least 60 minutes a day.

Also, if your infant only tolerates 30 seconds, then do 30 seconds, take a break, and repeat so that over the course of the day the time adds up.

Ideas On Doing Tummy Time At Home

  • On your chest – As long as you are laying down, this counts as tummy time. This is often calming to your baby, they can look at you, and they can feel your heart beat.
  • Over your lap/towel roll/boppy pillow – anything that helps them at first to tolerate it longer, then progress to only a firm, flat surface.
  • Mirror – babies love mirrors. Can use a mirror to improve visual attention. Babies love to look at themselves.
  • Get on the floor with them – smile at them, make sounds, sing to them…. Have siblings entertain them….
  • Use toys for visual stimulation/interest
  • Rub their backs/legs/arms while they are on their tummies – this feels good and is not only calming, but also activates the muscles.

YOU CAN DO THIS! Tummy time is a great time to interact with your baby, bond with them and just have fun! Tummy time should be done when your baby is awake and always while supervised. You can keep track of tummy time with a simple chart to make it easier to keep track of and less stressful.

Catherine Stubbs, PT, DPT, PCS is a licensed Physical Therapist and Department Director at Pediatric Rehabilitation, Columbus, GA. She has been employed with HPRC since 2002. Catherine received her M.S. in Physical Therapy in 2000 from North Georgia College and State University and her DPT in 2019 from Arcadia University. She is an APTA board certified clinical specialist in pediatric physical therapy. Catherine lives with her husband, Brian, and children in Columbus, Georgia.


Take Advantage of Physical Therapy in a Fitness Facility Setting

Working out can bring big rewards, but as you get older, it’s important to also guard against injury. Taking advantage of a fitness facility’s in-house physical therapy clinic is a smart way to integrate injury prevention into your routine, and to get back to normal if you’ve experienced a setback. HPRC’s partnership with the Forest Drive location of MÜV Fitness in Columbia, South Carolina began in 2016, and it’s a great example of how gyms and clinics can combine forces to keep you active and injury free.

With 73 million individuals in the Baby Boomer generation, there’s already a high demand for physical therapists to support patients with workout-related overuse injuries as well as everyday conditions that impact us all as we age. Direct Access laws, which vary from state to state, have made it easier for patients to go straight to a physical therapist without having to see a physician first. Whether you’re experiencing a sore shoulder or knee, a stiff back or a tightness in the hip, a physical therapist can immediately evaluate the condition, determine its source and cause, and begin a therapy plan to restore function. This saves you time and money and returns you to normal activities faster.

When your physical therapist is located within a gym setting, there are even more benefits:

Immediate access leads to faster results

If you’re working out and you start to feel pain or diminishing function, you can immediately access an onsite physical therapist. At HPRC’s MÜV location in Columbia, we begin providing a complimentary screening to assess your condition. This helps you make an informed decision about pursuing therapy.

Assistance with pain control

Having access to an onsite physical therapist in a gym can also help you learn to better manage pain. A physical therapist can help you find the source of your pain and create a non-pharmacological plan for reducing and managing it.

Addressing onsite injuries fast

If you experience an injury while working out, you don’t have to wait to see a physician. You can go straight to a physical therapy clinic. The kinds of musculoskeletal conditions that people experience while exercising are the kinds of issues physical therapists see and treat every day.

Learning proper form

As you get back to full mobility after an injury, understanding your body mechanics is imperative. Your physical therapist can show you exactly how to position your body as you pursue different physical activities to empower you to prevent future injuries. In addition, your physical therapist can communicate with a personal trainer at the gym to develop a personalized program that keeps you safe and strong.


Dunny Dunlap, PT, ATC, is a licensed physical therapist employed with HPRC since 1987. He is Director of HPRC Physical Therapy in Columbia and Lexington, South Carolina. His education includes: Winthrop University, MBA 2001; Medical University of South Carolina, B.S. in PT 1987; The Citadel, M.Ed. in 1984 and B.S. in 1980. Dunny is certified in Dry Needling, Functional Movement Screen (FMS) and Selective Functional Movement Assessment (SFMA). He is also a Certified Athletic Trainer and his specialties and interests include orthopedics and sports injuries. Memberships include: APTA (American Physical Therapy Association); PPS (Private Practice Section of APTA); SPTS (Sports Physical Therapy Section of APTA); NATA(National Athletic Trainers Association); SCATA (South Carolina Athletic Trainers Association).

3 Ways Physical Therapists Help People with Down Syndrome

Down Syndrome: What is it?

Down Syndrome is a common genetic disorder in which a person has an extra chromosome. This extra chromosome affects how a baby is formed in Utero and produces a wide array of physical delays throughout childhood development.

What does it look like?

Some of the physical impairments commonly seen with Down Syndrome Include:

  • Hypotonia: Low muscle tone causing weakness
  • Joint Laxity: Loose joints causing increased risk of dislocation
  • Poor Balance
  • Poor Coordination
  • Delay in Gross Motor Milestone Development: Research shows that children with Down Syndrome will reach their motor milestones at a later age. For example, 78% of children will sit independently at 18 months, and 92% of children will walk at 36 months.

How Can Physical Therapy Help People with Down Syndrome?

Physical Therapists are trained to help children with Down Syndrome by improving their strength, balance and coordination, and through these improvements achieve motor milestones.

Strengthening: Physical Therapists can implement an early intervention strengthening program beginning at birth. The focus of PT will be to begin to improve neck and trunk strength in order to improve head control and help children learn to hold their head up, roll over, and sit independently. As time and age develop, goals will change to improve the strength and motor control to crawl, pull up, cruise along surfaces, and walk independently.

Balance and Coordination: As important as it is for kids to be strong enough to meet their milestones, it is equally important that they have the balance and coordination to execute the movements. Physical Therapist can begin to train a child’s balance and coordination at an early age by encouraging them to reach for toys, turn to look at things, and sitting and standing on unsteady surfaces to further challenge their balance reactions.

Promote Milestone Achievement: Improving strength and coordination in children with Down Syndrome will be the first step in promoting milestone achievement. Physical Therapists also promote further milestone achievement by implementing practice with jumping, running, skipping, stair climbing, ball skills, and more.

Physical Therapists are able to look at movement as a whole and break it down to identify where the movement impairments exist. By identifying the impairments, PT can set and address movement goals that will help children with Down Syndrome meet milestones to be able to participate in daily activities, sports, and anything else they set their minds to!

Learn more about the PT behind this article, Shelbi Moxley, PT

Chest Physical Therapy: A Help For Respiratory Distress

What is Chest Physical Therapy(CPT)?

     Chest Physical Therapy is a term used for a group of treatments used to improve respiratory efficiency, improve lung expansion, increase strength of the respiratory musculature, and reduce secretions in the lungs.  The secretions may be present in the lungs due to Viral / Bacterial Infectious Pneumonia, Cystic fibrosis, Muscular Dystrophy, Asthma, COPD, and multiple other immunodeficiency disorders. The treatments stated in this content piece may be helpful to all those in respiratory distress from lung secretions despite the etiology. Respiratory therapists, nurses, and trained family members are also able to implement these treatments to promote a continuum of care of affected individuals in multiple settings.

The treatments included within the scope of Chest Physical Therapy include the following:  postural drainage, chest percussion, chest vibration, deep breathing, and coughingPostural drainage involves sustained body positioning to allow gravity to assist drainage of the 5 lobes of the lungs.  With each position there are sections of both lungs facing downwards to promote mucus movement into the larger airways.  At this point the mucus can be huffed, or coughed, out of the airway or suctioned mechanically.  Chest Percussion, or hand clapping performed against the rib/lung field areas with a cupped hand, is a treatment used to facilitate movement of mucus from lung surfaces into the larger airways for removal.  Chest Vibration is a manual, or mechanical treatment, that is also used to promote mucus movement from the lungs.  It involves flat-hand placement over the affected lung lobe and a fine muscular tremoring of the shoulder/arm regions to shake the mucus loose.  Percussion and vibration are frequently used with the various postural drainage positions to promote the greatest dislodging of mucus from lung surfaces to improve quality of respirations.  Deep Breathing is performed to improve lung expansion and distribution of air into all of the lobes of the lung.  Coughing is used to bring the mucus out of the larger airways to eventually be spit out or suctioned from the mouth.

Precautions and Contraindications for CPT

     Adults or children with the following conditions should NOT receive CPT:

        *bleeding into the lungs                  *pulmonary embolism

*head or neck injuries                      *active hemorrhages

*fractured ribs/OI                             *open wounds/burns

*collapsed lungs                                *acute asthma

How do I perform CPT?

Find a place that is quiet and comfortable for both administrator and receiver of the treatment.  Plan the 20-40 minute treatment time prior to meals,  or 1.5 hours after a meal,  to avoid nausea, acid-reflux, vomiting, and possible aspiration from the vomiting.  Typically treatments are performed in morning and evening but frequency and duration are reliant on the physical condition of the recipient.  When working with children,  schedule the session around a favorite TV show, add a toy, or perform with favorite music on for a helpful distraction.  Comfortable clothing should be worn by the recipient of the treatment to protect the skin from the contact that will be made and jewelry/watches are not be worn by the caregiver to avoid abrasion.

  1. Choose a postural drainage position.  Use pillows, wedges, beanbags, ottomans, chairs, and other furniture to achieve desired angles as long as both parties are comfortable and breathing is not impeded.
  2. Perform percussion to region marked on postural drainage picture with cupped. The movements should be consistent and rhythmical presenting with a “hollow” sound due to the cupped position.  If you hear a “slapping” sound you are performing the technique incorrectly.  Perform the percussion for 3-5 minutes and follow-up with vibration and deep breathing/coughing (described in lower sections).  Percussion is not to be performed directly over the sternum, spine, stomach, or lowest ribs/back  to protect organs beneath those regions.
  3. Vibration is performed using both hands, in a firm, flat contour against the treated area, for 15-20 seconds or approximately 5 exhalations.  One hand is placed on top of the other hand while the arm/shoulder are creating a contraction that provides the fine vibrating movements.  The person receiving the treatment should be exhaling slowly while the vibration is present to facilitate mucus movement.
  4. Deep breathing and coughing follow the manual techniques of using the diaphragm to expand the belly during inhaling is promoted and a shrinking of the abdomen during slow exhaling is expected.  This technique promotes movement of the mucus and a spontaneous cough reflex in the recipient to expel it from the airway as well as promoting full lung expansion. Keep a trashcan, emesis container, or tissue handy for secretions to go into during coughing activity.

Chest Physical therapy is a way to help those in mild to moderate respiratory distress.  This may be a treatment given for the occasional family member that has a single bout of pneumonia or a consistent regimen that is used for a person with a chronic respiratory disease like Cystic Fibrosis or COPD. Talk with your HPRC physical therapist to find out more about how Chest Physical Therapy may help you or your family member.

Call Today To Request An Appointment With A Therapist At HPRC Auburn. Learn more about the author of this article, Karen Lynn, PT



Cystic Fibrosis Foundation. 6931 Arlington Road, Bethesda, MD 20814. Web site:

WEB SITES “Chest Physical Therapy.” Dr. Joseph F. Smith Medical Library , 2003. Available online at (accessed December 8, 2004)

5 Self Regulation Tips to Reduce Schoolwork Battles

In a time filled with so much uncertainty, we as adults are beginning to feel overwhelmed and out of control. It is important to remember that our children feel these emotions too and need our help in dealing with them. In a short period of time, everything about their daily routine has changed. It is normal to see some frustration erupt when it comes to sitting down and doing their schoolwork. Below are 5 self regulation tips to reduce schoolwork battles while you navigate school from home. We hope they help you and your little one!

Follow a Schedule

Your child is used to having a set schedule at school where they do table work, play outside and eat lunch all at certain times. Following a similar schedule or routine at home can help them adjust better and feel some normalcy in their day. Maybe you do schoolwork in the morning then take a walk or play outside before lunch and pick up with schoolwork in the afternoon. Depending on their age let them be involved in creating the schedule. Have the schedule hanging up where they can see it and mark items off as you go to show they have been completed. If your child is younger, use a picture schedule. Knowing what activity is coming next and what to expect gives your child a sense of control over their day.

Heavy Work

Activities that target the proprioceptive sense are referred to as “heavy work.” Receptors for this sense are located in the muscle and joints and are stimulated through activities that cause pressure or use arms and legs to push/pull, lift, hang and jump. Participation in heavy work has shown to improve attention and regulate arousal level. Having your child do heavy work right before sitting down for schoolwork (or taking breaks during) can be beneficial for learning and focus. Some ideas for heavy work activities are listed below!

  • Animal Walks (crab crawl, bear crawl, bunny hops)
  • Wall Pushups
  • Roll an exercise ball or weighted ball over their body
  • Hang from Monkey Bars or climb on playground equipment
  • Push/Pull a heavy box or laundry basket

Have a clear Start and End point

If you schedule 30 minutes of schoolwork after breakfast, have a clear start and end time for your child. For older children, you can simply say “We will do your schoolwork from 9:00-9:30” and have a clock visible. For younger children, a visual timer with light and/or sound cues can be helpful such as the one linked here. Knowing when the task will end and how much time is left can help your child focus and stay on task. Be careful not to schedule too much time for one schoolwork session. If you find your child getting frustrated and distracted after 15 minutes, schedule a break after 15 minutes for the following day.  The goal is for your child to be successful in that period of time.

Give Choices

Just like adults, children get upset and frustrated when they feel out of control. Giving your child some choices allows them some sense of control over their day.  However, too many choices at once can be overwhelming.   For young children, offer 2 specific choices, both of which have been approved by you.  Language like “this or that” is a good way to present the choices. Some examples for applying this to school work are listed below:

  • Would you like to read this book or that book?
  • Do you want to use the red pencil or the blue pencil to draw shapes?
  • Would you like to write about planes or dinosaurs?
  • Would you like to sit at the table or the counter to do your work today?
  • Do you want to try 2 or 3 math problems today?

Introduce Coping Strategies

Identifying emotions and knowing how to cope with them is not an easy task for your little one. Self regulation is something that is learned over time, and your child needs your help in knowing what works and what doesn’t. When you see your child getting frustrated or upset during schoolwork, help them identify the emotion they are feeling and offer a coping strategy to try. For example, “I see you are getting frustrated while doing your math work, why don’t you take some deep breaths and drink some water and we will start again in 2 minutes.” By offering different coping strategies each time, you and your child will begin to see what works for them. What works for one child won’t necessarily work for another. Some examples of coping strategies for children are listed below.

  • Find a quiet place to be alone
  • Blow bubbles (Deep breathing)
  • Listen to music
  • Name the emotion you are feeling
  • Drink water
  • Draw a picture
  • Bear hugs
  • Exercise
  • Yoga cards
  • Squeeze a ball as hard as you can
  • Go outside
  • Run around the room 3 times
  • Count to 10

Learn more about the Pediatric Occupational Therapist behind this article, Kelsey Sharp, OT.