Category Archives: Neurological Rehab

PT News March 2019

March 27, 2019 Teresa Stockton - Arm, Blog, Hand, Neurological Rehab

This time in PT News we recap what our clinics have been posting throughout March 2019. We are excited to begin a new year of new posts featuring published articles from PTandMe partnering clinics!

1. What Triggers Trigger Finger?
Written by Rebound Physical Therapy with physical therapy locations throughout Bend, OR and the surrounding areas.

Trigger Finger seems to be a diagnosis many people are familiar with but not actually sure what the diagnosis entails and what can be done to prevent or treat it. Read more

2. Patient Regains Use of Arm After Biceps Tear Surgery
Written by the Therapy Team at Ability Rehabilitation with multiple physical therapy locations throughout Central Florida.

After his biceps tendon repair surgery, Rob’s right arm was in a fragile state; it was locked at the elbow and Rob was fearful of moving it and causing further injury. Read more

3. Physical Therapists Undergo Pain Neuroscience Education
Written by the physical therapy team at ARC Physical Therapy+ with locations across Kansas, Missouri and Iowa.

Evidence has shown that neuroscience educational strategies focused on teaching people in pain more about the biological and physiological processes involved in their pain experience, changes patient beliefs regarding their pain, thus reducing the threat of pain. Read more

Postural Hypotension: What It Is and How to Manage It

August 1, 2017 Teresa Stockton - Balance & Vestibular Rehab, Blog, Neurological Rehab

Postural hypotension (or orthostatic hypotension) is when your blood pressure drops when you go from lying down to sitting up or from sitting to standing. When your blood pressure drops, less blood can go to your organs and muscles. This can make you likely to fall.

What are the symptoms?
Although many people with postural hypotension have no symptoms, others do. These symptoms can differ from person to person and may include:

Dizziness or lightheadedness
Feeling about to faint, passing out or falling
Headaches, blurry or tunnel vision
Feeling vague or muddled
Feeling pressure across the back of your shoulders or neck
Feeling nauseous or hot and clammy
Weakness or fatigue

When do symptoms tend to happen?
When standing or sitting up suddenly

In the morning when blood pressure is naturally lower
After a large meal or alcohol
During exercise
When straining on the toilet
When you are ill
If you become anxious or panicky

What causes postural hypotension?
Postural hypotension may be caused by or linked to:

High blood pressure
Diabetes, heart failure, atherosclerosis or hardening of the arteries
Taking some diuretics, antidepressants or medicines to lower blood pressure
Neurological conditions like Parkinson’s disease and some types of dementia
Dehydration
Vitamin B12 deficiency or anemia
Alcoholism
Prolonged bed rest

What can I do to manage my postural hypotension?

Tell your healthcare provider about any symptoms
Ask if any of your medicines should be reduced or stopped
Get out of bed slowly. First sit up, then sit on the side of the bed, then stand up
Take your time when changing position, such as when getting up from a chair
Try to sit down when washing, showering, dressing or working in the kitchen
Exercise gently before getting up (move your feet up and down and clench and unclench your hands) or after standing (march in place)
Make sure you have something to hold onto when you stand up
Do not walk if you feel dizzy
Drink 6-8 glasses of water or low-calorie drinks each day, unless you have been told to limit your fluid intake
Avoid taking very hot baths or showers
Try sleeping with extra pillows to raise your head

This information was written by Proactive Physical Therapy, an outpatient physical therapy clinic in Sioux Falls, South Dakota. At ProActive Physical Therapy, their number one priority is the patient. They strive to provide individualized treatment with hands-on, compassionate care. They do not rush their patients or their clinicians. Rather, they perform comprehensive evaluations and encourage patient input for treatment planning and goal setting. For more information click here.

Long Work Hours May Increase Risk of Stroke

April 14, 2016 Teresa Stockton - Blog, Neurological Rehab

Stroke is a brain injury caused by an interruption in blood flow. It is a leading cause of death in the US, and can also cause disability, decreased quality of life and increased healthcare expenses. There are many lifestyle factors that affect you risk of stroke including diet, exercise, smoking and stress. Other lifestyle habits like long periods of standing or long work hours are also being reviewed for their impact on stroke risk.

Earlier research has suggested that long working hours may be linked to stroke, but the evidence is limited. Researchers wanted to determine if there was a possible connection between long work hours and the risk of stroke. The study, published in Lancet, found that employees who work long hours have a higher risk of stroke than those who do not.

About the Study
The systematic review of observational studies included 528,908 men and women from Europe, the U.S. and Australia who were free from history of stroke at the beginning of the study. The participants volunteered their work hours and were tracked for the development of stroke. During an average 7.2 year follow up there were 1,722 stroke-related events.

Compared to those who worked standard hours (35-40 hours/week), participants who worked 49-54 and more than 55 hours a week had an increased risk of stroke.

The effects remained apparent even when other stroke factors like age, sex and health history were accounted for.

How Does This Affect You?
A systematic review pools a large number of trials to create a larger pool of data. The larger the pool of data, the more reliable outcomes are. However, the review is only as reliable as the trials that are included. The included studies were all observational studies which means a direct cause and effect link could not be established and the studies can only show a potential link between factors.

There is a reasonable link between extra work hours and stroke since longer hours are often associated with extra stress and less relaxation time. If you have long work hours, you may want to talk to your doctor about your personal risk factors for stroke and follow other stroke prevention methods such as:
• Exercising regularly
• Maintaining a healthy weight
• Eating more fruits, vegetables and whole grains and limiting dietary salt and fat
• If you smoke, talking to your doctor about way to quit
• Increasing your consumption of fish
• Drinking alcohol in moderation
• Managing chronic medical conditions, such as high blood pressure, high cholesterol and diabetes

Rehabilitation doesn’t reverse the effects of a stroke. Its goals are to build your strength, capability and confidence so you can continue your daily activities despite the effects of your stroke.

What is a Stroke?
A stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States.

• A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die.

What are the Effects of Stroke?
The brain is an extremely complex organ that controls various body functions. If a stroke occurs and blood flow can’t reach the region that controls a particular body function, that part of the body won’t work as it should. Rehabilitation is probably one of the most important phases of recovery for many stroke survivors. The effects of stroke may mean that you must change, relearn or redefine how you live. Stroke rehabilitation helps you return to independent living.

Rehabilitation doesn’t reverse the effects of a stroke. Its goals are to build your strength, capability and confidence so you can continue your daily activities despite the effects of your stroke.

What Will I Do in Rehabilitation?
What you do in rehabilitation depends on what you need to become independent. You may work to improve your independence in many areas. These include:
• Self-care skills such as feeding, grooming, bathing, toileting and dressing
• Mobility skills such as transferring, walking or self-propelling a wheelchair
• Communication skills in speech and language
• Cognitive skills such as memory or problem solving
• Social skills for interacting with other people

by Cynthia M. Johnson, MA

RESOURCES:

Family Doctor—American Academy of Family Physicians
http://familydoctor.org

American Stroke Association
http://www.strokeassociation.org

Kivimäki M, Jokela M, et al. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet. 2015 Oct 31;386(10005):1739-1746. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960295-1/fulltext. Accessed January 19, 2016.

Risk factors for stroke or transient ischemic attack. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 28, 2015. Accessed January 19, 2016.

Last reviewed January 2016 by Michael Woods, MD

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

Parkinson’s Relief

February 23, 2016 Teresa Stockton - Aging, Blog, Neurological Rehab

The four primary symptoms of Parkinson’s Disease (PD) are:
1.) Tremor, or trembling in hands, arms, legs, jaw, and face
2.) Rigidity, or stiffness of the limbs and trunk
3.) Bradykinesia, or slowness of movement
4.) Postural instability, or impaired balance and coordination

Parkinson’s disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50. 1

Should I exercise?
Research has shown that regular exercise benefits people with Parkinson’s disease. Exercise reduces stiffness and improves mobility, posture, balance and gait. Aerobic exercise increases oxygen delivery and neurotransmitters to keep our heart, lungs, and nervous system healthy. General exercise may also reduce depression. Learning-based memory exercises can also help keep our memory sharp.

What types of exercise are best for people with Parkinson’s disease?
Exercise programs that challenge our heart and our lungs as well as promote good biomechanics, good posture, trunk rotation and normal rhythmic, symmetric movements are the best. Exercises that promote attention and learning are also extremely beneficial.

What types of exercises do this? Exercises that require balance and preparatory adjustment of the body. Walking outside or in a mall, dancing, yoga classes, Tai Chi classes, stepping over obstacles, marching to music with big arm swings as well as participating in sports (ping pong, golf, tennis, volleyball) and aerobic or jazzercise classes promote motor learning.

When should I request a referral for Physical Therapy?
When first diagnosed, all patients should have a consultation with a physical therapist to define the appropriate exercise program tailored to “you”. This will also establish a baseline of your current physical status. Ideally, all patients with PD should have a good fitness program as well as specific exercises to maintain good posture and balance as well as improve symmetry in flexibility and strength. The therapist will also work on improving gait while using visual and auditory cues.

In some cases, where balance or musculoskeletal problems develop, supervised outpatient treatments a few times per week may be helpful. A program of individualized exercises addressing posture, balance and gait has been shown to be beneficial in decreasing the risk of falling. In every case, a regular home program of exercise is critical. 2

1. National Institute of Neurological Disorders & Stroke https://www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page

2. Parkinson’s Disease Clinic & Research Center http://pdcenter.neurology.ucsf.edu/