When Hip Pain Turns Into Parkinson’s Disease

Received a referral from an orthopod for home physical therapy to see a client who had fallen at home. She had both hips replaced in the last few years. The referral said “Left Hip Pain. Eval and Treat.” I figured I was walking into a situation of someone who had a painful left hip…possible hip contusion…probably would need a home safety assessment, some ice/heat, massage, gentle stretching and move toward more aggressive strengthening and fall prevention strategies.

When I saw her, she could hardly move and was in a lot of pain from the most recent fall that occurred the night before. Pain not from her hip but instead her back and left rib area because of the latest fall. She could hardly move from the pain. I arranged for an x-ray for possible rib or spinal fractures. The  x-ray did show left side rib fractures.

But things still just didn’t add up. Her motor recruitment or muscle contractions were diminished generally…she couldn’t move as well as I would have expected. She had a scissoring gait pattern…walked kind of pigeon toed, slight resting tremor or shake on right forearm that was worse when stressed. When her physicians asked about it she told them “doctors make me nervous” and her dad had it too. Awgh! Essential tremor…maybe.  But the dulled emotional tone on her face…she didn’t laugh outwardly at my amazing jokes….bad sign! …and the akinesia…all those light postural adjustments and lack of head rotation to track me as I moved around the room as we continued our conversation. Hmm….

So, I prodded a little deeper. Reviewed her medications again…hmm…depakote, clonazepam… and about ten other meds including a narcotic for the pain. That explains it…or does it?

Time to call her primary care doctor. I hate this! Get put on hold, get screened, someone tries to decide if my information is worth putting “the man” on the phone with me.  I’ve done this before and learned the hard way. Don’t assume you know the “new and unknown diagnosis that will save the day!” Just ask questions and state your observations and concerns. Anticipate what they will ask you and have your responses ready. State objectively your findings, then ask a few questions of your own. Why is this sweet woman falling so often? Why is her motor pattern and response the way it is? Have you seen her get up in the office and walk across the room, moved her arms and felt her tone?…why no right arm swing when she walks at normal speed? Why no little postural adjustments that we all usually make all the time? Why does she not rotate her head and follow me as I move around her apartment?

It is very easy to get “tunnel visioned” into seeing what the referral script says…left hip pain.  But do I see the tree and miss the forest. A tree can tell you a lot, but step back and look at the forest…you may be surprised at the view.

This is one reason I love working as a home health physical therapist. I can make time to look at the tree and even step back and view the forest.

The Dementia Queen is in the House!

Sue Paul, The Dementia Queen

Let me take a moment to introduce you to the Dementia Queen!

The “Queen of Dementia” a.k.a.  Sue Paul has been the Chief Operating Officer of Baker Rehab Group since 2002.She has held certifications in geriatrics through the American Occupational Therapy Association and served as AOTA representative for the End of Life Practice Recommendations for the National Alzheimer’s Association in Washington D.C.  She is the author of the Head, Hands, Heart Dementia Assessment System, which is a healthcare provider tool for assessing and treating persons with dementia.

Check out her blog The Dementia Queen for insight into a segment of the population that is largely neglected by our healthcare system. As the body of knowledge pertaining to the causes, symptoms, and treatments of Alzheimer’s disease and other dementias evolve, Sue shares her findings in hopes that it helps someone, somewhere, who struggles with the challenges of Alzheimer’s.

January Spotlight on Excellence

Tracey Cannon, PT Team Leader

Many of you know her, many more of you should: This is Tracey Cannon, and she is this month’s Spotlight On Excellence physical therapist.

Tracey has worked for Baker Rehab Group for nearly ten years, honing her skills as the consummate geriatric physical therapist.

Tracey’s primary clinical focus is on treating patients with Alzheimer’s disease and other dementias, balance problems, and deconditioning due to hospitalization or illness.

Tracey has been an invaluable part of the Baker Rehab team, overseeing physical therapy assistants and general operations of five assisted living facilities in Frederick and Washington counties. She has been an instrumental leader in staff training and implementation of the BalanceWorks program.

BalanceWorks is a unique fall prevention program offered by BRG that utilizes a variety of standardized tests to assess balance and fall risk in the geriatric population. Based on patient findings, individualized treatment plans and outcome measures are presented both at the initial evaluation and at the completion of the treatment program to demonstrate the response to the skilled interventions provided to the patient. Tracey’s dedication to the program and excellent leadership skills were an integral part of BRG’s first continuing education class provided to our therapists, as Tracey sought and received approval for continuation education credit for all physical therapists in attendance. She expertly delivered nine contact hours of instruction for assessing and treating balance dysfunction.

Because of Tracey’s obvious commitment to excellence, and because of her contagiously positive attitude, Tracey was BRG’s 2011 Sunshine Award recipient. She also managed to find the time- between juggling her fulltime job, two kids, and a sweet husband- to travel to South America on a medical mission trip for a week this fall. We all admire her generosity with her time and talents.

Baker Rehab Group is so proud to have Tracey as part of our leadership team. In her own words, “What I like best about my job is that I get to help people at a point in their lives when it appears on the surface that nothing more can be done. I get to be creative and find ways to improve their situation for added safety and quality of life.”

Well said, Tracey. And thanks again for all you do!

If you’d like more information about our BalanceWorks Program, please send us an email to info@bakerrehabgroup.com.

Senior Focused Clinic??? A Gimic?

Seniors do have special concerns that a clinic needs to respond to for the senior to benefit to their fullest. I remember 20 years ago workings at Frederick Memorial Hospital, when there still weren’t any separate off campus rehab clinics and we serviced the outpatient clients in house.
I remember working with folks with dementia for about a 20-30 minute session hands on, then give them things to work on, usually with exercises written with pictures to follow along with while I moved to the next client. I would periodically come back and check on them and I could still visually see them while working with another client.
What I noticed over and over again, unless they had a caregiver to guide them through the practice or had an assistant work directly with them, they were distracted, didn’t really do what I wanted them to do, and eventually just stopped and watched all the activities in the clinic. They were a “kid in a candy store” with too much to see. If they were in later stages of dementia, then they usually picked at something in their immediate surroundings…a piece of lint a or spot on the treatment table…anything close in distracted them. They weren’t getting their monies worth. Clearly not ideal!
So, what’s a better set up? These folks need one on one therapy with an environment that is low on distractions. Home may be an ideal place to treat them or a clinic that isn’t noisy and has a lot going on so they can focus on what they are needing to accomplish.
REMEMBER, that is why we set up our clinic the way we did at Edenton Retirement Center off Crestwood Blvd. So, if this type of set up is ideal for your client, give us a call! Amy Clouser, PT is waiting to see your client and give senior oriented one on one care in a low distracting environment.

Will We Survive All the Home Health Changes?

I recently had a conversation with a therapist who was frustrated and worn out from all the changes that occur in home health and was thinking about switching to an outpatient clinic-based or skilled nursing facility environment for “consistency and ease of mind.”

We discussed the recent reassessment requirement, cuts in reimbursement, and increased documentation requirements that are occurring in home health. I tried to help her see this is just one component of a universal “sea change” that is in the early phases and is by no way unique to home health. It is occurring throughout the industry. How we deliver and “do healthcare now” will be very different from how we will deliver it in 5-7 years from now. Change is inevitable.

Theologians and psychologists alike will all tell us that “how we approach change” will often determine how successful we will be in adapting to the new healthcare system beginning to emerge.

I was reading a Parkinson’s study that correlated the clinical outcomes with attitude and willingness to accept change. As one might expect, those patients who approached change with a positive attitude had better clinical outcomes and lower stress levels.

What a great reminder for the importance of being willing to adapt to change in our own profession.

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Dr. John Baker | CEO, PT, MA, GCS, NCS, NDT, DScPT
To learn more visit www.BakerRehabGroup.com or call  1.866.727.3422
Twitter | @BakerRehabGroup
Facebook | www.facebook.com/BakerRehabGroup

Prehab…A Matter of Life or Death?

Last Sunday I attended a memorial service for a frail elderly woman from my church community who had fallen while exiting the service two weeks ago and fractured her pelvis. She was admitted to the hospital and one week into her hospital stay, had a myocardial infarct and died. This scenario is all too familiar to those of us in healthcare and particularly rehab. She survived the fracture but her body wasn’t strong enough to handle all the added stresses of a typical hospitalization…something will fail.

Since 2004, the data has been streaming in on the benefits from a Prehab program to prepare seniors for a joint replacement. This is especially striking for frail elderly and those with other co-mobidities like diabetes, heart disease or lung disease. Research clearly demonstrates all the outcomes…strength, pain level, range of motion, speed of return to independent living, patient satisfaction, lower infection rate and readmits are improve when the client is physically and mentally ready. Research also shows that elderly clients, especially those with other medical issues, also benefit from Prehab therapy programs.

This data supports the need for wellness programs that promote strengthening, endurance, flexibility, and healthy lifestyles for all seniors, especially the frail elderly.

Who should you talk to today to help them prevent or survive their next fall?

Two Big Events

Hi Folks,

Last Friday, HomeCare Rehab and Nursing, LLC celebrated two important milestones. Firstly, we rolled out our new “Baker Rehab Group” dba name change and our new website www.BakerRehabGroup.com went live!  This was accompanied by a new Facebook page and Twitter handle… so make sure you’re following us!

The other big event event took place the same day.  We conducted our first approved continuing education course for physical therapists and physical therapy assistants (9 hours of ceu training) on utilizing our own BalanceWorks Fall Prevention and Assessment System. This was very intentional timing in that Friday September 23, 2011 is National Fall Prevention Awareness Day. Our goal is to make sure what we are doing in clinical practice to address fall prevention is based on “best practice guidelines” and can objectively be quantified through tests that have a high degree of reliability and validity.  The feedback from our therapists was very positive, and Tracey Cannon PT did a fantastic job presenting a ton of material in an engaging and dynamic way.

On that note…

Falls are a BIG problem! According to the Centers for Disease Control and Prevention one out of three adults age 65 and older fall each year and among this group, falls are the leading cause of injury death. In 2008, almost 20,000 older adults died from unintentional fall injuries in the US, and this is a sharp rise over the last decade. The CDC estimates that about $30 billion this year will be spent on direct medical costs from falls.

We are serious about changing these trends and doing what we can to keep seniors healthy and fall free. We will be providing free physical therapy screenings related to strength, mobility, and balance deficits at Edenton Retirement Community in Frederick, MD on Friday September 23rd.  We will also be providing low vision screenings and scheduling home safety assessments on site.  Please join us from 10 am to 12 pm.

Check out this web link on ways older adults can prevent falls.

http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Am I crazy or what?

Physical therapist heads profession’s Md. board
Originally published August 07, 2011

By Ed Waters Jr.
Frederick News-Post Staff

A Frederick physical therapist has been elected to the prestigious position of chairman of the Maryland Physical Therapy Board of Examiners.

John Baker, CEO of Baker Rehab Group, formerly HomeCare Rehab and Nursing, was elected by the other seven members of the board to serve a one-year term as chairman.

The board oversees the physical therapy profession in Maryland, including licensing, regulation and disciplining in the case of problems.

Baker, who balances his new position with his full-time business, holds professional degrees including a doctorate of science in physical therapy. A physical therapist for more than 20 years, he has been advocate for the profession and was named to the eight-member board of examiners 2 1/2 years ago. That appointment, by the governor, is for four years and can be extended another four years.

The board, made up of five physical therapists, a physical therapist assistant and consumers, is dedicated to making sure the public is protected, Baker said.

“I was a bit surprised at being elected as chairman,” Baker said, noting that most of the chairmen in the past have been from the larger metropolitan hospitals or health care systems.

“Maryland has historically taken a lead in the nation for its PT board,” Baker said during an interview at Edenton, a retirement and assisted living community in Frederick. Edenton has a senior-focused outpatient rehabilitation clinic that serves not only Edenton residents but also anyone in the county who needs physical therapy and wellness care.

“Maryland was the first board to authorize direct access, in 1987, that said a patient does not need a physician’s order to get physical therapy,” Baker said. “We are the first state to allow ‘dry needling,’” Baker said, which is used to reduce pain in muscles, but has a different approach than acupuncture.

The board has investigators, attorneys and an assistant attorney general to provide services and counsel.

Complaints, Baker said, include a patient who claims “crossing boundaries,” such as a physical therapist who makes sexual or other inappropriate contact, fraud or other issues.

Many times, the complaint can be settled with a letter from the board, Baker said. But if it warrants investigation and a potential problem is seen, several steps are taken, Baker said.

“The first step is an informal talk with the physical therapist,” Baker said. If that doesn’t work, the next move is a case resolution conference. That is something that could go to trial, but also could be settled among those involved and legal counsel.

“Aggressive issues that are serious to public protection would go to court,” Baker said.

That could result in the potential revocation of a license.

Physical therapy is evolving, Baker said. Although the physical therapy board has an excellent reputation for working with other boards in the state, Baker said there can be potential conflicts. Allowing a physical therapist to check the blood sugar of a diabetic while at their home or other location might upset the home care nursing profession, but it better serves patients in the long run, Baker said.

Baker speaks to the doctoral graduates at area colleges in physical therapy. “I tell them how to make sure they don’t come before our board” with problems, Baker said.

His goals are to ensure access to the board by the public, resolve issues quickly and look at residents of Maryland as “customers” who needed to be served in the most cost-efficient, professional and correct way.