New Seminar Announced: Managing Difficult Behaviors

This three-hour behavior strategy intensive is designed to give clinicians methods to use with children who present various difficult behaviors during treatment sessions. The speaker will explain and demonstrate techniques to uncover the underlying motivation for behavior (such as boredom, embarrassment, lack of motivation,etc.).

To gain free entry into these events, sign on with Therapeutic Resources for the Department of Education Bid. To sign on with Therapeutic Resources, please call Wendy Toussaint at 212.529.9780.  If you have already signed on and want to register for this course, please contact Angelina Conti at 212.589.1205. 

Learn more about the conference or register here.

In the Brain, Signs of Autism as Early as 6 Months Old

Measuring brain activity in infants as young as six months may help to predict the future development of autism symptoms.

Research conducted at the Centre for Brain and Cognitive Development, Birkbeck, University of London, and published in the January edition of Current Biology, shows that in their first year of life, babies who will go on to develop autism already show different brain responses when someone looks at them or away.

"The study is only a first step toward earlier diagnosis, but our findings demonstrate for the first time that direct measures of brain functioning during the first year of life associate with a later diagnosis of autism -- well before the emergence of behavioural symptoms," said Professor Mark Johnson, MRC scientist and head of the Centre for Brain and Cognitive Development at Birkbeck.

The behaviours characteristic of autism emerge over the first few years of life and firm diagnoses are currently made in children only after the age of two. Professor Johnson's team looked to six- to ten-month-old babies at greater risk of developing autism because they had an older brother or sister with the condition. They placed passive sensors on the scalp to register brain activity while the babies viewed faces that switched from looking at them to looking away from them or vice versa.

The human brain shows characteristic patterns of activity in response to eye contact with another person, and that response is a critical foundation for face-to-face social interactions. Older children diagnosed with autism show unusual patterns of eye contact and of brain responses to social interactions that involve eye contact.

The new studies reveal that the brains of infants who will go on to develop autism already process social information in a different way. "At this age, no behavioural markers of autism are yet evident, and so measurements of brain function may be a more sensitive indicator of risk," Professor Johnson said.

However, in the study some babies who showed these differences in brain function were not later diagnosed and vice versa. The method will need refining, most likely in combination with other factors, if it is to form the basis of a predictor accurate enough for clinical use in the general population.

The study was co-led by Professor Tony Charman of the Centre for Research in Autism and Education at the Institute of Education, and was funded by the UK Medical Research Council and the BASIS funding consortium led by Autistica.

Professor Christopher Kennard, Chair of the MRC's Neuroscience and Mental Health funding board said: "This is a very interesting study which suggests that early signs of brain responses to eye contact can contribute to an earlier diagnosis for children at high risk of autism; crucial for ensuring that they receive appropriate care. An investment like this can improve our understanding of the basis of autism, which hopefully will lead to new ways of treating those affected in the future and so dramatically affect the quality of life for patients and their families."

(Source: sciencedaily.com)

App Thursday: iPad2 video Mirroring, Verbally & Speech Trainer App Demo

Geekslp.com talks about using video mirroring on the ipad 2 and also demos Speech Trainer

For more information on Verbally you can visit their website: http://www.verballyapp.com/

Our Subacute and Long Term Care Council Meeting Is Here!

We are pleased to announce that our next Subacute and Long Term Care Council Meeting has been announced:  March 15th, 2012

Our topic is Integrating Rehab Software and Electronic Medical Records for Rehab Success.  With mandates to establish electronic medical records impacting all long term care facilities, rehab managers are being challenged to identify   rehabilitation software which can be integrated into the facility’s selected EMR system.  

Rehabilitation software provides managers with a sophisticated management tool which tracks reimbursement data and measures revenue generating trends while providing treating therapists with a powerful  documentation tool.  This session provides a demonstration of the power of Cassamba, a leading software provider who is currently working on integrating their software with the most widely used electronic medical records systems. A Cassamba software representative will present an overview of its management and documentation functionality, followed by a group discussion.

The event will be taking place at the Adria Hotel and Conference Center in Bayside, NY.   Registration is free to all Long Term Care Directors, Department Heads and OT, PT, and SLP Supervisors.


Register here! 

Talking Up Speech Language Pathology

After decades of quietly operating in their field, speech language pathologists are now making their voices heard in skilled nursing and rehab. No longer are they simply “speech therapists” — their profession has elevated itself to Speech Language Pathologist, complete with SLP initials.

Once referred to as “speech teachers” who worked predominantly in the school systems, an SLP is now found in many different medical practice settings: acute care, inpatient and outpatient rehab hospitals, long-term care facilities, assisted living and independent living centers, as well as the home health environment. Today, SLPs are an integral part of interdisciplinary teams across all practice settings, and vigorous demand for their services is fueling a surge in their numbers.

“The role of the SLP in long-term care has certainly gained more credibility and respect in recent years,” notes Ken Scholten, president of Agility Health. “The role of the SLP has evolved significantly, with an increase in education, treatment efficacy data and advocacy regarding the scope of practice, particularly with regard to the impact SLP services can have on the elderly and individuals with dementia.”

A decade of differenceTen years ago, Scholten says, one SLP would typically cover four buildings in long-term care. The SLP would go to each building, each day, and typically see two or three patients for 30 minutes for dysphagia treatment.

“It was not unusual to have a week with less than full-time hours,” he said. “SLPs now see a caseload requiring the services of at least one full-time SLP within a facility, if not more.”

“We are in a good place because there are a number of improvements and advances that have fundamentally enabled us to see patients in the acute phase of their speech condition. With early diagnosis, we have the opportunity to provide improved patient outcomes,” says Martha Schram, president of Aegis Therapies.

Yet even as the profession's overall state of speech pathology stock has risen in clinical circles, the role of the SLP is still misunderstood, says Erin Knoepfel, director of SLP clinical services for Genesis Rehab Services.

“There is often a misperception of what we do in the rehab setting. Typically. we are referred to as speech therapists, but that title is very misleading and does not represent our broad scope of practice,” she says.
“In the rehab setting, many people are aware of our knowledge and skill in the area of swallowing and swallowing disorders but do not realize that we also assess and provide therapeutic interventions to address receptive and expressive communication disorders, cognitive-communication disorders and speech impairments due to various types of medical conditions and disorders.”

SLPs also are responsible for the provision of therapeutic services to establish a communication system for patients with hearing impairments, and for those requiring alternative and augmentative communication systems, she adds.

From an industry-wide perspective, speech language pathology has experienced significant expansion and growth in the past 10 to 15 years. In particular, Schram says speech language pathology has become a much larger component of her company's long-term care services.

“Historically, SLP was thought of as a service provided primarily to the pediatric patient population and was isolated to language or speech impediments in school-age children,” she says. “Today, speech pathology is frequently administered to an aging population and includes some physical treatment such as in the case of dysphagia, which afflicts about 80% of the patient base.”

Dysphagia and dementia:To be sure, dysphagia's impact on healthcare economics, quality of life and caregiver burden is significant. SLPs play a primary role in the evaluation and treatment of adults with swallowing disorders, notes Ethel Coppa, director of SLP clinical services for Fox Rehabilitation.

“Given the high incidence and prevalence of dysphagia and the potentially severe and even fatal consequences, appropriate diagnosis and management of swallowing is critical,” she said. “SLPs are knowledgeable about both normal and abnormal anatomy, physiology, and neurophysiology of the tracts responsible for respiration, swallowing and speech. Both their educational and clinical background allows them to assume a variety of roles with expertise related to the evaluation and treatment of those with swallowing disorders.”

People with dementia-associated communication problems are the SLP profession's fastest-growing clinical population, Coppa noted, with an estimated 4.5 million Americans currently diagnosed with Alzheimer's disease.

That incidence is projected to rise to between 11.3 and 16 million by the end of 2050. These projections make it “crucial that appropriate assessments and interventions are implemented and carried through with caregiver education,” she said.

Schram says her firm is seeing more patients with dementia and has “more therapies” available to treat a wider range of patients.

Agility's Scholten also acknowledges the dementia growth and says that speech therapy will increasingly be made available in the residential setting.

“With the continued rise of the eldest of the elderly returning home, the length of rehab therapy stays declining and an increasing demand for rehab within their own environment, there will be much higher demand for homecare SLPs and an SLP specialty area in dementia,” he says.

Technology advances:From an SLP's standpoint, technology has made the day-to-day evaluation and treatment of patients easier, observes Carol Winchester, vice president of BEST Dysphagia Management Services.

“Whether it is a quick review of a standardized assessment on the Internet, ‘Googling' a diagnosis that may be new or an online literature review, today's SLPs have a wealth of information at their fingertips,” she says. “Diagnostic capabilities have blossomed with advancements in dysphagia diagnosis with the ability to perform the [fiberoptic endoscopic evaluation of swallowing] test at bedside.

“With the bedside endoscopic swallowing test formerly requiring more than 50 pounds of equipment being carted to the bedside, technology has reduced the equipment needed to that which can fit into a small laptop bag. This allows the test to be performed by a certified SLP in virtually any setting,” she says.

Gail Johnson, director of clinical practice and training for SunDance Rehabilitation, adds that as technology advancements continue to enhance rehabilitation opportunities, “one can imagine possibilities for improved communication with families at a distance through Skype or I-Chat, the ability to share test results and progress immediately during the chat, or the potential to have access to an off-site physician for consultation.”

Booming clientele:A burgeoning geriatric population, combined with breakthroughs in technology and clinical knowledge, have ensured that speech pathology will continue to grow in importance going forward, professionals say. In Johnson's view, the future of rehabilitation lies in the area of clinical outcomes, with the focus “on a rehabilitation team to provide functional therapy that will have a meaningful, measurable result for the patient.”

To be sure, there has been increasing focus on the need to obtain objective measures “not only during the initial assessment, but also during treatment sessions to quantify progress,” Knoepfel says. There is currently an increase in the development and research in the use of equipment such as the Iowa Oral Performance Instrument, Vital Stim/Neuromuscular Electrical Stimulation, and surface Electromyography (sEMG) Biofeedback units to measure progress in SLP practice areas, she explains.

“There is also an increased focus on obtaining outcome measures to show the amount of progress achieved following active SLP services,” she says. “By implementing these types of measures, there will be more consistency established between the number of treatment sessions needed to address clinical conditions.”
Schram is interested to see if Medicare will one day cover speech language pathologist assistants.

“As ‘therapist supply' becomes more challenging, beneficiary access to needed care may be an impetus for Medicare to consider this in the same manner as they have for occupational and physical therapists,” she explains. “That is likely something in the far distant future in long-term care, but something we can hope to see as a consideration.”

(Source:  mcknights.com)

Job Spotlight - 1/31/12

Early Intervention: Meet and exceed milestones!
    Work in a variety of environments and use your clinical skills to help babies!
    EI placements are opportunities for fulfilling, varied cases.  No two days will be the same.
    Therapeutic Resources offers free continuing education classes to our providers so they they can, enhance their knowledge, master their clinical skills, and network with other therapists in the field.
    We have cases in Queens, Manhattan, Brooklyn, and the Bronx for OTs, PTs, and SLPs. 

    Pick your schedule, location, and population, and Therapeutic Resources will show you how easy it is to have it all!  Contact us at 212.529.9780 or email info@therapeuticresource.com

Full time opportunities are also posted on www.therapeuticresource.com.

Muscle Endurance Tests Can Detect Abnormalities In The Early Stages of Multiple Sclerosis

Multiple sclerosis (MS), a neurodegenerative disease, causes periodic attacks of neurologic symptoms such as limb weakness and mobility defects. And while MS patients' walking abilities and muscle strength are examined on a regular basis, doctors have yet to determine when the lower limb muscles begin to deteriorate. That's important because with earlier identification of mobility problems, doctors would be able to implement early intervention programs that could make all the difference for those with MS.

Now, Dr. Alon Kalron and his fellow researchers from Tel Aviv University's Sackler Faculty of Medicine and the Multiple Sclerosis Centre in Sheba Medical Center, Tel-Hashomer, have discovered that specific laboratory tests for leg muscle endurance and gait - the pattern of movement while walking or running - are highly effective in identifying mobility deficits at the initial stage of MS. These deficits are difficult to discover during standard neurological testing.

According to Dr. Kalron, who was supervised by Profs. Anat Achiron and Zeevi Dvir, patients in the early stages of MS had 40 percent less muscle endurance compared to their healthy counterparts. Additionally, distinct abnormalities were observed in their walking patterns. The study, which was published in the Journal of Neurologic Physiotherapy, could help researchers understand the mechanisms underlying the evolution of MS, and improve the management of patients afflicted with the disease.

One step at a time

Reduced muscle endurance may be one of the earliest signs of MS and is a common complaint among patients, but it is hard to detect, says Dr. Kalron. In order to quantify muscle fatigue, the researchers conducted a study that included 52 patients in the early stage of MS, and a control group of 28 healthy subjects.

Participants were examined using an isokinetic dynamometer, a special instrument for measuring lower limb muscle strength and endurance. They were asked to attempt to bend or straighten a knee exerting maximum effort, and maintain this position for 30 seconds. Muscle fatigue was calculated by measuring the decline in muscle strength during that period. On average, those in the early stages of MS were not able to maintain their strength - they demonstrated 40 percent less endurance compared to the healthy control group.

In addition, patients' gait was observed for factors such as how far a patient spreads his legs while walking, the length of their steps, and symmetry of movement. By examining walking patterns, the researchers discovered specific abnormalities in the MS group. Patients in the early stages of MS "tend to walk with a wider base, because walking with your legs further apart helps to improve stability. It's probably a compensation strategy due to the lower muscle endurance," explains Dr. Kalron. The participants in the MS group also walked more slowly, in an asymmetrical pattern with shorter steps.

Giving physical therapy a head start

Clinicians should be more aware of possible gait and lower limb muscle deficits very early in the disease process, especially because minor impairments are difficult to detect with regular neurological examinations. "The downside of detecting such deficits using advanced instruments is offset by the positive potential of early intervention programs," suggests Dr. Kalron. "If we find the abnormalities earlier, then we can start intervention programs when they have a chance to benefit the most." Programs based around physical therapy and fitness can help MS patients maintain higher levels of muscle endurance and improve balance, holding off the fatigue that typically accompanies the disease.

(Source:medicalnewstoday.com)

Sensory-enhanced hatha yoga can help manage battlefield stress

A program of sensory-enhanced hatha yoga can help reduce anxiety in deployed military personnel, according to a study published in the January/February issue of the American Journal of Occupational Therapy.

Researchers found the yoga program led to decreases in the anxiety levels of study participants and increased their self-reported quality of life. Yoga participants also reported other benefits: 54% said they were better able to sleep even with ongoing disruptions such as gunfire, helicopters and generators; 37% reported feeling more calm; 26% reported other physical benefits; and 11% said they experienced reduced frustration and anger or better anger management.

Seventy deployed military personnel at the Forward Operating Base Warrior, Kirkuk, Iraq, took part in the study. The participants were divided into control and yoga therapy groups, and their anxiety levels were measured using the Adolescent/Adult Sensory Profile, State-Trait Anxiety Inventory and the Quality of Life Survey.

The sensory-enhanced hatha yoga treatment was scheduled in 75-minute classes, seven days a week, for three weeks. Participants in the treatment group were to attend a minimum of two classes a week and a total of nine during the entire study period. Classes were taught by certified yoga instructor U.S. Air Force Maj. Jon H. Greuel, MHR, RYT, the study's principal investigator, who rigidly followed the "Yoga Warrior Lesson Plan" co-created by Carolyn C. Stoller, OTR/L, MS, RYT, and Lucy S. Cimini, RYT, founding director of Yoga Warriors International. This plan included initial centering, pranayama techniques, asanas, meditation and final relaxation, designed to enhance proprioceptive input and deep touch pressure, and calm breathing and the nervous system. Props such as straps and wooden blocks were used to increase proprioceptive input and deep touch pressure. Zen meditation music was used to decrease distraction from gunfire, generators and helicopters during classes. Military personnel in the control group did not attend any yoga classes during the study.

For state anxiety, the yoga treatment group showed a mean decrease of 8.23 compared with the control group, who reported a mean increase of 1.38. Similar results were found for trait anxiety, with the yoga group showing a mean decrease of 6.86, and the control group a mean increase of 1.21. Yoga participants also showed significantly greater improvement on 16 of the 18 factors in the Quality of Life Survey than control participants.

According to the researchers, study results validate the use of sensory-enhanced hatha yoga by occupational therapists to help reduce hyperarousal and improve self-regulation in adults. They also point out the treatment shows promise in addressing symptoms of post-traumatic stress disorder before they turn into full-blown PTSD, and proactive use may prevent the onset of PTSD-associated occupational dysfunction.

(Source:  todayinot.com)