The Therapeutic Resources Blog

Subacute/Long Term Care Council Meeting

2012-02-16T12:34:00.000-05:00

Not too late to sign up!!!

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.

Jane Moffet, RN is the Vice President, Marketing and Customer Relations at Cassamba. Jane has 20+ years of experience in the Acute and Long Term Care settings. Throughout her career, Jane has helped healthcare organizations design and apply technological solutions to address critical needs and challenges. Today, Jane leverages these strengths in support to current and prospective customers and selects and deploys solutions that add real value to organizations.

Thursday, March 15th, 9:30AM—12:00PM, Adria Hotel & Conference Center
221-17 Northern Boulevard, Bayside, NY 11361

And the WINNER is...

2012-02-16T11:38:00.002-05:00

L.Sigal of Brooklyn NY...

Congratulations... you are the lucky winner of our Big Deal Giveaway!

Don't worry folks, there is always next month!!!.

Stay in the Loop, click here to like us on facebook for seminar information, free events and next months Big Deal Giveaway, a Hide Me Tent & Tunnel!

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App Thursday: Rethinking Testing in the Age of the iPad

2012-02-16T09:45:00.003-05:00

In the 3,200-student East Haven schools in Connecticut, elementary teachers did their initial student reading assessments a bit differently this school year.

Instead of using paper and pencil to jot down observations about each of their students and then collecting and analyzing those notes by hand, each teacher used an iPad to collect the information and send it to a centralized database through software from the New York City-based ed-tech company Wireless Generation.

"One of our primary goals was to be able to develop a system that would bring a lot of the data into one place," says Taylor Auger, a technology-integration teacher in the district who helped incorporate use of the iPads into classrooms. "Previously, the data was processed by hand, and it wasn't really being put to use effectively. I'm all for data, but that data has to drive instruction."

Moving assessments onto mobile devices may open the door to quicker feedback for students and teachers as well as richer data, but without proper management of the devices and a strong infrastructure to support them, integrating the devices can be a challenge.

"It's great to have the technology," says Erica Forti, the district's assistant superintendent for curriculum and instruction, "but once it's purchased, there is a management piece involved."

Leaders in the East Haven district decided to buy 210 iPads when the lease for desktop computers in the elementary schools' computer labs was up. Instead of replacing those computers, they decided to explore mobile technology.

"We liked the idea of having mobile computing devices, since most of the technology was fixed," or stationary, says Forti. "It opened up the doors for different types of teaching and learning."
In addition, having the data collected on the iPads allowed the information to be easily shared with parents during conferences, Forti says.

Maintaining that one-teacher-to-one-student assessment ratio through the mobile devices is also important for students, especially in the earlier grades, says Krista Curran, the general manager of assessment and intervention products for Wireless Generation.

"In the early grades, the [mobile] assessments are used by teachers with their students so it's less obtrusive, in order to make that interaction friendly to the student," she says. "The end goal is to provide that immediate access to data that informs instruction."

(Wireless Generation's founder and chief executive officer, Larry Berger, is a trustee of Editorial Projects in Education, the nonprofit corporation that publishes Education Week Digital Directions.)

Making iPads Work
After the East Haven elementary students were initially assessed on their reading levels, the iPads were distributed onto seven carts—one for each elementary school in the district—to be used for instruction.
From a teacher's standpoint, the iPads are an easy device to use, says Auger. "They can pick it up, turn it on, and use it how they wish," he says.

"But the ability to do that," he cautions, "requires a lot of background work from the rest of the technology team that if you do not have, it will not work."

The district also underwent an upgrade to a fiber-optic wireless network during the 2010-11 school year, which was critical to the success of the iPad implementation, says Auger.

After the initial reading assessments, he says, some teachers have continued to use the iPads for assessment by having students take screenshots of their scores on various educational apps and email the images to the teachers to be stored in the students' electronic portfolios.

"One of the greatest things about the iPad is its versatility," he says. "It can really be what you want it to be."
Similarly, the 2,000-student Lowndes County school system in Hayneville, Ala., rolled out 1,100 iPads to teachers in the district last fall with the help of Information Transport Solutions, or ITS, a technology-services company in Wetumpka, Ala.

Students in the district undergo a pre- and post-test every 45 days in core subjects that helps pinpoint where students may need more support, says Lucy Long, the director of professional learning for ITS.

"We use the data from the post-test to really structure how we approach the next 45 days," she says. In between those assessments, teachers use the iPads to create their own assessments, which are pushed out to the students and then returned to the teacher for data collection, says John Loiselle, an integration technology specialist for ITS.

In addition to using mobile devices to gather observational data, teachers can use the devices to get a glimpse into the thought processes of students, says Reshan Richards, the director of educational technology at Montclair Kimberley Academy, a private school serving grades preK-12 in Montclair, N.J.

"You can gather a lot of data quickly, and you can do a lot of quick checks of understanding in a class, but I'm more interested in the deeper, more qualitative understanding that mobile might bring," Richards says.
For instance, screencasting, which records what students are doing on the display screens of their devices, allows teachers to see students work through problems without having to stand over their shoulders the whole time, he says.

That kind of assessment on a mobile device turns testing into more than just one number, Richards says. Most schools are hesitant, however, to jump into assessing with mobile devices, he says.

'Rich Feedback'
But those schools and classrooms that have embraced mobile devices have seen them as a catalyst for change in teaching, learning, and assessment, says Julie Evans, the chief executive officer of the Irvine, Calif.-based Project Tomorrow, a national education nonprofit group that promotes technology use in the classroom.

"The access of having a [mobile] device in your hand changes the way that classroom environment feels," she says. "Students are walking around with the devices, doing things to get them out of the structured environment of the traditional school."

And because students feel a sense of connection and ownership over their mobile devices, they feel "enabled to be part of the assessment process," says Evans.

Christopher Dede, a professor at the Harvard Graduate School of Education, also notes the unique relationship between students and their mobile devices. "Kids think of phones as an extension of themselves in a way that they don't think of with laptops or workstations," he says. "Part of what you have is this intellectual partnership with your cellphone where you do some of the thinking, and your cellphone does some of the thinking, and then you're smarter."

Educators are beginning to tackle how such devices can be used for assessment, taking into consideration screen size and assessment platforms, says Dede. But it's clear, he says, that mobile devices have potential as assessment tools in at least two ways: asking a question and getting an answer, and recording and capturing a process.

"We can give students some kind of thought question and look at the response they give and understand formatively where they are in their comprehension, and perhaps modify what comes next based on that kind of feedback," Dede says. "It's very rich feedback for students on how they're doing and how to get better."
Dede is also exploring how mobile devices can be used as assessment tools through "augmented reality," a process by which students interact with the real world, which is enhanced by information from a mobile device. For example, students in a science class could take mobile devices onto school grounds and use them to identify plants or trees, or students in a history class could use the GPS capabilities on their mobile devices to lead them to sites of historical importance.

Student-Owned Devices
Johnny Kissko, a math teacher for the 2,000-student Frenship High School in the Frenship Independent School District in Texas, is also interested in using augmented reality in his classes.

This school year, Frenship High has changed its policy to allow students to bring their own mobile devices into class at the discretion of the teacher, says Kissko.

Taking advantage of the new policy, Kissko has created worksheets for his classes that use QR, or quick-response, codes that pull up video solutions for the problems his students are working on. To read the QR codes, which are black-and-white barcode-type images, students download apps; when the apps are running, the students hold their devices over the codes to be linked to the website.

Around the country, the mobile devices are being used primarily for formative assessments rather than high-stakes standardized tests.

For example, in the 5,000-student Canby school district, south of Portland, Ore., teachers are using classroom sets of iPod touches to receive quick feedback on where students are in learning their subject matter, says Joe Morelock, the director of technology and innovation for the district.

"We're doing a lot of formative assessments on them," Morelock says. Using apps such as iResponse and resources like Google Documents, teachers are able to receive feedback from students and record their own observations about students' progress, he says.

Teachers have full autonomy in deciding which apps they use and how they use the mobile devices in the classroom, says Morelock. That leeway cuts down on the management load for the district's technology team.

"The teachers are updating them, syncing them, and they're finding a thousand different ways to use them," he says of the devices. "It's been really incredible, and it really has to do with the ease of using the device, and the teachers really taking the lead."
(Source: edweek.org)

Still Time to Enter to Win!!

2012-02-15T12:39:00.002-05:00

The big winner will be announced tomorrow February, 16th at noon....

just in time for the weekend!

Still time to enter for our Valentine's Day Big Deal Giveaway!

A $100 American Express Giftcard to the restaurant of your choice.

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Just follow these 2 steps!

1. Like us on Facebook!

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The ABC's of ABA in a SLP World

2012-02-15T10:40:00.003-05:00

We speech-language therapists have a lot of acronyms in our little speechy world. We are SLPs (speech-language pathologists) who have our CCCs (Certificates of Clinical Competence) from ASHA (the American Speech-Language and Hearing Association). When I graduated with my M.S. (okay, you all know that one) in speech-language pathology, I was pretty sure I’d mastered the alphabet soup of our profession.

Until I fell in love with kids with autism, that is. That’s when I was introduced to the world of ABA. If you’ve loved a child with autism, you’ve no doubt run smack into this term, too, and probably very early along the journey you took. Despite the fact that this word swirls around the autism world with great furiosity, it is often misused and a bit misunderstood. Some people love it with a passion; others hate it with the same intensity. Me? I think it both extremely valuable and sometimes overused.

But I’m getting ahead of myself. My goal today is to begin to define the term for those who don’t know it well. Later, when I’ve laid the groundwork just a bit, we’ll delve into the true complexities that exist with what appears, at first glance, to be a very simple concept.

ABA stands for Applied Behavioral Analysis. It’s based on the work of B.F. Skinner, a psychologist who focused on operant conditioning, or the study of observable behaviors and the events that cause and reinforce those behaviors. The applied part of ABA means that we take this system of looking at the way behaviors are shaped and apply it to everyday life; we use it to shape behaviors that are important to the lives we lead. When we peer at the world through the eyes of ABA, we find ourselves looking at three main things.

The Antecedent: What happened in the environment before the behavior occurred?

The Behavior: This part involves describing the overt behavior that you see or want to see. Not the motives, not the intent, not the feelings behind the behavior. Simply the behavior as you can observe it in front of you. Those who study and use the principles of ABA believe in describing the behavior as clearly and objectively as possible. For example, instead of saying “Sally got mad,” a behavior analyst would say “Sally screamed and hit the door with her fist.”

Consequence: What happens after the behavior? Does this thing that occurs after the behavior (the consequence) increase the chances the behavior will occur again, making it a reinforcement? Or does it decrease the chances the behavior will occur again, making it a punishment?

To help explain, let me share a couple examples.

Say you are teaching a child to say “cookie.” The steps behind teaching the word might go a little something like this:

Antecedent: You hold up a cookie and say, “cookie”
Behavior: The child imitates “cookie”
Consequence: You give the child the cookie. (This would be positive reinforcement, assuming that giving the child the cookie increases the chances he will say the word again in the presence of the the cookie. Or, in plain English, assuming the child actually wants the cookie–although behavior analysts would probably shy away from describing it this way, as it reflects the child’s internal state, rather than his behavior).

Or, perhaps you are teaching your child to walk.

Antecedent: You hold out your hands and say “come here!”
Behavior: Your child takes his first step toward you.
Consequence: You cheer and throw your child in the air as he giggles. (Again, this is only reinforcement if it actually increases the chances your child will take a step toward you the next time you hold out your hands and say, “come here!” It wouldn’t be a reinforcement if he hated being thrown in the air- in this case, it might decrease the chances that he’d come to you and would, then, become a punishment*. Consequences are different for different people- the exact same action that is a reinforcement for one person can be a punishment for another).

These three things- the antecedent, behavior and consequence (Or ABCs of ABA, if you will…yes, another acronym), make up the core of ABA. Those who live in the world of ABA focus very carefully on the ABCs behind any and all behaviors. They graph and chart and study these elements of life and plan interactions around them.

ABA is much more complex than this, of course; I took four full graduate level classes about ABA when I completed my graduate certificate in Behavioral Intervention in Autism. There are those that study ABA all their life and still don’t have all the answers, and there are entire, complex, and well-graphed treatments for autism that are based the concepts behind ABA. It is not nearly as simple as I am making it at the moment. And yet, if you understand the ABCs behind ABA, you can begin to understand the world through the eyes of an applied behavior analyst.

How, then, does ABA fit into the world of SLP? As an experienced applied behavior analyst once told me, we all (parents, teachers, speech-therapists, all of us) use ABA in one form or another. SLPs are no exception. We use the principles of ABA to teach children first words (Antecedent: “Say, Ball!” Child’s Behavior: “Ball!” Consequence: Child is rolled the ball). We use ABA methods to teach children how to behave and understand language (Antecedent: “Sit down please.” Child’s behavior: sits down. Consequence: “Here’s your snack.”). We call on ABA to help us figure why children behave in certain ways, so that we might help them find a better response and eliminate challenging behavior. For example, we might look at what comes just before a child hits another child (the antecedent), discover that it happens whenever another child obstructs the way, and then give the child a new behavior (saying, “move please”) by teaching and reinforcing this new behavior.

So yes, we all use the concepts behind ABA, intuitively and frequently, to teach, motivate, and shape our children’s behaviors. And yet, controversy behind these methods exists. Why so? Because there are significant differences in how and when we apply these methods, in how stringently we define the behaviors we expect, in how we select and apply consequences, and in how strongly we believe that the ABA lens is the only one through which we can view the world.

That’s a post for a different day though. For now, we’ll just be happy that we’ve learned our ABCs.

(Source: This post originally appeared on Child Talk; reposted via blog.asha.org)

Job Spotlight Bulletin

2012-02-14T14:35:00.000-05:00

What does the future hold for adult homecare?
Meeting the individual needs of a client in their home helps them to maintain a familiar lifestyle and hold on to community relationships.
We have adult homecare cases in Long Island, Queens, Brooklyn, Staten Island, Manhattan, the Bronx, and Westchester for OTs, PTs, and SLPs

Email us to learn more!

Early Intervention Cases
We need OTs, PTs and SLPs to fill our cases! Contact us for rates and available caseloads.

Valentine's Day Big Deal Giveaway!

2012-02-14T10:30:00.000-05:00

Dinner For Two
Whether you want a romantic evening for 2 or a casual supper with a friend, Therapeutic Resources wants you to make the most of this Valentine's weekend with a $100 American Express gift check towards the restaurant of your choice!

So how do you win? Just follow these 2 steps!

1. Like us on Facebook!
You MUST be a Facebook fan to win the giveaway!
So click here to like us now.
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Wheelchair Tai Chi: One of the Simplest Ways for People Who Use Wheelchairs to Improve Their Physical and Mental Health

2012-02-14T09:41:00.000-05:00

Studies overwhelmingly point to regular physical exercise as the crucial medicine for what ails Americans. Physicians have a hard time convincing even healthy patients to take action, but it's a much harder sell for those with limited movement caused by physical disabilities. They often lack the self-confidence to begin a physical fitness plan, and it's easy to understand why. They face transportation obstacles to visit an exercise facility. If they can get to the facility, accessing the building and equipment is often difficult or impossible, and fees are often high, says Dr. Zibin Guo, a medical anthropologist in The University of Tennessee at Chattanooga Department of Sociology, Anthropology, and Geography. He says appropriate and interesting exercise is often not available to this group.

"Physical inactivity often further deteriorates the general health condition for these individuals, and it also tends to make them more reliant on professional medical care rather than taking a proactive approach by engaging self-care, including medications to deal with their health issues," Guo says.

As a result, the cost of care, treatment, rehabilitation, and reduced productivity totals a whopping $300 billion a year in the U.S. alone.

"Physical disabilities in general and severe ambulatory disabilities in particular not only bring a tremendous amount of physiological and psychological suffering to the individuals, they can also create enormous burdens for families, relatives, and friends," Guo says.

The University of Tennessee at Chattanooga professor has a fresh idea-wheelchair Tai Chi. Tai Chi is one of the ancient Chinese martial arts, a noncompetitive self-paced system of gentle physical exercise that Guo has adapted for wheelchair-dependent individuals in the U.S. and China. For his efforts, The Tennessee Higher Education Commission recently named Guo a faculty recipient of the state Love Award, recognizing his commitment to community service.

He says wheelchair Tai Chi is one of the simplest ways for people who use wheelchairs to improve their physical and mental health. His holistic approach has been embraced in China, where he was invited by the Beijing 2008 Olympic Committee and the All China Federation for People with Disabilities to conduct a wheelchair demonstration for the International Paralympics Committee one day before the opening ceremony of the 2008 Paralympics in Beijing.

"Before I left Beijing in September, I learned that in order to systematically promote the wheelchair Tai Chi program nationwide, the All China Federation for People with Disabilities and the China Paralympics Administrative Center decided to organize an annual national wheelchair tai chi competition," Guo says.

Guo's technique is benefitting people in Chattanooga, such as a 70-year-old woman who suffered a stroke seven years ago as the result of high blood pressure. Mrs. B's left arm was partially paralyzed, and over the years, she fell twice. She was confined to a wheelchair for more than two years and unable to walk even a short distance.

Mrs. B decided to participate in a small study of the effects of wheelchair tai chi, directed by Guo with University of Tennessee at Chattanooga faculty members Dr. Nancy Fell (physical therapy) and Dr. Janet Secrest (nursing) and Dr. Glenn Haban, a neuropsychologist at Siskin Hospital for Physical Rehabilitation in Chattanooga. The study is among the first in the country to explore the potential benefits of practicing a simple seated tai chi program for people with ambulatory disability resulting from health problems or injuries.

Participants who qualified were unable to walk independently 50 feet or more with an assistive device in one minute or less. Six women and four men signed on for two months of free classes. They met twice a week for 45-minute tai chi sessions. Classes were held at the new Fitness Center at Siskin Hospital, located on the main campus in downtown Chattanooga.

At the conclusion of the classes, Mrs. B's improvement was dramatic. She began walking and treading stairs unassisted, and she began to regain use of her left arm. With her strength and mobility vastly improved, she gives all the credit to the seated tai chi method.

"I made so much progress, and I've enjoyed it," she says. "I've been inspired by what I've seen others doing, and it helps me. And they say what I did helped them."

Many of the participants reported improved stamina and said they enjoyed the social nature of the classes. Mrs. K, a 46-year-old woman with multiple sclerosis and fibromyalgia, said her breathing improved.

"My energy is up, and my posture has gotten a lot better. I feel like I've accomplished something, and tai chi is easy-it's fun," she says. "The medical world should be aware that people need something like this."

Though his professional reaction to the study is one of guarded optimism, Haban says Siskin Hospital for Physical Rehabilitation is committed to continuing the study. He remains hopeful that using Tai Chi as an intervention will positively impact patients' functional strengths.

"The minimum that could be said in this study is that it points to the need for further research to be done," Haban says.

From a neuropsychological perspective, Haban says three factors are needed to promote health, as well as recovery following a significant illness: physical activity, mental stimulation, and social involvement. Too often, he says, circumstances limit these factors, and patients suffer as a result.

"Tai chi was able to intervene on all three dimensions," Haban says. "Also, a person's belief system about their illness will affect their outcome. That is, when a person believes they cannot get any better, they stop progressing. Toward that end, Tai Chi can foster hope and the person's belief that improvement in their status is possible. The significance of the study is that it provides some evidence that this relatively simple and inexpensive intervention can help improve a person's functional status."

Photo caption: Though he does not use a wheelchair for mobility, Dr. Zibin Guo used the device to demonstrate an innovative Tai Chi technique for a group in China.

(Source: MedicalNewsToday.com)

Cancer Drug Erases Alzheimer's in Mice

2012-02-13T09:40:00.001-05:00

A drug typically used to treat skin cancer quickly reversed Alzheimer’s disease in mice, according to a study published today in the journal Science. Alzheimer’s researchers call the results exciting, but they remain cautious about the drug’s ability to fight the disease in humans.

Researchers at Case Western Reserve University gave the drug to mice that had brain hallmarks of Alzheimer’s disease: abnormal protein plaques and tangles, which destroy the brain’s centers for memory and cognitive function.

Within hours of taking the drug, the plaques began to clear out of the mice’s brains. After three days on the drug, more than 50 percent of the Alzheimer’s plaques had disappeared, and the mice regained some of the cognitive and memory functions typically lost by the disease’s march through the brain.

“We were absolutely astounded and thrilled,” said Paige Cramer, the study’s lead author and a doctoral candidate at Case Western Reserve University School of Medicine. “The research on treatments out there doesn’t show such improvement with such speed.”

The drug, bexarotene, is approved by the U.S. Food and Drug Administration for the treatment of skin cancer. Cramer said it helps the body increase its stores of a key protein, called ApoE, which helps clear Alzheimer’s plaques from the brain.

“As a consequence of aging, the ability to clear plaque from the brain goes down, and we are able to enhance ApoE,” Cramer said. “The benefit of this drug is we are just facilitating or enhancing Mother Nature.”

But the drug must make the leap from success in mice to success in humans, which has foiled many other promising Alzheimer’s drugs. Researchers say bexarotene has an advantage because it is already approved by the FDA for use in humans.

“It’s still an animal study, and it still needs to be moved into humans. But it is exciting and is a novel approach,” said Maria Carrillo, senior director of medical and scientific relations for the Alzheimer’s Association.

A host of potential drugs for Alzheimer’s disease have shown promise in early research, then failed to show any actual effectiveness against the disease upon further study. Most recently, in January, Pfizer and Medivation pulled the plug on clinical trials for dimebon, an antihistamine nasal spray that had shown some benefit for Alzheimer’s patients. The companies said the clinical trials failed to show that the drug actually worked against the disease.

Dr. William Klunk, co-director of the Alzheimer’s Disease Research Center at the University of Pittsburgh, said the current study on bexarotene opens an exciting new avenue for the potential successful treatment of the disease. But he remains cautiously optimistic.

“We in this field have seen enough success in mouse studies not pan out in human studies to know this is just the beginning and there’s a long way to go,” Klunk said.

(Source: abcnews.go.com)

Last Chance for Early Bird Registration: Therapy Ball Techniques For Early Childhood Development and Treating the Medically Fragile Child

2012-02-10T14:48:00.000-05:00

Therapy Ball Techniques for Early Childhood Development
Sunday, March 25th, 2012
Bounce Gymnastics in Great Neck, NY
Price $239.00 on or before 2/15/12; $259 after
Register>>>

This course will focus on the therapeutic value of therapy balls in the development of vestibular responses, balance, spatial orientation, body awareness, muscle strength and tone. As a foundation there will be a review of normal development of the central nervous system and a discussion of what happens in the child exhibiting delayed motor development. Participants will be shown how to develop appropriate treatment strategies using handling techniques with the therapy ball. Through videotaped treatment sessions of children, the speaker will demonstrate effective hand placement and how to use the ball for maximum treatment impact. Participants will be able to experience actual handling and ball activities via a lab
demonstration in the latter part of the workshop day.

Treating the Medically Fragile Child
March 27th or March 29th
Therapeutic Resources, Long Island City, NY
Price $119 or FREE if you sign on with Therapeutic Resources for the Department of Education Bid or you currently hold early intervention cases through us
Register>>>

When is a child considered medically fragile? What special precautions and medical considerations must be taken when treating the fragile child in the home? This evening will cover treatment interventions, contraindications, recognition of medical problems that may require referral, positioning, medical monitoring and equipment planning for this population. Videos will be used to demonstrate treatment interventions. Participants will observe compromised children with a variety of conditions and plan treatment together.

Halting Bone-Building Osteoporosis Reduces Risk for Additional Atypical Femur Fracture

2012-02-10T09:50:00.003-05:00

There is growing evidence that supports an association between atypical fractures of the femur – a rare break of the thigh bone, typically without trauma – and the use of bisphosphonates, drugs proven to enhance bone density and reduce fracture incidence caused by osteoporosis. While the risk for suffering an atypical femur fracture while taking bisphosphonates is still very small – just 1 in 1,000 patients after 6 years of treatment – research presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons found that discontinuing bisphosphonate use following an atypical femur fracture can significantly lower the risk for a subsequent atypical fracture.
Scientists believe that bisphosphonates may suppress the body’s natural process of remodeling -- where old bone tissue is replaced with new, healthy tissue – in some patients, resulting in brittle bones susceptible to atypical fractures, especially in the femur.

Investigators reviewed femur fracture data from Jan. 1, 2007 until Dec. 31, 2009 in patients older than 45 years enrolled in a large California HMO. There were 126 patients with an atypical femur fracture who reportedly took bisphosphonates prior to their bone break.

The incidence of a subsequent atypical femur fracture occurring in the other thigh was 53.9 percent in patients who continued bisphosphonates for 3 or more years after their first fracture, compared to 19.3 percent in patients who discontinued bisphosphonate use. Overall, subsequent atypical femur fractures were decreased by 65.6 percent when bisphosphonates were stopped within one year following the first fracture.

“The risk of a contralateral atypical femur fracture (on the opposite side) increases over time if the bisphosphonates are continued,” said lead investigator Richard Dell, MD, a researcher in the Department of Orthopaedics at Kaiser Permanente. “Based on these observations, we recommend discontinuing bisphosphonate use as soon as possible after the initial atypical femur fracture has occurred.”

Dr. Dell then recommends the ongoing evaluation of these patients, through X-ray or MRI, as they still are at risk for a subsequent, atypical femur fracture on the other femur.

If the patient is at high risk for other fractures, the study recommends use of an alternative osteoporosis medication.

(Source: amjorthopedics.com)

Insurance Industry Take-Over of EI Must Be Stopped

2012-02-09T12:50:00.004-05:00

Governor Cuomo has proposed changes for Early Intervention which will greatly impede our ability to provide services, drastically limit parental-choice, and dramatically drive up the administrative costs of Early intervention.

In short, the Governor proposes turning over much of the Early Intervention Program to insurance companies, who would:

(1) be in charge of setting rates,

(2) impact service utilization, and

(3) limit a parent's ability to be served by the provider or evaluator of their choice.

The Governor's proposal originates from the desire of local Counties to be relieved of their role and responsibility in providing quality and accessible E.I. programs. There is also talk of allowing new co-pays to be levied and insurance policy deductibles to be met. Additionally, if a particular provider is not on the panel of a child's insurance company, that provider would not be allowed to evaluate or deliver therapy for that child, in spite of being a licensed professional with credentials and experience providing E.I. services!

These proposals will destroy the very fabric of the necessary and successful Early Intervention Program that has been built in New York State. We URGE you to voice your opposition to this insurance scheme IMMEDIATELY while the Legislature is still in a position to reject it in the State budget.

Click Here for ONE-STEP to STOP the Insurance Industry Take-Over of Early Intervention!

Sign Our Online Petition!

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Thank you-

App Thursday: Apps Gone Free!

2012-02-09T09:23:00.001-05:00

Pirate Scribblebeard’s Treasure was mentioned and recommended previously as a worthwhile drawing app – currently gone free!

Available only for iPad and Android, this is a drawing app that provides the tools to draw in characters and objects in a pirate theme. Fun app, however will require imagination and ability to draw people and objects and enjoy a pirate theme. This app would present a difficult task for younger students and students with visual perceptual or visual motor challenges. A fun theme but requires imagination and a concept of pirates to carry out the thematic activities. Cleverly presented with sounds and some animation, this app would be fun for the right kids or students.

(Source: otwithapps.wordpress.com)

In Memoriam Virginia Hoagland

2012-02-08T13:22:00.003-05:00

In Memoriam

Virginia (Ginny) Hoagland, MA, OTR/L, chairperson of the New York State Occupational Therapy Association from 1981 to 1987, and a devoted occupational therapist, died on November 7, 2011, in Ames, Iowa. She was 65.

Hoagland came to New York City after attending Earlham College in Indiana. She received her master’s degree from New York University and started her career at the VA Medical Center of NYC. She became the program coordinator and supervisor for the Mental Health division of the hospital and worked there from 1978 to 1993. She also worked for the nonprofit NYC Visiting Nurse home health care agency, providing occupational therapy to people in their homes from 1991 to 2006. Recognized as a valuable asset in this organization, she was promoted from staff clinician to supervisor of rehabilitation, a position she held from 1998 to 2006. She worked for various agencies as a consultant from 2006 to 2011, also providing home care services.

Hoagland will be remembered for her soft-spoken but hardworking nature in providing therapy, supervising students, mentoring new graduates, and guiding experienced therapists. Hoagland was honored with a recognition award from NYSOTA in 1991. From the Metropolitan New York District, she received a community service award in 1989, an appreciation award in 1991, and the Abreu Service Award in 1992, for her devotion to the occupational therapy community.

-Lisa Davis, MA, OTR/L

Speech Therapist Vows to Make a Difference in the Middle East

2012-02-08T10:11:00.003-05:00

(Muscat: Oman) Oman’s first clinic dedicated to speech-language and hearing, which had its grand opening Wednesday evening, aims to provide much-needed services in Oman.

Najah Al Abdulsalam, a speech therapist who was trained in the USA and Jordan, opened the Icommunicate Speech-Language Pathology clinic, fulfilling her long-time dream of having her own clinic.
“It’s time to have a specialised clinic in Oman,” she said.
“The demand is really, really high,” she added.

There are only 13 Omani speech therapists in the Sultanate, but many people who need their services. Common problems in Oman include stuttering, swallowing, voice speed, language, and problems with clefts, Al Abdulsalam explained.

“All the communication problems we get in big numbers, mainly because there are so few speech therapists,” Al Abdulsalam said.
She has already had many people contact her for services and built up a long list of patients. While Al Abdulsalam will treat most of the patients herself, she has also lined up a couple of other specialists to help with certain cases.

She says she is very happy to have opened her own clinic. Her long-term plan is to have a specialised speech-therapy centre that will focus on other problems.

“In Oman we need a specialised speech-language therapy centre which will focus on autism, and offer play therapy, trauma therapy, and all the different types of therapy that will complement our sessions,” Al Abdulsalam explained.

Another area she hopes to do more research on is Arabic-specific speech therapy, since there isn’t much information on it. Her studies in Jordan provided her with the expertise, but given the different dialects in Oman, more work here can be done.

Some of Al Abdulsalam’s colleagues attended the opening, as well as other members of the medical community.

They visited the clinic, which has special features like a room with tinted windows which allow parents to watch their children receive therapy but the children can’t see their parents.
“It’s quite an achievement and we’re very happy that she has taken this step. We need it. There are a lot of patients who want to go to a private clinic,” said Ibtisam Al Riyami, a speech therapist at the Royal Oman Police Hospital.

Al Riyami said speech therapy is relatively new in Oman, and there is a growing demand for it, so the services offered at Icommunicate, which include assessment and intervention for autism, stuttering, learning difficulties, Down Syndrome, and hearing impairment, among other things, is an asset for the Sultanate.

“This is a great step forward for speech therapy in general in Oman,” Al Riyami said.

(Source: timesofoman.com)

Jobs Alert Bulletin 2-7-12

2012-02-07T12:18:00.002-05:00

Profession: PT
Population: Adult
Location: Westchester
Schedule: Full Time
Description: A PT is needed for full time adult homecare cases in Westchester. This is a full time salaried position, paying $70,000/year, benefits, and working 30 hours per week. Candidates should have at least 2 years’ experience working with adults in the home.

Profession: COTA
Population: Adult
Location: Staten Island
Schedule: Coverage
Description: A long term care nursing and hospice center that provides short-term rehab (including outpatient) seeks a COTA for a series of Saturday coverage’s. The Staten Island based facility offers a full range of services and specializes in cardiac rehabilitation.

Profession: SLP
Population: Pediatric
Location: Queens
Schedule: Early Intervention Homecare Case
Description: A SLP is needed for a 25 month old male who resides in Woodside, Queens and has the need for speech therapy services 3x a week. He has expressive language delays. The evaluation reveals that he does not imitate sounds, or words despite prompts by his mother. There is decreased strength in the oral musculature as well.

Profession: OT
Population: Pediatric
Location: Queens
Schedule: Part Time
Description: Multiservice organization that specializes in pediatric therapy programs in various locations in all five boroughs seeks an OT for a part time contract position in their Western Queens location. Therapists can be part of a large team of professionals and use their treatment skills in state of the art therapy clinics. Interested candidates should be available 2 days a week (4.5 hours a week, 2.5 hours one day and 2 hours the other, children are treated in groups of 4).

Profession: PT
Population: Pediatric
Location: Brooklyn
Schedule: Full Time
Description: An early childhood school nestled in the Bedford-Stuyvesant section of Brooklyn that offers a center based treatment environment for children ages 3-5 seeks a full time staff PT (7:45-3:00 or 8:00-4:30). Their mission is to provide a success-oriented, supportive, and nurturing environment within a developmental learning center
model. The selected candidates will enjoy a competitive salary along with benefits such as medical, dental/vision, matching 401K, life insurance, and continuing education reimbursement.

Profession: SLP
Population: Adult
Location: Brooklyn
Schedule: Part Time
Description: Nearly three hundred beds are served by this non-profit nursing home that seeks a SLP for an ongoing coverage position (4 hours a day). The facility is located in a nice, residential setting within a Park Slope, Brooklyn neighborhood.

Profession: OT
Population: Adult
Location: Manhattan
Schedule: Saturday Coverage
Description: District 75 school on Park Place in Brooklyn needs 2 full-time OT's for their caseload.

Profession: PTA
Population: Adult
Location: Bronx
Schedule: Coverage
Description: Central Bronx located (near Arthur Avenue), not for profit acute care community hospital and Level 1 Trauma center that has over 450 beds seeks a PTA for coverage 2/14 and 2/24 from 8-4pm. This facility offers nearly twenty programs for adults and children including services for mentally ill, day treatment programs and special programs for victims as well as employee assistance programs.

Profession: PT
Population: Pediatric
Location: Bronx
Schedule: School-Based Case load
Description: A PT is needed for a school in the Bronx with 12 children. Their mandates are for 30 minutes, twice a week. Children are 12-15 years of age with balance, gait, and coordination issues. Evaluations have already identified problems for treatment focus.

Profession: SLP
Population: Pediatric
Location: Bronx
Schedule: Early Intervention Homecare Case
Description: A SLP is needed 2x30 for 1.5 year old child, male, unable to bring hands to midline, presents with low tone, and general delays that do not meet expected developmental norms. He does not make his needs known through gestures, and displays significant speech delays. Both Occupational Therapy and Speech services have been request and evaluations have already been completed. This child resides near Tremont Avenue in the Bronx.

Profession: OT
Population: Pediatric
Location: Queens
Schedule: School Based/Part Time
Description: An OT is needed for an elementary school in Queens. Candidates can work 3 days a week from 8:30-2:30 in one school. Children have already been evaluated and need services mandated by an individualized education plan (IEP).

Profession: PT
Population: Pediatric
Location: Brooklyn
Schedule: Part Time
Description: An early childhood school nestled in the Bedford-Stuyvesant section of Brooklyn that offers a center based treatment environment for children ages 3-5 seeks a PT for a part-time contract position until mid-August (2 mornings, 13 sessions). Their mission is to provide a success-oriented, supportive, and nurturing environment within a developmental learning center model.

Profession: OT
Population: Pediatric
Location: Queens
Schedule: Maternity Coverage
Description: An OT is needed for a 6 week maternity coverage for 2 great elementary schools in South Ozone Park, Queens. Interested candidates should be available March 1st.

Profession: PTA
Population: Adult
Location: Brooklyn
Schedule: Temporary Assignment
Description: Over 500 beds are served at this scenic Brooklyn Heights/Cobble Hill located facility that needs a PTA on 2/16 and 2/22. Providing baseline, adult day health, clinical and radiology services, this facility is not-for-profit.

Profession: PTA
Population: Adult
Location: Staten Island
Schedule: Saturday Coverages
Description: A long term care nursing and hospice center that provides short-term rehab (including outpatient) seeks a PTA for a series of Saturday coverage’s. The Staten Island based facility offers a full range of services and specializes in cardiac rehabilitation.

Profession: OT
Population: Pediatric
Location: Bronx
Schedule: Early Intervention Homecare Case
Description: An OT is needed 2x30 for 1.5 year old child, male, unable to bring hands to midline, presents with low tone, and general delays that do not meet expected developmental norms. He does not make his needs known through gestures, and displays significant speech delays. Both Occupational Therapy and Speech services have been request and evaluations have already been completed. This child resides near Tremont Avenue in the Bronx.

Profession: COTA
Population: Adult
Location: Staten Island
Schedule: Saturday Coverages
Description: Providing short-term rehab (including outpatient), this long term skilled nursing and hospice care, this facility has over 500 beds and 800 employees. The Staten Island based facility offers a full range of services and specializes in cardiac rehabilitation and seeks a COTA for coverage on Saturday’s.

Profession: PT
Population: Pediatric
Location: Brooklyn
Schedule: Part Time
Description: A PT is needed for a part-time staff position 2 days a week at early childhood school in Brooklyn that offers a center based treatment environment for children ages 3-5. Their mission is to provide a success-oriented, supportive, and nurturing environment within a developmental learning center model.

Profession: SLP
Population: Pediatric
Location: Bronx
Schedule: Part Time
Description: A preschool located in a scenic area in the Bronx seeks a Bilingual SLP for a part time contract position (2-3 days a week from 8:30-2:30).

Profession: COTA
Population: Adult
Location: Bronx
Schedule: Temporary Assignment
Description: An educational facility in the Bronx, serving approximately 500 children with special needs seeks a PT for a staff position. (7:45-3:00 or 8:00-4:30). Facility features a variety of programs such as Center-Based Special Education, Integrated Services, Day Care, Inclusionary Programs, and Evaluation Services.

The Right Mix: Nutrition Intervention by Physical Therapists

2012-02-07T09:51:00.002-05:00

Older adults' often poor dietary habits can negatively affect physical rehabilitation, but with a thorough assessment, a therapist can detect problems that may interfere with healing and address those issues — either directly or through a referral. "Nutrition is one of the most overlooked aspects that can help rehabilitate or remediate functional recovery," said Jim Tholany, DPT, at Performance Spine & Sports Medicine in Lawrenceville, N.J. "The body is powered by the nutrients in the food we eat."

A well-balanced diet rich in protein and nutrients will allow patients to rehab as fast as possible and avoid roadblocks in the recovery process, Tholany said.

Dana Hilz, PT, DPT, CSCS, at Cascade Sport and Spine in Centralia, Wash., dubbed nutrition the missing link in physical therapy. Without good nutrition, she said, "the patient isn't going to have as good a chance of healing or recovery from an injury or surgery."

In fact, rehabilitating patients may need higher caloric intake than normal. "When someone has an injury, the body turns up the metabolic rate for the process of healing, so they burn more calories," said Cindy Bailey, DPT, OCS, SCS, ATC, EMT, at Los Angeles Orthopaedic Hospital.

Bailey said a thin person will need to consume more calories than usual to give the healing tissue enough nourishment. She said she recommends eating more protein, in balance with carbohydrates and fats — 40% protein, 30% carbohydrates and 30% fats. However, an overweight person can eat about the same or less than usual, cutting back on carbohydrate and fat intake, she said.

"The healing process is determined so much by whether you have the nutritional components to draw into the healing tissue," Bailey said, adding poor nutrient intake may delay healing.

Wendy Fox, DPT, GCS, WCS, a physical therapist at Women & Infants Hospital of Rhode Island in Providence, said she times her patient appointments to avoid disrupting meals for deconditioned or post-op oncology patients, and she consults with their dieticians.

Poor diet creates downward spiral
An inadequate diet can lead to injuries or other conditions for which older patients will need physical therapy, according to Jill Horbacewicz, PT, MA, PhD, chair/director and associate professor of the Touro College Physical Therapy Department in New York.

"Nutrition is important for the body to heal properly but also for prevention of disease," Horbacewicz said. For example, lack of calcium can lead to osteoporosis and being overweight can contribute to osteoarthritis, she said.

Australian researchers reported in the May 15, 2011, Journal of Nutrition Health & Aging that malnutrition in older adults was associated with reduced mobility and a greater risk of falling during the elders' admission to a tertiary teaching hospital.

Endocrinologist and geriatrician John E. Morley, MD, at St. Louis University, outlined the pathophysiology associated with frailty in older adults in a different article in the same journal Aug. 15, 2011. Poor eating and anorexia, he said, leads to lack of muscle mass, which in turn, limits a person's ability to move about and reduces gait speed. In reverse, anemia, depression and cognitive decline can contribute to fatigue and poor food intake.

Many factors associated with aging contribute to inadequate intake of healthy, nutrient-rich foods, putting older adults at greater risk for problems. "When elders eat alone, often their nutritional needs are out of balance," Bailey said. She explained people who live alone tend not to eat as often or as healthily.

Tholany said older adults often lose their senses of smell and taste, which can reduce their appetites and caloric intake. Problems with teeth or dentures also can deter healthy eating. People experiencing difficulty chewing often eat soft foods, missing out on more healthy options requiring mastication. "Dentition has a big effect on elders and whether they are getting good nutrition or not," Bailey said.

The cost of healthy food works against lower-income older adults, but community resources, such as Meals on Wheels, can help provide well-balanced meals, Bailey said.

Limited access to fruits and vegetables, leading to inadequate dietary fiber, can result in constipation or fecal incontinence, said Fox, who works with older women experiencing pelvic floor disorders. She asks patients to record daily fiber intake and, if deficient, to gradually increase fiber consumption. Constipation also can occur when patients forget to drink enough fluids, she said.

Nutrition interventions by PTs
PTs should take an inventory of each patient's health in general, social support, barriers to care and diet, Horbacewicz said. "Nutrition plays a role in the body's ability to perform physical tasks, and we need to consider it," she said.

Bailey assesses patients' nutritional status. In addition to asking about what they eat, she assesses the quality of their nail beds, skin and eyes. She may consult with a physician to learn more about the patient's general health and medication regimen.

With cardio-pulmonary rehabilitation, Horbacewicz said, the PT also should ask about salt intake because it could contribute to fluid retention and may increase blood pressure. "I'm sure there are other people telling them this as well, but we are trying to be holistic in our approach," she said.

In addition to discussing the importance of consuming a healthy, balanced diet, PTs can recommend supplements. "The tissues involved would determine what we are going to tell the person to put more of in their diet," Bailey said. "It's usually protein or calcium."

Tholany suggested patients take fish oil and vitamin D supplements, which is important for bone health. Bailey sometimes recommends coenzyme Q10, a tissue builder, or amino acids to complete amino acid protein chains, depending on the person's diet, she said.

Horbacewicz cautioned against thinking a supplement or vitamin is a magic solution, preferring a more comprehensive approach to improving food intake. "It's hard to pin down any specific thing," she said. "It's more relevant to discuss general guidelines for each type of dysfunction."

An article in Jan. 20, 2010 issue of the Cochrane Review supports that assertion. The authors reviewed 23 clinical trials and found only weak evidence in support of protein and energy supplements in elderly patients recovering from hip fractures.

Referals may be one of the answers. For a patient with dental issues, Bailey would refer to a dentist and recommend liquid nutritional supplements. She also refers patients with nutritional deficits to nutritionists or social workers to assess the home environment.

(Source: todayinpt.com)

A Solution for Sensory Disorders

2012-02-06T09:56:00.001-05:00

For many children, and even adults, hearing loud or intense noises is startling. But for those with auditory processing disorder, it can be debilitating.

Mary Vozza realized her 5-year-old son John had a sensitivity to sound when he was a toddler.

"We took him to the circus, and when the lights went down and the music started, he wigged out, for lack of a better term. And we literally had to pick up and leave," Vozza said.

Vozza struggled with John's meltdowns and was unable to participate in normal family activities.

So she turned to services of Marcia Hacohen, an occupational therapist in Larchmont, N.Y. Hacohen introduced John to the electronic auditory stimulation effect, or EASe.

"I decided to implement the therapeutic listening program. I started with the EASe program because it really works well for children who have a hard time tolerating certain sounds," Hacohen said.

The EASe program works by constantly playing sounds at a variety of volumes and intensity levels while the child completes normal therapeutic activities.

Laurette Olson, an occupational therapist and professor of occupational therapy at Mercy College in New York City, has extensive experience with therapeutic listening.

"What therapeutic listening allows a child to begin to do is to start with sounds in a simpler form. And the sounds are adjusted as the therapy continues," Olson said.

Therapists can change the settings of the EASe app to fit the needs of each individual child, and then receive a detailed report via email following each therapy session.

"It's a great way to measure, in very small increments, how a child is progressing," Hacohen said.

Although John has not been diagnosed with autism, the EASe program can also help treat the same sensory issues that many children on the spectrum face.

"Children with autism are sensory defensive and are particularly sensitive to sound, but there are a whole cluster of children who aren't autistic who also have sound sensitivities," Olson said.

The EASe app is catching on worldwide, according to Vozza, and therapists – and families – are seeing big results.

"We are able to do so much more as a family. It is like a big weight off our shoulders," Vozza said.

For more information on the EASe app, visit www.vision-audio.com.

(Source: foxnews.com)

New Seminar Announced: Managing Difficult Behaviors

2012-02-03T13:07:00.002-05:00

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

2012-02-03T09:48:00.000-05:00

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

2012-02-02T10:12:00.001-05:00

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!

2012-02-01T13:16:00.000-05:00

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

2012-02-01T09:49:00.002-05:00

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

2012-01-31T15:09:00.000-05:00

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

2012-01-31T10:17:00.002-05:00

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

2012-01-30T10:08:00.002-05:00

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)

Increased Arm Asymmetry is Early Sign of Parkinson's Disease

2012-01-27T09:40:00.003-05:00

People with Parkinson's disease swing their arms asymmetrically -- one arm swings less than the other -- when walking. This unusual movement is easily detected early when drugs and other interventions may help slow the disease, according to Penn State researchers who used inexpensive accelerometers on the arms of Parkinson's disease patients to measure arm swing.

"Scientists have known for some time that people with Parkinson's disease exhibit reduced arm swing during the later stages of the disease, but no one had come up with an easy way to measure this," said Stephen Piazza, associate professor of kinesiology. "We found that not only do people with the disease exhibit reduced arm swing, but they also exhibit asymmetric arm swing, and this asymmetric arm swing can easily be detected early in the disease's progression."

No cure for Parkinson's disease exists, but according to Piazza, if taken early, certain drugs can improve some of the disease's symptoms and even reduce the likelihood of death, making early diagnosis important. Some people also believe that changes in nutrition and other lifestyle factors can modify the progression of the disease.

The researchers attached inexpensive accelerometers to the arms of eight Parkinson's disease patients who were in the early stages of the disease -- within three years of clinical diagnosis. They also attached the accelerometers to the arms of eight age- and sex-matched people who did not have the disease. The team asked the subjects to walk continuously for about eight minutes at a comfortable pace. The researchers downloaded the acceleration data and used software they developed -- that will be available free to interested doctors -- to analyze it. They published their results in the current issue of Gait & Posture.
The scientists found significantly higher acceleration asymmetry, lower cross-correlation between the arms and reduced synchronization of the arms in the early Parkinson's disease patients. According to Joseph Cusumano, professor of engineering science and mechanics, the lower cross-correlation and reduced synchronization suggest that the arm movements are poorly coordinated.

"In other words, if I measure the location of your right arm, it is difficult to use that measurement to predict the location of your left arm," he said. "It is well known that Parkinson's disease has an impact on how people move -- neurologists have been using this fact as the basis for clinical examinations for a very, very long time -- but here we are for the first time precisely quantifying how the disease not only affects the relative amount of limb movements, but also how well coordinated in time these movements are."

To diagnose patients with Parkinson's disease early, some doctors and scientists have proposed the use of a smell test, because people with the disease lose their ability to distinguish odors, according to Xuemei Huang, movement disorders physician, Penn State Milton S. Hershey Medical Center. "But conditions other than Parkinson's disease also can affect a person's ability to smell," she said.

The Penn State team's method of evaluating arm swing can be applied quickly and inexpensively by primary care physicians in their own offices when the smell test is inconclusive and before the application of an expensive brain scan.

"Measuring arm swing asymmetry and coordination with our method may be the cheapest and most effective way to detect Parkinson's disease early in patients' lives when it still is possible to treat the symptoms of the disease and to improve longevity," said Piazza.

The scientists plan to further investigate whether the arm swing evaluation in combination with a smell test can enhance early diagnosis even more. They also plan to further develop their technique so that the accelerometers give immediate readings, which, they said, would save the extra step of downloading the data to a computer and analyzing it, thereby making the arm swing assessments of Parkinson's disease even easier.

(source: sciencedaily.com)

New Date Added - Treating ASD in the Schools - February 15th

2012-01-26T12:46:00.001-05:00

Seminar: Treating Autism Spectrum Disorders In The Schools
Cost: $119.00
FREE if you sign on with Therapeutic Resources for the DOE Bid
Speaker Name: Julianne Costa, OTR/L, DPT

Seminar Date: February 15, 2012

Start Time: 5:00

End Time: 8:00

Duration: 4:30-5:00-Registration/Refreshments 5:00-8:00-Course

Brief:

To gain free entry into these events, sign on with Therapeutic Resources for the Department of Education 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.

Description:

What kinds of treatment strategies are effective for the school aged child with autism spectrum disorders? What can you do in a thirty minute therapy slot? With a focus on the school environment, this presentation will demonstrate therapeutic techniques which can be used to address behavioral and academic issues as well as odd habits frequently seen in the child with Autism Spectrum Disorder. Videos, lecture, and demonstrations will be utilized to illustrate concepts.

Who Should Attend:
Occupational Therapists, Physical Therapists

Learning Outcomes:

1. Identify at least two treatment strategies to approach autism spectrum disorders.
2. Plan an effective treatment session in a school setting.
3. Remediate odd behaviors utilizing the treatment methods presented.

Speaker Bio:

Julianne Costa, OTR, PT received her BS in Occupational Therapy and an MS in Physical Therapy from Boston University Sargent College. She has worked in pediatrics for the past 20 years. Julianne has taught at the University of Maryland, Washington University, Columbia University, and New York University. She has been giving seminars to parents , teachers, and fellow clinicians on a regular basis since 1995. Julianne is trained in Sensory Integration and Neurodevelopmental Treatment under master clinicians like Ingrid Tscharnuter and Reggie Boehme. In addition to a number of pediatric consulting positions, she serves as OT/PT supervisor at Therapeutic Resources.

App Thursday: A Quirky FREE App-Awesome Crayon!

2012-01-26T10:00:00.002-05:00

Well, health is still proving elusive this week. It’s all about finding those comfort apps when comfort food isn’t an option. Today’s app is Awesome Crayon. That’s right. We’re back to coloring with crayons now. Awesome Crayon offers four different backgrounds and a wide spectrum of colors. Seriously, there are 132 different colors to choose from. I counted all of them myself. Well, with the help of basic math.

Awesome Crayon also allows you to adjust the width of your brush strokes. It doesn’t change the texture of the strokes though. Texture? Yes, the app uses a brush stroke that has the texture of crayon on paper. The only thing I’m missing is the scent of wax scraping off the crayon and onto the paper.

Once you’ve selected your paper and your color, just tap the button marked “Play.” If you like what you’ve made, you can save it to the in-app gallery. Your picture will be tacked onto a wood backdrop. It’s like hanging it up on the refrigerator, only better. I think. I honestly don’t know how to rank the levels of childhood artwork. If it’s good enough to save to your phone, then it must be pretty darn good.

This app is FREE!! Download here

(Source: appadvice.com)

Headphones Linked to Pedestrian Deaths, Injuries

2012-01-25T09:46:00.000-05:00

Listen up, pedestrians wearing headphones. Can you hear the trains or cars around you? Many probably can’t, especially young adult males. Serious injuries to pedestrians listening to headphones have more than tripled in six years, according to new research from the University of Maryland School of Medicine and the University of Maryland Medical Center in Baltimore. In many cases, the cars or trains are sounding horns that the pedestrians cannot hear, leading to fatalities in nearly three-quarters of cases.

“Everybody is aware of the risk of cell phones and texting in automobiles, but I see more and more teens distracted with the latest devices and headphones in their ears,” says lead author Richard Lichenstein, MD, associate professor of pediatrics at the University of Maryland School of Medicine and director of pediatric emergency medicine at the University of Maryland Medical Center. “Unfortunately as we make more and more enticing devices, the risk of injury from distraction and blocking out other sounds increases.”

Dr. Lichenstein and his colleagues studied retrospective case reports from the National Electronic Injury Surveillance System, the US Consumer Product Safety Commission, Google News Archives, and Westlaw Campus Research databases for reports published between 2004 and 2011 of pedestrian injuries or fatalities from crashes involving trains or motor vehicles. Cases involving headphone use were extracted and summarized. The research is published online in the journal Injury Prevention.

Researchers reviewed 116 accident cases from 2004 to 2011 in which injured pedestrians were documented to be using headphones. Seventy percent of the 116 accidents resulted in death to the pedestrian. More than two-thirds of victims were male (68%) and under the age of 30 (67%). More than half of the moving vehicles involved in the accidents were trains (55%), and nearly a third (29%) of the vehicles reported sounding some type of warning horn prior to the crash. The increased incidence of accidents over the years closely corresponds to documented rising popularity of auditory technologies with headphones.

“This research is a wonderful example of taking what our physicians see every day in the hospital and applying a broader scientific view to uncover a troubling societal problem that needs greater awareness,” says E. Albert Reece, MD, PhD, MBA, vice president for medical affairs at the University of Maryland and John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine. “I hope that these results will help to significantly reduce incidence of injuries and lead us to a better understanding of how such injuries occur and how we can prevent them.”

Dr. Lichenstein and his colleagues noted two likely phenomena associated with these injuries and deaths: distraction and sensory deprivation. The distraction caused by the use of electronic devices has been coined “inattentional blindness,” in which multiple stimuli divide the brain’s mental resource allocation. In cases of headphone-wearing pedestrian collisions with vehicles, the distraction is intensified by sensory deprivation, in which the pedestrian’s ability to hear a train or car warning signal is masked by the sounds produced by the portable electronic device and headphones.

Dr. Lichenstein says the study was initiated after reviewing a tragic pediatric death where a local teen died crossing railroad tracks. The teen was noted to be wearing headphones and did not avoid the oncoming train despite auditory alarms. Further review revealed other cases not only in Maryland but in other states too. “As a pediatric emergency physician and someone interested in safety and prevention I saw this as an opportunity to—at minimum—alert parents of teens and young adults of the potential risk of wearing headphones where moving vehicles are present,” he says.

(Source: news-line.com)

Introducing: Ellison Henry Stucklen

2012-01-24T15:37:00.001-05:00

Today our office was graced by the presence of, what I can only imagine, will be a new fixture to our working environment, Baby Ellison Henry Stucklen, the son of our EI Director, Jennifer Stucklen.

As we welcome him to Jennifer's family and to our extended Therapeutic Resources clan, we wish Ellison and Jennifer a joyous year of new experiences.

Job Alert Bulletin January 24th, 2012

2012-01-24T12:11:00.001-05:00

Looking for the most up-to-date positions in your area?
We always have jobs for OT's, OTA's, PT's, PTA's and SLP's! Click on any of the jobs below to apply. A placement associate will contact you within 24 hours.

Profession: COTA
Population: Adult
Location: Brooklyn
Schedule: Full Time
Description: A COTA is wanted for a full time position in a multi-faceted, 320-bed skilled nursing facility in Brooklyn that provides groundbreaking elder care through innovations such as an environmentally-friendly facility; a horticulture program; computer access for residents; and a music therapy program.

Profession: OT
Population: Pediatric
Location: Brooklyn
Schedule: Part Time
Description: A nursery school that serves children age 3-5 with severe emotional/developmental issues with a specialty in PDD (Pervasive Developmental
Disorder/Autism) in Brooklyn seeks an OT for a part time contract position (three to five days a week). Within this setting an opportunity is present to work in a small, team setting of three professionals to three children.

Profession: OT
Population: Adult
Location: Brooklyn
Schedule: Full Time
Description: A pain management center in Brooklyn seeks an OTA for a full time contract position.

Profession: PT
Population: Adult
Location: Brooklyn
Schedule: Coverage
Description: Small (less than 150 beds) nursing home located in very hip area of Brooklyn seeks a PT for coverage 2/20-2/24 from 9:00-4:00pm. A full complement of services are provided both on and off site for its residents.

Profession: SLP
Population: Pediatric
Location: Bronx
Schedule: Part Time
Description: A preschool located in a scenic area in the Bronx seeks a Bilingual SLP for a part time contract position (2-3 days a week from 8:30-2:30).

Profession: OT
Population: Pediatric & Adult
Location: Bronx
Schedule: Part Time
Description: Multi-service organization providing therapeutic services to children and adults with developmental disabilities and profound delays in the Bronx seeks an OT for a part time contract position 5 days a week from 8:30-2:30pm. There are openings in day treatment centers for therapists who want to use theory skills and make a difference. Some openings are with a pediatric population.

Profession: PTA
Population: Adult
Location: Brooklyn
Schedule: Coverage
Description: Multi-faceted, 320-bed skilled nursing facility that provides groundbreaking elder care through innovations such as an environmentally-friendly facility; a horticulture program; computer access for residents; and a music therapy program in Brooklyn seeks a PTA for coverage on 3/2 and 3/12-3/16.

Profession: OT
Population: Pediatric
Location: Brooklyn
Schedule: Part Time
Description: A well-established children’s center in Brooklyn that promotes the healthy development of children and youth, and empowers them to become self-sufficient to a level which they are capable of seeks an OT for a part time position, 2 days a week (1 hour per day between 8:30 and 2:30).

Profession: COTA
Population: Adult
Location: Brooklyn
Schedule: Part Time
Description: Nursing and rehab center in Brooklyn that provides both in and outpatient services including PT/OT, and speech language pathology seeks a COTA. Over two hundred residents are served by this facility.

Profession: COTA
Population: Adult
Location: Manhattan
Schedule: Coverage
Description: A non-profit facility caring for the frail elderly population and other individuals unable to care for themselves in Manhattan seeks a COTA for a temporary coverage position. This facility boasts a broad array of services including a Program of All-inclusive Care for the Elderly (PACE), Medicare Advantage Special Needs Plan, home care, hospice a long-term acute care hospital, adult day health care.

Profession: COTA
Population: Adult
Location: Queens
Schedule: Full Time
Description: A 320-bed skilled nursing facility in Flushing seeks a COTA for a full time position (5 days a week). This facility offers both in and outpatient services, pain management, respiratory therapy, and wound care.

Profession: OT
Population: Adult
Location: Brooklyn
Schedule: Part Time
Description: A rehab facility is located in scenic Coney Island on the beach with views of the ocean seeks an OT for a part time contract position. Within this placid setting, over three hundred residents are served. Candidates should be available in the morning or afternoon.

For even more job openings, please visit www.therapeuticresource.com.

For more information on any of these jobs,
please call 212.529.9780.

Looking for CEUs?
You can register online now for all of Therapeutic Resources Fall seminars!
Click here to see the full list of events and to register.

Anatomically Designed Seat Developed for Wheelchairs Encourages User Movement

2012-01-24T10:21:00.001-05:00

Empa engineers, together with the firm 'r going', have succeeded in developing an ergonomic seat for electric wheelchairs which encourages the user to move around frequently. True to the motto 'life is movement' the aim is to enhance the freedom of movement of wheelchair users with a range of disabilities.

Today's office workplaces are designed to be as ergonomic as possible. Even so, after hours of hunching over a desk it does you good to stand up, stretch your legs and relax your back. Spending a whole day in practically the same cramped position is a very tiring proposition.

Wheelchair users in particular face the problem of being forced to spend long periods in the same position. The result can be pain, deformities and decubitus ulcers (or bedsores). The engineer and ergotherapist Roger Hochstrasser, founder of the company 'r going', wanted to help improve this situation. He took his idea for a novel seat shell to Bernard Weisse, an Empa engineer together with whose team Hochstrasser had previously worked very successfully. The newly developed seat was intended to improve the ergonomics of the wheelchair and thereby save the cost of additional treatment.

From concept to realization
Within 18 months Empa and 'r going' completed the development of the innovative seat and constructed the first prototype in a project financed by the Swiss Confederation's Commission for Technology and Innovation. The new seat shell has an articulated backrest constructed of of ribs and movable joints which are designed to match the contours of the user's torso. Depending on the version, the backrest can be tilted up to 22° forwards and 40° backwards and seat can also be rotated by a good 30° in each direction horizontally. The wheelchair user is therefore strongly encouraged to keep changing his or her position, thereby shifting the location of the pressure points, as measurements with a pressure mat on the seat have shown.

Researchers from the Institute for Energy and Mobility of the Berne University of Applied Sciences have developed the drive concept and a control console which allows the ergotherapist to program the movements of the backrest so that the wheelchair user's sitting position is altered in an optimal fashion. "Despite this, if anyone should ever feel uncomfortable they can adjust the settings themselves at any time to suit their individual needs", explains Weisse. A particularly practical point is that the backrest is powered by the same 24 battery as drives the wheelchair.

The institution's grounds as a test track

Empa wouldn't be Empa if it hadn't given the new development a comprehensive practical test, in this case in its own grounds. Test users of various weights drove the wheelchair with its innovative new seat along gravel paths, up and down ramps and over kerbstones and cobbled roadways. A road trip in the Tixi-Taxi, a transport service for handicapped persons, with lots of curves included, served to evaluate the loads being placed on the backrest. All the tests were completed to Hochstrasser and Weisse's full satisfaction.

DemClinical tests are planned for the near future. These will show whether the improved pressure data which was measured in the laboratory does actually lead to improvement in the well-being and health of the wheelchair users and whether the innovative seat gains full acceptance by those for whom it has been designed.

(Source: medicalnewstoday.com)

Today is National Handwriting Day: Summit to Make Case for Teaching Handwriting

2012-01-23T10:12:00.006-05:00

Handwriting still has a place in the digital age, its proponents say, and they hoped that what they billed as a "summit" on the subject this week would spotlight their case for the enduring value of handwriting in the learning process.

The Washington conference was designed to draw together research from psychology, occupational therapy, education, and neuroscience to demonstrate handwriting's role in students' physical and cognitive development, states' learning standards, and the classroom.

The occasion also marked National Handwriting Day, Jan. 23—the birthday of that most famous exemplar of penmanship, John Hancock.

Doubt about the continued worth of handwriting skill is "similar to what happened with math as calculators and computers came into vogue," said Daniel A. Domenech, the executive director of the American Association of School Administrators, which co-sponsored the gathering with Zaner-Bloser, a Columbus, Ohio, company that produces a handwriting curriculum. "People wondered whether students needed to learn how to do math. The answer in both cases is absolutely yes. Writing is not obsolete."

Proponents of teaching—in some cases, reintroducing—handwriting in the school curriculum say their concern over the fading importance of handwriting became more urgent with the advent of the Common Core State Standards. The standards, which were released in 2010 and have been adopted by all but four states, mention keyboarding but not handwriting.

"The conversation about handwriting instruction has been growing," said Kathleen Wright, the coordinator of this week's event and the national product coordinator at Zaner-Bloser.

The company advocates that states supplement the common core with handwriting standards, as Massachusetts and California have already done. Ms. Wright said the conference, called the "Handwriting in the 21st Century?: An Educational Summit," was timed so policymakers could address any lack of attention to handwriting while their states are still rolling out their own versions of the common core.

Cognitive and Motor Skills
Virginia Berninger, a professor of educational psychology at the University of Washington, in Seattle, and a scheduled presenter at the conference, said that learning handwriting has both cognitive and motor benefits, and that letter formation is a skill that needs to be taught and practiced.

"The artist needs a paintbrush in order to paint. Children need tools for producing letters to support their composing," she said.

"Handwriting" refers to any cursive writing or printing by hand with pen, pencil, or other such implement, although cursive handwriting—in which the letters within each word are joined in a continuous flow—is the skill most likely to be lost.

Ms. Berninger noted that when students struggle with handwriting, "people usually think, well, just put them on the computer." But her studies of normally developing and struggling students learning handwriting suggest that may not be the solution. "It turns out that many of the problems relating to why they have trouble learning handwriting might also affect how they use a keyboard."

When handwriting is not taught, reader comprehension may suffer, according to Steve Graham, a professor of special education and literacy at Vanderbilt University, in Nashville, Tenn., whose research was slated to be presented at the conference.

But more commonly, having legible but shaky handwriting "strongly impacts people's perception of the quality of the message," he said. In a meta-analysis of research on writing, his research team found that teachers and others scoring students' tests are more likely to give lower marks to papers with less-legible handwriting.

Not practicing the motor skills associated with writing also makes it more difficult for people to communicate their ideas, Mr. Graham said. If handwriting skills aren't automatic, he said, "it interferes with the whole writing process."

Other research scheduled to be presented at the conference suggests handwriting may spur important brain activity in children.

Karin Harman-James of Indiana University in Bloomington based her findings on results from functional Magnetic Resonance Imaging, or fMRI, scans taken of children as they wrote and typed. The brain scans indicated that "handwriting, not keyboarding, leads to adult-like neural processing in the visual system," which Ms. Harman-James says suggests that handwriting may have a particular role in setting children up for reading acquisition.

Most schoolwork is still produced by hand, said Mr. Graham. But he emphasized that handwriting should not be taught to the exclusion of typing.

Common-Core Concerns
For some experts, the common-core standards in English/language arts heighten the fear that students won't pick up handwriting skills. "If it's not in the standards, then the schools will think they don't have to monitor and make sure children are learning handwriting and spelling," Ms. Berninger said.

Kathy Simmons-O'Neal, a kindergarten teacher in West Carroll Parish, La., and past president of the Louisiana Reading Association who includes handwriting in her daily instruction, said excluding handwriting from the common core would have detrimental effects. "We're not doing it as a practice daily, we’re not starting early enough, and it's causing severe motor problems with children," she said.

Several researchers said beginning teachers also are less likely to have been taught how to teach handwriting themselves in their teacher-preparation programs. Ms. Berninger described a teacher in Dallas: "She said, 'We didn't learn how to teach letters in teacher education programs.' "

Mr. Domenech of the Alexandria, Va.-based AASA, meanwhile, said the common core's lack of handwriting standards didn't necessarily mean that handwriting wouldn't be taught. "I think they assume and take it for granted," he said of the standards writers, "that that's such a basic and necessary skill that it must be taught."

Kate Dando, a spokeswoman for the Council of Chief State School Officers, one of the Washington-based groups that helped spearhead the development of the common standards, said in an email that "the Common Core State Standards allow communities and teachers to make decisions at the local level about how to teach reading and writing (and mathematics)," and that doesn't preclude them from incorporating handwriting instruction.

Outside the research community, there is some debate about which letter forms students should be learning: print or cursive. Indiana state Sen. Jean Leising, a Republican from Oldenburg, is the author of a bill that would mandate that cursive letters be taught in the state's schools. She said that when newspapers reported that Indiana would no longer mandate cursive after it adopted the common core, "I immediately got contacts from constituents about it."

Ms. Leising said the bill, which she hopes will get a hearing this month, has bipartisan support.

But Ross McMullin, a spokesman for the Indiana education department, said lessons in cursive handwriting were not being prohibited by the state. Schools can "still include cursive in their curriculum offerings if they want to," he noted.

Blending Styles
Proponents of cursive cite mutual legibility, tradition, and speed as benefits of that writing style. But according to the University of Washington's Ms. Berninger, though cursive is usually faster, there's no inherent benefit to cursive or print. She recommended teaching both forms. Mr. Graham said that "about two-thirds of kids actually mixed two scripts together," and those who mix forms wrote more quickly.

Judith Gustafson, a document examiner for the Internal Revenue Service, said that a trend toward people mixing both styles has complicated the task of identifying handwriting, signatures, and forgeries on tax forms.

Finland's National Core Curriculum for Basic Education, an inspiration for the common-core standards in the United States, includes "drawing the form of letters, learning capital and lower-case printed and cursive letters, and combining letters" in its standards for grades 1 and 2.

Meanwhile, in England, handwriting was not taught in the 1970s and 1980s because of fears that focusing on rote skills stifled creativity, according to Angela Webb, who chairs the United Kingdom's National Handwriting Association.

But the skill re-entered the curriculum in the late 1990s, Ms. Webb added, and there is no talk of removing it. She said that students are scored on handwriting on national exams. Unlike most European countries, she said, England does not have a national handwriting style, but students do learn cursive.

Ms. Webb said her group was advocating extending handwriting instruction to later grades and increasing the emphasis on speed.

Some of the same cultural concerns resonate on both sides of the Atlantic. "Journalists are writing about whether handwriting is a dying art," Ms. Webb said of the British press. But, she said, "if we view it only as an art, we've missed the point entirely"—that "handwriting is a tool."

As handwriting receives its moment in the spotlight at the national summit, Mr. Graham of Vanderbilt said, it's important to remember that the skill should be taught in service of something greater.

"As far as I'm concerned, kids need to have a legible and fluent style of handwriting, and they need to have fluent typing skills," he said. "But that's because I don't want kids to have to think about those things. I want them thinking about what they're going to say and how they're going to say it."

(Source: edweek.org)

Bacteria in the Gut of Autistic Children Different from Non-Autistic Children

2012-01-20T09:07:00.003-05:00

The underlying reason autism is often associated with gastrointestinal problems is an unknown, but new results to be published in the online journal mBio® on January 10 reveal that the guts of autistic children differ from other children in at least one important way: many children with autism harbor a type of bacteria in their guts that non-autistic children do not.

The study was conducted by Brent Williams and colleagues at the Mailman School of Public Health at Columbia University.

Earlier work has revealed that autistic individuals with gastrointestinal symptoms often exhibit inflammation and other abnormalities in their upper and lower intestinal tracts. However, scientists do not know what causes the inflammation or how the condition relates to the developmental disorders that characterize autism. The research results appearing in mBio® indicate the communities of microorganisms that reside in the gut of autistic children with gastrointestinal problems are different than the communities of non-autistic children. Whether or not these differences are a cause or effect of autism remains to be seen.

"The relationship between different microorganisms and the host and the outcomes for disease and development is an exciting issue," says Christine A. Biron, the Brintzenhoff Professor of Medical Science at Brown University and editor of the study. "This paper is important because it starts to advance the question of how the resident microbes interact with a disorder that is poorly understood."

Bacteria belonging to the group Sutterella represented a relatively large proportion of the microorganisms found in 12 of 23 tissue samples from the guts of autistic children, but these organisms were not detected in any samples from non-autistic children. Why this organism is present only in autistic kids with gastrointestinal problems and not in unaffected kids is unclear.

"Sutterella has been associated with gastrointestinal diseases below the diaphragm, and whether it's a pathogen or not is still not clear," explains Jorge Benach, Chairman of the Department of Microbiology at Stony Brook University and a reviewer of the report. "It is not a very well-known bacterium."

In children with autism, digestive problems can be quite serious and can contribute to behavioral problems, making it difficult for doctors and therapists to help their patients. Autism, itself, is poorly understood, but the frequent linkage between this set of developmental disorders and problems in the gut is even less so.
Benach says the study was uniquely powerful because they used tissue samples from the guts of patients.

"Most work that has been done linking the gut microbiome with autism has been done with stool samples," says Benach, but the microorganisms shed in stool don't necessarily represent the microbes that line the intestinal wall. "What may show up in a stool sample may be different from what is directly attached to the tissue," he says.

Tissue biopsy samples require surgery to acquire and represent a difficult process for the patient, facts that underscore the seriousness of the gastrointestinal problems many autistic children and their families must cope with.

Benach emphasizes that the study is statistically powerful, but future work is needed to determine what role Sutterella plays, if any, in the problems in the gut. "It is an observation that needs to be followed through," says Benach.

(Source: sciencedaily.com)

Last Chance to Register for Treating ASD in the Schools

2012-01-19T11:17:00.001-05:00

Cost: $119.00

FREE if you sign on with Therapeutic Resources for the DOE Bid

Speaker Name: Julianne Costa, OTR/L, DPT

Seminar Date: January 31, 2012
Start Time: 5:00
End Time: 8:00
Duration: 4:30-5:00-Registration/Refreshments 5:00-8:00-Course

What kinds of treatment strategies are effective for the school aged child with autism spectrum disorders? What can you do in a thirty minute therapy slot? With a focus on the school environment, this presentation will demonstrate therapeutic techniques which can be used to address behavioral and academic issues as well as odd habits frequently seen in the child with Autism Spectrum Disorder. Videos, lecture, and demonstrations will be utilized to illustrate concepts.

Learning Outcomes:

1. Identify at least two treatment strategies to approach autism spectrum disorders.
2. Plan an effective treatment session in a school setting.
3. Remediate odd behaviors utilizing the treatment methods presented

To gain free entry into these events, sign on with Therapeutic Resources for the Department of Education 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. Treating Autism Spectrum Disorders In The Schools

Top Ten Interventions for the Classroom Recap

2012-01-19T11:05:00.001-05:00

Thank you to all who came out to, "Top Ten Interventions For the Classroom". This exciting seminar, presented by Laurette Olson, PhD, OTR/L centered on identifying the challenges of providing OT services in the classroom. The course analyzed what is the most important issue to address for each student so that they can participate in the classroom. Topics covered also included exploring the top ten interventions for delivering OT in the classroom setting.

The course was offered for free in exchange for participation in the Department of Education Bid process. For more information and other courses, please visit our website.

App Thursday: IPAD for Autism-Communication

2012-01-19T09:59:00.002-05:00

This great video we found on youtube, shows the IPAD in action as it helps one family help their daughter become more independent...

Tablet Computer Technology Transforming Speech Therapy

2012-01-18T10:46:00.001-05:00

It turns out the iPad, the touch-screen tablet computer made by Apple Inc., is more than the latest must-have gadget.

The iPad has revolutionized speech therapy in the two years since its release, including in the Centerville Community School District.

Brianne Thompson, 25, a speech-language pathologist at the Great Prairie Area Education Agency, works with about 50 children in the Centerville district. She said the iPad is quickly changing the way speech therapy is practiced.

“Number one, kids want to use it,” Thompson said. “Speech therapy can be extremely monotonous work, and you need tons of repetition. Whenever a kid is motivated, it means you are going to see more progress more quickly.”

Initially a few iPads were purchased about a year ago as a pilot project, said Tom Mosbach, regional special education director at the Great Prairie AEA. Mosbach, whose office is in Albia, said the agency had the speech therapists do research on the different applications that were available and test out the iPads during therapy sessions with children.

“We found that it was an extremely useful tool,” Mosbach said. “There were just dozens and dozens of applications that really facilitated the learning and the progress of the kids.”

Mosbach said the iPad has been especially effective for working with autistic children, compared with past therapies.

“It is just really amazing some of the progress the kids have made,” he said.

An iPad costs several hundred dollars, with the iPad 2 currently retailing at $499. Thompson said this is a significant savings over older speech therapy tools. She said the iPad not only has replaced devices that can cost up to $10,000, she no longer has to try to get a large amount of funding approved before providing a service a child needs.

Thompson estimated she has about 60 different applications that she uses on a regular basis. She added that while some of the applications cost money, some only cost a dollar or two. Many of them are free.

She said one of the most useful applications, Proloquo2Go, costs $190. Proloquo2Go is an augmentative communication device for children who have cognitive ability and language skills but who have trouble expressing themselves. The application displays icons that children click on to build sentences that allow them to communicate.

“You have a $190 app on an iPad that could completely change a kid’s life and how he interacts with people,” Thompson said.

Mosbach said the iPad does not necessarily replace all other tools. If a child needs a more sophisticated tool, he said, the agency intends to provide that. But he added that the iPad is capable of performing many of the same tasks as the old devices for less cost.

“A lot of the equipment we use with the kids is extremely expensive, costing thousands of dollars,” Mosbach said. “We have seen the iPad being able to do some really similar things.”

Thompson started her position with the Great Prairie AEA a year and a half ago and worked with children during her master’s program as well. She said the iPad has changed her daily life. Whereas she used to bring a cart loaded down with materials to schools with her, now she often brings only the iPad.

“[Speech therapists] are notorious for having to carry around like pack mules everything under the sun,” she said. “Now I have just about everything I need for therapy is on one device.”

Thompson said one reason she was drawn to her field was because she received speech therapy as a child for a mild problem with her s’s and r’s. When her sister, Lindsey Mulnix, studied to become a speech pathologist, Thompson was inspired. Mulnix, who is three years older, is a speech pathologist in northern Iowa.

“I thought it looked like the best job ever, so I decided I wanted to look into it as well,” Thompson said.

To become a speech-language pathologist, Thompson attended the University of Northern Iowa for four years for an undergraduate degree in communicative sciences and disorders and then completed a master’s degree in speech-language pathology.

Thompson said she was glad she found employment in her field in this region. Thompson, the daughter of Scott and Andrea Clark, grew up in Centerville. Her husband, Matt Thompson, 27, grew up in Moulton. He works as an MRI and CT scan technologist at Davis County Hospital.

“We were high school sweethearts,” she said. “We knew we wanted to get back where our families are.”

Thompson said children tend to think of the iPad as more fun than other tools. Also, if they do a good job in her sessions, they can earn the right to spend a few minutes playing a game on the iPad.

“When you’re working with 5-year-olds, you have to make it fun somehow. … Now they are content, every single time, to work with the iPad,” Thompson said. “So I don’t have to get quite so wrapped up in the motivational end of it either.”

She said another benefit of the iPad applications is that students can evaluate their own progress. If they think they made a sound correctly, they click one box. If they think the sound was not quite right, they click another. The iPad stores their answers and tracks their progress.

“It gives them more ownership of their work,” she said.

Thompson said the thing she loves most about the iPad is its versatility.

“I use it with my 2-year-olds, I use it with my severely intellectually impaired kids, and I use it with my sixth-graders who are just working on one sound,” Thompson said. “I have all these kids with these different diagnoses, and it just fits in somehow for all of them.”

(Source: dailyiowegian.com)

Job Spotlight Bulletin 1-17-12

2012-01-17T11:44:00.002-05:00

Change the future: Work with Children in Schools Settings

If you are looking for the chance to make a difference in the life of a child, have steady work, and be in a great enviornment, a career in a school might be for you!
School placements are opportunities for fulfilling, varied cases. No two days will be the same.
Work with children in all 5 boroughs.

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 http://www.therapeuticresource.com/.

Trigger Point Dry Needling for Lateral Epicondylitis

2012-01-17T10:18:00.000-05:00

Trigger Point Dry Needling
Dry Needling is a physical therapy modality used in conjunction with other interventions to treat myofascial pain and dysfunction caused by trigger points. Myofascial trigger points (MTrP’s) are defined as hyperirritable nodules located within a taut band of skeletal muscle (Simons et al., 1999). Palpation of a MTrP produces local pain and sensitivity, as well as diffuse and referred pain patterns away from the affected area. Painful MTrP’s activate muscle nociceptors that, upon sustained noxious stimulation, initiate motor and sensory changes in the peripheral and central nervous systems. (Shah et al., 2008).

Trigger point dry needling can be used to achieve one of three objectives. First, trigger point dry needling can confirm a clinic diagnosis by relieving the patient’s pain or symptoms of nerve entrapment. Second, inactivation of a MTrP by needling can rapidly eliminate pain in an acute pain condition. Third, inactivation of the MTrP through needling can relax the taut band for hours or days in order to facilitate other therapeutic approaches such as physical therapy and self stretching (Dommerholt and Gerwin, 2006).

Universal precautions are always followed when utilizing dry needling in patient care. During the procedure, a solid filament needle is inserted into the skin and muscle directly at the myofascial trigger point. The trigger point is penetrated with straight in and out motions of the needle. The needle can be drawn back to the level of the skin and redirected to treat other parts of the trigger point not reached in the first pass (Dommerholt and Gerwin, 2006). During this procedure, it is essential to elicit twitch responses in the muscle. The local twitch response (LTR) is an involuntary spinal reflex contraction of muscle fibers within a taut band during needling. Research shows that biochemical changes occur after a LTR, which correlate with a clinically observed decrease in pain and tenderness after MTrP release by dry needling (Shah and Gilliams, 2008).

Trigger Point Dry Needling for Lateral Epicondylitis
Trigger point dry needling is an effective treatment modality for numerous acute and chronic musculoskeletal issues. One condition that responds favorably to dry needling is lateral epicondylitis. Therapists know that this problem has usually become chronic by the time the patient seeks treatment, and progress is usually frustratingly slow for both the patient and the therapist.

When dry needling is incorporated into the treatment plan, results are often seen after 2 or 3 visits. The entire forearm is easily treated with the patient supine on the treatment table, and multiple TrP’s can be treated in a matter of minutes. After a thorough history and physical exam, the therapist assesses the forearm for taut bands and trigger points. Muscles commonly involved in symptoms of lateral epicondylitis include: triceps, brachioradialis, extensor carpi radialis longus (and sometimes brevis), extensor digitorum, anconeus, and supinator. As always, the therapist should screen the neck and shoulder region for MTrP’s. Muscles that may refer pain to the lateral epicondyle include: supraspinatus, infraspinatus, teres major and scalenes.

The needling treatment is completed when all LTR’s are eliminated or the patient requests to stop the treatment. The needle is discarded in a sharps container and hemostasis is applied to the area to decrease bruising. The therapist provides manual therapy with a local stretch to the taut band, myofascial release and therapeutic stretch. The patient is taught a self stretch for home, and the treatment can be concluded with ice or heat to the area. The patient is instructed to stretch the area throughout the day and apply heat/ice as needed. It is not unusual to have some increased soreness at the needling site that may last for up to 48 hours. After 48 hours, most patients report a significant decrease in pain, increase in range of motion and some return of strength.

In conclusion, trigger point dry needling can be used in conjunction with other interventions to treat myofascial pain. At the current time, each state has made its own ruling with regard to the physical therapist’s ability to utilize dry needling. The therapist would be best served by reading the State Practice Act for the state in which they practice to determine their ability to use this modality. I went through 100 hours of classroom and practical training in dry needling and successfully passed both a written and practical exam to become a Certified Myofascial Trigger Point Therapist through Myopain Seminars. I highly recommend this course and I find dry needling to be a very effective part of my practice.

(Source: mikereinold.com)

Top Ten Interventions for the Classroom is Sold Out!

2012-01-16T15:59:00.003-05:00

Top Ten Interventions for the Classroom, taking place this Wednesday evening at Therapeutic Resources, is sold out! If you would like information on when this course will be offered again, please call us at 212.529.9780.

You can view all of our upcoming courses here.

Senior Driving Study Eyes For Safer Roadways

2012-01-16T11:58:00.001-05:00

Jan Polgar, an occupational therapy professor at Western, is co-leader of AUTO21’s Enhancing Vehicular Mobility in Older Adults project. For some, a GPS is an invaluable part of a lengthy commute, helping drivers navigate unfamiliar cities. For others - and seniors, in particular - a GPS, along with a number of other automotive gadgets, often proves a distraction, doing more harm than good. Credit: Adela Talbot, Western News
For some, a GPS is an invaluable part of a lengthy commute, helping drivers navigate unfamiliar cities. For others – and seniors, in particular – a GPS, along with a number of other automotive gadgets, often proves a distraction, doing more harm than good.

So, how do we reconcile advancements in automotive technology with an aging driver population? What needs to be done to make driving safer and more accessible to seniors?
These are just some of the questions at the heart of the Enhancing Vehicular Mobility in Older Adults project, co-led by Jan Polgar, a professor at The University of Western Ontario’s School of Occupational Therapy and part of AUTO21, a Canadian Network of Centres of Excellence.
Polgar, together with Western colleague Lynn Shaw, contributed to two recent studies she says show a need to improve on senior driver evaluation, training and access to public transportation in order to make the roads safer for everyone.

“With the project, we have really two prongs – one of them is driver evaluation and driver retraining,” Polgar says. “The other is using technology as part of a re-training program and developing a support or checklist for seniors to help them if they are looking to purchase a car that has new technology in it and to determine if (that car) is right for them.”

In one study, researchers surveyed seniors across Canada, asking about their comfort with technologies developed to make driving easier, and generally safer, for the average driver.
“The group was looking at whether technology is, in fact, a benefit to older drivers or if it is a distraction,” Polgar explains.

The survey looked at a number of devices – among them a GPS – to determine if they are easy to use, if their directions are clear and what features tend to give senior drivers trouble when operating them while driving a car.

“A GPS, for an example, is getting easier to use. But some of them assume you’ve got experience using a computer. If someone isn’t used to computers, they won’t know how to use that technology, so it might be a challenge,” Polgar says.

Features such as ‘lane assist’ with lights on side mirrors that light up if another car is in a driver’s blind spot and flash if the driver signals a lane change, require less input from a driver and are easier to use. Even so, advancements such as these can be distracting to senior drivers, Polgar explains.

The results of the study will benefit occupational therapists working with mobile seniors and can also be used toward the future development of more intuitive, senior-friendly automotive technologies.

“Age isn’t a determining factor for safe driving. But we start to see a split after 75, with problems that can affect driving – vision, hearing and musculoskeletal disorders,” Polgar says.
This is why a better evaluation of senior drivers is needed.

“We need to have really good evaluations, and it’s a two-step process – a screening process to determine who is fine to drive and who needs to come off the road. The work is being done by OTs (occupational therapists) but it’s not readily available,” Polgar says.

Once a proper evaluation process is in place, occupational therapists who work with seniors can help develop evidence-based driver re-training programs that are readily accessible and don’t cost $350, the current tab for a senior driver training program.

A second study carried out by Polgar’s team looked at a number of London seniors unable to drive, dependent on public transportation for their livelihood.

The study found seniors were reluctant to give up licenses because they weren’t comfortable using public transportation. Participants didn’t know how to use a bus, navigate routes and schedules and found some transportation inaccessible due to long walking distances to bus stops as well as poor hours and a lack of kneeling busses on certain routes.

Researchers are looking to partner with the city, senior transpiration groups or the Kiwanis Senior Community Centre to develop a ‘bus buddies’ program, available in some Canadian cities, to help seniors access public transportation.

Whether they remain on the road as drivers or take public transportation, an improvement to senior driver evaluations, training and public transportation is needed, not just for safety, Polgar notes.

“It would make mobility easier and there’s been lots of work showing that if people can get out and continue doing what they do, there are a lot of health and emotional benefits.”

Provided by University of Western Ontario
(Source: physorg.com)

PET Effectively Detects Dementia, Decade of Research

2012-01-13T11:11:00.001-05:00

In a new review of imaging studies spanning more than ten years, scientists find that a method of positron emission tomography (PET)safely and accurately detects dementia, including the most common and devastating form among the elderly, Alzheimer's disease. This research is featured in the January issue of The Journal of Nuclear Medicine.

Researchers reviewed numerous PET studies to evaluate a molecular imaging technique that combines PET, which provides functional images of biological processes, with an injected biomarker called 18F-FDG to pinpoint key areas of metabolic decline in the brain indicating dementia. Having physiological evidence of neurodegenerative disease by imaging patients with PET could give clinicians the information they need to make more accurate diagnoses earlier than ever before.

"The new data support the role of 18F-FDG PET as an effective addition to other diagnostic methods used to assess patients with symptoms of dementia," says Nicolaas Bohnen, MD, PhD, lead author of the study and professor of radiology and neurology at the University of Michigan, Ann Arbor, Mich. "The review also identified new literature showing the benefit of this imaging technique for not only helping to diagnose dementia but also for improving physician confidence when diagnosing a patient with dementia. This process can be difficult for physicians, especially when evaluating younger patients or those who have subtle signs of disease."

Dementia is not a specific illness but a pattern of symptoms characterized by a loss of cognitive ability. These disorders can be caused by injury or progressive disease affecting areas of the brain that control attention, memory, language and mobility. While Alzheimer's is most commonly associated with progressive memory impairment, dementia with Lewy bodies, another form of the disease, can be associated with symptoms of Parkinson's and prominent hallucinations, while another disorder, called frontotemporal dementia, can be seen in patients showing uncharacteristic personality changes and difficulties in relating and communicating. Physicians can use FDG-PET with high accuracy to not only help diagnose dementia but also differentiate between the individual disorders. The role molecular imaging plays in the diagnosis of dementia has expanded enough that the official criteria physicians use to diagnose patients now includes evidence from molecular imaging studies.

"For the first time, imaging biomarkers of Alzheimer's disease are included in the newly revised clinical diagnostic criteria for the disease," says Bohnen. "This is a major shift in disease definition, as previously an Alzheimer's diagnosis was based mainly on a process of evaluating patients to exclude possible trauma, hemorrhage, tumor or metabolic disorder. Now it is becoming a process of inclusion based on biomarker evidence from molecular imaging."

The PET biomarker 18F-FDG comprises a radionuclide combined with fluorodeoxyglucose (FDG), which mimics glucose in the body. Cells metabolize FDG as fuel, and the variation in this uptake by cells throughout the body can then be imaged to detect a range of abnormalities. In the case of dementia, marked reductions in the metabolism of different lobes of the cerebral cortex can confirm a patient's disorder. Physicians can tell Alzheimer's disease apart from other dementias, depending on the specific cortices affected.

This review presents the most up-to-date and salient evidence of FDG-PET's usefulness for the evaluation of patients with suspected dementia. The objective of the study was to replace prior retrospective reviews that were performed as the technique was just emerging and that suggested methodological improvements. The new review includes studies with better methodology, including confirmation of diagnoses with autopsy, more expansive recruitment of subjects and use of multi-center studies. After reviewing 11 studies that occurred since the year 2000 and that met more stringent study review standards, researchers conclude that 18F-FDG is highly effective for detecting the presence and type of dementia.

"Using 18F-FDG PET in the evaluation of patients with dementia can improve diagnostic accuracy and lead to earlier treatment and better patient care," says Bohnen. "The earlier we make a diagnosis, the more we can alleviate uncertainty and suffering for patients and their families."

The biomarker 18F-FDG is among a variety of imaging agents being investigated for its efficacy in Alzheimer's imaging. As treatments for dementia become available for clinical use, PET will no doubt play an important role in not only the diagnosis of these diseases, but also the assessment and monitoring of future therapies.

According to the World Health Organization, an estimated 18 million people worldwide are currently living with Alzheimer disease. That number is projected to almost double by 2025.

(Source: sciencedaily.com)

Seniors Using iPhone Apps to Alert When They Fall

2012-01-12T09:55:00.001-05:00

Each year falls create fractures, bruising, and serious injuries for the elderly, as their bodies are not as durable and they often cannot get up on their own. The elderly often live at home alone until they move into senior housing, and not having anyone around is a frequent worry for their loved ones who are concerned with their safety. Now there are some new apps for the iPhone or iPod Touch that seniors can use to help alert others when they take a fall. The two apps starting to generate buzz in the space are Fall Alert and iDown, which both rely on the internal accelerometer which allows the app to detect rapid acceleration like a fall. Seniors using iDown will only have emails sent to others when they take a fall, but those using Fall Alert will have the app call a designated phone number.

The iDown and Fall Alert apps are still relatively new, and early reviews indicate that they still have work to do to become more useful to those seniors who are looking for extra support if they were to take a fall. Falls happen in all sorts of directions, and the accelerometer is only so intelligent on picking up all falls, so many people who have downloaded the app report that it only works about half of the time. If app developers continue to improve upon this technology, it could give millions of seniors an easy way to add a fall detection app into their everyday life to help keep them safe.

(Source: guidetonursinghomes.com)

When Nurses Catch Compassion Fatigue, Patients Suffer

2012-01-11T09:53:00.005-05:00

I think a lot of us can relate to this really great article from the Wall Street Journal...

As a nurse in the cancer center at Barnes-Jewish Hospital in St. Louis, Wilhelmina Roney, 26, sometimes feels overwhelmed by demands from patients, even though she tries her best to care for them. During a rough week, patients may die in such quick succession that she barely has time to cope.

With the help of an innovative program offered by the hospital, Ms. Roney says she's learned how to handle an occupational hazard she wasn't prepared for: compassion fatigue.

The Barnes-Jewish program is one of a growing number of efforts by hospitals and nursing groups to help combat the constant assault on nurse's psyches. In addition to meditation and stress-reduction workshops, such programs include discussions about difficult patient situations, support groups, and staff retreats focused on the emotional aspects of care giving.

Compassion fatigue is a combination of secondary traumatic stress from witnessing the suffering of others and burnout. It can lead nurses to feel sadness and despair that impair their health and well-being. Hospitals are tackling the problem amid a worsening shortage of nurses and concerns that patients may suffer. Compassion fatigue can reduce nurses' empathy and lead them to dread or even avoid certain patients, raising the risk of substandard care.

Nurses who avoid patients "don't form the relationship necessary to truly understand the patient, identify their problems early, and adapt therapies to their needs," says Patricia Potter, a nurse researcher and director of research for patient-care services at Barnes-Jewish. Nurses can also become rude and cynical, which can discourage patients from asking them for help, she says, adding less observant nurses may be more error-prone.

Compassion fatigue has been linked to decreased productivity, more sick days and higher turnover among cancer-care providers. A 2008 study led by the University of Nevada, Reno's nursing school found that about 12% of registered nurses in the U.S. weren't working. Of those, more than 27% cited burnout or stressful work environments. High turnover and the subsequent increased workload on remaining nurses can result in higher death rates and reduced patient safety, studies show.

"Recognizing, managing and relieving these issues are critical for nurses and their employers," as well as for patients, says Holly Carpenter, a senior staff specialist at the Center for Occupational and Environmental Health of the American Nurses Association in Silver Spring, Md.

Compassion fatigue was identified as a special problem for nurses in the early 1990s. The ANA's Healthy Nurse program sponsored its first workshop on the issue at its annual conference last year, with another planned for this year, and it offers special resources on its website. The New York State Nurses Association conducted its first compassion-fatigue workshop at a hospital last year and is urging hospitals and nursing schools in the state to offer such programs.

Concerned about turnover in the oncology unit and evidence of stress among nurses, three Barnes-Jewish nurse managers approached Dr. Potter and the head of the hospital's patient and family counseling program, Theresa Deshields, for help in 2009. The problem was especially acute for those caring daily for very ill patients whose survival was in doubt. The nurses seemed susceptible to emotional and physical stress and as a result, sometimes disengaged from their patients.

A survey of 150 staffers found that compassion-fatigue symptoms were high enough to warrant intervention.

The hospital turned to Eric Gentry, a Sarasota, Fla., psychotherapist who specializes in teaching stress-management techniques to disaster responders and emergency physicians. A pilot program he created for 14 nurses was promising enough for the hospital to fund development of the compassion fatigue course, now open to all staffers at the hospital, from physicians to housekeepers.

The course includes a checklist of symptoms to watch out for, and offers "antidotes" to compassion fatigue, such as creating a support network. Participants are taught the importance of focusing on "intentionality"—the caring intention that brought them to the health care field in the first place—while accepting their own limits in doing only the best they can on any given day.

The course also teaches physical, stress-relieving exercises. Dr. Gentry says that in anxious or stressful environments, people often react by keeping their bodies tightly clenched all day in anticipation of danger. Relaxing the pelvic floor—the area under and around the pelvis—has been shown to release tension and help control anxiety, he says.

"Being a caregiver is difficult and full of challenges, and that isn't going to change," says Dr. Potter. But nurses, she says, can be taught to "self-regulate their stress and restore the energy they need to provide the best patient care."

Ms. Roney, the cancer-unit nurse, says she first learned about the course after asking a supervisor if there was any way to help with low morale on her unit, including her own. She found herself discouraged when patients or families weren't satisfied with her care or had a negative outlook.

A particularly draining experience came when a patient in his 40s demanded to know how she felt about caring for cancer patients and if she liked her job. She said she loved it and tried to keep the conversation positive, but he declared, "Well, I'm dying," despite a likelihood that treatment could extend his life.

"Trying to be compassionate with someone like that is much more difficult" than with some other patients who remain upbeat, even while undergoing chemotherapy, she says.

Jamie Bugg, a 32-year-old nurse at the oncology center, says some of the training felt awkward, such as a session in which participants team up and look into each other's eyes silently for a minute, and then say positive things about what they observed about each other during the exercise.

Still, Ms. Bugg says she hopes all of her colleagues take the compassion-fatigue course.

"There is a daily toll when you see so many sad aspects of things and people at the end of life, knowing how sick they are and knowing this could be their last holiday," she says. "We need better ways of coping than internalizing everything."

Nursing's Emotional Toll
Compassion fatigue, a combination of secondary traumatic stress and burnout from increasing demands of nursing, can include these symptoms:

Work Related
•Avoidance or dread of working with certain patients

•Reduced ability to feel empathy towards patients or families

•Frequent use of sick days

•Lack of joyfulness

Physical

•Headaches

•Upset stomach, digestive problems

•Muscle tension

•Insomnia, too much sleep

•Fatigue

•Chest pain/pressure, palpitations, tachycardia (elevated heart rate)

Emotional
•Mood swings

•Restlessness

•Irritability

•Oversensitivity

•Anxiety

•Excessive use of nicotine, alcohol, illicit drugs

•Depression

•Anger and resentment

•Loss of objectivity

•Memory issues

•Poor concentration, focus and judgment

Jobs Alert Bulletin-January 10th

2012-01-10T14:00:00.000-05:00

The latest job openings from Therapeutic Resources is here! In addition to the positions listed below, (which you can apply to by clicking on any of the professions) we have work in Early Intervention Homecare, Adult Homecare, and Schools! Call us at 212.529.9780 or email us!

Profession: OT
Population: Pediatrics & Adult
Location: ManhattanSchedule: Part Time
Description: An Upper West Side (Manhattan), not-for-profit program offers services to children and adults with visual impairments seeks an OT for a part time contract position, 3 days a week. (Tuesday’s, Wednesday’s, and Thursday’s are preferred) In addition to early intervention programs, there are services for preschool and school age children. Clinical and rehab services are also offered to all, including adults.

Profession: PT
Population: Pediatric
Location: BronxSchedule: Part TimeDescription: A PT is needed for a part time position 3 days a week at a dynamic pediatric center in the Bronx that serves over 2,800 children, adults and families in the greater NY area. Services include: Educational Services, Early Childhood Service, Children and family Services, Services to children & Adults with Developmental, Physical & Mental Health Services and Juvenile Justice Services. Recently expanded services to children & adults with developmental disabilities to include a second group home, recreation and respite services both on-site and at-home, and sday habilitation services.

Profession: SLP
Population: Adult
Location: QueensSchedule: CoverageDescription: 160-bed facility for both short and long-term patients in Forest Hills, Queens seeks a SLP for coverage 1/25-2/4. In addition to short and long term care programs, they also offer specialized wound care, pain management, and hospice programs. This facility is a licensed skilled nursing facility with 24-hour comprehensive nursing care, attending physicians at the facility every day, and a wide range of MD specialists always on call.

Profession: COTA
Population: AdultLocation: BronxSchedule: CoverageDescription: A COTA is needed for coverage 1/16 at a 200 + bed facility in the Kingsbridge section of the Bronx serving a unique and diverse population of residents with varied clinical deficits including spinal cord injuries, strokes, and AIDS related conditions.

Profession: COTA
Population: Adult
Location: BrooklynSchedule: Coverage
Description: A new modern long term care center in Brooklyn that accommodates 240 full-time residents along with rehabilitation and Adult Day Health Care clients seeks a COTA for coverage 1/16. It unites generations of quality health care under one roof, along with a commitment to serving the community and the ability to meet the challenges of the changing health care system. Qualified and experienced staff are genuinely interested in making this home a wonderful place to live.

Profession: PT
Population: Pediatric
Location: Bronx
Schedule: Part Time
Description: A PT is needed for a part time contract position for a Bronx Preschool 2 days a week from 8:30-4:30pm. This preschool follows a creative curriculum which emphasizes and builds on each child’s strengths. They are also aggressively exposing children to reading and building literary skills as early as possible. Therapists are also agents for promoting skills necessary to future success. Therapy can be done in the clinic, classroom or even the playground.

Profession: OT
Population: Adult
Location: Manhattan
Schedule: Saturday CoverageDescription: This a great opportunity for Saturday coverage. An OT is needed for temporary coverage from 9-5 on Saturday’s at a large, Upper East Side Manhattan rehab and nursing center. This facility has a huge therapy gym and a large staff.

Profession: PTA
Population: Adult
Location: BronxSchedule: CoverageDescription: Large (close to 500) bed nursing home and rehab center in Co-Op City, Bronx seeks a PTA for coverage from 1/19-1/27. This facility prides itself on a very involved staff, which provides therapy services six days a week.

Profession: PT
Population: Adult
Location: Manhattan
Schedule: Long Term CoverageDescription: Lower East Side Manhattan facility offers nursing and rehab services seeks a PT for long term coverage starting 1/31. With 240 beds, this center serves the diverse community surrounding it. Interested candidates should be bilingual mandarin.

Profession: COTA
Population: Adult
Location: BronxSchedule: Temporary AssignmentDescription: Central Bronx located (near Arthur Avenue), not for profit acute care community hospital and Level 1 Trauma center that has over 450 beds seeks a COTA for a temporary assignment. This facility offers nearly twenty programs for adults and children including services for mentally ill, day treatment programs and special programs for victims as well as employee assistance programs.

Congratulations to our January Winner Loreene C. of Bronx, NY

2012-01-10T10:30:00.001-05:00

Congragulations to Loreene C. of Bronx, NY on winning our January Big Deal Giveaway, a Gaiam Balance Ball Chair. Look out for our February contest, which can happen at point during the month.

Physical Therapy Could Reduce Cost of Lymphedema Treatment

2012-01-10T09:40:00.001-05:00

Early diagnosis and treatment of breast cancer lymphedema by a physical therapist could significantly reduce the cost and need for intensive rehabilitation, according to latest research.
Scientists writing an article published in the January issue of the journal Physical Therapy for the American Physical Therapy Association (APTA) suggested that a prospective surveillance model for the treatment of breast cancer-related lymphedema was significantly lower in cost compared to a traditional model of impairment-based care.

APTA member and spokesperson Nicole Stout, who led the programme, said: "This study begins to paint a picture of evidence showing that prevention of chronic conditions such as lymphedema - using rehabilitation models of care - may result in significant cost savings."
Researchers found that the prospective surveillance model cost around $636.19 a year compared to $3,124.92 for the traditional treatment of advanced lymphedema, also known as a lymphatic obstruction.

The condition is a blockage of the lymph vessels that drain fluid from tissues throughout the body and could affect the workings of the immune system.

(Source: spirehealthcare.com)

Sweet Freedom: Occupational Therapy Plays Key Role In Reducing Restraint Use

2012-01-09T08:57:00.000-05:00

Occupational therapists at 20 nursing homes across New Jersey helped develop strategies to reduce significantly the use of restraints on patients during the past three years as part of a nationwide initiative launched by the Centers for Medicare and Medicaid Services

“Overall, the reduction rate was 54%. The majority of nursing homes in the initiative were able to get under a 6% patient restraining rate,” said Dolores Viotti, program manager for Healthcare Quality Strategies Inc., the Medicare-designated quality-improvement organization for New Jersey based in East Brunswick, N.J.

CMS’ Physical Restraint Reduction Project set a goal of a 20% reduction at nursing homes with a rate of 6% rate or more.

A physical restraint is defined as any device a patient cannot remove easily and that restricts his or her freedom of movement or access to his or her own body. Examples include vest restraints, waist belts, geri-chairs, hand mitts, lap trays and side rails on beds.

According to a 2008 report by CMS, the use of restraints can result in accidents that may cause serious injury, bruises, cuts, entrapment, and even death by strangulation and suffocation with the use of side rails.

Other effects from restraints may include poor circulation, constipation, incontinence, weak muscles and bone structure, pressure sores, agitation, depressed appetite and infections. Restrained patients may become depressed and agitated and withdraw from social contact. Restraints also can disrupt sleep.

According to the latest data from CMS, New Jersey nursing homes have a 3.8% restraining average, slightly under the national average of 4%, but not as low as the 1% average of Kansas long-term care facilities.

While the restraint reduction initiative was facility specific, teams from each of the nursing homes would get together via conference calls, the Internet or face-to-face conferences. “The teams would meet on difficult cases and identify best practices on case studies,” Viotti said.

Tool kits available through a Learning and Action Network developed by Healthcare Quality Strategies for web access will continue the process past this initiative and onto the next targeted group of nursing homes, which is being identified, she said.

Interestingly, the New Jersey results showed despite reducing physical restraint, patients did not end up falling more during the three-year project, Viotti said.

“One of the key aspects we were looking at was the fall rate, and it did not go up as a result of the reduction in restraints,” she said. The restraint reducing initiative also showed positive results toward another CMS initiative on reducing pressure ulcers in this population group, she said.

OTs were instrumental in designing the multidisciplinary approach to restraint reduction, which included physical therapists, activity coordinators and nutritionists. OTs provided alternative solutions to nursing staff, Viotti said. “OTs took a very large piece of this project,” she said.

Success story
Seeing no change in the fall rate was important, said Teresa Hubbard, OTR, lead therapist at Christian Health Care Center in Wyckoff, N.J., one of the facilities in the restraint reduction initiative.

“The false idea is if you restrain, then you have less falls,” she said. “That’s not what occurred at all. Some restraints — like long bed rails — can cause greater injury as patients slide through them or try to get over them. As therapists we have been talking about this for years.”

CHCC was able to reduce its use of restraints from 8% to 1.6% by the conclusion of the project.

OTs are involved in restraint reduction of patients from the onset of therapy, said Kimberly Martin, OTR/L, senior clinical specialist at CHCC. “One of the primary responsibilities for OTs in this initiative has been wheelchair seating and positioning,” Martin said. “That starts with a full assessment to determine if we are using restraint, why? And can they be decreased or eliminated?”

Through assessing such issues as a patient’s trunk balance, postural control and weakness on one side, OTs are able to devise a treatment plan that can strengthen a patient so he or she can reposition safely without restraints, Martin said.

Using a variety of modifications for long-term care patients who use wheelchairs also helped decrease restraint use, Martin said. Modifications such as cushions, back rests, foot rests, and upper-extremity supports can increase comfort and compensate for balance issues, Martin said.

Wedges and saddle cushions can help support the patient instead of a belt. In addition, gel and foam cushions can be enlisted to help with sores in the sacrum area. Some cushions have air bladders that can automatically inflate and deflate to shift patients who can’t move themselves.

Lowering the bed to the floor, adding a soft mat beside the bed and using half-bed rails are other strategies used to lower restraint use, Hubbard said. “That makes them safe in bed without the use of a full bed rail,” she said.

Other available equipment in place of restraints include a belt designed like a car seat belt or with Velcro that can be pulled open easily by the patient. Some belts will sound an alarm when opened, which can be used by patients with dementia or Alzheimer’s to notify both the patient and the staff when it has been opened.

Active follow-through
Therapeutic activities play a role in reducing restraint use, Martin said. Activities programs keep patients and residents engaged and active, reducing agitation and pressure ulcers. “If they are not having enough stimuli, patients can get bored and antsy,” she said. “We get them involved in more activity programs, even if they have limitations.”

Another key component of the initiative is position change schedules, Martin said. Patients may stand for short periods, or move from a wheelchair to a table chair in the dining room, or to a lounge chair that will allow them to extend their feet, for example. Wrist bands can identify at-risk patients.

Hubbard said patients often do not mention their wheelchair discomfort, so it’s important for staff to pick up on visual clues. “They may not be able to verbalize their discomfort, but they may be trying to move or get out of the chair,” she said. “We teach the staff to watch for behaviors, and before they put on a restraint, see if there’s another option.”

The restraint reduction initiative will continue at Christian Health Care Center, Hubbard said. “When I first started working, I saw a patient tied with a sheet to a chair at another nursing home,” she said. “That was 18 years ago. We’ve come a long way.”
(Source: TodayInOT.com)

2012-01-06T12:00:00.000-05:00

Therapeutic Resources
Big Deal Giveaway
January 2012
This month we are giving one (1) Gaiam Balance Ball Chair

The Gaiam Balance Ball Chair, developed under the consultation of chiropractic pioneer Dr. Randy Weinzoff, greatly alleviates the aching back/legs/arms syndrome that comes from working at a desk for hours. Designed for people between 5-feet and 5-feet, 11-inches tall, this unique chair employs the same balance ball used in your workout routine, but with an adjustable support bar, easy-glide casters, an air pump, and a desktop guide to help keep you moving. Designed by leading health and fitness experts, the Gaiam Balance Ball chair helps relieve pain and promote proper spinal alignment, posture, a healthier back, and overall well-being.

So how do you win? Easy! Just follow these two steps:

1. Like Us on Facebook!
You MUST be a Facebook fan to win the giveaway!
So click here to Like Us now.

2. Reply to this email with your full name, phone number and email address where you can be reached for prize verification.

Already like us on facebook? You can still enter by e-mail to win!

Facility Residents with Dementia See Decline Slowed Without Drugs: Study

2012-01-06T09:25:00.001-05:00

Nursing facility residents suffering from dementia and living in a group of Bavarian facilities in Germany were able to postpone their decline in cognitive function through nonpharmacological means, according to a new study released in the journal BMC Medicine.
The study, “Non-pharmacological, Multicomponent Group Therapy in Patients with Degenerative Dementia: A 12-month Randomised, Controlled Trial,” found a prolonged, intensive program of motor stimulation and other means worked better than the regular drug routine.
The reason for the study is that currently available pharmacological and nonpharmacological treatments have shown only modest effects in slowing the progression of dementia. The study’s objective was to assess the impact of a long-term nonpharmacological group intervention on cognitive function in patients with dementia and on their ability to carry out activities of daily living (ADLs) compared with a control group receiving the usual care.
The trial involved 98 patients with primary degenerative dementia in five nursing homes in Bavaria. The intervention consisted of motor stimulation, practice in ADLs (like going to the bathroom), and cognitive stimulation (acronym MAKS). The care was conducted in groups of 10 residents led by two therapists for two hours, six days a week for 12 months.
Cognitive function was assessed using the cognitive subscale of the Alzheimer’s Disease Assessment Scale and the ability to carry out ADLs using the Erlangen Test of Activities of Daily Living at baseline and after 12 months.
Report authors said after 12 months, the results showed that cognitive function and the ability to carry out ADLs had remained stable in the intervention group but had decreased in the control patients.
This result led to the conclusion that a highly standardized, nonpharmacological, multicomponent group intervention conducted in a nursing facility setting was able to postpone a decline in cognitive function in dementia patients and in their ability to carry out ADLs for at least 12 months.

(Source: providermagazine.com)

2012-01-05T12:33:00.003-05:00

Last Chance to Register for

Top 10 Interventions in the Classroom

Cost: $119
FREE if you sign on with Therapeutic Resources for the Department of Education bid!

Date: January 18th, 2012

Speaker Name: Laurette Olson, PhD, OTR/L

Therapeutic Resources36-36 33rd Street (SUITE 500)
Long Island City, NY 11106

With a changing national economy and dramatic changes in public education, school-based practitioners are being asked to integrate mandated therapy services into classroom interventions. Therapists must develop treatment priorities and activities appropriate for the classroom which will facilitate success in achieving IEP goals. This course will cover strategies to be employed in the classroom. Participants will gain knowledge of specific “top ten” interventions to add to their therapy toolkit.

To gain free entry into these events, sign on with Therapeutic Resources for the Department of Education Bid. Signing on with Therapeutic Resources does not obligate you to work for us, even if we are awarded the Department of Education contract. 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.

App Thursday: iPhone App Uses Kinesthetics to Help Kids Get Their Letters Straight

2012-01-05T09:24:00.004-05:00

San Diego, California - With their new mobile app LetterReflex, BinaryLabs is taking on another common childhood malady: letter reversals. The app features kinesthetic learning techniques to help kids tell the difference between b's and d's, as well as other commonly reversed letters and words.

"Reading and writing letters backwards is extremely common among young learners, and there a lot of ways to overcome it" said Frank Jensen, CEO of BinaryLabs. "Current remedies range from mnemonic devices to rote memorization to ignoring it in the hopes it goes away. We are taking a different approach."

Kinesthetic learning teaches concepts through doing and moving, and the iPad/iPhone are ideally suited for supporting this learning approach. "A key reason for letter reversals is that kids don't really know their left from right. They may know that the letter loop of a "d" should go on the left side, but they get their right and left mixed up" said Jensen. "LetterReflex takes advantage of the iPad/Phone's tilt and touch screen interface and uses kinesthetic learning techniques to help them form an instinctive association of left and right to correct letter formation. They have to tilt and motion left and right and up and down to succeed using the app."

The app runs on iPhones/iPads/iPod touch and is available now in the iTunes App store for an introductory price of $2.99. It adds to the company's mission of using mobile devices as therapeutic tools rather than just for content delivery. "Our apps are used as part of a practice or therapeutic regime and cast the use of the hardware in a different light" said Jensen. "With our apps, the mobile device is not just the delivery medium. The hardware works in tandem with our apps to provide a tactile or kinesthetic learning experience. Our apps exploit the unique functionality of today's mobile devices."

The app is being targeted at the same audience as Dexteria: occupational therapists, teachers, and parents who are engaged in their children's development.

Purchase here

(Source: prmac.com)

Cleft Lip Corrected Genetically in Mouse Model

2012-01-04T09:36:00.000-05:00

Scientists at Weill Cornell Medical College used genetic methods to successfully repair cleft lips in mice embryos specially engineered for the study of cleft lip and cleft palate. The research breakthrough may show the way to prevent or treat the conditions in humans.

Cleft lip and cleft palate are among the most common birth defects, with treatment requiring multiple cycles of surgery, speech therapy and orthodontics. To date, there have been very few pre-clinical methods that allow researchers to study the molecular causes of these malformations. In particular, there has been a lack of animal models that accurately reflect the contribution of multiple genes to these congenital deformities in humans.

In a report in a recent issue of the journal Developmental Cell, Dr. Licia Selleri, associate professor of cell and developmental biology at Weill Cornell Medical College, and her co-authors report the first multigenic mouse model of cleft lip with or without cleft palate. The researchers uncovered the role of genes for Pbx (Pre-B Cell Leukemia Transcription Factor) proteins in coordinating cellular signaling behaviors crucial for the development of these abnormalities. They also discovered that altering one type of molecule within the Wnt signaling pathway (that comprises a network of proteins best known for their roles in embryogenesis) is sufficient to correct the defects.

Dr. Selleri has studied Pbx proteins for many years and has previously demonstrated their involvement in organ and skeletal development. In her latest study, she and her collaborators, including postdoctoral fellows Drs. Elisabetta Ferretti and Bingsi Li, tested whether these proteins also play a role in facial development by using mutant mice that lacked various combinations of three Pbx genes in the ectoderm, the embryonic cell layer that gives rise to the lip and nose.

The researchers found that only mutations affecting multiple Pbx genes resulted in complete cleft lip, with or without cleft palate, in all of the mouse embryos with these compound mutations. This finding differs from those of previous studies using other mammal models of these conditions, in which a mutation in a single gene produced defects in only some of the animals, Dr. Selleri says. The role of Pbx genes in the development of the shape of the face is a new and surprising finding, she adds.

Moreover, the mouse embryos with multiple Pbx mutations also had reduced or absent Wnt activity, which plays a prominent role in embryo development, within the ectoderm. Dr. Ferretti, the first author of this study, found that Pbx genes regulate a chain of signaling molecules implicated in cleft lip with or without cleft palate, including Wnt, fibroblast growth factors (FGFs), p63, and interferon regulatory factor 6 (Irf6)—signaling pathways that exist across mammal species. Disturbances in this network lead to a decrease in programmed cell death, thereby interfering with the proper fusion of facial tissues and resulting in cleft lip.

When Dr. Li, the second author of this study, used genetic methods to restore Wnt activity in the ectoderm of mouse embryos with compound Pbx mutations, the cleft lips in all of these animals completely disappeared. "To my knowledge, this is the first time that anyone has corrected this defect in embryos, and we really show here that Wnt is a critical factor," Dr. Selleri says. "This is a very provocative result because it opens a completely new avenue of strategies for tissue repair."

To follow up on this work, Dr. Selleri plans to test whether supplying Wnt molecules to Pbx-mutated mouse embryos placed within an environment that mimics the uterus is sufficient to correct or even prevent the abnormalities. Compared with genetic manipulations, this approach of delivering Wnt signals directly to the uterus would be more realistic for implementation in humans, Dr. Selleri says. She has just initiated a collaboration with Jason Spector, assistant professor of plastic surgery at Weill Cornell Medical College and with Larry Bonassar, associate professor of biomedical engineering at Cornell University, to envision Wnt-related strategies for tissue repair, such as tissue implants that would deliver Wnt molecules to correct these defects either in utero before the birth of the fetus, or after birth without the need of many surgeries.

Additional study collaborators include Rediet Zewdu and Victoria Wells of Weill Cornell Medical College; Jean M. Hebert of Albert Einstein College of Medicine in the Bronx, New York; Courtney Karner of the University of Texas, Southwestern Medical Center, in Dallas, Texas; Matthew J. Anderson of the National Cancer Institute in Frederick, Maryland; Trevor Williams of the University of Colorado, Denver; Jill Dixon and Michael J. Dixon of the University of Manchester in the UK; and Michael J. Depew of King's College London in the UK.

The research was supported by a Marie Curie Fellowship, the Medical Research Council in the UK, the Royal Society, King's College London, March of Dimes and Birth Defects Foundation, the National Institutes of Health, the Cleft Palate Foundation, and the Alice Bohmfalk Trust.

(Source: news-line.com)

Therapy Puts the BIG Back Into Small Movements Experienced by Parkinson's Patients

2012-01-03T09:02:00.000-05:00

(Great Falls, Montana) Eileen Lane's doctor first thought something might be wrong when he noticed that she no longer swung her left arm when she walked.

Soon after, Lane, 75, was diagnosed with Parkinson's disease.

Lane had no idea her arm didn't swing normally. That's a common issue with Parkinson's — people think their movements are normal, when in reality they are actually small and weak.

"It slows your movement down, and it can almost freeze your movement," said Julie Bliss, physical therapist at the Great Falls Clinic. "They're really not aware that they're not moving right."

Bliss recently started offering a physical therapy program to help treat the movement, balance and flexibility issues that can accompany Parkinson's.

"They're saying it may slow down the disease progression," Bliss said of the program.

The program is called LSVT-BIG. LSVT originally was developed as a speech therapy program, called LSVT-LOUD, launched in 1993. It focused on teaching patients to speak louder. Parkinson's can cause people to speak softly, but they often aren't aware of the change in their voice.

LSVT-BIG, introduced in 2007, uses the same theory, but with movement. Patients use exaggerated movements during therapy sessions, such as big arm swings, or high knee steps, with the idea that those large movements will balance out with their small movements to keep them moving normally.

The research for both programs was funded through National Institutes of Health grants.

Bliss said the program retrains the body to move normally.

"It's kind of changing the sense of what your body's doing and what your mind thinks you're doing," Bliss said. "The brain is actually retraining how to do some of the movements."

Patients attend LSVT sessions an hour a day, four days a week, for four consecutive weeks.

Lane and Tom Mitcham graduated from the program last week.

They both saw huge improvements over the past month.

"Every day we came back, there was improvement," Mitcham said.

Lane had no idea how much her walking and other movements had declined in the two years since she was diagnosed with Parkinson's.

"I thought I was really OK, but I wasn't," she said.

Mitcham had been dragging a foot when he walked. Now, after LSVT, he's running and jogging, something he hasn't been able to do in several years. He also no longer uses a handrail going up and down stairs.

"I wish I would have done it three years ago," Mitcham said of the program.

On the first day of the program, Bliss did a series of tests with Lane and Mitcham. During the last week, she tested them again.

One of those tests measures how long it takes the patient to get out of a chair, walk a short distance and sit back down. On the first day, Lane's time was 17 seconds. On the last day she was down to seven seconds.

Another test measures how many times in 30 seconds a person can stand up and sit back down in a chair. On the first day, Mitcham was able to complete nine repetitions. On the last day, he did 27.

After patients finish the program, they continue to do the exercises everyday for the rest of their lives.

"Exercise is your medicine," Bliss said.

"I'm 75," Lane said. "If I live to be 90, I'm going to do it everyday."

The sooner people get into the LSVT program the better because it may actually slow the Parkinson's progression.

"It's never too late, but the sooner the better," Bliss said.

Bliss can modify the program to meet each patient's needs, depending on where they are in the disease's progression.

"It's very different with each patient," she said.

Bliss will continue to offer LSVT-BIG to about two patients a month.
(Source: greatfallstribune.com)

Occupational Therapy Team Helps Wounded Warriors

2012-01-02T08:53:00.003-05:00

In a deployed environment servicemembers are subject to risks such as post Traumatic Stress Disorder and Traumatic Brain Injury. Cases vary in severity but some can be treated in theater allowing servicemembers to return to duty. The Occupational Therapy Team is just one of the specialized groups that work together to help the wounded warriors. (Source: dodlive.com)

Happy New Year 2012!

2012-01-01T09:18:00.002-05:00

Happy New Year and many, many thank you's to all who have been following us this past year. If anything, 2012 should prove to be an exciting year for our field. Let us contribute, educate, and grow together!

Is There a Central Brain Area for Hearing Melodies and Speech Cues? Still an Open Question.

2011-12-30T07:36:00.003-05:00

The perceptual feature of sound known as pitch is fundamental to human hearing, allowing us to enjoy the melodies and harmonies of music and recognize the inflection of speech. Previous studies have suggested that a particular hotspot in the brain might be responsible for perceiving pitch. However, auditory neuroscientists are still hotly debating whether this "pitch center" actually exists. In a new review article, Daniel Bendor, Ph.D., of the Massachusetts Institute of Technology, discusses a recent study claiming that this pitch center may not exist after all, or alternatively, may not be located where previous research has suggested.

The article is entitled "Does a Pitch Center Exist in Auditory Cortex?"and appears in the Articles in PresS section of the Journal of Neurophysiology, published by the American Physiological Society.

Methodology
Dr. Bendor writes a brief review outlining previous research that found a pitch processing center in a region of human auditory cortex located in lateral Heschl's gyrus, as well as other more recent studies that report data that contradict these earlier findings.

Results
The review points out decades-old research suggesting that the auditory cortex plays a pivotal role in pitch perception. Researchers originally obtained this finding by training cats to distinguish pitch, then removing the auditory cortex on both sides of the brain -- rendering the animals unable to distinguish pitch, but still able to discriminate other aspects of sound, such as frequency. Studies using functional Magnetic Resonance Imaging (fMRI), a technique that examines brain activity while subjects are actively performing tasks in an MRI scanner, suggested that the lateral Heschl's gyrus is the main player in pitch perception. Several fMRI studies have scanned subjects' brains while listening to noise, then compared the brain activity to when subjects listen to a sound called iterated ripple noise (IRN), similar to noise but with a pitch component. However, recent studies that compare IRN and an IRN stimulus modified to have no pitch found that both sounds seem to activate the same region of the brain, suggesting that this area may not be involved in pitch perception after all. Bendor points out that it is too soon to dismiss the existence of a pitch center, however additional studies are needed to confirm its existence given these new results. He adds, although auditory cortex overlaps Heschl's gyrus, the exact placement can vary between subjects. Intersubject variability presents a significant problem when averaging data across multiple subjects, and could be one reason why an fMRI study fails to replicate a result.

Bendor notes that other research suggests that a different area of the brain behind the lateral Heschl's gyrus, called the anterior planum temporale, may play a role in perceiving pitch -- a topic that needs further investigation.

Importance of the Findings

The reviewed studies suggest that the existence of a pitch center, especially one located in the lateral Heschl's gyrus, is still an open question.

"Although there is general agreement that the auditory cortex is essential for pitch perception, whether pitch processing is localized within a single functionally-specific region within the auditory cortex remains a controversial issue among auditory neuroscientists," Bendor says. Dr. Bendor is affiliated with the Picower Institute for Learning and Memory, Department of Brain and Cognitive Science at the Massachusetts Institute of Technology.
(Source: sciencedaily.com)

App Thursday: Tabelts Open Up New Roads to Work, Fun, Learning

2011-12-29T08:25:00.002-05:00

Before getting out of bed, Topekan Keith Sconiers is on his iPad2 conducting an interview with a photojournalist from The Topeka Capital-Journal for this story.

Sconiers, 28, is a deejay and photographer who got his first iPad a little more than a year ago.

“I had a chance to play with a friend’s iPad, and it kind of grabbed me,” Sconiers typed on his iPad2.

During the interview, which lasted an hour, Sconiers was able to make breakfast, get dressed, make coffee, go to the leasing office at his apartment, feed his fish, order Christmas cards for a limousine company he works for and pay his telephone bill online.

“At home, it’s by the bed and goes from room to room with me while I am cleaning,” Sconiers said. “It has helped increase my productivity a lot. It’s nice to have a source of information always on tap.”

Tablets are a popular trend, with the iPad leading the way. Since the iPad first launched in 2010, Apple has said it has sold more than 39 million tablets, according to the Los Angeles Times.

And it’s a popular draw for all ages.

Jocelyn Powers reaches for her iPad2 and makes a selection on the screen. A fan sitting on the desk turns on, giving her a blast of air.

Jocelyn, is a 20-month-old from Lawrence who has cerebral palsy. She was introduced to the iPad through an infant child development program.

“The iPad2 was the first learning-type toy she showed interest in,” said Jocelyn’s mother, Angie Powers.

Jocelyn uses the iPad2 during sessions with Julie Erb, an Easter Seals Capper Foundation speech and language pathologist.

“The iPad2 is a great learning tool,” Erb said. “It is a huge motivator. Children think it is fun. They forget they’re doing work.”

In Jocelyn’s case, the iPad2 has replaced a traditional augmentative communication device, which cost about $7,000. Erb emphasized there is still a role for the traditional augmentative communication devices, such as with adults who have more complex speech.

Erb said over the past six months she has seen developers coming up with new attachments and developing new applications for the iPad2.

“The iPad2 is great,” Erb said. “But it is still important to have a speech and language evaluation to determine your needs.”

Angie Powers said the iPad2 is just what Jocelyn needs. Without it, Powers said, the learning process would be much more difficult.

“We would be nowhere near where we are developmentally,” Powers said. “It gives her the opportunity to feel successful and to learn.”

The iPad2 also is being used locally by members of the media.

Melissa Brunner, an anchor at WIBW TV, is just one of many who take advantage of the technology.

“We are using iPads to replace the paper scripts,” Brunner said.

She jokingly said anchors play “Angry Birds” and “Words with Friends” during commercial breaks.

Topeka Capital-Journal reporters and photographers often use the iPad2 to record and edit video to be displayed at CJOnline and on its iPad app.

Meanwhile, Sconiers said one of the main reasons he purchased an iPad was to show clients their photographs.

“I was awed at how easily I would be able to show off photos without handing off my iPhone,” he said.

(Source: cjonline.com)

Study Could Lead to a Treatment For Angelman Syndrome

2011-12-28T09:04:00.001-05:00

Results of a new study from the University of North Carolina at Chapel Hill may help pave the way to a treatment for a neurogenetic disorder often misdiagnosed as cerebral palsy or autism.

Known as Angelman syndrome, or AS, its most characteristic feature is the absence or near absence of speech throughout the person’s life. Occurring in one in 15,000 live births, other AS characteristics include intellectual and developmental delay, severe intellectual disability, seizures, sleep disturbance, motor and balance disorders. Individuals with the syndrome typically have a happy, excitable demeanor with frequent smiling, laughter, and hand flapping.

No effective therapies exist for AS, which arises from mutations or deletions of the gene Ube3a on chromosome 15. The Ube3a protein produced by the gene is a key component of a molecular pathway that is very important to all cells, especially brain neurons by helping them pass electrical or chemical signals to other neurons via the synapse.

Angelman syndrome is linked to mutations or deletions in the Ube3a gene inherited from the mother; thus, the maternal allele. In most tissues of the body, both the maternal and paternal alleles are expressed. But in rodents and humans, the paternal Ube3a allele is intact but silent, or dormant.

What apparently accounts for the dormancy of that allele is a strand of ribonucleic acid known as antisense RNA, which in terms of gene expression keeps paternal Ube3a silenced, or off. Once referred to as the genome’s “dark matter,” antisense RNA makes no functioning gene product, but works to repress expression of another gene by binding to its RNA.

“We wanted to determine if there could be a way to “awaken” the dormant allele and restore Ube3a expression in neurons,” said neuroscientist Benjamin D. Philpot, PhD, associate professor of cell and molecular physiology, one of three senior investigators in the study and a member of the UNC Neuroscience Center.

In a report of the research published online in the journal Nature, the interdisciplinary team of UNC scientists say they have found a way to “awaken” the paternal allele of Ube3a, which could lead to a potential treatment strategy for AS.

“We have taken advantage of a tool that allows us to distinguish between active and inactive alleles,” Philpot said. “That tool is a modified mouse that’s engineered so that the Ube3a gene has a fluorescent ‘reporter’ gene attached to it, which tells you when the gene is on or when it’s off. When the gene is on, neurons will fluoresce in yellow, but won’t when the gene is off.”

Other ‘tools’ available on the UNC campus come from study senior author Bryan L. Roth, MD, PhD, Michael Hooker Distinguished Professor of Pharmacology and Translational Proteomics and director of the National Institute of Mental Health Psychoactive Drug Screening Program. These include highly automated robotics of the sort normally found in major pharmaceutical companies: fluid handling robotics and automated high-content imaging that combine the molecular tools of modern cell biology with automated high resolution microscopy and robotic handling (see http://pdspdb.unc.edu/download/robotLab2011.php).

Using a library of FDA-approved drugs obtained from the National Institute of Health (the NIH Clinical Collection) the UNC team discovered that irinotecan, a topoisomerase (TOPO-EYE-SOM-ERASE) inhibitor known to be active in the central nervous system—robustly ‘awakened’ Ube3a. Subsequently, the team identified the FDA approved medication topotecan and several other topoisomerase inhibitors as drugs which can ‘awaken’ Ube3a.

“When we gave topotecan to these neurons they would now glow, indicating that the paternal allele was now on,” Philpot said. Topotecan apparently awakened the dormant Ube3a allele by down-regulating, or reducing, antisense RNA in the paternal copy of Ube3a, the researchers determined.

When topotecan was given to the genetically engineered mice, “it unsilenced the paternal Ube3a allele in several regions of the nervous system, including neurons in several areas of the brain and in the spinal cord,” the authors state. These findings also held true for irinotecan.

Importantly, the protein from the unsilenced paternal Ube3a was functional and was expressed by the gene in amounts comparable to that of normal maternal Ube3a in ‘control’ animals.

The study’s third senior co-author, neuroscientist Mark J, Zylka, PhD, assistant professor of cell and molecular physiology and a UNC Neuroscience Center member says the study is “the first example of a drug that regulates antisense RNA and, as a result, regulates [protein] levels of a coding gene.”

According to Philpot, the increased scientific interest in Ube3a is because certain DNA copies, or duplications, in maternal chromosome 15 are associated with classic forms of autism. “If you have too little Ube3a you have Angelman syndrome. If the maternal allele is duplicated, it might be a contributing factor to autism.”

Zylka and Philpot caution against using topoisomerase inhibitors now to treat Angelman syndrome, given the limits of current knowledge.

“We’d like to stress that these compounds are not ready to be used clinically for Angelman syndrome,” Zylka said. “We don’t know what the off-target effects might be on a gene or genes with similar DNA sequences. We need to figure out optimal concentrations and dosing before we move to clinical trials. And we need to determine which drug is best.”

For people to use these drugs now for Angelman syndrome, without further preclinical studies, might be a health risk, Philpot adds, “one that could jeopardize successfully bringing these compounds to clinical trials.”

Along with Philpot, Zylka and Roth, coauthors from UNC were Hsien-Sung Huang, John A. Allen, Angela M. Mabb, Ian F. King, Jayalakshmi Miriyala, Bonnie Taylor-Blake, Noah Sciaky, J. Walter Dutton Jr., Hyeong-Min Lee, Xin Chen, Jian Jin, and Arlene S. Bridges.

The research was supported in part by funds from the Angelman Syndrome Foundation, the Simons Foundation, the National Institute of Mental Health, the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the NIMH Psychoactive Drug Screening Program, and NC TraCS Institute funded by the NIH Clinical and Translational Science Awards (CTSA)

(Source: news-line.net)

Tutor System Developed for Children Recovering from TBI

2011-12-26T10:51:00.001-05:00

Treating kids with traumatic brain injuries
Fifty thousand people in the U.S die each year from TBI and 85,000 people suffer long term disabilities. In the U.S more than 5.3 million people live with disabilities caused by TBI. Different levels of treatment exist for TBI patients including the initial treatment that stabilizes an individual immediately following a traumatic brain injury and rehabilitative care to help restore the patient to daily life. Acute treatment of Traumatic Brain Injury is aimed a minimizing secondary injury and life support; and surgical treatment that may be used to prevent secondary injury by helping to maintain blood flow and oxygen to the brain and minimize swelling and pressure.

There are many causes of TBI. The top three are car accidents, firearms and falls. Young adults and the elderly are the groups at higher risks of TBI. The mechanisms that are the highest cause of brain injury are: open head injury, closed head injury, deceleration injuries, chemical/toxic, hypoxia, tumors, infections and stroke. An open head injury results from something such as a bullet wound in which there is penetration of the skull. A closed head injury results from something such as a slip and fall or motor vehicle accident. Deceleration occurs when the brain is slammed back and forth in the skull because of its gelatinous consistency causing even the nerve cells to stretch and compress where if it stretches enough the nerve cells can tear. Certain chemicals and toxins can also damage neurons, such as insecticides, lead poisoning and solvents. Hypoxia is lack of oxygen and can be caused by respiratory failure, heart attacks and drops in blood pressure. This can cause severe cognitive and memory deficits.

TBI is classified into two categories: mild and severe. A brain injury can be classified as mild if loss of consciousness and/or confusion and disorientation is shorter than 30 minutes. While MRI and CAT scans are normal the individual has cognitive problems such as headache, difficulty thinking, memory problems, attention deficits, mood swings and frustration.
Severe brain injury is associated with loss of consciousness and memory loss for more than 30 minutes after the injury or penetrating skull injury longer than 24 hours. The deficits range from impairment of higher level cognitive functions to comatose states. Survivors may have limited function of arms or legs, abnormal speech or language, loss of thinking ability or emotional problems. The range of injuries and degree of recovery is very variable and varies on an individual basis.

Dr. Jose Pineda, Pediatrician, Director of Neurocritical Care, St. Louis Children’s Hospital, Washington University, talks about a new approach to teach kids with traumatic brain injury.
Dr. Pineda says that traumatic brain injury is the number one cause of death and disability in children. Every day it kills more children than cancer or any other disease. As a matter of fact TBI kills more children than all other top ten diseases put together. Not only is it very common, but also the brain is very complex. We don’t even understand how it functions fully. So when it’s injured it’s very difficult to treat it.

Dr. Pineda says additionally that the quest started about five years ago. He was recruited to St. Louis Children’s Hospital to tackle this new challenge.He took on that quest and over the past five years a seventy percent decrease in mortality in children with severe traumatic brain injury has occurred. We also observed an improvement in outcome on those children who survived. And that’s very important with brain injury. The fear always is you do something that decreases the number of children who die but increases the number of children who survive in bad shape. The good news is with previous leaps in improving recovery children go from, “I was going to die” to “I do great.” They skip the middle and that is exactly what has been seen. So there has been a seventy percent decrease in mortality matched to an improvement in the outcome of survivors. Since 2008 every child with severe traumatic brain injury treated has gone home except for one child. In the past these children had to go to extended care facilities but that’s disappearing too. There has been improvement in function in those children who survived. The vast majority of them are now going home.

The HandTutor, ArmTutor, Leg Tutor and 3d Tutor have been developed to teach children how to reuse their joints after a brain or spinal cord injury. The unique and successful devices use a dedicated software that utilizes games to enhance and improve their movement.
When TBI occurs and recovery is progressing the Tutor system (HandTutor, ArmTutor, LegTutor, 3DTutor) has shown much success in rehabilitation of joint movement. The Tutor system consists of ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients, both children and adults, in rehabilitation centers, private clinics and the home where it can be supported by telerehabilitation. It is designed for those who have head, trunk, upper and lower extremity movement dysfunction.

The system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. Controlled exercise practice helps to prevent the development of compensatory movement patterns. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. In addition the therapist can objectively and quantitatively evaluate and report on the treatment progress. The rehabilitation system optimizes the patient’s motor, sensory and cognitive performance and allows the patient to better perform everyday functional tasks to improve their quality of life. The Tutor system is FDA and CE certified. See www.HandTutor.com for more information.

(Source: handtutorblog.wordpress.com)