Genetics – the Key to the Challenges We Face

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I really enjoyed this http://audio.thisamericanlife.org/widget/widget.min.js

“>THIS AMERICAN LIFE EPISODE.  I hope you can find time to listen to it.   A young girl dove into medical research in an effort to discover the cause of her weakness and problems with movement.  Jill Viles’ tenacity and curiosity led to information that saved her father’s life and the life of an Olympic medial winner. Her questions led to a change in medical research in a way that rarely occurs from outside the medical community.

As a person with Multiple Sclerosis I understand the relief that comes from finally getting validation  from a terrible diagnosis.  It is frustrating to know something is wrong but to not have a name for the problem.  When the diagnosis is elusive you feel as though the medical community views you as someone too obsessed with every small bodily function. A patient doesn’t know which parts of the puzzle are important to the physician in making a diagnosis and which ones are not. Everything can be thrown into the doctor visit as a result.

As a physical therapist I had exceptional access to physicians and an understanding of how to relate my symptoms.  I recognize that my position helped me to gain a diagnosis much earlier than most and thus the treatment that would keep me from suffering the damage to the nervous system leading to clinical picture more easily diagnosed. I am grateful for this but feel for those who don’t have that privilege.

I admire the young woman in this story.  She dove into research in a way that is remarkable.  When opportunity and clues presented themselves she was poised to take advantage and finally gained the answers she needed. I can only imagine the number of people who will be helped as a result of Jill’s drive for answers.

Trying to get creative in gait training

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I picked up some paint sample cards the other day.  I choose about 10 bold colors that were 4 X 4 in size.   I have a patient that becomes pretty anxious as she walks in therapy due to shortness of breath.  She lives in an apartment building and we usually work on walking in the halls.  Before I entered her apartment I hid the paint cards “in plain sight” at different levels and on both sides of the hall.  As we headed out her door I announced my plan for a “color hunt”.  As she walked she had to turn her head more and pay attention to something other than her difficulty breathing.  Turning the head provided a greater challenge in balance and was much more functional.

I learned a long while back that practicing walking a straight path in protected situations does not provide for the level of improvement we need within the community.  As a person shops they have to turn the head each way and move while distracted.  I found my “color hunt” to be fun way to increase the level of function in our walk for the day.

A Trick for Putting on Your Boots

A patient of mine had difficulty putting on her ankle brace and showed me a technique she learned as a young girl.  She put a plastic bag inside the brace after cutting out the bottom of the bag.  She leaves the bag in the brace but said that you can pull it out if you want after getting it on.  She allowed me to take a photo of the set up to share with anyone interested.

I learn something everyday.

 

Starting a Collection!

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I am attracted to things that are beautiful and functional. As a physical therapist I especially appreciate a beautiful cane or hiking stick, especially one with a story.  I recently decided to start a collection of walking sticks. I was visiting a patient of mine recently and when she heard of my interest in collecting them, she showed me one of hers that has a special meaning for her.

Hand carved cane

Hand carved cane

carving of fishing trip

carving of fishing trip

She told me that a friend of her husband made it for him years before he passed away. The friend carved a bird on the top and then carved scenes representing memories they shared. She now uses the cane to pull up the covers at night.

I received my first cane for the collection from a dear friend the other day. She said it belonged to her great grandfather. It is such an honor to own something that belonged in her family for so long. I wonder at the journey it made possible.

My first cane for the collection.

My first cane for the collection.

Periscope

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I like to watch Periscope and while I enjoy it for its educational and entertainment value, I believe it has an important place in the lives of our elderly and injured.

Periscope is an app for watching others and gives  individuals and groups the ability to show things from their perspectives.  When you open the Periscope app on your smart phone or device, a map of the world comes up.  Little red dots show up all over the world indicating the number of live streaming events at that point in time.  You can zoom in and the dots break apart providing a more detailed view of where the people are that are presently providing a little view of their world. When you click on a live streaming event, you can see them but they can’t see you.  You can interact with them by typing messages on your device if you wish to participate.

I love checking out things from all over.  During the Paris attacks, I watched individuals live stream from their advantage point of the events as they occurred.  One night Rhonda Rousey, a female fighter was in a big match-up and I was amazed at the number of people from many nations who were showing viewing parties of the fight.  On one occasion I went along with a man  as he showed the fall foliage on the grounds of  a famous (and very crowed) Japanese Temple. The foliage was at its peak and it was a very special time for those that were there.

On Periscope if you find someone or some group to be particularly  interesting, you can “follow” them and then you get alerts when they are on. I am following the Park Rangers at Yellowstone and they are often coming on and showing things that interest them. One morning the steam from the hot springs was freezing on the trees and the sun was shining through. One day  an otter was playing on the river and the ranger talked about the otters and their part in the park.  One day they showed the Bison moving along a park road.  You could hear their snorting and watch their breaths in the cold air as if you were right there. I recently started following a farmer in Pennsylvania (The Wallace’s). He props the camera up in the barn, you can hear his radio playing in the background and watch him feeding his calves buckets of warm milk. He talks to the calves and answers people’s questions. It is nice stress reliever.

Most of the seniors I work with in therapy aren’t comfortable with technology and can’t take advantage of these opportunities for reaching out to the world from the comfort of their homes.  But I have noticed in the last few years that more and more patients have email addresses and more have the ability to text so I know we are getting there.  I know that when I am a “legitimate senior” I will not be able to go without my electronics and all that comes with it. And from all the people I see in our communities with head bent down over a small screen, I know that I am not alone.

I am excited for how technology will provide for stimulation and motivation from the outside world.  I can imagine that if a person can’t physically get to a family reunion, one of the family can Periscope (or FaceTime or Skype)  the reunion, interviewing different family members all with the help of a smart phone.  Many churches have made services available for those that can’t make it there through Periscope.

When I was working with worker’s comp patients in an outpatient setting, it was well known that a worker that remained separate from the work place for too long would not likely return to the job.  A person loses the interaction with co-workers.  They lose confidence for the job and they lose the routine of going to work.  I believe that anyone can start to lose confidence and then motivation for “going” places.  It is my belief that Periscope has the ability to motivate for renewed participation and with the help of therapy improve the likelihood of return to community mobility.

Clothing for the Gadget Happy Traveler

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The other day I went shopping with someone and we looked at things that are pretty to look at but I found I was completely uninterested.  I realized that while I love beauty in design, the object must have some useful purpose to inspire me.  If it is a statue then I want it to hold my glasses or rings or…. something.  I am jazzed by tables with lift-off trays.  I like camera bags that don’t just carry the camera but that have color coded spots for batteries so that you can easily separate the charged from the non charged.  I like books that entertain but that also teach me something.  I am more attracted to a car by the ergonomics of the interior than the look of the exterior.  If a car comes with wifi and a swivel seat for ease of performing work while sitting in the car but it looks like a tank on the outside, I am good. That is why I found myself attracted to this website that advertises clothing with specific pockets for items such as glasses, memory cards, iPod, and even iPads with loops to control the position of the headphones.   click here to visit scottevest.com  I haven’t tried ordered from them yet but you can bet I will.

 

Lifting weights in space

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As our astronauts are spending more and more time in space we have had to work to create methods to maintain their muscle and bone mass.  If we don’t have the effect of gravity on our bodies and if we don’t have the pull of muscles against the bones we quickly lose bone density.  Tests are performed to monitor the loss of calcium into the urine to assess the effectiveness of the established exercises in our space program.

Loss of bone density is a concern for many of our earthbound population as well but due to inactivity.  Therapists should discuss the effects of exercise on maintaining bone density to help motivate our patients that are concerned that the exercise is going to make them more sore and have more pain.  The effects of muscle pull on bone creates an increase in strength of connective tissue.  When I was in PT school we were sent home with a “bone box”.  We actually had real human bones to study while taking anatomy.  I recall laying the bones out in my floor and running my hands over them as I tried to learn the muscle attachments. I could feel ridges and protuberances  where muscles had attached, the pull on the bones creating changes in the bones due to the tension.

Just as astronauts must invest time in exercise to achieve health, we must invest time and effort in exercise.  It is much less expensive and less complicated to achieve this in our own homes and communities.  Our body weight can serve as resistance by using body position to change the effects of gravity on movement.  Physical Therapists prescribe exercise based on an assessment of a person’s base level of strength.  The program is advanced as strength is gained.

It is fun to find ways to provide resistance in the home.  Weights can be made out of normal household items.  Proper body mechanics can be emphasized in conjunction with strength training improving the carryover of those tasks that are performed repetitively.  Performance in the patient’s own environment improves the possibility that the proper mechanics will be followed routinely.

Strength training in home care may not be rocket science but we approach the same concerns for strong bones and muscles that the astronauts face.

Click on this and enjoy watching the way our astronauts approach weight training

 

Use of Barriers in Home Care Treatment

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When I first began working as a home care physical therapist I felt funny about bringing in a barrier to the patient’s home and putting it on their furniture to “protect my bag”.   When I cleaned my equipment in front of the patient and their family members I felt as though I was saying to them “I don’t want your germs on my things”.  I began making sure they saw me wiping down the parts of the equipment that touched me first before wiping down the parts that had touched them.  Then one day one of my patients told me “I like that you clean your equipment. No one else does.”  I was relieved that the patient saw my efforts as protection of her and not myself.  I was dismayed that she didn’t see the same thing from the other professionals coming to her home.

No one likes to have an auditor follow you in a visit.  I have had the pleasure of this twice.  No one wants to have the patient watch you perform proper bag technique for the first time while an auditor is sitting there.  How horrible it would be to have the patient remark “Oh, I’ve never seen you do that before.”  Practicing good technique is important for many reasons and one of them is so performing proper technique is natural and easy when under the stress of a monitored visit.

After practicing longer I can tell you that I have seen situations more than once that made me understand why the barriers are important.  I have seen cats throw-up on couches.  I have seen urinals spill in the floor.  I have watched other caregivers come in the rooms and place their bags on floor and cringed knowing that their bag would be placed in their car seat and carried into another home.

Once you become aware of cleaning techniques, you become acutely aware of situations that cause that need.  How often do you see a patient stand from the toilet after cleaning themselves with only 4 squares of toilet paper and then put their hands on their walker. It is important to teach them to clean the grips of the walker after washing hands.   I have seen more than once someone pick their nose and 5 minutes later reach for my pen to sign the form. Keeping a disinfectant wipe handy to wipe pens and computers down as you talk should be a habit.

People frequently don’t recognize their unclean personal habits.  Try watching your own actions more carefully for one day and you will be surprised by the many opportunities for disease transmission.    At this time of year when colds and flu are spreading remember to work to protect those most vulnerable to illness.  WASH YOUR HANDS and CLEAN YOUR EQUIPMENT without apology.

Bag Technique

 

Could this awesome exercise tool be used in home care?! I sure hope so!

MorfBoard

This awesome tool has so much potential for the weakest of our patients to the strongest of our clients.  I love how it would tap into the creativity of the therapist and provide a tool that patients don’t expect.  My patients love to have new challenges and while I wouldn’t send them down the hall on the skate board, I sure could use it for range of motion in more interesting ways.

Check this out Occupational Therapists!

FORMcard – a product that could help us show an inventive side in home care FORMcard – a product that could help us show an inventive side in home care

When I was in physical therapy school we spent time learning how to make wrist splints and other items that are usually made by occupational therapists.  The materials were heated and shaped while malleable into forms needed to promote improved function.  This Kickstarter product reminds me of this and can be used by anyone in expression of creative genius or in repair of broken items.  I see this being used in home health care practice in situations when invention is needed to address a specific need.  People with arthritis have difficulty gripping small items. This can be used to build up keys, knobs that need to be larger, and lamp switches that are too small.  I like the bright colors as this will make it easier to see for people with difficulties with vision.