Therapy Achievements is dedicated to helping people with physical, cognitive and visual limits re-gain function and reach their potential. By providing out-patient physical, occupational and speech therapy services, we help people maximize their independence and reach their potential. Our multi-disciplinary team approach to rehabilitation enables us to tailor your plan of care to your specific and unique needs.
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April is Parkinson’s Disease Awareness Month. Approximately one million Americans live with Parkinson’s disease. Parkinson’s disease typically affects people over the age of 50 and is characterized by resting tremor, rigidity, postural instability, slowness of movement, and reduced amplitude of movement. It is a progressive disorder that results in the loss of nerve cells in the brain that produce dopamine. Dopamine is a chemical messenger that transmits signals between two regions of the brain to coordinate activity. If there is deficiency of dopamine, nerve cells “fire” out of control. This leaves people unable to direct or control movements. When people with Parkinson’s disease try to move, they encounter the following problems:
- The “Get Ready” signal is too weak: This results in inadequate preparation or anticipation for movement. There is bradykinesia – slowness of movement, and hypokinesia – reduced amplitude of movement.
- The “Go” signal is too weak: This results in inadequate selection or ability to start movement. There is freezing or start hesitation when trying to move.
- The “No Go” signal is too weak: This results in inadequate completion of movement. There is festination – small, accelerating steps when walking, and sequential movements more difficult and run together.
Treatment of Parkinson ’s Disease:
Medication is a vital component of treatment for Parkinson’s Disease. There have been many advances in medication therapy for treatment for Parkinson’s Disease and many new treatments are on the horizon. In addition to medication, other treatments include:
Physical, occupational and speech therapists can assess the person’s abilities and needs, and provide exercises to help maintain the highest possible range of motion, muscle tone, balance and flexibility, and communication ability.
LSVT Big and Loud are rehabilitative treatment programs that are designed specifically for people with Parkinson’s Disease. LSVT BIG trains people with Parkinson disease (PD) to use their body more normally. People living with PD or other neurological conditions often move differently, with gestures and actions that become smaller and slower. They may have trouble with getting around, getting dressed and with other activities of daily living. LSVT BIG effectively trains improved movements for any activity, whether “small motor” tasks like buttoning a shirt or “large motor” tasks like getting up from sofa or chair or maintaining balance while walking. The treatment improves walking, self-care and other tasks by helping people “recalibrate” how they perceive their movements with what others actually see. It also teaches them how and when to apply extra effort to produce bigger motions – more like the movements of everyone around them.
Because LSVT BIG treatment is customized to each person’s specific needs and goals, it can help regardless of the stage or severity of your condition. That said, the treatment may be most effective in early or middle stages of your condition, when you can both improve function and potentially slow further symptom progression. Beginning your work with LSVT BIG before you’ve noticed significant problems with balance, mobility or posture will often lead to the best results, but it’s never too late to start. LSVT BIG can produce significant improvements even for people facing considerable physical difficulties.
LSVT LOUD is an effective speech treatment for people with Parkinson’s disease (PD) and other neurological conditions. Named for Mrs. Lee Silverman (Lee Silverman Voice Treatment), a woman living with PD, the program trains people with PD to use their voice at a more normal loudness level while speaking at home, work, or in the community. Key to the treatment is helping people “recalibrate” their perceptions so they know how loud or soft they sound to other people and can feel comfortable using a stronger voice at a normal loudness level.
LSVT LOUD has also helped people with atypical parkinsonisms, such as progressive supranuclear palsy (PSP), and has recently shown promise for adults with speech issues arising from stroke or multiple sclerosis and children with cerebral palsy or Down syndrome. Beginning your work with LSVT LOUD before you’ve noticed significant problems with voice, speech and communication will often lead to the best results, but it’s never too late to start. LSVT LOUD has the potential to produce significant improvements even for people facing considerable communication difficulties.
Exercise helps maintain muscle tone and strength. Diet is important for nutrition, for maintaining an appropriate weight, and because protein level may be a factor in the person’s condition. Rest and stress reduction are also important.
Support Groups –
Huntsville enjoys a very active Parkinson’s support group that offers aid, support, education, discussion and raises research funds for treatment of Parkinson’s disease. Information about Huntsville’s support group can be found at http://parkinsons-huntsville.webs.com/ or calling 256-509-4398.
The therapists at Therapy Achievements have worked with people with Parkinson’s Disease for over 20 years. Our physical therapists are LSVT BIG certified and help people re-gain strength, balance and coordination for walking and moving. Our occupational therapist are LSVT BIG certified as well and help people re-gain fine motor coordination for writing and manipulating objects, help identify adaptive equipment to make completing tasks easier, and assess safety for driving and train in adaptive driving strategies. Our speech therapists are LSVT LOUD and Speak Out certified and help people re-gain voice volume and articulation for speaking, concentration, memory and problem solving for thinking, and chewing and swallowing function for eating.
For more information on what Therapy Achievements can do for you call 256-509-4398.
April is Occupational Therapy Month and Therapy Achievements wants to celebrate! With over 100 years of combined experience, the occupational therapists at Therapy Achievements are able to provide the best blend of cutting edge technology combined with proficiency and knowledge that comes with dedication and practice.
But what does “occupation” have to do with therapy? Occupational therapists help people participate in the things they want and need to do – their “occupations” – through the therapeutic use of everyday activities. Common occupational therapy interventions include helping people recovering from injury to regain skills and providing supports to cope with physical and cognitive changes. Occupational therapy services typically include:
- Individualized evaluations to determine the person’s goals
- Customized interventions to improve the person’s ability to perform daily activities and reach their goals
- Re-evaluation to ensure goals are being met and changes are made to the intervention plan to maximize outcomes.
Occupational therapy services may include:
- Practice of self-care, home management, school/work or community activities to become proficient and identify strategies for success.
- Exercise for flexibility, coordination, balance, strength, and endurance to better enable participation in activities of daily living and functional mobility
- Evaluations of home, work, school or other environments to identify modification and adaptive equipment to increase independence.
Occupational therapy services are typically covered by health insurance and Therapy Achievements is an in-network provider for most insurances.
Therapy Achievements is a Rehabilitation Center that provides Physical, Occupational and Speech Therapy for Balance and Movement, Speech and Swallowing, Swelling from Lymphedema and Edema, Driving Rehabilitation and Functional Living Skills for visual and cognitive re-training. We help people with Brain Injury, Stroke, Multiple Sclerosis, Parkinson’s Disease, Lymphedema, Head and Neck Cancer, Vertigo and Dizziness, and other disorders that interfere with mobility and function. We offer VitalStim Technology, Saebo Technology, LSVT LOUD Treatment, LSVT BIG Treatment, and Neuro-Developmental Treatment.
March is Multiple Sclerosis Awareness Month!
Multiple sclerosis (MS) affects nearly 1 million in the US including celebrities Montel Williams, Clay Waler, and Jami Lynn Sigler. It is a disease in which your body attacks itself and causes a breakdown of myelin – the insulating sheath that wraps around your nerves to protect them. The word “sclerosis” refers to the scar tissue or lesions that appear as the myelin is damaged. The unprotected nerves can’t function as they would with normal, healthy myelin. The damaged nerves produce a wide range of symptoms that vary in severity. Symptoms can include numbness and tingling, vision problems, balance and mobility issues, difficulty with thinking and slurred speech.
There is no such thing as a “typical” symptom of MS because each person experiences the disease differently. The same type of symptoms may come and go frequently, or you may regain a lost function after a period of time. The unpredictable pattern of symptoms has to do with which nerves your immune system attacks at any given time.
Therapy Achievements is committed to supporting people with MS:
- We host the Rocket City MS Awareness group that meets at 6:00 pm on the 3rd Tuesday of every month
- We support and are involved in MS Society events in our area
- We provide out-patient physical therapy to improve balance, strength and endurance, occupational therapy to improve the ability to complete functional activities such as driving, dressing and bathing, and speech therapy to improve eating, swallowing, and thinking skills.
Although there is not yet a cure for multiple sclerosis, much research is currently underway to better understand not only how to stop the progression but restore lost function. Want to help?
Click Here to Join or Donate to our MS Walk Team
The 2019 Walk MS Huntsville is Sat 4-27-19 at 10:00 am at Campus 805 S.R. Butler Green Park. Join us for a fun time and to help raise funds to research a cure!
For more information on the Rocket City Awareness Group, the MS Walk or to schedule and appointment for therapy, call 256-509-4398. Don’t wait!
Lymphedema and Edema
Approximately 60% of our body mass is composed of fluid. Interstitial spaces or compartments are the spaces within the tissues that are outside of the blood vessels and under the skin. The fluid in this space is called interstitial fluid. Our bodies have two systems to deal with body fluid: The blood circulatory system & The lymph circulatory system
The Blood System & Edema
The Blood System moves fluid into the tissues from the blood capillaries to bring oxygen and nutrition to the tissues. 90% of fluid moves out of the tissues by the blood system to remove waste products from the tissues and to be re-oxygenated. The other 10% of fluids is managed by the lymph system. When either system fails to function correctly, fluid accumulates in the interstitial spaces and swelling occurs. When the blood system is not working correctly, the swelling that results is called edema. Edema can result from:
- Conditions that increase fluid pressure such as venous insufficiency, congestive heart failure, deep vein thrombosis, reflex sympathetic dystrophy
- Conditions that decrease oncotic pressure such as heavy loss of blood protein with renal disease, malnutrition, malabsorption, cirrhosis
- Conditions that result in altered permeability such as trauma, burns, infection, chemo and radiation therapy
Edema can result from any other impairment of the blood system which is not lymphedema. When the blood system is not working correctly, the lymph system works harder and faster to pick up the slack. Chronic edema, left untreated, can progress into lymphedema.
The Lymphatic System & Lymphedema
The lymphatic system is composed of superficial capillaries (pre-lymphatics) that empty into deeper collectors – valved vessels, lymph nodes, and valved trunks. The lymph capillaries are just under the skin and cover the body like a net. The capillaries end in 1-3 finger-like projections that are held in place with fibers called anchoring filaments. A rise in fluid levels, haphazard forces, and muscle contractions put tension on the anchoring filaments which pull the swing flaps open, allowing fluid and molecules to enter. The lymphatic system is designed to carry large molecules:
- nutrients such as fat and proteins
- immune components
- waste products such as foreign molecules, bacteria and virus.
It filters the fluid through the lymph nodes before it is returned to the blood system. The lymph nodes filter the lymph fluid for foreign bodies and activate white blood cells to attack and destroy them. It is estimated there are between 600 – 700 lymph nodes in the human body. There are approximately 15-25 lymph nodes under each arm and 6-12 in each groin. Lymphedema occurs when the lymphatic system is not functioning sufficiently to transport lymph fluid from the tissues back into the blood circulation system. Left untreated, protein-rich lymphedema fluid reduces oxygen availability:
- The limbs feel tired and heavy.
- The skin of the limb becomes oxygen deficient, dry and flaky. This can lead to itching, scratching, infection, and/or wounds.
- Low oxygen availability interferes with wound healing, and provides a medium for bacteria that can result in infection (cellulitus).
Lymphedema can develop when lymphatic vessels are missing or impaired – called Primary Lymphedema. Or when lymph vessels are damaged or lymph nodes removed – called Secondary Lymphedema. Primary lymphedemas are birth disorders:
- Milroy is familial and occurs at birth
- Merge is familial and occurs at puberty
- Lymphedema praecox is non-familial and occurs at birth or puberty
- Lymphedema tardum is non-familial and occurs at middle adult years.
Secondary lymphedema, or acquired lymphedema, occurs when a normally functioning lymphatic system is interrupted by surgery, radiation, infection, trauma, toxins, or parasites. In the U.S., cancer and cancer treatment are the leading cause of lymphedema. Secondary lymphedema can develop immediately post-operatively, or weeks, months, even years later.
Risk Factors for Lymphedema
Risk Factors for Lymphedema Include:
- Surgery that requires removal of lymph nodes
- Radiation therapy that damages otherwise healthy lymph nodes and vessels, causing scar tissue to form which interrupts the normal flow of the lymphatic fluid.
- Cellulites – an infection which interrupts normal lymphatic pathway function.
- Repeated aspirations of a seroma (a pocket of fluid which occurs commonly post-operatively). This often causes infection and, subsequently, lymphedema.
- Severe traumatic injury that interrupts and/or damages the lymphatic system.
Lymphedema can occur anywhere in the body, depending on where the impendence to lymph function is. It can manifest in the arms, face, neck, breast, trunk, axilla, legs or groin. Signs or symptoms of lymphedema include:
- a full sensation in the limb(s)
- skin feeling tight
- decreased flexibility in the hand, wrist or ankle
- difficulty fitting into clothing in one specific area, or ring/wristwatch/bracelet tightness.
If you notice persistent swelling, it is very important that you seek treatment. Early diagnosis and treatment improves both the prognosis and the condition. Get at least one second opinion if you are not satisfied with your doctor’s recommendations.
Treatment of Lymphedema
A treatment approach based on the Complex Decongestive Therapy (CDT) methods gives the best results. Complex Decongestive Therapy includes:
- Manual Lymphatic Drainage
- Compression: Bandaging and/or Compression Garments
- Remedial Exercises
- Proper Skin Care & Diet
Therapy can be provided by massage therapists, occupational therapists or physical therapists who have completed basic or advanced training in treatment of lymphedema. Basic training involves 16 hours of course work and lab. Advanced training involves 135 hours of course work and lab ending with a certification exam.
Evaluation of Lymphedema
At the initial evaluation, the therapist will take your medical history:
- When swelling started and how quickly it progressed
- Occurrence of cancer, injury or illness
- Surgeries, lymph node dissections
- Chemo & radiation treatments,
- Infections, cellulitis, pain and other factors that are related to your lymphedema.
- Baseline measurements will be taken to determine lymphedema volume.
If swelling is in an arm or leg, measurements of both limbs are taken to compare the difference between the swollen and non-swollen limb. Pictures may be taken of the swollen limb or if swelling is in the face, neck, breast or trunk. This helps to determine what the course of treatment should be and gives a baseline from which progress can be measured.
Treatment of Lymphedema
Treatment sessions are typically scheduled as one-hour sessions, 2-3 times per week initially, then tapering to 1 time per week as you make progress. The patient and therapist will work together to develop an individualized treatment plan to address the lymphedema.
Skin Care for Lymphedema
Skin Care Education is part of treatment and includes information to minimize the possibility of infection:
- cleansing with antibacterial washes and moisturizing lotions to help eliminate bacterial and fungal growth
- reducing risk of scratches, punctures or other openings in the skin
Education on Risk Factors for Lymphedema
ETreatment includes education on risk factors and includes information on:
- what your risk factors are
- how to minimize risk of a flare-up
- when to seek intervention
Manual Lymph Drainage for Lymphedema
MEach session includes Manual Lymph Decongestion (MLD). MLD is a massage that opens the lymphatics and stimulates their activity to drain the affected area. MLD provides light touch on the skin that stimulates the initial lymphatics to dilate. The node sites are stimulated first to prepare them for an increase in fluid movement. The movement of the skin pulls the anchoring filaments which, in turn, opens the gap junctions and allows fluid to enter the lymphatic system. MLD increases the lymph transport load, increase the lymph transport rate and influence the direction of the lymph fluid. The therapist can direct the fluid to enable fluid trapped in damaged quadrants to be moved to non-damaged quadrants. The limb is then drained working proximal to distal – the area you want the fluid to move into must be emptied before the fluid can move in. Effects of this stimulation are known to last for approximately one hour.
Compression for Lymphedema
Compression is used to maintain the fluid reduction – Bandaging or other types of compression follows each MLD session. External graduated compression has a massaging effect on the muscle pump and improves return of venous blood. Teamed with muscle contraction, blood circulation increases and assures a better oxygen supply to the affected limb.
Short Stretch Bandages for Lymphedema
Short stretch bandages look like Ace bandages but have less elastic. They provide a limited stretch, so they give little pressure at rest but prevent expansion of the muscle diameter when the muscles are contracting. This forces the deep venous system to increase its working pressure during muscular relaxation, allowing a more intense retrograde refilling of superficial veins to occur.
Compression Garments for Lymphedema
Once the goal of reduction is achieved, garments are fitted and worn to maintain the reduction. Compression sleeves and stockings provide stretch, so they give high pressure when muscles are at rest but allow muscles to expand with contraction. This affects the superficial venous system and they provide compression of superficial veins at all times.
Exercise for Lymphedema
Lymphedema exercise is active motion of the involved extremity. The goal of exercise is to enhance the muscle pump activity and thus promote improved venous and lymphatic return in the involved extremity. Exercise done in compression enhances the muscle pump action. Exercise can include any one or combination of the following types of exercise:
Goal – stretch soft tissues thereby minimizing tightness and the effects of scarring which can block lymph flow.
Goal – improve muscle power, stamina and tone. The introduction of weights should be gradual.
Goal – improve or maintain cardiovascular fitness. Methods include walking, jogging, cycling, and swimming.
Caution: Exercise can have potential negative effects to individuals with lymphedema. Blood flow is increased during exercise possibly causing an increase in lymphatic load. Increased muscle metabolism results in an increase in metabolic waste. Improper exercise may cause inflammation and trauma to the tissues.
Measurements for Lymphedema
Circumferential measurements are taken on a weekly basis or when a change occurs to determine progress.
Home Program for Lymphedema
Patient training enables individuals to become independent in managing lymphedema. You will be taught how to do manual lymph drainage, use compression and complete skin hygiene on yourself early on in the treatment program. This will help you will feel comfortable doing the home program at the time of discharge. As you achieve reduction and become independent with your home program, session frequency is decreased:
- 2-3 times per week
- 1 time per week
- 1 time per 2 weeks
- 1 time per month
Follow-up sessions are typically scheduled on a monthly basis after you have completed the program. Follow-up continues for as long as needed to ensure your reduction is being maintained.
Although lymphedema is a condition that cannot be cured, it can be managed to enable you to accomplish the things that are important to you.
Therapy Achievements has been providing high quality physical, occupational and speech therapy services for 10 years. Thanks to all who came to celebrate our birthday and to wish us well!
Go Red! February is Heart Awareness Month
If you had heart disease, would you recognize the symptoms? You might be thinking, “Of course!” But there’s plenty more you need to know besides pain in your chest. While pain in the chest is one symptom, there are more – symptoms that if recognized could save your life. So before you pass that jaw pain off as the result of sleeping funny or lightheadedness as something a snack or rest can fix, learn the symptoms. And don’t ignore them!
Signs and Symptoms of Stroke
If you have any of these signs, call 9-1-1 and get to a hospital right away.
* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
* Sudden confusion, trouble speaking or understanding
* Sudden trouble seeing or blurred vision in one or both eyes
* Sudden trouble walking, dizziness, loss of balance or coordination
* Sudden severe headache with no known cause
Using an exoskeleton for walking after weakness or paralysis has generated a lot of attention and I have had a number of patient ask me about it. ReWalk is a battery-powered robotic exoskeleton that attaches to the legs and lower back. It contains motors at the knee and hip joints and sensors to help it adjust with each footfall. While wearing the device and holding two forearm crutches, someone with complete lower-limb paralysis can walk.
Exoskeletons have sparked hope for those with paralysis. Using an exoskeleton for walking seems like a dream come true, but, sadly for most the technology is still out of reach. The cost is prohibitive and health insurers generally don’t cover the expensive equipment. The ReWalk System costs, on average, $81,000. Ottobock’s C-Brace is priced at $75,000. And the Indego Personal is $98,000.
Not only is cost an issue, but the device is not practical in all environments. One user of the Ottobock C-Brace exoskeleton finds the device very helpful in her home, but when she hiked the Appalachian Trail. She had difficulty keeping the battery charged for long periods and found rain to be problematic because it isn’t waterproof.
For some, no price is too high for the hope of walking again. In our area, Spain Rehab Center – UAB in Birmingham, AL and Shepherd Center in Atlanta, GA are the two closest training centers that can evaluate the benefit of an exoskeleton for walking for people interested in this system.
Have you had experience with an exoskeleton? If so, please share what it was like for you.
How does seated yoga help Multiple Sclerosis? Find out at Seated Yoga at Rocket City Multiple Sclerosis Support on 8-21-18.
Yoga is a wonderful, but gentle form of exercise and there are many reasons for someone with multiple sclerosis to try it. Pam Herdy will conduct a Seated Yoga at Rocket City Multiple Sclerosis Support and you won’t want to miss! Pam Herdy has extensive experience with both yoga and working with people with physical challenges. She is a nurse practitioner and who has worked in rehabilitation settings for over 20 years. Pam’s calm demeanor and proficient teaching skills make her seated yoga class especially enjoyable.
The main reason yoga is so beneficial is because it increases strength, improve coordination, increase balance and even promote a calmer lifestyle. Yoga is very adaptive and many of the exercises can be done no matter where you are. It can be as simple as doing a breathing exercise while waiting at the doctor’s office! The peaceful benefit can help you stay calm in stressful situations such as waiting in line or even laying still in an MRI machine. The goals of yoga are very simple and include improved breathing, posture, balance and better alignment of the body. Yoga helps with the everyday tasks of life like standing, waking, sitting, and even going to the bathroom.
Another benefit of yoga is that it can provide an improvement in overall pain and soreness. Because Yoga requires focus with deep breathing, it produces pain reducing effects of body relaxation and stress reduction.
If you are interested with starting yoga exercise, make sure you find a qualified instructor who is familiar with your condition and is adept at modifying the exercises to accommodate your specific needs. To give it a try, join us for Seated Yoga at Rocket City Multiple Sclerosis Support on 8-21-18 at 6:00 at Therapy Achievements at CCI. We meet the 3rd Tuesday of every month and have a topic of interest to MS, food, and time to talk and make friends.
Therapy Achievements is dedicated to helping people with physical, cognitive and visual limits re-gain function and reach their potential. We provide programs for Nuero Rehab, Ortho Rehab, Driving Rehab and Lymphedema. By providing out-patient physical, occupational and speech therapy services, we help people maximize their independence and reach their potential.