General PT Home Exercise Program (Balance, Strengthening & Coordination)

Shawna September 5, 2016 2 Comments

General Balance, Strength & Coordination HEP

Welcome,

This page was designed to show how I, a Home Health Physical Therapist, address balance problems, leg muscle weakness, and coordination deficits. I recommend watching the video (it’s a little over 11 minutes) and learning the reasons I use the methods in the video to challenge my patient’s balance, strength, and coordination required for safe standing and walking in the home as well as going up/down ramps, steps or curbs.

INTRODUCTION

Maintaining strength, decreasing falls and improving independence are probably the most common reasons for Home Health Physical Therapy. Following a hospitalization, my patients seem to be overwhelmed and face numerous obstacles from general weakness of the legs, difficulty breathing (sometimes from pneumonia), bone-cold chilliness, appetite changes, and swelling to depression, poor endurance, and healing surgical incisions.

This is a video of an actual Physical Therapy home therapy treatment. Please, DO NOT attempt this or any new home exercise program without seeking the advice/supervision of a medical professional first!

Most patients are discharged home from either a hospital where they have had no therapy, or an inpatient rehabilitation facility (Skilled Nursing & Rehab aka SNF) where they had varying degrees of therapy. Most of a patient’s therapy at this stage is focused on promoting initial healing processes without complications such as infection, pneumonia, and blood clots through very low-level walking (slow paced on even surfaces), exercises (usually sitting down), basic transfer training (standing up, getting in/out of bed, going from a wheelchair to/from the bed, toilet and chair), and bed mobility (rolling, scooting, and sometimes bridging).

In the home setting, patients are still trying to conquer the healing process, but they have advanced beyond the initial therapeutic exercises mentioned above. In the home, patients face different challenges and therapy needs to be different (look different and feel different) compared to the therapy he/she received in both the hospital and inpatient rehab. For example, in the home, they have soft, cushy recliners, couches, and often beds that are more difficult to stand up from compared to the hospital bed, the medically equipped bathroom facilities, and the chairs with armrests. Stairs, steps, and carpet can even be challenging after a recent hospitalization.

RATIONAL BEHIND MY TREATMENT METHODS

As an experienced Home Health Physical Therapist, I have several beliefs/treatment practices (some of these beliefs were mentioned in the video) to address and improve my patient’s level of independence, safety, and quality of life in the home setting.

Belief #1: You are only going to get good at what you practice, so you need to PRACTICE what you want or need to get better at while you have the skilled therapist available to assist with problem-solving and fall risk management.

If you are safe and functional in sitting, but lose your balance, get really tired, or stagger around during standing and walking activities, THEN therapy needs to be 90% completed in STANDING and not sitting down peddling a floor bike, kicking your legs, etc….

Belief #2: Everything changes once you are home!

If you were in therapy at an inpatient rehab facility and discharged home, THEN you obviously met your goals and successfully completed the initial stages of rehabilitation appropriate for either going home or continuing rehab in an outpatient rehab setting.

Therefore, therapy in the home SHOULD look, feel and be different from the therapy received in the hospital or inpatient rehab setting. Furthermore, therapy should look, feel and be different for different goals and problems. In other words, therapy after a total knee replacement should look, feel, and be different to therapy after a stroke, heart attack, fall with significant injury, etc…

Belief #3: During therapy, especially in the home, there needs to be a goal (FUNCTION-al reason for doing an exercise) behind EVERY exercise/intervention.

I encourage and sometimes prompt my patients to ask questions! For example, “What FUNCTION-al goal is being addressed with riding a floor bike for 20 minutes in the home?” Experience has taught me that being able to pedal a floor bike for 20 minutes primarily promotes circulation when someone is not able to/not suppose to put weight on his/her leg and to decrease stiffness using the pedaling motion. I DO NOT believe the floor bike is an effective treatment method for strengthening because to build strength, you need the proper amount of resistance applied in a specific/appropriate position. I personally do not ride a bike through my house and neither do my patients. Therefore, I DO NOT have my patients PRACTICE riding a bike during therapy because riding a bike does not make walking or standing easier.

On the contrary, in the video, I explain why I have every one of my patients with balance problems and increased fall risks complete standing heel and toe raises WITHOUT holding onto a walker! The foot and ankle are the 1st things to contact with the ground. When walking UP a ramp, the ankle is in the “TOE UP” position of toe raises. When walking DOWN a ramp, the ankle is in the “TOE DOWN” position of heel raises. If my patients don’t want or need to remain on a walker, THEN they need to practice all standing exercises and walking (UNDER MY SKILLED SUPERVISION AS A PT) without using a walker or holding onto something (I have not seen a kitchen countertop in the middle of a parking lot for someone to hold onto). This goes back to my 1st Rule–You are only going to get better at what you PRACTICE!

No one enjoys wasting their time! If you understand the “Why” behind certain exercises, then you do not feel like you’re wasting your time, and you are more likely to do your home exercise program because it makes sense. In previous videos and posts, I explain why I DO NOT use a floor bike, theraband or leg weights during home therapy treatments. The primary reason I DO NOT use these therapy methods is: I have never observed someone walk better, stand up easier, or keep their balance because he/she can peddle a bike for 20 minutes in sitting or sit and move their legs 20 times against the resistance of a red theraband or with 5 pounds on their legs.

Remember: These are my OPINIONS and I treat home therapy differently because I believe rehab in the home IS different from rehabilitation in the hospital or inpatient facility.

If you have any questions or would like to share your own experience with Physical Therapy, please leave a comment below. I hope this video and post were helpful. I am available for any questions, suggestions or comments because I am dedicated to making care in the home easier and safer!

Until Next Time,

Be Safe!

Shawna, PT, MPT

Categories: Weekly Tips & Tricks

Total Hip Replacement Rehab & Recovery Guide

Shawna August 27, 2016 6 Comments

$hip fracture xray image$

One of the most dreaded diagnoses associated with elderly falls is a subsequent hip fracture. Fractures involving the hip joint and/or the femur (leg bone above the knee) can either require a TOTAL HIP REPLACEMENT (THR)–aka TOTAL HIP ARTHROPLASTY (THA)–or an OPEN REDUCTION INTERNAL FIXATION (ORIF) surgery. Hip fractures requiring total replacement of the hip joint generally require rehabilitation and special precautions. This page will provide general facts/tips, basic Physical Therapy Exercises, and an overview of the precautions associated with a Total Hip Replacement.

General Facts & Tips

Falls can be very dangerous and even lethal. Fractures, head trauma, wounds, pressure sores (develop as a result of decreased out of bed activity), skin tears, depression, blood clots, infections, muscle atrophy (weakness), pain, swelling, and inability to resume one’s prior level of function–are some of the potential complications associated with falls and significant injuries.

Hip fractures can be particularly challenging, life-altering and fatal in the elderly population. Elderly patients either rehab well or dramatically decline, fail to thrive, and eventually either give up (pass away) or withdraw into severe depression following a hip fracture and joint replacement surgery.

Did you know, the long bones of the legs (femurs) and the flat bones of the pelvis are where the body manufactures a large portion of its blood supply? In other words, the bones of the hips and upper legs are essentially the body’s blood bank. Therefore, a fracture involving the hip and/or femur can compromise the body’s blood bank resulting in:

extensive bruising, pain, swelling, and risk for anemia,
pronounced fatigue/weakness,
and even the potential need for blood transfusion(s) to replenish the blood supply.

To decrease bruising, I have had good results with my patients drinking pineapple juice. The enzymes apparently help to promote healing and decrease the discoloration of bruises. In addition, it is very important for patients to wear their COMPRESSION HOSE per his/her doctor’s orders. Compression hose control swelling and decrease the risk of developing blood clots. Click HERE to view a video demonstrating how to easily put on compression hose.

Moreover, falling and fracturing a bone/joint–especial in the aging population–results in decreased independence, increased need/use of medical equipment and additional assistance for activities of daily living (showering, dressing, toileting) as well as compromised mobility (walking, transferring, rolling, scooting, and getting in/out of bed) due to an increased fear of another fall.

Recommended Home Medical Equipment

Total Hip Kit	Elevated Toilet Options	Showering & Bathing
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**The Bed Side Commode is very VERSATILE. Use it over the existing bathroom toilet by removing the bucket and/or in the shower as a shower chair (clean the BSC while showering your loved one).

Exercises Before and Following a Total Hip Replacement

Lying Down Exercises

Ankle Pumps & Circles

Heel Slides

Short Arc Quads

Gluteal Sets (Buttock Squeezes)

Sitting Exercises

Kicking

Reclined Marches (Knee Raises)

Standing Exercises Both Legs

Heel Raises

Toe Raises

1/4 Squats

Side Stepping

Standing Exercises For the Surgical Leg Only

Knee raises

Forward Kicking with a Straight Leg

Backward kicking with a Straight Leg

Ham curls

Walk, Walk, Walk–The Most Important Exercise

When walking there are some important things to remember

Make sure the walker has been adjusted appropriately. The hand grip should be at the same height as the bend of the wrist when standing up straight. I also recommend moving the wheels to the INSIDE of the walker to increase the likelihood of the walker clearing narrow doorways. Click HERE for a video demonstrating how to move the rolling walker wheels to the inside of the walker.
Make sure both feet walk past each other with every step. In other words, decrease limping and short, choppy steps.
Do NOT plant the surgical foot and pivot when turning! In other words, pick up the surgical foot while turning.

Hip Precaution Overview

Every caregiver of a loved one, patient, and client should know the total hip precautions set forth and prescribed by orthopedic surgeons following a THR. Below is a table of pictures to help describe hip precautions after hip replacement.

Hip Precaution DO’s	Hip Precaution DO NOT’s
Toes CAN point out to the side	DO NOT CROSS THE LEGS
Toes CAN point straight up to the ceiling	DO NOT let the toes point in toward the other leg
The height of the knees should be the same or LOWER than the hip	DO NOT sit with the knees HIGHER than the hip

Related Tips and Helpful Information

Now let’s take the precautions a step further…

After a hip replacement surgery, the hip joint is weak and vulnerable to certain movements and positions. One position of vulnerability is bending at the hip beyond 90 degrees, but what does that mean? Bending over 90 degrees at the hip means either the knees come closer to the shoulders (sitting in a low chair or on a low toilet takes the height of the knees higher than the hips as seen above) or the shoulders come closer to the knees (lying in bed and reaching to the bottom of the bed to pull the comforter up, bending over to tie shoes or put on socks). To avoid bending at the hips, patients should be familiar and use the Total Hip Kit (Pictured Above) that includes: a Reacher/Grabber, a Long-handled shoe horn, a Long-handled sponge, a Sock Aid, a Looped Leg Lifter, and Elastic Shoe Strings.

Another position of vulnerability is crossing the legs. Crossing the legs at any time (lying in bed, sleeping, sitting down, and standing/walking) is a significant violation of the hip precautions after surgery. Be very careful and avoid crossing your surgical leg when you turn around in standing, change directions/turn during walking, and rolling over to get out of bed. To prevent the legs from crossing while sitting and lying down, patients are usually prescribed a knee separator pillow and leg wedge (Abductor wedge) to keep the legs apart (Both are pictured above as well). To avoid crossing the legs while walking and standing, Physical Therapists instruct patients to PICK UP the FEET with every step of turning. Specifically, patients are trained not to PLANT their surgical foot on the ground and turn toward the opposite foot.

The final position of vulnerability occurs during exercises or getting in and out of bed. Keeping the knees 90 degrees away from the shoulders can be difficult when doing certain exercises like MARCHES and LOWER EXTREMITY FLOOR BIKE (PEDDLER) cycling in sitting. Therefore, I have my patients lean back or recline their upper body to do any knee raises (marches) in sitting. I personally DO NOT use a peddler in the home because I focus on functional strengthening through standing and walking versus less challenging exercises such as sitting and peddling the feet. However, I have provided a picture of a floor peddler below because the pedlar is commonly used in several rehab settings.

Finally, I am sure your loved one has been advised not to sleep on his/her surgical hip, but I want to explain why this is important. I constantly inform my patients, “If there are any outward signs of a recent surgery like a healing incision, imagine what the surgical site looks like under the skin.” Healing requires good circulation and oxygen. Sleeping on the surgical side will compress the surgical site and impede (slow down) both circulation and oxygen. Therefore, it is important to avoid sleeping on the surgical hip to promote optimal healing through good circulation of blood and oxygen.

Hip replacement recovery and rehabilitation are very important following a hip fracture. However, if you have any questions or would like additional advice, please leave a comment or question below. I will make the best attempt to answer within 48 hours to make the responsibility of caring for a loved one easier and safer before and after a hip replacement surgery.

Until Next Time Be Safe and Stay Health 🙂

Shawna Watts, PT, MPT

Categories: Weekly Tips & Tricks

What D.M.E Does Medicare Cover In the Home?

Shawna July 13, 2016 5 Comments

Did you know Medicare is the GOLDEN STANDARD for defining diseases/disorders and stipulating what treatments & equipment are covered (paid) under the definition of those diseases/disorders? In other words, there are certain criteria for someone to be diagnosed as DIABETIC under both Medicare and Private Insurance policies. If he/she meets the criteria of a defined diabetic, then he/she is eligible to receive certain supplies, treatments, and care. If Medicare defines a disease, illness or condition, then Private insurance usually follows the direction of MEDICARE making MEDICARE the GOLDEN STANDARD!

IF MEDICARE pays, PRIVATE INSURANCE generally will pay as well!!

So, you are bringing your loved one home, need durable medical equipment (DME), but do not know what is covered? Coverage and reimbursement are dependent upon several factors including the required onsite physician evaluation/prescription, physician and supplier participation and/or enrollment in Medicare, and the presence of the Medicare Competitive Bidding Program in your area. Once you get the basic criteria met, you need to be able to answer,”Yes,” to these questions?

Is it durable?

Will it be used in the home?

Is it required to meet a medical need?

Is it only useful and needed for someone with a medical – based problem/illness?

Will it last a minimum of 3 years before needing to be replaced?

Okay, now you have an idea of the criteria for which MEDICARE and PRIVATE INSURANCE use for covering and providing home medical equipment, and here is a general list provided by Medicare.gov to help you even further:

Air-fluidized beds and other support surfaces (these supplies are only rented)
Diabetic supplies/monitoring
Canes (EXCLUDING white canes for the blind), Crutches, and
Commode chairs
Continuous passive motion (CPM) machine
and Walkers
Hospital beds
Infusion pumps and supplies (when necessary to administer certain drugs)
Manual wheelchairs and power mobility devices
Nebulizers and nebulizer medications
Oxygen equipment and accessories
Patient lifts
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Suction pumps
Traction equipment

I don’t know if you noticed but shower chairs, tub transfer benches, raised toilet seats, adjustable (full-electric/luxury) based beds , pulse oximeter, ramps, automobile lifts, and grab bars were not listed above. According to Medicare/Private Insurance, these items are considered self-help (not medically necessary), comfort, and convenience-based versus medically necessary! In other words, it appears that what MEDICARE/PRIVATE INSURANCE supplies in the home stop at the bathroom door!

Personally, I believe there are many medically necessary activities best completed in the bathroom but the challenge(s) involved are too great to contend with so patients and caregivers either resort to bed/sponge bathing or opt for more expensive resolutions (construction, special medical equipment installation/use). Most of the problem with bathing, showering, and toileting in an existing bathroom is ACCESSIBILITY (How to manage a narrow doorway).

The best wheelchair for accessing a narrow doorway is a transport wheelchair (the wheels are small and in alignment); however, make sure the armrests remove and/or swing out of the way such as the one pictured on the left below. If you do not want to have 2 types of wheelchairs–a manual/standard wheelchair with large outer wheels AND a transport wheelchair with inline wheels–there are wheelchairs that convert from a manual wheelchair into a transport chair (pictured on the right)!

Once in the bathroom, transfers can be managed with fairly inexpensive equipment–especially if you have or can get an Elevated Toilet Seat, Tub Transfer Bench, and/or Shower Chair. If standing is not an option for you or your loved one, I highly recommend using a sliding board to transfer from the wheelchair to and from the Elevated Toilet Seat, Tub Transfer Bench, or Shower Chair.

If you are not familiar with the use, safety, and types of sliding boards, I recommend visiting my post on Medical Transfer Boards (aka Sliding Boards).

For certain patients and bathroom setups, I have created a simple solution with inexpensive products available at your local home improvement store. Click HERE to view my solution for accessing narrow bathrooms. Please keep in mind, my patients that use this alternative accessibility method are able to walk with either a walker, cane, or rollator.

Where can you find or get assistance for medical equipment not provided by Medicare?

I encourage my caregivers to search Craigslist, research “aging in your area” or Community-Based Assistance Programs, visit local Goodwill stores, or seek advice from family and friends–especially therapists, nurses, engineers/carpenters and adult protective services.

Please, remember if you purchase any medical equipment on the internet, reimbursement by Medicare/Private Insurance is NOT available. Attempt to get reimbursement FIRST, but if you can’t because you want or need an item on the NOT COVERED list, I recommend looking to the internet or investigating your social circles (church, community groups, Department of Aging, family and friends) for a solution to your medical equipment needs.

If you have a specific question or need medical equipment advice, please feel free to contact me.

I am honored to have you visit my site, and I will continue to provide tips/tricks in an effort to make daily care of a loved one easier and safer.

Sincerely,

Shawna PT, MPT

Categories: Weekly Tips & Tricks

Exercise Balls: The Benefits Using an Exercise Ball

Shawna June 2, 2016 No Comments

Exercise Ball (aka Balance Ball, Stability Ball, Swiss Ball)

There are several benefits for using an exercise ball as a chair for sitting exercises for the elderly. Below is a video explaining the reasons and demonstrating how I use the exercise ball in the home to do sitting exercises! You just can’t beat the benefits of an exercise ball as a chair for sitting exercises and other uses! I encourage you to watch the video and continue to read.

For additional information about Exercise Ball Benefits, Please continue to read.

Benefits

Improved posture

Unlike sitting on a chair or any other flat surface, the ball’s shape encourages proper sitting posture and body alignment (shoulders above the hips). If the shoulders are shifted any direction, the redistribution of weight challenges overall balance, and the ball shifts in response to the altered postural alignment. Consequently, the abdominal, back and leg muscles engage and AUTOMATICALLY respond to correct the alignment, control the loss of balance, and restore sitting stability.

Sitting exercises on a flat surface (chair, bed, gym/rehab table) do NOT challenge posture to improve postural control (keeping the shoulders over the hips when the legs are moving).

QUESTION: Is it possible to slump/slouch down sitting on a chair/bed and still be able to raise a knee up?

ANSWER: Yes, it is possible. In fact, I challenge you to sit down and slump over (round the shoulders forward over your legs and then raise one knee up and down. Now sit with your hips toward the edge of the chair with your shoulders behind you (BE CAREFUL not to sit too close to the edge of the chair because you can slip out of the chair when you move your shoulders backward) and do a knee raise.

Sitting on a flat, firm surface does not challenge or improve posture. So why worry about poor posture in your loved one? If sitting posture is bad, standing posture will be worse and walking is both more DIFFICULT and DANGEROUS. Furthermore, breathing is more difficult.

TRY THIS: round your shoulders forward again (slump over in sitting or standing) and now try and take a deep breath! Now, sit or stand up with your shoulders over your hips and take a deep breath. Subsequently, if you add any breathing problems your loved one might already have (asthma, COPD, Emphysema, Pneumonia) to poor posture–no wonder he/she is short of breath, easily fatigued, and weak with very light activities.

Improved Balance

Being able to move either in sitting or standing without staggering, stumbling, or falling takes good balance, reaction time, and coordination. Balance is time-sensitive. In other words, slow reaction times combined with weak muscles or poor balance strategies will increase your loved one’s fall risk. If you want to improve balance, you have to challenge your balance.

For example, when learning to ride a bike, you have to learn how to BALANCE on two wheels that are in alignment. At first, you lose your balance side-to-side, start out really slow, and have to put your foot down quickly to prevent falling. Eventually, you learn how to balance and ride in a straight line but turning is more difficult and requires a slightly different balance strategy. If you persevere, you can successfully keep your balance while turning both directions. Later, you challenge your balance more by increasing the speed, jumping ramps/inclines, or even riding WITHOUT any hands! In summary, first you lose your balance, then you challenge/strengthen your balance strategies, and eventually you can do more without falling.

Now let’s compare balance sitting on a flat surface (bed, chair) to sitting on an exercise ball.

QUESTION: What is providing the balance/stability in each situation?

ANSWER: The flat surface is providing all the balance/stability when you exercise on a chair or bed. Your legs, abdominal muscles, and core are providing the balance/stability because the ball DOES NOT and WILL NOT balance you. TRY or THINK ABOUT THIS: Can you sit on a chair with one foot off the ground and still be able to kick the other foot out in front of you or raise the other knee up and down? Now, can you sit on a ball with one foot completely off the ground and still move the other leg (kick or march the knee up and down)? You can move your leg when the other is completely off the ground while sitting on a chair/bed because the CHAIR/BED is supplying all the balance you need. However, when sitting on a ball, your BODY must react with the ground for you to keep your balance because the BALL does not provide ANY external balance.

Improved Strength

WARNING: THE FOLLOWING STATEMENTS ARE MY OPINIONS BASED ON MY EXPERIENCES!!!

If my patients demonstrated improved functional independence during standing, walking, transferring, and bed mobility doing sitting exercises on a chair/bed with therabands, ankle weights, or a floor bike, then I would have them do these tasks until the cows come home. HOWEVER, I have not observed any significant or pronounced functional outcome with standing, walking or transferring doing these TYPICAL exercises on a chair/bed; therefore, I DO NOT use these techniques while treating my patients. If my patients do ANY sitting exercises, they do them while sitting on an exercise ball!

What is one of the requirements for building strength? Resistance! Our bodies respond to the forces we put on them. When someone goes to the gym with the purpose of their workout focused on improving his/her overall strength, they utilize resistance either with weights, exercise equipment, or moving their own body weight against gravity to build muscle strength. Furthermore, combining muscle groups and movements is more effective than isolating specific muscles when building strength.

Sitting on a ball allows a wide variety of movements and when someone is extremely weak–like my patients that are technically/literally unable to physically leave their home due to their pronounced weakness/fatigue–moving their own body weight against the force of gravity to stand up, transfer, get in/out of bed, sit without back support or walk short distances is extraordinarily difficult. Therefore, in the home setting, I focus my strengthening exercises around my patient being successful, efficient and safe moving their body weight against gravity and combining different movements simultaneously.

For example, on the exercise ball, I have my patients bounce up and down while simultaneously shifting their weight all directions in a circular pattern, OR I have them complete sit to stand transfers combined with different foot positions and/or using one hand to no hands while standing up. The resistance created from my patient’s body weight reacting to the shift and dynamic movements of the ball simultaneously improve the FUNCTIONAL strength of various muscle, the balance strategies of the hip/ankles, the postural alignment and control of the core, and general coordination between numerous joints and muscle groups.

When compared to sitting on a flat, firm, static (immobile) surface such as a chair or bed, leg strength generally does not improve–especially in the muscles required for maintaining balance, postural alignment, coordination and endurance for standing up, walking, transferring, and bed mobility.

Improved Coordination

Robots move in one or maybe 2 dimensions. Physical therapists battle choppy, robotic movements especially when patients are turning in a circle while standing up, walking with a cane or walker, and transitioning from side lying to sitting or sitting to standing. Every movement we make requires a symphony of coordinated movements, muscles, joints and systems (nerves, heart, lungs, senses, etc…). Sitting and exercising on an exercise ball improves coordination through multidimensional movements (up, down, side-to-side, forward and backward). It is easier to have robotic, isolated movements while exercising and sitting down on a chair/bed. Doing the exact same exercises on a ball (sitting on air) will produce smoother, more controlled and coordinated movements due to the shape/surface of the ball and how your body reacts to the movements of the ball.

Decreased Effort/Reps without Sacrificing Results

Typically, patients get frustrated and bored with repeating more than 10 repetitions of the same exercise over a short period of time. Everyone likes knowing they are working SMARTER and not HARDER! I can have my patients complete decreased repetitions of different exercises (movement patterns) on the exercise ball because every movement on the ball incorporates posture, balance, muscle strength, and coordination. In other words, one leg cannot be on vacation while the other leg is moving, core strength is engaged, proper postural alignment is active/reactive, breathing and balance are improved, and overall coordination is challenged. Unlike exercising on a chair/bed, the ball is similar to in-home circuit or interval training so doing fewer reps/exercises yields greater results.

Here are products and links to purchase your own exercise ball!

RELATED PRODUCTS

Below I have listed the 5 exercises I use with most of my patients to warm them up before I customize the rest of their treatment to meet his/her specific needs and goals. Please, leave me a comment or ask me a question if you are interested in learning more about home-based exercises on an exercise ball for knee replacements, hip replacements, and other diagnoses.

General Exercises Appropriate for Several Disorders & Deficits

Bouncing

Weight Shifts all directions (rocking forward/backward & Side-to-Side shifts, circles clockwise/counter-clockwise)

Knee Raises (Marches)

Kicks

Sit-to-Stand from the ball

Other Uses for an Exercise Ball

Swelling Control – I place the ball under the ankles to elevate the feet above the level of the heart for swelling control. I can place the ball on the footrest of a recliner, on the bed, or even on the couch for effective swelling management.

Pressure Relief – If my patients have a pressure sore (decubitus ulcer) on the heel, I can relieve the pressure and manage any swelling due to the curve of the ball.

Alternative Sitting – The ball is an excellent chair! My daughters use an exercise ball at their computer desks. The ball promotes posture, improved level of alertness, and helps my daughters get through their homework with decreased mental fatigue after school. My daughters stay awake even after a long day at school through bouncing! Their posture, like my patients, is improved and they stay focused until their homework is complete. I have recently read blogs where office personnel use balance balls at their desks and have noticed decreased back pain with improved posture and productivity! An exercise ball is inexpensive and very versatile not only in the home but in the office as well.

WARNING: If there are children present in the home, the ball will most likely be confiscated for their fun and entertainment–this is a common occurrence when I am treating a patient, using the ball, and children are in the home.

If you have an exercise ball or want to share your story, I would love to hear from you! If you have any questions, please leave me a comment below and I will get back to you withing 48 hours.

I hope you enjoyed and learned something new, and I look forward to hearing from you!

Best Regards,

Shawna PT, MPT

Categories: Weekly Tips & Tricks

Mobility Aids For The Disabled…What You Need To Know About Walkers & Canes

Shawna May 17, 2016 4 Comments

Welcome,

Home Health supplies for the elderly can be confusing especially when learning how to adjust and use mobility aids for the disabled. Here is a video reviewing, explaining, and showing the proper use of a walker and how to use a walking cane. Please, watch the video and continue reading for a summary of the information covered in the video as well as an opportunity to ask any questions!

Rolling Walkers

There are several very common walking aids used to help with balance problems, pain, and/or an inability to tolerate bearing weight on a leg due to an injury, surgical procedure, or decline in health (stroke, Parkinson’s Disease, etc…). Rolling walkers are one of the many assistive devices commonly used in a variety of settings (home, hospital, inpatient rehab) to decrease the effort and fall risk during walking and standing activities.

Did you know rolling walkers have 2-wheels on the front and the wheels come in different sizes? The larger the wheels (5 inches or larger), the better the walker will roll on rough terrain such as asphalt parking lots, dirt roads, grass, and sidewalks with large cracks. Smaller front wheels require increased effort and do not roll easily on plush carpet, sidewalks, wooden ramps, or any type of textured surface.

Using a rolling walker is not difficult if the walker is properly adjusted to the person’s height. Rolling walkers, canes, and even the hand grips on crutches are easily adjusted to the appropriate height if the hand grip is even with the bend of the person’s wrist.

The walker and the person using the walker should make a box! In other words, your loved one should be instructed to “walk inside the walker,” so the walker remains close to him/her, and their body completes the back of the box.

PROBLEM: Walker Does Not Fit Through The Door

SOLUTION: I highly recommend re-positioning the front wheels to the inside of the walker. Moving the wheels from the outside of the walker will NOT change the stability of the walker. Subsequently, if the back of the walker fits through a narrow doorway but the front of the walker does not fit because of the additional width of the front wheels, then moving the wheels to the inside of the walker will solve the problem!

Canes

Canes are another common walking device and canes are more mobile, lighter, and easier to use on steps compared to walkers and rollators. There are several types of canes.

Single Tip – A cane with 1-point that does not stand up by itself so it propped up and can be easily forgotten–“Out of Sight, Out of Mind.”

Quad Cane – A cane with 4- tips/points that can stand up by itself without needing to be propped up against a wall. Not as easily forgotten and provides more balance/stability compared to the Single-Tip cane.

Tri-Tip cane – A cane with 3-tips/points.

Walking Cane Tip:

Regardless of how many tips, all canes need to be properly adjusted for height. If the handgrip on the cane is too high or too short, the arm cannot effectively decrease the weight, improve the balance, or manage the pain of an injured, weak, or painful leg. Furthermore, the cane provides the optimal level of assistance and stability when used in the hand OPPOSITE of the injured, weak and/or painful leg.

How to walk with a cane….

Remember: the cane should mirror the hurt, surgical or weaker leg. In other words, when the hurt, surgical or weaker leg goes forward, the cane should either proceed the leg OR the cane should move with the leg simultaneously.

The sequence is EITHER: Cane…..Affected Leg….Strong leg

OR

Cane and Affected Leg at the same time….Strong leg

In the same manner, going up and down a step has a specific sequence, regardless of the mobility device (rolling walker, crutches, cane, etc…). The sequence for going up a step is to lead up the step with the stronger leg. For going down a step, lead down with the weaker/hurt/surgical leg first. An easy way to remember which leg goes up first and which leg goes down a step first is the following statement:

The good go up and the bad go down!

Below you will discover Amazon links under “Related Products.”

Take Advantage of Me and My Experience

When I provide images of related products, I am simply showing you some of the options available to address a particular situation. However, if you have friend/relative give you medical equipment and you have a question about how to use, adjust, or set up the equipment, leave me a comment. I guarantee you are neither the first nor the last person to take on the responsibility of caring for someone with mobility problems that needs & would benefit from medical equipment but you’re just not sure what to get, how to set it up, or how to use it.

In the same manner, when equipment is delivered, sometimes the representative takes very little time to explain and demonstrate all the features, uses, and adjustments before leaving you with the equipment. To that end, I say, “There is no such thing as a stupid question especially when it is the safety and comfort of you and your loved one hanging in the balance of falls and injuries in the home.” The only stupid question is the one not asked!

Like I mentioned before, these are some suggestions for mobility devices (walkers, canes, wheelchair, etc…). If you are considering a mobility device but are not confident and would like some advice on whether a 4-point cane, single-tip cane or walker would be better, then message me. I will ask you some questions and then offer my advice, tips and/or reasons for using a certain mobility device over another one. I might even be able to make a video to help you make the BEST decision based on your loved one’s needs

I am here to make caregiving easier and safer , and I look forward to hearing from you.

Related Products

I want to thank you for visiting my site and I hope you leave having learned something to make caregiving easier & safer, and a desire to return for future updates. Please leave a comment, question, or idea so I can continue to help you with any daily caregiving issues.

Once again thank you for stopping by and I look forward to seeing you again soon!

Best Regards,

Shawna PT, MPT

Categories: Weekly Tips & Tricks

Bed Mobility Techniques…Get Someone In & Out of Bed Easier

Shawna May 10, 2016 4 Comments

Welcome,

Getting Someone In and Out of Bed Safely can be difficult! Here are some bed mobility techniques to make getting in and out of bed easier. I encourage you to watch the video and continue to read for more information as well as an opportunity to ask any questions!

Bed Mobility Training…Get Someone In & Out of Bed Easier

It’s Too Hard…It Will Hurt…I Don’t Want To…

Sounds like the excuses for not exercising, but these are the excuses I get from most patients when I approach them with the task of getting out of bed. Weakness, muscle atrophy from inactivity, and other very serious problems can occur when someone stays in bed! Bed sores, blood clots, and an increased risk for choking are just a few reasons for patients to GET OUT OF BED every day!

Have you ever heard of or seen a bed sore/pressure ulcer/decubitus wound? Prolonged bed rest causes pressure to build up in specific areas of the body (shoulder blades, tailbone/coccyx, and heels). When the pressure is not decreased or properly managed, a sore develops. Hence, the name PRESSURE UlCER/BED SORE!

The problem with pressure sores is once you see the pressure sore on the surface of the skin, the damage is getting worse under the skin! That’s right…the tissue under the skin is already degrading because pressure sores start under the skin and then work their way to the surface. Nerves, muscles, and even bone can be involved and permanently damaged! There are different stages of a bed/pressure sores based on the depth and degree of tissue involved.

Stages of Pressure Sores	Signs & Degree of Tissue Involvment	Pain	Likely Permanent Damage
Stage 1	Redness that does not go away when you touch the red area, Warm to the Touch-like the skin has a fever, No broken skin or open wound visible Tissues Involved: Skin Only	Can be VERY painful from the nerves involved inside the layers of skin	No
Stage 2	Open wound is visible or skin is broken. Can have a blister-like appearance. Tissues Involved: Skin + Possible Fatty Layer just under the skin	Mild to Moderately Painful from nerve endings in the skin	Yes
Stage 3	Visible crater/Open Wound. Tissues Involved: Skin + Fat layer under the skin	Possibly Painful–depends on severity of nerve/tissue damage(debrided)	Yes
Stage 4	Open Wound very visible. Tissue Involved: Skin + Fat+ Muscle + Bone	Pain Possible but not likely due to severe tissue/nerve damage	Yes
Deep Tissue Injury	No OPEN WOUND but the underlying Tissue is Damaged. The depth of tissue involvement is difficult to assess because there is no open wound. The skin is Purple or Dark Red, Soft (Squishy) to the touch, and is either warmer or colder to the touch compared to the surrounding skin.	Painful & Tender to the Touch	Yes
Undetermined/Unstagable	Open Wound very visible. Wound bed–what is visible–is covered by a layer of tissue that can be black, gray, brown, have yellow/greenish-yellow puss, and the wound does not fit into the other categories because the depth of the tissue involvement is not clear due to abnormal/discolored layer of tissue masking the base of the wound	Pain Possible but not likely due to severe tissue/nerve damage	Yes

*Pictures provided by Wikimedia Commons
**Permanent tissue damage can occur with Stage 2, 3, & 4
***Bone infections (osteomyelitis) or sepsis can occur with Stage 4 leading to increased risk of amputation/death

PREVENTION & TREATMENT: Pressure Sores

Below you can view and even purchase heel protectors/pressure sore prevention boots wheelchair cushions for tailbone pressure relief, and bed mobility aids.

You can prevent and treat pressure sores with frequent pressure RELIEF techniques. In bed, turning and using different positions (lying on one side, on the back, and then lying on the other side) every 1.5 to 2 hours with an emphasis on relieving pressure on the bony areas of the shoulder, shoulder blades, hip, coccyx (tailbone), ischial tuberosities (the bony areas just below the cheeks of the glutes/buttocks), and the heels of the feet. When someone sits in a wheelchair, sitting on a BOPPY PILLOW (see picture below) is more comfortable and easily positioned in a wheelchair if a wheelchair cushion is not already in use.

Believe me, the DONUT pillow for coccyx pressure relief is not COMFORTABLE. A BOPPY PILLOW is larger so the surface area is larger resulting in increased distribution of pressure in sitting and overall improved comfort. In the same manner, the BEST position for pressure relief in sitting is leaning forward like you are tying your shoes or positioning the wheelchair in front of the edge of a bed, couch, or recliner, and leaning over the bed, couch, or recliner until the pressure is relieved from the coccyx (tailbone). When decreasing pressure, I recommend leaning forward a minimum of 5 minutes and several times a day if your loved one is sitting in a wheelchair all day.

Go With The Flow…It Does the Body Good

If bed sores are not enough reason to GET OUT of BED, then consider something else that is potentially lethal–BLOOD CLOTS (Deep Vein Thrombosis/DVT). Blood clots can develop when circulation slows down or stops! The veins in our bodies are like a river. When a river is moving fast, it moves debris forcefully downstream. However, if the river flow slows down, the force of water does not clear debris downstream, and debris can build up along the edges. Eventually, the buildup of debris can either stay lodged on the edge of the river (slowing down the flow more) or some of the debris can dislodge along the edges, travel downstream, and make a dam downstream. Either way, the debris disrupts the flow of water! In our blood stream, the debris (aka thrombosis) can be molecules of fat, blood cells, or even air molecules. If the thrombosis dislodges, it can travel (embolize/move) to the heart, lungs, or the brain. When an embolus reaches the heart, lungs or brain, the end result can be sudden DEATH!

Use It or Lose It…Risking Your Secondary Pump

We all agree our heart is a pump–with every contraction-relaxation, blood is pumped/moved throughout the body. In the same manner, the large muscles of the legs are a secondary pump to help the heart move blood from the toes all the way back up to the heart and lungs because the toes are a very long distance from our heart and lungs compared to the head, abdomen, and hands. However, the only way our legs can work as an effective pump is through ACTIVE muscle contraction-relaxation during walking, standing up, transferring, etc… Subsequently, when the legs get weak due to inactivity, increased bed rest, and/or circulation problems (diabetes, cellulitis, congestive heart failure, surgery, etc…), the risk of developing a blood clot increases exponentially! Keeping the legs ACTIVE and STRONG decreases the risk of developing a blood clot because the secondary pump effectively moves blood–inhibiting debris buildup.

So what are the signs of a potential blood clot?

♦ Redness – generally on the back (posterior) side of the leg, soft area behind the knee, or in the calf area

♦ Warmth (fever) – the red area feels warmer than the surrounding skin

♦ Pain/Tenderness – if the clot is in the calf, pain/tenderness occurs with toe raises (the clot is squeezed when the muscle contracts around it).

♦ Swelling/Edema – the leg, ankle, and foot swell due to impeded circulation

♦ Positive Doppler Test – an ultrasound test that assesses the flow of blood for any abnormal flow caused by a clot.

Choking & Aspiration…Not Appropriate Bed Activities

Choking…when food or an object completely blocks the windpipe (trachea) effectively stopping all breathing. What do you do when someone is choking–you administer the Heimlich Maneuver! Okay, now consider trying to successfully administer the Heimlich Maneuver on someone choking IN A BED! Precious seconds are lost as you try to set up yourself and the choking victim in a position for effective delivery of forceful abdominal thrusts.

Aspiration…when food or an object goes down the wrong way–it goes down the windpipe into the lungs instead of down the esophagus into the stomach. Eating while reclined in bed increases both the risk of choking and of aspirating. Both situations can be LIFE THREATENING!

Obviously, daily out of bed activity is very advantageous, but (and there always seems to be a ‘BUT’) you might be struggling with getting someone out of bed after he/she has agreed to GET OUT OF BED. Here is a quick review of the key points covered in the video followed by links for pressure relief equipment, bed mobility aids, and wheelchair cushions.

TIPS for Getting OUT of bed:

1) Bend the knees! A ball rolls better and easier than a board. Bending both of the knees will make rolling easier.

2) Roll him/her on their side and don’t leave anything behind! Make sure he/she reaches toward the edge of the bed with his/her “free” hand and brings the shoulder close to the surface of the bed.

3) Instruct your loved one to, “Look for, find, and keep his/her eyes on the floor.” Usually, we are afraid of what we can’t see and the unknown. By having your loved one keep his/her eyes on the floor, you are boosting their confidence and calming their subconscious fear of falling because they can “see where they are in relation to the floor.”

4) Block his/her bent knees with your body. Your loved one will automatically keep his/her shoulders on the bed; therefore, you need to control the knees so you have control over the “control panel.” If you block the knees, he/she will not FALL OUT OF BED.

5) Keeping the top shoulder forward will “ACTIVATE” the teeter totter–when the legs/feet lower to the ground, the head will raise up!

Tips for Getting IN Bed:

1) Make sure your loved one/client is sitting near the head of the bed (close to the pillow). If he/she sits too low in the bed, they will have to exert unnecessary energy to scoot up toward the pillow once they lie down.

2) Position him/her like they are “side sitting on a horse.” When he/she begins to lie down, side-sitting on the edge of the bed will “ACTIVATE” the teeter totter–when the head/shoulders lower to the surface of the bed, the legs–especially the top leg–will rise up to the surface of the bed.

3) If he/she needs help moving to the center of the bed, I recommend “PULLING” the control panel (hips) toward you with both of their knees bent. REMEMBER: A ball rolls/moves easier than a board. If the legs are straight, you’re trying to move a board!

Take Advantage of Me and My Experience

When I provide images of related products, I am simply showing you some of the options available to address a particular situation. However, if you have friend/relative give you medical equipment and you have a question about how to use, adjust, or set up the equipment, please leave me a comment below and I will make every effort to answer you within 48 hours. I guarantee you are neither the first nor the last person to take on the responsibility of caring for someone that needs medical equipment and are just not sure what to get, how to set it up, or how to use it.

In the same manner, when equipment is delivered, sometimes the representative takes very little time to explain and demonstrate all the features, uses, and adjustments before leaving you with the equipment. To that end, I say, “There is no such thing as a stupid question especially when it is the safety and comfort of you and your loved one hanging in the balance of falls and injuries in the home.”

I encourage you to browse, locate and ask questions before purchasing any medical equipment for the sake of you and your loved one’s safety and sanity.

Related Products

Pressure Relief & Heel Protectors

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I want to thank you for visiting my site and I hope you leave having learned something to make caregiving easier & safer as well as a desire to return for future updates. Please leave a comment, question, or idea so I can continue to help you with any other daily caregiving issues.

Once again thank you for stopping by and I look forward to seeing you again soon!

Best Regards,

Shawna PT, MPT

Categories: Weekly Tips & Tricks

What Are the Health Benefits of Apple Cider Vinegar, Ice and Coconut Oil?

Shawna May 4, 2016 No Comments

Welcome,

Apple Cider Vinegar, Ice and Coconut Oil are 3 ingredients I use personally and during patient care in the home for several reasons. Sit back and Discover 5 Reasons You Should Take Advantage of the Many Benefits of Ice, How to Use Coconut Oil and The Natural Healing Qualities of Apple Cider Vinegar.

Who said you have to spend a lot of money to look younger, cure skin problems, reduce pain instantly, heal wounds or even improve overall health . Most likely, you already have 3 very inexpensive remedies in your kitchen right now!

BRAGG APPLE CIDER VINEGAR BENEFITS

There are literally hundreds of benefits to using ACV. From curing warts, sore throats, toenail fungus, wounds, and moles to improving the health of your hair. ACV is an inexpensive and very effective MIRACLE solution. These are pictures of one of my patients that treated his foot with ACV and EPSOM salt soaks once a day for about 1 week.

Foot Wound Before ACV Treatment	Foot Wound AFTER ACV Treatment

Have plantar’s warts? No problem. Soak a piece of a cotton ball in ACV, put it over the wart, secure it with a bandaid, and do this until the wart turns black and eventually falls apart. Generally, my daughter has to do this for 5-7 days, but the good news…the wart does not come back, there is no SPREADING or making of additional warts, AND it does not cost me $75-100 for a dermatologist to “Freeze the wart off.” Win, Win, Win in my book.

What about sinus congestion, sore throats, or that “I feel like I am coming down with something?” Yep, I treat it all with a “SHOT” of ACV. I have literally saved hundreds of dollars in trips to the “Doc-In-The-Box” clinics because when my family or I get the first signs of not feeling well, a shot (1-2 Tablespoons) of ACV for about 3 days and Ta Dah…the symptoms go away!

Ok so maybe you want to look younger, have shinier hair, whiter teeth, manage sunspots (dark pigmentation on the skin from the sun), tone the skin’s surface, or get rid of moles. I have done all of these using ACV. Literally, Apple Cider Vinegar has been an ALL NATURAL, CHEAP, and VERY VERSATILE cure for me, my family and patients for YEARS.

Natural Sunspot, Skin Toner Secret: Apply ACV directly on the face at night (keep your eyes closed until the ACV dries and DO NOT rub ACV near the eyes or in the EYES) by soaking a cotton ball in ACV.

Whiter Teeth: Use ACV as a mouth wash (swish/gargle about 2 TBSP ACV) and spit it out- I only do this once a week!

Wart Removal: Use a STERILE straight pin and pierce the mole about 4 times (moles do not have nerve/pain receptors so this should not hurt and you ONLY are penetrating the surface of the mole–DO NOT make it bleed) on the surface. Soak a piece of a cotton ball in ACV and place the cotton ball over the mole. Secure with a bandaid. Repeat every day until the mole disappears. My mole disappeared in 7 days.

Healthier/Shinier Hair: 1 tsp Vegetable Glycerin (I get this at Walmart), 2 TBSP ACV, 2 TBSP Castor Oil (I get this at Walmart), 1 Egg, and 1 TBSP Warm Honey. Mix it all together. Apply directly all over the hair. Wrap hair in Saran Wrap and leave on for 1-2 hours. Wash hair with SHAMPOO only. I do this twice a week for a month.

Go on PINTEREST and search uses of ACV and you will be AMAZED!!! I only mentioned what I have PERSONALLY been successful with using ACV for, but I have never been let down by its healing, cleansing, and inexpensive solutions. I love, love, love ACV, and I know you will too.

If you have any questions about my personal recipes I have used to treat toenail fungus, improve the health of my hair and skin, or you have a personal story to tell me about ACV, PLEASE leave me a comment. I believe knowledge is powerful and experience combined with knowledge can be MIRACULOUS.

ICE, ICE BABY

You have been told all your life, use ICE on that injury! Do you know why you should use ICE versus HEAT on a recent injury?

Without delving really far back into chemistry class, think about what happens when something gets cold versus hot. Cold temperatures SLOW down and SHRINK things. I know when I am cold I want to curl up under a blanket (get as small as I can and cover up as much of my body as I can). Snakes move slower, concrete shrinks and cold syrup pours slower than hot syrup.

In the same manner, when ice is applied to the skin the skin cells get smaller and circulation of fluid (blood, swelling fluids, etc…) slows down, and the blood vessels in the skin/tissue shrink down as well . Consequently, swelling, pain, and bleeding under the skin (bruising) is decreased when ice is applied rather than heat. Heat does the exact opposite–dilates (expands) cells/blood vessels and speeds up circulation–and when applied to a new wound, an already swollen and/or bruised area, it makes the bleeding, swelling, and pain worse.

Need pinpoint pain relief fast? Use an ice massage!

Styrofoam Cup of ICE

Take an ice cube or better yet, freeze water in either a paper or styrofoam cup (Sonic cup work great). If you use a cup with water frozen inside, tear the edge of the cup down (hence the reason for using paper or styrofoam) to expose about 1/2 inch of ice (See Above picture). Place a towel under the area you are going to massage with the ice to catch the melted water. Using either the ice cube or the cup of frozen water, apply the ice in circular movements over the area that is painful, swollen, and/or bruised.

NOTE: the skin will go through the following sensations before it goes numb: feels cold, burns, and then goes numb! Stick with the ice massage until the area goes numb–this is the desired pinpoint pain relief–and the skin will be red.

TIP: When doing a massage with or without ice, always massage the area to promote drainage. In other words, start at the area where the bruise/swelling is the furthest from the heart and massage TOWARD the direction of the heart!

LADIES — Want to decrease fine lines, acne, and/or smooth out your foundation—THAT’S RIGHT USE ICE!!!

Every morning before I apply my makeup I do 2 things. First, I wash my face with a sugar scrub to clean the pores, remove dead skin cells, and even thin out those irritating fine hairs. What do I use for a sugar scrub? Simple, I use my regular liquid body wash and just add 2 Tablespoons of sugar. It’s that simple!

Second, I take 2 ice cubes and rub them all over my face until both are melted. I concentrate on the T-zone area, around my eyes and mouth. Remember, ice “shrinks cells” so by massaging my face with ice BEFORE I put on makeup I make my pores smaller which closes my pores so makeup does not clog up the pores causing acne and my makeup goes on smoother!

WHAT IS THE HEALTH BENEFITS OF COCONUT OIL

Another tool in my arsenal is coconut oil for moisturized skin, healthier hair, and for massaging purposes on my patients when I do swelling control massages.

Coconut oil absorbs into the skin with little to no residue on clothes/linens. It instantly moisturizes the skin and hair better and cheaper than ANYTHING else I have tried (Meaningful Beauty, Avon, Sheer Cover, Beauty Control, Mary Kay). Dry, fragile, cracking, and itchy skin is instantly infused with moisture providing relief and decreasing the risk of additional skin problems associated with scratching. I massage my patients’ skin with coconut oil because it is quickly absorbed into the skin and does not leave an oily residue on the linens. I highly recommend coconut oil for softer, healthier, and moisture-rich skin and hair. Here are my personal recipes:

Hair Care: I apply Coconut Oil all over my hair when it is dry. Then I braid and bun my hair with the oil in it. I sleep in the coconut oil and wash my hair with both shampoo/conditioner the next morning. I do this once a month–usually the 2nd week of the month because I use my ACV recipe as well.

Furthermore, I personally use and my patients have successfully used Coconut Oil to:

1) heal/manage surgical scars after the steri-strips are removed from the surgical incision

2) heal skin abrasions

3) manage bruises

4) resolve eczema, psoriasis, dry/cracking skin

Coconut oil is CHEAP and has worked better & faster on me and my patients compared to medicated ointments and lotions.

Did you know Coconut oil has been featured on the “Dr. Oz” and “The Doctors” to treat Diabetes? Coconut oil is natural and can be used in Diabetic shakes, coffee, and other HEALTHY recipes. I highly recommend PINTEREST.com for recipes, but my husband was PRE-DIABETIC and has successfully controlled his blood sugars with these recipes. You are welcome to try one of my personal recipes below. In the same manner, if you have a recipe or have used coconut oil and would like to share your experience, please leave me a comment.

Pina Colada Shake

1/2 cup Coconut Milk (Unsweetened)
1/2 cup Coconut Water
1 Tablespoon liquid coconut oil
1/2 cup Frozen Pineapple
1/2 scoop Whey Vanilla Protein Powder

1 Teaspoon Green Tea Powder
1/2 Teaspoon Organic Honey
6 cubes of ice

Place all ingredients in a Blender (I use my Ninja Auto IQ Blender)

Mango Maniac Shake

1 cup Almond Milk (Unsweetened)
1 Teaspoon Green Tea Powder
1/2 cup Frozen Mango
1 Tablespoon Coconut Liquid Oil
1/2 of a lime squeezed for juice
1/2 Tablespoon Organic Honey
6 cubes of ice

Place all ingredients in a Blender (I use my Ninja Auto IQ Blender)

Obviously, Apple Cider Vinegar, ICE, and Coconut Oil are 3 FANTASTIC KITCHEN ingredients that I literally use or have used for several years. I love learning natural remedies and would love to hear about some of your experiences or answer any questions about apple cider vinegar, ice and coconut oil. Please leave a comment and share your thoughts or ideas.

Until we connect again, Be Safe and Healthy,

Shawna PT, MPT

Categories: Weekly Tips & Tricks

How To Get Elderly Off the Floor, Elderly Fear of Falling & Balance Strategies

Shawna April 16, 2016 4 Comments

Falls….Fear of Falling….Overcoming Falls in the Elderly

Learn Physical Therapy Techniques for getting elderly off the floor, reasons for elderly falls, and easy home-based balance exercises for the elderly.

There are several reasons for elderly falls. However, the Balance Strategies of the ankle and hip and Elderly fear of falling are two contributing factors that are commonly overlooked! Before we delve into elderly fear of falling and balance strategies, I would like to show you a safe wheelchair floor transfer technique!

Sometimes Falls Just Happen…How to Get Elderly Off the Floor

Ok, so if a loved one falls, is obviously not hurt, and needs to get off the floor–what are your options? If you have a wheelchair AND the armrests can be removed, then you can use a wheelchair transfer technique to lift your loved one off the floor (as seen in the video below). I have also used sturdy chairs like a dining room chair to demonstrate and train the floor transfer technique featured in the video below. REMEMBER: Do NOT move,lift, or transfer anyone from the floor if you suspect or observe an injury as the result of a fall. In the same manner, ask for HELP–even if the person helping you just guides/spots you during the transfer.

Elderly fear of falling, Basiphobia (the fear of falling), is REAL, can be a LIFE CHANGING event, and can steal a person’s QUALITY of LIFE away in the blink of an eye. Senior citizens are more vulnerable to developing a fear of falling–generally following a substantial fall that required hospitalization, surgery, or medical treatment of a significant injury. Typically, the fear of falling does not develop from a single fall. The fear of falling generally develops over time through a cycle of events.

Fear of Falling (1)

BREAKING THE CYCLE

The cycle can be broken at any stage! Focused management of swelling, bruising, pain, and stiffness can minimize inactivity that leads to total body weakness. Strengthening the leg muscles and the 3-balance strategies can promote increased walking with decreased anxiety. Increased walking and activity will decrease the risk of secondary problems such as blood clots, pressure sores, pneumonia, and joint contractures.

Strengthening the leg muscles is not very difficult. One the fastest, easiest and most effective lower leg exercise–besides walking–is the sit to stand! Similar to doing a squat, the sit to stand exercise is easily modified, very versatile, and has the added benefit of strengthening the pelvic floor muscles responsible for bladder control. Here are some tips for progressing and doing different variations of the sit-to-stand exercise:

Height of Sitting Surface	Higher/Elevated	Lower
Variations	Easiest	Hardest
Firmness of Sitting Surface	Very Firm/Does not move	Very Soft/Rocks and moves
Use of hands to push shoulders over the feet	Use both hands	No hands are used/the legs do all the work
Position of the feet	Shoulder-width apart or Stronger leg slightly behind	The weaker leg/foot is slightly behind
Scooting out to the EDGE	Scoot all the way to the front	Stand up without scooting forward
Number of Repetitions	Less than 5	More than 8

Combining different variations from the table above such as standing from a low/soft surface (couch) with one armrest (using one hand) and completing 3 repetitions with different foot positions (Both feet shoulder width apart, the Right foot slightly behind the Left foot, and then the Left foot slightly behind the Right foot) is another way to use the sit to stand exercise to both challenge and strengthen the lower legs.

Balance Strategies of the Ankle and Hip

Have you ever heard of Balance Strategies-the techniques our bodies use to correct loss of balance and prevent falls? There are 3 strategies for correcting different levels of loss of balance. Here is a video explaining the 3 strategies because if you understand how balance is lost, you can relate to the exercises and understand the rationale behind specific exercises used to decrease falls associated with weakness and delayed reaction times.

If you go watch people work out in a gym or fitness facility, you typically observe people strengthening the large muscles of the legs, the abdominals for those washboard abs, and the arms. Rarely you will see people target 1 out of 3 most important areas responsible for balance–the ankles.

When I work with patient’s in the home setting, I always address the ankles and the Ankle Balance Strategy. Below are some general balance-based exercises I have my patients complete.

Balance Exercise Tips

Warm up

Sit to Stand 8 to 10 repetitions
Standing Up do 8 to 10 heel raises
Standing Up do 8 to 10 toe raises
Side Step either along the edge of a couch or a bed

Walking

Walk Forward
Walk Backward
Walk in a Grapevine pattern: cross one foot over the other foot in the front of you, then cross the other foot over behind you!

Sitting Balance (You Need a Balance Ball!)

Bounce Up and Down
Shift Your Weight Side to Side
Shift Your Weight Forward and Backward
Alternate Kicking Your Legs in Front of You
Alternate Marching or Raising Your Knees Up

Ultimately, I hope your loved one does not fall and get hurt, but hopefully, you learned more about how Physical Therapists address strengthening, balance, and transfers to manage the risk of falling.

I want to thank you for visiting my site and I hope you leave with having learned something to make caregiving easier/safer and a desire to return for future updates. Please leave a comment, question, or idea so I can continue to help you with any other daily caregiving issues.

Once again thank you for stopping by and I look forward to seeing you again soon!

Best Regards,

Shawna PT, MPT

Categories: Weekly Tips & Tricks

Medical Recliner Lift Chairs… Overview & Recommendations

Shawna April 7, 2016 8 Comments

What is the Best Power Lift Recliner Chair? Learn The Advantages of Zero Gravity Lift Chairs (Recliners), What to Consider When Buying a Medical Lift Chair, and Safe Sit to Stand Transfer Techniques.

Product Description

Zero Gravity Lift Chair

Medical lift recliners are becoming more and more common as well as popular in the home, nursing home, and assistive living setting. Medical lift chairs are marketed to make standing up easier and safer.

Amenities include:

1) Varied position settings

• such as Trendelenburg (feet are higher than the head- good for managing swelling of the legs)

• zero gravity (reclined position with head slightly elevated, hip and knees slightly bent)

• napping (reclined position with head slightly elevated but legs are straight)

• seated (typical sitting posture with head up and hip/knees bent at 90º)

• lift (adjusts to various heights of elevation for decreased effort during sit to stand transfer)

2. Massage with and without heat

3. Numerous colors and different material (leather, cloth) options

4. Various sizes (petite, wide, tall back, wide seat width, etc…)

Lift recliners require electricity (must be plugged into an outlet) and an operational motor(s)-some chairs lift up to 700 pounds against gravity and some have 2 motors that work independently to adjust the head and the legs. There are 3 categories of lift chairs:

♦ 2-position – has only one motor that simultaneously adjusts the head and footrest (when the head goes down for reclining the footrest simultaneously goes up). The headrest or back of the chair only reclines slightly to approximately 15º. Therefore, when the footrest is up, the head is still elevated–this position is similar to the position of a reclined seat in a car or at a movie theater–you are technically reclined but your head is still elevated.

♦ 3-position – has one motor as well BUT the headrest or back of the chair reclines up to 45º. The head is still slightly elevated but not as high compared to the 2-position lift chair.

♦ Infinity/Zero Gravity – has 2, independently operating motors. One motor operates the head/back of the chair, and the other motor operates the footrests. Infinity chairs are the only medical lift chairs that offer the Trendelenburg and zero-gravity positions.

As a Physical Therapist, I focus and treat patients with the goal of improving overall strength, balance, endurance, and coordination for optimal safety and independence. When I evaluate/treat a patient with a medical lift chair, I determine if he/she has the potential for standing without elevating the height of the recliner. Some patients ultimately and conclusively MUST use the elevation feature of a medical lift chair to transfer due to rigidity/contractures (pronounced stiffness of several joints making the joints not move). However, there is a hidden complication most consumers do not know about or even consider when deciding on a medical lift chair/recliner.

For Every Action, There is a Reaction….

Our bodies respond to the forces (resistance, gravity, nutrition, sleep) we put our bodies through. For example, with increased resistance our bodies respond by building muscle mass and strength. Through sitting around, staying in bed, or inactivity, our bodies become intolerant to activity, weak and fatigued. In the same manner, if you constantly rely on the electricity of a medical lift chair to raise yourself up against gravity and stand, your legs become DEPENDENT on the electrical lift, weak, and eventually standing up from the toilet, wheelchair, surface of the bed, seat of a car–surfaces that DO NOT have electrical lifting options–becomes difficult and/or impossible.

As a Home Health Physical Therapist, I have 3 basic philosophies: 1) You are only going to get good at what you want or need to do SO you SHOULD practice what you want or need to do better, 2) Do not waste precious time on SILLY-LITTLE-EXERCISES (this is a major pet peeve of mine!), and 3) the resistance created by the weight of your body moving against the force of gravity, is the most important strength-building program in the home setting. With these 3 principles in mind, let’s revisit the HIDDEN PROBLEM of the medical lift chair and relate it to my 3 basic concepts.

Like I stated previously, practice what you want and/or need to get better at doing. If standing up from a low chair or chair without armrests is difficult because of leg muscle weakness, then you would benefit from sit-to-stand exercises.

For instance, practice standing up using both hands to push yourself up AGAINST GRAVITY, then stand up using only one hand, and finally end up standing up only using your legs–LOOK MOM NO HANDS!!!! In the case of the medical lift chair, I start my patients standing up from the recliner at the highest level of elevation he/she can safely and successfully can stand up using both his/her hands on the armrest, gradually decrease the degree of elevation until he/she can stand up from the recliner without relying on the medical lift mechanism, and end with standing up either using one hand on the armrest or no-hands on the armrest. I have discovered, if my patients can stand up using only his/her legs (no hands), then he/she can stand up from the toilet, the seat of a car, the wheelchair, and the shower chair with decreased effort, loss of balance, and possible falls!

I can confidently surmise 95% of my patients do not have a problem keeping his/her balance, moving his/her arms and legs, or falling when he/she is SITTING DOWN. On the contrary, 95% to 100% of my patients have a problem with his/her balance, moving his/her arms/legs and/or falling when he/she is STANDING UP. Therefore, as a home-based physical therapist, I do not waste precious time doing sitting exercises or activities if my patients do not need to get any better sitting down moving his/her arms and legs. Instead of sitting exercises, he/she needs to practice standing up from different surfaces as well as safely walking, pushing, pulling, lifting and carrying activities because those activities are what my patients want and/need to get better at doing in the home under the supervision of a SKILLED Physical Therapist.

I DO NOT EVER, and NEVER will have my patients pedal a bike on the floor, do exercises in sitting with a theraband (usually a red, green, or yellow rubber band), or sit down while he/she moves his/her arms and legs with weights. Why? In my experience as a PT in the home, I have NEVER witnessed my patients stand up from different surfaces, walk safer/easier/farther, get up from the floor, or improve his/her standing balance as a result of SITTING DOWN and pedaling a bike for 20 minutes and/or SITTING DOWN and moving his/her arms against the ARTIFICIAL resistance of therabands/weights (in my opinion, these are SILLY-LITTLE-EXERCISES with no functional benefit). Instead of these exercises, I use FUNCTION-FOCUSED exercises to improve the strength, standing balance and walking of my patients.

My Recommendation…Get Functionally Focused

Ultimately, I have nothing against medical lift chairs, BUT it is very important to remember for every action (becoming 100% DEPENDENT on the lift chair for standing up), there is a reaction (increased difficulty standing up from other surfaces). If I were to recommend a medical lift chair, it would be the infinity/zero gravity because it is the only medical lift chair capable of achieving the Trendelenburg position which effectively elevates the lower extremities ABOVE the level of the heart for gravity-assisted lower extremity swelling management.

All medical lift chairs recline, but only the zero-gravity/infinity lift chair offers the Trendelenburg position for improved swelling management. In addition, zero-gravity/infinity chairs offer a wider variety of positions resulting in improved pressure relief options. A large portion of my patients prefers to sleep and spend more than 75% of their day sitting in their recliner for meals, watching television, etc… Frequent position changes reduce pressure on the tailbone (coccyx), shoulder blades, and heels resulting in decreased risk of developing pressure sores (bed sores).

I recommend treated-cloth upholstery over leather for easy cleanup, and decreased sweating, and skin breakdown associated with “sticking to the sitting surface.” Unfortunately, urinary incontinence is very common as well as dropping food and drinks. Having a surface such as scotch-guarded/treated upholstery makes clean up and disinfecting much easier.

I believe in versatility and getting as much bang for my buck; therefore, I recommend the medical lift chair that provides the most versatility/functionality without sacrificing comfort, quality of life, or level of independence. I provided several options with prices from Amazon. NOTE: for approximately the same price, you can purchase a more versatile medical lift chair–more bang for your buck!

♥ For the purpose of full disclosure, I want you to know I am an affiliate partner with Amazon. However, I wanted to provide the below illustrations for you to compare products and prices for each type of recliner. Regardless of where you purchase a medical lift chair, be sure to purchase a chair that meets ALL of your loved one’s needs!

Take Advantage of Me and My Experience

When I provide images of related products, I am simply showing you some of the options available to address a particular situation. However, if you have friend/relative give you medical equipment and you have a question about how to use, adjust, or set up the equipment, leave me a comment because I guarantee you are neither the first nor the last person to take on the responsibility of caring for someone that needs/would benefit from medical equipment but you’re just not sure what to get, how to set it up, or how to use it.

In the same manner, when equipment is delivered, sometimes the representative takes very little time to explain and demonstrate all the features, uses, and adjustments before leaving you with the equipment. To that end, I say, “There is no such thing as a stupid question especially when it is the safety and comfort of you and your loved one hanging in the balance of falls and injuries in the home.”

I encourage you to browse, locate and ask questions before purchasing any medical equipment for the sake of you and your loved one’s safety and sanity.

2-Position Lift Chairs

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3-Position Lift Chairs
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Infinity/Zero Gravity Chairs
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Summary…Go for Versatility…Focus on Function…Practice to Be Better!

I am here to provide my opinion, tips, and tricks to help make caregiving easier and safer. Here’s a video showing some tips and techniques for easier sit to stand transfers. Please feel free to contact me, leave a comment or provide a suggestion. I look forward to connecting with you soon.

Until Your Next Visit, Take Care and Be Safe,

Shawna PT, MPT

Categories: Product Reviews

When Walker Does Not Fit Through The Bathroom Door: A Cheap & Easy Alternative

Shawna April 3, 2016 6 Comments

Closet Rod As A Handrail

WALKER DOES NOT FIT THROUGH BATHROOM DOOR!!!

When nature calls, you can’t put her on hold but the walker, rollator, and wheelchair will not fit through the bathroom door! What can you do? I have just described what most of my patients struggle with when they need to walk into the bathroom, but their walker/rollator will not fit through the narrow bathroom door frame. Most homes, both new and old, have 28″ to 32″ bathroom doorway openings. Consequently, even when the front wheels of the rolling walker are repositioned to be on the inside of the walker, neither a standard rolling walker (walker with 2 front wheels) nor a rollator (walker with 4 wheels, generally a seat with a basket, and front brakes) will fit through a narrow door. To add insult to injury, many homes with narrow doorways also have long, narrow walkways between the tub/shower and the sink with a countertop. Furthermore, the toilet is at the very back of the bathroom (just like the bathroom in the pictures below)!

Most of us have heard the saying, “necessity (desperation) is the root of invention.” Well, when nature calls desperation and necessity become top priority–especially when my patients DESPERATELY want/need to stop using the bedside commode because they are embarrassed by the appearance, odor, and decreased modesty/privacy associated with using a bedside commode–but narrow doorways put using the bathroom for nature’s call on HOLD!

THINKING OUTSIDE OF THE BOX OR THE BATHROOM = CHEAP SOLUTION!

The pictures below illustrate how I solved 2 problems with one system–aka killing two birds with one stone!!

PROBLEM 1: the bathroom door opening and walkway between the tub and countertop are too narrow for a walker/rollator and the toilet is at the end of the bathroom.

PROBLEM 2: no grab bar or handrail on the RIGHT side (my patient is Right-Hand Dominant) when sitting and needing to stand up from the tub/shower bench.

Materials needed: Closet rod wall mount brackets and 1- Metal pole (Home Depot cut the pole to fit the opening of the tub)

Total Cost: $15.23

SOLUTION 1: As a bar to walk to the toilet	SOLUTION 2: As a handrail to stand up from shower chair/bench

Use the bar and the counter top like parallel bars to walk to the toilet	Easily lift out of the way to get in the tub

Lean the bar on the wall to get it out of the way	Use the bar to stand up

Close up picture of open end bracket mount	Close up picture of closed end bracket

Using the wall mounts and a closet hanging rod was a cheap but very effective solution to my patient’s problems. In addition, my patient is able to prevent water from “spraying” outside of the tub because she drapes the shower curtain over the closet rod and the bottom of the shower curtain stays inside the tub!

I want to thank you for visiting my site and I hope you leave with the following: 1) having learned something to make caregiving easier/safer, 2) a desire to return for future updates, and 3) having left a comment, question or idea so I can continue to help you with any daily caregiving issues.

Once again thank you for stopping by and I look forward to seeing you again soon!

Best Regards,

Shawna PT, MPT

Categories: Weekly Tips & Tricks

Archives

General PT Home Exercise Program (Balance, Strengthening & Coordination)

Welcome,

INTRODUCTION

This is a video of an actual Physical Therapy home therapy treatment. Please, DO NOT attempt this or any new home exercise program without seeking the advice/supervision of a medical professional first!

RATIONAL BEHIND MY TREATMENT METHODS

As an experienced Home Health Physical Therapist, I have several beliefs/treatment practices (some of these beliefs were mentioned in the video) to address and improve my patient’s level of independence, safety, and quality of life in the home setting.

Belief #1: You are only going to get good at what you practice, so you need to PRACTICE what you want or need to get better at while you have the skilled therapist available to assist with problem-solving and fall risk management.

If you are safe and functional in sitting, but lose your balance, get really tired, or stagger around during standing and walking activities, THEN therapy needs to be 90% completed in STANDING and not sitting down peddling a floor bike, kicking your legs, etc….

Belief #2: Everything changes once you are home!

If you were in therapy at an inpatient rehab facility and discharged home, THEN you obviously met your goals and successfully completed the initial stages of rehabilitation appropriate for either going home or continuing rehab in an outpatient rehab setting.

Belief #3: During therapy, especially in the home, there needs to be a goal (FUNCTION-al reason for doing an exercise) behind EVERY exercise/intervention.

Remember: These are my OPINIONS and I treat home therapy differently because I believe rehab in the home IS different from rehabilitation in the hospital or inpatient facility.

If you have any questions or would like to share your own experience with Physical Therapy, please leave a comment below. I hope this video and post were helpful. I am available for any questions, suggestions or comments because I am dedicated to making care in the home easier and safer!

Until Next Time,

Be Safe!

Shawna, PT, MPT

Total Hip Replacement Rehab & Recovery Guide

General Facts & Tips

Recommended Home Medical Equipment

**The Bed Side Commode is very VERSATILE. Use it over the existing bathroom toilet by removing the bucket and/or in the shower as a shower chair (clean the BSC while showering your loved one).

Exercises Before and Following a Total Hip Replacement

Lying Down Exercises

Sitting Exercises

Standing Exercises Both Legs

Standing Exercises For the Surgical Leg Only

Walk, Walk, Walk–The Most Important Exercise

Hip Precaution Overview

Every caregiver of a loved one, patient, and client should know the total hip precautions set forth and prescribed by orthopedic surgeons following a THR. Below is a table of pictures to help describe hip precautions after hip replacement.

Hip Precaution DO’s

Hip Precaution DO NOT’s

Related Tips and Helpful Information

Now let’s take the precautions a step further…

Until Next Time Be Safe and Stay Health 🙂

Shawna Watts, PT, MPT

What D.M.E Does Medicare Cover In the Home?

IF MEDICARE pays, PRIVATE INSURANCE generally will pay as well!!

Is it durable?

Will it be used in the home?

Is it required to meet a medical need?

Is it only useful and needed for someone with a medical – based problem/illness?

Will it last a minimum of 3 years before needing to be replaced?

Okay, now you have an idea of the criteria for which MEDICARE and PRIVATE INSURANCE use for covering and providing home medical equipment, and here is a general list provided by Medicare.gov to help you even further:

If you are not familiar with the use, safety, and types of sliding boards, I recommend visiting my post on Medical Transfer Boards (aka Sliding Boards).

Where can you find or get assistance for medical equipment not provided by Medicare?

I encourage my caregivers to search Craigslist, research “aging in your area” or Community-Based Assistance Programs, visit local Goodwill stores, or seek advice from family and friends–especially therapists, nurses, engineers/carpenters and adult protective services.

If you have a specific question or need medical equipment advice, please feel free to contact me.

I am honored to have you visit my site, and I will continue to provide tips/tricks in an effort to make daily care of a loved one easier and safer.

Sincerely,

Shawna PT, MPT

Exercise Balls: The Benefits Using an Exercise Ball

Exercise Ball (aka Balance Ball, Stability Ball, Swiss Ball)

For additional information about Exercise Ball Benefits, Please continue to read.

Benefits

Improved posture

Sitting exercises on a flat surface (chair, bed, gym/rehab table) do NOT challenge posture to improve postural control (keeping the shoulders over the hips when the legs are moving).

QUESTION: Is it possible to slump/slouch down sitting on a chair/bed and still be able to raise a knee up?

Sitting on a flat, firm surface does not challenge or improve posture. So why worry about poor posture in your loved one? If sitting posture is bad, standing posture will be worse and walking is both more DIFFICULT and DANGEROUS. Furthermore, breathing is more difficult.

Improved Balance

Now let’s compare balance sitting on a flat surface (bed, chair) to sitting on an exercise ball.

QUESTION: What is providing the balance/stability in each situation?

Improved Strength

WARNING: THE FOLLOWING STATEMENTS ARE MY OPINIONS BASED ON MY EXPERIENCES!!!

When compared to sitting on a flat, firm, static (immobile) surface such as a chair or bed, leg strength generally does not improve–especially in the muscles required for maintaining balance, postural alignment, coordination and endurance for standing up, walking, transferring, and bed mobility.

Improved Coordination

Decreased Effort/Reps without Sacrificing Results

Here are products and links to purchase your own exercise ball!

RELATED PRODUCTS

General Exercises Appropriate for Several Disorders & Deficits

Other Uses for an Exercise Ball

Swelling Control – I place the ball under the ankles to elevate the feet above the level of the heart for swelling control. I can place the ball on the footrest of a recliner, on the bed, or even on the couch for effective swelling management.

Pressure Relief – If my patients have a pressure sore (decubitus ulcer) on the heel, I can relieve the pressure and manage any swelling due to the curve of the ball.

WARNING: If there are children present in the home, the ball will most likely be confiscated for their fun and entertainment–this is a common occurrence when I am treating a patient, using the ball, and children are in the home.

If you have an exercise ball or want to share your story, I would love to hear from you! If you have any questions, please leave me a comment below and I will get back to you withing 48 hours.

I hope you enjoyed and learned something new, and I look forward to hearing from you!

Best Regards,

Shawna PT, MPT

Mobility Aids For The Disabled…What You Need To Know About Walkers & Canes

Welcome,