It has been common knowledge for about three decades that children should not be given aspirin because it can lead to the development of Reye’s syndrome. Around the time this discovery was made doctors and parents began giving infants and children acetaminophen to reduce fever instead. However, about a decade later some doctors began to think that the increase in childhood asthma might be linked to the increased use of acetaminophen. A 1998 paper indicated the link and recommended further testing in animals and studies in other countries where childhood asthma was increasing.

Since the publication of that paper almost two dozen additional studies have been completed. In one of the most recently published articles on the topic, Dr. McBride of Akron Children’s Hospital in Ohio, recommends that children and infants who have asthma as well as those who are at high risk for developing the disease avoid acetaminophen completely. This recommendation was based on an abundance of evidence but the author still recommends further testing to determine if the medication may be used safely. There is even some evidence that a child’s chance of developing asthma increases if the mother takes acetaminophen while pregnant.

Other physicians feel that advising against the use of acetaminophen altogether is a bit rash simply because there are risks associated with all medications, and this risk has not been proven. Instead, they recommend using all pain relievers, such as acetaminophen and ibuprofen, more sparingly. By utilizing these medications only for high fevers and severe pain rather than teething and immunizations, the risk could be limited for all children.

The question for health professionals such as doctors, nurses, and even pharmacists is what one should tell patients. The general population does not have the time or inclination to read obscure research studies published in medical journals. Therefore, most parents will not be aware that there is even the potential for their children to be harmed if they use acetaminophen. Is it your job to educate your patient on every potential threat they face from taking a certain medication? Pharmacies include the warnings required by the FDA when they dispense medication, but suspected complications are not listed.

As a professional, you already have the information. Think about the problem from the point of view of a parent. Would you want to be told if there was a small chance? Most parents probably would. One option is to create a resource list for parents to let them research the information for themselves if they are concerned.

Will you be telling parents about this potential risk or are you going to wait for more reliable proof that a threat exists?

Acetaminophen Linked to Increased Childhood Asthma is a post from: Sunbelt Staffing

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Congress was in the news quite a bit in December because of the many extensions that were set to expire the first of January if they were not extended. The therapy cap provision was especially concerning for those in speech, physical, and occupational therapy positions. Fortunately, it has been extended until February. However, it could still be eliminated unless Congress makes a more permanent decision. Had the legislation not been extended there would have been a 27.4% reduction in the fee schedule and exceptions for the early $1,880 therapy cap would have been removed. Just how important is it that these measures not be removed?

Giving Needed Care

There are two considerations to the therapy cap issue in regards to patients. First, is the fee reduction for providers. If Medicare reduces the amount providers will be paid, many will simply stop accepting Medicare patients. In some areas, it may be become impossible to find services locally and would make it necessary for patients to travel considerable distances to find the care they need. It may also mean they would have to begin services with a new provider even if they have developed a relationship with their current therapist.

The second problem is the amount of services a patient can receive each year. While there is currently a cap, it can be exceeded for special circumstances. Some patients may need years of therapy if they have had a severe accident or suffered a stroke. If there is a firm limit, there would be no way for them to receive the care they desperately need with their Medicare benefits. If they have no other insurance option many of these patients will simply not get the care they need at all. For a person who is trying to learn to walk or talk again this is unthinkable.

Livable Wage

While it is obviously important that the patients who need specific care are given the quality and quantity of treatments they need and deserve, it is also important that the professionals are able to make a living giving the care. In addition to paying the therapist, other staff must also be paid such as clerks and therapy assistants. If the Medicare fees are cut and the therapy offices decide to continue seeing Medicare patients, they may have to make staffing cuts because of the fee reductions. In a time where jobs are difficult to obtain, this could be a disaster for newer therapist and the staff that supports them.

Have you contacted your Congressional representatives to let them know how you feel about these possible cuts? While the cuts have been delayed, they have not been prevented. The American Speech Language Hearing Association maintains a database of representatives if you want to talk to your representative.

Medicare Therapy Caps is a post from: Sunbelt Staffing

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Physical therapists are heroes and villains in the story of recovery. At first, they are the villains of the story because they make the patient hurt more. The patient has dutifully been “taking it easy” for a bit after their surgery or accident and they have begun to feel a smidge better. Then they are suddenly being asked to bend, stretch, and move in ways that make the pain come back tenfold. This is, of course, a necessary component in healing and regaining full motion – but it still hurts. Usually it isn’t too terribly hard to motivate a patient to come back for their therapy appointments during this initial stage because it is all too obvious that they desperately need help to get back to their pre-injury state. However, motivating the patient to complete their exercises at home can be quite the challenge. The task of motivation becomes even more challenging once the initial phase of therapy is over and the time for maintenance begins.

At Home

While the patient is in your office, you can use a mixture of the good cop/bad cop routine. But what about once they walk out of your office and need to do their exercises at home to get ready for the next appointment? Many patients think they don’t really need to complete all of those exercises, or that you won’t notice if they don’t, or that they don’t have enough time, or any other number of reasons that prevent them from doing what they need to do at home to get better. How do you make sure they follow through?

First, make it as easy to do as possible. Give them cues that will jog their memory and remind them it is time to exercise. Suggest they do their exercises with part of their daily routine such as brushing their teeth, taking a shower, eating a meal, or even going to the bathroom. If they do several small exercises at each of these daily activities, they will have worked in their physical therapy exercises without having to “find time” each day to do them.

Next, make sure they know how to do each of their home exercises completely before letting them leave the first day. If you wait until the end of their session to hand them a flyer and quickly review it, they may say they understand even if they are mostly unclear. Consider yourself a teacher and the patient your student. How many students really ask questions if they don’t understand and want to get out of the classroom? By showing them their “homework” at the beginning of the session and walking them through each exercise, they are more likely to remember the correct method and follow through during the week.

Maintenance

By the end of your therapy relationship, you will know that your patient understands the importance of his or her therapy and how to complete the exercises you have prescribed. What you will not know is if the patient has the motivation to do so. Have you ever heard someone say a picture is worth a thousand words? Find a picture, video, or patient with a similar injury who did not complete their maintenance to show or introduce to your patients. It will likely take years of practice to accumulate samples for a variety of injuries, but you can enlist the help of fellow therapists and doctors to create a database. Show your patients just how badly their recovery can go if they don’t follow through. It is much easier to believe what you are shown than what you are told.

How do you motivate your physical therapy patients?

Motivating Physical Therapy Patients is a post from: Sunbelt Staffing

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Seasonal affective disorder is aptly referred to as SAD, because the people suffering from the disorder often diagnose themselves as being simply sad at first. While there are variations of seasonal affective disorder that affect people during the spring and summer, most cases begin sometime in the fall and last throughout the winter with symptoms finally subsiding in the spring.

Symptoms

Symptoms of fall and winter seasonal affective disorder include:

• Anxiety
• Changes in appetite, particularly cravings for carbohydrates
• Decrease of energy
• Depression
• Difficulty focusing
• Excessive sleeping
• Feelings of hopelessness
• Heavy feeling of the legs or arms
• Loss of enthusiasm in previously enjoyable activities
• Weight increase
• Withdrawal

Causes

No specific cause has been discovered for seasonal affective disorder, however, as with other mental health issues it is likely that age, genetics, and chemical makeup all play a part. There are some indications that melatonin and serotonin levels may play a role as well as the individual’s circadian rhythm.

Tests

Seasonal affective disorder can be quite difficult to diagnose as it closely mimics other forms of depression. While there is no medical test for SAD, tests and exams can be used to rule out other causes for the depression. Certain criteria do have to be met for a diagnosis of seasonal affective disorder to be made which include:

• Symptoms are followed by periods that are symptom free.
• Symptoms cannot be explained by other means.
• Symptoms occur during the same season for a minimum of two consecutive years.

Treatments

Light therapy, medications, and psychotherapy are the most common treatments. Light therapy is usually the first treatment, because there are virtually no side effects. Some antidepressants have been used to successfully treat seasonal affective disorder. Psychotherapy can help make people more aware of what is happening to them and help them learn to deal with the symptoms, although it is unlikely to actually alleviate the symptoms. In extreme cases, people have been known to move from areas that experience drastic changes in the winter to areas that have much milder winters. Although it is possible for people to suffer with seasonal affective disorder in sunnier areas, such as Florida, it is much less common.

How to Help

Many people will suffer in silence thinking they simply have the holiday blues or that they are having a few bad weeks. Be sure to advertise the symptoms associated with the disorder to bring awareness to a larger group of people. Many people may be relieved to know that there is something wrong with them that can be treated and that other people feel the same way.

Have you treated a patient with seasonal affective disorder? What treatments have you found to be most effective?

Seasonal Affective Disorder is a post from: Sunbelt Staffing

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A stability ball is one of the few physical therapy tools that look more like a game than a device of torture, at least from the perspective of the patient. The balls come in a variety of colors and sizes and are likely to remind patients of toys from childhood. They can be a great introduction to physical therapy because they are less intimidating and the exercises can seem more fun. This is true for both adults and children, both can benefit from the use of a stability ball. As any health practitioner knows, success largely depends on attitude. Use the stability ball to improve your patient’s attitude and watch the results follow.

Therapy for Adults

It can be difficult for some patients to effectively strengthen their abdominal or back muscles due to injury. A stability ball can target both muscle groups with minimal impact. However, at first it is necessary that the individual be closely supervised until he or she becomes accustomed to the stability ball to prevent additional injury.

Stretching is another key benefit of a stability ball. Using the ball makes it much easier for many people to move into and out of stretching positions. Tightness can be a significant factor in the recovery of many patients and making the stretches easier to initiate can improve long term success.

Therapy for Children

Children love to play with stability balls. They come in a wide range of sizes, so there are options for pediatric therapy. In addition to the regular exercises that are also used with adults, the smaller balls can be used for coordination activities during occupational therapy, such as catching or kicking the ball while it is moving. Introducing children to physical or occupational therapy with what looks like a toy can be a great way to ease them into a new routine that may otherwise be intimidating.

Outside of Therapy

A balance ball can also be used as an office chair, either alone or with a chair frame. Sitting on the ball regularly will help build core and back strength and help improve posture which may help alleviate some back pain. If the ball is used in a frame it can easily be removed to be used with a regular exercise routine at home or in the office.

Unlike many other therapy aids, these are very easy to travel with and are relatively inexpensive. This means the patient can purchase a ball for home use and will be more inclined to take it with them if they travel.

How have your patients responded to their stability ball routines? Do they seem to enjoy them more and be open to the idea of using them outside of the office?

Stability Ball Benefits is a post from: Sunbelt Staffing

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While it may not be true that suicide increases around the holiday season, it is true that many people do experience what has become known as holiday blues. This may be because people are more aware of their feelings at this time of the year or because their expectations of happiness are higher during the holidays and so they feel like they are sadder than they “should” be. Regardless, the triggers for these feelings seem to be similar regardless of the patient and many of the non-medical treatment options are viable for most patients as well. Of course it is important to remember that not all patients who feel depressed will have these “holiday blues” and may be in need of more intense treatment.

Causes

Some of the most common triggers for an episode of holiday blues include the pressure to feel happy, memories of past holidays, loneliness, and financial difficulties.

Pressure – the pressure to feel merry and bright dramatically increases during the holidays. Everyone is speaking of good will and those who are naturally more somber or who do not enjoy the holidays may feel worse during the season simply because more people are telling them the way they feel is wrong.

Memories – Memories of both good and bad holiday experiences can lead to the holiday blues. Individuals may feel that their good experiences in the past cannot or will not be replicated this season leading to a feeling of dissatisfaction. Memories of bad holidays can lead to trepidation of upcoming festivities.

Loneliness – Many people must spend the holiday season alone for any number of reasons such as relocation, military service, or a death of a loved one. For a season that is supposed to be devoted to family and friends this can be especially difficult.

Finances – Financial problems have become more common over the past few years. People who are accustomed to spending freely during the holiday season may feel the pressure to do so again this year, even if they know they cannot afford it. Whether they decide to spend on credit or to trim their budget, the necessity of doing either can lead to feelings of inadequacy and sadness.

Support

While there are several things the patient can do on their own to overcome the holiday blues, what they really need is an enhanced overall support structure during the holiday season. You may want to consider increasing therapy sessions prior to and immediately following the holiday. Another option is to include group therapy sessions for patients who seem receptive to the idea.

Do you see patients suffering from the holiday blues? What do you do to help them cope with the added stress during the holiday season? What treatments have been most effective?

Holiday Blues is a post from: Sunbelt Staffing

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With the leaves blow from the trees and snow flurries begin to flutter, consider changing up patient routines to prepare them for the new environment they are about to confront. People who have suffered an accident or injury may have been seeing you for the past several months, they may even be showing progress, but the change in the weather will likely have a few surprises in store for them. If they have never used their crutch, cane, or walker on the ice, how will they know how to do so properly? Right now, they still have the safety of familiar weather conditions, but in a few weeks, they will be facing snow and ice for possibly the very first time since they began therapy. What are you going to do to help them?

Knowledge

Sometimes just being aware there could be a problem is more than half the fight. It is quite possible your patient has not even thought about the upcoming winter season and what it could mean for their mobility. If you point out to them the possible challenges they will be facing, they still have time to prepare themselves mentally and physically.

Preparation

Just how should they prepare themselves physically? If they are accustomed to being able to shovel snow but are unable to do so in their current condition, now would be a good time to enlist friends or family for assistance. Have them schedule someone to come help them when it snows so they won’t be stuck without any help at the last minute. Review their normal winter routine and ask them if there is anything they think they will have trouble with. Brainstorm solutions for these problems and help them follow through with their plan of action.

Action

Think of ways you can change your patient’s physical therapy routine to help prepare them for the slippery conditions they may encounter. Additional flexibility and stability exercises may make them surer of their footing. Strength training for core muscles may help them recover if they do begin to slip. Obviously the exact changes will depend on the problems and abilities of individual patients, but take time to consider what can be done for each patient.

 Of course not all therapists and patients live in areas where snow and ice are a problem. What about those living in southern Florida or Texas where the temperatures stay moderate for most of the year? Sit

Back and enjoy the cooler temperatures! For those of you in snowier regions, what will you do to prepare your patients?

Physical Therapy in the Fall is a post from: Sunbelt Staffing

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CAS, or childhood apraxia of speech, may also be known as verbal apraxia. This speech disorder is not fully understood, however, it causes the patient to be unable to fully perform the movements required to create speech. While it may be called by a variety of names, the important connection is the child has difficulty planning and following through with the actions required to speak.

A school speech therapist or speech pathologist may be called in to consult with the child and school to develop an Individual Education Plan, or IEP, to address the speech disorder.

Symptoms

 The signs for a very young child are different than those for an older child. However, the signs a school employed speech pathologist should look for in a school age child include:

• Inconsistent errors in creating a sound that are not due to the child’s age.
• The child understands language far better than he or she can speak.
• The child has difficulty repeating words, but words that are repeated are clearer than those created spontaneously.
• Child may visibly struggle when trying to form sounds or words.
• The child may have more difficulty with longer phrases or words than with those that are shorter.
• Speech may be more difficult when the child is anxious or upset.
• The child may be difficult to understand for anyone not familiar with his or her speech patterns.
• Words may be delivered in a monotonous or choppy rhythm and the wrong syllables may be stressed on individual words.

 Treatment

 Treatment for children with apraxia of speech is much more intense than other forms of speech therapy. Typically, a school speech pathologist will see a student once a week. Children with apraxia of speech need more frequent sessions, usually a minimum of three sessions per week. At first, the child will require individual sessions, and as improvement begins, he or she may be able to receive fewer sessions per week or be placed in group therapy for some sessions.

 In treatment, the focus is on improving the child’s ability to plan and sequence sounds as well as their ability to control the muscles needed for the production of speech. Specific exercises to strengthen these muscles are not necessary as the disorder is a result of a lack of coordination not strength. Multi-sensory feedback may be utilized to help children receive the feedback they need when attempting speech. For severe cases, the child may need to be taught sign language in order to more effectively communicate until speech improves.

 Finally, family involvement will be critical to the success of the student. They will need to be given specific instructions on how to help the child practice at home.

 How do you get the family involved with the treatment plan?

Apraxia of Speech is a post from: Sunbelt Staffing

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Vestibular swings are therapeutic devices designed to address a variety of vestibular disorders. VRT, or vestibular rehabilitation therapy, is the first line of treatment for most patients with this type of condition. The exercises designed by the therapist help to retrain the brain of the patient to compensate for their condition. Often VRT will make it possible for patients to lead a normal life without requiring surgery. This therapy is usually provided by a physical or occupational therapist.

 Vestibular Disorders

The vestibular system controls the processing of sensory information, such as controlling balance. If the area is affected through injury, disease, a genetic condition, or environmental conditions a vestibular disorder may occur. The most common problems cited by patients suffering from a vestibular disorder are vertigo, imbalance, and dizziness. Specific conditions include Meniere’s disease, acoustic neuroma, ototoxicity, cholesteatoma, and autoimmune inner ear disease. According to some studies, about 35% of American adults over the age of 40 will experience a vestibular dysfunction. These conditions are often overlooked and underdiagnosed.

Types of Swings

Vestibular swings can be an important component of VRT. There are a variety of swings that can be utilized for this type of treatment. Each gives a different sensory experience. They may be used together or separately depending on the condition being treated. Indoor swings include the disc swing, spinning top swing, string swing, and the around about swing. Autism patients may also benefit from the sensory input these devices provide.

Children especially seem to enjoy this type of therapy because it seems more like playing than working. Adults may be more resistant to the initial increased feelings of vertigo and dizziness the swings may cause; however, repeated treatments tend to resolve these issues.

Grants

Vestibular swings can be prohibitively expensive for a practice that only treats a small number of vestibular disorders each year. With such a small percentage of patients using the devices it can be difficult to find the funding to invest in one of these therapy options. One way to afford specialty devices is through grant funding. If your therapy establishment is connected to a hospital, inquire with the hospital’s grant writer. If you work at a private practice consider government, state, or foundation grants.

To learn more about vestibular disorders, visit the Vestibular Disorders Association. Have you had experience with a patient suffering from a vestibular disorder? Have you seen improvement with balance exercises or vestibular swings? What is your favorite type of swing?

Using Vestibular Swings for Your Patients is a post from: Sunbelt Staffing

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September is National Alcohol and Drug Addiction Recovery Month. Alcoholics and drug addicts who are no long are actively using or drinking will often tell people they are recovering rather than reformed or cured. This is because addiction is a lifelong condition. Patients who are recovering alcoholics or drug addicts work very hard to refrain from going back to the destructive path they were once on. It is important that people become aware of the difficulties associated with using drugs or consuming excessive amounts of alcohol, to know that there are options available to help with quitting, and that there are support programs to help them stay sober.

Prevention

Prevention must start in early childhood. Schools can use this month to teach students about the dangers of drinking and using drugs. Numerous community outreach programs are willing to come into schools to give presentations. Mothers Against Drunk Driving and Students Against Destructive Decisions are two of the most well-known. Therapists, drug counselors, or sponsors from Alcoholics Anonymous or Narcotics Anonymous may also be willing to present to individual classes or school assemblies. To promote conversation and understanding consider sponsoring contests or competitions among the students to raise awareness of the problems associated with drug and alcohol abuse.

Cessation

Any medical profession regularly in contact with the general population is in the perfect position to discuss cessation methods with their clients. Therapists and nurses can place posters showing the effects of smoking, drug use, or alcohol abuse and provide information to treatment centers. Pharmacies can provide brochures or display posters discussing the dangers of abusing prescription medications and the warning signs that dependency may be evolving.

Recovery

Offer to let support groups place literature in your office or possibly hold meetings after hours in your facility. Physical therapist can offer to teach relaxation techniques to members who need alternative ways to deal with stressful situations. Ask groups such as Alcoholics Anonymous and Narcotics Anonymous what you can do to help reach more of your patients who may be suffering in silence.

Coworkers  

Health care professionals have a high instance of substance abuse because of the easy availability at work and high levels of stress associated with having a career in caring for others. If you or someone you work with has developed a dependency on drugs or alcohol, it is important to seek medical assistance. Your coworkers and others in the medical field understand the temptations and will be able to support you, or those you work with. Alcohol and drug addiction happen across income, social, and ethnic groups. Recovery is just as possible and important for healthcare professionals as it is for the patients they serve.

How do you help your patients with their recovery? Do you think drug prevention strategies are important in schools? Do you think it is more difficult for educators and healthcare professionals to seek and receive treatment?

National Alcohol and Drug Addiction Recovery Month is a post from: Sunbelt Staffing

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