The Baker Beacon

Posts Tagged ‘physical therapy’

Staying Steady

Posted in The Baker Beacon

Staying Steady: Balance Problems and Treatment

It’s estimated that at any given moment, 6.2 million American adults struggle with a chronic problem of balance, dizziness, or both. And, the problem only increases with age.

Effective balance involved comfortably controlling and maintaining your body’s position when walking, climbing stairs, standing, or even sitting.

This grand balancing act is no easy process! It requires your muscles to work smoothly with several sensory systems. Any interruption or issue in any of these systems can lead to dizziness, loss of balance, and falls.

  • Vision: Eyes send impulses to the brain that provide visual cues identifying how a person is oriented relative to other objects.
  • Somatic System: With any movement of the legs, arms, and other body parts, sensory receptors respond by sending impulses to the brain. These impulses help our brain determine where our body is in space.
  • Auditory System: Nerve signals from your inner ear are sent to the brain with more information about your body’s motion, equilibrium, and spatial orientation.

As we grow older, these systems also weaken. Our eyesight fades and our muscles ability to sense surroundings declines. So, balance problems can come from a variety of physical and neurological issues.

The good news, however, is that balance problems aren’t something you just have to live with.

Depending on the cause, your doctor can prescribe a variety of treatments including diet and lifestyle changes, balances retraining exercises, medication, or even cognitive behavioral therapy.

At Baker Rehab Group, we provide balance treatment through physical therapy.

Under the guidance of our trained professionals, patients participate in exercises that involve specific movements of the head and body. These exercises teach the brain and body how to compensate for any weaknesses helping reduce the effects of balance problems. Contact Baker Rehab Group’s Brain & Balance Center to learn more about our treatment options.

Stroke Recovery: How Therapy Can Help

Posted in The Baker Beacon

Nearly 800,000 Americans suffer from a stroke each year.[1]

That leaves many survivors with the tough task of relearning. They have to start parts of their life over as they work on walking, talking, and even processing and remembering as they once did. And, it leaves many family members and loved ones with the challenge of taking this journey with them.

The good news, though, is that there are many caring and capable people willing to help. Physical, occupational, and speech therapists all play an important role in the relearning process.

The damage suffered from a stroke can vary from patient to patient. Each stroke looks different based on how much damage occurred and what part of the brain was affected.[2] Stroke survivors face a variety of problems including pain, numbness, or muscle weakness. These can lead to difficulties with sense of touch and difficulties with swallowing and eating. Problems with language and thinking are very common as well.

Therapy helps patients regain their independence and their ability to take care of themselves. Here are a few ways in which the individual therapies can help recovery after a stroke.

Speech Therapy

Stroke survivors may develop aphasia. They’ll have difficulty speaking, finding words, and understanding what others are saying. Speech therapists use repetition and reading and writing exercises to help survivors learn how to communicate.[3]

Physical Therapy

Physical therapists help with any movement problems. They use exercises and activities to help survivors regain strength, coordination, balance, and control.[4]

Occupational Therapy

Occupational therapists help survivors relearn self-care skills. They focus on daily activities such as bathing, getting dresses, eating and cooking.

The biggest key to success: don’t give up hope! Recovery from stroke is often a long process. Some skills come back quickly and others take more hard work and more time. But, improvements and growth can come even years into the recovery process.







Celebrating Physical Therapy

Posted in The Baker Beacon

October is National Physical Therapy month and we want to celebrate!

Each year, the American Physical Therapy Association works to educate the public about the benefits of physical therapy and this year’s theme is on pain management. Over 25 million Americans suffer from chronic pain and for many, physical therapy can be a safer alternative for managing long term pain than prescription drugs. [1]

Chronic pain includes any and all aches, pains and discomfort that are persistent for three or more months. Doctors and patients alike are discovering the benefits of physical therapy programs as an alternative to prescription drugs like Vicodin and OxyContin. While they can provide relief, they are not a good long-term solution. They are highly addictive, are often accompanied with harmful side-effects and mask pain rather than addressing the underlying issue.

Physical therapists use a variety of strength and motion exercises and conditioning to help manage and alleviate chronic pain.

Physical Therapy gets to the Root of the Issue.

Physical therapists are trained to identify the cause of the pain rather than to just treat the pain. Once the cause is discovered, they use appropriate postural education, ergonomics, body awareness training, flexibility, strength and cardiovascular conditioning to address the issue.[2]

Physical Therapy Creates a Personalized Plan of Care.

Physical therapists work with each individual patient to develop a program specific to their pain. They help set realistic goals and expectations that both the therapist and the patient work to meet over the period of treatment.

So, celebrate physical therapy month with us and help get the word out! If you suffer from chronic pain, talk to your doctor about physical therapy.




Spotlight on Excellence: Vennela Pulikanti, PT

Posted in Spotlight on Excellence, The Baker Beacon

If you are a resident, staff member, or family member of a resident at Sunrise Assisted Living in Montgomery Village, Maryland, then you already know what a great person she is.

For those of you who are not familiar with Vennela Pulikanti, allow us to enlighten you.

Vennela has been a physical therapist for over ten years, having a diverse background in pediatrics, sports medicine, acute care, skilled nursing, and geriatrics. She has specialized training in manual therapy.

But she is much more than a great clinician. As this month’s Spotlight on Excellence recipient, Vennela has earned recognition for many of the things she does above and beyond her role as physical therapist.

One of Vennela’s coworkers, Connie Mulloy, say it best: “She is extraordinary with the residents, but she’s also a remarkable asset at Sunrise Montgomery Village. She does so much more than just see clients. She come in on her days off just to see a resident. She helps in the building with anything and everything asked. I have even seen her helping clear tables at lunch while waiting for a resident. The staff love her. She’ll check out a wheelchair or walk a resident who asks for help. She does all of this cheerfully and sincerely.”

Vennela has a busy family life too. She has a husband named Kalyan, a daughter Shriya, and a son named Pranav.

“I enjoy being a home health therapist. As physical therapists, we make a very important connection between clients and community. Having a personal one on one time with client is very important for me. I also like flexibility that home health offers in terms of scheduling.”

Congratulations Vennela! You are a wonderful asset to Baker Rehab Group and you epitomize our Committed to Excellence motto. Thank you for all you do and for setting such a great example.

New Clinical Director of Operations

Posted in The Baker Beacon

Perhaps you’ve noticed that Baker Rehab is growing by leaps and bounds. In spite of a few farewells in 2013, we have continued to expand our staff and our geographic footprint in three states.

Because we are a small company, we depend on everybody pitching in to make it all work. We are especially grateful to Lisa, Pat, and Jess for continuously adjusting to the changes in our organization and holding down the fort at times when it seems like it might just blow away.

In 2013, we reached a milestone, a crucial crossroads, where it became necessary to have someone help us in the proper care and feeding of our most important assets, our therapists.

We are pleased to announce that Tracey Cannon, PT is our new Clinical Director of Operations.

Tracey has been with us for over ten years, nearly since the inception of our company. She has become fluent in five home health agency software languages, a master of OASIS documentation, and the steady hand who keeps our internal processes running smoothly and efficiently. She is someone we find ourselves turning to for organizational help with systems and projects. Without any conscious effort, Tracey has become someone we lean on when there is a job to get done. It’s time we recognize her for that.

Tracey’s new role provides our staff with someone who knows the answers tough questions, or at least knows who to ask. Tracey is responsible for training our new hires, keeping up with competencies on an annual basis, and maintaining our relationships with the various agencies and assisted living communities we partner with. Tracey’s passion is organization, her gift is time management and system processes. She’s never met a form she didn’t love. She will streamline, standardize, and simplify the organizational challenges that have historically slowed us down.

We are excited to have Tracey in this new role and are confident she will have a positive impact on our mission to provide excellent care to our clients in 2014 and beyond.

Spotlight on Excellence: Deb Cline, PT

Posted in Spotlight on Excellence, The Baker Beacon

You know that when you receive glowing feedback from a client about one of your employees, you’ve got someone very special on your team.

When Elmcroft Assisted Living in Martinsburg, WV sent us this note, we knew we had our November Spotlight on Excellence therapist: “Deb Cline is of the highest quality therapists. The staff and patients think she is the best. She is caring, always pleasant, and a joy to have at the facility.”

Deb Cline is a physical therapy assistant who has worked in a variety of settings including acute care, outpatient, and pediatrics for nearly four years. We asked her what she liked about working as a therapist for Baker Rehab Group:

“My favorite part of the job is making people smile. Sometimes I am their only “visitor” for the day and I try to be a bright spot for them. I feel like people put more effort into their therapy sessions when you are willing to invest your time in them and show them you are interested in them as a person- not just a patient.”

When Deb is not working, she is busy taking her kids (Dylan, Peyton, and Jackson) to their endless activities. Her ultimate idea of fun and relaxation is at the beach, but she also enjoys shopping and spending time with her family and friends.

Deb is a can-do workhorse with an infectious smile and bubbly energy. She is the face of Baker Rehab Group in West Virginia, and we owe much of our continued success to her commitment to excellence as a therapist, company representative, and compassionate human being.

“I also work with a phenomenal group of people- from the office staff to the other therapists- and everyone at Baker Rehab is fantastic!”

We feel the same way about you, Deb. Way to go!

Debbie provides physical therapy at Elmcroft Assisted Living in Martinsburg, WV. If you’d like her to work with you or your family member, please email us or call our office at 866.727.3422.

Total Joint Rehab . . . A Functional Approach

Posted in The Mind Of John

Most people who experience joint dysfunction over time don’t just lose mobility in a single joint; they lose entire patterns of movement. A person with an unstable knee or painful hip gradually stops squatting, bending, and rotating. He or she may lose vestibular and peripheral balance responses due to lack of use. Compensatory movement patterns eventually replace normal movement, which can cause undo stress to otherwise healthy joints. By the time a patient presents for joint replacement surgery, multiple movement patterns and functional abilities have been adversely affected.

A shift in traditional thinking has led many physical therapists to consider the needs of their joint replacement patients more holistically. In the not too distant past, physical therapists used the hash marks on the goniometer and the distance a patient could ambulate with a single point cane as indicators of successful joint replacement surgery. With fewer healthcare dollars and increased comorbidities, physical therapists now need to integrate bodies of knowledge across orthopedic, neurological, respiratory, and circulatory systems and break away from the conventional approaches that targeted the optimization of movement of a single joint in a cardinal plane.

Optimal outcomes following single joint arthroplasty are rarely limited to the pain, range of motion, and integrity of a single joint. In fact, the buzzword “outcomes” means different things to different people. Positive outcomes for the engaged consumer have mushroomed to include nebulous measures like quality of life, resumption of activities, and a rehabilitative course that matches his or her expectations. The healthcare industry, including payers like Medicare and private insurance companies, consider complication-free procedures, timely discharges, and low re-hospitalization rates to be the benchmarks for success.

Such are the challenges of the new-age physical therapist specializing in joint replacement surgery.

Gone are the days of lengthy hospital stays- where in-bed exercises consisting of feeble ankle pumps and gentle heel slides dominated the first few physical therapy visits following a hip or knee replacement. Gone, also, are the seven page home exercise programs, neatly assembled by the therapist and ultimately ignored by the patient whose only desire is to get back to walking. Shorter hospital stays and pressure for quicker outcomes translate into immediate out of bed and weight bearing physical therapy protocols.

The optimal exercise program, the one that offers the greatest bang for the buck, consists of closed chain, multi-joint, functional movement patterns performed in standing. Instead of passively stretching a tight calf in bed, adequate calf stretch can be achieved in standing, with the body weight shifted onto the foot and the knee dropped slightly forward. This simple stretching pose also provides trunk stabilization, hip and knee control, proprioceptive and somatosensory feedback, bowel motility, cardiovascular training, and pneumonia prevention. A simple head turn during a sit to stand exercise engages the vestibular system. Three or four standing, weight-bearing exercises can accelerate the rehab process, largely by improving the general health of the body’s systems, improving compliance with home exercises that promote function, and optimally recruiting more motor units with the closed chain.

In today’s healthcare environment, physical therapists are being pressured for better and quicker results with their joint replacement patients. The fitness industry has been employing these techniques with growing popularity- as seen in sledge hammer swinging, shovel scooping, and overhead heaving movement patterns dominating the curriculum of warehouse fitness clubs. The diverse definition of “outcomes” among decision-makers, limited healthcare dollars, and an increase in medically complex patients receiving joint replacement surgery requires physical therapists to produce excellent results in shorter timeframes. Functional movement patterns may be the secret sauce.

Successful Outcomes in Home Health: Sometimes It Takes More Than a Great Clinician

Posted in The Mind Of John

Sometimes it takes a village.

I recently treated a client who made tremendous progress and experienced very successful outcomes.  It’s a great example of how family involvement can facilitate positive changes with only a few helpful, yet firm, recommendations.

An elderly woman with a history of Parkinson’s disease was referred to home physical therapy by her physician due to multiple recent falls.  She had already had therapy in the home before, but still she continued to fall.  During my first visit to her home, it was immediately clear why she kept falling.

Her house was cluttered- not to “hoarder” status- but so full of furniture and piles of stuff that neither her rolling walker nor rollator could fit through some of the passageways.  Without being able to use an assistive device, she relied on furniture and walls for stability. She also demonstrated some impulsive behaviors, common in many neurodegenerative diseases, which only increased her risk of falling.

I knew that the only way to achieve positive outcomes in this situation was to modify the environment, and that was going to require the family’s help.

I posed the options to the client and family clearly and gently, “Unless this house is decluttered and cleared out, she will continue to fall.  This will lead to a downhill spiral in her general health that could have been prevented with a good spring cleaning.”  I told the family that I couldn’t help her unless her environment improved.  I walked through the house with the family, questioned the necessity of each chair, table, and ottoman, and suggested that anything that wasn’t regularly used be moved to the garage.   These items were largely valued for their sentimental meaning, not for their practical significance.  I told them that on my next visit I expected a clear path into each room on both levels of the house, with wide-open, accessible spaces in each room.

On my second visit, I was pleasantly surprised to see that my recommendations had been followed.  My client was able to use her rollator to travel safely from room to room.  She had space to turn around and navigate around corners and obstacles.  Her risk of falling had been largely mitigated.

On my third visit, I taught my client how to enter and exit the house.  I instructed her how to navigate the three steps to the front door.  I also taught her techniques to alleviate “gait freezing”- the phenomenon that occurs in some people with Parkinson’s disease where they have trouble initiating movement.  She was able to independently use these strategies whenever she got “stuck” and get herself moving again.

On my fourth visit, my client was able to show her family her newfound sense of independence.  The family was amazed at how stable she was when she used her rollator, how easy it was for them to help her enter and exit the home, and how she was able to “unfreeze” herself without falling.

I was most pleased that this level of achievement was accomplished in only four visits, and that the successful outcome was directly correlated to her family’s willingness to make hard decisions and implement changes.  Sometimes just helping people view a lifetime collection of sentimental items as just “stuff”- stuff that gets in the way of leading a safe, productive life- is the best way to be of service to our clients.

Dr. John Baker | CEO, PT, MA, GCS, NCS, NDT, DScPT
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When Hip Pain Turns Into Parkinson’s Disease

Posted in The Mind Of John

Received a referral from an orthopod for home physical therapy to see a client who had fallen at home. She had both hips replaced in the last few years. The referral said “Left Hip Pain. Eval and Treat.” I figured I was walking into a situation of someone who had a painful left hip…possible hip contusion…probably would need a home safety assessment, some ice/heat, massage, gentle stretching and move toward more aggressive strengthening and fall prevention strategies.

When I saw her, she could hardly move and was in a lot of pain from the most recent fall that occurred the night before. Pain not from her hip but instead her back and left rib area because of the latest fall. She could hardly move from the pain. I arranged for an x-ray for possible rib or spinal fractures. The  x-ray did show left side rib fractures.

But things still just didn’t add up. Her motor recruitment or muscle contractions were diminished generally…she couldn’t move as well as I would have expected. She had a scissoring gait pattern…walked kind of pigeon toed, slight resting tremor or shake on right forearm that was worse when stressed. When her physicians asked about it she told them “doctors make me nervous” and her dad had it too. Awgh! Essential tremor…maybe.  But the dulled emotional tone on her face…she didn’t laugh outwardly at my amazing jokes….bad sign! …and the akinesia…all those light postural adjustments and lack of head rotation to track me as I moved around the room as we continued our conversation. Hmm….

So, I prodded a little deeper. Reviewed her medications again…hmm…depakote, clonazepam… and about ten other meds including a narcotic for the pain. That explains it…or does it?

Time to call her primary care doctor. I hate this! Get put on hold, get screened, someone tries to decide if my information is worth putting “the man” on the phone with me.  I’ve done this before and learned the hard way. Don’t assume you know the “new and unknown diagnosis that will save the day!” Just ask questions and state your observations and concerns. Anticipate what they will ask you and have your responses ready. State objectively your findings, then ask a few questions of your own. Why is this sweet woman falling so often? Why is her motor pattern and response the way it is? Have you seen her get up in the office and walk across the room, moved her arms and felt her tone?…why no right arm swing when she walks at normal speed? Why no little postural adjustments that we all usually make all the time? Why does she not rotate her head and follow me as I move around her apartment?

It is very easy to get “tunnel visioned” into seeing what the referral script says…left hip pain.  But do I see the tree and miss the forest. A tree can tell you a lot, but step back and look at the forest…you may be surprised at the view.

This is one reason I love working as a home health physical therapist. I can make time to look at the tree and even step back and view the forest.

Am I crazy or what?

Posted in The Mind Of John

Physical therapist heads profession’s Md. board
Originally published August 07, 2011

By Ed Waters Jr.
Frederick News-Post Staff

A Frederick physical therapist has been elected to the prestigious position of chairman of the Maryland Physical Therapy Board of Examiners.

John Baker, CEO of Baker Rehab Group, formerly HomeCare Rehab and Nursing, was elected by the other seven members of the board to serve a one-year term as chairman.

The board oversees the physical therapy profession in Maryland, including licensing, regulation and disciplining in the case of problems.

Baker, who balances his new position with his full-time business, holds professional degrees including a doctorate of science in physical therapy. A physical therapist for more than 20 years, he has been advocate for the profession and was named to the eight-member board of examiners 2 1/2 years ago. That appointment, by the governor, is for four years and can be extended another four years.

The board, made up of five physical therapists, a physical therapist assistant and consumers, is dedicated to making sure the public is protected, Baker said.

“I was a bit surprised at being elected as chairman,” Baker said, noting that most of the chairmen in the past have been from the larger metropolitan hospitals or health care systems.

“Maryland has historically taken a lead in the nation for its PT board,” Baker said during an interview at Edenton, a retirement and assisted living community in Frederick. Edenton has a senior-focused outpatient rehabilitation clinic that serves not only Edenton residents but also anyone in the county who needs physical therapy and wellness care.

“Maryland was the first board to authorize direct access, in 1987, that said a patient does not need a physician’s order to get physical therapy,” Baker said. “We are the first state to allow ‘dry needling,'” Baker said, which is used to reduce pain in muscles, but has a different approach than acupuncture.

The board has investigators, attorneys and an assistant attorney general to provide services and counsel.

Complaints, Baker said, include a patient who claims “crossing boundaries,” such as a physical therapist who makes sexual or other inappropriate contact, fraud or other issues.

Many times, the complaint can be settled with a letter from the board, Baker said. But if it warrants investigation and a potential problem is seen, several steps are taken, Baker said.

“The first step is an informal talk with the physical therapist,” Baker said. If that doesn’t work, the next move is a case resolution conference. That is something that could go to trial, but also could be settled among those involved and legal counsel.

“Aggressive issues that are serious to public protection would go to court,” Baker said.

That could result in the potential revocation of a license.

Physical therapy is evolving, Baker said. Although the physical therapy board has an excellent reputation for working with other boards in the state, Baker said there can be potential conflicts. Allowing a physical therapist to check the blood sugar of a diabetic while at their home or other location might upset the home care nursing profession, but it better serves patients in the long run, Baker said.

Baker speaks to the doctoral graduates at area colleges in physical therapy. “I tell them how to make sure they don’t come before our board” with problems, Baker said.

His goals are to ensure access to the board by the public, resolve issues quickly and look at residents of Maryland as “customers” who needed to be served in the most cost-efficient, professional and correct way.