Henry Hoffman
Wednesday, September 16th, 2015
Last modified on April 25th, 2022
Strokes aren’t always predictable or preventable. However, there are many different traits and habits that overwhelmingly correspond to higher risks, so it’s easier than ever to determine your individual risk factors. In 2007, the Centers for Disease Control and Prevention (CDC) added another factor to the list when they began to collect and compare data about strokes in each individual state.
The CDC confirmed decades’ worth of evidence that strokes consistently occur in some regions more than others. Their research also unveiled some startlingly specific risks: eleven states had unusually high stroke rates and mortality rates. Following this revelation, several organizations have conducted research to compare stroke prevalence, care costs, mortality rates, behavioral risks, and other factors on a state-by-state basis.
Henry Hoffman
Thursday, August 20th, 2015
Last modified on October 11th, 2019
EvaluationEvidence-Based TreatmentFrozen ShoulderShoulder ImpingementShoulder Pain
Successful clinical outcomes are typically the result of the therapist’s ability to perform a thorough and accurate examination. In order to diagnose and prescribe lesion specific treatment, a clinician must not only be knowledgeable with the musculoskeletal system and how to systematically examine the affected joint, but feel confident with interpreting the results. Without an accurate assessment using proven orthopedic-based diagnostic techniques, pain and disability can persist unnecessarily for months or years. In a previous article, we looked at the biomechanics, pathoanatomy and pathomechanics of the hemiplegic shoulder. Today, I would like to continue this series by reviewing the clinical examination of the painful neurological shoulder.
Henry Hoffman
Wednesday, August 19th, 2015
Last modified on May 15th, 2020
Evidence-Based TreatmentSpasticitystrengthening
Not as much now, but in the recent past, discussing strength training a hyperactive or spastic muscle was a very controversial topic amongst clinicians at happy hour, in the clinic, or at CEU’s. For many, the thought of having upper motor neuron lesion clients squeeze their hyperactive finger flexors or flex their spastic biceps in the late 1980-90’s (and earlier) would have made many clinicians cringe. The visual that comes to mind for me is something out of a CSI show, but instead of a homicide, you were looking at a clinical “assault and battery” where security would have been called and the crime scene tape would have been wrapped around the patient and the plinth. The suspected serial criminal then would have collected his or her belongings and performed the famous perp walk out of the clinic for all of the fellow clinicians to see. Yes, the media would have eventually covered this story and learned that this inept clinician, known publically now as “high toner”, would be linked to previous clinical crimes ranging from “excessive upper trap activation” to “absence of manual cues”. OK, maybe a bit melodramatic and a tad over-exaggerated, but I think you get the idea.
Henry Hoffman
Wednesday, January 21st, 2015
Last modified on May 15th, 2020
EvaluationEvidence-Based TreatmentFrozen ShoulderShoulder ImpingementShoulder Pain
If you have attended a Saebo course in the past, you most likely have heard the comment “it is the hand that guides the arm”. Although this is theoretically true when discussing the importance of incorporating one’s hand functionally, broadly speaking however, we should avoid providing too much importance to the hand as it is only one element of the interdependent kinetic chain. Yes, the hand mainly guides the arm to interact and problem-solve the environment, however, if pain and limited motion exists proximally (i.e., shoulder), function will be compromised regardless of the hand’s ability to participate.
Henry Hoffman
Friday, November 28th, 2014
Last modified on September 2nd, 2022
EvaluationFrozen ShoulderShoulder ImpingementShoulder Pain
Before I co-founded Saebo, I was a practicing occupational therapist specializing in non-operative orthopedic medicine and manual therapy of the upper quadrant. While working at Burke Rehabilitation Hospital in White Plains, NY, part of my caseload was dedicated to orthopedic rehabilitation including the treatment of overhead athletes. Through the International Academy of Orthopedic Medicine (IAOM), I received my post-professional education training on diagnosis specific musculoskeletal management.
Saebo
Monday, May 5th, 2014
Last modified on May 15th, 2020
ContracturesElectrical StimulationEvidence-Based TreatmentSaeboStretchSpasticitystrengtheningTask-Oriented TrainingWeakness
There is alot we still don’t know about what constitutes “best practice” when it comes to neurorehabilitation and how to affect optimal recovery and outcomes, but there are some things that we do have a better understanding of. Let’s take stroke recovery and rehabilitation as an example, specifically upper extremity (UE) recovery, since it is reported that at least 50% of individuals who suffer a stroke have UE involvement and impairments (though the numbers vary depending on which study you are reading).
Saebo
Thursday, December 19th, 2013
Last modified on April 16th, 2022
Evidence-Based TreatmentHealthcareMedicare
Social Issue
According to the American Heart Association (AHA, 2013) stroke can occur at any age however recent studies indicate that over the past 15 years there has been an increase in the incidence of ischemic stroke occurring in young adults (George, Tong, Kuklina, & Labarthe, 2011). Risks associated with increased obesity, hypertension, diabetes, and tobacco and alcohol use have been proposed factors contributing to this rise (George et al., 2011). With increased rates of survival, younger individuals are living longer with disability and the direct and indirect costs associated with healthcare and lost productivity can be significant (George et al., 2011; Wolf, Baum, & Connor, 2009). According to AHA (2013), loss of earnings is projected to be the highest costs associated with stroke.
Saebo
Wednesday, October 2nd, 2013
Last modified on May 15th, 2020
The term “evidence based practice” is now ingrained in our clinical knowledge and discussions though there still remains a gap between knowledge and actual implementation of evidence based interventions. Much research has been done on why this gap persists in order to find methods of bridging this gap. I recently read an article by Fleming-Castaldy & Gillen (2013) in the American Journal of Occupational Therapy that discussed some of these issues. As Director of Clinical Services at Saebo Inc, I couldn’t help but feel a sense of satisfaction when reading this article as it fully validates that Saebo is providing current and evidence based education and products. I will provide a summary here but strongly advocate that clinicians working in neurorehabilitation should read this article.
Saebo
Monday, July 22nd, 2013
Last modified on May 15th, 2020
BotoxContracturesElectrical StimulationEvidence-Based TreatmentSpasticity
Muscle spasticity is a negative symptom which can occur following a central nervous system disorder (Kinnear, 2012). The use of Botulinum Toxin Type A (BTX-A), commonly referred to as Botox, is used extensively in the treatment of muscle spasticity following stroke and other neurological conditions. Following BTX-A injections, physical and occupational therapy are typically provided and include stretching, casting, splinting, strengthening, and functional movement retraining (Kinnear, 2012).
Having provided the above types of occupational therapy interventions with numerous individuals who have received Botox injections to the UE, I have formulated my own opinions as to the functional benefits of Botox injections in the UE. I recently did a literature review to find out what the research reports.
Saebo
Thursday, June 6th, 2013
Last modified on April 2nd, 2019
Evidence-Based TreatmentHealthcareMedicare
As clinicians, our ability to provide therapy services to clients is influenced by federal laws and regulations, administrative laws from agencies, and sometimes case law. It becomes challenging to keep track of all the changes that occur in the laws, rules, and regulations that impact our practice. More often, we are aware of changes that negatively impact our ability to provide comprehensive and medically necessary skilled services to achieve optimum client outcomes, such as therapy caps. We are also aware of changes in regulations that impact what we document and the way we document.
