The Value of CBIS to your Clinical Practice

CBIS certification has raised the industry standard for educational pursuit and knowledge acquisition. Importantly, it has numerous benefits for the individuals who seek the certification.

1. It will enhance your clinical practice!


Becoming a Certified Brain Injury specialist will connect you to a wider network of other professionals in the brain injury rehab field. Currently, there are over 7,000 CBIS’ practicing here and internationally- and they are all linked through the attainment of this credential! Being a part of this network can help you problem-solve various challenges that can pop up in practice, learn about resources and tools helpful to practice, and initiatives that you may not otherwise have known about. 

Once you become a CBIS, you automatically gain a subscription to the Journal of Head Trauma Rehabilitation, which will help you to stay super current on the best brain injury rehab and resources that are upcoming in the field. 

Staying up to date on the evidence is not always easy- read this for three ways how!

And of course – there is the focus that requires to maintain your Certification status! In order to maintain the CBIS credential, you must take 10 hours worth of continuing education per year related to ABI practice. Those resources must be from current material – published or presented within the preceding three years. This means that once you gain your credential, you are forced to stay current and on top of new advances – sealing your status as a specialist!

2. It makes you a more well rounded clinician

The CBIS specialist course and exam does not only discuss Traumatic Brain Injury (TBI) but also non-traumatic brain injuries (NTBI) – which can sometimes be missed in BI practice. The Certified brain injury specialist course and exam also requires the learner to be versed in mild, moderate and severe injuries – and even touches on disorders of consciousness. This makes us, as clinicians, step outside of our comfort zones and learn more about populations and conditions that we perhaps might not normally have examined. 

Brain injury-serving organizations value hiring and training CBIS certified staff, because it allows them to work with and promote clinicians who understand the unique needs of persons recovering from brain injury and staying abreast of current resources in the field. By becoming more well-rounded, you are also establishing your own value as a clinician- go you!

3. It will empower you to develop programs/problem solve

As a certified brain injury specialist – your knowledge goes beyond management and treatment, and expands into advocacy, visibility, accessibility and systemic issues. This places you in a great position to develop brain injury specific programs for your facility, hospital, clinic or community! You will be able to examine the programs from a larger scale and perspective and look beyond your own practice, into the issues facing the brain injury community.

You will also be able to examine barriers to supportive programs where you work, and have knowledge and resources to be able to roll out initiatives and education in your clinic. This will help empower your colleagues on a larger scale, and create more effective outcomes for all clinical staff and patients. 

 Become a CBIS… and super-charge the way you work!

4. Make you a more effective educator/advocate

The act of studying, staying up to date, and being part of a network of like minded clinicians will have another side effect – it will naturally make you a great advocate. You will have the tools you would need to educate patients, family members, and your own colleagues, about what is supportive, appropriate and what is the most cutting edge in terms of interventions and treatments. 

Also, you can further advocate and educate by initiating or running a local brain injury support group – another aspect discussed in the CBIS Training course! Facilitating a group where those who have lived with brain injury can share successes, challenges, resources and more will be an incredibly empowering and positive addition to your clinic or community. 

Obtaining your CBIS really sets you apart from your peers and shows that you are committed to keeping your clinical skills with the ABI population sharp. It can inspire confidence in your patients and their families and give you the tools you need to assist your patients recover. 

Interested in becoming a CBIS? Check out the Certified Brain Injury Specialization (CBIS) Training

Like this article? Sign up to our mailing list for a weekly education right to your inbox! We promise to treat your email with the respect and love it deserves 🙂

How to Use Evidence Based Practice in Occupational Therapy

Evidence-based practice (EBP) has become the gold standard for healthcare professionals, including occupational therapists (OTs). It’s a phrase we hear constantly – at school, at work, at conferences – and we all know the importance of testing and examining the efficacy of what we are doing. 

But with so many other demands on us, how do we make sure that we are constantly integrating EBP into clinical practice?

What is Evidence Based Practice?

EBP is the process of using the best available evidence combined with clinical expertise to make decisions about patient care. It helps Occupational Therapists to provide the highest quality of care to their clients, both by informing clinical practice and by providing evidence to back up therapeutic interventions. As OTs, using evidence-based practice will also ensure we are following the latest standards of care, while also considering the individual needs and preferences of their clients.

Why is EBP central to good OT practice?

Evidence-based practice has become a cornerstone of occupational therapy. As OT as a profession moved toward a higher level of academia and science, testing and proving interventions became key to establishing OT as a vital health profession. 

As with many professions, clinicians can become comfortable and settled in a certain way of practicing – and this can take the edge out of our treatments. It is important that practitioners understand not only the importance of evidence-based practice, but also how to realistically integrate it into the therapeutic process. 

How do I include evidence based practice in daily occupational therapy?

First – get clear on your goals. Understand the importance of staying current with new research and continually updating your knowledge and skills. When you are creating your care plans, it is essential to ensure you are basing your decisions on the best available evidence. This means looking at research studies that have been conducted on the topic and considering their results. It also means staying up-to-date on the latest evidence; for example, reading journal articles or listening to webinars.

However, OTs should consider their own clinical expertise and patient preferences when making decisions – your experience and clinical expertise are also a form of evidence based practice!

Research Articles

It is clearly important to be up-to-date on the latest research. This includes the latest clinical practice guidelines, current research, and the best available evidence.

To ensure that you are using the best evidence-based practice, you should have a working understanding of the research process and its components. This includes being able to find, appraise and interpret evidence while also applying it to clinical practice. 

When evaluating a source of evidence for use in occupational therapy practice, there are a few key criteria to consider. Is the article peer-reviewed? Are the authors reputable? Was the sample size appropriate?

Look for high-quality research studies. Look for research studies that are randomized, controlled trials with a large sample size and minimal bias

Consider the author’s qualifications, the study design, and the results of the study. Furthermore, it is important to look for evidence of peer-review and to be aware of any potential conflicts of interest. 

Finally- it is important to consider the generalizability of the results and to make sure that the study results adhere to current ethical guidelines. 

Scholarly articles are a great source for evidence-based practice that have been reviewed and evaluated by peers. Additionally, articles from reputable journals and organizations are also a good source of evidence. 

Peer and Team Collaboration

Additionally, it is beneficial for OTs to consult with other professionals, such as physicians and nurses, to get their perspectives on evidence-based practice. By utilizing a team approach and keeping up-to-date with the latest research, OTs can be sure that they are providing the highest quality of care to their clients.

Clinical Expertise

Additionally, it’s important to consider the individual needs of your clients and critically evaluate the evidence for interventions. 

Three ways to include EBP in your daily practice

1. Subscribe to a journal – that is relevant to your practice!

Knowing that remaining current on literature is the most reliable way to stay on top of what is being examined in your field. Although not every assessment and intervention that you complete in a day is likely to be included in the journal – it will examine issues and treatments that are current in your field and may give you food for thought for future, contemporaneous treatments. 

Reading a journal will also expose you to treatments that are outside of your ‘typical’ practice and encourage more expansive thinking when it comes to approaching your client base and their needs.

Ensure the journal you subscribe to is one that you are interested in and that is accessible to you! Some articles can be overwhelming – and that’s where our next steps come in.

2. Critically reflect and analyze your own practice

Make sure that you are regularly stepping back, asking yourself what your plan of care is going to include, and why. Even for discrete therapy sessions – take a critical reflection on why you chose the intervention, and whether the person is receiving the intensity/repetitions/and so on to ensure the treatment is at an effective level.

Joining or starting a journal club can assist with self reflection, and encourage some inter-disciplinary feedback and learning too. Disease specific journal clubs are a great way to niche down into an area of interest but also appreciate the approach of other clinicians in that space; whereas discipline specific journal clubs can help explore many different conditions and OT interventions that are relevant to your practice!

Join our club here

3. Take a course!

Wading your way through understanding Evidence based practice is not easy. Thankfully, we have a course for that! Learn more about how to critically understand and appraise evidence, how to set up your own research, and much more, with our course “Evidence Based Practice for the Everyday Clinician

Check out Evidence Based Practice for the Everyday Clinician here!

Here, you will:

– Learn to find the most relevant evidence

– Be able to appraise and critically consume evidence

– Know how to formulate your own questions and find evidence to support or refute practice

– Understand variables, data, and analyses

– Have a blueprint as to how to start and manage your own research

Appreciate the true ‘power’ of EBP!

Including Evidence based practice as a daily part of your clinical life can make a huge difference to you, your patients, and your team. Try these techniques to make it an intuitive part of your life!

Like this article? Sign up to our mailing list for a weekly education right to your inbox! We promise to treat your email with the respect and love it deserves 🙂

Learn How to Maintain your CBIS Certification

So you have done your prep course, studied your head off, and passed your Certified Brain Injury Specialist (CBIS) credential exam – Congratulations!

Now as a practicing CBIS, what do you need to do to maintain your certification?

What do I need to do to maintain my CBIS?


In order to maintain your credential, you have to do 10 hours of continuing education per year related to acquired brain injury.  That education has to be a mix of at least two different mediums – webinars, live courses, journal articles, etc.  For example, you can’t do 10-hour long webinars and count them all – you have to have a mix. 

Once you complete your 10 hours of education, you have to complete your recertification application, and pay the recertification fee ($70) – that’s it! 

Having and maintaining your CBIS really encourages you to keep up with current research related to ABI, new evidenced based initiatives,  and makes you stay at the top of your clinical game. 

Can I use a mixture of resources to maintain my CBIS?

Yes!  You need to obtain the necessary CEUs from at least 2 different mediums such as webinars, journal article reviews, attending conferences, etc.  This ensures that you’re always expanding your ABI knowledge from a variety of different sources.  

Where can I find high quality CEUs to help maintain my CBIS?

Allison provisional brain injury certification and CBIS journal club

ARC Seminars offers a variety of live and pre recorded CEUs (check our courses) that can help you maintain your CBIS credential.  Also, offer a free journal club that counts for 1 hour towards your recertification!  All CEUs have to be acquired brain injury related.  Keep in mind any courses taken prior to obtaining your credential do not count towards your recertification (which includes the CBIS exam prep course itself).

Are there are free resources to help maintain my CBIS?

Yes, here is a link to download our FREE CBIS Starter Pack, which includes lots of great information about the CBIS credential, as well as some excellent clinical resources for immediate use.

Watch the video below for more information!

Like this article? Sign up to our mailing list for a weekly education right to your inbox! We promise to treat your email with the respect and love it deserves 🙂

What Does It Feel Like To Have Post-traumatic Stress Disorder?

Working in rehab, as a therapist, means that we often meet people who have very recently gone through a life changing, shocking event – like an accident, stroke, Brain injury – or other scary, unplanned event. We may also meet people who have had chronic low-level trauma throughout their lives, or who are having to adjust to a new life or way of living.

And, although we are used to treating these clients for the symptoms of their stroke/TBI/multi-trauma accident -we may not always consider the implications that the trauma has on their psyche. An awareness and sensitivity to PTSD is helpful to we therapists who are in acute and post-acute care. Not only can we be mindful of issues that we can pick up on quickly, we can also use the knowledge to enhance our treatments and our therapeutic rapport. So with that in mind, let’s take a closer look at PTSD with this article guest written by the team at Take A Seat – therapy services.

What is Post-traumatic Stress Disorder?

Post-traumatic stress disorder is a psychological disorder that occurs in people who have undergone a traumatic event like an earthquake, terrorist attack, war or rape, etc. It was known as shell shock during the days of World War 1 and combat fatigue after World War 2. PTSD can occur in people of any ethnicity, religion, culture, or age. However, PTSD does differ in males and females. Women are more susceptible to PTSD. People with PTSD have a pattern of thoughts related to the incident, which makes them anxious, fearful, and detached. They might go through the pain of the incident again through nightmares.

Symptoms and Diagnosis

In psychological terms, a condition has not termed a disorder unless it fulfills all the symptoms criteria and the period for them. Some prominent symptoms of Post-traumatic stress disorder are given below;
  • Intrusions; the victims repeatedly see the same incidents in dreams or routine while sitting idle etc. The flashbacks are intense, like the incident plays in front of the patient’s eyes like a movie.
  • Detachment; the patients tend to avoid people related to the incident even if the link is not direct. Looking at those familiar faces reminds them of their pain and misery.
  • Change in mood; it would not be wrong if we say PTSD change the behavior and attitude of a person to a great degree. They forget some significant part of the tragedy and frequently have negative thoughts about themself. In some extreme cases, the victims start blaming themself and often wrongly accuse someone.
  • Change in response; the victims have a 360-degree change in their behavior. They have irritable nature and might have anger outbursts over minor problems.
For a person to have PTSD, these symptoms must have an age of at least a month. We can only describe it as a disorder and start the treatment to improve the victim’s behavior.


As it is a psychological issue, PTSD are treated by psychotherapy, specifically CBT. Cognitive behavioral treatment involves the deepest secrets of unconscious and conscious memory. Hormonal imbalances may also be addressed prior to the initiation of psychotherapy, for best outcomes. Psychotherapy prepares you to deal with life post-trauma with strength. However, completely getting over the therapy experience from familiar counselors can be very beneficial. They add positive energies inside you and help you escape the experience’s dark memories. Nowadays, therapies are available online at the person’s convenience – although for inpatient rehab there may be a psychiatrist on board who may assist with adjustment and PTSD issues. Many  therapy sessions are conducted online for people who have a problem stepping out of their homes or other issues. Finding an online therapist may be a suggestion that, as a clinician, you can make for your patients.


As mentioned earlier, if the PTSD has gone to an extreme level, a psychiatrist is referred for the hormones controlling brain activities to be kept under control. The psychiatrist prescribes certain medicines that would calm the mind and reduce the intensity of other psychological issues that might have damaged the patient’s mind. Patients with PTSD are given antidepressants such as SNRIs and SSRIs. Other medications include a controlled dose of sleeping pills, antianxiety, and medicines to elevate peace so that the patient’s mind can rest from the constant worries and pressures.

Therapy for patients with PTSD

Patients with PTSD undergo a lot of pain that others cannot see or understand. The tragedy takes away the joys from their life and a part of their personality with it. They look for someone to whom they can rant their frustration, speak and cry their hearts out. Psychologists do help them stabilize, but their profession does not allow them to be an emotional support to the patient. Specific therapy centers with alternative therapists can support patients with PTSD, and alternative therapists provide counseling outside the barrier of mental health sciences. Patients may find it much easier to connect to them than other health care professionals. You can find many online therapists in UK that have a commendable professional background and would help you move on from the trauma quickly.


Each therapy has its benefit for treating Post-traumatic stress disorder. Only if all three possible practices, psychotherapy, treatment from a psychiatrist, and alternative therapies, work together the treatment of the condition can be made 100% efficient.

Like this article? Sign up to our mailing list for a weekly education right to your inbox! We promise to treat your email with the respect and love it deserves 🙂

Have you heard? Occupational Therapy’s Value in Jail is Big News

The value of occupational therapy as a community-based service in jail settings is becoming better understood as more research becomes available.  Read up on what these services look like and why you should care…

Occupational Therapy in Community Services

Community-based occupational therapy services in jail is becoming increasingly common, especially as the body of knowledge focused on justice-based occupational therapy (JBOT) grows.  Occupational therapy is well equipped to address patients at a community level as the profession values and prioritizes addressing barriers to engagement, identifying causes of and solutions to occupational deprivation, advocating for access and occupational justice, and promotion of social well-being initiatives.  

Community-based occupational therapy addresses a wide variety of service recipients including families, people struggling with substance abuse, undomiciled persons, incarcerated persons, victims of domestic violence and more.  Geriatrics and mental health-focused community-based OT programs are most common.  Occupational therapy services based in the community are important for the continuum of care for patient populations who are underinsured, under privileged, and/or not appropriate for OT services in traditional clinical settings.

There is a very surprising link between TBI & incarceration…learn more in our CBIS credentialing course!

OT’s Role in Jail 

One important factor supporting occupational therapy’s presence in jail settings is that the USA has the largest population of incarcerated persons compared to other developed nations; this statistic indicates a systemic issue that requires advocacy and occupational-justice informed approaches.  Occupational therapy services are valuable in assisting preparation for offender re-entry into society as a productive member. 

Community-based occupational therapy services within jails may focus on addressing life, work and employment skills as well as psychosocial and interpersonal skills.  Occupational therapy services in jail also aims to reduce likelihood offenders will recidivate through introduction of positive coping mechanisms, awareness of community resources, and addressing mental health factors.

Value of Occupational Therapy Services in jail

Early studies show that participants of jail-based OT services find it valuable, especially when life skills including employment and coping are addressed.  This is important to recognize as it has been shown that offenders who are able to secure and maintain employment post-release are less likely to recidivate.  Many existing non-OT programs are talk-based and heavily theoretical in application; offenders are not given the opportunity to the practice hands-on application and understand applicability of material to their daily routines in the way that occupational therapy allows.  There is unfortunately still a gap in information regarding the effectiveness of occupational therapy services in reducing recidivism.

Where Can I Learn More?

value of occupational therapy

The University of Findlay in Findlay, Ohio is involved in jail-based occupational therapy research bodies and initiatives–they also host fieldwork rotations at the local jail.  Read their 2020 article describing the establishment and purpose behind these services & keep an eye out for future publications.

Dr. Jaime Muñoz of Duquesne University has several publications exploring and fleshing out the importance of OT in jail settings and justice-based occupational therapy (JBOT).  Check out his university profile here to learn more.

St. Louis University (you may have used/heard of their SLUMS assessment) hosts JBOT newsletters and information and seeks to build a collaborative network for JBOT practitioners.  Check that out here

Like this article? Sign up to our mailing list for a weekly education right to your inbox! We promise to treat your email with the respect and love it deserves 🙂

Shoulder Subluxation and Stroke: Can These Three Methods Save a Shoulder?

Shoulder subluxation after stroke can be quite puzzling for therapists to treat.  Can these three treatment methods save a shoulder?

How a shoulder subluxation rears its ugly head can vary greatly–it may develop more quickly with some patients than others, it may be painful or even go completely unnoticed.  As therapists, regardless of the how or when, we consistently try to prevent shoulder subluxation from happening and reduce the severity if it does happen… but are we truly being effective? 

Should we be grabbing that sling to support their shoulder?  Does e-stim help reduce the degree of translation? Is taping effective for prevention?  Let’s dive in and strengthen our evidence-based application.

For strategies on how to help your patients maintain dignity and respect when dealing with dysphagia after stroke, download our ‘Say This, Not That’ handouts here!

Why does Shoulder Subluxation Happen?

shoulder subluxation Glenohumeral subluxation happens in up to 81% of patients post-stroke.  The shoulder joint is multiaxial and has three degrees of freedom–flexion/extension, abduction/adduction, and internal/external rotation .  The joint relies on the rotator cuff musculature–supraspinatus, infraspinatus, teres minor and subscapularis– as well as other surrounding musculature to keep everything aligned and to give the joint the ability to have smooth and efficient arthrokinematics.  During the initial period post-stroke, when the affected side may be flaccid, the rotator cuff musculature is not able to provide the stability it normally does to the joint.  This instability combined with the pull of gravity and improper positioning can lead to lengthening of tissues and the separation of the humeral head from the glenoid fossa, also known as a subluxation. Flaccidity is not our only enemy when it comes to developing a subluxation.  Even if your patient has some degree of active movement in their affected arm, spasticity can also be a factor in developing a subluxation as it often creates a significant imbalance in the movement patterns of a joint or limb.  If the spasticity is strong enough, it can even pull the humerus out of alignment.   Subluxation may also be influenced by other predisposing factors, according to some research.  One study found that “subluxation occurs more frequently in patients with a known presence of fluid in the subhumeral and subdeltoid bursae and in patients with reduced functional capacity.”  This is interesting to think about and can lead us to the conclusion that there are multiple factors that can help us identify those who are at more risk of developing a shoulder subluxation… versus assuming the patient is at risk solely because they present with hemiplegia.    

What Interventions are Available…and What Do They Do?


Prevention & Management:  Slings are what we grab first, right?  In fairness, a sling or orthotic has been shown time and time again to be effective at reducing shoulder subluxation while it’s in place and worn correctly.  But there is no evidence that using a sling can prevent a shoulder subluxation from happening or that it can have a long-term effect on the reduction of an already existing subluxation.  One study compared 3 groups (2 with sling and 1 without sling) and found that shoulder subluxation seemed to reduce over time in the group of patients who did not wear a sling. This information alone should make us rethink our ‘one-sling-fits-all’ mindset!

Clinical Application:  It goes without saying that more research needs to be completed (as with many areas of practice), but we should always be striving to tailor our choice of interventions, so they are specific to our patient’s needs.   In the case of a sling, there is still a useful application even if it’s not going to make a difference in the degree of shoulder subluxation.  A sling could be beneficial in protecting your patient’s limb during transfers, or it may be helpful in reduction of pain associated with subluxation.  But if there is no pain and the limb seems to stay in a good position during functional mobility…leaving the sling out of it may be the way to go!


Prevention & Management:  There is minimal evidence clarifying whether taping is effective at prevention of shoulder subluxation, but there is plentiful research that indicates that taping methods–both kinesiology and inelastic tape–can reduce present shoulder subluxation and reduce pain associated with it.  Other studies found that while unable to prevent subluxation, specific techniques have been found to result in improvements in shoulder flexion and proximal arm function. Clinical Application:  With taping showing consistent results in the reduction of shoulder subluxation and pain, this should be a staple in your stroke rehab toolbox!  There may be a few reasons you wouldn’t move forward with this, such as patients with fragile skin or sensitivities to adhesives, but with the equipment being both inexpensive and accessible… we need to be moving our thoughts away from slings and more toward taping!


e-stim unitPrevention & Management:  Some studies have shown that e-stim combined with other treatments or approaches has been effective in preventing and reducing subluxation in the acute phase of stroke but has not been effective in the chronic stage.   Clinical Application:  Therapists have been using e-stim for many different indications for decades and we all know well that parameters matter if you want to achieve a specific purpose or goal.  The main consideration for e-stim with shoulder subluxation is timing!  If we can provide this treatment early in the patient’s recovery from stroke, we will have a better chance of preventing and managing shoulder subluxation.  If you can utilize e-stim during the acute or subacute phases in stroke rehabilitation, go for it!  

Where Do I Go from Here?

Make sure to look at your patient as a whole and see what they specifically need in their plan of care–a blanket plan of action will not be as effective as a patient-centered plan of care.  If you are treating your patient in the acute or subacute phase of stroke rehab, e-stim may be a great starting point as a preventative measure.   If shoulder subluxation is unfortunately already present, taping would then be a smart move to prevent further separation & pain prevention.  If that limb looks unstable during transfers or is causing high pain–it may be time to consider our old friend the sling. 

So, it’s all about being up to date with the latest research in combination with the clinical presentation and needs of your patient–if something is not working well enough to meet their needs, do not be afraid to move on and try something else!


If you are interested in learning more about Stroke Rehab and upgrading your practice, check out our fantastic, 7 Contact Hour course, In-Patient Stroke Rehab: 14 strategies to get your patient HOME!  to get great techniques and tips to get your patients back to where they want to be: back home!


Interested in more clinical tips, articles, and resources for your practice? Sign up for our bi-weekly mailing list below! We promise to treat your inbox with the respect and love it deserves 🙂

Self Care and Dementia: 5 Steps to Promote Agency

Completing self care activities including dressing and bathing can be a stressful and frightful experience for the patient with dementia.  They are exposed, potentially in an unfamiliar environment and all too often being made to follow the lead of another person.

Let’s talk about 5 steps we as practitioners and caregivers can take to promote the agency and independence of the patient with dementia–improving their experience and yours all at once!

1 – Prioritize and promote their ability to make decisions

Giving your client agency on choices will help associate your assistance–and the completion of self-care tasks overall–with a positive emotion.

Yes, this means taking the hard no or modifying your expectations for completion of the bathing and grooming task.  While it may not be ideal, completing even a small part of a bathing routine 

If your person is able to, giving them simple choices will make them feel more in control over the task overall and decrease feelings of being tricked or controlled.  Simple choices like what soap to use or if they want to wash their hair or body first will help your person feel more autonomous.

To read more about intervening and helping your patient with dementia manage distressed behavior, check out this article!

2 – Lean on old habits

Your person may have a preferred routine for how they wash themselves or complete a grooming task–like brushing their teeth before they wash their face, or always bathing in the evening versus the mornings. 

 Using these routines and habits to your advantage will decrease the likelihood that your person will feel unsafe, frustrated or frightened and potentially decrease the amount of assistance of cues they require to complete grooming/bathing.

Again, this returns as much control to your person. 

3 – Protect privacy

Try to have a familiar caretaker or preferred provider assist with bathing when possible to reduce feelings of being exposed.  Self care for those dementia can be made easier if there is a safe relationship already established with a trusted carer.

Keep towels on-hand for them to cover up with if they find that more comfortable

Be sure they have access to washcloths and towels in-hand while assistance is given so they can participate and/or cover up.

4 – Minimize steps when possible

Minimize steps with 2-in-1 shampoo/conditioners or body wash/shampoos.  This will reduce the amount of time spent on the bathing task overall

Reduced steps also allows your person to have more autonomy over completion of the task with potentially fewer cues for completion–setting them up for success.

Grab this handy self-care checklist to help with communication when working with your patients with dementia!

5 – Address potential fears to increase willingness

Knowing your person well will be a major strength in identifying what potential barriers or causes of fear may be ahead of time.

For example–It is not uncommon for people with dementia to have fear around stepping into a tub of water; ways to work around this potential barrier would be filling up the tub while your person is already there, using a shower hose or taking sponge baths.

Learn More with ARC Seminars!

Undoubtedly, promoting agency with people with dementia can help patients live safer, more comfortable, and more independent lives. Visit ARC Seminars today to learn how we empower clinicians to treat intimidating conditions like dementia and more!

Plus, register for our self-paced seminar ‘Settled and Secure’: Managing Challenging Behaviors Associated with Dementia to access applicable techniques and skills for engaging with patients, building rapport, and fundamentally improving the way you work with clients.

Interested in more clinical tips, articles, and resources for your practice? Sign up for our bi-weekly mailing list below! We promise to treat your inbox with the respect and love it deserves.

Heterotopic Ossification: Why Therapists Need to Know HO

Heterotopic Ossification can be confusing, misunderstood and underdiagnosed in sensitive patient populations including TBI, SCI and ortho. Learn why HO is not your average diagnosis and what you can do to protect your patients.

Why Therapists Need to Know Heterotopic Ossification

stretching to prevent heterotopic ossificationAbnormal bone growth in non-osseous tissues like muscle and other connective tissue?  It sounds like a sci-fi phenomenon that one would only encounter in a movie or on some dramatic medical television show.

In reality, heterotopic ossification (HO) occurs in 10-20% of patients with severe trauma and insults to the central nervous system (CNS), and 20% of people with severe brain injury.   That percentage can climb up to as high as 50% if there is severe brain injury and concomitant femur fracture.  Patients with brain injuries are at greater risk for developing heterotopic ossification if they have significant spasticity in the involved extremity, unconsciousness lasting longer than 2 weeks, long-bone or associated fractures, and decreased range of motion (ROM).

The risk of development of heterotopic ossification in a patient with brain injury increases as the severity of injury, length of immobilization, and duration of coma increase.  The incidence of HO. in military amputees related to conflicts in Iraq and Afghanistan has been found to be as high as 65%.  HO poses a threat to the integrity of wound healing, rehabilitation, and prosthetic fitting.

What Exactly is Heterotopic Ossification?

 HO is essentially bone growth in tissues like muscle and other connective tissues. Several terms have been used to describe the condition, including heterotopic ossification, ectopic ossification, and myositis ossificans .  HO is usually induced by fracture, burn, neurological damage including brain and spinal cord injuries and joint replacement.

Patients with HO experience swelling of tissues, inflammation, pain, limited motion and joint adhesion.  HO can be further specified into three categories:  myositis ossificans progressiva, myositis ossificans circumscripta without trauma (also known as neurogenic HO), and traumatic myositis ossificans.

Myositis ossificans progressive:  a rare metabolic bone disease present in children with progressive metamorphosis of skeletal muscle to bone
Myositis ossificans circumscripta without trauma:  also known as ‘neurologic heterotopic ossification’ localized soft tissue ossification occurring after neurologic injury or burns

Traumatic myositis ossificans:  occurs from direct injury to the muscle; fibrous, cartilaginous, and osseous tissue near the bone are affected and the muscle may not be involved.

For purposes of this article, we’ll be focusing on the latter two types of heterotopic ossification.

How is Heterotopic Ossification Diagnosed?

Not all people who experience trauma or severe brain injury are going to develop heterotopic ossification, however it is important as a clinician to know the signs and symptoms.  This will ensure early intervention for services rendered, preventing additional loss of function and interruption in therapeutic services. It is important to note that 75% of post-traumatic HO was diagnosed in the rehabilitation unit.

If you work in inpatient rehabilitation, you know that someone’s time there is both limited and precious–something like a missed heterotopic ossification diagnosis can completely derail your patient’s rehabilitation course.  Learn more about 14 Strategies to get your CVA patient home quicker!

The first signs and symptoms of heterotopic ossification are reduced joint ROM and painful ROM testing, swelling, erythema, and contracture formation.  In people with severe neurological impairment, other signs including autonomic dysfunction and local inflammation in addition to ROM should be considered.

Local pain and a palpable mass may be present one to three months post-injury, however in severe brain injury, HO may be present up to seven months post-injury.  Things like laboratory tests, radiology studies, and bone scans should be utilized to accurately confirm an HO diagnosis.

heterotopic ossification labs

Lab Tests:  Alkaline phosphates should be measured, as there has been shown to be a correlation between a rise in levels and level of ossification. There is also evidence supporting that when alkaline phosphate levels return to normal, ossification will have stopped.

Radiology:  X-rays will not show HO in the acute phase of inflammation when there is still active pain and swelling.   X-rays taken 4-5 weeks post injury will begin to show immature ossification and possibly mature bone growth.  It can take anywhere from 8-14 months for HO to reach full maturity, so repeat imaging may be in the patient’s best interest if HO is suspected.

Bone Scans:  Triple phase bone scanning has been the most effective diagnostic method for early detection of HO as it detects early increases in vascularity.  The first and second phases of the triple-phase bone scan show increased uptake. Areas demonstrating increased blood flow and soft-tissue concentration of the tracer on early imaging (blood flow phase) correlate with sites of subsequent HO development. The optimal timing of the imaging for accurate assessment of the presence of ectopic bone has not been established, but 3 weeks or more following the injury should be sufficient for early detection (Bruno-Petrina, 2021).

How is Heterotopic Ossification Treated?

Therapy’s role in the management of HO is challenging and somewhat ill defined.  The goal of HO management should be to maintain ROM in order not to lose any function.  The literature generally supports the common use of active ROM exercises and gentle, passive ROM exercises to maintain available joint motion and to avoid progressive contractures.

There has been no evidence found for increased HO or decreased ROM with passive ROM exercises.  Surgical intervention can also take place to remove the abnormal bone growth if it is severely impairing functional mobility, but it is recommended that take place approximately 18 months post injury.

Can Heterotopic Ossification be Prevented?

learning about heterotopic ossification

The short answer is possibly.  (Per Sun in 2021) Prevention involves identifying patients with high risk of developing HO. It is important to note that routine prevention on all patients is not recommended. Current recommendations for prevention of HO are gentle ROM exercises, pharmacologic agents (indomethacin and etidronat), and external beam radiation (which is primarily used after joint arthroplasty).

Management of risk factors, such as spasticity, is also incredibly important. NSAIDS are thought to reduce the inflammation around joints which could prevent the development of HO.  Indomethacin is the most commonly used NSAID for prophylaxis, with other effective NSAIDS being meloxicam, celecoxib, rofecoxib, and ibuprofen. Etidronate is a bisphosphonate–a type of drug that slows bone loss–that has been approved for prevention of HO in spinal cord injuries and complications of total hip arthroplasty.

How Can I Improve my care for Patients with Heterotopic Ossification?

Be well informed--especially if your setting has patients who are at risk of developing HO–it puts you one step ahead if you are up to speed with the potential complications that can occur with a particular patient population.  Seeking out meaningful continuing education and collaborating with the interdisciplinary care team is a great way to stay on top of the most recent developments in HO treatment.

If you feel a patient is meeting the criteria for development of HO or is beginning to display early symptoms, speak up!  Speak with the physician regarding your concerns and ensure you bring the data with you to validate your claims.  It cannot be stressed enough that the best treatment for HO is prevention–prevention of the abnormal bone growth as well as prevention of  any further physical complications if the bone growth occurs.  Advocate for your patients, and educate your fellow staff members & fight back against HO.

Interested in more clinical tips, articles, and resources for your practice? Sign up for our bi-weekly mailing list below! We promise to treat your inbox with the respect and love it deserves.

Fall Prevention: It is So Much More than Rug Removal

I’m definitely not saying rugs aren’t public enemy #1 when it comes to fall prevention–in fact my peers have joked before about my personal vendetta against the throw rug.  But fall prevention is a much bigger issue–falls are the #1 cause of injury, hospital visits due to trauma and death from injury among people 65 and older.  It’s time we take fall prevention one step further (but seriously, get rid of those throw rugs, people).

Falls are a Serious Cause of Injury

Especially if you’re working with geriatric populations. It is estimated that in a year, one out of every three older adults will experience a fall per year and that every ~11 seconds, an older adult in the US will be treated for injuries related to a fall.  Falls result in almost 3 million injuries treated in ED’s annually, including over 800k hospitalizations and 27k deaths.  If all of this wasn’t enough to stress the severity of falls–they also account for 48% of all acquired brain injuries. There are losses associated with falls that aren’t represented in many data points that are important for practitioners to be cognizant of– loss of mobility, independence, functional decline, mental health and overall quality of life–all things we aim to prevent or protect for our patient populations.

Well that’s intimidating—Who specifically is at risk for falls?

Is it helpful if I say everyone?  On a serious note, it is important to recognize that not just elderly people are at risk for falls.  People challenged with low vision, polypharmacy, balance and gait issues, and any impaired memory or mental status are all at increased risk for falls both within the home and community.  It may seem obvious that people with a history of falling are at increased risk–but even the first initial fall doubles the likelihood of subsequent falls–so it is worth the mention.  People with ill-fitting footwear are also at an increased risk for falls, so be sure to exercise extra caution with your slipper-loving patients.

Check out ‘Slippin’ on Slippers: How to reduce falls through footwear’ to learn more about footwear’s role in falls!

Fall Risks Within the Home

It can be terrifying for patients to consider the possibility of falling within their home–what is normally a safe space for them is suddenly a potential danger.  For good fall prevention interventions within the home, it will be important to empathize and respect your person’s potential hesitancy to make changes.  After all, if someone came into my home and tried to tell me my Target haul of decor was a potential safety hazard, I probably wouldn’t invite them back.

For fall prevention within the home, generally you will want to be sure that paths, stairways and any thresholds are clearly lit, secure and free of clutter.  If there are concerns about low vision or impaired perception, contrasting colored tape can be used to mark steps and thresholds.  Bilateral, sturdy handrails are ideal for any stairs or inclines.  Encourage your patients to reduce or eliminate floor clutter including shoes, decorations, power cords and the like.  Poorly lit areas and low-visibility areas like a tight bedroom space also present a fall risk.  Encourage your person to consider properly installed grab bars in the bathroom and educate them on safe use.  And it almost goes without saying–those loose throw rugs are a huge fall risk and should be secured down at all edges if your person is unwilling to part with them.

Fall Risks Within the Community

Falls within the community are difficult to track and therefore underreported, however people with good community mobility are naturally at a higher risk for outdoor and community falls.  Uneven pavement on sidewalks, lack of sidewalks or interruptions in sidewalk continuity and sloped surfaces are potential sources of falls.  Areas with poor lightning, poor drainage and potential for ice also increase the risks for community falls.  If you are working with a person that is an active driver, consider referring them to the CarFit program and ensuring their balance is strong enough for getting in and out of their vehicle.  Balance will be an important area to look at for persons mobile at the community level–looking at you, uneven sidewalks–to be sure they can navigate walking spaces that are not necessarily the safest.  Footwear with proper fit and traction for grip will also help reduce the likelihood of a slip and fall.



Assessments for Fall Prevention

There are a plethora of outcome measures for use to determine a persons’ potential risk of falling–check out these two resources here & here for some great measures.  These outcome measures should always be used in combination with skilled observation and clinical judgement in order to best determine someone’s fall risk and preventative steps to take.  Having a strong understanding of your person, their habits and lifestyle will aid you greatly in enacting fall prevention measures.

What fall prevention interventions can I use?

It goes without saying that your interventions should be tailored to the needs and priorities of your person, so keep that in mind while we suggest the following starting places.  In addition to the aforementioned education & environmental modifications, there are a few great interventions to check out for fall prevention.  Primarily, recognize that there is a way to fall right.  Reviewing and practicing with your person how to fall correctly, get up from a fall and ways to protect their body best in case of a fall is an excellent harm reduction method.  This can take some of the fear out of the potential of falling and empower your person to feel more secure in their ability to recover safely should a fall happen.  Reactive balance training can be a great way to improve your person’s ability to recover their balance and prevent falls in addition to strengthening full-body.  In addition to this, balance rehabilitation approaches in general are always a key intervention point for fall prevention.

Okay, I got it. Fall prevention is serious and not just limited to in-hospital and in-home measures…where can I find more information?

Thrilled you asked!  The National Council on Aging has amazing resources & educational information valuable for both clinicians and families.  USC Leonard Davis school of gerontology has excellent resources including state-specific links, considerations for patients of different ethnic backgrounds and economic backgrounds, and fantastic resources for home modifications.  They host an expert in home modifications for fall prevention monthly, so be sure to not miss out!

Learn More About Practical Aspects to Fall Prevention ?

At ARC Seminars, we’re here to empower clinicians to treat intimidating conditions. To continue your education and further develop your skills to treat patients with the best care possible, register for our self-paced webinar Update Your Care Plan: Balance Rehab today!

Interested in more clinical tips, articles, and resources for your practice? Sign up for our bi-weekly mailing list below! We promise to treat your inbox with the respect and love it deserves.

Top Tips for Preventing Hospital Readmission

How Nurses Can Help Reduce Hospital Readmissions

Reducing hospital readmissions is not only better for your patients’ health—it can also prevent your healthcare facility from facing financial penalties. Fortunately, there are many ways nurses can help reduce hospital readmissions. Read on to learn how to better assist your patients with our tips!

Key Strategies for Preventing Hospital Readmission

Assess Physical Function & SDOH Barriers

Assessing patients’ physical function thoroughly before discharging patients is the first step in preventing hospital readmission. After a proper assessment, you’ll be entirely sure that your patients are ready to leave the facility.

Additionally, you must account for potential social determinants of health (SDOH) barriers before discharging patients from the hospital. SDOH barriers, such as transportation access or housing instability, are common causes for hospital readmission. Understand your patients’ living situations and needs and make a comprehensive plan tailored to patients’ risks before discharging them.

Grab this Free ‘Care Approaches’ Cheat sheet to enhance your dementia practice!

Educate Your Patients

Patient education also goes a long way in reducing readmission. It is essential to make sure patients understand their conditions, know how to communicate their needs, and are informed on future health precautions and needed treatment. This education should start while the patient is hospitalized and continue throughout their treatment and beyond.

Plan for Post-Acute Care and Rehabilitation

Finally, successful and thorough transitions of care are critical in reducing readmission. Patients having access to comprehensive rehabilitation services promptly and consistently after being discharged is also integral to reducing readmission.

When implementing post-acute care (PAC) and rehabilitation strategies, make sure all of your patient’s care team are informed on the patient’s needs, risks, medication safety, and any other information needed to keep your patient safe and healthy. Communication between the PAC provider and the initial provider is vital for PAC success and hospital readmission prevention.

Consider Telehealth Services

Monitoring and manipulating patient data in a streamlined way, such as with a telehealth service, can help keep track of patients’ health and progress and alert you of any issues before readmission becomes necessary.

Communication with patients is key to reducing readmission, which is another reason why telehealth or other encrypted and secure communication services can help open lines of communication and maintain consistency in provider-patient communication. Choose a system that works for your facility’s and patients’ needs. Think about your patients’ age, abilities, and access to technology when choosing a telehealth or communication platform.

Implementing Strategies

While each of these tips can help reduce hospital readmission in your patients, implementing several readmission reduction strategies in conjunction further increases your success. When used together, your facility will see a lower frequency of readmission than just implementing one strategy at a time.

Grow Your Skillset with ARC Seminars

Understanding the leading causes of hospital readmission and educating yourself on successful strategies for preventing readmission are critical in providing your patients with the best care possible. Care doesn’t end when your patient is discharged, and ensuring your patients’ long-term health and safety are paramount to being an effective healthcare provider.

To continue your understanding and education on best practices for decreasing hospital readmission, register for one of our courses or one of our self-paced webinars today!

Like this article? Sign up to our mailing list for weekly education right to your inbox! We promise to treat your email with the respect and love it deserves 🙂