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 us 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 themselves. In some extreme cases, the victims start blaming themselves 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.

Treatment

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.

Medication

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.

Conclusion

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.

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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

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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?

Slings

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!


Taping

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

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!

 

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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.

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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.

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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!

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Keeping Your Cool:  How to Stay Calm at Work in Healthcare


Someone once was quoted as saying “You can’t control what happens to you.  You can only control how you react to it.”  This statement couldn’t be more true… but especially when it comes to clinicians, working with those who have sustained a neurological injury.

Controlling your reactions is easier said than done. To stay calm at work requires not only patience, but also some intense self-reflection.  It is very easy to get wrapped up in your emotions when you are working in a high pressure, high stress environment (i.e., healthcare).  Not only do you have to manage the patients and their families, but there is also schedules, equipment, co-workers, deadlines… the list goes on.  The question that probably always crosses your mind is “How do I maintain my composure when something intense is happening?”.

Suppressing your emotions is any given situation is not healthy, but it is important to remember that there is a time and a place for everything… emotions included.

Our priority should be facilitating a calm environment filled with mutual respect and support for our patients as they recover.  At the end of the day, that is why we are all in healthcare, right?  Modulating our own behavior can have a positive effect on our patients, especially those who are having difficulty regulating their own behavior.

So how can we maintain a calm, cool, and collected demeanor in the face of adversity?  The Crisis Prevention Institute (CPI) is a really great resource regarding verbal de-escalation techniques and management.  CPI was founded in 1980 to give people the tools to better manage conflict, and they believe that empathy, compassion, and meaningful connections are powerful tools to maintain a safe working environment.

CPI suggests the following as being the “Top 10” De-escalation Tips:

  1. Be empathetic and nonjudgmental
  2. Respect personal space
  3. Use nonthreatening nonverbal
  4. Keep your emotional brain in check
  5. Focus on feelings
  6. Ignore challenging questions
  7. Set limits
  8. Choose wisely what you insist upon
  9. Allow silence for reflection
  10. Allow time for decisions

The tips listed above are really great actionable items you can use to stay calm at work, when someone becomes agitated, confrontational, or upset (these can also be useful outside of work as well!).  We need to keep in mind that our patients are probably experiencing the worst time in their lives – we are unfortunately meeting them when they are not at their best, and are probably going to be unable to reason and regulate their own behavior/reactions to things. It is up to us, the professional, to take a step back and have empathy for our patients (and their families!).

Interested in learning about becoming a Certified Brain Injury Specialist? Download the FREE, 16-page Starter pack right here!

In addition to those things from CPI that can be done in the moment when things are escalating, there are also other things we can be doing at work to ensure we will stay calm and be ready to implement our training when needed:

Get training… often.

A ‘one off’ training focusing on de-escalation is not sufficient.  A training like CPI is a great tool to have in your toolbox, but it is just that… one tool in your toolbox.  There are other programs out there as well such as Handle with Care, and NAPPI.  You have to choose the training that is being going to fit the needs of your team, and your patient population.  Also, consider how you learn best.  Some people enjoy going to a live, in person seminar while others prefer a self-paced course that can be completed on their own time at home.  There is not one ‘magic training’ that is going to be a one size fits all and it is very important you do your homework to see what is going to fit you best.  Lastly, make sure the ongoing education needed is something that is going to be feasible for you and your team/facility.  You do not want to set yourself up to fail with something that is not going to fit into your schedule well.

Function as a team.

Management of crisis situations should not and cannot fall onto one person.  It truly does ‘take a village’ to be successful and ensuring all members of your team are adequately trained and comfortable with your facility’s plan is paramount to success.  If you see a colleague in situation that appears it is going to escalate, hang around and hang back.  Stay within an earshot so that way you are able to assist if needed.  Try and let your colleague know that you are there for them to increase that overall feeling of security.  It can also help to have a designated group of staff that will respond to a crisis situation.  There truly is safety in numbers and knowing that your team has your back will enable you to more effectively manage that crisis situation.

Decompress.

It is important that you build in some time to decompress after a crisis situation.  Emotions are running high, and there is a solid chance that your heart is beating in over drive.  Talk a walk outside, sit in a quiet space, or put on some comforting music so you are able to come down and refocus. The situation that you just handled did not go from 0 to 100 in .2 seconds, and you are not expected to come back to zero instantaneously.  It is more than ok to tell your work colleagues that you ‘need a minute’ to stay settled and calm, and that you will be available at a later time in the day.

Set aside time after you decompress from the crisis situation to discuss why and how the situation escalated how it did.  It is very important to talk through the good, the bad, and the ugly to further refine your process and response.  Constructive criticism and feedback should be welcome and viewed as an opportunity for you to refine your skills and self-reflect instead of punishment.  There is always going to be something that could have been better handled in each situation – no one is perfect (and that’s ok!)!

Self-care.

This term is a bit overused at times, but it is something that is vital for you to continue to be your best, calm self in the face of a crisis.  Taking a break from your 9-5 can assist you with being fresh and positive at work.  Self-care takes many forms, and can range from taking a short walk outside, to planning a relaxing vacation, to listening to some true crime podcasts in your down time.  You are no good to your patients and colleagues if you are not being good to yourself first.  You have PTO, USE IT!

As you can see, to stay calm in the face of a work crisis is so much more than just attending a one-time workshop on effective communication skills.

Getting training and education and just one piece of the self-regulation puzzle.  Taking a step back and looking at the bigger picture for the patient is always necessary.  Ask yourself “What am I doing to contribute to this person’s recovery?  How can I better conduct myself to ensure a calm, safe environment?”.  Remembering that it is not all about you, but the patient, can put things into a different perspective and assist you with how you can change your behavior.  The best thing you can do is treat everyone you encounter with a mix of warmth, professionalism, and respect… Remember, people may forget what said… people may forget what you do… but people will never forget how you make them feel – Maya Angelou

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.

Physical Therapy Continuing Education: Kickstart Your Career in 2022!


How to Choose the Best Physical Therapy Continuing Education Courses

With so many physical therapy continuing education courses out there, it can be difficult to know which ones to choose to further develop your professional skills. Fortunately, ARC Seminars makes it easy to do so, offering a number of courses to choose from in a variety of subjects. Keep reading to learn how to kickstart your career in 2022 with our physical therapy continuing education courses!

Why ARC Seminars?

We know you love to learn and grow your skills (our team does too!), but we also want to ensure you earn the credits you deserve for the courses you take. That’s why all of our professional development courses—including our physical therapy continuing education offerings—are flexible, affordable, and credible.

Our courses are approved for continuing education units by various organizations, including APTA Kentucky, the Physical Therapy Board of California, the American Occupational Therapy Association, and ASHA. Within each course, you’ll receive access to useful resources and information that are immediately applicable to your own practice, as well as guidance for setting up your own successful programs after your course concludes.

For any questions regarding your course certifications, contact our team for assistance.

Our Featured Physical Therapy Continuing Education Courses…

…For Mastering Neurological Conditions

Is your 2022 PT resolution to become an expert on neurological conditions? If so, you should check out:

  • Certified Brain Injury Specialist (CBIS) Training — One of the best ways you can super-charge the way you work is to become a CBIS. Specializing in acquired brain injury (ABI) and acquiring the Certified Brain Injury Specialist Credential (CBIS) is a great way to set yourself apart from your peers and indicate that you are dedicated to learning more about assisting patients with brain injuries. Our two-day training will prepare you to sit for the certification exam to join over 7,000 CBISs worldwide.
  • In-patient Stroke Rehabilitation: 14 Strategies to Get your Patient Home! — This course will empower you with cutting-edge techniques and strategies to treat people who have sustained a stroke in the in-patient setting! In this course, you’ll focus on real-life patients and the impairments and complications that they have secondary to a CVA, as well as address the most common issues that clinicians face and how to manage them.
  • Practical Approaches to Concussion Management — In this seminar, you’ll examine the common complications and side effects that can occur with concussions, or mild TBI. We teach assessment and treatment strategies that can be used to manage patients in the rehab setting, outpatient setting, and in-home care.

Download our Headache Management Cheat Sheet for FREE, right here!

  • Update Your Care Plan: Balance Rehab — In this 2.5 hour course, you’ll learn how to break free from providing the same intervention strategies over and over again by focusing on evidence-based and current research in the balance rehabilitation field. As with all of our courses, the skills and information presented in this seminar are immediately applicable to the clinician’s practice.

…For Gaining Valuable Expertise in Chronic Conditions

If your 2022 PT resolution is to become an expert in chronic conditions seen in all settings, we recommend exploring these:

  • Update Your Care Plan: Diabetes — Diabetes is pervasive condition that complicates diagnoses in many areas of clinical practice. Empower and update your approach to this condition with this course, which will equip you with knowledge of its varying causes, prognoses of different diabetic diagnoses, and complications to watch for, as well as provide you with goal-setting tactics, client-based labs, and case studies.
  • Update Your Care Plan: Heart Failure — With congestive heart failure (CHF) being an intimidating, devastating, and often underrepresented condition affecting millions of people worldwide, you need to ensure you have the most up-to-date and effective information to provide the best care possible. By enrolling in this seminar, you’ll learn how to debunk treatment myths, address fears and misconceptions, and make informed decisions when creating a plan of care.
  • Cancer Care: A Collaborative Approach — Prepare to upskill your therapy practice when working with the oncologic population! This seminar is presented by two expert oncology therapists, and will equip you with the knowledge and skills needed to debunk common misconceptions, utilize up-to-date therapeutic approaches, and bridge the gap between the patient and therapy/nursing.
  • ‘Settled and Secure’: Managing “Challenging” Behaviors Associated with Dementia —Challenging dementia-related behavior can be intimidating for many clinicians and clinical assistants to deal with, especially in a busy clinical environment. That’s why this seminar is a perfect choice for boosting your skills. Learn how to engage with clients, build rapport, and fundamentally change your ways of working during dementia care.

…For Growing Your Wound & Edema Management Skillset

Becoming an expert in managing wounds and edema will also set you apart from your peers. These courses will help you sharpen your skills:

  • Edema Management in Inpatient Rehabilitation This seminar will teach you techniques from Complete Decongestive Therapy to therapeutically manage edema in the in-patient environment, a setting where edema management is a chronically underserved and undervalued aspect of treatment. You’ll learn how to approach common conditions such as joint fracture and replacement, lymphedema, dependency edema, renal and cardiac insufficiency, and more.
  • A Comprehensive Guide to Wound Care: Tools for the Everyday Clinician — In this practical and user-friendly seminar, you’ll learn about the common causes and physiology of wounds, gain access to assessment tools, and explore management techniques and documentation/goal setting guidelines. Enhance your practice with accessible and applicable skills that you can use the very next day!

Not seeing the topic that you’re looking for? Contact us! We’d be happy to direct you to what you need, whether it’s one of our courses or one of our self-paced webinars.

Revamp Your Approach to Physical Therapy Continuing Education!

If you’re ready to make a commitment to expanding your knowledge and career in 2022, let ARC Seminars help! From physical therapy-focused courses to cancer care, dementia management, and more, we’re here to help you grow your clinical skillset for years to come.

Make your success a priority, and register for one of our courses 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.

What is Vestibular Rehabilitation Therapy (VRT)?


Understanding the types and uses of vestibular rehabilitation therapy can help you to better serve patients. Vestibular rehabilitation therapy (VRT) is a type of physical therapy used to alleviate problems caused by vestibular (inner ear) disorders such as vertigo, dizziness, gaze instability, imbalance, and falls.