How do we RETRAIN the BRAIN?

Ever wonder how to RETRAIN the BRAIN? Read on learn all about the wonderful world of NEUROPLASTICITY….

I asked a patient of mine to do a particular exercise "100 Times a Day" last week. I told him I didn't care if he did it 100 times in a row or if he breaks it up throughout the day, but I told him it was the only thing I wanted him to focus for the week. I walked in today, and not only did he tell me he's done it every day, but that one night he went to bed at 11:30PM, realized he forgot and got OUT OF BED to do his last 25. (Yes, this WAS the highlight of my day!)

Now, this is not something I do all the time, and certainly not an effective way to strengthen a muscle or stretch something tight. But what I wanted to do, is 'retrain' his brain to recognize a movement pattern and perform it better to improve his walking pattern. Did you know it takes an average of 2000 trials for an animal to learn a reward-motivated pattern (like tapping a lever for a treat), and even more for athletes or musicians to master a new motor skill involved with their sport or craft?

Rehab is no different. If we are asking our patients to make changes that we hope become habit, we need to follow the principals of neuroplasticity (neuro-what??! Yes, neuroplasticity is one of my favorite words - no surprise there, right!). Neuroplasticity is the ability for the brain to change - and this change can be positive, like learning a new skill, or negative, like losing a motor pattern like walking, dressing or eating, after experiencing a stroke, brain injury or other neurologic injury.

So what encourages 'positive neuroplasticity' - and how DO we 'retrain the brain?' It's simpler than you may think:

1. Repetition: Back 'in the day,' (aka when I went to grad school), it was thought that we had to complete repetitions in perfect form to retrain the brain properly. This meant lots of hands-on guidance from therapists, and even passive exercise like forced cycling. Fortunately, what the research has shown lately, is that the movement doesn't have to be perfect, but it does have to be repetitive...and INTENSE.

2. Intensity: Like the old adage says, nothing good ever comes easy, and harnessing the power of neuroplasticity is no different. Retraining the brain is just like strengthening a muscle. If I wanted stronger biceps, lifting a one-pound weight over and over is not going to cut it. I'd have to lift something heavier than I can currently handle, to stimulate the muscles to grow STRONGER to be able to manage this new load. The brain is the same. We need to give it a task that requires focus, concentration and demands attention. It needs to be INTENSE to give the brain a good reason to pay attention!

3. Saliency: PS. It's also got to MATTER. The brain pays more attention to something that it cares about. Picture someone on an assembly line doing the same menial task day in and day out. This is not salient to that person, but making money to feed his or her family may be, so they show up and do it again each day. We've got to choose tasks, and activities that are interesting, motivating and personally relevant to our patients, to encourage neuroplasticity. Whether this means linking an exercise or activity directly to one of their personal goals, or engaging them in activity that they get joy, pride or some other form of satisfaction from participating in, it’s got to MATTER to make a DIFFERENCE.

4. Repetition: See what I did there? (ahh, PT jokes...), but seriously, repetition MATTERS, maybe more than anything on this list. I'm learning as I become a more experienced (/OLDER) clinician to give less, while giving more. Ever been gone to PT and been given 10 pages of exercises only to 'lose them' on the way home, or tuck them away somewhere never to be seen again? (yes, I have too...no judgement here). What if we give them ONE thing to focus on - that hits all these criteria - something intense, meaningful and challenging - and ask them to do it over and over again? THAT'S where the magic is going to happen.

So back to my motivated, compliant, amazing patient above. Guess what? I came back to today, and he was walking BETTER. Five days of specific focus on one activity. It works, guys, I promise...

Who are we and where do we go?

Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.

We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.

How to Reduce Your Chance of Dying from Covid-19

Two recent studies came out that I think every Adult over 50 should know about. Read on for a brief review of these two journal articles + 5 Simple Ways to INCREASE your physical activity level to REDUCE your chance of death and disability from Covid-19.

First off, a September 2022 American Journal of Physical Medicine and Rehab (Physical Activity and Physical Activity Participation Barriers Among Adults 50 Years and Older During the COVID-19 Pandemic - PubMed (nih.gov)) looked at the impact the Covid-19 pandemic has had on exercise and physical activity levels in Adults over 50 years old in the United States. Now let me preface this with the fact that even prior to 2020, 60-80% of Older Adults were ALREADY not meeting the recommended levels of weekly physical activity that have been established to achieve improved health outcomes. (To remind you, this includes at least 150-300 Minutes per week of Moderately to Vigorously Intense Physical Activity + 2-3 Days per Week of Strength Training.) This study found that since the pandemic began, 43% of adults over 50 surveyed in this population report a FURTHER REDUCTION in their overall physical activity. Not surprisingly, common barriers cited included anxiety, difficulty accessing places to workout and difficulty committing to exercise. Further, individuals with heart or lung disease or a history of falling had further odds of reduced physical activity (and these are the folks that arguably need it the most!)

Secondly, and here's where this gets even more mind-blowing, the CDC released a systematic review of 25 studies that examined the impact of physical activity and Covid-19 outcomes (Brief Summary of Findings on the Association Between Physical Inactivity and Severe COVID-19 Outcomes (cdc.gov)). Not surprisingly, the data OVERWHELMINGLY indicates that reduced physical activity is associated with increased risk of hospitalization and death from Covid-19. Given the association between reduced activity and cardiovascular disease, obesity and diabetes, and the link between these diseases and worse outcomes in Covid-19, this, of course, makes total sense.

So, as we enter the FOURTH year of this never-ending pandemic, it is GLARINGLY CLEAR (to me, at least), that it is even MORE IMPORTANT, to help people find a way to make exercise a part of their everyday lives, ESPECIALLY when they have barriers to access and/or physical impairments or health conditions that impact their ability to do so. Healthy Aging Physical Therapy can be your partner in health and wellness and can help you INCREASE your Exercise and Physical Activity. If you find yourself limited by pain, fear, falls or physical limitations, we WANT to help you find ways to move better and move more. Whether you join us for a group class or prefer 1:1 Therapy or Wellness, give us a call, text or email and we'll find a way to help. 

In the meantime, here are 5 Simple Ways to Improve your Daily Activity to REDUCE your risk of hospitalization and death from Covid-19:

1) Increase your Daily Step Count.

It doesn’t matter if you take 10 steps a day or 10,000, adding to your daily step count is a simple and effective way to increase your overall physical activity. If you spend most of your time at home, try to add an extra lap around your house each time you walk to the bathroom. If you go out and about each day, park a little further from your destination or walk an extra lap or two around the store. If you’re already pretty active, try using a step counter or Apple watch and increase your Step Goal by 500-1000 steps each month for some extra motivation.

2) Build in some Exercise Snacks.

‘Exercise Snacks’ are just what they sound like - quick 1–2 minute exercises you can ‘snack on’ throughout the day. Pick simple, but effective exercises like sit to stands, counter pushups, marching in place as fast as you can or standing on one leg to work on your balance and try to do these a few times a day. It can be helpful to ‘habit stack’ by doing them before or after another ‘habit’ you already do daily, like making your coffee, washing your hands or feeding a pet. Make a mental note that each time you do that ‘habit,’ you also have to do 10 sit to stands (or other ‘exercise snack’ of your choosing).

3) Try an Online Class or You-Tube Video

With Covid-19 came a big growth of Online Fitness programs. Healthy Aging offers Strong Bones, Strong Life and Back School virtually (Read more or sign up here!) or you can simply jump on You Tube and try one of the many free programs out there designed for Older Adults. Some of my favorites include Silver Sneakers, HasFit and Yoga with Adriene.

If you need work on your balance, you can even join me for an Otago Workout. The Otago Program is an evidenced-based balance program that has been shown to reduce risk of falls by 30-40% when performed regularly. You can try it with me here.

4) Consult with a Professional.

There’s no shame in needing a little help. Even I see a trainer twice a week! Whether you’re starting from scratch or already active and just want some guidance on the best exercises for you, Physical Therapists or other Rehab Professionals are here to help. We can help you develop a safe and effective exercise program that not only improves your overall health and wellness but addresses specific problems like shortness of breath or fatigue, weakness or pain or balance and instability that may be impacting your function or your ability to exercise regularly.

5) Don’t get overwhelmed by the big picture. Just take it one step (or stair) at a time.

Take a moment to think about a giant set of stairs. The idea of climbing the whole thing may be daunting, but how would it feel just to think about climbing one step? Try to think of increasing your physical activity in the same way. If it’s overwhelming to think about trying to meet the ‘recommended weekly amount of exercise,’ just think about what you can do, today, to take one small step in that direction. Each day you take a small step, you’re further up that flight of stairs, and closer to those guidelines. Even if you never hit ‘150 minutes’ there is plenty of evidence that even increasing your weekly physical activity a little can make a big difference in your health. So even if that ‘staircase’ feels too big, just focus on the first step. Consistency over time creates change and progress, no matter the speed, will still take you in the right direction.

Who are we and where do we go?

Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.

We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.

Breaking up is hard to do…

Believe it or not, I hate discharging patients. It’s always a hard conversation. I become attached. They become attached. Most people feel BETTER after their therapy visits and who would want to stop that? But the truth is, we can’t see you forever (except sometimes, but that’s a story for a different blog post). So, I penned this Dear John letter to put all my feelings into words and let you know what is actually going through our heads when we come to the hard decision that it is time to discharge you from your physical therapy care.

Dear discharging patient,

I know this isn’t the news you wanted to hear, but the time has come to discharge you from therapy and breaking up is hard to do. But for the record, this is hard on us, too. Believe it or not, we physical therapists really do feel truly invested in your success. Given a choice in the matter, we would love to keep visiting you, having our chats, helping you move and feel better. And could you benefit from more therapy? Sure, everyone could use some physical therapy every day! But can I ethically keep charging your insurance for it? Unfortunately, no.

It’s not me, it’s you - but I want you to understand why. Somewhere along the line, and fortunately so, Medicare decided we therapists have enough education to make the call as to what is so-called not only “medically-necessary,” but also “skilled” and “reasonable.” And believe it or not, and contrary to common belief, it’s not all about whether or not you’re improving! ‘Medical-necessity’ supersedes your potential to improve. It may be as ‘medically-necessary’ to help you heal from a broken hip to get you back to work, as it is for us to help you deal with a progressive or terminal illness - even if we know you’ll never get back to where you were before. Sometimes, we can keep you on forever, but only if you really need to in order to prevent imminent decline or progression of your disability (but these situations are pretty specific, and if we are discharging you, it means you don’t qualify under these conditions - we’re really sorry!).  

So, what’s this about being “skilled”? Ask yourself this question: does what my therapist is doing with me absolutely require he or she to be present for it to ‘work’ or could I do this on my own or with someone else helping me? If the answer is no, then your therapy is no longer skilled. ‘Reasonable’ speaks to industry-standards. The therapy profession continues to develop evidence-based practice standards and it is expected that the therapy we provide falls under these commonly accepted care guidelines. And this is a good thing! It means your therapist is required to provide a certain level of care that should reasonably be expected to help you - or they shouldn’t be getting paid for it!

We truly hope that what we have taught you will help you manage your pain, injury or illness on your own. If we are discharging you, it’s because we truly think you are capable of taking care of yourself now, or we think you have the support in place to do so if you need the help. But this doesn’t have to be goodbye - it is really just a ‘see you later.’ Why? Because we’re here for you! If you need us again, just call. We want to be your go-to gal (or guy) if your pain comes back, if you’re feeling worse, or if you hit any other bumps in the road. Just like you call your doctor if you’re feeling sick, don’t hesitate to call us if movement and mobility problems are interfering with your life. So, while this is goodbye for now, but don’t be a stranger! 

Sincerely,

Your (also very sad) Physical Therapist

Medicare B - Demystified!

As a ‘Medicare B’ therapy practice, we hear all sorts of crazy myths and misconceptions that often keep people from getting the care they need. Read on to hear about the top 5 Medicare Myths and learn how you can make the most of your Medicare B Therapy Benefit.

Myth #1: You can ONLY have At-Home PT AFTER you have a hospital stay.

WRONG! Busting this myth requires a quick breakdown the different types of Medicare benefits.

Medicare A covers anything INPATIENT: Hospital stays, rehab stays and the type of In-Home PT that happens when you receive VNA (visiting nursing agency) care. You must be HOMEBOUND to receive this level of care.

Medicare B covers anything OUTPATIENT: Doctor visits, imaging and outpatient rehabilitation. HOWEVER, your outpatient therapists CAN provide services at a clinic OR in your home. This is how Healthy Aging Physical Therapy operates - we are a Medicare B credentialed rehab clinic who offers AT-HOME Physical and Occupational Therapy. And bonus, you don't HAVE TO BE homebound to receive Medicare B covered therapies.

So, now we can BUST this common Medicare Myth and confirm you CAN have At-Home PT at any time - whether you've been at at a hospital, had PT suggested by your doctor, or simply think you could benefit from our services.

Myth #2: You've got to see your doctor FIRST to get a referral for At-Home Physical Therapy.

WRONG! Physical Therapists are 'Direct Access' clinicians, which means we can see you FIRST, and without a referral from a physician if you are a Medicare beneficiary. While it is our responsibility to send our evaluation on your PCP for certification, you do NOT need to see your doctor first to get a referral for At-Home Physical Therapy.

Myth #3: There is a 'Cap' on how many PT visits you can have each year.

WRONG! The idea that there is a 'cap' on how many visits you can have each year is OUTDATED and INCORRECT. Medicare B covers Physical Therapy as long as it is 'Medically Necessary' and there is no set number of visits you can 'have' each year.

What does 'Medically Necessary' mean? It means you have a physical impairment, or multiple physical impairments, that impair your ability to function and participate fully in the every-day activities of your daily life. While you don't 'run out' of visits, a physical therapist may determine you no longer qualify for skilled physical therapy when you have made enough progress that it is no longer medically necessary - or when you are independently able to maintain your health and wellness without further skilled intervention.

Myth #4: If I stop improving, Medicare will stop paying for my therapy

.

WRONG! Although this myth requires a little more nuance, there are situations in which Medicare will continue to cover care, even if you have improved as much as you likely will - or even if you are getting worse.

Medicare B will cover what they call 'Maintenance Therapy,' if these services are necessary to keep an individual from progressing towards further disease or disability IF such a program continues to warrant the skills of a licensed physical therapist. Sometimes this requires weekly visits, and more often, monthly or every few months to check in, assess the effectiveness of the program and make changes as indicated.

Clinically, this kind of therapy can be CRITICAL to someone living with a chronic disease. These check-ins can allow us to identify problems early, before they become bigger issues, and keep you on the right track without so many ups and downs.

Myth #5: You can't see us for PT if you have a MEDICARE ADVANTAGE plan because we are 'Out of Network'. .

WRONG! Even though we are not enrolled with many managed plans (Blue Cross Blue Shield is the exception!), almost every Medicare Managed Plan has Out of Network Benefits. This means you can choose to see a provider that is willing to bill on your behalf and 'accept assignment' for your care. Healthy Aging Physical Therapy is happy to see you even if you have an Medicare Advantage Plan, like Tufts Medicare, AARP or United Health Care, if you have Out of Network benefits. Not sure if your plan covers Out of Network therapists? Just ask:) We're happy to call your insurance for you to check, and do the leg work to get a referral in place to get you the best care possible.

Here are 5 great reasons to use your Medicare B Benefit to see a physical therapist:

1) If you've had a fall or are worried about falls.

2) If you're having a harder time moving around your house

or out and about in the community.

3) If you're feeling weaker or more unsteady on your feet.

4) If pain is making it harder for you to walk, to take care of

yourself, your loved one or your home

5) If you've had a recent hospitalization, illness or injury.

Interested in Therapy with Healthy Aging PT?

Click Here to Schedule a Free Consultation Phone Call to learn more about how we can help you feel your best.

PWR! Moves for Parkinson’s Disease

This post is dedicated to PWR! Moves Mobility, a therapeutic approach both myself and Dr. Allison Leonard are proudly certified in. There are four main Moves we use in PWR! Moves Parkinson's Therapy. Each of them is special in their own way, but all of them work towards a strong, upright posture that lets you MOVE safety and efficiently in ALL of the direction’s life takes you.

You can read about this therapy on our website at https://healthyagingpt.com/pwr and check out some videos of these moves in action. Read on to learn more about each of these Moves and how they can improve your mobility if you are living with Parkinson’s Disease (or other Mobility Disorders!)

All about the PWR! Up...

The PWR! Up is all about ANTIGRAVITY EXTENSION. This move focuses on the STRENGTH and POWER to rise up from sitting, to squat down in standing and to get up and out of bed. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional muscle patterns that involve the glutes, quads, and scapular muscles and is a GREAT exercise for those of you who may feel STUCK in your chairs when you go to rise up.

All about the PWR! Rock...

The PWR! Rock is all about WEIGHT SHIFTING. This move focuses on the ROCKING and REACHING to achieve MOVEMENT outside of the straight plane. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional muscle patterns that strengthen your HIPS and SHOULDERS and is a GREAT exercise for those of you who may feel STUCK when you go to turn around or reverse directions.

All about the PWR! Twist...

The PWR! Twist is all about AXIAL MOBILITY. This move focuses on the SPINAL MOBILITY to achieve ROTATION across your body. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional movement patterns like OPENING AND CLOSING your arms and is a GREAT exercise for those of you who may feel STUCK when you go to roll over in bed or put on your shirt or coat.

All about the PWR! Step...

The PWR! Step is all about TRANSITIONS AND MOBILITY. This move focuses on the STEPPING STRATEGIES to achieve WALKING and MOBILITY. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional movement patterns like STEPPING and TRANSITIONING is a GREAT exercise for those of you who may feel STUCK when you approach a doorway or go to turn to sit in a chair.

Now that you’ve got an intro to the Moves, you can put them together for an entire Home Workout! Check out these great vides from the therapists at Parkinsons Wellness Recovery - the team that created the PWR! Moves Mobility Program.

PWR! Moves Seated Class

PWR! Moves Class - All Postures

PWR! Moves - Standing with Weights

PWR! Moves - Standing with Bands

To request an Free Phone Consultation to see How Healthy Aging PT can help you, click the button below:

To learn more about our Power over Parkinson’s Group Fitness Class, click the button below:

To learn more about BIG/LSVT & PWR! Moves Parkinson’s Therapy, click here the button below: