May Staff Meeting Updates

Did you know that HAPT meets monthly to review patient cases and provide feedback and ideas, as well as for in-services and education? (Ten heads ARE better than one!) As much as I love learning, I love teaching even more, so thought I'd share a few lessons learned with you.

This month we were lucky enough to have two great presentations. First, Dahlia Cohen, Registered Dietician, spoke to us about Nutrition in Parkinson's Disease. We learned that weight management, in particular keeping weight ON, is a big issue for people with Parkinson's Disease. Not only are there changes in taste, swallowing and digestion that can be problematic, but due to the extra movement and muscle resistance that occurs in movement disorders, individuals with PD are often burning way more calories than normal during the day. This creates an energy deficit and this leads to weight loss. How can we help our patients with this problem? Here are a few ideas Dahlia gave us:

• Encourage 3 meals a day + 3 Nutrient Dense snacks (like greek yogurt, or nuts).
  

•  Make sure to get adequate amounts of protein throughout the day. Your body can only digest about 30 grams at one sitting, so one big steak at dinner won't cut it. Try adding in smaller amounts, more frequently, making sure to time around your meds (levodopa competes with protein for receptor access, so it can make your meds less effective if taken with protein!). Protein is best eaten 30 minutes before taking levadopa or 60-90 minutes after taking meds.

•  Don't forget your fiber! We need 25-30 grams of fiber/day for optimal digestion and bowel management, and constipation is even more common in PD because gastrointestinal motility is slowed. Adding in green vegetables, whole grains and beans to your daily diet is helpful, and supplementing if needed with something like Metamucil can be helpful when needed.

After we finished learning about what to take in, we talked about 'how it comes out' with our staff PT, Katie Moulison. Katie just finished a great course in Pelvic Health and shared some helpful considerations for working with individuals who may be experiencing incontinence as they age. Here are some helpful take home messages:

•  Incontinence is common, but not a normal part of aging and there is a lot we can do about it. Wondering if how often you wake at night to 'go' is normal? Normal nocturia (peeing at night) is waking 0-1 times to get up. If it's more often than that, it can disrupt sleep cycles, leave you more tired during the day and lead to increased risk of falls.

•  Dehydration, constipation and bladder irritants are all common causes of increased frequency, urgency, nocturia and leakage (PS. the acronym FUNL can help you remember what to ask your patients about!). 

•  If you're wondering about your own bladder habits, or trying to help a patient problem-solve their incontinence troubles, start by keeping a Bladder Diary and share it with a pelvic health specialist to get their take. There may be some simple strategies we can try to make it better!

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 NOT to Fall on the Ice this Winter

It’s Black Ice Season here in Boston and time for me to share my best tips for how NOT to fall on the ice.

But before I do, I have to share my #1, Hands-down, favorite video on the internet. This came across my feed years ago, and I still watch it every so often just because it cracks me up every time. I don’t know if it’s the dad’s laugh, or the fact that I so relate to spending hours waiting in pick up lines outside of schools, but it is absolute gold. Don’t worry, no teens were harmed in the making of this film.

Now, onto the good stuff. What is the best way to avoid taking a digger on the ice this season? Here are my Top 5 Tips to Keep You on Your Feet (and off your rear!) this Winter:

1) Invest in a pair of Ice Cleats:

These come in various brands, shapes and sizes, but a good pair of ice cleats can be your best friend. They are generally mesh and can wrap around whatever shoes or boots you are wearing to give you better traction on the ice. I typically recommend Yak Tracks (See on Amazon here), but LL-Bean also sells their own version (LL Bean Stabilizers), as does REI and other Outdoor stores.

2) Ice-Proof your Cane:

Whether you use a cane on a regular basis or not, it can be a helpful tool in the winter, especially if you add on an Ice-Tip (See Vive Ice Tip on Amazon here). Another great alternative is a hiking pole, and these generally come with a set of tips for various conditions as well (this one is the kind I typically use). Having something to ‘grab’ the ground with, in case of a slip, can be the difference between a ‘phew’ and a hard landing.

3) Walk like a Penguin:

When you’re out there trying to get from Point A to Point B, walk like a penguin! Take wide, short steps and avoid pushing off at the end. Basically, waddle like a penguin! It may seem silly, but it works:

4) Bulletproof Your Balance:

We all know that Prevention is the best Medicine and when it comes to walking around this winter, this is especially true. We all have these automatic fall-prevention reflexes, called Reactive Balance Strategies, that are designed to help us regain our footing after a loss of balance. Whether that is a little ankle rock, bending over at the trunk to lower your center of mass, or getting a foot out there to step and prevent a fall, these need to be practiced to remain effective! If you’ve been having falls, or even find yourself having a lot or near misses, it may be a good time to see a Physical Therapist to work on your balance. Even if you feel like your balance is pretty good, as you age, it’s a good habit to do some regular balance exercises to keep it up to snuff. Check out our Otago Exercise Page for a routine you’d an try at home, or join us at one of our Strong and STEADI sessions if there is one available near you. Looking for 1:1 Balance Training? Contact us today to see if we can help.

4) Stick the Landing:

Slips, trips and falls happen, so if you’re going down, you’re better off knowing how to land. We’ve put a page together with helpful tips on how to land safely to reduce risk of fractures and other injuries and practice this skill often with our patients. If it can mean the difference between a bump or bruise and a hip fracture or head injury, believe me, it’s well worth it. Check out our How to Fall Safely page here.

We hope these tips keep you on your feet and off the ice this winter! Physical Therapists like us are Fall Prevention Experts and we love to help. Read more below to learn about our practice, meet our therapists and find out how to get in touch so we can help you stay safe this winter.

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 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