January 2010 - Our first issue #1

In This Issue

  • What to expect: Knock, Knock - Who's There? Part 1
  • Fight back with fitness: Arthritis Part 1
  • Beefed up basics: Heel Slides
  • Avoiding home care PT: Fighting Debility
  • Safer than Safe: Ramps
  • Laughter: Boomer Busters :)
  • Green PT: Saving Your Dollars

My commitment to you

Welcome to Home Care Physical Therapy - What to Expect. My goal is to raise the standard of home health care delivered by physical therapists throughout this great nation by informing you of what to expect from your home health care physical therapist (PT).

Home care PT is almost never foreseen but an almost immediate necessity. In a day and age where we can Google everything for the best deal, service or advice, often the whirlwind of circumstances surrounding the need for home care PT leaves many uninformed and downright nervous.

I want to keep you as safe as possible. I'll be taking your hand and walking you through this maze of physical therapy at so you know what you can expect from those who have committed to help you with your PT needs.

Knowledge is power, sometimes you need to fill in the gaps... I'm giving you all the tips and tricks I know to do just that! If you like this e-zine, please do a friend and me a big favor and "pay it forward" by hitting the forward button and sending it on.

If a friend DID forward this to you and if you like what you read, please sign up here.

Knock, Knock - Who's There? Part 1

You taught your children and grandchildren to never talk to strangers - now it's your turn.

Home Health Care is just that - professionals coming to your house, knocking on your door. Make sure they are who they say they are.

Medical home care is usually initiated by you, your doctor or the hospital/nursing home that you are coming home from. Sometimes in the scurry of things, the patient is not informed of these details, or may forget.

The important detail to remember here is that Medicare will not pay for Home Health Care unless they have a doctor's order prescribing the services.

When the Home Health Agency (HHA) gets this order/referral, they have so many hours to get the services in place. The order typically goes something like this:

  • HHA gets the order/referral
  • HHA verifies insurance coverage
  • HHA calls you to set up an initial visit time in your home
  • Professional comes to your home at that time
  • Home care is initiated

Occasionally we will just "show up." That seems rude but here are some reasons why we would do that:

  • We were told you would be home on a certain date but we can't get a hold of you via phone
  • We were given the wrong phone number
  • We get the address of perhaps the friends home where you are staying but your own home phone number
These are rare but they do happen and more and more often. Sometimes patients come home and fall or have complications that leave them unable to contact help. The reason we just show up or do a "drive by" is to make sure that you are OK.

You still need to know who's there!

Find out how to know who's at your door in our next issue!

Fight Back With Fitness: Arthritis - Part 1

With over 100 rheumatologic disease, the two most common osteoarthritis (OA) (degenerative joint disease (DJD)) and rheumatoid arthritis (RA) (inflammatory, multijoint, multisystem disease).

OA seems to target a specific joint while RA works through the immune system to target joint tissues.

What you need to know:

  • RA can affect your cardio-pulmonary function - talk to your doctor before starting a vigorous exercise program.
  • Acute red, hot, swollen or painful joints are not ready for vigorous exercise.
  • RA can increase your resting energy expenditure. Keep this in mind when thinking about expending more with exercise.
  • Just like trying to walk through water or on sand, energy expenditure can increase by 50% due to pain and stiffness.
  • Pain and stiffness may limit your ability to perform rapid or repetitive movements such as fast walking or bicycling.
  • You can usually find some exercise to do to work around specifically painful joints.
  • Don't be afraid to use neoprene or other brace supports for deconditioned joints. Protect them from further injury.

Effects of Exercise Training

The most immediate benefits of an exercise conditioning program in the arthritic population seems to be the lessening of the effects of inactivity. People with joint involvement tend to be less active and therefore less fit then their active, unaffected peers.

What are your immediate benefits of a low to moderate gradually progressed exercise?

  • increase flexibility
  • stop muscle wasting
  • strengthen weak muscles
  • slow osteoporosis
  • enhance your ability to manage pain
  • enhance your energy level
  • lessen inactivity depression

Exercise smart. Change inactivity to activity. However, remember to protect your joints...they are, in a sense, injured. Become educated in how to optimize health while restoring function. Discover how to manage arthritis in a healthful, moderate, productive way in our next issue.

Beefed up Basics: Heel-Slides

From total knee replacements to general debility... any veteran recipient of home care physical therapy has no doubt done a few heel-slides! They seem somewhat benign and useless but let's look deeper.

Heel-slides as a strength training exercise can strengthen four muscle groups if they are taught correctly for the targeted muscle group.

A heel-slide consists of you lying on your back and sliding your heel towards your bottom (glutes) and therefore bending your knee.

For what you are trying to accomplish with this exercise, here's the inside scoop. Remember that the key here is in how you are consciously doing the exercise.

  • Hip Lifting Strengthening - (stepping over the bathtub edge or climbing steps) When sliding your heel towards your glutes, think, "knee to shoulder." This will help to target the hip flexer muscle.
  • Posterior thigh/knee Strengthening - (taking a step forwards in the walking pattern) When performing your heel-slide, remember to think, "heel to butt" This will help to target the hamstring muscle group.
  • Bending ankle up and down strengthening (pulling your toes up when you take a step and pushing them down when you roll off the ground from that step) For strengthening toes up: pull the toes and ankle up towards your knee while doing the heel-slide and think "knee to shoulder." For strengthening toes down: point toes down and think "slide-heel to butt" while doing heel slide.
  • For those info guru's out there... to strengthen the external or lateral rotators in the ankle, leg and hip, simply rotate the ankle outward while doing the heel-slide.
  • To strengthen the internal or medial rotators in the ankle, leg and hip, turn the ankle inwards while doing the heel-slide!

The heel-slide is a great exercise but take advantage of it to really key in on what you are trying to accomplish. Ask your physical therapist if you aren't sure.

Avoid Home Care: Fighting Debility

Simple, cost effective tips to get healthy and avoid home health care later in life:
  • Always try the basics first: rest, fresh air, sunshine, pure water, nutritious meals and freedom from worry
  • Detoxify your body
  • Cool the sex-o-meter - give your body a vacation
  • Cut back on coffe, tea, tobacco, chocolate, soft drinks, alcohol, and processed +/or junk foods
  • Get outdoors 30-60 minutes a day to work or walk
  • Try a cooler or cold morning to shower to invigorate you
  • Are you sensitive to chemicals or foods? Find out which ones and eliminate them
  • Include Vitamin C, magnesium and lots of green foods and water in your diet

  • Safer than Safe: Ramps

    There may come a time when your normal route of entry into your home becomes unsafe or impossible to navigate. This could be due to weakness on your part or perhaps frost/root heaves in your sidewalk have made it dangerous to navigate.

    You may want to consider installing a ramp or railings in appropriate places. A ramp replaces the sidewalk and any steps and should have railing on both sides.

    Build the ramp out of weather resistant materials and maintain it accordingly.

    The slope should be built to code which may vary from state to state.

    Be sure to purchase some no slip sheets from Lowes if it will get wet or icy. Put a one or two inch high border on both sides to keep wheelchair wheels from succumbing to gravity - even if you have a railing.

    A ramp can be like a new set of legs - giving you safe and easy access, once again to the outside world...now, go dance!

    Green PT- Saving your dollars

    Consider using a plastic patio chair for your shower chair needs. You likely already have one.

    Plastic is ideal for getting wet, it already has slits in it for easy drainage, already has a back and arms and is comfy! You'll pay an arm and a leg for something like this in a medical equipment store!

    Be sure to put a rubber mat under all four legs to avoid it surprise sliding. These chairs can be bulky.

    Don't try to force them into your tub if it's just too small.

    Another penny saved!

    Until next time, keep dancing!

    Marcia Oliver MSPT, CPT

    Laughter: THE best medicine

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