New Advances in Rehabilitative Stroke Treatment Improves Quality of Life
By April Terreri

Years ago when people suffered a stroke and its consequent debilitating effects, they were told to ignore the affected side and to learn to live and function with the unaffected side of their bodies. “The important thing about stroke rehabilitation today is it has shifted from that mindset to the emphasis on using, incorporating, and improving the function of the affected side,” says Catherine Birk, M.D., physiatrist for the Stroke Program at Harmarville Rehabilitation Hospital. “We do this through the use of a variety of physical techniques. We also have access to some of the latest and greatest technology that allows us to do these things for our patients.”

The Technology
Stroke rehabilitation has made significant strides, especially in the technologies available to help people retrain and rehabilitate their affected areas so they can achieve as close to normal functionality as possible. Here are a few of those technologies.

AutoAmbulator™
In order to help patients regain a normal gait pattern, HEALTHSOUTH uses the AutoAmbulator, a robotic treadmill designed by HEALTHSOUTH engineers. “The apparatus incorporates computerized walking patterns that allow patients to practice at length in a weight-supported harness,” explains Dr. Birk. The walking patterns imprint in the patient’s brain, helping them achieve a close-to-normal gait once again.

Bioness H200
This portable unit retrains motor functionality using electrical stimulation to improve walking and hand functions by retraining muscles, reducing spasticity, preventing atrophy, and increasing the range of motion and blood circulation to the stroke-affected areas.

Reo Therapy
This is a robot-assisted platform that facilitates high repetitions of functionally oriented arm exercises by reestablishing motor strength. It also reestablishes eye-hand coordination.

VitalStim®
This unit uses neuromuscular electrical stimulation therapy to treat dysphagia. Small electrical currents stimulate the muscles responsible for swallowing. Speech and language pathologists use this unit to train patients to speak more naturally by strengthening the muscles.

Myomo e100 System
This unit helps patients regain motion in their arms by sensing weak electrical activity in arm muscles. It provides enough assistance to allow the patient to complete simple exercises.

SaeboFlex®
This is a wrist splint and exercise station promoting increased function for shoulders, elbows, wrists, and hands through dynamic splinting combined with creative exercises.

Retraining the Brain
It’s important not to forget the therapist behind the treatments, says Dr. Birk. “They use a variety of techniques to enhance the best functional use of the affected parts of the body.”
One of these techniques is NDT (neuro-developmental technique). “We combine this with a lot of motor learning,” says Meri Slaugenhaupt, physical therapist and team leader for the Stroke Program. “We incorporate both sides of the body and use things like forced use, making the affected side involved in activities like transfers, walking, and just about every physical activity.” Constraint induced therapy also forces the use of the affected side. “We teach compensatory strategies only when they are necessary.”
One of the fascinating things emerging in neurological rehabilitation explains Dr. Birk, is the brain’s ability to be retrained to take up the slack from the affected part of the brain. “It’s the idea of neuronal plasticity. Imagine you are learning how to play the piano. You are reading music and you are moving your hands accordingly. In doing this, you are teaching the brain to move your hands as a result of reading music.”

Early Intervention: Less Injured Brains
The combination of advanced technologies and highly trained therapists provides a well-coordinated approach to stroke rehabilitation. “There is a lot more going on in the initial treatment of stroke today, so there are more people with less injured brains,” Dr. Birk says. “Before the advent of rapid treatment following a stroke, there were considerably greater stroke injuries than I see currently. People finally understand the message that time is brain and that the window to seek medical help is just three hours.” Dr. Birk says she sees less extremely severe disabilities now due to stroke awareness.
Although much has changed over the last few decades, stroke is still the No. 3 killer in the U.S. Heart disease and cancer are the top two killers. “Stroke is the largest cause of disability in adults,” continues Dr. Birk. Research shows that about one-third of people suffering a stroke die. But the news gets better if they live past the first month. Two-thirds of the number of people surviving that first month may live for another 10 years.”
Recognizing the symptoms and getting early treatment and then acute care is very important, notes Slaugenhaupt. “Also important is the recognition of how important rehab is, with its focus on a multi-disciplinary approach including PT, OT, speech therapy, and neuro-behavioral therapy. The highly trained nursing staff and the patient’s family involvement also play important roles. It is no longer about telling patients they had a stroke and now they have to choose which nursing home they want to go to.”
Allegheny County is fortunate in having a comprehensive network of delivering community awareness of the risk factors to watch for, says Mark VanVolkenburg, director of clinical services at HEALTHSOUTH Harmarville. “We see patients who have successful outcomes because they are getting in early for treatment and they understanding how important that three-hour window really is. We have very good rehab facilities in the Pittsburgh area.”
Therapy usually does not end once patients complete their inpatient rehabilitation, notes Dr. Birk. “People continue to need care after their acute care ends. They need to follow up on their care of physical motor and functional problems that can continue after stroke.”
For more information, contact Ann Ciotoli,
HEALTHSOUTH, at (412) 826-2707.

Stroke Warning Signs
Timing is extremely critical when you suspect you are having a stroke, and a medical doctor must treat you within three hours of the onset of these symptoms:
• Sudden weakness or numbness of the face, arm, or leg – especially on one side of the body.
• Sudden confusion, trouble speaking, or understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, or loss of balance or coordination.
• Sudden severe headaches with no known cause.

Risk factors for stroke:
• High blood pressure
• Tobacco use
• Diabetes mellitus
• Carotid or other artery disease
• TIAs (transient ischemic attacks –
or mini strokes)
• Atrial fibrillation or other
heart disease
• Certain blood disorders
• High blood cholesterol
• Physical inactivity and obesity
• Excessive alcohol intake
• Illegal drug use

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The Importance
of Certified Hand Therapists
By Lois Thomson

If you had a particular medical condition that required the care of, say, a heart specialist, you would make sure you located the physician who you thought could give you the best possible treatment. So why wouldn't you do the same thing if you needed therapy on your hand or arm?
That is the question Paul Brach, founder of The Hand Center of Pittsburgh, poses. "It's important for people to realize that if they go to specialists for medical care, they should also see specialists for rehabilitative care. It's important that they spend time doing the same research on the therapist as they would on a surgeon or a regular physician to get their qualifications, and make sure the individual understands their injury."
To underscore his position, Paul gave an example of a person who is seen by a physician, and the physician suggests going to physical therapy for the patient's wrist or hand injury. If the physician does not have a recommendation of where to go, it would be very easy for the patient to schedule an appointment at the place most convenient to home or work, instead of researching and finding the most qualified therapist to take care of that particular injury.
A certified hand therapist (CHT) can be either a physical or an occupational therapist. Both have to have more than 4,000 hours of training to sit for the certification exam and then pass the exam before they can refer to themselves as a CHT. In light of that fact, a CHT has a thorough understanding of the pertinent anatomy related to the upper extremity and how that anatomy applies to the function of the injured site.
When looking for a certified hand therapist, Paul offers additional advice. "When calling a physical therapy clinic, it is important to ask if there is a certified hand therapist on staff who can take care of your wrist or hand injury. Our clinic is rather fortunate, and I am very proud of the fact that my associate, Susan Christie, and I are two of the only three physical therapists who are also certified hand therapists in all of Western Pennsylvania.
"So the point is, if you do the research and you realize that you should be seen by a hand therapist for an injury to your hand or upper extremity, in the end you may save yourself time and money – because it may take less treatments, and less co-pays, which can equal less out-of-pocket expense and less time away from your job or hobbies."
For more information, call Paul Brach at The Hand Center of Pittsburgh at (412) 429-1980 or visit the web site www.handcenterpgh.com.

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Therapists at Centers for Rehab Services Known for Clinical Excellence, Patient Satisfaction
By Vanessa Orr

Every day, changes take place in the medical field that can make a difference in the way patients are treated. For this reason, it’s vital that those who practice medicine, or provide one-on-one care to patients such as physical and occupational therapists, stay abreast of all of the innovations taking place. By taking a leadership role, healthcare professionals can not only educate and treat their patients more effectively, but can provide the highest quality of clinical excellence.
At Centers for Rehab Services (CRS), the staff takes pride in providing patients with a superior level of care. “Our physical and occupational therapists are considered leaders in their professions,” explained Regional Director Tony Sanks. “Many of them hold advanced degrees, and specialize in specific areas such as women’s health, balance disorders, neurologic disorders, hands and general orthopedics. They may also participate in studies and research that furthers their education.”
One of the qualities that Sanks looks for when hiring new employees is their dedication to continuing education. “All of our therapists are involved in continuing education as a way to develop new skills and learn new specialties,” he said. “This enables them to provide their patients with the most up-to-date treatments available.” CRS also nurtures its highly skilled professionals through a commitment to advanced specialty training, certification, and teaching.
As a partner of UPMC and an affiliate of the University of Pittsburgh, Centers for Rehab Services is able to provide patients with services at UPMC hospitals and long-term care facilities, and patients can be seen at more than 40 outpatient locations throughout western Pennsylvania. Joint therapy programs with the UPMC Institute for Rehabilitation and Research and the UPMC Center for Sports Medicine are also evidence of the Center’s continuing commitment to provide progressive, high-quality treatment.
In addition to staying at the forefront of technology and new techniques, the staff at Centers for Rehab Services makes patient care a priority. “When it comes to customer services, I put us up in the top echelon of businesses, including those that are not in the medical field,” said Sanks. “There are a lot of different personalities out there, and many of the people we’re dealing with are injured or depressed; they don’t want to be there. But our staff is able to connect with them and get them to work towards specific goals. We treat everyone as an individual, and it’s one of the reasons that people come back.”
Staff at CRS also makes it a priority to communicate with doctors and other healthcare providers to ensure that everyone works in conjunction to treat the patient. “We want to make sure that the doctors are getting what they want, and that they know what we’re doing,” said Sanks. “We encourage multidisciplinary collaboration.” Staff is also monitored and undergoes utilization reviews to make sure that all patients’ needs are met.
“When people are really into their professions, it shows right away,” said Sanks of the caliber of CRS staff. “These are people who are leaders both in their professions and in their communities.”
For more information on Centers for Rehab Services, visit the web site www.centers4rehab.com or call 1-888-723-4CRS (4277).

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Schenley Gardens Comprehensive Outpatient Rehabilitation Facility
‘Keeping the Body in Motion’

Focus your energy on healing and let the Outpatient Rehabilitation Center at Schenley Gardens handle the details. The Comprehensive Outpatient Rehabilitation Center at Schenley Gardens is a participating provider with most health insurance plans, including traditional and managed Medicare, all Highmark Blue Cross/Blue Shield products, and commercial insurances. Our experienced, certified therapists coordinate your individualized treatment with your family, physician, and insurance carrier.
Schenley Gardens Physical Therapy Program includes Gait and Balance Training, Range of Motion and Strengthening, as well as Orthotic and Prosthetic Training. When appropriate, Aquatic Therapy can enhance recovery in a warm water therapy pool, which can be complimented by whirlpool treatments. In conjunction with the Arthritis Foundation, there are designated aquatic classes available to people of all ages with a diagnosis of arthritis.
In addition to physical and aquatic therapy, Schenley Gardens Rehabilitation Center also offers Occupational Therapy and Speech Therapy. Psychological Services are available in conjunction with the treating physician’s recovery plan.
Located at 3890 Bigelow Boulevard in Oakland, outpatients may take advantage of our free indoor parking and complimentary transportation services within a five-mile radius.
Respite Care Services (short-stay) are available in participation with Schenley Gardens Assisted Living Community. Respite Residents can rest assured that with 24-hour nursing care, three meals daily, private apartments, and an onsite Comprehensive Rehabilitation Center, they can focus on efforts to improve their health.
To schedule your therapy service or for more information, please contact the Schenley Gardens Rehabilitation Center at (412) 621-4200.

For more articles, download the Spring '08 issue (PDF)