The Clinical Progression: Treadmill to Overground Ambulation
Gait training is central in the rehabilitation of individuals with neuromotor disabilities. In clinical circles, there is considerable debate over whether gait training is best performed over a treadmill or over ground. Is one intervention more effective than the other? The research on this topic is inconclusive at best. What we do know, however, is that studies comparing the two gait training approaches...
Evidence Update: Supported Standing Protocols
For decades already we’ve seen standing programs used as a therapeutic intervention for adults with neurological conditions. We’ve known that without such intervention, patients with spinal cord injuries, strokes, traumatic brain injuries or multiple sclerosis spend hours and hours each day in sedentary postures—with devastating results. Sitting for upwards of eight hours a day leads to...
Spotlight on SCI Rehab
By an act of Congress, September is Spinal Cord Injury Awareness Month. And well it should be: one person becomes paralyzed every 48 seconds—in the U.S. alone. Advancements in treatment continue today but we have a long way to go. To draw attention to the needs of SCI victims (and before September is gone) I’d like to tell about a recent visit I made to a fabulous clinic in Tampa.
Evidence Based Practice
Evidence Update: Quicker Recovery with Early Movement
A recent study at Cleveland Clinic, a leading rehabilitation provider, found that patients participating in early mobility routines after neurological injury recovered quicker and went home earlier than those receiving standard care.
NPR recently ran an excellent segment on this study providing good detail and anecdotes from the researchers illustrating how early mobilization is improving the...
Improved Rehab Intervention with the TRAM
The Rifton TRAM is a great addition to our skilled rehabilitation department, especially for those patients with neurological deficits. One therapist can safely assist a patient in the TRAM through a functional mobility progression starting with sitting balance on the edge of the bed, standing tolerance, posture and then gait normalization. In the past, many of these therapeutic activities needed multiple...
The Rifton TRAM vs the Standard Four-Wheeled Walker
For those of us concerned with rehab following central nervous system lesions, the last ten years have been exciting. There has been extensive research focused on the brain and its neuroplastic properties, and it’s changing the way we think about treatment.
Specifically, recent research has encouraged gait rehabilitation—task-specific and repetitive. We all recognize now that ambulation...
Evidence Based Practice
Three Principles of Neural Plasticity to Apply in Your Rehabilitation Practice
There has been a great deal of interest in recent years in the study of plasticity in the nervous system. Plasticity simply means the capacity of the central nervous system to adapt and change. Changes in the structure and function of the nervous system accompany improvements in motor skills that happen with learning and with rehabilitation after neurological damage. Although much of the work on neural...
Safe Patient Handling and Movement: Effectively Using Gait Training Equipment
It is an exciting time in the field of rehabilitation. For people who have sustained a neurological injury such as a stroke, incomplete spinal cord injury or traumatic brain injury there is now hope for regaining the ability to ambulate and sometimes even achieving a full recovery. In the past, a neurological injury was viewed as irreversible, and rehabilitation was focused on helping patients adapt and...
Safe Patient Handling and Movement: Early Mobility in the ICU
Early Mobility in the ICU and the Role of Therapists
Early mobility in the intensive care unit is a hot topic for therapists working in acute care. Recently, with help from the ICU nursing staff, therapists have been assisting patients out of bed and in exercise and mobility routines earlier during their recovery than previously thought possible. Why? Because a growing body of evidence is pointing to the...
Safe Patient Handling and Mobility: Optimizing Patient Outcomes
Physical and occupational therapists, though keenly cognizant of ergonomic issues, are still at risk for work-related musculoskeletal injuries.1,2 In fact, therapists may be more susceptible than others to this type of injury considering the nature of their work, involving repetitive and sustained forces for soft tissue treatment and lifting and transferring patients.3 Even when using careful body...