As the Physical Therapist and Owner of Stepping Forward Physical Therapy, I bring 30 years of varied experience including Acute Care, Subacute Rehabilitation, Outpatient and School based environments. I continue to update my treatment strategies in both Neurological and Orthopedic fields which has enhanced progression, variety, and quality of Home Exercise Programs.
In addition to continuing my education, I have seen certain treatments continue to be used due to their high level of success. In addition to traditional range of motion, joint mobilization, progressive resistance exercise, conditioning, and functional exercise training, these treatments include Dynamic Lumbar Stabilization, Vestibular/ Balance Rehabilitation, Motor Control Training (task specific practice), Body Mechanics Training, Tone Inhibitory and Facilitatory Techniques, Trigger Point Release, and Instrument Assisted Soft Tissue Massage (AISTM). I choose to teach patients how to manage their exercise progression and self applied trigger point release.
Specialties
Dynamic Lumbar Stabilization For Back Pain
Dynamic Lumbar Stabilization has stood the test of time for improving trunk strength and function while reducing low back pain. Dynamic Lumbar stabilization is needed for best alignment during activities of daily living and job related tasks. There are many levels of exercise in the Dynamic Lumbar Stabilization Exercise Program which allows for personal home exercise development.
Research:
Cardiopulmonary Monitoring
Monitoring vitals, oxygen saturation, BORG Scale for rate of perceived exertion is important for cardiopulmonary compromised individuals. Pacing, deep breathing and exercise modification are important for patients with COPD, MI, CABG, arteriosclerosis, and peripheral vascular disease, Recognizing signs and symptoms for complex regional pain syndrome, vascular claudication, neurogenic claudication, avascular necrosis DVT, AAA, and compartment syndrome also help to ensure the health and safety of the patient.
Orthopedic Rehabilitation
My own personal experience with ACL reconstruction and rehabilitation as a teenager peeked my interest in Physical Therapy over thirty years ago. I was amazed at how muscles went from atrophied to full strength given specific exercise. Orthopedic surgical repair and rehabilitation continues to hold special meaning and interest in my work as a Physical Therapist. Patients treated include THA, TKA, reverse total shoulder, rotator cuff repair, spine/ankle/leg/pelvic fractures, spinal instrumentation, scoliosis surgery, laminectomy, spinal fusion, ACL repair, other ligament/tendon/cartilage repair and reconstruction.
Research:
Vestibular Rehabilitation for BPPV (Benign Paroxymal Postional Vertigo)
Dizziness is a common complaint which increases with advancing age. Research has shown treatment offered for BPPV is very successful. Testing for this vestibular impairment is simple and can often relieve dizziness within in two sessions.
Research:
Neuromuscular Rehabiliation
Eastern Maine Medical Center rotations in acute neurology and subacute rehabilitation have given me the experience of following individuals who have suffered neurological trauma from the special care unit to discharge home with outpatient services. I have a strong appreciation of what patients who have suffered head injury, stroke, and spinal cord injury have been through. I also know of the potential that can be achieved up to two years after the initial incident. Facilitation of strength using "powder board", and inhibition of hypertonicity for muscle isolation is important in obtaining desired motor outcomes.
Research:
Functional Outcome Measures
Functional outcome measures are used to determine an objective change in functional status. Functional measures are used during the evaluation and reassessed as needed to focus on purposeful goal attainment. Some examples of Functional Outcomes are:
30 Second Chair Stand Test
Stair Climb Test
6 Minute Walk Test
Timed Up and Go Test
40m Fast Paced Walk Test
Canadian Performance Measure
The Activities specific Balance Confidence (ABC) Scale
The Barthel Index
Functional Gait Assessment
Stroke Impact Scale
Postural Assessment Scale for Stroke Patients
Fugl Meyer Assessment of Sensormotor Recovery After Stroke
Dynamic Gait Index
Wisconsin Gait Scale (WGS)
The Riverbed Visual Gait Assessment Form
Berg Balance Scale
Tinneti Gaint and Balnce Instrument
Post Concussion Symptoms Scale
Functional Reach Test
Rhomberg Test
Dynamic Gait Index
The Dizzyness Handicap Inventory
Oswestry Low Back Pain Questionnaire
Upper Extremity Functional Index
Lower Extremity Functional Scale
Amputee Pre-Gait and Gait Training
Woking within physician recommendations and prosthetist expertise is crucial for best success with prosthetic training and functional outcome.
- Desensitizing for pre - gait readiness
- Pre-Gait Strengthening
- Prosthetic Gait Training
- Personal Goal attainment
Balance Training
Balance reactions are the key to staying on your feet when you trip or have muscle weakness. Ankle and hip strategies are elicited as stretched tendons send messages to the brain to "right" one self over their base of support. Vestibular mechanisms too play a part in the inner ear as small hairs are moved by fluid when the head is tilted. The nerve in the inner ear sends messages to the brain about whether the head is in or out of place. There is thus a nerve pathway that stimulates movement of the joints, head and trunk during balance training. Ones with neuralgic involvement are not the only ones who need balance retrain-ing. Many orthopedic surgeries will alter or remove ligaments that once held a role in the original balance strategy. This person will now need central and peripheral reorganization (a new nerve to brain pathway). Balance training is best advanced with safety measures in place such as a gait belt and an experienced Physical Therapist to direct and progress movement.
Research:
Functional Mobility for Cancer Patients
The American Cancer Society Recommends patients stay as physically active as possible during their cancer treatments. There is a fine balance of when a patient can tolerate exercise and what type of exercise can be done. A Physical Therapist can often see physical potential in a person they may not see in themselves. From simple goals such as walking independently to more advanced goals such as improving cardiovascular fitness, Physical Therapy is a safe way to meet your physical goals during and after cancer treatments.
Research:
Pediatric Physical Therapy
I have have worked closely with school aged children who have physical impairment I(including Autism) for the past seventeen years. I enjoy progressing the child through developmental milestones using functional strengthening,
facilitating low tone and inhibiting high tone to promote best access to the special education curriculum. The child with neurological impairment is at high risk for orthopedic problems such as Slipped Capital Femoral Epiphysis, Hemipelvis, Femoral Retroversion/ Anteversion, Knee Varus/Valgus Deformity, Knee Hyperxtension, Joint Subluxation and various foot deformities. Physical Therapy assessment of alignment during functional training is ongoing in order to make
appropriate referrals to Orthopedic physicians and orthotists.
Pediatric Assessment Tools:
Pediatric Evaluation of Disibility Inventory
Bruininks Oseretsky Test of Motor Proficiency
Test of Gross Motor Development
Peabody Developmental Motor Scale
Pediatric Borg Balance Scale
School Function Assessment
Gross Motor Function Measure 88
Modified Ashworth Scale
Observational Gait Scale
Timed Up and Go Test
6 Minute Walk Test
Research:
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Back Care for Care Providers
Back Care for care providers is important to help keep the provider free from injury and chronic pain. Repetitively stooping over, lifting with the arms out straight, and twisting while the feet are planted are all ways one could strain back muscles. Please see my book,"Coby and Miss Strong Play Tall - A Guide to Good Posture for Teachers and Students" for more tips on protecting your back while working with children or who have special needs.