Health Care Reform? What's next?

Well who has read the new Health Care Reform Bill?  Nobody has glanced through all the pages?  Well I haven't either, there are more important things to read...like Pinkalicious to my 5 year old daughter at night for her bedtime story.

I think only time will tell what it will mean to American Health Care.  I do have faith that we have some of the greatest clinical practitioners in many areas (Physical Therapy being one that I am obviously most biased towards) and that patients will receive excellent caring and compassionate care.  But I often wonder if we may see more a shift toward health care providers being more educators and teachers to patients and families.  With the increase in people supposedly accessing the system with all people covered, there may be delays in care.  And when one does get in to be seen, there may be increased time between appointments.  I'm thinking of Physical Therapy for example, typically most patients in the outpatient setting I am in are seen 2-3 times per week.  But if there is more patients to see and most likely not an increase in staff, we will have to decrease the number of times each week the patient is seen to allow access for the additional patients.  The patient and family will take on increasing responsibility to know and understand their injury or illness along with what they need to do for their care.  While in many ways this can be a great thing for people to take increasing ownership in their healthcare, but will they?

Also with growing new research in neuroplasticity, The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science (James H. Silberman Books).  We are learning the amazing capabilities of our brains to continue to change and relearn things even after severe brain damage.  These changes for stroke, traumatic brain injuries and others are amazing to our once thought of a very static brain that once injured did not have much chance for recovery.  We are now learning with gradual properly graded therapy, significant changes in their function can be achieved far beyond our previous expectations.  The big thing that is needed is patience and persistence in the treatment approach.  I am not sure the health care system will be willing to pay for either.  But patients and families can be trained to carry out this treatment on their own with monitoring and ongoing training from qualified health care providers.  The delivery might look different, but it may actually get better.

While I don't know exactly what health care reform will bring, as none of us do (even though most everyone has an opinion), I do know the brain does change itself and it is was created for survival.  And spending time with my daughter reading books is far more important than worring to much over health care reform.

I'm curious to hear others thoughts on what the changes may mean to health care in America?

Interesting thought about ankle sprains

An article came out in USA Today Vulnerability to ankle sprains varies with age.   I wanted to add a few interesting thoughts from a Physical Therapists perspective.

1. This is something I have noticed with ankle sprain injuries for many years and in some ways seems kind of strange.  Why is there more sprained ankles in basketball (40%) compared to soccer (8%)?  Granted I don't know in this study if it is matched to the percent of those actually playing the sport, which could skew the percentage if a higher number of people possilbly play basketball compared to soccer.  But think about this:  basketball is always on a flat surface and players often times wear hightop shoes and brace or tape their ankles, compared to soccer which is usually on a grass natrual field, with tiny not very supported shoes and they are always moving around a round ball on the ground.  From the outside one would think that soccer would probably see more sprains.  Or, because soccer players actually train in a more challenging situation that they are better prepared to reduce the risk for ankle sprains.
2. I thought another interesting statement in the article needs to be looked at deeper as well:
• "The good news is that most ankle sprains feel better in a few days and heal completely in a few weeks. But previous studies suggest 60% of people who have one sprain will have another or will suffer long-term instability, weakness or pain."
• My question is do they heal completely?, if 60% will suffer long term difficulties.  I would like to think that this is not healing completely.  If we take simple knowledge of tissue damage, we need to see that complete healing probably takes longer than a few of weeks.  This is true probably for most injuries.  I am afraid we don't allow the body go through all the stages of healing and work to fully rehabilitate from an injury like an ankle sprain usually.  There is loss of strength, flexibility and proprioception after an ankle sprain.  Unless we work to retrain all of these appropriately we are most likely looking at further problems.  Also we need to look to see if there was a movement impairment that may have been the cause behind the injury.
• An example I can give is a patient I had once that I saw the day after her ankle sprain and talked to her about acute treatment (RICE - rest, ice, compression and elevation).  Then importance of working to normalize her walking as soon as possible.  She came back about a week later and said she was fine and did not think she needed any more therapy.  I asked her to try and stand and balance on that one foot.  To her amazement (not mine) she couldn't!  I explained what all happens after an ankle sprain and that just because the swelling and pain was down, did not mean that it was completely healed.  So after a couple more visits over about 4 to 6 weeks and instruction on proper exercise progression to regain strength, flexibility and proprioception her ankle was fine.

My advice if you suffer an ankle sprain, do not think it is fine just because the swelling and pain are less in a few weeks.  See a physical therapist to get proper treatment to make sure that you do fully rehabilitate from an ankle sprain and reduce the risk of reinjury.  If you do play sports you are at higher risk for ankle sprains, so as part of your training do specific functional exercises to reduce your risk of injury.  Talk to a physical therapist to learn functional training exercises that you can do for your specific sport.

picture by: By Suzy Parker, USA TODAY

Effects of good health practices on therapy outcomes

I wanted to share with my readers something I have been working on to give to our new patients that come in for Physical or Occupational Therapy at our clinic.  I wanted to give the patient some additional information on other things that can help their outcome with therapy.  Here's what I have put together so far, let me know what good and bad you see in it.

Welcome to CRMC Physical Medicine and Rehab, maximizing your outcome from your Physical or Occupational Therapy treatment is our goal. Here are a few additional things you can do to help maximize your outcome, if you are not already doing them.
Stop Smoking. You probably already know that smoking affects your lungs and heart health in detrimental ways. And if you are a smoker it is not easy to quit, so talk to your doctor or therapist about options to help you quit. With the lungs and heart it affects the oxygen uptake in the lungs and narrows our arteries decreasing the blood flow to our muscles and organs. With decreased oxygen and blood flow our muscles are not getting the energy they need to repair them and work optimally. Smoking also has an effect on brain neurotransmitters (chemicals in the brain) these help our brain and nervous system function optimally. When our nervous system and brain are not working optimally it effects how our muscles work along with other systems in our body. It also affects our metabolic system (the part of our body that breaks down food and medicine into parts it can use). So our body does not get the food and medicine it needs in the same way those that do not smoke do. There are other side effects of smoking, but these are some of the primary effects that will reduce your optimal outcome with therapy and effect your healing from your injury.
Get proper nutrition and water intake. Our body uses the food we eat to help repair any damage that has been done to it on a daily basis. The better the food choices we make the improved healing abilities our body will have. Please consult with your doctor, dietician or therapist if you want specific information to help you eat better. Generally following the web site info at http://www.MyPyramid.gov is a good guideline. Water intake is also important as most of our body tissues, especially muscles and fascia (the tissue that holds all of our muscles together). Our muscles and fascia are primary reservoirs for water storage; if they are dehydrated they will become stiffer. Take a sponge as an example – when the sponge is dried up it is stiff, when full of water it is more flexible.
Get adequate sleep. Our bodies require 7 to 8 hours of sleep each night. Some people “think” they do can go on less, but every major study done on sleep always points to the body needing 7-8 hours of sleep (more if you are a child) to function optimally. Lack of sleep will affect brain function and attention. These can affect our muscles and nervous system to not work as well. Also it has been found to decrease healing when we have a lack of sleep. Unfortunately pain can be a factor in inhibiting our sleeping, so talk to your doctor or therapist if you are having difficulty sleeping due to your injury.
Decrease your stress levels. This like sleep is a double edge sword for some of you with an injury, as the injury is the cause of your added stress. Small amount of stress is good for the body as that is what makes us stronger by “stressing” our muscles. Unfortunately prolonged or too much stress puts our body into distress, which is what is detrimental. Our body uses its sympathetic nervous system to respond to stress. This system increases activation of our peripheral muscles, raises our heart rate, and over activates our nervous system making us more sensitive to everything. This is helpful in short durations, such as needing to run away or fight in a dangerous situation, but long term can cause negative effects due to increase in the chemical, cortisol, in our system which affects our brain and nervous system as well as immune, respiratory, cardiac and digestive systems. It can also lead to increase in depression, anxiety, and increase in disease (you are more likely to catch a cold when over stressed). We need an equal balance of our parasympathetic system (the opposite of the sympathetic system) to keep our body systems working properly. The increase in activation of your nervous system is one reason why when stressed your pain will most likely be more. Talk with your doctor or therapist on techniques to help improve relaxation and decrease stress.
Understand your injury and know what you can do to make it better. There is power in knowledge. We will do our best to try and explain why you are having the problems you are having, but please ask questions if you don’t understand. While we will do everything we can to help you for the half hour or hour that you are in therapy, but you will need to help yourself the other 23 hours out of the day, so in many ways you have a larger impact on your health than we will.
Make every effort to make your scheduled appointments. Obviously there are things that might come up that limit your ability to make an appointment, but we can only maximize your outcome if you come to your appointment. It is your body and your health, while we appreciate the opportunity to help you recover; you ultimately hold the key to helping that become a reality.
This is a short summary of the few effects other health practices have on your outcome with Physical or Occupational Therapy. If you want more detail on any of them talk to your doctor or therapist. We look forward to working with you to maximize your optimal movement and achieve efficient function with your body as you rehabilitate from your injury.

I'm curious to hear what everyone thinks.  I know in today's age of Twitter and 140 characters for communicating or articles that should be 500 words or less this goes beyond that, so let me know if you think it is too long or not long enough to cover in detail enough.  Also, for the normal healthy individual most of these are common practices, but unfortunately most of my patient clientele does not meet these criteria.  I am a believer that if you can plant seeds that change is possible.  So I am excited to see comments on what others think.