Wednesday, December 19, 2018

Medical Acupuncture – Eastern Medicine Meets Western Medicine

Among the most famous medical polemics is the conflict between Eastern and Western medicine. On one side we have spiritually, life energy and holistic remedies; on the other we have science, reason and – as and when needed – medication. In this debate the Western tradition might say that Eastern medicine is not backed up by science and brazenly ignores centuries of medical innovations in favor of a more spiritual treatments. Conversely, an Eastern practitioner might suggest that Western medicine does nothing more than treat the physical, bodily condition – without accounting for the non-physical – through drugs that possibly have a host of side-effects. Thankfully, at the Mount Sinai Department or Rehabilitation Medicine our specialists are able to see the virtues in both philosophies and combine them to work wonders for our patients through medical acupuncture either as a stand-alone treatment or as complement to a comprehensive medical treatment plan. 


Acupuncture comes from ancient Chinese medicine and is a treatment by which fine needles are inserted into specific parts on the body called acupuncture points for therapeutic or preventative purposes. It is a form of complementary or alternative medicine (CAM) to treat a range of musculoskeletal and pain conditions. Acupuncture involves stimulating sensory nerves under the skin and in muscles to help the body produce natural chemicals including pain-relieving endorphins. It is believe that these chemicals are responsible for the benefits attributed to acupuncture. According to the ancient Chinese tradition a life force known as Qi (pronounced chee) flows through the body in channels called meridians, but that when it cannot travel freely throughout the body the result is illness. To restore Qi – and therefore to restore health and prevent sickness – acupuncture is required. 

While a skeptic might find this dubious, there is very good scientific evidence showing that acupuncture can help with a range of pain relief in the body as well as headaches and migraines. There is also evidence that suggest a causal link between acupuncture and relief from nausea and vomiting. However, there are many ailments that acupuncture treats that are simply not based on rigorous scientific evidence, not because there is not any to be found as much as the research has not yet been conducted. While acupuncture on its own can never guarantee the patient’s desired result, a course of acupuncture usually creates better and longer pain relief than a single session. What is more, acupuncture often promotes relaxation and a feeling of improved wellbeing. 

A course of acupuncture sessions will begin with an assessment of general health, medical history and a physical examination. Once completed, depending on the treatment required, you will be asked to sit or lie down and may be asked to remove some cloths so your Mound Sinai medical acupuncturist can easily access certain parts of your body. While the idea of needles being inserted into the skin may sound like a frightening prospect, aside from possible momentary discomfort or a tingling, you should not experience significant pain (of course, if you do, let your acupuncturist know immediately). The needles that will be inserted into your skin are very fine and usually about an inch long. They will always be single use and pre-sterilized and will be disposed of immediately after your session. Up to 12 acupuncture points may be used in a normal session, sometimes more, depending on your condition. The needles will be either inserted just under your skin or slightly deeper to reach muscle tissue. Once they are in place, they may be left in their position for anywhere from a few minutes to up to a half hour. In some cases, your acupuncturist may rotate the needles or stimulate them with a mild electrical current, know as electroacupuncture. Many of our patients use medical acupuncture in addition to certain medications, osteopathic manipulation, joint or trigger point injections, physical therapy, psychotherapy and herbal therapies. Indeed, at the Mount Sinai Department of Rehabilitation Medicine it is not a case of having to choose the evidence-based science of Western medicine over the holistic and spiritual nature of Eastern; rather it is a case of harnessing the robust power of both to intertwine and complement one another to heal you, the patient. 

If you are interested in acupuncture and believe it may be among the treatments for you, please get in touch with our team of medical acupuncturists at the Mount Sinai Department or Rehabilitation Medicine at (212) 241-6321.



Thursday, December 6, 2018

One Step at a Time - Exoskeletal Assisted Walking Therapy

Walking has a meaning that transcends the locomotive act of putting one foot in front on the other. The value of movement in both a literal and figurative sense is woven into the fabric of who we are. Words like progress, dynamism and evolution are all positive and words that often inspire, while conversely regression, stasis and devolution are all negative and dispiriting. When we encounter a patient at the Mount Sinai Department of Rehabilitation Medicine whose ability to walk or move has been impaired or limited, for these reasons and more we always consider it a priority to get them back to an independent state whereby they can move either on their own or through the assistance of a walking aid, prosthetic or a wheelchair. And yet, there is another tool at our disposal of which Mount Sinai patients whose ability to walk and/or stand due to paralysis, a spinal cord injury (SCI), a stroke, Parkinson’s disease, multiple sclerosis or a brain injury can take full advantage: exoskeletal assisted walking therapy. 

An exoskeletal walking devise is a wearable motorized exoskeleton that provides the full or partial support required to allow its wearer the ability to amble around their homes, in the community or in a rehabilitation setting. And what can it do for you? It firmly places your newly dynamic two feet on the path where becoming anything and going anywhere is once again possible; it means that your injury and/or condition will no longer have the capacity to relegate you to a position of immobility and being a spectator in life. Exoskeletal assisted walking therapy has the potential to increase self-esteem, enhance your sleep quality, aid in weight loss and improve bowel and bladder function. Our exoskeletal therapy programs can begin as soon as your doctors clears you – in the meantime, let’s learn a bit about the cutting-edge exoskeletal walking devises that await you, including the Ekso GT and the ReWalk.


Ekso GT

The Ekso GT is primarily a rehabilitation tool for those whose walking has been affected by an SCI, a stroke or other condition to help them relearn standing, weight shifting and stepping patterns for walking, as well as improve their speed, stamina, balance and control. It is strapped onto the body and powered by a system of electric motors, levers and hydraulics. Your Mount Sinai physical therapist will use the Ekso GT’s variable assist software to determine how much power and resistance is required to support each side of the your body to get a clear picture of the extent of paralysis as well your rehabilitation progress. Clinical evidence suggests that patients who rehabilitate with the Ekso GT will eventually be able to walk to some degree unassisted by an exoskeletal devise through some combination of improved functional balance, the ability to walk greater distances and increased gait speed.


ReWalk

The ReWalk is also an amazing tool for exoskeletal assisted walking therapy, but what makes it unique is that it is also available for personal use to comfortably navigate your own home or to explore the world on foot. It is an exoskeletal device primarily for people with an SCI but can also be used for people with other conditions that affect or limit walking. It also features a wearable exoskeleton with motorized hip and knee joints and its moves through sensors that detect upper body movements that create a stepping sequence that mimics a natural gait and walking movement. ReWalk can transform the lives of those whose injury has either prevented or limited the ability to walk and will put them in a position in which they can once again literally go wherever their feet will take them!

If you, a friend or family member might benefit from Exoskeletal Assisted Walking Therapy, please get in touch with us at the Mount Sinai Department of Rehabilitation Medicine at (212) 241-6321.

The Most Common Physical Effects of Brain Injury

After a brain injury – particularly a traumatic brain injury (TBI) – the brain’s nerve cells may not send signals between each other as they used to. As a result – aside from a range of possible behavioral and cognitive issues – there will often be physical effects, which might get better quickly during recovery while others might take time or become a lasting problem. The more traumatic a brain injury, the more widespread and longer-lasting the effects will likely be. At the Mount Sinai Department of Rehabilitation Medicine we take brain injury and its effects on directly to help our patients resume active, healthy and independent lives. Our rehabilitation program is a made to suit the individual needs of each patient with a combination of cognitive, physical, occupational, neuropsychologicaland speech therapy. Our brain injury rehabilitation program is one of only two CARF-accredited programs in New York City and patients can also access our CARF-accredited outpatient services once they have been discharged from hospital. 

Below we will discuss the most common physical effects of brain injury and give tips to help manage them.


Headaches

Headaches are very common following a brain injury – thankfully they usually improve over time. For some the pain comes and goes; for others it is a constant. Headaches are often exacerbated by fatigue and stress. Ways to manage include mitigating your stress, resting in a dark and quiet place when the pain is at its worst and avoiding bright sunlight, alcohol and foods that might trigger a headache such as cold items, aged cheese and chocolate.

Poor Sleep

Changed sleeping patterns and poor quality sleep are both very common after a brain injury. It is usual at its worst in the early stages of recovery and will generally tend to get better as time progresses. Many patients will sleep during the day and be awake at night; napping is also common. To help manage poor sleep, do not use your bed for anything besides sleep and sex (e.g. watching TV), ideally have dinner four hours before bedtime and avoid caffeine and exercise once the morning has ended. 

Fatigue

For those who have suffered anything from a mild to a traumatic brain injury, fatigue will be extremely common. Patients will find that their stamina might be dramatically less than what it once was, with even small tasks like getting dressed or walking around the house becoming exhausting. To manage, take regular rest periods during the day, avoid overly taxing social and familial activities and when appropriate have your physical therapist create a safe exercise program to build up stamina. 


Balance and Mobility
Following a brain injury one’s sense of balance can be affected which can make basic mobility an issue. This is a common effect in the early stages of recovery, but it can go away over time with physical therapy. It is important to be aware of this issue and to lie down and rest when a dizzy spell occurs as falls are the leading cause of non-combat TBI. Ways to manage while working with your physical therapist include using a cane or other walking aid and making your home fall-proof by removing rugs, electrical cords and other items on which one could slip, fall and possibly cause another brain injury.

Sensory Impairment

As the brain controls all five of our senses, when brain injury occurs each is at risk of changing. Not much can be done about sensory impairment in the first year of recovery and a ‘wait and see’ approach is often taken in the hope that the patient’s senses will return on their own. The sensation of touch may be reduced, lost or exaggerated; eyesight may be affected and unable to be improved through glasses, taste and smell might go away completely, be altered or replaced with a metallic flavor and one might have muffled hearing or a ringing in the ears (one or both). The best tip is to be patient, know that sensory changes often improve or revert to pre-injury levels and to trust in the medical professionals looking after your rehabilitation.

If you, a friend or family member has suffered a brain injury and you would like to discuss the ways in which the Mount Sinai Department of Rehabilitation Medicine can help, please get in touch with us at (212) 241-6321.



Wednesday, November 21, 2018

Game Changers – Innovations in Upper-Limb Prosthetics

Despite major achievements and advances in upper-limb prosthetics technology during that past half-century, a high number of upper-limb amputees have generally decided to live prosthesis free relative to lower-limb amputees. On face value, this is relatively straightforward to understand as – unlike lower-limb amputees who require a prosthesis for walking – upper-limb amputees can generally function pretty well without one. There are also notable drawbacks to wearing an upper-limb prosthesis, including sweating, heat rashes, blisters, contact dermatitis, ingrown hairs, bacteria infections and abrasions. Beyond that, many have been faced with how inadequate their prosthetic hand has been relative to a real human hand, which is a tremendously complex body part and therefore difficult to mimic, and have opted to live unimpeded by a cumbersome prosthesis as a result. 


Thankfully for upper-limb amputees, never have technologies been more useful or better able to mimic a real human arm and hand than what is currently available. As opposed to the less-effective and unrealistic prosthetics of yesteryear, today’s incarnations look brilliant cosmetically, and they add real value to the lives of upper-limb amputees by making Activities of Daily Living (ADLs) achievable and also allow for more freedom and the ability to participate in the activities and hobbies they love most. Beyond the way in which innovations in upper-limb prosthetics have opened up the world to amputees, wearing a prosthetic mitigates the frequency and severity of phantom limb and lessens the likelihood of developing tendinitis, bursitis and arthritis by having to overwork one’s intact limb. We believe the medical community is standing on the threshold of even further innovation that will make life for upper-limb amputees even more seamless and amazing than ever before. We invite you to continue reading to see the miraculous prosthetics that exist today that will put your own life back in your hands.

Innovations in Below-Elbow Prosthetics

Recent innovations in below-elbow prosthetics evoke not only the Terminator movies, but also Luke Skywalker’s life-like bionic hand as seen in Star Wars – The Empire Strikes Back. What these prosthetics hands can do is amazing by any standard, as they make a range of ADLs extremely achievable and let wearers participate in both active and intense activities and exercise. The real difference maker that has allowed today’s cutting-edge prosthetic hands to offer so much to their wearer and mimic a real hand so accurately is that they are myoelectric-controlled, meaning they are powered, moved and negotiated through the electrical signals generated by the wearer’s muscles. The aptly named Michelangelo Hand is a fully articulated robotic hand prosthesis and is the first to feature an electronically operated thumb that beautifully mimics natural human hand movements. It allows the wearer the freedom perform a range of delicate every day tasks, such as gardening, tying shoelaces, operating tools and far more through holding, gripping and pinching motions. Another stunning innovation that boasts being ‘the world’s most lifelike bionic hand’ is the Bebionic Hand. Through its individually motored fingers, powerful microprocessors and auto grip it offers 14 different grip patterns to allow wearers to do pretty much anything an average day might throw at them. TheBebionic Hand is made to handle up to 100 pounds which means that wearers can enjoy unprecedented levels of freedom in their domestic, working and sporting lives. 



Innovations in Above-Elbow Prosthetics

The DynamicArmElbow prosthesis by Ottobock has been a real game-changer for above-elbow amputees. It is not just cosmetically pleasing and natural looking – it is built to allow wearers to use it in their active lives. The DynamicArm is myoelectric-controlled and allows wearers to both flex and extend the elbow and to carry up to 11 pounds while in motion and 50 pounds while static. The attached hand is the fastest available for above-elbow prosthetics and can open and close nearly 3 times faster than other hands. The wrist can also twist and turn through the myoelectric-sensors. The DynamicArm provides for a natural all-around experience, makes a range of ADLs possible and lets wearers seamlessly participates in activities that would not have been possible through previous generations of above-elbow prosthetics.

There been major innovations in upper-limb prosthetics in recent years and we expect technologies to become even more exciting, useful and capable of catalyzing amputees to a happy, healthy and active life filled with doing the things they love most. If you would like to speak about the latest developments in upper-limb prosthetics, please do not hesitate to get in touch with the team at the Mount Sinai Department of Rehabilitation Medicine at(212) 241-6321.

Behavioral Effects of Brain Injury

People who have sustained a brain injury can experience a range of physical and emotional issues that can affect their identity and personality, relationships and their independence. The more severe or traumatic a brain injury, the more likely it is that the effects will be more pronounced and longer lasting. The way in which a brain injury might affect someone is complex, varied and unpredictable: sometimes a patient may display exaggerated manifestations of pre-injury personality traits whereas others might act in a fashion that is completely out of character. Indeed, often we see a mixture of the two. At the Mount Sinai Department of Rehabilitation Medicine we offer a dynamic and structured rehabilitation program to those who have experienced brain injury, Traumatic Brain Injury (TBI) or a stroke. This includes our TBI peer mentoring program, our Stroke Club, evaluation and treatment of vestibular and visual impairment as well opportunities to participate in TBI research studies.  Our brain injury rehabilitation program is an integral part of Mount Sinai’s Traumatic Brain Injury Model System of care and is one of only two CARF-accredited programs in New York City. Our brain injury patients can also access our CARF-accredited outpatient services available once they have been discharged from hospital. 

Let us go through some of the most common behavioral effects of brain injury, including what they are, what to look out for and ways to help. 



Disinhibition

A common behavioral change in early recovery is disinhibition, or an inability to control or manage socially inappropriate behavior. This might manifest itself through unpredictable anger or rage, divulging secrets to others too freely, inappropriate remarks and even exhibitionism or making unwanted sexual advances. This might be difficult for family and friends to handle, but the best advice is to try to be calm as appearing shocked or distressed might make the sufferer feel there is something wrong with them. It is also wise to discuss the inappropriate behavior with the patient – always in a non-judgement way – and to set firm boundaries as well as discovering appropriate ways for them to express themselves, their personality and their sexuality. 

Impulsiveness

Another common behavioral effect of brain injury is an inclination to speak or act without thinking about the possible consequences. Aside from a range of embarrassing, awkward or even threatening social situations, there are some practical implications that may affect one’s ability to manage their own life independently. One of the most salient issues is the ability to manage one’s finances as patients might impulsively spend money quickly, rashly and above and beyond what is affordable. In helping patients manage their finances it is important to have a situation that allows a guardian to help compensate for their inability to manage money while also allowing for the least restrictive solution possible. A common practice is to have the patient agree to not have access to credit cards and finances while not being supervised, but to allow them a credit card with a modest maximum a well as some spending cash for everyday needs. Depending on the situation and your relationship with the patient, it might be necessary to seek legal advice from a lawyer or local court’s guardianship office to obtain information about how to create a suitable and legal guardianship over a brain injury patient’s finances.


Apathy and Disaffection

After a brain injury a patient may become passive, unresponsive, apathetic, emotionless and lacking the capacity for initiative. In the early stages of recovery, a patient will often appear unaware or unconcerned with their injury and resulting inabilities. Others may demonstrate a will to be active and to connect with others, but are often unable to follow through. For the patient with a brain injury, this apathetic and disaffected state is not just the result of depression, but also from the physical damage endured by the brain. As such, it is essential that friends and family are extremely sensitive to the patient’s needs and emotions or inability to express emotion. Often the best way to help someone showing these signs of brain injury is to support, love and accept them, along with offering plenty of affection and practical help to make their lives easier.

If you, a friend or family member has suffered a brain injury and you would like to discuss the ways in which the Mount Sinai Department of Rehabilitation Medicine can help, please get in touch with us at (212) 241-6321.

Monday, November 12, 2018

Game Changers – Innovations in Lower-Limb Prosthetics

In very recent memory, there was a time in which it was a medical and engineering achievement to have a prosthetic lower-limb merely able to provide an amputee with the ability to have basic ambulatory movement like being able to get around the house or take a short walk outside. Yet, as brilliant as this was, it simply was not good enough as amputation would often remain a barrier to leading the active life that many desired. Indeed before recent innovations, those with lower-limb amputations had to plan their days and lives around their limited ability to walk. For instances, places with stairs or uneven sidewalks would have presented a most daunting and intimidating obstacle for amputees, which meant that often many would have opted to stay at home and miss out on the fun and excitement outside their front door. Thankfully, as a result of some serious innovations to lower-limb prosthetics amputees need not sit on the sidelines of life any longer – they can jump head first into the active, happy and healthy life they deserve.


Innovations in Prosthetic Feet and Blades

Those with below-knee amputations can now benefit from prosthetics that will put the world back at their feet once again. Previous prosthetic feet were marred by an unnatural or limited range of ankle motion, which often resulted in strain on knees, hips and back, or – worse yet – nasty trips and falls. The latest technology – seen in prosthetic feet like the Ossur Proprio Foot with Evo – offers a motor-powered ankle that increases ground clearance and allows the user to walk across all kinds of terrain in a natural and safe fashion. Such an innovation allows lower-limb amputees to walk virtually anywhere again: to the shops, long country walks or even exploring cities like New York, Paris or London on foot!

Walking is brilliant, but how about running? Thanks to the emergence of the Paralympics as a bona fide sporting event, we have all seen the so-called ‘blade runners’ – the world class track and field athletes that defy their disability to achieve feats about which able-bodied persons might only dream. But it is not only paralympians who can access this life-altering blade technology – it is available to all amputees who either want to resume their old sporting lives or to explore new ways to be active. Technologies like Blatchford’s Elite Blade – a lightweight, e-carbon foot with flexible, independent springs that reduce shock transmission – let users participate in high impact sports from serious running to football, basketball and more. These amazing innovations to prosthetic feet and blades mean that those with below-knee amputations can live their lives to the fullest and most active extent, unimpeded by their disability.

Innovations in Prosthetic Legs

One of the most exciting innovations in engineering – not to mention prosthetics – in recent years has been the multi-award winning Blatchford Linx. This prosthetic leg for above-knee amputees is practically out of a science fiction movie as it is the first one ever that is integrated with robotic control of both the knee and foot that communicate with each other to move just like a human leg. It uses a network of sensors that act like human nerves to continuously collect data about the way in which the user walks, their activity and the terrain on which they are moving. This information is processed by Linx’s central computer to adapt its responses so its wearer can always walk confidently, knowing that they will always be at the right speed and enjoy the right support at all times on practically any terrain and on slopes and steps. Beyond walking and navigating one’s world happily and uninhibited, users can participate in a range of sporting activities, notably cycling. Linx has even innovated the mere act of standing still, which has long been a difficult and painful task for amputees, by sensing when it has come to a standstill and automatically locking so its wearer can relax in a normal standing position. Lastly, unlike previous cutting-edge prosthetic legs, there is no need to endure the lengthy process of recalibrating the ankle and knee joints again and again; Linx uses a smart algorithm to calibrate the limb automatically.

There been major innovations in lower-limb prosthetics in recent years and we expect technologies to become even more exciting, useful and capable of catalyzing amputees to a happy, healthy and active life filled with doing the things they love most. If you would like to speak about the latest developments in lower-limb prosthetics, please do not hesitate to get in touch with the team at the Mount Sinai Department of Rehabilitation Medicine at (212) 241-6321.

A Personalized and Dynamic Amputation Treatment and Rehabilitation Plan

As each amputation patient carries with them a range of unpredictable factors – which limb or limbs have been amputated, age, fitness levels, reason for amputation, mental health and far more – it is essential that the Mount Sinai Department of Rehabilitation Medicine offer a treatment and rehabilitation plan that is as personalized, flexible and dynamic as it is cutting-edge, empathetic and motivating. When a patient is young and is standing on the threshold of a brilliant life ahead, we offer a treatment plan that gives them the physical and emotional tools to return to the path that was interrupted by amputation. When the patient is an avid sports person, our goal is to make sure that through physical and occupational therapy – along with the help of one of our leading prosthetists – they can get back on the field, surf board or even resume extreme hobbies like jumping out of an airplane as soon as possible. For patients who have suffered a traumatic amputation, we lovingly nurturer them back to physical health, offer robust and caring emotional and group therapy and guide them to a place of peace and acceptance where they can begin to see the light at the end of their harrowing tunnel. 


These examples barely scratch the surface of the spectrum of patients we look after at the Mount Sinai Department of Rehabilitation Medicine – and yet it shows that a ‘one-size-fits–all’ plan will not cut it. Our patients require a treatment and rehabilitation plan that takes into consideration their physical condition and life outside of a rehab setting, their age, life goals and temperament, with a robust emphasis on providing the emotional support so that they can pursue a post-amputation life that is comfortable and fulfilling. 

Each personalized and dynamic amputation and treatment rehabilitation plan is focused on the following features:

  • Access to and care from Mount Sinai’s world-leading team of physicians who will look after you and any potentially complex medical needs from the moment of amputation until you fully recover.
  • Compassionate and evidence-based care from our rehabilitation nurses who will help patients with goal-setting and managing pain and discomfort.
  • Therapy from our physical and occupational therapists who will begin working with patients from the moment they wake up from general anesthesia until they are pursuing life again on their own terms, as well as increasing independence and teaching self-care and Activities of Daily Living (ADLs).
  • Access to and care from psychologists who will help patients develop coping skills to emotionally handle the stresses that may come with experiencing amputation as well as community re-integration.
  • Access to and care from dietitians who will work to make sure patients’ diets are nutritious, promote healing and mitigate the potential for diabetes and other conditions.
  • Being put in the hands of an expert prosthetists who will make sure the patient has the full range of prosthetics they require to live life to the fullest.
  • Access to our Limb Loss Support Group, our monthly peer support for patients following an amputation. It is led by a psychologist and discusses topics like body image, social acceptance and techniques for maintaining a positive attitude. 


At the Mount Sinai Department of Rehabilitation Medicine the full weight of our expertise and experience in treating and rehabilitating amputee patients is passed through a bespoke prism to ensure that it is personalized, dynamic and that it seamlessly fits into the patients needs and sensibilities so they can return to their old selves again.

If you are – or somebody you know is – scheduled to have an amputation and you would like to discuss the ways in which the Mount Sinai Department of Rehabilitation Medicine can offer a personalized and dynamic post-amputation treatment and rehabilitation program, please get in touch with us at (212) 241-6321.