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.

What Is Craniosacral Therapy? And How Can It Change Your Life?

Acute physical pain like headaches or back aches ruin well deserved days off at the weekend. If allowed to continue, not only will you be suffering from chronic pain but also mental fatigue. Issues like chronic pain can be pervasive and cause serious mental health problems like depression and increase likelihood of illness as they drain your ability to rest. They can increase stress levels and make what would be otherwise easy to manage health conditions much more difficult to deal with. At Mount Sinai’s Department of Rehabilitative Medicine, we have a fantastic method of dealing acute pain.

Craniosacral Therapists work to improve the movement of cerebrospinal fluid and reduce tension through gentle manipulation of the head and spine which can help you not only overcome daily hassles but also thwart chronic and emotional pain. Treatment consists of entering our relaxation sanctuaries with our fantastic on-site craniosacral therapists and beginning your treatment on a couch.

Our therapists will begin by exploring your with gentle hands, identifying and working through pressure points and built up tension in the body. Your body and nerve system will respond to the therapists touch as they pick up on tensions or distortions which may be indicative of ill health. Your therapist will help your body relax allowing the body to find an equilibrium.

What makes craniosacral therapy unique is the empathy our therapists have with your body. Their unique training allows them to identify and patiently relieve your body of tension and chronic pain.

The Primary Respiratory Mechanism (PRM)

This is a mechanism that is proficient in working and has been summarized in five ideas and encompasses the routine.

1. Inherent motility of the central nervous system
2. Fluctuation of the cerebrospinal fluid
3. Mobility of the intracranial and intraspinal dural membranes
4. Mobility of the cranial bones
5. Involuntary motion of the sacrum between the ilia

If you are experiencing chronic pain and heightened levels of stress in your daily life, and especially if you are struggling to cope, please call (212) 241-6321) to see if we can help.

 

What Is Stress? And How Can Yoga Help You Cope?

We realize that sometimes we need to think outside the realms of the norm when dealing with stress and relaxation. If there were a safe long-term prescription to tackle stress – then everyone would take it. Unfortunately, there is not – and part of our bespoke patient diagnosis often includes taking up yoga. This is a practice that refers to loosening ourselves of bodily and mental tension while learning to consciously disengage our stress and muscles systems when they are not needed.

 

One of the most basic organic response systems is famously called the “fight or flight response”. It symbolically refers to the wild, cliched scenario in which the burly caveman, equipped with nothing more than a spear is being confronted by the sabretooth tiger. The body’s system engages – the heart accelerates, and he begins to perspire. The body has entered into a state where it is ready for a physical challenge.

 

There aren’t many sabre tooth tigers in rural, suburban, or city centres. So, what happens? Our bodies still have the fight or flight response when challenged by an obstacle (think of it as a mini sabre tooth) but we do not get the opportunity to fight or run. This means that our stress levels remain at a state of anxiety. We don’t have short term problems like the cave man, we have long term problems. If our bodies do not learn how to switch off, then our bodies remain in a state of preparation for something which never comes. This is why stress “runs us down” and we are more prone to illness and fatigue. Your body wants to run, but it can’t due to the environment we live in.

 

Yoga Can Teach You to Switch Off

 

Yoga is an interesting practice as it locates a space between effort and non-effort. You consciously engage in an activity that requires you to not engage in anything. Once we pass this somewhat paradoxical conundrum – you’ll find that yoga is simply switching off in an organized and methodological manner. Yoga is the practice of conscious relaxation. It is a way in which you can turn off your fight or flight response which will in turn increase your overall health. Conscious relaxation encourages you to release the grip of your muscles when you don’t need them – and allows you to switch off your high corticosteroid level.

 

Click here to read about how you can practice yoga and follow our series on stress related issues.

 

If you are considering yoga classes Mount Sinai offers classes with certified yoga teachers (CYTs). Please contact us on (212) 241-6321) to see if we can further help.

 

 

 

 

Regaining Language in Aphasia Patients

 The outcome of aphasiac brain damage can seem debilitating to patients as their range of communication abilities is reduced. Depending on the extent of damage, and the area affected, there are treatments that can be employed to restore language abilities, either partially or completely.

The most commonly employed treatment process is speech and language therapy (SLT) and involves the patient working with a therapist on a series of exercises specially tailored to the type of aphasia damage. For patients who struggle to understand the meaning of words, activities, such as pairing words to pictures, or sorting words into groups based on their meaning, may be suggested, to redevelop word association knowledge and definition memory. If the trouble stems from a difficulty in expressing oneself coherently, a therapist may employ tasks in which the patient must name what they see in a picture, or judge whether or not words rhyme with one another. On top of working in one-on-one sessions with a speech therapist, often specially-designed computer programmes are used, alongside group speech sessions in order to improve conversational abilities.

Under circumstances where speech abilities are not restored to a functional level, speech therapists may work with the patient to develop alternative methods of communication. These may be in the form of gestural language, drawing or writing, or communication charts, where the patient has a grid of words or letters and can point to them to convey what they want to say.

While SLT is the most common form of therapy, research is also ongoing into medications and brain stimulation therapies. Certain drugs are being analyzed for their affects on aphasia symptoms, such as bifemelane, which has been noted for its abilities to increase circulation of blood in the brain, while others are being tested for increasing the brain's ability to recover and repair itself, and to help raise levels of depleted chemicals in the brain. Transcranial magnetic stimulation also holds promise, a technique that involves placing an electromagnet on the scalp and briefly sending an electromagnetic current through it to affected areas of the brain to re-stimulate activity in them.

Many of these alternative theories are still in the trial phase and so, currently, SLT is the most effective and widely used treatment. The prognosis of aphasia treatments can be difficult to predict, as it is heavily influenced by how severe the damage was, and also how healthy the brain was pre-injury. Recovery attempts are more likely to be successful in younger patients and are more effective the sooner they are started. Improvements in language and communication are most prominent in the first six months after the injury, however, this does not mean that recovery is impossible after this stage, with improvements still possible after several years in some cases.  

Living With Osteoarthritis – Managing the Symptoms

 As we get older the cartilage covering our joints become worn, resulting osteoarthritis. This condition manifests itself in the form of joint pain and stiffness and, while there is no cure for this chronic disease, there are treatments and measures that can be taken to reduce suffering.

It may seem counter-intuitive to reduce joint pain by increasing your movement, however, exercise is proven to be incredibly beneficial in reducing osteoarthritis symptoms. Rather than wearing down the cartilage further, strengthening exercises will alleviate pain, through building up the surrounding muscles, reducing strain put on the joints. Exercises that focus on range of motion are also excellent for improving the condition, as they encourage flexibility of the joints and reduce stiffness. Choose exercises that work the joints but that aren't too strenuous. Taking a brisk walk, or joining a relaxing class such as yoga or tai chi, that gently uses your muscles, will keep your body working to support your bones and joints. For less impact while working out, swimming or water aerobics both engage muscles while avoiding putting force on the joints.

Linked to exercise, maintaining a healthy weight is integral to relieving osteoarthritic symptoms. Excess weight can add additional pressure to weight-bearing joints such as the hips, knees, feet and back bone. Losing this extra weight, and then maintaining a healthy one, will reduce pain and restrict further damage to cartilage. Combined with living an active and healthy lifestyle, medications are available that can reduce symptoms, such as pain and inflammation around the joints, making it more manageable.

Physical, or occupational, therapists can teach osteoarthritis patients the best ways to use, and move, joints to prevent further wear and tear of the cartilage. As well as introducing range of motion and flexibility exercises, thermotherapy treatments may be suggested to mediate symptoms. Cold treatments are effective at numbing pain, decreasing swelling, and blocking nerve impulses to the joints while heat therapy will improve blood circulation and relax muscles, removing tension. Often a combination of the two techniques are used, applying heat in the morning to loosen up joints, followed by cold treatment later in the day to reducing any swelling that builds up.

Although steps can be taken to reduce osteoarthritic suffering, assistive devices may become necessary. These can range from walking aids, such as walking sticks or specially modified shoes, to devices that help in carrying out everyday activities. Kneelers for gardening, extenders for door knobs and taps, and clothing that is easier to fasten are all available so that patients can keep their everyday lives as normal as possible.  

Relearning the Activities of Daily Living

 For patients who are recovering from a recent stroke, or similar brain injury, one of the struggles they face is the loss of independence in everyday life. The basics of self-care – eating, bathing, dressing, toileting, transferring (walking), and continence – which we usually take for granted, become activities that cannot be done without assistance. These activities of daily living (ADL) are tasks that must be relearned.

Regaining the ability to care for oneself is synonymous with returning to living an independent life. This is achieved through a process of occupational therapy which involves both relearning the muscular movements necessary to carry out tasks as well as increasing confidence levels in one's abilities in order to achieve a full recovery.

Task-specific Training

In order to relearn the processes needed to carry out the ADLs patients must undergo a regimen of exercises to regain coordination and strength, and to improve motor skills. These exercises are task-specific and tailored to the patient depending on which components they are missing. They focus around using repetition to build up muscle strength and memory.

A variety of techniques are used to retrain the muscles. For example, mirror therapy in which a mirror is placed on a table so that it covers the affected arm and reflects the unaffected one. This triggers mirror neurons, which are in the same area of the brain as motor neurons, making the patient think both arms are carrying out the same action. Recovery can also be aided through brain stimulation. Wires are placed on the scalp through which current stimulation is sent to the brain. This excites damaged areas of the brain, helping to increase the chances of them recovering.

The tasks do produce improvements in function and also cortical reorganization, however, these improvements do not generalize and transfer beyond the targeted activity or area. As such a range of exercises is required to improve motor activity in several areas.

Cognitive Strategy Training

While task-specific training is the only way to help patients recover their previous coordination and muscle power, this can be supplemented by cognitive strategy training. This involves utilizing the brain's ability to reorganize and create new pathways to improve cognitive skills such as attention, working memory, logical thinking, reading, and occasionally psychosocial functioning. This can be used in tandem with the physical exercises to increase self-esteem, and problem-solving strategies, as well as regulating training frustration.

Recovery can be a long and discouraging process. In order for the combination of these training techniques to have any lasting effect on motor improvement consistency is crucial. However, with time these exercises can enable stroke rehabilitation patients to live independently again.