Sample Articles: April - June 2008

A 21st Century Solution to Weakness Following Neurological Injury

Kelly DeLong, ATP, PT, DPT

As we move forward into the 21st century, technological advances have been developed to assist people in all aspects of their lives. The rehabilitation industry has kept up with these advances with two devices from Bioness Inc. Bioness has developed functional electrical stimulation devices for certain cases of a paralyzed or weak hand (NESS H200® Hand Rehabilitation System) and for some cases of foot drop (NESS L300™ Foot Drop System). The devices work by stimulating nerves to activate muscles in the hand or foot to produce motions that a patient otherwise may not be able to perform. The Bioness devices work with patients who have certain central nervous system disorders, including stroke, multiple sclerosis, traumatic brain injury, and incomplete spinal cord injury. Unfortunately, these devices do not work for injuries to the peripheral nervous system, including severed nerves in the arm or leg.
The NESS H200® Hand Rehabilitation System includes a brace on the forearm and hand, and a control unit. The brace has electrodes that provide low-level stimulation to the muscles required to open and close the hand. The control unit has easy-to-use buttons to change the stimulation patterns to achieve the best function possible for the particular patient. The H200 can easily be put on with just one hand. A person may be able to use the H200 Hand Rehabilitation System to assist in performing tasks that require two hands—-holding a glass, reaching for objects, or even writing.
The NESS L300™ Foot Drop System may be used instead of the traditional rigid or hinged plastic or metal braces that are typically provided to keep the foot from dragging while walking. Traditional braces can be uncomfortable, only fit in certain shoes, require the wearer to purchase larger shoes for the braced foot, and make it difficult to navigate on stairs, ramps, and uneven surfaces. For certain patients, the L300 may address all of these problems! Similar to the H200, the L300 can be put on with only one hand. It uses low-level stimulation to activate the muscles and nerves that pull the foot up to walk in a more natural pattern. The device may be used with almost any shoe and can adapt to walking on many terrains, including stairs, ramps, and hills. Plus, the L300 does not limit mobility in the ankle joint, which is important to recovery of walking.

Real Stories:
A 50-year-old woman I worked with, who had suffered a stroke, was using a plastic brace to help keep her foot from dragging. She had difficulty with her walking speed, walking on uneven ground, and she even developed a rash on her leg from the hot plastic brace. She “trialed” the L300 in therapy and decided to purchase a unit. She can now walk much faster, wear almost any shoe she likes, and handle difficult surfaces with ease. “I love the Bioness”, she says.
In another case, a 62-year-old woman who sustained a spinal cord injury in her neck in 2005, had difficulty with the use of her right hand. Her hand was very tight and she could not open her fingers wide enough to grasp anything larger than a pencil. She purchased the NESS H200 and used it 3 hours per day. She now demonstrates increased hand mobility with decreased tightness in her fingers. She is even able to pick up a water bottle and hold it in her right hand! She said to me, “I can comb my hair with my right hand…this is new! I can tweeze my eyebrows with my right rather than my left.” She is excited about working on building new strength in her right hand, since she has not been able to use it for so long.
Please remember, while results like these are extremely encouraging, people interested in the H200 and L300 should note that individual results do vary. They should consult with a qualified physician to determine if these devices might be right for them (the H200 and L300 are both available by prescription only).

For more information about products that may aid in recovery from certain neurological conditions, such as stroke, multiple sclerosis, traumatic brain injury or spinal injuries, please call HEALTHSOUTH Scottsdale Rehabilitation Hospital at 480-551-5447.

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Dr. Art Mollen's Corner - Your Questions Answered

Dr. Art Mollen

Dear Dr. Mollen:
Will growth hormones help me anti-age?

Dear Ageless:
Endocrinologists have known for decades that growth hormone levels decline with age, and that a deficiency in this hormone increases fat mass, decreases lean mass, and decreases exercise tolerance. Growth hormone secretion gradually declines by about 14% per decade of your adult life. There are many claims (and dubious assertions) about the alleged anti-aging benefits of growth hormone. It is often sold as a supplement, which is far different than the actual human growth hormone. It does not have the same effects. Growth hormone can increase the number of red blood cells and their concentration as well as the risk of clotting. There is also the risk of leg swelling, carpal tunnel syndrome, and prostate and breast cancer. Although, people often report that they feel better when taking it. There are potential benefits, but it may not be as healthy as you think

Dear Dr. Mollen:
Any idea why I might always be sleepy, even in the day?

Dear Sleepy:
If you have been falling asleep during the day, perhaps you are not sleeping very well at night. The reason could be depression. Excessive daytime sleepiness is commonly assumed to be the result of disturbed or inadequate sleep, but depression is most often the problem—-in fact, about 75% of the time. A recent study in The Journal of Clinical Endocrinology suggested that people seeking help for insomnia and excessive daytime sleepiness should be screened for depression. It appears that excessive sleepiness during the day is more strongly associated with mood factors, such as depression, than anything else. People, who yawn excessively during the day, feel tired, have a lack of energy, and simply can’t get going, may be depressed. So, instead of being treated with sleeping pills (ncluding Sonata, Ambien, and Lunesta) talk to your doctor about being treated with an anti-depressant. Seek counseling, in order to discern the underlying cause of your yawning and daytime sleepiness.

Dear Dr. Mollen:
I am worried about prostate cancer. Is there anything that might help?
Worried

Dear Worrier:
If you are looking for a way to either slow or stop the growth of prostate cancer, it could be diet and exercise. A recent study shows that diet and exercise play a significant role in stopping or even reversing early prostate cancer. Prostate cancer is the most common cancer in men, particularly those over the age of 65. A high fat diet increases the likelihood of developing prostate cancer. Some men with an early diagnosis of prostate cancer are apt to delay treatment and see how things go, which is called “watchful waiting.” But it is not always the best choice. It has been suggested that besides exercising every day for at least 30-60 minutes, eating a vegetarian diet with mostly salads, fruits and vegetables, taking soy supplements, fish oils, vitamin E and selenium, are all helpful in slowing down the process. Researchers found that men who followed this type of exercise and diet program after being diagnosed with early prostate cancer had a decrease in their prostate cancer blood test, known as PSA.

Dear Dr. Mollen:
How much salt in my diet is too much?
An Old Salty Dog

Dear Salty Dog:
Cutting back on salt has been recommended for a number of health reasons, particularly that of controlling high blood pressure. Most people consume up to 10,000 mg of sodium a day. In reality, they should limit their salt intake to about 2,400 mg, which is approximately one teaspoon. This is perhaps more important for people with high blood pressure, heart failure and edema. Processed foods account for most of the sodium and salt that is subtly consumed, and not necessarily from your salt shaker. Check food labels, because there is salt in some foods you might not even expect, including soy sauce and certain antacids. Reducing salt in your diet can help to lower blood pressure. Interestingly enough, 75% of the salt you consume is from meals prepared and eaten at home.

Dear Dr. Mollen:
I can’t seem to quit smoking. Can you help me quit?
Non-quitter

Dear Non-quitter:
If you need one more reason to stop smoking, here it is. Cigarette smokers are more likely than nonsmokers to go blind. In fact, smoking is associated with a three-fold increase in the risk of developing age-related macular degeneration. The condition is irreversible and difficult to treat. It causes blurring of vision, and affects the central part of your vision. Skills like reading and driving are often most impaired. The studies confirmed that smokers were significantly more likely to develop visual difficulties than nonsmokers. Most smokers would definitely quit if they developed early signs of blindness. Smoking is the only proven cause of macular degeneration that you can do anything about, particularly if you have a family history. So stop smoking now. “No man is so blind as he who will not see!” See the light before it is too late!

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Staying Safe

Lorena Llamas - Alzheimer's Association

As important as safety is for everyone, it should be a greater priority when caring for individuals with dementia. The changes they experience affect their judgment, sense of time and place, physical ability, behavior, and senses. This means looking at one’s home through the eyes of a person with dementia very necessary for caregivers. Because most accidents occur while eating, bathing, and using the restroom, some of the activities most often done, one must take particular safety measures during these times. Safety is generally considered after an accident has happened. Fortunately, making safety a priority for individuals with dementia also benefits the family in many ways.
Although limiting access to potentially dangerous places is a great piece of advice to take when making changes to the home, there are also other areas of one’s home one can alter to improve safety precautions. For instance, enhancing safety in the kitchen to meet safety precautions can be achieved by removing vitamins, prescription drugs, sugar substitutes and seasonings from the kitchen table and counters. Also, enhancing safety in the bathroom can be achieved by installing walk-in showers and grab bars in the shower or tub. It is also great to consider replacing towel bars with sturdy grab bars and ensuring there is enough and even lighting on the way to the bathroom.
Understanding how important safety is for everyone, especially individuals with dementia is essential when caregiving. Taking the measures just mentioned can enhance the quality of life for individuals with dementia as well as for their caregivers and family members. Although such alterations cannot eliminate all accidents, it can help reduce the amount of concern caregivers experience for their loved one’s safety.

For further information about this article or to request information about Alzheimer’s disease or a related form of dementia, please call the Alzheimer’s Association at 1.800.272.3900.

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That's Funny!

Christine Harper, BA Psychology/Gerontology

“You don’t stop laughing because you grow old. You grow old because you stop laughing.” —- Michael Pritchard

Did you know that humor and laughter will greatly improve your physical well-being and mental and social outlook?

“Belly laugh” benefits:
Boosts immune system
Improves cardiovascular
health while lowering
blood pressure
Aids pain relief
Expands breathing function
Reduces tension, stress,
anxiety, depression and
lightens our burdens
Helps keep things in
perspective and gives us
new insights
Enhances energy level and
creativity
Decreases the chance of loneliness; connecting
us with others

Laughter decreases hardening of the arteries and lowers blood pressure by dilating blood vessels and increasing blood flow. It also increases the production of beta-endorphin and HGH (human growth hormone), which in turn improves mood. Another chemical affected positively by adding daily humor is the level of cortisol. Expanding your sense of humor reduces this stress hormone that damages the immune system, harms brain function and packs on the pounds when large amounts are constantly present. Inflammation throughout the body decreases when we look at the lighter side of life, improving countless health concerns.
Where do we find humor? Everywhere! Sometimes we need to be intentional about incorporating it into our lives. Taking five to ten minutes a day for a “humor break” can reap positive results. Begin compiling jokes, riddles, funny stories and sayings that bring a smile to you in a humor notebook. Watch funny movies and TV shows. Observe infants and young children to learn how to find fun in the most ordinary of situations. (On the average, children laugh 200 times a day compared to an adult’s output of only 15 to 18.) Tape something funny to your bathroom mirror or refrigerator. Scan the comic strips. Find a stuffed animal that makes you laugh, and place it where you will see it often. Incorporate positive upbeat people into your life. (We are 30 times more likely to laugh out loud around people versus being alone.) Tell humorous stories to your kids and grandkids. Sing and dance around the house.

Don’t forget to spread laughter and let others reap the benefits too. Bumper stickers, totes and t-shirts with funny expressions are a great visual for a giggle. Here are a few phrases to get you started: “Procrastinate Now.” “No sense in being pessimistic, it wouldn’t work anyway.” “I’m not a complete idiot, some parts are missing.” Why not go to a t-shirt shop and create your own humorous phrase?
Basic search words and phrases on the Internet boost your humor quotient. One of the best is simply “senior humor.” A great web site for “clean” humor is www.GCFL.net, which stands for Good Clean Funnies List.

Continue to develop your silly playful side and remember, “The most wasted of all days is one without laughter.” —-E.E. Cummings