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Amazing Results of Physical Medicine.

Amazing Results of  Physical Medicine.

Just a decade ago, physical medicine (rehabilitation therapies) seemed an afterthought to care, often overlooked and underutilized. 

Now patients, their families and doctors are seeing amazing benefits from physical, occupational and speech therapies for many injuries, diseases and health conditions.

Marlon, a patient in his 60s, fully appreciates what physical therapy (PT) and occupational therapy (OT) have meant to his life.

Wheelchair bound, Marlon, who is married with children and now grandchildren, once served as a city services employee living a ‘normal’ life. A car accident changed everything. 

Complications affected his immune system, as well as the ability to use his right leg. Then, five years ago, he developed multiple sclerosis, also known as MS. 

Purpose of Therapies.

Rehabilitation therapies can provide many benefits: helping an elderly person stay independent longer; helping stroke victims improve range of motion or even walk again; helping amputees adjust to a prosthetic. It also can get athletes back in their game.

In short, Dr. Alvarez defines the key therapies this way:

Physical therapy strengthens the lower extremities, and includes helping patients with balance, endurance and basic mobility, and often involves exercises of the legs.

Occupational therapy is for strengthening the upper extremities to help with fine motor skills, including activities of daily living, such as eating, buttoning a shirt, having fuller range of motion, and visual and spatial skills, and usually involves exercises of the arms. OT therapists also do home evaluations to assess the environment and make changes where needed to make things safer and easier for patients.

Speech therapy includes speech, cognition, language and swallowing, and involves muscle exercises to help with these functions.

For the most part, all include strengthening and improving range of motion.

Therapy Helps Maintain Independence.

“Since having therapy, I am able to do more for myself,” said Marlon, whose therapists are at Missouri Baptist’s Outpatient Rehabilitation Services.

“I do as much therapy, including exercises at home, as I can handle to keep my upper body strong for transferring myself into the shower or to the bed.
I am able to take my own showers and can shave with no problems.” 

Getting The Right Fit.

Marlon explained that working with Lizette Alvarez, MD, physical medicine and rehabilitation physician on staff at Missouri Baptist, has been the “right fit.”

The benefit of seeing someone like Dr. Alvarez is that she oversees the complete package of healthcare issues related to his disease, including determining which medicines to use and where to go for the right mix of help. 

“She recommended I start working with Sara and Kara for my therapy,” Marlon said. Sara Wilhite, DPT, MSCS, is a physical therapist who also is certified in MS, and Kara Knetzer, OTR/L, CLT, is an occupational therapist.

“This is the first time I actually feel something good is happening for me even though I have this rotten disease,” he said.

“Dr. Alvarez really listens and shows true concern. She understands the changes I’m going through due to MS, which is a progressive illness.”

She also administers injections of Botox into Marlon’s muscles every three months to help reduce spasms, or
involuntary movements. 

Designing A Therapy Program.

“Therapy programs must be designed for specific purposes or problems affecting an individual’s functional ability, such as a brain injury, multiple sclerosis, an amputation, or a stroke,” explained Dr. Alvarez. “Therapy also can be prescribed for such things as fall prevention or cognitive deficits.”

“In summary, we look at prescribing therapy when there has been a change in a person’s functional abilities.” 

After just a few PT sessions with
Wilhite, Marlon’s dizziness problem was improved. 

“I used to get extremely dizzy if I leaned forward. Sara helped re-circuit my brain signals with my eyes,” he said, describing exercises, such as spotting an “X” mark on a wall and moving his head from side-to-side.

Wilhite continues to help him build up core strength and keep his upper body strong.

Occupational therapy sessions included pulling back on rubber bands for strengthening and functional balance work. These helped improve his muscle strength and ability to move. Exercises focused on improving his ability to move himself from wheelchair to the toilet or wheelchair to bed. 

“The ultimate goal of a rehabilitation program is to preserve or restore patients to their prior functional status,” said Dr. Alvarez. 

“We often hear from older patients that they have better balance and cognitive abilities after therapy than ever before.”

Therapy may extend a person’s ability to remain in his environment versus needing a higher level of care, such as assisted living.

Dr. Alvarez said that patients with chronic illnesses should be followed by a rehabilitation specialist for the rest of their lives to make sure they are maximizing their function. Their rehabilitation program may need to be updated to meet their changing needs. Insurance often covers therapies for declining function, pain or new issues.

After completing a therapy program, many need an at-home daily exercise program to help maintain functionality. 

“With rehab therapies, we aren’t talking about someone who wants to tone or lose weight, or just work out in a gym,” said Dr. Alvarez. “We are talking about those who need guidance from a therapist.”

“Therapy can also help people with preoperative exercises, such as before a joint replacement,” said Dr. Alvarez. “Other examples of patients who benefit from physical therapy include women who have pregnancy-related back pain or post-partum muscle loss.”

For those who tend to push limits, such as an athlete who has suffered a fracture, muscle or sports-related injury, physical therapy can help recovery in a coordinated manner. 

“‘No pain, no gain’ is not true – not doing the right exercises the correct way, could cause re-injury or further damage,” she said.

Other Treatments Help.

Therapy is often aided by other treatments, such as ultrasound and electrical stimulation for treatment of pain; muscle stimulation to strengthen the muscles; heating pads and ice, deep heat, or hot wax or paraffin, to decrease inflammation and increase range of motion; etc.

For patients post-stroke or with spinal cord injuries, cerebral palsy, etc., an injection of Botox, administered by a physician, can relax the muscles.

“Botox can improve range of motion even helping protect against skin breakdown,” said Dr. Alvarez, describing patients with limbs or elbows locked into one position, who often experience skin irritations.

Dr. Alvarez said results can be dramatic. She had one patient who told her she’d contemplated suicide until she got relief with Botox from cervical dystonia, where the neck is stuck in one position. 

Besides feeling embarrassed, Dr. Alvarez said patients with such issues may be in pain, unable to relax or sleep well. Physical therapies also can help them strengthen neck muscles and regain the correct muscle balance. 

Choosing A Rehab Therapist.

It’s important to know what to look for in choosing an outpatient therapist.

Dr. Alvarez said the therapist should be well-versed with the patient’s diagnosis and its rehabilitation.

“Some therapists may specialize, for example, in pelvic floor, shoulders, lower back pain or lymphedema.” 

“You should work with a therapist on a one-on-one basis. You need to ‘click’ with or like that person. There should be consistency with seeing the same person or where that person is overseeing your therapy.”

Dr. Alvarez, who has been in practice since 1996, enjoys seeing her patients improve. “I became interested in becoming this type of doctor because I was interested in muscles and nerves and seeing people through the recovery period.”

Lizette Alvarez, MD, is a board-certified physical medicine and rehabilitation physician on staff at Missouri Baptist Medical Center. She received her medical degree from Ponce School of Medicine in Puerto Rico and completed her residency and fellowship at the University of Virginia Hospitals. 

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