There are many types of arthritis, but the most common are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis is an auto-immune disease – meaning the body’s immune system mistakenly attacks the thin membrane that lines the joints, called synovium, as if it was an infection.  The result can be joint damage, pain, inflammation, loss of function and disability. In about one of every six cases, it can cause deformity.   The joints most commonly affected are those in the hands, feet, wrists, knees, elbows, and ankles. Joint involvement is usually symmetrical, meaning if one join is affected, the same joint on the opposite side is usually affected as well. Rheumatoid arthritis can affect children or adults.

Osteoarthritis, sometimes called degenerative joint disease or degenerative arthritis, affects approximately 27 million Americans over the age of 60. Osteoarthritis is the breakdown in cartilage covering the ends of bones where they meet to form a joint and allow movement.  Over time, as the cartilage wears away, the bones are exposed and rub against each other, causing the joints to no longer function smoothly resulting in pain and discomfort.  

Many arthritis sufferers claim they can predict the weather based on their pain level.   Though researchers aren’t sure why, changes in temperature or barometric pressure, a measure that refers to the weight of the surrounding air, does trigger joint pain. A study at Tufts University in Boston reported that with every 10-degree drop in temperature, participants experienced incremental increased arthritis pain. Studies on cadavers further prove that the barometric pressure affects the pressure inside the joints.  ArthritisToday.org even offers a Weather Arthritis Index to help arthritis patients predict painful days before their symptoms do.

Arthritis suffers can often tolerate the pain associated with the change in temperature by using hot therapy. Hot therapy warms the tissues and eases pain by increasing blood flow to affected areas. This can help decrease inflammation, relax tight muscles and eliminate waste products such as lactic acid that cause stiffness and soreness.  A hot bath or a dip in the Jacuzzi can help, or for more isolated pain, use hot packs like Norco™ Moist Heat Packs or Natra Cure Warming Gel Mittens, or a low-level continuous heat wrap, like Thermophore® 4 Stage Moist Heat Therapy Pads.  Coating the hands or feet in melted paraffin wax using Therabath™ traps the heat where it’s needed, and as an added bonus, softens skin.

If you are experiencing an arthritic flare up, or acute levels of pain in certain areas from overuse, try using cold therapy, or cryotherapy, to decrease the blood flow and reduce swelling.  This will slow the transmission of pain signals through nerves and inhibiting inflammatory chemicals.  For acute pain and swelling or during a flare up, cold packs such ad  Flexi™-Freeze can be used for 15 to 30 minutes.

Unfortunately however, there is no single technique that guarantees complete and consistent pain relief. You may need a combination of different methods or to change your habits over time.  The best thing you can do for your arthritis is to learn as much as possible.  Educating yourself regarding pain treatments can help break down roadblocks to pain relief and help get back to feeling like yourself again, not like yourself with arthritis.

Sources:
http://www.arthritistoday.org/conditions/rheumatoid-arthritis/all-about-ra/index.php
http://www.arthritistoday.org/conditions/osteoarthritis/all-about-oa/index.php
http://www.arthritistoday.org/community/weather–arthritis-index/index.php
Arthritis Foundation®, comp. Arthritis Information: Basic Facts Answers To Your Questions. Atlanta: Arthritis Foundation®. Print.

Mirror therapy was developed by V.S. Ramachandran, a Cognitive Neuroscientist and Director of the Center for Brain and Cognition at the University of California, San Diego. Since it was first developed in 1995, mirror visual feedback therapy (MVF) has been evaluated by many other researchers with test results chronicled in scientific and academic journals.(Altschuler, Flor, Knecht, Longo, McCabe, et al.)

Why MVF works is as confounding and interesting as the ailments it treats. In his initial experiments, Dr. Ramachandran theorized that mirror therapy reversed some of the sensory confusion occurring in amputees that he believed was caused when ‘orphaned’ axons from severed limbs migrated within the somatosensory cortex to nearby sensory areas (represented by Penfield’s sensory brain map)[2].  According to Ramachandran, “in this way, perception of the severed body part could be misrepresented by moving from one location to the next.” The brain’s apparent malleability led to the theory that if the brain could be fooled once, perhaps it could be fooled again, by the visual representation of an intact limb or healthy body part.

“Far from being wired up according to rigid, prenatal genetic blueprints, the brain’s wiring is highly malleable—and not just in infants and young children, but throughout every adult lifetime. As we have seen, even the basic “touch” map in the brain can be modified over relatively large distances, and a phantom can be “amputated” with a mirror. We can now say with confidence that the brain is an extraordinarily plastic biological system that is in a state of dynamic equilibrium with the external world. Even its basic connections are being constantly updated in response to changing sensory demands.”[3]

“Apart from its clinical importance, mirror visual feedback paves the way for a paradigm shift in the way we approach neurological disorders. Instead of resulting entirely from irreversible damage to specialized brain modules, some of them may arise from short-term functional shifts that are potentially reversible. If so, relatively simple therapies can be devised—of which mirror visual feedback is an example—to restore function.” [4]

At the College of Adaptive Arts (CAA) however, adults with “differing abilities” are provided with an opportunity to develop their fine motor, social and cognitive skills in a campus setting.  Students of CAA can learn and are enabled to live a full, empowered life as successful, contributing members of the community.  Unlike typical therapeutic recreational programs that offer a variety of incongruent courses, CAA provides a curriculum that builds upon each course, allowing the adult to grow in the artistic area of their choice while they develop the same skills they would in a clinical setting.

We invited co-founder, Pamela Lindsey to North Coast Medical to tell us a little bit more about the therapeutic benefits of the college.  We were thrilled to hear about the “well rounded experience within the classes that incorporate the fine motor, gross motor, visual processing, auditory processing and social cognitive skills” that Pamela mentions in her video:

The College of Adaptive Arts truly believes that these adults have an incredible wealth of talent, ability and community contribution capabilities when people in the typically-developing world can create safe, engaging and creative outlets for their abilities.  At North Coast Medical, we believe that by encouraging these individuals to grow with art, they are given an opportunity to express themselves in a new way, and build the confidence to know that even if they struggle in a therapy setting, on stage they are superstars.

For more information on the College of Adaptive Arts, visit: www.collegeofadaptivearts.org

On behalf of North Coast Medical, we would like to give a huge THANK YOU to the students of the College of Adaptive Arts for their beautiful, hand-inspired painting, presented to us by Pam Lindsay.

However, not everyone is pleased with their efforts, considering that many of the proposed changes in reimbursement levels and service caps will adversely affect both patient care and healthcare providers’ profitability. The agency may be left with little choice, given the economic realities of unprecedented debt to GDP (Gross Domestic Product) levels, an intractable budget deficit, stagnant economic growth and high unemployment. Adding to the crisis is a simultaneous demographic time-bomb of an aging baby-boom generation entering retirement age, en masse.

Among the most unpopular upcoming proposals to control Medicare costs is slated to start in 2013, when the Medicare Part B therapy cap without exceptions and the 27.4% payment cut for Part B outpatient physical therapy services both go into effect. Also effective in 2013, will be a 2.3% excise tax on the first sale of medical devices, with certain exceptions. (Expect more hidden taxes in the future).

Currently, the Centers for Medicare and Medicaid Services are about to reach their final decision regarding TENS reimbursement coverage for chronic low back pain. This decision appears to have many DME providers that specialize in pain management growing concerned that any change in reimbursement for one group of patients might be the start of a chipping away at the entire TENS reimbursement program.

References:
http://www.apta.org/PTinMotion/NewsNow/2012/2/15/SGRDeal/
http://dpc.senate.gov/healthreformbill/healthbill65.pdf pg, 7

Leprechauns prefer Norco™ Heavy Duty Quad Canes

The world will look a little greener on St. Patrick’s day, covered in four-leaf clovers and leprechauns with pots of gold. Though St. Patrick’s day is traditionally a day to commemorate Saint Patrick, at North Coast Medical, we celebrate helping the world be greener – in an eco-friendly, sustainable energy kind of way.

This year, we are proud to announce our Facilities Administrator’s acceptance of the 2011 Gilroy Business Recycler of The Year Award from Recology South Valley on behalf of North Coast Medical, for establish a recycling program and energy sustaining procedures for a greener working environment. The effort was fronted by Pablo, who worked closely with Recology South Valley  in order to manage the recycling program, and has been contagious throughout North Coast. Employees embrace the program by ensuring everything that can be recycled is done so. When accepting the award this month, Pablo mentioned, “Really when I’m accepting this award, I’m doing it for all the employees at North Coast – It’s not just me doing this, and it’s not just about cutting costs.  We all watch each other’s backs because we all care for our planet and that is what motivates employees.  It’s the right thing to do.”

With a commitment to the preservation of the environment, Recology South Valleycreates unique recycling programs that meet each business’ specific needs.   When North Coast Medical moved to Gilroy, Pablo partnered with Recology South Valleyto develop a greener work environment.  North Coast chose to make simple modifications to the new builiding that help sustain energy and cut costs.  By moving away from tile ceilings and using skylights to provide natural light, less energy is required to light the room.  All artificial lighting is motion sensitive to prevent wasting energy on a room no one is in. The ceilings are also insulated, so less heat is required to maintain the temperature of the office.  The result has been significant with thousands of dollars saved monthly in energy costs. Further conservation efforts were realized when replacing all the interior plants with artificial plants saving almost $500 a month on our water bill.

Pablo Zertuche (left) of North Coast Medical with Julie Atler (right) of Recology South Valley, and our energy efficient skylight ceilings.

It is a group effort and Pablo made sure recycling bins were at every desk and  spread strategically throughout the building.   Large bins were set up in the warehouse to collect used corrugated cardboard for pickup by Recology South Valley for recycle along with all the paper waste collected throughout the company.

However, it didn’t stop there. Pablo went above and beyond by providing North Coast Medical employees with a battery recycling drop box, where employees can drop off dead batteries.  He would then take them to a local recycling center.

In addition, our partnership with HOPE Services has provided Pablo with more opportunities to recycle.   Clothing drives are often set up in the North Coast parking lot where employees can bring clothes to benefit the members of HOPE.   Together with HOPE Services , North Coast Medical promotes and manages E-waste Events in the North Coast parking lot,so the  local community has a place to safely dispose of  computers, monitors, keyboards, faxes, etc.

So while we all celebrate today with a little green, we highly encourage everyone to make each day a little greener by recycling and conserving energy. If you would like to know how you can make a difference at your place of business, please contact Recology.

Pablo and Julie in North Coast Medical's warehouse, as they go over the details of the recycling program

We want to thank everyone who was able to make it out to visit us at APTA CSM 2012. For those of you who were not able to attend, we will be posting a virtual tour within the next few days for you to catch up on what you missed. You will also have the opportunity to see us again at the Philadelphia Hand Symposium on March 3-6, 2012.

One of our more popular booths was for a product in the final development stages, the SMART-Mirror™.  The SMART-Mirror™ is a mirror therapy device, which can be used as part of graded motor imagery therapy.  For those of you who are unfamiliar, we want to help break down the concept to give you a better understanding of how the SMART-Mirror™ should be used.

Graded motor imagery is composed of three steps: laterality training, imagined hand movements, and mirror visual feedback (MVF) therapy.²

Laterality training is important because people with painful limbs often lose the ability to distinguish between left or right images of limbs, which can hinder a successful recovery.  Laterality training is a process to restore the ability of the patient to identify images of the left and right sides of the body.  Laterality training involves having the patient correctly identify pictures of right and left hands in various positions, while both time and accuracy are recorded.³ The average person can do so in 2.4 seconds, but a patient with persistent pain will take twice as long to correctly distinguish between the two.⁴

The ability to differentiate between right and left depends on an intact body schema, or how the brain interprets the body’s shape.  When the body schema is believed to be accurate, patients are asked to imagine pain-free movement.³   Around 25 percent of the neurons in your brain are called mirror neurons, and are activated when you watch someone else move or think of performing an action.   The theory is that there is such a high degree of overlap in the brain regions involved in imagined movement and actual movement, that imagined movement can lead to pain-free actual movement.²

The final step is called mirror visual feedback therapy.  MVF requires a mirror therapy device, like the SMART-Mirror™.  A mirror therapy device allows the patient to place their injured hand inside the device and out of view, while the unaffected hand is placed outside the device, in front of the mirror.  The patient is then instructed to look in the mirror at the mirrored, unaffected hand and watch the “mirrored” hand move. This creates the illusion that the injured hand is moving without any pain.

When done properly, graded motor imagery and MVF are thought to provide such strong positive sensory feedback, that the brain is convinced that not all movement needs to be painful, and is proven to decrease pain and disability.¹

If you did not get the opportunity to see the SMART-Mirror™ at APTA CSM, meet us in Philadelphia, PA. for the Philly Hand Show.

References:

1. McCabe, C. (2011). Mirror Visual Feedback Therapy. A Practical Approach. Journal of Hand Therapy, 24(2), 170-179.
2. Moseley, L. GMI – Graded motor imagery. NOI Graded Motor Imagery.
3. Priganc, V., & Stralka, S. (2011). Graded Motor Imagery. Journal of Hand Therapy, 24(2), 164-168.
4. Wood, D. (2011, November 14). See Where it Hurts. TodayinPT.com

Hippotherapy takes this idea a step further, by using horses as part of a physical, occupational or speech and language therapy treatment strategy utilizing equine movement. Research conducted by the American Hippotherapy Association has proven that the multidimensional movements of the horse provide a disabled rider with “the opportunity to explore, control and coordinate posture and movement”. Horseback riding, as part of horse therapy, gently and rhythmically moves the rider’s body in a manner similar to the way a human walks. Learning to ride a horse requires both balance and coordination, and because many physically disabled individuals lack muscle tone, their coordination is severely lacking. Horse therapy gives a disabled person a physically enjoyable experience; helps develop muscle tone, balance and coordination.

Alternatively, animal assisted therapy is designed to promote improvement in human physical, social, emotional, and/or cognitive functioning and is delivered by a health professional with specialized expertise. One study, conducted in 2009, concluded that adults who use animal assisted therapy while recovering from total joint-replacement surgery required 50 percent less pain medication than those who did not.* An example would be a woman with a stroke, who has difficulty standing or walking for long periods of time. To encourage her to stand for longer, a dog is put up on a table and she is willing to stand longer to pet the dog. She challenges herself to walk longer distances to walk the dog.

Children are especially likely to respond well to animal assisted therapy. In animal assisted therapy, a child will feed, pet, and clean the animal, which encourages movement and gives a child a sense of empowerment. It allows the child to decide when and what to feed the animal, when to clean it, and how to make the animal trust him or her. Additionally, the child must control emotions such as anger and frustration in order to get the animal to cooperate, and this control transfers to outside activities.

Therapy dog handler Deborah Nozawa says that the healing benefits she has witnessed derived from animal assisted therapy is “miraculous.” A therapy dog named Cassie worked with a visually impaired child that also had other physical and emotional disabilities. The child started out curled up on a beanbag chair, and Cassie approached her and gently nudged her arm with her nose. The therapy dog then pushed her muzzle under the child’s clenched hand and licked her. Before long, the child opened her hand and relaxed it. Then Cassie laid down next to the little girl, and the child relaxed her hands even more and was able to pet the dog. Soon the child was even smiling.

Animal assisted therapy such as a therapy dog or horse therapy are just some of many different strategies that health care providers can use to promote patient compliance and improve traditional therapy results. Interestingly, horse therapy is opening other doors for the physically and mentally handicapped. The Special Olympics now includes equestrian competitions at both the national and international levels and the Paralympic Summer Games includes equestrian categories.

To learn more, visit the American Hippotherapy Association or Equine Therapy.com.

*For more information: http://www.sciencedaily.com/releases/2009/11/091116131824.htm

North Coast will be exhibiting at the American Physical Therapy Association’s Private Practice Sessions. PPS is the business section of APTA that focuses on the growth, economic viability, and business success of physical therapists, and North Coast wants to help foster that growth.

The American Society for Surgery of the Hand (ASSH) provides state-of-the-art continuing medical education in the field of hand and upper extremity surgery. North Coast Medical will meet and engage with the attending thought leaders.