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HealthMatters To Help People Be Healthy

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July 2013

Rehabilitation Restores Quality of Life

HaysMed


HealthMatters Acute Inpatient Therapy. .......4 Rehab. ..........6

We’re here to help Joyce Mattison, RN, Director of Post Acute Care Services

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ehabilitation at HaysMed strives to assess a patient’s functional needs and to provide interventions to facilitate the highest level of physical function of the patient in their environment or home setting. The rehab team consists of a physician including a physiatrist or rehab physician, physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, athletic trainers, speech language pathologists, nurses, social workers and support staff. This dedicated team of professionals develops individualized plans of care to meet the physical, psychological, social and spiritual needs of each patient. This is accomplished in several care settings including the acute care hospital, inpatient rehab unit and outpatient

Outpatient Therapy. .......11

therapy setting. The patient-centered care approach helps to enhance the quality of life for individuals, families and communities. Our rehabilitation team specializes in treating functional impairments including sports and recreational injuries, post-surgical repairs, musculoskeletal disorders, arthritis, joint replacements, amputations, myofascial syndromes, chronic pain disorders, stroke, spinal cord injuries, multiple sclerosis, Parkinson’s disease, vertigo and other balance/vestibular disorders. The interdisciplinary rehabilitation team works closely with the primary care physician, family and patient to meet the individualized needs of each patient with the main goal of rehabilitation being to restore and maintain maximal wellness and health.


Ashley Dronberger, LMSW, Dr. Frederick Smith, medical director of inpatient rehab, and Janice Jones, RN supervisor of inpatient rehab.

‘Quick-paced’ recovery

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bilitation is available to patients who need additional therapy after their initial hospital stay. Acute occupational, physical and speech therapy sessions can be provided in a patient’s room or in one of the hospital gyms during the duration of an inpatient stay. The amount and type of therapy provided is based on the patient’s need and activity tolerance and also on the severity of their illness or injury. “In an acute setting, they’re not expected to stay here a week,” said occupational therapist Ross McDonell. “Our job is very quick-paced and thinking on our feet.” Therapists make the most of their limited amount of time, identifying the Acute Care

patient’s needs and, in many cases, creating an exercise regimen for them that can be continued at home. Patients with many diagnoses can benefit from therapy during their hospital stay. Therapists routinely see patients who have undergone orthopedic surgeries, heart attacks, pneumonia, cancer or other severe illnesses. “I think on acute care we pretty much see the majority of the patients, because the physician wants to be sure they are safe and ready to be going to another facility or going home,” said physical therapist Joyce Dinges. Following an acute stay at HaysMed, medical providers will determine if further therapy is needed on an inpatient or outpatient basis.

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hen patients are facing a difficult recovery from an injury or illness, HaysMed is there to help. A team of physical and occupational therapists help patients regain strength and capabilities, with the ultimate goal of helping them return to a normal life at home. “The ideal would be to get them back to where they were prior to the illness or injury, or at least improve it so they can do a better job of taking care of themselves,” said Dr. Frederick Smith, a physical medicine specialist. “The ideal thing is to try to keep them at home.” HaysMed offers acute therapy for patients admitted to the hospital with a serious illness or injury. Inpatient reha-

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Mary Selensky, Aaron Leuenberger, PTA, Danielle Still, PT, Kyle Bandy, PTA, Jennifer Lowry, PT, Stephanie Carlin, PTA, Julianne Sparks, OTR/L, Pam Leiker, COTA/L, Joyce Dinges, PT, and Alicia Rymer, OTR/L, comprise a portion of the inpatient rehabilitation team.

Inpatient staff gets patients moving Page 6

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aysMed is home to an 11-bed inpatient rehabilitation unit for patients who need more intense therapy before returning to life at home. A team of occupational therapists, physical therapists, speech therapists and nurses work together to help patients maximize their capabilities. The inpatient unit is a good option for patients who still require constant nursing care, said Joyce Mattison, director of post-acute care. “Inpatient rehab is a nursing unit that has a special focus for patients who have, due to a health reason, a decrease in the functional status they had prior to the event,” she said. “Our main purpose is to reclaim as much of their independence as possible.” Nursing care is provided to address health issues associated with the patient’s condition while therapy is provided to regain function and independence. Patients with certain diagnoses, such as those recovering from strokes or battling multiple sclerosis or rheumatoid arthritis, are eligible for admission to the inpatient unit. Criteria for admission is governed by Medicare, said Dr. Frederick Smith, a physical medicine specialist. The average length of stay ranges from 10 to 15 days, and patients are required to complete a minimum of three hours of therapy a day, which can be a combination of physical, occupational and speech therapy. According to HaysMed, the unit averages 150 patients each year, and approximately 70 percent are able to return to their homes versus returning to another care facility. Inpatient Care

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Janice Jones, RN, and Danielle Still, PT, demonstrate the patient lift used during inpatient therapy sessions.

The inpatient unit has a wide coverage area and often gets referrals from surrounding hospitals. Patients who have been transferred to a larger medical center also can be sent back to Hays for rehab, Smith said, noting Hays was the first Kansas community to establish a rehabilitation unit. Rehabilitation first was emphasized in the medical community during World War II to help disabled veterans. Since then, medical outcomes continue to suggest mobility is an essential part of recovery. “Even a healthy person, if you put them to bed for about a week, they’ll lose about a third of their strength,” Smith said. “That’s one of our things … to get people up and walking and moving around.” That’s where the therapists come in. From balance to strength and endurance, HaysMed’s team of physical therapists spend a considerable amount of time helping patients get back on their feet. Physical therapists place a special emphasis on mobility and balance. Building endurance is another issue often addressed, said Aaron Leuenberger, a physical therapist assistant. “They can walk 10 feet and have to sit, and if there’s no place to sit, then they’re in trouble,” Leuenberger said. “We get them to understand their limitations and work to decrease those.” Health Matters

“Our main purpose is to reclaim as much of their independence as possible.”

Danielle Still, PT, left, and Aaron Leuenberger, PTA, right, assist Phyllis Riedel during a physical therapy session.

Inpatient Care

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Alicia Rymer, OTR/L, and Julianne Sparks, OTR/L, demonstrate some of the tasks patients learn during inpatient occupational therapy.

“If they’re really weak, they think they can’t do anything. It’s hard work, and we’re just trying to make it fun, too.” Page 8

Patients have access to a special gym featuring a variety of equipment to help rehabilitation patients build strength and gain mobility. Family education is another important component of inpatient care. Physical and occupational therapists can make home visits to help the patient and caregivers address any safety concerns prior to going home. Changes can include moving furniture and rugs, or installing hand rails and other assistive equipment. “It usually gives them a pretty good peace of mind,” said physical therapist Jennifer Lowry. “If they’re in rehab, they’ve been in the hospital for a long time by now and they’re scared to go home because they’ve been in a place where everything’s taken care of for them.” Therapists also strive to keep exercises fun. Techniques include playing sports video games and other creative ideas to help keep patients motivated. “If they’re really weak, they think they can’t do anything. It’s hard work, and we’re just trying to make it fun, too,” said physical therapist Joyce Dinges. “Nobody just likes to do exerInpatient Care

cises. You like to have fun with it, too.” The physical therapists work closely with occupational therapists, who strive to help patients regain independence by performing everyday activities. “Sometimes they lose the ability to eat, perform grooming tasks and get dressed because they are so weak,” said occupational therapist Alicia Rymer. “Occupational therapy helps to get those functional tasks back.” The inpatient unit also features a special room that can be used as a transitional apartment. Some patients spend time in the unit before being discharged so staff can observe how they manage in a home-like setting. The rehabilitation gym also includes a small kitchen area, complete with a refrigerator, oven, table and even laundry facilities. This allows patients to get hands-on experience with everyday chores. Besides helping patients regain physical capabilities, occupational therapists help patients become more aware of their surroundings. Health Matters


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Inpatient Care

others lose the cognitive ability to understand. “Part of our cognitive communication would be functional things, such as thought organization, conversational skills,” she said. “A lot of times if a patient has had a brain injury, they have no idea how to actively and effectively participate in a conversation.” For some patients, the ability to swallow also is impaired. HaysMed offers swallow studies in which patients are given various liquids and solids to swallow while being monitored via X-ray. The images help determine if food is going into the lungs, or if diet modifications are needed. Services are available on an inpatient and outpatient basis. Compassion is essential when working with patients struggling to perform these essential skills, she said. “There are things we take for granted,” she said. “When they’re taken away from us, it’s hard.” The most rewarding part of her job, she said, is seeing patients regain their abilities. “It is rewarding to see patients after they are discharged and are able to communicate effectively with their family and loved ones,” Albers said.

Speech therapy is about more than just words

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atients rehabilitating from illness and injury sometimes need help relearning two critically important skills — speaking and swallowing. Dawn Albers, a speech language pathologist at HaysMed, evaluates and treats patients experiencing communication and swallowing problems. “People always ask, ‘Why is the speech therapist working with swallowing?’ “ Albers said. “Well, the same muscles and anatomy we use to speak is what we use to swallow.” Patients with neurological diseases such as Parkinson’s disease, ALS or recovering from a stroke might require speech therapy. When the ability to communicate is affected, some patients start by going back to the basics. In severe cases, patients might begin pointing at pictures to communicate, Albers said. “Every person is different in the way they’re affected from a stroke, so we have to do an evaluation and see what we’re working with for that individual,” she said. From there, therapy can start with simple words and syllables and continue to progress. While some patients cannot speak,

Alicia Rymer, OTR/L, and Pam Leiker, COTA/L, demonstrate how patients learn to bathe during inpatient occupational therapy.

Some patients also battle mental diagnoses such as depression. “When someone kind of loses reality, when you give them something functional to do, it kind of brings them back to what’s going on at that time,” said LaShelle Schroter, an occupational therapy assistant. Above all, therapists strive to provide patient-centered care based on each person’s specific needs. Since inpatients often stay in the unit for weeks at a time, therapists also have the opportunity to build relationships with their patients. “It’s very rewarding when you get to see a patient all the way through from when they couldn’t put socks on or get themselves dressed to be able to go home and do everything themselves,” said occupational therapist Julianne Sparks. “You can see the reward of them being able to keep their independence.”

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Lindsey Dreiling, PT, helps Julie Reed rehabilitate her shoulder during a session at HaysMed.

J Expertise for care at home Therapy allows individuals to get well outside hospital Health Matters

ulie Reed is the first to admit she was a skeptic. When an injury caused bone spurs on her left shoulder in February, her physician prescribed physical therapy to help relieve the pain. Reed said she wasn’t optimistic it would work, though. Her attitude quickly changed. “Let me tell you, every single exercise that I was taught, I probably was heard all throughout the whole center,” she said. “I couldn’t believe how much relief I felt from each single one they taught me. It was unbelievable.” Julie Reed Her pain level dropped from a 10 to a 4 after only two therapy sessions. She completed six outpatient physical therapy sessions at HaysMed and has been medication-free since her third visit. Besides getting her pain level down to “zero-plus,” her time in physical therapy inspired her to make healthy lifestyle changes. She’s continued her exercise regimen at home and has begun “preaching to my family,” the 57-year-old Hays woman said.

Outpatient Focus

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Outpatient rehabilitation staff members include Janna Manning, PT, Debbie Cook, PT, Lindsey Dreiling, PT, Teresa Heimann, PT, Whitney Ford, PT, DPT, and Jill Billinger, PT, DPT.

Manning demonstrates a hamstring stretch.

“When you get this age, I think you have a tendency to think that it’s a little too late to learn,” she said. “With just the few visits I had here, I realized after the third visit it’s not too late for me.” ••• From physical and occupational therapy to athletic training, Page 12

HaysMed offers a wide spectrum of outpatient rehabilitation services for patients. A team of physical therapists and assistants provide education and support to help patients regain mobility following an injury or illness. Serving a wide area in western Kansas, the outpatient rehab department at HaysMed offers several specialized services, such as therapy for patients experiencing dizziness and balance problems. “Many patients have been putting up with it because they didn’t think anything could be done,” said physical therapist Teresa Heimann. “But there are many, many things that can be done to the point they are not dizzy anymore, or at least they are functioning with the dizziness and they are able to move around.” A machine called a Balance Master helps therapists determine what is causing the problem. It could be deficiencies in vision, hearing or the musculoskeletal system. Once the problem is identified, therapists can lead patients through specific exercises and techniques to address the problems and help them regain functionality. Patients recovering from strokes or head and spinal cord injuries often struggle to regain balance, Heimann said, noting the program sometimes requires hard work.

Outpatient Focus

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Bob McAnany, PTA demonstrates aquatic therapy in the warm water therapy pool.

“A lot of times they have to be really committed to these exercises,” she said. “And by four weeks, six weeks, they’re feeling much better, and they have their life back.” HaysMed also offers a specialized rehabilitation program for lymphedema patients. Lymphedema is an abnormal buildup of fluid that results in swelling, typically in the arms or legs. The condition often develops from damage to or removal of lymph nodes during treatment of diseases such as cancer. The program places less emphasis on exercise, but strives to educate the patient about how to manage the swelling and prevent infections, which can hinder mobility, said physical therapist Debbie Cook. “The main thing is to prevent infection from occurring,” Cook said. “If they don’t get control over the swelling, they will get infections.” As the only area hospital offering a specialized lymphedema program, HaysMed draws referrals from a large region. Another feature that sets HaysMed’s rehabilitation program apart is a warm-water therapy pool inside the Center for Health Improvement. Patients suffering from arthritis or pain following joint replacement surgery often benefit considerably from exercise in the water, said physical therapist Lindsey Dreiling. The warmth soothes aching joints and muscles, and the water provides an important exercise benefit, she said. Health Matters

McAnany, PTA, and Jill Billinger, PT, DPT, demonstrate Biodex testing.

“The water helps to unload some of their body weight so they don’t have the stresses on their joints like their hips, knees and also their back,” she said. A deeper lap pool also can be used for exercises. Because water has been found to offer so many therapeutic benefits, HaysMed often gets referrals specifically for its aquatics program.

Outpatient Focus

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Cari Readle, COTA/L, instructs Kelly Richmeier on wrist exercises using a wrist maze.

“We do a lot of different activities, but we try to incorporate function with the activity.”

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“Some patients perform aquatic exercises in the pool if they have pain with land or weightbearing exercises,” said Jill Billinger, physical therapist. “Once they get a little stronger from their aquatic sessions, they can progress back to land or weight-bearing routines, and they just do better.” The outpatient program even offers a solution for patients struggling with post-surgical scarring and restrictive tissues from work and overuse activities. Bob McAnany, a physical therapist assistant, is trained in ASTYM treatment, which is a soft-tissue mobilization technique. McAnany uses special tools to gently remold and remodel the affected tissue, often resulting in healthier, more functional tissue. He said the results have been overwhelmingly positive since the program began last year. “A great percent of patients have seen pain reduction and improved tissue mobility and range of motion,” McAnany said. “I’ve been really pleased with the overall outcomes with our patients in the months I’ve Outpatient Focus

been doing ASTYM.” ••• Just down the hall, a dedicated occupational therapy staff seeks to help patients relearn the skills they need to function on a daily basis and live safely at home. The staff sees patients with a variety of injuries and impairments including shoulder, elbow, wrist and hand injuries, stroke victims, and people with visual impairments. “We’re all about the getting them back into functional activities such as going back to work or sports activities,” said Cari Readle, an occupational therapy assistant. “Many activities along with strengthening are worked on during therapy sessions including proper throwing mechanics for an athlete and activities for hand patients including manipulation of coins for counting change or putting money into a vending machine. We do a lot of different activities, but we try to incorporate function with the activity.” Activities of daily living are a large part of occupational therapy. Health Matters


Cari Readle, COTA/L, fabricates a custom splint for Kelly Richmeier.

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••• A group of athletic trainers at HaysMed also provides therapy for western Kansas athletes. Athletic trainers travel to many area schools where they work with injured students and even monitor games and practices. “We’re there when the injury happens, so we get to see the injury, tell them what we think it is,” said athletic trainer Jamie Kohl. The athletic trainers then spend time with the injured athlete after school, helping them regain mobility with the ultimate goal of returning to the game as soon as possible. They also help athletes with techniques to avoid injury or reinjury. The athletic training staff also is heading a new program at HaysMed called Prehab. Orthopedic patients preparing for a joint replacement or ACL repair in Hays can receive several weeks of free training before the procedure. The program began in full force approximately a year ago and also is availOutpatient Focus

able to patients undergoing procedures at other hospitals for a small fee, Kohl said. Improving strength and flexibility before a significant surgery results in better post-surgical outcomes, Kohl said. “The thought process is a shorter time in the hospital and then hopefully a quicker recovery in therapy,” he said. “It’s one month, basically, for a total of two to three hours, addressing the main goal of being ready for surgery.” The athletic trainers also can continue to work with patients in HaysMed’s postrehab program. After working with physical therapists, patients can be referred to continue working with the athletic trainers for the three months of the program. “It’s kind of a stepping stone for us to lead them to where they need to be,” said athletic trainer Jenny Guernsey. “They’ve done therapy, but maybe they’re not ready to be completely on their own and just go straight into the fitness side and start working out again. We’re there to kind of guide them.”

The outpatient rehab department uses an ADL room, which is equipped with a bed, kitchen and living area. The room gives patients a chance to practice homemaking activities in a safe environment. Some patients also learn to use adaptive equipment when new ways of performing tasks are needed following an injury. Besides regaining physical skills, occupational therapists assist those who might have cognitive impairments following a brain injury or stroke. In many cases, they can work on skills such as memory recognition and comprehension and problem-solving skills. This could involve home environment safety recognition and memory books to aid in orientation to people and environment. “HaysMed is also a premier rehab center in the area offering custom splinting,” Readle said. “We can fabricate custom, static or dynamic splints that include the elbow, wrist or hand to ensure an accurate fit to the individual rather than just an over-the-counter splint.”

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Health Matters July 2013  

HaysMed's feature publication. This month's focus is rehabilitation, including inpatient, acute and outpatient rehab, with services in physi...

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