During your first visit you can expect the following:

• You will provide us with your prescription for therapy and fill out your paperwork.
• We will copy your insurance card.
• You will be seen for the initial evaluation by the therapist.
• The therapist will discuss the following:
  
  
  1. Your medical history.
  2. Your current problems/complaints.
  3. Pain intensity, what aggravates and eases the problem.
  4. How this is impacting your daily activities or your functional limitations.
  5. Your goals with therapy.
  6. Medications, tests, and procedures related to your health.
• The therapist will then perform the objective evaluation which may include some of the following:
  
  
  1. Palpation - touching around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inflammation, etc.
  2. Range of Motion (ROM) - the therapist will move the joint(s) to check for the quality of movement and any restrictions.
  3. Muscle Testing - the therapist is checking for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.
  4. Neurological Screening - the therapist may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reflexes may be assessed as well.
  5. Special Tests - the therapist may perform special tests to confirm/rule out the presence of additional problems.
  6. Posture Assessment - the positions of joints relative to ideal and each other may be assessed.

The therapist will then formulate a list of problems you are having, and how to treat those problems. A plan is subsequently developed with the patient's input. This includes how many times you should see the therapist per week, how many weeks you will need therapy, home programs, patient education, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created from input from you, your therapist, and your doctor.

Make sure you bring your therapy prescription (provided to you by your doctor) and your payment information. If your insurance is covering the cost of occupational therapy, bring your insurance card. If you're covered by Workers' Compensation, bring your claim number and your case manager's contact information. If you are being covered by auto insurance or an attorney lien, make sure you bring this information.

You should wear loose fitting clothing so you can expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice, and for low back problems, wear a loose fitting shirt and pants, again so we can perform a thorough examination.

Treatment sessions typically last 45 to 60 minutes per visit.

This is highly variable. You may need one visit or you may need months of care. It depends on your diagnosis, the severity of your impairments, your past medical history, etc. You will be re-evaluated on a weekly basis and when you see your doctor, we will provide you with a progress report with our recommendations.

More than half of all Americans are suffering from pain. Whether it is a recent episode or chronic, an ABC News/Stanford study revealed that pain in America is a serious problem. However, many don't even know that occupational therapists/physical therapists are well equipped to not only treat pain but also its source.

Occupational therapists and physical therapists are experts at treating movement and neuro-musculoskeletal disorders. Pain often accompanies a movement disorder and occupational therapists/physical therapists can help correct the disorder and relieve the pain.

Occupational Therapists

Based upon their training in human anatomy and physiology, knowledge of various disabilities and diseases human development, psychology, adaptive technology, and standardized and non-standardized assessments of functioning, OTs/PTs evaluate their clients' functional abilities and limitations in a number of different settings and roles. For example, the OT may look at how the person functions in school, home, or work settings as a student, caregiver, or employee. As part of the evaluation, the OT interviews the client in order to get a good sense of the client's priorities. The OT then incorporates all of this material into a treatment plan that outlines specific goals and breaks down those goals into manageable steps.

OT treatment usually consists of weekly or regular sessions in which the OT helps the client to practice the skills that will enable the person to be more functional. This may include being able to accomplish everyday tasks (also known as activities of daily living) such as brushing teeth, preparing a snack, or making a grocery list.

According to the American Occupational Therapy Association (AOTA), in addition to dealing with an individual's physical well-being, occupational therapy practitioners address psychological, social, and environmental factors that may hinder an individual's functioning in different ways.

Source: www.ontheotherhand.org

Physical Therapists

You have probably heard of the profession of physical therapy. Maybe you have had a conversation with a friend about how physical therapy helped get rid of his or her back pain, or you might know someone who needed physical therapy after an injury. You might even have been treated by a physical therapist yourself. But have you ever wondered about physical therapists--who they are and what they do? Many people are familiar with physical therapists' work helping patients with orthopedic problems, such as low back pain or knee surgeries, to reduce pain and regain function. Others may be aware of the treatment that physical therapists provide to assist patients recovering from a stroke (e.g., assisting them with recovering use of their limbs and walking again).

The ability to maintain an upright posture and to move your arms and legs to perform all sorts of tasks and activities is an important component of your health. Most of us can learn to live with the various medical conditions that we may develop, but only if we are able to continue at our jobs, take care of our families, and enjoy important occasions with family and friends. All of these activities require the ability to move without difficulty or pain.

Because physical therapists are experts in movement and function, they do not confine their talents to treating people who are ill. A large part of a physical therapist's program is directed at preventing injury, loss of movement, and even surgery. Physical therapists work as consultants in industrial settings to improve the design of the workplace and reduce the risk of workers overusing certain muscles or developing low back pain. They also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs. With the boom in the golf and fitness industries, a number of physical therapists are engaged in consulting with recreational golfers and fitness clubs to develop workouts that are safe and effective, especially for people who already know that they have a problem with their joints or their backs.

The cornerstones of physical therapy treatment are therapeutic exercise and functional training. In addition to "hands-on" care, physical therapists also educate patients to take care of themselves and to perform certain exercises on their own. Depending on the particular needs of a patient, physical therapists may also "mobilize" a joint (that is, perform certain types of movements at the end of your range of motion) or massage a muscle to promote proper movement and function. Physical therapists also use methods such as ultrasound (which uses high frequency waves to produce heat), hot packs, and ice. Although other kinds of practitioners will offer some of these treatments as "physical therapy," it's important for you to know that physical therapy can only be provided by qualified physical therapists or by physical therapist assistants, who must complete a 2-year education program and who work only under the direction and supervision of physical therapists.

Most forms of physical therapy treatment are covered by your insurance, but the coverage will vary with each plan. Most states do not legally require patients to see their physicians before seeing a physical therapist. Most of the time all you have to do is ask your doctor if physical therapy is right for you.

Reference: APTA

In most cases health insurance, Medicare, Tricare, the Workers' Compensation system, etc will cover your treatment.  Depending on your particular plan, you may/will be responsible for co-payments or deductibles.  Please make sure to talk to our receptionist so we can help you clarify your insurance coverage.

You will be evaluated by one of our licensed and highly trained occupational therapists/physical therapists and he/she will also treat you during subsequent visits. Unlike some clinics where you see someone different each visit, we feel it is very important to develop a one-on-one relationship with you to maintain continuity of care. Since only one occupational therapist/physical therapist knows your problems best, he/she is the one that will be working closely with you to speed your recovery.

Occupational Therapists

Occupational therapists are healthcare workers who work with people with disabilities, the elderly, newborns, school-aged children, and with anyone who has a permanent or temporary impairment in their physical or mental functioning. The aim of occupational therapy is to help the client to perform daily tasks in their living and working environments, and to assist them to develop the skills to live independent, satisfying, and productive lives.

Interventions used by occupational therapists to achieve greater independence by clients include rehabilitation of:

• Rotator cuff dysfunction.
• Shoulder instability.
• Sport-specific injuries to the upper extremity.
• Neuropsychological deficits (memory, attention, complex reasoning).
• Motor function.
• Sensory function (vision, perception of touch).
• Interpersonal skills (e.g., social skills).

The medium of treatment usually involves the use of purposeful activities, which have some meaning and relevance to clients' lifestyle (these are also called 'occupations' and include routine behaviors associated with work, leisure and self care.)

There are two primary ways that OT can improve people's lives. The occupational therapist (OT) can adapt the person's environment, such as replacing round door knobs with lever door handles, or teach the person strategies to simplify or make a task easier to perform, such using more efficient movements when handwriting. Or, the OT can teach a person new skills that enable him to be more independent or reach a developmental milestone, such as helping a child to learn how to use a pincer grasp to pick up finger foods. Sometimes the OT instructs the client how to strengthen a part of the body so that the person is better able to accomplish a task without adaptations. For example, the OT may create an exercise program for someone with weak arm muscles, so that the person can be more active.

An additional way that OT helps people is through pain management strategies. This can include teaching a child better ways to use his body, or creating splints to hold his fingers in a resting position.

Source: wikipedia.org, www.ontheotherhand.org

Physical Therapists

Manual Therapy - Manual therapy is a broad term that describes a variety of hands-on treatment techniques that are applied to movement dysfunctions. Grade five mobilizations, Mulligan mobilizations with movement, Maitland and Kaltenborn techniques, functional technique, neural mobilization, joint mobilization, craniosacral therapy, strain/counter strain, myofascial release, etc. These are some of the more popular manual therapy techniques. Many manual therapists will take continuing education courses, obtain certifications in manual therapy, and will sit for board certification from the American Physical Therapy Association and other organizations. Most physical therapists incorporate manual therapy techniques as a part of a complete treatment plan.

Geriatric Physical Therapy - Some therapists specialize in the rehabilitation of seniors. As the body ages, a variety of challenges arise. We stiffen, we lose strength, our balance skills decline, our bones become brittle (osteoporosis), our endurance decreases, and we take longer to recover from injuries. Balance and fall prevention are of paramount importance to the therapist who is working with seniors and some clinics are solely dedicated to caring for those with balance problems. Most physical therapists work with seniors/geriatric patients. Some have obtained additional education, have passed a board examination, and have earned the Geriatric Certified Specialist (GCS) title.

Sports Rehabilitation - Experts in assisting with recovery after injury and surgery. Many sports specialists help with retraining the athlete utilizing running, throwing, jumping, and sport-specific programs to name a few. A therapist with the Sports Certified Specialist (SCS) title has passed a board certified test.

Fitness and Wellness - Physical therapists are well trained to help with your fitness needs and wellness programs. If you need an exercise program, have trouble with your weight, are concerned about osteoporosis, have an issue with diabetes, or you would like to learn how to prevent falls, physical therapists can help. The previous examples are just a few of the many programs physical therapists offer.

Hand Therapy - Most physical therapists are well trained to treat hand and wrist conditions. Some therapists have taken additional courses and training and have passed a hand therapy certification examination. These therapists are called Certified Hand Therapists (CHTs).

Women's Health - Some therapists specialize in women's issues such as pregnancy problems, pelvic pain, and incontinence. Special treatment is available for women who have these problems. Many that suffer from incontinence do so needlessly. A physical therapist may be able to help.

Industrial Rehabilitation - Specialists in industrial rehabilitation help with those that have suffered on-the-job injuries. Moreover, they will evaluate work tasks, fabricate assistive devices, evaluate your ergonomic situation, and help redesign work flow/tasks to decrease the incidence of injury. Often, industrial rehabilitation specialists will evaluate your ability to perform certain job tasks with a Functional Capacity Evaluation (FCE).

Pediatric Physical Therapy - Pediatric therapists specialize in the rehabilitation of children. They may assist with kids who suffer from cerebral palsy, developmental disorders, neurological disorders, and/or orthopedic problems. A Pediatric Certified Specialist (PCS) is a board certification that some may obtain from the American Physical Therapy Association.

Aquatic Physical Therapy - Aquatic therapy takes advantage of the physical properties of water to assist with the rehabilitative process. Buoyancy, turbulence, hydrostatic pressure, and thermal properties of water can assist with the rehabilitation of a patient. Those suffering from chronic pain, osteoarthritis, fibromyalgia, rheumatoid arthritis, lumbar fusion surgery, or with a limited weight-bearing status are just a few of the many different patient populations that can benefit from aquatic therapy.

Cardiac and Pulmonary Rehabilitation - A small percentage of physical therapists practice in this discipline. Those that pass the board certification have the title of Cardiovascular and Pulmonary Certified Specialist (CCS) work with patients who have had heart attacks, bypass surgeries, angioplasty, breathing problems, emphysema, and other heart/lung related conditions. Physical therapists are well equipped to work with these types of patients because many of them have orthopedic ailments that limit their ability to function. In other words, a physical therapist can address the heart and lung problems as well as the muscle problems that are concurrently present.

Neurological, Spinal Cord Injury, and Traumatic Brain Injury Rehab - A large portion of physical therapists work with patients who suffer from these conditions. Functional retraining including, walking, wheelchair use, getting in and out of bed or chairs (transfer training), moving in bed (bed mobility), and retraining patients to use their shoulders, arms, and hands are just some of the services these therapists provide to those with neurological involvement. A certified specialist holds a Neurologic Certified Specialist title (NCS).

Balance, Dizziness, and Vertigo Rehabilitation - Many suffer from dizziness or BPPV (benign paroxysmal positional vertigo). Some clinics specialize in the rehabilitation of patients with vertigo. Patient education, strengthening, safety awareness, posture and balance exercise, walking exercise, and special techniques that affect sensory and balance centers of the brain and limbs are all important components of a rehabilitation program.

Amputee Rehabilitation - many physical therapists specialize in the rehabilitation of amputees. Caring for the injured limb, functional and walking training, training in the use of assistive devices (crutches, canes, prosthetic limbs, etc.) are all provided by a therapist who specializes in care for amputees.

Wound Care - Some therapists specialize in the treatment and care of wounds. This is accomplished by the removal of unviable tissue (debridement), the application of special dressings and prescription drugs/ointments, and the use of ultrasound, electrical stimulation, and aquatic modalities to promote healing. Exercise and patient education are also routine components of a wound care program.

ECS (Clinical Electrophysiologic Certified Specialist) - A physical therapist who is board certified to perform electroneurophysiology examinations such as nerve conduction studies and electromyography.

Lymphedema Rehabilitation - We take it for granted but a special component of the circulatory system, the lymph system, helps filter and drain fluid from our arms and legs. When this drainage system is damaged, painful swelling can result. Some therapists specialize in the treatment of lymphedema as it is called. Special positioning, massage and bandaging techniques are utilized by the lymphedema specialist.

Osteoporosis Rehabilitation and Prevention - Some practitioners specialize in the evaluation and treatment of osteoporosis patients. Working in concert with your medical doctor, the therapist will often design a specialized weight-bearing and resistance training program for those with this silent disease.

For many patients, one of the primary objectives is pain relief. This is frequently accomplished with hands-on techniques, modalities such as ultrasound, electrical stimulation, and/or heat or cold therapy. Movement often provides pain relief as well. Your occupational therapist/physical therapists will provide you with the appropriate exercises not only for pain relief but to recover range of motion, strength, and endurance.

In some cases, occupational therapy/physical therapy techniques can be painful. For example, recovering shoulder range of motion after shoulder surgery may be painful. Your occupational therapist/physical therapist will utilize a variety of techniques to help maximize your treatment goals. It is important that you communicate the intensity, frequency, and duration of pain to your therapist. Without this information, it is difficult for the therapist to adjust your treatment plan.

There are dozens of different types of treatment interventions. Here is a list of treatment interventions:

Active Range of Motion (AROM) - the patient lifts or moves a body part through range of motion against gravity. AROM is usually one of the first modalities prescribed for arthritis.

Active Assistive Range of Motion (AAROM) - therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

Stationary Bicycle - with or without resistance. This is usually prescribed for improving the strength and/or range of motion of the shoulder and mid back as well as cardio-vascular endurance.

Isometrics - muscle contraction without joint movement. This is usually prescribed for strengthening without stressing or damaging the joint, e.g. arthritis, or exercises to be performed in a cast, or right after surgery if recommended by the therapist/doctor.

Isotonics- muscle(s) contracting through the ROM with resistance. This is usually prescribed for strengthening.

Soft Tissue Mobilization - therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

Mobilization - hands-on therapeutic procedures intended to increase soft tissue or joint mobility. Mobilization is usually prescribed to increase mobility, delaying progressive stiffness, and to relieve pain. There are many types of mobilization techinques including Maitland, Kaltenborn, Isometric Mobilizations, etc.

Proprioceptive Neuromuscular Facilitation (PNF) - a system of manually resisted exercises performed in diagonal patterns that mimic functional movements. Initially used in developmentally and neurologically impaired patients, but now used in almost every aspect of neuromuscular retraining from athletes in sports facilities to the very weak in hospitals and nursing homes.

Posture Training - instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have ideal posture. Therapists educate patients about the importance of improving posture with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

Progressive Resistive Exercises (PRE) - exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

Passive Range of Motion (PROM) - the patient or therapist moves the body part through a range of motion without the use of the muscles that "actively" move the joint(s).

Stretching/Flexibility Exercise - exercise designed to lengthen muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

Cryotherapy or Cold Therapy - used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain.

Neck Traction - a gentle longitudinal/axial pull on the neck, either manual or mechanical, intermittent or continuous for relief of neck pain, to decrease muscle spasm, and facilitate unloading of the spine.

Heat - heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or "new" injury.

Iontophoresis - medications are propelled through the skin by an electrical charge. This modality works on the physical concept that like charges repel each other, therefore, a positively charged medication will be repelled through the skin to the underlying tissues by the positively charged pad of an iontophoresis machine. Iontophoresis is usually prescribed for injuries such as shoulder or elbow bursitis.

Transcutaneous Electrical Nerve Stimulation (TENS) - a relatively low voltage applied over painful areas through small self-adhesive electrodes. The electrical stimulation "disguises" or "overrides" the sensation of pain. It is a small, portable unit, used in intervals, to control pain and reduce dependence on drugs. It is usually prescribed for relief of pain.

Ultrasound - ultrasound uses a high frequency sound wave emitted from the sound head when electricity is passed through a quartz crystal. The sound waves cause the vibration of water molecules deep within tissue causing a heating effect. When the sound waves are pulsed, they cause a vibration of the tissue rather than heating. The stream of sound waves helps with nutrition exchange at the cellular level and healing. Studies have shown that ultrasound is helpful for ligament healing and clinically, for carpal tunnel syndrome, and muscle spasm.

Whirlpool - immersion of a body part into water with small "agitators" to provide a gentle massaging motion. A warm whirlpool provides relief from pain and muscle spasm and is often preparatory to stretching or exercise. Cold whirlpool is used to decrease inflammation and swelling.

Massage may be part of your treatment. Rehabilitation specialists are trained in a variety of techniques that may help with your recovery. Deep tissue techniques, may be part of the rehabilitative process. Massage is used for three reasons typically - to facilitate venous return from a swollen area, to relax a tight muscle, or to relieve pain. Contrary to common thought, massage does not increase circulation.

Flare ups are not uncommon. If you have a flare up (exacerbation), give us a call. We may suggest you come back to see us, return to your doctor, or simply modify your daily activities or exercise routine.

In most cases, you have the right to choose any occupational therapy/physical therapy clinic. Our clinic may not be a provider for your insurance plan. You can still come to our clinic, but it is likely that you will have to pay out-of-pocket for the treatments.

The best thing to do is give us a call and we will attempt to answer all of your questions.

Billing for occupational therapy/physical therapy services is similar to what happens at your doctor's office. When you are seen for treatment the following occurs:

1. The occupational therapist/physical therapist bills your insurance company, Worker's Comp, or charges you based on CPT (Common Procedure Terminology) codes.
2. Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer.
3. The payer processes this information and makes payments according to an agreed upon fee schedule.
4. An EOB (Explanation of Benefits) is generated and sent to the patient and the occupational therapy/physical therapy clinic with a check for payment and a balance due by the patient.
5. The patient is expected to make the payment on the balance if any.

It is important to understand that there are many small steps (beyond the outline provided above) within the process. Exceptions are common to the above example as well. At any time along the way, information may be missing, mis-communicated, or misunderstood. This can delay the payment process. While it is common for the payment process to be completed in 60 days or less, it is not uncommon for the occupational therapy/physical therapy clinic to receive payment as long as 6 months after the treatment date.

Some patients will need to continue with home exercises. Some may choose to continue with a gym exercise program. Others will complete their rehabilitation and return to normal daily activities. It is important that you communicate your goals to your therapist, so he/she can develop a custom program for you.

Occupational therapists (OT's), certified occupational therapy assistants (COTA's) and physical therapists (PT's) are licensed by their respective states.

• Do they have a service that can address your problem?
• Do they take your insurance or are they willing to work with you if they are not a preferred provider?
• What are the hours of operation?
• Can they provide satisfaction survey results?
• Do they accept your insurance?
• The therapist should provide the treatment.
• Can you briefly interview the therapist before the first visit?
• Ask your family and friends who they would recommend.
• Do they possess specialty certifications in areas that directy relate to the kind of treatment I require?