The County Woman Magazine www.TheCountyWoman.com July/August 2015

# Medical Professionals

The County Woman Magazine www.TheCountyWoman.com May/June 2015

Alzheimer’s disease is the most common form of dementia, affecting one in eight Americans over the age of 65. Dementia is a general term for a variety of conditions that develop as a result of malfunctioning nerve cells in the brain.

Research has shown that individuals with Alzheimer’s disease tend to develop abnormal structures in the brain, called plaques and tangles, that block communication between nerve cells in the brain and body. Plaques build up in the spaces in between nerve cells, and consist of a protein called beta-amyloid. Tangles are described as a collection of twisted fibers made from a different protein, called tau, that develop inside nerve cells rather than in between them. Because the nerve cells are unable to work properly, individuals can experience a variety of cognitive, behavioral, and physical symptoms. Alzheimer’s disease is progressive, meaning that is worsens over time, and although there is currently no cure for Alzheimer’s disease, medication and physical activity can be helpful in slowing its progression.

What are the signs and symptoms?The most common symptom of early-stage Alzheimer’s disease is difficulty remembering

newly learned information. As we age, it is common to experience occasional memory loss or slowed thinking; however, serious memory difficulties and confusion are signs that the brain is not working exactly as it should.

As the disease progresses, individuals tend to experience mood and behavior changes, increased confusion about time and place, disorientation, and difficulty responding to the demands in their environment. Physical symptoms accompany cognitive changes, particularly muscle disuse, difficulty walking, negotiating turns and obstacles, and loss of balance.

How can physical therapy help?The physical symptoms mentioned above

ultimately increase an individual’s risk of falling, which can possibly lead to serious injury. Research has shown the importance of physical activity for overall well-being. During a physical therapy evaluation, a licensed physical therapist evaluates various components of the body in order to determine impairments that may be contributing to

a patient’s symptoms. From there, an individualized exercise program is created to meet the specific needs of each patient. A supervised exercise program, with

the goal of increasing muscle strength and improving balance, will ultimately lead to improved safety awareness and decrease a patient’s fall risk. The following are important aspects that are addressed in each exercise program, as deemed appropriate by a physical therapist:

Strength and FlexibilityAs Alzheimer’s disease progresses, individuals tend to become more sedentary, which

leads to muscles becoming weak and tight. This is predominantly true for the muscles of

the hips and legs. The lower extremity muscles are very important for standing and walking, so as they become weak, it becomes particularly difficult to perform daily tasks and ambulate, or walk around. Physical therapy can help break this cycle by developing a safe strengthening and flexibility program to improve muscle performance. As an individual’s strength starts to improve, exercises may be altered or advanced to further maximize strength gains.

Gait TrainingIn addition to developing an exercise program, a physical therapist will evaluate and

determine the most appropriate assistive device for each patient in order to provide safe ambulation. The most common assistive devices are rolling walkers, single point canes, and quad canes. The physical therapist will educate and train the patient on how to correctly use his/her assistive device during ambulation. If unsafe ambulation is identified during the initial evaluation, subsequent treatment sessions will consist of gait training, in order to maximize safety awareness. As quality of gait improves, the patient will be challenged to negotiate obstacles and ambulate on various surfaces, in order to simulate real life situations. Continued practice will eventually lead to improved safety awareness during community ambulation and while performing daily tasks.

BalanceAlong with safe ambulation, balance is by far one of the most important aspects of

minimizing an individual’s fall risk. Balance can be divided into two components: static and dynamic. Static balance refers to an individual’s ability to maintain balance while in a still position, whether that be while seated or standing. Dynamic balance refers to maintaining balance while moving. Both static and dynamic balance are addressed during physical therapy by simulating tasks that individual’s experience in their daily lives. These tasks include reaching, stepping onto and off of various pliable surfaces, and negotiating obstacles while walking. This is a great opportunity to not only challenge balance, but also memory, as the patient will need to follow directions and remember multi-step commands. By challenging balance in various ways, the body is better able to adapt and learn how to respond safely and appropriately during real life situations.

What happens after you finish physical therapy?All of the factors addressed during physical therapy work together to improve overall

function and safety. Once an individual has achieved his/her goals and is ready to be discharged, the physical therapist will provide the patient with a home exercise program so that the gains made during physical therapy can be maintained. Physical therapy can provide the tools for success, however it is up to the individual to use the information he/she has learned to continue to maximize safety and functional mobility!

Call 732-849-0700 to schedule an appointment at the Whiting facility

Whiting • Toms River • BrickManchester • Barnegat • Jackson

1-(855)-3ALLCARE

www.AllCarePTC.com

Free Transportation For Patients In Need

Come Experience The All-Care Difference For Yourself!

Certified Hand

Therapist

Elise Paolantonio, DPT. graduated from the University of Delaware in 2011 with a Bachelor of Science in Exercise Physiology and a minor in Disabilities Studies. She continued her education at the University of Delaware where she earned her Doctorate of Physical

Therapy degree in January 2014. Elise has clinical experience in a variety of settings, including inpatient rehabilitation, acute care, outpatient orthopedics, and pediatric rehabilitation. Her professional areas of interest include post-operative rehab, orthopedics, amputation, and neurological rehabilitation of the pediatric and geriatric populations.

Alzheimer’s Disease & Physical TherapyWhat is Alzheimer’s Disease?

All-Care’s Jackson location at 355 North Countyline Road opened March of 2015. Call 732-833-1133 today for information

Written by Elise Paolantonio, DPT

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Has one of your fingers ever become stuck in a bent position, becoming painful and difficult to straighten after holding your cup of coffee?

Or, does your finger click when you are holding a knife and fork? If so, then you may be experiencing trigger finger.

Stenosing tenosynovitis, commonly known as trigger finger, is a condition where the lining of the flexor tendon becomes thick or swollen. The increased thickness and swelling compresses the tendon preventing it from gliding smoothly. This can cause the tendon to click or get stuck and lock. Prolonged irritation through repetitive use of the hand may cause scarring and the formation of nodules. According to the National Center for Biotechnology Information, 2% to 3% of the population will experience trigger finger in their lifetime, but increases to 10% in the diabetic population. Women are six times more likely than men to develop trigger finger and the average age of onset is 50 or older. Evidence suggests that the ring finger is the most commonly affected finger followed by the thumb, but all of the digits can be affected. Let’s review the basic anatomy of trigger finger. Each finger has tendons that run on the palm side of the finger that are responsible for flexing or bending the finger. These tendons are surrounded by a protective sheath and run through a system of pulleys that help to keep the tendon in place. In most cases, the most common location for trigger finger is at the base of the finger on the palm side of the hand at the large knuckle called the metacarpophalangeal joint (MCP). This is the area of the A1 pulley and it is prone to irritation due to the high levels of force applied during gripping. You can think of the A1 pulley as the eye of a sewing needle and the flexor tendon in its sheath as a piece of thread. When the tendon sheath becomes swollen and irritated it would be like trying to thread twine through the sewing needle; it would become stuck. Signs and Symptoms• Stiffness in your finger• Tenderness and/or a nodule at the base of the finger• Locking of your finger in a bent position and then it will pop straight or need to be straightened using your other hand.• Popping or clicking when you move your finger

Causes and Risk FactorsThe exact cause of trigger finger is not known. There are several factors that could contribute to trigger finger including some of the following.• Repetitive use of the hand.• Prolonged use of hand held tools.• Local trauma to the hand/finger.• Degenerative forces and stress to the hand. Research has shown that individuals with diabetes, rheumatoid arthritis, carpal tunnel syndrome, and DeQuervain’s tendonitis are at higher risk for developing trigger finger.Treatment OptionsThere are several treatment options for trigger finger ranging from conservative techniques, including occupational or physical therapy, to surgical intervention. Some of the treatment options include:• Splinting the involved finger to help decrease friction at the A1 pulley and decrease inflammation. The finger splint is typically worn during times of activity during the day and can be used at nighttime as well. An occupational therapist would be able to fabricate a custom trigger finger splint.• Activity modification, including rest, to reduce irritation to the involved finger while maintaining the ability to participate in your daily activities.• Corticosteroid injection. • Surgical release of the trigger finger. Surgery is typically indicated when conservative treatments are unsuccessful and has proven to alleviate trigger finger symptoms. Trigger Finger can have a significant impact on the use of your hand and your daily routine. Recognizing and addressing symptoms early is a key factor in treating trigger finger. At All Care Physical Therapy, our Certified Hand Therapist specializes in the treatment of trigger finger and other hand disorders. Contact your physician if you are experiencing these symptoms and ask if an Occupational therapist at All-Care can help. OT Hand Therapy is currently practiced in our Toms River (732-505-1300) orWhiting (732-849-0700) locations.

Understanding Trigger Finger

Jessica abraham,chT, OT

Jessica Abraham received her Master’s Degree of Science in Occupational Therapy from Richard Stockton College of New Jersey in 2006. She became a certified hand therapist in 2014.Jessica’s professional focus has been in outpatient upper extremity orthopedic care with a focus in hand therapy. She has completed affiliations in hand therapy, outpatient orthopedic rehabilitation, and pediatrics. Jessica’s areas of interest include splint fabrication for the upper extremity, neural mobilization techniques, and manual therapy. Jessica has continued her education by taking courses such as:• Completed over 4,000 hours in Hand Therapy Treatment• Neural Mobility: Examination and Intervention Strategies• The Elbow: Current Trends in Assessment and Treatment• 2011 Surgery and Rehabilitation of the Hand with Emphasis on the Elbow and Shoulder• Incorporating Yoga into Upper Extremity Rehabilitation