Topics in Women’s Health – Incontinence

Urinary incontinence is a common complaint in women. It is also easily treatable, most of the time. Numerous studies show that incontinence issues affect up to 25% of American women.  Amanda Blaz, DPT urges women who suffer from this widespread disorder to consider a non-invasive examination. Following examination, physical therapy treatment may be recommended. The incontinence program at MOSAIC Rehabilitation includes pelvic floor muscle training (not just Kegels!). It also includes, diaphragmatic breathing, postural  examination/correction, biofeedback and recommendations for lifestyle changes. These things can significantly improve, or completely eliminate bladder leakage during everyday activities.  Improvements are usually seen within 4-6 weeks. During this time, you may even see elimination of signs and symptoms.

When to Refer to a Women’s Health Physical Therapist?

Women with these difficulties:

  • Leaking urine during normal daily activities
  • Urine leakage with sneezing, coughing, or laughing
  • Difficulty starting the urine stream
  • Trouble holding urine when feeling a strong urge to go
  • Trouble with frequent urination (more than every 3-4 hours during the day and up more than once to urinate at night)
  • Difficulty getting to the bathroom because of other problems such as knee/hip/back pain or balance problems

Early Language and Literacy

early languageThe development of early language and literacy (reading and writing) begins in the first 3 years of life.  A child’s interaction with adults as well as with books, paper and pencils/crayons provides the groundwork for development of language, reading, and writing. Learning these skills is an ongoing process that develops through social experiences. This process builds as children develop their oral language and gain awareness of sounds used in language. It continues to grow as children understand meaning in the symbols/print around them.  The end result is acquiring reading and writing skills.

Early literacy does not mean learning to read early. Formal reading instruction is not developmentally appropriate for infants or toddlers. Early literacy behaviors can include manipulation of books such as page turning, looking at pictures in a book (especially favorite pictures), pointing to pictures of familiar objects, imitating an action seen in a book, talking about an event in the story, singing nursery rhymes, pretending to read or write and scribbling.  A strong foundation facilitates the development of literacy.

When oral language is emphasized in early childhood, children experience more success when learning to read and write.  Identifying children’s strengths and needs in speech, language and emerging literacy, allows for early detection of academic risk. Subsequently, it also allows for early intervention.  The goal is to prevent or reduce difficulties with literacy development. You can also check out our newer blog Early Literacy: Reading, Writing, Learning and Speech and Language Kids to learn more.

Topics in Physical Therapy — Osteoporosis

What is Osteoporosis?

Osteoporosis is a disease in which bones become more fragile and are therefore, more likely to break. In people with low bone  density, more bone is removed than replaced. Consequently, these people are at increased risk for developing osteoporosis and fractures.  Fractures occur most in the hip, back (spine), and wrist.1 Moreover, osteoporosis can be prevented, diagnosed, and treated  before a fracture even occurs.2  People older than 50 years have an increased risk of bone loss and fractures. In addition, one out of every two women and one out of every five men in the US experiences an osteoporosis-related fracture during their lifetime.1

Prevention of osteoporosis:

  • Firstly, see your health care provider for a yearly physical
  • Ensure that you have adequate calcium and vitamin D intake
  • Take prescribed medications for osteoporosis
  • Moreover, avoid tobacco and excessive alcohol intake
  • Weight bearing & strengthening exercises to help maintain bone strength
  • Balance exercises reduce the risk of  falls and thus reduce the risk of fractures
  • Finally, have good posture:  ears over shoulders, shoulders over hips, hips over knees, knees over ankles (1)

A Physical Therapist can prescribe an individualized program after a full examination is conducted

Avoid these movements:

  • Forward bending or hunching of the spine such as when completing toe touches or crunches 
  • Extreme back rotation as if straining to swing a golf club
  • Activities that place you at risk for falls

See your doctor:

  • Firstly, if you think you may have fractured your back (back pain)
  • Secondly, if you have a loss of ½ inch of height in 1 year or loss of 1 ½ inch from original height
  • Finally, if you have increased stooped or hunched posture (1)

Your doctor may recommend bone mineral density (BMD) testing if he/she believes you are at risk for having osteoporosis (2).  Ask your doctor for a PT referral to develop a safe and effective exercise program if osteopenia or osteoporosis are found.

1. National Osteoporosis Foundation and Karen Kemmis, PT, DPT.  (September/October 2010).  “Protect the spine through exercise”. Functional U: Exercise and Activity for Healthy Aging at http://www.nof.org/sites/default/files/pdfs/ICAA_Spine.pdf, accessed 2/1/2011.

2. National Osteoporosis Foundation.  (2010).  “Clinician’s Guide to Prevention and Treatment of Osteoporosis”. Pg 1-36.

Concussion: Why Seeing A Speech Pathologist After May Be Beneficial For Your Child

What is a Concussion?

A concussion is a traumatic brain injury (TBI). This occurs when the brain is damaged suddenly by an external force. A TBI can result from the skull being penetrated or pierced by an object. Likewise, it could also occur when the head is forcefully struck by or hits an object. The severity of a TBI can be mild, moderate, or severe due to the damage done to the brain.5 In fact, approximately 1.5-2 million people in the United States sustain a TBI each year. Of these, 75% are concussions. Therefore, concussions are the most common type of TBI.1 Concussions are often called mild traumatic brain injury (mTBI), but concussions are serious. The term “mild” refers to the severity of the original physical trauma, but it does not indicate the severity of symptoms following the injury.

Symptoms of a Concussion

A person with a mTBI may or may not lose consciousness at the time of injury, however, mTBI is characterized by one or more of the follow symptoms:

  • Loss of consciousness
  • Memory loss immediately prior to or following the injury
  • A change in mental status (for example: confusion, agitation, fatigue, etc.), or focal neurological deficits (such as: loss of coordination, dilated pupil or pupils, dizziness, etc.)2,5 immediately prior to or following the injury

Recovery

Recovery from an mTBI is not always quick, for example, it can be sporadic. Additionally, some people suffer long-term impairments. This is known as post-concussive syndrome (PCS). People with PCS may demonstrate significant changes in personality and deficits in cognition.2

Impairments Following a Concussion

The cognitive/communicative impairments following mTBI can include deficits in speech, language, and social communication, as well as information processing, attention, memory, and swallowing.6 Moreover, it is also common to have deficits in executive functioning skills, such as planning and organizing, time management, and completing tasks, in addition to, monitoring and inhibiting behavior and emotions, and prioritizing.6

What Can a Speech Pathologist Do To Help?

Speech Language Pathologists (SLPs) are responsible for evaluating and treating cognitive-communicative deficits of mTMI.3 Initially, the SLP will complete a formal evaluation of speech and language skills. In addition, they will assess social communication skills, and cognitive/communicative skills. Following the evaluation the SLP will develop a treatment plan and provide strategies to target individual deficits.

Firstly, according to the American Speech Language Hearing Association (ASHA), the most effective treatment plans are individualized to the patient.6 These plans can include behavioral approaches and skill training. In addition, they can also include process specific training, and metacognitive approaches.4,6 Treatment plans vary depending on the severity of the symptoms and the stage of recovery the person is in. Most importantly, treatment plans always focus on increasing the person’s independent functioning in everyday life.4

When Should You See a Speech Pathologist?

Contact a therapist or your doctor if you are experiencing one or more of the following symptoms after sustaining a TBI.

  • Difficulty producing speech sounds correctly
  • Difficulty using or understanding  the intonation, fluctuations, and inflections of speech
  • Experiencing aprosodia, the inability to understand or use the affective aspects  of speech
  • Difficulty understanding or using spoken and/or written language
  • Increased difficulty understanding the subtleties of language. For instance, using or identifying emotions, facial expressions, gestures, or body language.
  • Difficulty carrying on conversations
  • Inability or difficulty paying attention or staying on-task
  • Decrease in memory function
  • Increased information processing time or decreased information processing skills
  • Lack of or decrease in executive functioning skills. For example, initiation and completion of tasks, self-regulation, sequencing, organizing, prioritizing, time management, or mental flexibility
  • Difficulty eating or swallowing liquids or foods
References
  1. Faul, M., Xu, L., Wald, M.M., Coronado, V.G. (2010). Traumatic Brain Injury in the United States:  Emergency Department Visits, Hospitalizations and Deaths 2002–2006. CDC.  Available at: http://www.cdc.gov/traumaticbraininjury/tbi_ed.html.
  2. Overview of Traumatic Brain Injury.  CNS TBI Resource Guide.  Available at: http://www.neuroskills.com/tbi/injury.shtml.
  3. Parrish, C., Roth, C., Roberts, B., Davie, G. (2009). Assessment of Cognitive-Communicative Disorders of Mild Traumatic Brain Injury Sustained in Combat. Available at: http://div2perspectives.asha.org/cgi/content/full/19/2/47.
  4. Traumatic Brain Injury:  Benefits of Speech Language Pathology Services. ASHA. Available at: http://www.asha.org/public/speech/disorders/TBIslpBenefits.htm.
  5. Traumatic Brain Injury Information Page. NINDS. April 2011. Available at: http://www.ninds.nih.gov/disorders/tbi/tbi.htm.
  6. Treatment Efficacy Summary: Cognitive-communicative Disorders following Traumatic Brain Injury.  ASHA. Available at:  http://www.asha.org/uploadedFiles/public/TESCognitiveCommunicationDisordersFromTBI.pdf

Topics in Women’s Health: Physical Therapy and Postpartum Recovery

Can Physical Therapy Help Me?

Physical therapy is can be an excellent way to ease a woman’s recovery from childbirth. It can also help to promote a healthy and happy time with new baby.  Many women believe most issues that are present after childbirth are normal. Several issues may be common, however, they may not be normal.  Physical therapy can help with low back pain and pelvic pain. It can also help with posture and body mechanics while caring for a baby. The therapist can also address incontinence, and cesarean scar management.

Pain and Pregnancy

Ignoring back or pelvic pain during pregnancy or after giving birth is not advised. Women with back pain during pregnancy are at a greater risk for back pain after childbirth. If it is not treated it can lead to worse pain in the future. Back and pelvic issues after delivery may be due to pelvic floor problems or abdominal weakness. Pain may also be due to diastasis recti, and/or postures during childcare tasks. Pelvic and abdominal pain can also be experienced after a c-section. This occurs if the scar is not healing correctly. It can also occur if significant scar tissue is present. Scar tissue in the lower abdominal area can make it difficult for the muscles of the abdomen and pelvic floor to work together and  move correctly. This sometimes causes pain and subsequent weakness.

Pelvic Dysfunction

Along with pelvic pain, women may also suffer from other issues associated with pelvic dysfunction. This includes different types of incontinence.  Women often say “I leak urine when I cough, sneeze, laugh, jump, or run. But I guess that’s what happens when you have a baby”.  This can happen after pregnancy and childbirth, but it is fixable.  Pregnancy and childbirth can strain and sometimes injure the pelvic floor muscles. This may cause problems for up to 4-6 weeks postpartum.  If problems continue past 6 weeks, a woman should request a referral to a women’s health physical therapist. A PT trained in pelvic floor rehab can help you perform kegels correctly and effectively. They can also offer other suggestions for pelvic floor health.

Back and Shoulder Pain

Lastly, the change in the way a woman’s body weight is distributed after giving birth, and the new physical demands of taking care of a child or multiple children, can cause upper back, shoulder, and lower back pain.  These issues may be due to weak, stretched out muscles or the way the body is aligned during childcare tasks. A home evaluation can determine whether or not the nursery or feeding area is set up appropriately to decrease strain to the back and shoulders.

The Physical Therapist’s Role

A women’s health physical therapist can safely and effectively evaluate these areas. They will develop a plan to resolve back or pelvic pain sooner rather than later. It may also be helpful to have an assessment of positioning during feeding. If you have any questions, a women’s health physical therapist should be able to help. Don’t suffer with pain and discomfort, especially if it can be helped.

Topics in Women’s Health — Maintaining Fitness During Pregnancy

Benefits of Exercise During Pregnancy

There are many benefits to maintaining a safe exercise routine during pregnancy.  These include lower risk for gestational diabetes, less weight gain, improved muscle tone and lower risk of varicose veins. Decreased low back pain, improved self-esteem, and better sleep are also benefits.  Moreover, exercise also improves improve labor & delivery. It shortens the second stage of labor. This therefore decreases risk of C-sections, lowers amounts of inductions and decreases episiotomies. In addition, it also decreases use of anesthesia, and decreases the risk for preterm delivery.

Fitness and Pregnancy: Is it Safe?

Many women are often afraid of exercise during pregnancy. They fear it may cause harm to their baby. Although this is a common concern, if exercise is done correctly it can enhance the pregnancy. Both the mother and the fetus will reap the benefits of exercise. Adverse pregnancy and neonatal outcomes are not increased in women who exercise. In fact, a woman can  maintain her fitness throughout her pregnancy and into postpartum if she continues to exercise as symptoms permit.  Two studies by Clapp (1991) and Lotgering (1991), women had no change in their absolute VO2 max (a fitness measure) during each trimester and into the postpartum. In order to exercise safely, the American College of Obstetrics and Gynecology recommends the following guidelines for aerobic exercise during pregnancy.

Safe Exercise Guidelines

  • Exercise should be at 65-85% of maximum predicted heart rate
  • Exercise should occur at least 3x/week for no more than 45 minutes
  • Avoid lying on your back, especially after the first trimester
  • Stay hydrated and cool (body temps should not exceed 101.66°F)
  • Avoid any exercise with potential for contact with another object/person or loss of balance. This minimizes risk for abdominal trauma.

Other exercises should include upper and lower body resistance training specific to a pregnant woman’s needs regarding change in center of gravity, muscle strength, and joint laxity. STOP exercise immediately if ANY of the following signs or symptoms are present:

  • Vaginal bleeding
  • Shortness of breath prior to exertion
  • Dizziness
  •  Headache
  • Chest Pain
  • Muscle weakness not consistent with exercise intensity
  • Calf pain or swelling
  • Abdominal pain, cramping or contractions before due date
  • Decreased fetal movements
  • Vaginal leakage of clear fluid

If you are pregnant and would like to know what exercises are right for you, call and set up an appointment with Amanda Fehrer, pregnancy specialized physical therapist, at (406) 388-4988.  You will receive a treadmill walking test that will determine your fitness level and a personalized upper body and lower body exercise program specific to your needs, including a gym visit if needed.