Specialized Physical Therapy, LLC

What is Direct Access?

Direct access to physical therapy services means an individual can be evaluated and treated by a physical therapist without first seeing their physician for a prescription/referral. Currently, 45 states and the District of Columbia have direct access. In 2003, New Jersey became a direct access state.

What are the benefits of Direct Access?

Accessibility to and timely treatment by a licensed physical therapist promotes optimal outcomes and recovery. An individual can relieve their pain, improve their movement, and restore their quality of life without delay. Waiting for your physician to order physical therapy delays care and can result in higher costs, increased number of visits, and decreased functional outcomes. In addition to helping people save time and money, direct access also results in savings in the overall health care system by reducing physician visits and testing while freeing the physicians to devote their time to patients who require the skill of a physician versus the skill of a physical therapist. 

Is Direct Access Safe?

Yes. Physical therapists are educated at the post-baccalaureate level and receive extensive education and clinical training in the evaluation and treatment of patients with functional limitations and disabilities. Physical therapists always evalaute patients to determine appropriate treatment and, as necessary, refer patients to another health care provider who can best meet their needs. Liability insurers and the Federation of State Boards of Physical Therapy affirm that direct access does not jeopardize the health, safety, or welfare of patients seeking physical therapists’ services without prescription/referral.

What about Medicare and Direct Access?

Currently, a physician referral or certification of the plan of care is required to initiate physical therapists’ services under Medicare Part B. This requirement causes delays in delivering health care to Medicare beneficiaries. Legislation has been introduced that would improve access to physical therapists for Medicare beneficiaries: The Medicare Patient Access to Physical Therapists Act (H.R.1829/S. 950). To learn more about H.R.1829/S.950 please visit www.apta.org.

What is Specialized Physical Therapy’s viewpoint on Direct Access?

We believe that direct access to physical therapy services promotes effective and efficient utilization of health care resources. It is not our intention to replace physicians. In fact, we work closely with our physician colleagues to provide the best care possible to our patients. There are times when a patient needs the expertise of a physical therapist more than the expertise of their physician and direct access makes this possible.

This entry builds upon our first concussion blog post. As of this posting, we continue to see a growing number of children/adolescents who have sustained a concussion.

The Vestibular System
The vestibular system is responsible for sensing and perceiving motion as well as producing reflexive movement of the eyes and limbs in response to head motion as to properly stabilize and orient our bodies to the line of gravity. Meaning the vestibular system is essential for proper balance, especially when we move about in our environment. The vestibular system is also active at rest and responds to movement of the head. There are two parts to the vestibular system: 1. The inner –ear (peripheral vestibular system) and 2. The brainstem (central vestibular system, ie: the brain).
Whether at rest or in motion, the reflexive movement of the eyes produced by the vestibular system allows an individual to maintain clear vision when viewing an object (still object or moving object). A few examples would be driving in a car, reading a book, working on the computer, walking, or viewing a chalk board. When the reflexive movements of the eyes are disrupted due to disease, condition, or trauma, the result can be and most often is dizziness, blurry vision, imbalance, and headache.
When a problem arises in the vestibular system (peripherally and/or centrally) an individual has difficulty orienting to his or her environment because of dizziness, blurry vision, imbalance, and headache. The vestibular system is not the only system that contributes to balance. The other major systems that contribute to proper balance are the visual system, somatosensory system (how we feel through our joints/muscles), and auditory system. When each of these systems is working properly, an individual is properly balanced. The information generated by each of these systems is sent to the brain (central nervous system). It is in the brain where all the information is gathered and made sense of so appropriate responses are generated (ie: moving about in the environment). So naturally balance is a complex and coordinated effort between peripheral and central processes.
This information is important as related to concussion or what we should truthfully call a traumatic brain injury. The vestibular system is compromised both peripherally and centrally because both areas are located within the skull. So reflexive movement of the eyes and limbs are compromised, meaning the individual will experience dizziness, blurry vision, imbalance, and headache. Depending on the degree of injury as well as the number of times an individual has sustained a concussion will play a significant role in recovery (ie: severity/duration of symptoms). Since the brain is involved recovery takes longer than say an isolated peripheral problem.
Symptoms related to vestibular system compromise are made worse when other systems (visual, somatosensory, auditory) are challenged. Visual challenges could be bright lights, moving objects, lack of light, variable colors, etc… Auditory challenges could be background noise, loud noises, etc… These challenges make it difficult for an individual to concentrate because the patient is trying to deal with their vestibular symptoms. This becomes a negative cycle, as the individual either tries to concentrate harder making symptoms worse or just “shuts down” because the symptoms are too much for the individual to handle.
Often times the individual will experience emotional and social problems as no one can “see” their problem. They are not wearing a cast, so nothing is “wrong”. This unfortunately creates more problems for the individual. So a true physiological/physical problem is now complicated by psychosocial issues.
Appropriate changes in an individual’s environment are recommended to allow for optimal recovery. For a student in school, this may mean making reasonable modifications/accommodations so the effects of concussion can be minimized and allow the student the best environment to recover without losing significant academic time in school as well as minimize any psychosocial difficulties that may be experienced.

Recently, our office has been examining and treating a growing number of children/adolescents who have sustained a concussion. Most of these children/adolescents suffer a concussion while playing sports or participating in sport-related activity. What is a concussion? Quite simply, a concussion is a brain injury caused by a blow to the head and may impair brain function. A concussion can be mild or be quite severe. Symptoms of concussion can include: headache, dizziness, nausea, blurry vision, confusion, memory problems, sensitivity to light and/or noise, feeling tired/sluggish. A person with a concussion may appear to be dazed and confused and often reports being “foggy”. Answering questions slowly, forgetfullness, clumsiness, and loss of consciousness may be observed in a person who has experienced a concussion. The following are examples from our office of how children/adolescents have reported being struck in the head: by a field hockey stick, a soccer ball, elbows and knees of other players, falling and hitting their head, and being thrown off a wave runner. The duration of concussion symptoms vary and may take up to one year for symptoms to go away. It is very important, especially soon after a concussion, that a child/adolescent gets plenty of rest. This will allow the still developing brain time to heal. Activities such as watching television, texting on your cell phone, playing on the computer, listening to music, and reading a book may be detrimental in the first few hours, days, and weeks after a concussion. The brain needs time and energy to recover. That is why it is very important not to “over-do” or even participate in any physical activity soon after a concussion. Experts agree that return to activity, especially sporting activity be considered only after 1. there are no symptoms at rest or with exertion, 2. normal neurological exam, and 3. neuroimaging is unremarkable.

In our next posting we will share how physical therapy treatment can help children/adolescents recover from a concussion.

The following link may be helpful:

http://www.cdc.gov/concussion/HeadsUp/youth.html

Did you know that one the most common cause of vertigo is due to displaced microscopic calcium carbonate crystals located within the inner ear?  Did you also know that successful treatment of this most common cause of vertigo is performed without medication or surgery?

This condition is called benign paroxysmal positional vertigo, otherwise known as BPPV.  As the name implies, a person will experience vertigo with positional changes, such as lying in bed, rolling in bed, looking up, bending down, etc.

There are a few causes of BPPV.  It can be degenerative, brought on by head injury, after prolonged bedrest, or sometimes it can just happen (insidious onset).  Other times it can come on after a viral infection.  Since it is benign vertigo, it is not fatal, yet it can have a significant impact on your ability to function.  Typically, vertigo brought on by positional changes will last no more than 60 seconds.  BPPV can be detected and treated in the office quite effectively and efficiently.  In fact, there is a 90% success rate in one office visit.

The treatment for BPPV is known as a canalith repositioning technique, most commonly known as the Epley maneuver.  The Epley maneuver mobilizes the calcium carbonate crystals into the correct place of the inner ear.  Here at Specialized Physical Therapy, LLC we see about 10 cases of BPPV a week.  We have a high success rate with the Epley maneuver and our referring physicians are very pleased with how their patients respond.

Due to the nature of BPPV it may come back and when it does our patients come right back to us because we were able to help them out and restore their quality of life.  If you have vertigo or experience dizziness or you know someone who does, please do not hesitate to contact us.

Welcome to our blog! This online forum is intended to share any questions, thoughts, suggestions, and information, related to physical therapy, among patients, guests, and healthcare providers. Some of the more popular topics include low back pain, vertigo/dizziness, difficulty with balance/falling, and rehabilitation after orthopedic surgery. Information exchanged on this blog is not intended to replace consultation and/or treatment from your healthcare provider.

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