PeaceHealth St. Joseph Medical Center

Center for Rehabilitation Medicine

Physical Therapy Services

Our programs offer comprehensive care for treating injuries, disorders and surgery follow up as well as helping to educate you in how to avoid re-injury at work and play.

Conditions treated include: 

Back and neck injuries	Osteoporosis
Extremity injuries (shoulder, hip, knee, ankle, foot including post-op total joint replacements)	Neurological conditions (stroke, brain injury, spinal cord injury, Parkinson's, MS)
Lymphedema	Fibromyalgia
Balance disorders	Chronic pain conditions
Vestibular disorders (vertigo, BPPV)	Amputation post-care
Athletic injuries

Programs and services available:

Graston Technique	Falls Risk Reduction program
Gait assessment and foot orthotics fabrication	Aquatic therapy
Vestibular Rehab	Prosthetic gait training
Fibromyalgia Pathway	Work site evaluation
Work conditioning	Functional capacity evaluation
Osteoporosis program	Lymphedema program

Falls Risk Reduction Program

Falls are not a part of the “normal” aging process nor are they random. Many falls can be prevented. Clinical research supports the use of exercise as a means to improve balance and mobility function while reducing the likelihood of falls among community-dwelling older adults with a history of falling.

This program includes:

• Comprehensive evaluation of all aspects of balance and fall risk including strength, range of motion, sensation and coordination, gait, balance reactions and strategies, limits of stability, and computerized dynamic force plate testing (Balance Master)
• Individualized program of exercises, balance retraining activities and education to reduce risk of falling
• Program emphasis on home and community exercise program
• Treatment one to two times per week for up to six to eight weeks
• Benefits include improved balance, increased strength, greater mobility around the community, reduced fear of falling, and better recognition of environmental hazards.

Risk factors for falling:

Balance, vision or cognitive impairment	Arthritis
Decreased physical activity	Environmental hazards
History of dizziness or fainting	Impaired gait
Joint or muscle restrictions	Parkinson’s disease
Taking multiple medications	Poor posture
Peripheral neuropathy or decreased sensation in feet	Stroke

In balance

Community classes for those who wish to improve their balance and reduce their risk of falling are offered at South Campus. These classes include gentle stretches, strengthening, and balance exercises.

• Location: St. Joseph Hospital South Campus Rehab Conference Room
• Time: Monday, Wednesday, Friday 1:15 p.m. to 2 p.m.
• Cost: $25 per month
• Call to register: (360) 738-6300 ext. 2032

Vestibular Rehabilitation

St. Joseph’s Physical Therapists treat people who experience dizziness or balance problems related to problems of the inner ear or vestibular system.

Our program includes:

Coordination testing	Oculomotor testing
Motion sensitivity testing	Gait and balance
Clinical testing for Benign Paroxysmal Positional Vertigo (BPPV)

Treatment for the “dizzy” patient may include:

• Treatment of BPPV with canalith repositioning maneuver or alternative methods
• Gaze stabilization exercises
• Vestibular habituation exercises
• Compensation exercises for balance retraining

Benefits include improved balance, decreased dizziness and nausea, and improved strategies to compensate for functional losses.

Lymphedema Management Program

Lymphedema is an excess of protein-enriched lymph fluid in a body part caused by disruption of the lymph system. Primary lymphedema results from developmental abnormalities. The more common secondary lymphedema can result from surgery (especially involving lymph node removal), radiation therapy, tumors or infection and trauma. Symptoms include tightness, swelling or thickening of the body part, burning or tingling radiating down the extremity and feelings of heaviness and aching.

Our treatment program includes:

• Patient self-management education
• Range of motion, strengthening and cardiovascular exercises to stimulate the lymph system
• Specialized compression bandages to be worn most of the day and night for six to eight weeks
• Manual lymphatic drainage techniques
• Custom compression garments to be worn during the day<.li>

Fibromyalgia Syndrome Program

Fibromyalgia Syndrome (FMS) is a disorder that causes pain, tenderness and stiffness in the muscles. It might be considered a “hypersensitivity syndrome throughout the body.” The current diagnostic criteria presented by the American College of Rheumatology (1990) states that the following indicators must be present for a diagnosis of FMS:

• Wide-spread pain involving muscles of four quadrants, including the trunk, which has been present for at least three months
• Excessive tenderness of 11 out of 18 tender points

Sufferers also commonly report a sleep disorder with non-restorative sleep.

Other symptoms may include:

Tingling and burning sensations	Memory problems
Headaches	Irritable bowel and bladder syndromes
Dry mouth	Anxiety/depression
Sensitivity to medications	Intolerance to heat, cold, noise, and light

The FMS Program at the Center for Rehab Medicine provides comprehensive patient education over the course of eight visits usually within six weeks.

Topics covered include:

Conditioning program via walking or aquatic exercises	Proper stretching technique and individualized stretching program
Gentle strengthening exercises	Pacing strategies
Proper posture and body mechanics training	Relaxation techniques and abdominal breathing
Sleep strategies	Stress management considerations
Trigger point release	Use of home modalities (heat/cold) and other symptom-reducing techniques

Participants of our program report improved symptom management, improved sleep, decreased use of medication, improved tolerance to daily activities and increased sense of self-efficacy or belief in one’s own ability to cope.

Osteoporosis/Osteopenia Program

“Osteoporosis and low bone mass are currently estimated to be a major public health threat for almost 44 million U.S. women and men aged 50 and older.” (America’s Bone Health: The State of Osteoporosis and Low Bone Mass, National Osteoporosis Foundation, 2002)

Osteoporosis, literally “porous bones” is a disease that is characterized by low bone mass or bone loss. Weakened bones are more fragile and prone to fracture. Any bone in the body can be affected by osteoporosis but fractures of the hips and spine are of special concern. Osteopenia is a milder form of bone loss that may advance to osteoporosis if untreated.

Risk factors for osteoporosis include:¹

• Gender – women are more likely to develop the disease than men
• Over 65 years of age – the older the person, the higher the risk. Bones become weaker and less dense with age
• Post-menopausal state – estrogen deficiency is linked to bone loss
• Family history and personal history– history of osteoporosis and hip fractures on maternal side, a personal history of fracture as an adult
• Race – Caucasian and Asian women are more likely to develop osteoporosis
• Bone structure and body weight – small boned and thin women (under 127 pounds) are at greater risk
• Lifestyle – smoking, excessive alcohol or caffeine, consuming inadequate amount of calcium, or getting little or no weight bearing exercise can all increase risk
• Medications/Chronic Diseases – Some medications used to treat chronic conditions can have side effects that damage bone and lead to osteoporosis.

The Osteoporosis Program at St. Joseph Hospital Center for Rehabilitation Medicine includes a structured, individualized program of education and personal management.

The program includes the following:

• A detailed evaluation of posture, strength, range of motion, balance and functional movement 
• Education regarding risk factors for osteoporosis, calcium intake, safety for minimizing falls risks, and correct movement biomechanics
• A personalized home exercise program involving strengthening and postural exercises as well as a walking program to help maintain or prevent bone loss
• Acute fracture management for patients with compression fractures
• Direct treatment of musculoskeletal dysfunction when indicated

¹National Osteoporosis Foundation: www.nof.org

Graston Technique

Physical Therapists and Occupational Therapists at South Campus and the Therapy and Spine Clinic have received specialized training in this “innovative, patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions. The Technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.” 

Diagnoses which have responded well to Graston Technique include:

Cervical sprain/strain (neck pain)	Lumbar sprain/strain (back pain)
Carpal tunnel syndrome	Plantar fasciitis (foot pain)
Tennis elbow	Golfer’s elbow
Rotator cuff tendinitis	Patellofemoral disorders (knee pain)
Achilles tendinitis	Myofascial pain and restrictions
Chronic and acute sprains/strains	Non-acute bursitis

Not all patients are appropriate for this technique. Certain conditions such as open wounds, thrombophlebitis, and osteomyelitis among others are contraindicated. Check with one of our several of our clinicians who have received specialized training in Graston Technique to see if you would benefit from this specialized soft tissue mobilization.

www.grastontechnique.com

Aquatic Therapy

The Center for Rehab Medicine South Campus location has a warm therapeutic pool for one-on-one therapy sessions as well as limited community classes. See below for information about the community classes.

Benefits of aquatic therapy

The buoyancy of the water helps support the weight of the person, creating less stress on the joints and making exercise and movement easier for people with arthritis, those who are overweight or recovering from fractures of the legs or spine.

The resistance the water provides can be used to help build strength.

Warm water pools have added benefit of providing relaxation, relieving pain and promoting increased range of motion and muscle flexibility.

Community classes offered

Three types of community classes are offered on a pre-pay basis:

1. Arthritis class: This class is a set of exercises formatted by the Arthritis Foundation including stretching, strengthening and gentle conditioning targeting the individual with arthritic conditions.

2. Water fitness class: This class is geared toward the more active adult and includes stretches, strengthening and gentle aerobics that can be altered to one’s own abilities.

3. Independent exercise class: This class is geared for individuals who have completed personal physical therapy and have an individualized exercise program that they can perform on their own. Supervision is provided for safety, not exercise instruction.

There is typically a lengthy waiting list for these classes due to the popularity of the warm pool. If you are interested in finding out more about class times, costs and how to qualify for these classes, please call (360) 738-6300 ext. 2032

Note of caution: Some medical conditions make water exercise not appropriate or unsafe. Check with your doctor or the clinic staff if you have questions.

You should not participate in pool therapy if you are experiencing any of the following:

Uncontrolled cardiac disease	Fever
Infection	Bowel or bladder incontinence
Open wound	Uncontrolled seizure disorder

Occupational Therapy Services

PeaceHealth St. Joseph Medical Center Occupational Therapy (OT) services at South Campus are integral and collaborate within a multidisciplinary environment to provide the best possible rehabilitation outcomes.  The OT staff has many skills to apply principles of task analysis within therapeutic use of functional activities to facilitate change in people whose occupational performance may be compromised by injury.  Our outpatient department is used to providing a hands-on approach to maximize your success in our programs offered, as well as trained in many specialty areas.  Helping patients to become as independent and functional as possible is our goal, so collaborating with individuals, family, caregivers and physicians to develop comprehensive treatment programs based on the principles of function is our key to success.  

We work with patients to return to their previous levels of daily living, or assist them in adapting as needed to maximize independence. At PeaceHealth St. Joseph, our services include:

Neurological Rehabilitation for strokes, Parkinson, Multiple Sclerosis, spinal cord injuries and others.
Upper Extremity Splinting for both neurological as well as post-operative conditions
Home Safety Evaluations
Joint Protection Strategies for those suffering from arthritis
Energy Conservation Techniques

Speech Language Pathology Services

PeaceHealth St. Joseph offers a variety of speech language services to meet the needs of our patients and their families.  Speech language pathologists specialize in providing comprehensive evaluations and individualized treatments for these disorders allowing clients to optimize their communication skills and return to a fulfilling life.  

If you or a loved one is dealing with these difficulties, the skilled speech-language therapists at PeaceHealth St. Joseph can help you understand the nature of your impairment, and help you fulfill your functional potential.  Family and caregiver training is also a large part of the therapy provided. 

Services for these difficulties include: 

• Communication – use of speech, understanding, reading and writing
• Cognition (mental rehabilitation) attention, memory, problem solving
• Swallow evaluations 
• Voice 

For more information, visit the following pages:

• Communication/Cognitive Therapy
• Swallowing Therapy
• Voice Therapy
• Voice Therapy for Parkinson's Disease