Celebrate

 

“Music is the art which is most near to tears and memory.” — Oscar Wilde
One of the reasons the link between music and memory is so powerful is that it activates so many portions of the brain at the same time. For example:

• Tonality processes in the pre-frontal cortex, the cerebellum and the temporal lobe.
• Lyrics process in the Wernicke’s and Broca’s area, as well as the visual cortex and the motor cortex.
• Rhythm processes in the left frontal cortex, the right cerebellum and the left parietal cortex.
• The medial pre-frontal cortex is responsible for music processing and music memories. Most importantly, the prefrontal cortex is among the last regions of the brain to atrophy.

Neurological research clearly shows that the Music & Memory program provides many therapeutic benefits for individuals with cognitive impairment or physical health decline, including:

• Boosts cognitive function by reaching into the deep recesses of memory
• Reduces the need for anti-psychotic medications
• Provides an enjoyable, fulfilling and individualized musical experience
• Triggers musical memories
• Stimulates recognition abilities
• Enhances engagement and socialization with family, friends, staff and peers
• Reduces falls by decreasing restlessness and agitation
• Provides person-centered care
• Improves the quality of life for our residents

Getting Started

This program needs a Champion, as it is time-consuming to start and maintain. The Champion in Park Manor Rehabilitation Facility is our Social Services Director and one of her SS students who is doing an internship with us. They went to the Music & Memory course and became certified in the program. However, you can do the program without being certified; you just can’t use their name and logo.

You can start with your most agitated residents first to get the program up and running slower, so it won’t be so daunting. The SS student did an iPod (new or used), headphone and iTunes card drive at the university where she was a student and helped with all the initial setup. Park Manor employees also donated, as well as brought in CDs or flash drives with music to download. Our SSD orders used iPods, headphones and iTunes cards from Amazon periodically.

We also sent out letters to our family members letting them know that we were implementing the Music & Memory program. We asked them to let us know what their loved ones’ favorite music was and/or bring in any music they thought they would like.

To help prepare our staff, we had a facility viewing of the movie “Alive Inside,” a documentary about music and its effects on dementia (the start of the Music & Memory foundation), currently available on Netflix or at Amazon.com.

With the program up and running, we use the following process to personalize the experience for each resident:

• Each iPod is assigned a number for each resident.
• The iPods are then personalized with the resident’s playlist.
• The staff check the iPods in and out for the residents (to help prevent them from getting lost or stolen).
• When any staff member notices a resident appears restless or agitated, is yelling (but has no care needs), or even just appears bored or lonely, we ask them if they would like to listen to music.

Results

The Music & Memory program has enhanced the lives of our residents. Park Manor has one of the lowest rates in the state of Washington for psychotropic medication use. We have decreased our falls, and the program has decreased the noise level by reducing yelling and agitation.

Meanwhile, it has provided our staff with a powerful tool to care for our residents holistically. It has freed up staff time to assist with resident cares. Undoubtedly, the Music & Memory program is an essential tool to provide compassionate, patient care to our residents with dementia.

 

At Somerset Subacute Nursing and Rehab, it’s not just a job for our rehab team; we also enjoy each other’s company. We always find time to eat and celebrate!

At the same time, our therapists are always working diligently to find the best ways to support our patients through rehab. Below are some of the highlights of our rehab team’s efforts.

Physical Therapy

Our PTs work with all types of patients, including those who are developmentally disabled, deaf or mute. Our staff learned to communicate via sign language, and patients have progressed from total assist and unable to ambulate to Modified Indep without AD upon discharge.

In addition, our DOR, together with other PTs from various facilities, collaborated on PT Day of Service for Alzheimer’s and Brain Awareness Month and was featured on the APTA website.

Occupational Therapy

We celebrated OT month together with Earth Day through the use of fine motor movements. We incorporated psychosocial stimulation of planting their own flowers and personalized it with their own pot painting.

Speech Therapy

Speech-language pathologists make a difference by making effective communication, a human right, accessible and achievable for all.

Our STs also work with trach/vent patients to address dysphagia and to improve overall quality of life.

By reaching out to one another and finding ways to connect as a team, we have built a supportive, interconnected culture at Somerset Subacute Nursing and Rehab. Even as we celebrate each other’s company, our therapists continually work together for the benefit of patients.

By Michelle Worth, PT, DOR, Somerset Subacute Nursing and Rehab, El Cajon, CA

Medicine adds Days to Life. Physical Therapy adds Life to Days!
Happy PT Month from Carmel Mountain Rehabilitation & Healthcare!

Upon admission at La Villa Rehabilitation & Healthcare Center three years ago, one 92-year-old Spanish-speaking patient came to us with a history of dementia, heart disease and renal failure. She had undergone prior hospice care as well as multiple episodes of skilled therapy intervention.

On admission, she would walk a short distance of 20 to 30 feet with a flexed trunk and knees. Having experienced a recent decline in function secondary to a hospital stay, she avoided socializing and disliked therapy. She has a history of not participating in therapy and tends to leave her sessions if she feels she has to do too much activity.

Interventions

Therapy evaluation revealed decreased ROM to B knees secondary to arthritic changes and hamstring tightness. Due to her long periods of sitting and the fact that she keeps her knees flexed during WC mobility and primarily uses her UEs for propelling, she presents with tight hamstrings and hip flexors.

With skilled therapy services, the focus was to increase BLE ROM with hamstring stretches and hip flexor stretches. However, the patient was not interested in these interventions. Family then expressed that she would like a new WC. The therapy team discussed with her that if she would help more with transfers and other mobility and allow us to stretch her out, then a new WC would benefit her much more.

The patient worked on the Sci Fit to increase her ROM and strength, with a focus on sit-to-stands on the parallel bars with max A and transfers with max A. The patient would help to stand, but once in standing, she would flex her knees again and would not bear weight.

During this time, we brought in the Barihab Table and encouraged her to let us try using the table with her for transfers, with assistance from the L side bar. This allowed her to feel more secure after the first try. Within a couple of days, the patient was gradually able to utilize the table for hamstring stretches.

We also used the back support to progressively lower her from sitting to a more supine position to obtain a hip flexor stretch. The patient began to perform crutches to increase trunk control, and she was beginning to like the outcomes of the treatment sessions.

We then introduced her to the seat lift for lower body support to move into standing. She was able to gain strength and trust, and she allowed herself to stand with one-handed support and slowly progressed to releasing both hands. She will now play catch with the ball and is helping with transfers as she stands up taller and takes steps to stand and pivot.

Conclusion

We are amazed at the progress we’ve made with a patient who previously disliked therapy and now knows to come to therapy on her own. She has a new custom WC, and even though she still keeps her knees flexed, she is stretching them out on her own and performs stand-pivot transfers with mod A with nursing. The patient’s initial smile when she could stand was priceless, and we continue to gain her trust with each therapy session.

Our patient Polly Bee had not walked in 20 years, but our therapy team did not let that stop them from helping Polly follow her dream of walking again. Some of the approaches used by Lake Village therapists with Polly Bee included:

• Barihab utilized for balance, proprioception and standing tolerance
• Mobilization techniques to facilitate muscle flexibility for knee
• Muscle energy
• Joint mobility
• Standing activity tolerance
• Custom shoe for leg-length discrepancy
• Adaptive equipment for ADls/self-care training
• Postural alignment
• Home evaluation for environment modifications

Here, in her own words, is Polly Bee’s story.

It was a cold, wet morning 23 years ago when my life ended, as it was, in an accident that kept me in a wheelchair from then on. While riding in my mobile home, I was forced off the road by a tractor trailer. This broke my left femur in half, and my right foot yanked completely off by getting hung between the door and the step of my mobile home. Before we could get the wheels of the mobile home back on the road, we hit a 6-foot ditch, nose down, making it into an accordion.

The accident happened at 4:30 a.m., and I was taken to the emergency room, where I waited until 2:30 p.m. before I was operated on. Infection took over my left femur during that waiting time, and 32 surgeries later, I had lost not only my femur, but my whole left leg bone. My last surgery left me with a titanium bone from my left ankle to my pelvis. My knee cap was left on top of my internal prosthesis, floating and getting caught in the hinge of my knee, causing very severe pain. Ever since then, I have been in a wheelchair suffering with this pain, living life the best I could.

Two months ago, at 9:30 p.m., I fell off the bed and landed on my left knee, causing me to end up in the hospital for pain control. After getting my pain under control, I was forced to come to Lake Village Nursing & Rehabilitation Center in Lewisville, Texas, because I had no one to care for me at home. My only consolation of coming to Lake Village was that it was very close to my youngest daughter’s home.

At Lake Village, they have an excellent therapy department! I started off exercising my legs, which I had done many times in several rehab centers. But this time, one of my therapists, Addie, actually listened to me and addressed the problem that was causing the pain. She mobilized my kneecap to its proper position with use of slight pressure and used Biofreeze to massage my leg muscles to increase flexibility and facilitate joint movement.

I started to practice standing from there, because my pain was finally under control. I realized that I needed a built-up shoe that would lengthen my internal prosthesis leg to match the length of the normal leg. Once I received my custom shoe, I had overcome all the barriers. Before I knew it, I was walking over 100 feet on my walker! This was the first time I had walked or even taken a single step in 23 years!

This was not only a huge accomplishment for me, but also for Addie, Chris, Ellen and Eric. Hats off to the greatest therapists in the United States! This is the eighth rehab that I have been in since my accident. They all helped me make many accomplishments, but none as great as Lake Village. I always had a dream to walk again, but 10 years ago, I gave up on it and had no hope of ever standing on my own two feet, much less walking. Now I see some light at the end of the tunnel. I will be moving to my daughter’s home soon, and as I get stronger, my long-term goal is to be able to go back to my home in Colorado. All of this is due to the great therapists at Lake Village Nursing & Rehabilitation Center.

Johnny Johnson, age 71, has been here at Lake Village Nursing & Rehabilitation Center for about five or six months. He is one of our star patients who has come a long way.

Initially, Johnny would not participate in therapy services, until therapy was presented as an elite exercise club not offered to everyone, with a membership card that was marked off after each exercise session. Once the card was completed, then he moved up to the next level. He chose his membership gift, a steak dinner, and Therapy took him to a local diner for chicken-fried steak with his daughter.

Some of the approaches used by Lake Village therapists included:

• Barihab to increase standing tolerance/weight bearing
• SciFit for endurance and total body conditioning
• Safety awareness
• Functional activity tolerance
• Gait training
• Strength training

We would like to share Johnny’s story, because everyone loves a happy ending! Here is a summary in his own words of his experience at Lake Village.

Back in January, at my country house in Arkansas, I was out hunting for deer on a cool, crisp morning. I fell out of an 18-foot metal deer stand. As I was falling, I remember, I was face-first, but somehow I made myself turn over in the air and land on my back. I laid on the ground for about an hour because I just couldn’t get up. Slowly, I crawled to my four-wheeler and drove home.

I could hardly walk because of the pain, so my wife took me to the Wadley Hospital in Texarkana. It turned out I had trouble with my vertebrae and a head injury. I knew I needed rehab, so my wife asked around and heard great things about Lake Village in Lewisville. It was a good option because my daughter lived here.

I don’t remember much about this time at the Wadley Hospital or even my first few weeks at Lake Village. I was extremely sick and partly crazy. I was cursing more than a sailor, wouldn’t take my medication and wouldn’t do anything they wanted me to. They were needling me all the time with a bunch of pain meds, so I just was out of it.

When I finally felt better, I joined the rehab exercises with a Basic membership. I finally started to walk, build strength and work my mind. I was upgraded to the Gold membership, which focused on even more walking. Now, I’m almost done with Gold, so I’ll be getting a steak dinner. Next, I’ll do the Platinum and Diamond until I’m ready to go home.

The staff here are just wonderful, especially the ones in the fitness center. It’s a nice facility; everybody works with you and gets along with you. I’ve been real satisfied with this place.

I want to give a big shout-out to all the DORs to remind you that you are not alone out there. Every DOR in every Ensign facility shares your struggles and wants to celebrate your successes. We do our best to be strong leaders for our teams, but we also need to remember to lean on each other when times are tough.

What makes a strong leader? The dictionary defines a leader as one who inspires and guides others. He or she must possess certain qualities such as honesty, confidence, a good sense of humor, a positive attitude, good communication skills and intuition for reading people.

As a leader, you set the mood every day when you enter the office. Staff members feed off of the energy you exude; whether it is positive or negative is entirely up to you. Remember to take a moment before you walk through that door to put on your game face for the day. You get what you give.

You are probably the first one in the door in the morning and the last to leave at night. You try to lead by example, but not everyone realizes the time and effort it takes to stay on top of productivity, census, compliance audit updates, case mix, clinically appropriate RUGs, staffing challenges, continuing education and great outcomes in patient care. You are always on call. If you are truly honest, I bet you have worked on your computer while on vacation! (I know I am guilty.)

You work your hotlist daily and spend time analyzing reports to make sure everything is done on time. You hold your therapists accountable for their treatment minutes, paperwork, productivity and outcomes while never forgetting to provide each and every one of them with respect and encouragement, for a job well-done. One of the things I enjoy the most with my team is setting team goals together and then celebrating together as each goal is met. The importance of celebration can’t be overstated!

Remember, your therapy team is a group of highly educated professionals who can help you in your daily tasks if you delegate appropriately. Allow them to be creative in their treatment approaches, provide monthly continuing education, explore their career interests, and find new ways to assist them in advancing patient care to new levels in your facility. Ask their opinion on goals for the department in the coming year. Have them discuss the group strengths and areas for improvement. These educated people are a strong resource for all DORs when you are feeling stuck. Set your goals as a team, and your team will shine.

By Donna Black, DOR, The Courtyard Rehabilitation and Healthcare, Victoria, TX

For over 75 years, May has been designated as Better Hearing and Speech Month — a time to raise public awareness, knowledge, and understanding of the various forms of communication impairments to include those of hearing, speech, language, and voice. Communication impairments often affect the most vulnerable in our society — the young, the aged, and the disabled.

Helen Keller once noted that of all her impairments, she was perhaps troubled most by her lack of speech and hearing. She elaborated that while blindness separated her from things, her lack of speech and hearing separated her from people — the human connection of communication.

For a fun way to share some common speech disorders – click here for a video with our favorite Looney Tunes characters!

https://youtu.be/UASW6zSuXaE?list=PL6GgE3NLyHD6WlIsVXhi-rThjkF25f8E0

For more information on Better Hearing and Speech Month: http://www.asha.org/bhsm/

Littleton Rehab’s OT team once again promoted OT Month in their facility to educate residents, staff and families. They not only hung a large informational and colorful board in the hallway, but each of the Littleton staff was given a small gift with a message about occupational therapy. The message was written by AOTA president Ginny Stoffel: “Occupational therapy addresses real, down to earth, everyday life issues. We are true to our profession when our practice results in helping people reengage in everyday life activities that hold meaning, purpose and value for them.”

What is Occupational Therapy? Spread the word!

Occupational therapy is the only profession that helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations). Occupational therapy practitioners enable people of all ages to live life to its fullest by helping them promote health, and prevent-or live better with-injury, illness, or disability. Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes. Occupational therapy services typically include an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals, customized intervention to improve the person’s ability to perform daily activities and reach the goals, and an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan. Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment and/or task to fit the person, and the person is an integral part of the therapy team. It is an evidence-based practice deeply rooted in science. Learn more at:http://www.aota.org/Conference-Events/OTMonth/what-is-OT.aspx#sthash.of9qsny6.dpuf