Everyday we examined patients in San Juan at a rehab facility associated with a local hospital. This clinic provides physical therapy to patients in the area, however in most cases the people cannot afford the 'luxury' of these services. The need for physical therapy appears to be the same as in the United States. By my best estimate, San Juan proper is about 130,000 people, and the rehab facility is the only one between San Juan and Santo Domingo (about a three hour drive.) It would be like having one PT clinic within 200 miles...only the drive to get there would much more interesting with partially paved roads and intermittent livestock crossings.) Diagnoses included SCI, CVA, BKA and patients with numerous neuromusculoskeletal issues, including many complaints of mechanical neck and LBP. In addition we saw a number of patients with diagnoses we probably just wouldn't have the opportunity to manage in the United States. For example a man with neurofibromatosis had a 40# tumor removed from his leg. Had the tumor not been removed, the man would have undergone an amputation, and my perception is prosthetic limbs in this part of the Dominican Republic are not readily available to all. Another patient had significant scarring on his chest and axillary region from a burn he received as a child. As a direct result of this, he has had limited function in his right upper extremity for the majority of his life. Because of the widespread access we have to quality health care here in our own country, conditions like these would be addressed much earlier in a patient's life and long before mechanical problems developed. Dorothy, Dawn and Abigail were involved in pre and post-op management and assisted in both surgeries. In just a week's time they were able to make a pretty significant difference in the lives of these patients. 
"Life changes when your child's doctor tells you your daughter won't walk, or use her right hand and will always need assistance for daily tasks. You begin a journey to find ways to allow your child to live as independently and normal as possible. You learn that there are barriers that you hadn't anticipated and become passionate to find solutions to remove as many obstacles as possible. PAWS Giving Independence has given our family hope for our daughter's future independence. 
Since Naomi can't use her right hand, a simple task like removing her coat becomes possible with the help of Sasha, her service dog. Holding a door open to let her wheelchair pass through is also a task that Sasha is training to do for Naomi. Picking up dropped items like a cell phone, remote control, wallet or keys is probably our most used task for Sasha. The assistance is empowering for Naomi because she isn't always calling upon other people or feeling as though she is interrupting the activities of others to come to her rescue. Above all, Sasha has bridged a social gap between Naomi and non disabled people in the community and in social settings. Everywhere Naomi goes with Sasha, people are drawn to make conversation.
I didn't realize how substantial the social barrier was for our daughter until she recently started beaming about how popular she feels when Sasha is with her."
History
The Bradley Physical Therapy Department was instrumental in helping three Bradley students start a non-profit organization in September 2008. Michelle Kosner, Brandi Arnold and Eric Swanson came to the physical therapy department looking for help to build the philanthropic association known as Paws Giving Independence. Paws Giving Independence rescues dogs from animal shelters, trains them to become service dogs for children and adults with disabilities, and places them free of charge to the families. 
Their motto is "Saving a Life to Change a Life".
When Amy, a 24 year old woman with quadriplegia, received a dog, she commented that prior to this people would first see her wheelchair and now they see her dog. She notes people are always stopping to talk with her about her companion and to ask questions. She states she felt as though no one ever acknowledged or engaged her in public before this.
Each dog has various expenses such as adoption fees, vaccinations, medications for heartworm, grooming, vests and patches, leashes, collars, insurance, and food. PGI is a 501 (C) (3) corporation and all donations are tax deductible.
Upon reading an article regarding the physical stress theory, I couldn't help but think about how important understanding basic science is. I remember so many times throughout undergrad thinking "how is this even important?"However, it comes down to the fact that basic science is essential, and we need to remind ourselves when we are working in the clinics of the 'basics' when considering the source of our patients' problems.
In this article on physical stress theory, I was drawn to a section regarding how physiological factors influence the ability of our tissues to adapt to physical stress. This authors covered medication, age, pathologies, and obesity, yet much to my surprise they failed to mention the other extreme: low weight as a result of disordered eating.
A 2008 study by Barrack et al reports that there is an association with increased dietary restraint and low bone mineral density. This study included 93 female cross country runners ranging from age 13-18. Cross country runners cause moderate to high stress on their bones daily (regularly,) and the addition of dietary restrictions could potentially lead to injuries and decreased ability of the tissue to handle that stress.
My point being that there is a significant amount to consider regarding basic sciences when treating patients like these. For example, Gonzalez et al. mentions that people with low weight/eating disorders commonly have an abnormal variation in electrolytes, low blood sugar, and decreased calcium due to these dietary restrictions. Well, we all know when we take the time to consider our basic sciences that our muscles require ATP(comes from things that increase our blood sugars) to contract and relax. Low electrolytes can lead to an alteration in the sodium potassium ion channels. Lastly, calcium has a direct effect on muscular contraction considering its interaction with the sarcoplasmic reticulum, trasverse T-tubules, troponin, and tropomyosin. Aside from muscles, calcium is also a key component to the bones.
Presumably, this can be overwhelming to keep into perspective at times, but when we are managing patients in the clinic it is important to decipher the hints they are throwing at us. Caloric restriction and disordered eating ARE problems that can go undiagnosed. If left unchecked for long enough they can be damaging to the musculoskeletal, integumentary, cardiopulmonary, and neuromuscular systems. For example, a person who is restricting his or her caloric intake is picking and choosing certain foods with little thought about which nutrients he is going to get that day. A weight paranoid person is going to cut out calories however she can. Dairy products can be high in fat and calories and therefore neglected all together. Patients may forego drinking calcium rich milk when they know they can drink water with zero calories. If we consider basic science, isn't it possible that this lack of calcium from dairy products will affect bone regeneration and muscular function in the musculoskeletal system? How then will this patient's tissue respond to the stress of a work out?
When we look at the integumentary system, we know that a basic component of skin is protein. Therefore when our patients are restricting sources of protein is it reasonable to think this would have a negative effect on wound healing? Prolonged nutrient deprivation can also have serious effects on the cardiovascular system. A common problem that occurs with eating disorders is bradycardia. Long term disordered eating can also lead to cardiac failure. What if we push our patients to get better and their heart cannot handle the extra strain? The neurological system is affected at an even deeper level. Commonly, depression is associated with eating disorders. Depression alters the flow of chemicals within the brain. Most of us have seen the pharmaceutical television commercials which state, "depression hurts". Additionally, many times there is a lack of energy which can lend itself to inactivity and lead to muscular atrophy. Depression can also be a part of a vicious cycle which causes a person to not eat.
I am not sure that I would say that eating more or less than normal is unhealthier than the other. If taken to the extremes both are extremely unhealthy and create a new category of stresses put upon the tissues in each of the systems. The key is good nutrition and the input of proper physical stress. I think my main point of all of this is that regardless if your patient is young, old, eating too much, eating too little, on medications etc. it is important that physical therapists get 'back to the basics.' Rehabilitation is still dependent upon minute factors such as these. So here's my question: If we are what we eat or what we do not eat… shouldn't we be screening for eating disorders in our patients? How do we know if we are inputting the proper amount of physical stress? Are we even looking and considering how a patient's personal nutritional situation impacts the results of their therapy? How can we truly help our patients if we do not know for sure... if we are not asking the questions? It's food for thought!
Stormie Prather, SPT
1st Year DPT student
Posts
All Comments
