The Dynasplint® Blog
- Head & Shoulders Above the Rest
- What Actually is a Sprained Ankle?
- Dr. Oz and Dr. Roizen: Once your feet go, so does physical fitness
- Because Stretching is Always Good
- A Message for Team Physicians, Athletic Trainers and Sports Therapists
- Avoiding Surgery
- Bringing Andrea Back from Brain Injury: A Father's Story
- Do NOT Let Your Pain Spread
- Creep Phenomenon
- Angry Joints
- Tim Has a Story to Share
- I'm going under the knife!
- Chronic Ankle Contracture Reduced: A case series
- Joint of the month: ANKLE
- "PIP" is just so much easier than Proximal Interphalengeal
- Dynasplint to the rescue!
- What is Dupuytren's disease? A Great Read!
- Dupuytren's Disease and Dynasplint
- New Knee! Total Knee Replacement
- Your Knee Injury Worst Nightmare
- The Knee + The Sum of Its Parts
- Tibial Plateau Fracture & the ROM Challenge
- Hopping is for Bunnies
- Dallas Friday- A Dynasplint Knee Story
- When Stroke Happens-Challenges and Treatment
- What Exactly Is A Distal Radius or Colles's Fracture?
- We GET To Do This Work - real stories, real life....
- Stroke victory- from hardly working to working out!
- Once upon a time, Denise stood on a chair and fell....
- Sweet 16 and a Fractured Wrist
- Dynamic Splint for Pediatric Contracture Reduction of the Upper Limb
- A "New Normal"
- Dynamic Splinting for the Wrist
- March Right On In
- Dynamic Splinting for the Neurological Patients
- DSI Neuro Milestone
- Dynasplint Systems Celebrates 30th Anniversary
- Range of Motion and External Fixation
- Race Across America
- Supporting Service Members
- Love House
- ITB Syndrome
Head & Shoulders Above the Rest
July is Shoulder month, and as we focus on this work-horse of a joint we acknowledge that we ignore it until it hurts. Why is it that everything that we do to make ourselves groomed (as in beautiful) takes shoulder mobility? We get out of bed, change (ouch! nightclothes over the head) shower (ouch! reach to turn on shower, ouch! to wash hair) get ready for the day (ouch! brush teeth, shave, comb hair, apply makeup, get into shirt) and eat breakfast (ouch! to getting and pouring cereal, OJ etc.) and gather our bags (ouch) get in the car (ouch!) Need I go on?
Meet John C. In October of 2009 he had a bad fall on the concrete, and his biceps tendon injury finally resulted in surgery in February of 2010. This was followed by immobilization and months to rehab. In May, Dynasplint was his help to regain his shoulder range of motion. Might it be yours?
What Actually is a Sprained Ankle?
(A "sprained ankle" is such a common term, and we toss it around to describe any hurt ankle. Here are the details on this frustrating and complex injury from the good folks at www.sportsmd.com.)
A sprained ankle is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.
Are there different types of ankle sprains?
The severity of a sprained ankle depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Physicians generally classify a sprained ankle based on their severity as a grade one, two, or three.
- Grade 1 sprain:
Some stretching or perhaps minor tearing of the lateral ankle ligaments.
Little or no joint instability.
There may be mild swelling around the bone on the outside of the ankle.
Some joint stiffness or difficulty walking or running.
- Grade 2 sprain:
Moderate tearing of the ligament fibers.
Some instability of the joint.
Moderate to severe pain and difficulty walking.
Swelling and stiffness in the ankle joint.
Minor bruising may be evident.
- Grade 3 sprain:
Total rupture of a ligament.
Gross instability of the joint.
Severe pain initially followed later by no pain.
Usually extensive bruising.
Other signs of a more extensive injury include tenderness along the bone, either on the inside or outside, as well as swelling and bruising along the inside of the ankle.
I have heard of professional athletes recovering from so called “high ankle sprains.” What’s the difference?
A high ankle sprain, also known as a syndesmotic ankle sprain, is a sprain of the syndesmotic ligaments that connect the tibia and fibula on the lower leg. Syndesmotic ankle sprains are known as high because their location on the lower leg is above the ankle. Unlike common ankle sprains when ligaments around the ankle are torn or receive injury through an inward twisting, high ankle sprains are caused when the lower leg and foot twist out. The biggest difference between the two injuries is that whereas athletes can predictably return their to sport in 4-6 weeks after a standard sprained ankle, it can take much longer to return after high ankle sprains--as long as 6 months. Additionally, in cases of unstable high ankle sprains, surgery is usually needed. In order to rule out a high ankle sprain and/or an associated fracture your physician may order a series of tests including an xray, CT scan, or MRI.
How do I know if I have a sprained ankle?
The signs and symptoms of a sprained ankle may include:
• Pain or soreness
• Difficulty walking
• Stiffness in the joint
These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains—instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if you don’t have pain or swelling with a sprained ankle, treatment is crucial.
What causes a sprained ankle?
The most frequently seen sprain occurs when weight is applied to a foot which is on an uneven surface and the foot rolls over on the outside. Because the sole of the foot is pointing inward as force is applied, the ligaments stabilizing the lateral - or outside - part of the ankle are stressed. A sprained ankle commonly occurs while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface. There are a number of factors that predispose an individual to a sprained ankle. These include:
1) Minimal rehabilitation of a previously sprained ankle
2) Poor joint proprioception (proprioception is the ability to sense where a joint is .... if you don't know where your ankle is, the muscles will not be able to prevent the ankle sprain)
3) Generalized ligament laxity (some individuals have loose joints so to speak and can roll over their ankles very easily
4) Weak muscles (they are just not strong enough to prevent the sprain occurring)
When should I seek medical attention?
Any sprained ankle—whether it’s your first or your fifth—requires prompt medical attention. The sooner treatment starts, the greater the chance to prevent chronic pain and long term instability. Many of the problems resulting from sprains are due to blood and edema in and around the ankle. Minimizing swelling helps the ankle heal faster. Sports injury treatment using the P.R.I.C.E. principle (Protection, Rest, Icing, Compression, Elevation) facilitates this and should be initiated ASAP even before a physician is seen:
Protection -- The first principle is protection. The purpose of protection is to avoid further injury to the ankle by protecting the injured structures. The type of protection used varies but may include an ACE bandage, protective tape, or over-the-counter brace.
Rest -- You may need to rest your ankle, either completely or partly, depending on how serious your sprain is. Use crutches for as long as it hurts you to stand on your foot.
Ice -- Using ice packs, ice slush baths or ice massages can decrease the swelling, pain, and bruising and muscle spasms. Keep using ice for up to 3 days after the injury.
Compression -- Wrapping your ankle may be the best way to avoid swelling and bruising. You'll probably need to keep your ankle wrapped for 1 or 2 days after the injury and perhaps for up to a week or more.
Elevation -- Raising your ankle to or above the level of your heart will help prevent the swelling from getting worse and will help reduce bruising. Try to keep your ankle elevated for about 2 to 3 hours a day if possible.
Prompt medical attention is crucial because an untreated sprained ankle may lead to chronic ankle instability, a condition marked by persistent discomfort and a “giving way” of the ankle. You may also develop weakness in the leg. In addition, you may have suffered a more severe ankle injury like an ankle fracture along with the sprain. This might include a serious bone fracture that could lead to troubling complications if it goes untreated. Lastly, rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.
Will I need surgery?
Except for specific instances of associated fractures and/or unstable high ankle sprains, the overwhelming majority of ankle sprains are treated with conservative measures. It is important to begin treatment immediately to ensure a good outcome.
In addition to the P.R.I.C.E. principle, your doctor may prescribe you a walking boot or even a cast for a short period to immobilize the ankle. Anti-inflammatory medication may also be used to help. Once the acute phase of pain and swelling has subsided then a course of physical therapy will be initiated. The rehabilitation exercises are the most important aspect of recovering full function of the ankle. These will consist of exercises to increase proprioception, ankle braces and strapping to facilitate activity, muscle strengthening and flexibility exercises, gradual return to any sporting activities, and the long term goal of maintaining fitness by doing alternative activities to prevent any recurrence.
When can I return to sports? Can I do anything to prevent this from happening again?
Most people can resume their activities of daily living within 5 to 7 days provided appropriate treatment has been initiated. For most simple ankle sprains, athletes typically can return to play at approximately 3-6 weeks. During this initial period of return to play, to help prevent further sprains and setbacks by wearing a semi-rigid ankle brace when exercising for another 1 to 2 months. Special wraps that use hook and loop fasteners, or air-filled or laced braces may also help prevent reinjury. Wearing high-top tennis shoes may also help prevent a sprained ankle if your shoes are laced snugly and if you also tape the ankle with a wide, non-elastic adhesive tape. Elastic tape or braces are usually not helpful because the elastic gives too much around the joint.
Once your sprain has completely healed, a program of ankle exercises will also help prevent reinjury by making the muscles stronger, which provides protection to the ligaments. The exercises may be prescribed by your physical therapist or trainer:
Sit on the floor with your legs stretched out in front of you. Move your ankle from side to side, up and down and around in circles. Do 5 to 10 circles in each direction at least 3 times per day.
Pull your toes back toward you while keeping your knee as straight as you can. Hold for 15 seconds. Do this 10 times.
Point your toes away from you while keeping your knee as straight as you can. Hold for 15 seconds. Do this 10 times.
In and Out
Turn your foot inward until you can't turn it anymore and hold for 15 seconds. Straighten your leg again. Turn it outward until you can't turn it anymore and hold for 15 seconds. Do this 10 times in both directions.
Resisted In and Out
Sit on a chair with your leg straight in front of you. Tie a large elastic exercise band together at one end to make a knot. Wrap the end of the band around the chair leg and the other end around the bottom of your injured foot. Keep your heel on the ground and slide your foot outward and hold for 10 seconds. Put your foot in front of you again. Slide your foot inward and hold for 10 seconds. Repeat at least 10 times each direction 2 or 3 times per day.
Put your injured foot on the first step of a staircase and your uninjured foot on the ground. Slowly straighten the knee of you injured leg while lifting your injured foot off the ground. Slowly put your injured foot back on the ground. Do this 3 to 5 times at least 3 times per day.
Sitting and Standing Heel Raises
Sit in a chair with your injured foot on the ground. Slowly raise the heel of your injured foot while keeping your toes on the ground. Return the heel to the floor. Repeat 10 times at least 2 or 3 times per day. As you get stronger, you can stand on your injured foot instead of sitting in a chair and raise the heel. Your injured foot should always stay on the ground.
Stand and place a chair next to your uninjured leg to balance you. At first, stand on the injured foot for 30 seconds. You can slowly increase this to up to 3 minutes at a time. Repeat at least 3 times a day. To increase the difficulty, repeat with your eyes closed.
If you suspect that you have a sprained ankle, it is critical to seek the urgent consultation of a local sports injuries doctor for appropriate care.
Dr. Oz and Dr. Roizen: Once your feet go, so does physical fitness
In 2009, 1,300 stilt walkers led by members of Cirque du Soleil claimed the world’s record for the most people perched high atop wooden poles at the same time. They must have missed lunch hour on Fifth Avenue when thousands of New York women teeter down the sidewalk in four- to six-inch stilettos. And where are they going? To the podiatrist — in record numbers. Calluses, corns, ingrown toenails and hammertoes all result from cramming feet into steeply arched, unpadded shoes that force the foot forward. This also can irritate nerves on the ball of the foot, triggering neuromas. But, according to the American Podiatric Medical Association, despite the discomfort (or downright agony), many women continue to wear painful shoes.
Unfortunately, once the feet go, so does physical activity, and guess what’s right behind (or about to be on your behind)? Weight gain. So take the proper steps now: If you wear heels over two inches high, save them for posing (at that office party), not walking around. And travel with flats. In love with toe-pinchers? Buy them a half or full size larger than usual; add heel liners to take pressure off the toes. Look for shoes with open toes so your little guys can stretch and breathe.And if you have tingling or pain in the balls of your feet, your arches ache or you have lower-back pain, go to a foot doc for an assessment and a shoe store for a pair of well-padded, good fitting walking shoes.
Copyright (c) The Province
Because Stretching is Always Good
Dynasplint Systems are often used in conjunction with physical therapy, and this combination has shown range of motion recovery up to 53% faster. Your doctor and physical therapist will give you the individual stretching protocol for your home exercise program. For those who want to keep that healthy range, here is a great ankle stretching routine from our friends at Livestrong.com
ANKLE STRETCHING ROUTINE
If you suffer from arthritis and the condition causes stiffness in your ankle joints, you may experience significant discomfort and have trouble walking. To help relieve your symptoms and increase joint range of motion, develop a thorough but practical ankle-stretching routine and repeat it three to four times a day. Work on a smooth, even surface, focus on using proper posture and form, and avoid any stretch that causes pain. If your ankle stiffness is the result of a previous injury, follow your doctor's recommendations for stretching and strengthening the injured joint.
Put on a pair of athletic shoes with solid heels. Stand with your feet shoulder-width apart, align your head with your spine and engage your core muscles. Slowly flex your toes upward and backward toward your shins. Maintaining full dorsiflexion, walk around the room on your heels. Take short, brisk steps, continuing the heel walk for up to two minutes. Lower your toes and rise up as much as possible on the balls of your feet. Walk around the room on the balls of your feet for an additional two minutes.
Heel Rise/Toe Flex
Remove your shoes and socks and work barefoot to allow for maximum range of motion. Stand with your right shoulder adjacent to a wall, your feet shoulder-width apart and your knees straight. Rest your right hand lightly on the wall for support. Align your head over your spine, press your shoulders down and slightly back, and engage your core and gluteal muscles as you slowly rise onto the balls of your feet. When you lift your heels as much as possible, hold the rise briefly and then slowly lower your heels to the floor. Transfer your weight to your heels and flex your toes back toward your shins. When you flex as much as possible, hold the stretch briefly and then lower your toes to the floor. Alternate the heel rise and toe flex 20 to 25 times.
Stand with the balls of your feet on a stair step, allowing your heels to extend off the edge of the step. Grasp a nearby handrail with one hand for support. Maintaining a straight spine, tighten your core and gluteal muscles and gradually rise onto the balls of your feet. At the highest point of your rise, hold briefly before slowly lowering your heels. Let your heels slowly drop down below the level of the step, promoting greater ankle dorsiflexion. Repeat the rise and fall 20 to 25 times.
Sit on the floor with your knees straight and your legs extended in front of you. Flex your right foot, drawing your toes toward you as much as possible. Hold the position for five seconds and then slowly extend the foot and toes away from you. Repeat the flex-and-point 10 to 15 times. When you complete the set, slowly rotate the foot to the right, drawing large circles in the air with your toes. Complete 10 to 15 rotations to the right and then reverse the direction with 10 to 15 rotations to the left. Switch to the left foot and repeat the entire exercise from the beginning.
A Message for Team Physicians, Athletic Trainers and Sports Therapists
If your athlete is plagued by plantar fasciitis, then you know the frustration. Whether acute or chronic, PF is not just for runners. Your job is to get your athlete back on the field, and back in the game safely and quickly. The Dynasplint® Ankle System employs a Low-Load, Prolonged-Duration stretch technology, that keeps the ankle at end range of motion in dorsiflexion while stretching the gastroc-soleus complex. Get your athlete on this protocol today!
There are times when our patients want to go on the record because they are so happy with the results that they were able to achieve in regaining their range of motion with Dynasplint Systems. In this case, Sylvia Santos was dealing with the pain of Plantar Fasciitis. Her first steps in the morning were brutal and she had tried many “remedies” such as the sock-with-band-that-pulls-toes-back (fail) as well as (her words) “a very expensive night splint that did nothing.” Watch and see what came to her rescue before her doctor performed a tendon release surgery (the only thing she had not tried to relieve her discomfort). Dynasplint - over 30 years of helping restore range of motion and life-the way it ought to be!
Bringing Andrea Back from Brain Injury: A Father's Story
Two parents help their daughter re-learn how to live, from walking to talking, after she suffered a traumatic brain injury in a car accident. Original MSNBC link
By Bill Briggs
Editors’ note: Andrea Briggs, the daughter of frequent TODAY.com contributor Bill Briggs, was critically injured in a car accident on July 26, 2011. On that summer night, she became one of the estimated 1.7 million people a year to suffer a traumatic brain injury. Since then, the family has been on a shared journey to help Andrea reclaim her life.
I had done all my crying weeks before. But pacing a hospital hallway -- as nurses changed the diapers of my silent, blank-faced, 20-year-old daughter in the room behind me -- I asked my wife for a hug. I don’t request many. I try to give more hugs than I get. But that August night, I yearned for the blonde girl lying in the bed 20 feet away, a respiration machine blowing oxygen through a hole cut into her trachea.
“I miss her voice. I miss her laugh,” I told Nancy -- my wife and Andrea’s stepmom -- as she wrapped her arms around me. “I really just miss Andrea.”
One month earlier, on July 26, my cell phone rang as I gobbled a final forkful of dinner in my living room. I didn’t recognize the number. A somber woman asked if I was the father of Andrea Briggs and told me, flatly, that Andrea was in a nearby hospital. Now standing, my knees flinched. I held a corner of my desk for support as I peppered the woman with urgent questions that she wouldn’t answer.
“Is she alive? Can you just please tell me if my daughter is alive?” I demanded, my voice rising. “She is in very critical condition,” the woman said. “Come to Denver Health Medical Center as soon as possible.” The nauseous pang in my stomach blended with a strange, detached numbness and I felt like I was walking in someone else’s body. I grabbed my car keys, fully believing I was on my way to say goodbye to my only child.
Nancy insisted on driving. The lights were not with us. We ignored them. Ten minutes later, a doctor met us outside the surgical intensive care unit. I remember snippets of our conversation: “severe, traumatic brain injury … shearing of white and grey matter … fixed pupils … brain swelling … ventilator.” I was not told -- until much later -- that the paramedic who had shoved a breathing tube down Andrea’s throat did not expect her to survive the night.
We were given several basic facts: Andrea had been a passenger in a Jetta driven by her friend; they were returning from a Denver ice cream parlor, both wearing seatbelts; on a rain-dampened street in a 35-mile-per-hour zone in fading light, the friend had tried to make a left turn in traffic; an oncoming SUV had slammed into Andrea’s side of the Jetta; Andrea’s friend sustained a concussion but was able to walk out of the hospital that night. My daughter was unconscious, unresponsive, and -- we later were told -- might remain so until Christmas.
We knew that our lives had just tumbled apart. The force of the collision had caused Andrea’s brain to slam against the left side of her skull, causing bleeding and tearing neurons that controlled her ability to breathe, swallow, think or communicate. She also had a collapsed lung and multiple fractures in her right hip, tail bone, rib cage, right pinky and right clavicle.
“Pace yourselves,” a nurse warned that night. “This is a marathon.”
Then I took my first steps into a terrifying, exhausting new reality. Nancy and I were escorted to Andrea’s bedside. We hovered near Andrea’s bed. My daughter’s eyes were closed. White tape held a respirator to her mouth, rhythmically pushing air in and out of her lungs. Lying on her back, her long hair was pulled back neatly into a ball. A thin, metal gauge protruded from a shaved spot just above her forehead, measuring the intracranial pressure within her skull. Each time the pressure rose to a dangerous level, the monitor beeped. That night, the monitor seemed to beep endlessly.
I held her hand. I kissed her cheek. I whispered that I was with her now. And I made a promise I wasn’t sure I could keep: “Andrea, we are going to get you through this, all the way through this.” My personal war to save my daughter had been launched.
Andrea began her life in an intensive care unit, born May 8, 1991, with a grapefruit-sized, benign tumor on her tailbone. On her third day, she underwent lengthy surgery to remove the growth. She came home weeks later with staples in her skin. Doctors weren’t sure if she would ever walk.
She walked. Early, in fact.
And she had me wrapped around her little finger. Immediately. I was her playmate. She loved her mom, Lorrie, of course, but as a little girl, she was my best friend. In our Denver basement, we toppled furniture, turning couches into caves, pillows into fortresses, transforming the room into the African landscape from her favorite movie, “The Lion King.” She repeatedly made me take the role of Scar, the evil uncle. In our kitchen, we played floor hockey. She was the Colorado Avalanche; I was the hated Detroit Red Wings. And we spent countless nights, lying atop a blanket in our backyard, staring at the black sky, discussing the vast emptiness of space. With starlight in her eyes, she loved noting: “It’s impossible to think about nothing. Because even if you’re thinking about nothing, that’s something!”
On our planned “dads and daughters” trips into the Rocky Mountains every few months, she heard the music that the other fathers and I cranked in the boom box, leading to our eventual shared affection for Sublime, Nirvana, Bob Marley and Pink Floyd. On many school nights, we stayed up late together watching David Letterman and Conan O’Brien, laughing equally hard, always at the same jokes.
Then around age 13: The Big Drift. Inevitable and a little sad. But, of course, quite normal. Dad was out. Friends were in. No more games. No more stars. Far less talking. My old pal was in a new place. I was happy for her.
Our music -- Sublime, Marley, Nirvana -- was really all that remained. But eventually it was her tool to drown me out. I remember, so often, as the teen years ticked toward age 20, driving Andrea to class or, later, to work, trying a variety of angles to pry open her distant thoughts and get her to share any shreds of her secret world. My simple questions about her day’s events drew curt, bored, one-word responses. I had lost her.
One distinct memory from last summer, minutes after I picked her up from the mall store where she worked part-time as a sales clerk: “Hey, Sweetie, tell me about your night!” I asked. “It was OK,” she replied. Then silence. She plugged in her earphones. Probably Nirvana. Then we drove through the same intersection where, weeks later, a paramedic would plunge a breathing tube down her throat and grimly predict that Andrea’s days were about to end.
Months later, at Craig Hospital, in Englewood, Colo., Andrea slowly began waking from her brain-injury haze. She learned to point to hand-written cards that said “yes” and “no” and could offer, finally, a sense of whether our Andrea was still in there. Using only those cards, Andrea routinely made her therapists laugh, artfully flashing them to comment on iPod songs she didn’t like (country) or tales of her teen past she didn’t want her dad to relay (college shenanigans, boy drama). By November, she was communicating daily by jamming an iPad stylus onto a laminated letterboard, plunking out words like “hungry” and “water.” One day, she typed out a plea: "Save me."
She was discharged in December after we reached the cap on her insurance. Andrea still wasn’t talking and we knew, at best, it would be many months before she started standing or walking. Yet Andrea was in the prime healing window for brain-injury recovery -- the first six to nine months, when neurons more quickly build detours around the lesions caused by the initial trauma, when a person typically posts noticeable, weekly physical and mental gains.
Her neuropsychologist emphasized that Andrea continue her outpatient recovery in a single, low-stimulation environment to help her brain heal. I’ve been divorced from Andrea’s mom, Lorrie, since 2002, though we remained linked as the parents of a challenging teen. After discharge, Lorrie, Nancy and I decided the best option for our next phase would be to rent Andrea a wheelchair-accessible, three-bedroom, dog-friendly apartment and trade 48-hour shifts caring for her -- showering, eating, dressing, and just hanging out and having fun. The Brady Bunch, we are not. But we’ve made it work with no drama.
We all returned to our jobs after devoting hundreds of summer, fall and winter days to lying with Andrea in her massive, hospital floor-bed or to cheering her during physical and speech therapy sessions. At the apartment, Andrea was not yet using complete sentences, only a stray, occasional word: “mom … thirsty… bed.” She was laughing, though. She seemed happy. Even more, for the first time in about seven years, she clearly seemed to revel in mundane moments spent with her parents and stepmom. I saw something fresh in how she looked at me. A warmth. An appreciation. Something welcoming. As her neurons healed and re-linked, I thought I might be seeing the embers of an emotional reconnection.
Still, the only real conversational bond I had with Andrea was her letterboard -- and a hauntingly frozen series of old Facebook messages from before the accident. Her final Facebook message was a requested favor, sent last June: “hey could you wake me up at 10 tomorrow. thanks”
On Jan. 18, after another day of therapy, her words returned in a gush. Lorrie was at the apartment with her. “I want to go,” was her first sentence, requesting to head to her bedroom. Later that night: “I want to see my dad. Now.” Clear and crisp.
Now that her language was back, Andrea and I laughed through our first chats in six months. She turned serious and politely said: “Tell me the story,” wanting to hear about a horrible injury she’ll never remember. Mostly, she repeated, over and over, how much she loved me. Like the Nirvana and Sublime tunes we’d both enjoyed a decade earlier, it was such sweet music to my ears.
Now, approaching the 11-month anniversary of the injury, Andrea continues to plow through the pain of therapy and the unknowns of her future, tapping an indomitable spirit, a hard-charging drive to “be normal” and, whenever she can, a sly sense of humor.
She confesses, occasionally, that she feels “nervous” about the prospects of walking again. But she recently stood up from a chair without any help and has maintained a standing position for 10 seconds without holding on to anything or anyone. While standing, she is shuffling her feet at home, moving from one chair to another as we guide her and keep her balanced.
Her memory is fast improving, though she still forgets some conversations, visits from friends, phone calls, or events from earlier in the day or from the day before. But with prodding, she can often recall certain details. Because every brain is unique -- making every TBI case different -- her doctor will not give us a precise prognosis. It would be simply his educated guess, anyway. So we choose to live in the moment, savoring and boasting about her weekly physical and mental victories.
Almost one year to the day after I’d received what almost was her final Facebook message, Andrea selected a birthday card for me. Her right hand is still regaining movement so when she writes -- she’s truly a laptop/iPhone girl -- she’s momentarily using her left hand. With those fingers clutching a pen, she’d scrawled “Dad” on the green envelope. On the card’s front flap was a picture of a smiling, panting golden retriever. (We both love dogs, especially goldens.) Inside the card, she revealed her appreciation: “I love you dad. Thanks for being there for me. I couldn’t imagine going through this without your love and support. Love, Andrea xoxo.”
We have some distance to travel before Andrea meets her three biggest goals: walking, returning to college, and living independently -- with a dog. But at this mile marker, finally, I have my daughter back.
Note from Dynasplint - It is stories like this one that make our work a gift. We get to help families like this one. High privilege.
Do NOT Let Your Pain Spread
Dr. Stephen Perns, a podiatric foot and ankle surgeon in Atlanta, discusses Achilles Tendonitis, Plantar Fasciitis and other dysfunction of the rear foot. The pain doesn't stop in the foot and ankle. Left alone, it can cause gait issues and produce pain in the knee and even the lower back. He believes that dynamic stretching is the answer to reduce pain and inflammation, speed up recovery, and ultimately reduce the cost of healthcare.
Is it a thrilling summer blockbuster?
Is it a skin eating disease?
Is it the Radiohead song?
No, indeed! Today, we learn more about range of motion. To explore ROM, we really need to understand what goes on inside the joint capsule. So, let’s put on our physiology hat and see what's happening when we experience joint stiffness. Meet the ankle joint:
When there has been trauma to the ankle like a fracture or surgery, the inflammation and swelling results in less movement. When restricted by a brace, boot or cast- the connective tissue (such as ligaments, tendon, etc) actually starts to shorten in length, the fibers become thicker, and additional collagen fiber, or scar tissue, forms.
So how do we re-model this connective tissue? There are 3 elements that this tissue responds to- time, force, and temperature. Very little force is needed, and that technology is employed in dynamic splinting with its low-load-prolonged stretch. Did you see the hint I just gave about time?
P r o l o n g e d. ....
Time is more important than high intensity when it comes to stretching. Think of a rubber band that you are stretching out just before you shoot it across the room. It does change shape, but just for an instant. That is called an elastic stretch. Now- take that rubber band and stretch it around your car visor and leave it for the month of July. Take it down and notice that it has remodeled and is now a very long rubber band. That is called a plastic response and is a permanent length change. This is the Creep Phenomenon and just what the doctor ordered for regaining your ROM.
Because you are special- so very special, keep yourself in motion!
Isn’t it truly remarkable what a delicate eco-system the joint capsule is? Overuse can lead to tendonitis, which leads to inflammation then swelling. Did I mention pain? Perhaps you are ordered to rest via immobilization in a boot and before you know it –BOOM- range of motion is limited. Our featured patient, Brent, experienced just this. What was his solution for regaining ankle motion? You guessed it.
Tim Has a Story to Share
Meet Tim. Although I am sure he has had a bad day here and there, you would never know it from this video. When I get tired and have swelling or stifffness in my ankle, I sometimes (OK-most of the time) want to take to the couch and eat bonbons and maybe- or maybe not- watch reality TV on Bravo. Not this man. He is a take charge kind of guy. When he was lacking range of motion in the right knee and the left ankle, he didn't give up; he took action. He didn't let a 60 hour work week deter him from his ankle stretching solution. Oh yeah- did I forget to mention that he is in a wheelchair after a spinal cord injury sustained in a car accident 21 years ago and is a T12? He might be one of my heroes. Full steam ahead, Tim!
I'm going under the knife!
Chronic Ankle Contracture Reduced: A case series
from the Foot and Ankle Online Journal July 2011
by Sarah A. Curran,PhD, BSc(Hons), FCPodMed, FHEA1 , F. Buck Willis, PhD2
Background: Contracture is molecular shortening of connective tissue that frequently occurs from arthrofibrosis following malleolar fractures, causing plantarflexion contracture. The purpose of this case series was to examine reduction of chronic contracture of ankle fracture patients with treatment of dynamic splinting which delivers prolonged durations of low-load stretching at end range (s) of motion.
Method: Eighteen patients (mean age 46, range 29 – 65 years, 9 females, 9 males) with a prior history of medial malleolar fracture, surgical fixation and contracture of more than one year took part. Dynamic splinting was prescribed for wear each night, achieving 6 to 8 hours of passive end-range stretching. The tension of the Dynasplintâ was changed twice a month to optimize the stretch at end range of motion.
Results: The mean duration was 16 weeks (range 12-22 weeks) and the patients mean wear was 784 hours (range 660 – 960) in end-range therapy from dynamic splinting. Maximal dorsiflexion was measured at baseline (enrolment) and at four months. The mean maximal change in dorsiflexion was 23.4º (SD=14.1).
Discussion and Conclusion: Contracture reduction is thought to require comparable amounts of time equaling the duration of contracture development. Low force, prolonged, passive stretching is considered to have the most beneficial effect in contracture reduction due to its ability to facilitate permanent changes in connective tissue elongation. The 60% change in maximal dorsiflexion noted in this study can be directly related to the duration of treatment as home therapy. A larger controlled trial should be conducted to measure empirical efficacy of dynamic splinting for contracture reduction following malleolar fractures.
Joint of the month: ANKLE
"PIP" is just so much easier than Proximal Interphalengeal
Proximal Interphalengeal- Proximal Interphalengeal- Proximal Interphalengeal- Say that 3 times fast! Now you see why the rest of us call the mid finger joint the PIP, and when the diagnosis such as: Boutonniere deformity, Dupuytren’s contracture, Fractures and dislocations, Tendon and ligament repairs, Burns, Arterial and venous microsurgical repairs, Rheumatoid arthritis, Cerebral palsy (CP), Cerebral vascular accident (CVA), and other neurological conditions are present the ease of incorpoating a Dynasplint finger splint into a home stretching program are as easy as saying PIP!
Dynasplint to the rescue!
Check out this pitcher's success story of how he embraced wearing his Dynasplint which now may contibute to winning the state championship this year... http://www.tampabay.com/hometeam/blog/state-baseball-tampa-prep-pitchers-benefit-require/13915/
What is Dupuytren's disease? A Great Read!
From: American Society for Surgery of the Hand www.handcare.org
Dupuytren’s disease is an abnormal thickening of the tissue just beneath the skin known as fascia. This thickening occurs in the palm and can extend into the fingers. Firm cords and lumps may develop that can cause the fingers to bend into the palm in which case it is described as Dupuytren’s contracture.
Although the skin may become involved in the process, the deeper structures—such as the tendons—are not directly involved. Occasionally, the disease will cause thickening on top of the finger knuckles (knuckle pads), or nodules or cords within the soles of the feet (plantar fibromatosis).
What causes Dupuytren’s disease?
The cause of Dupuytren’s disease is unknown but may be associated with certain biochemical factors within the involved fascia. The problem is more common in men over age 40 and in people of northern European descent. There is no proven evidence that hand injuries or specific occupational exposures lead to a higher risk of developing Dupuytren’s disease.
What are the symptoms and signs of Dupuytren’s disease?
Symptoms of Dupuytren’s disease usually include lumps and pits within the palm. The lumps are generally firm and adherent to the skin. Thick cords may develop, extending from the palm into one or more fingers, with the ring and little fingers most commonly affected. These cords may be mistaken for tendons, but they actually lie between the skin and the tendons. These cords cause bending or contractures of the fingers. In many cases, both hands are affected, although the degree of involvement may vary. The initial nodules may produce discomfort that usually resolves, but Dupuytren’s disease is not typically painful. The disease may first be noticed because of difficulty placing the hand flat on an even surface, such as a tabletop (see Figure 3). As the fingers are drawn into the palm, one may notice increasing difficulty with activities such as washing, wearing gloves, shaking hands, and putting hands into pockets. Progression is unpredictable. Some individuals will have only small lumps or cords while others will develop severely bent fingers. More severe disease often occurs with an earlier age of onset.
What are the treatment options for Dupuytren’s disease?
In mild cases, especially if hand function is not affected, only observation is needed. For more severe cases, various treatment options are available in order to straighten the finger(s). These options may include collagenase injection, needle aponeurotomy or open surgery. Collagenase injection is a technique where a small amount of medicine is injected into the Dupuytren’s tissue, weakening it so that the finger can be manipulated manually to make it straighter. Needle aponeurotomy is a method where a needle is placed through the skin and used to cut the Dupuytren’s tissue. Both collagenase injection and needle aponeurotomy are office procedures. Your hand surgeon can describe these options in more detail, including potential risks and benefits, to help you decide what treatment method is best for you.
And- a note from Dynasplint Sytems
No matter the treatment, when joint contracture is an issue, one fact cannot me contested- stretching is always good. Dynamic splinting in conjunction with injections is a great complement to restore finger extension. In tomorrow's post- Dupuytrens Contracture Reduced with Hand Therapy plus Dynasplint by Greg Vigoren, DMD and Buck Willis, PhD
Dupuytren's Disease and Dynasplint
If you treat Dupuytren's contractures, perhaps the Dynasplint Finger Extension unit is something which you would like to know more about.
Whether you are looking for an extension splint when the patient is first diagnosed or after an injection such as Xiaflex®, Dynsplint can offer a low-load force to keep the patient comfortably stretched out and positioned correctly to prevent the contracture from reoccuring.
We want to help get your patients' hands functioning correctly and also help get back and keep their ROM!
Contact your local Dynasplint representative to learn more!
New Knee! Total Knee Replacement
Ta dah! You have struggled with a stiff and painful knee for years and slowly have been “benched” during your activities that you used to do. You finally undergo Total Knee Replacement, (TKR), or Total Knee Arthroplasty (TKA). Arthroplasty simply means surgical repair of a joint. In this case you have a new knee. Have you ever wondered what that surgery looks like? Have a peek at this interactive animation.
Following TKR surgery, the rehabilitation goal is to regain range of motion in knee extension (straightening) and knee flexion (bending.) Sometimes range of motion is more stubborn in one direction than another. If you lack full extension, you will be standing on one slightly bent knee and that is exhausting, and not safe in regards to balance. Other times, the “bend” is not complete, and that is precisely what happened to Marlin. Have you ever tried to put on socks, climb the stairs or get up from a couch without the ability to bend your knee? Try it and you will understand why full knee flexion is so important for activities of daily living!
Your Knee Injury Worst Nightmare
“I tore my ACL, PCL, MCL, my meniscus and my Patellar tendon. So pretty much all of them. I was heartbroken.” World Champion WakeBoarder Dallas Friday
One moment Dallas Friday was leaving the dock to do her final 3 passes to claim Queen of Wake, and then next she was down with a season and potentially career ending knee injury.
Giving up was never in her vocabulary. Watch and be inspired by what is possible with hard work on the long road back to victory.
The Knee + The Sum of Its Parts
The knee joint is comprised of four bones: the femur, or thigh bone, the tibia and fibula, or the shin bones, and the patella, or kneecap. In the joint capsule there is soft tissue: ligaments that connect bone to bone, tendons that connect muscle to bone, and meniscus which distributes one’s body weight across the knee.
It may be that you have only heard of the initials of some of these connective tissues- ACL, PCL, MCL and LCL. These describe the specific ligaments that are named by their position. Each plays a part in stability of the knee. The Anterior Cruciate Ligament is in the front of the knee, and restricts forward movement and limits rotation. The Posterior Cruciate Ligament is in the back of the knee and restricts backward movement and also restricts rotation. The Medial Collateral Ligament is on the inside of the knee and restricts the widening of the knee. The Lateral Collateral Ligament is on the outside of the knee and prevents outer surfaces of the knee from opening or gapping.
Tommorrow- knee ligament injuries in sports.
Tibial Plateau Fracture & the ROM Challenge
Thanks to today’s guest blogger, Neal Church, PT
As a physical therapist, I love a challenge. One of my most formidable challenges is patients with tibial plateau fractures. Tibial plateau fractures are one of the most frustrating injuries for patients because it is such a long-drawn-out process. These fractures occur at the top of the tibia, or shin bone, which is a primary weight-bearing surface. Tibial plateau fractures are treated differently than fractures of the tibial shaft. When treating tibial plateau fractures, cartilage covers the top of the tibial plateau, which must be protected after these injuries in order to prevent arthritis. If the fracture is displaced, or isn’t lined up perfectly, the patient usually will need an open reduction internal fixation (ORIF). This means the surgeon will open the knee and use hardware, i.e., screw and plates, to hold the fractured bone in place. Whether displaced or non-displaced, the patient is usually non-weight bearing for an extended period of time, which lasts as long as three months. Additionally, if the meniscus is involved, the physician may immobilize the patient for an extended period of time as well. All of this adds up to a very stiff knee!
Regaining range of motion (ROM) is at the top of the list in rehab and does not come easily. Performing patellar joint mobilizations as soon as possible and establishing a solid home exercise program is vital. Gait training is always a part of the patient’s plan of care which progresses the patient from using a walker, to a cane, to independently ambulating without an assisted device. The gait training emphasizes heal strike, which is why straightening the knee is so crucial. Flexion, or bending the knee, can also be quite challenging and can make it difficult for the patient to go down steps, stand up from a sitting position, tie shoes and dress. Physical therapy visits are sometimes limited and there is much to be done while the patient is in the clinic. Utilizing time outside the clinic to regain ROM is crucial. A great modality that can be used at home is a Dynasplint. Dynasplint Knee Systems stretch the patient into extension or flexion and are available for every size patient. Remember, you can always wait to start strengthening, but you can’t wait to regain ROM. The longer you wait to regain ROM , the harder it will be.
Hopping is for Bunnies
“The only thing worse than a painful knee is a stiff, painful knee.”
Dr. Ronald Rook, Orthopedic Surgeon.
Motion is function, and knees that don’t fully bend and straighten are more than a nuisance. Did you know that lacking even those last 5 to 10 degrees of range of motion in knee extension leaves one standing with the quadriceps in a constant state of contracture to keep from falling forward? That’s not only exhausting, it’s dangerous. Compromised balance is a leading cause of falls, and falls- especially in the older population, can even lead to life-threatening complications. What about lacking flexion or a “good bend?” That can make day to day activities miserable from putting socks and shoes on first thing in the morning, to climbing stairs or getting out of the car or up from the couch. You never know how much a deficit in range of motion of the knee impacts life until one loses it, and you are walking with a limp or gait pattern that is just off.
Who loses knee range of motion? Just senior saints with Arthritis? The athlete who has a season-ending knee injury wants to get back on the field, and the baby boomer with the total knee placement is ready to move without pain. Many other diagnoses such as bucket handle meniscus tears, repair and reconstruction of the ACL, PCL, MCL and recovery from a tibial plateau fracture are most likely going to result in rehabilitation for range of motion.
Dallas Friday- A Dynasplint Knee Story
File this one under, “So you think you had a bad day?” World champion wakeboarder Dallas Friday shares the story of coming back from a season-ending injury. Just moments away from the top of the victory, stand Dallas crashes on her final pass. She destroys her knee, tearing the ACL, PCL, MCL, Meniscus and Patellar tendon. Dr. Clancy performs surgery and Dynasplint helps to protect and rehab her knee. Watch this video if you think she just gave up…http://www.youtube.com/watch?v=8ZTTFb6PWcI
When Stroke Happens- Challenges and Treatment
Many thanks to today’s guest blogger, Jonathan Schopp LOTR, MBA
A stroke, also known as a Cerebrovascular Accident (CVA) is a quick loss of brain functions due to a disruption in the blood supply to the brain. This disruption of blood flow can be due to a hemorrhage (leakage of blood) or ischemia (lack of blood flow due to a blockage). Every year 800,000 people are affected by a Stroke and this diagnosis continues to be the leading cause of serious long term disability in the United States.
Some of the most common disabilities that result from a stroke are speech and memory loss, cognitive deficits and paralysis on one side of the body. Many times this paralysis results in hypertonicity (or high levels of stiffness and high muscle tone) on the affected side. There have been many advancements in treatment for high muscle tone over the past year in the form of Baclofen (either taken orally or through an implanted pump) or by the use of Botox (a medication that is injected directly into the muscles that are affected by high tone). These treatments are very helpful when combined with Occupational and Physical Therapy but many times therapy is not enough. Most patients are now limited with the amount of therapy visits they can attend each year so it is now more important than ever to have a home treatment program that can provide intervention over the long haul.
Two of the main methods of treatment that are used by Occupational and Physical Therapists are tone management activities and gentle manual stretching to the affected arm or leg. These extremities typically responds well to long-term stretching under low amounts of force but the difficulty lies in the fact that most therapists only have 1 hour of treatment with their patient during a scheduled visit. In many cases this simply isn’t enough stretching to manage the stiffness in the affected extremity.
One of the most common challenges that a patient is faced with is stiffness and high muscle tone in their forearm and hand. Many patients experience fisting in their affected hand which results in the inability to use their hand for activities of daily living. When this happens, many times patient’s think the problem just lies in their hand but in order to treat the affected hand you also have to treat the muscles in the forearm. This can successfully be accomplished by using a dynamic splint.
Dynasplint Systems Inc. manufactures a variety of splints for every extremity that are designed to assist patients and their therapist with managing extremities that are affected by high tone and stiffness. These spring-loaded splints are worn at rest for a period of 2-8 hours a day and mimic a therapist’s stretch so that patient can continue to receive benefit even while in the privacy of their own home. One of the most commonly used splints for this is the Wrist Extension Dynasplint with a Neurological hand attachment. This splint simultaneously provides a therapeutic stretch to both the forearm and hand to help manage and correct the stiffness.
Although there are a number of different treatments for patients suffering from a Stroke, most clinicians would agree that a treatment plan consisting of tone inhibiting medication, Occupational/Physical therapy and dynamic splinting is a winning combination.
What Exactly Is A Distal Radius or Colles's Fracture?
This great read comes to us from one of my favorite sites, Web MD. I must admit that I am guilty of “google-doctoring” myself (to my children’s’ great dismay,) and Web MD is one of my favorite haunts. They do such a great job of unpacking medical jargon, allowing us to really understand the condition that we researching. So, today we take the mystery out of a broken wrist and define distal radius fracture, or Colles’ Fracture.
Colles’ Fracture (Distal Radius Fracture or Broken Wrist)
Article share from Web MD, http://www.webmd.com/a-to-z-guides/colles-fracture
A Colles’ fracture — or distal radius fracture — is often called a ”broken wrist.” Technically, it’s a break in the larger of the two bones in your forearm. The bone breaks on the lower end, close to where it connects to the bones of the hand on the thumb side of the wrist. Colles’ fractures are very common; they’re the most frequently broken bone in the arm. In the United States, one out of every 10 broken bones is a broken wrist.
So how does someone get a broken wrist? Usually, these injuries result from falling onto an outstretched arm or getting hit on the wrist.
Broken wrists are common in people who play contact sports, as well as skiers, inline skaters, and bikers. People with osteoporosis or thinning of the bones are at particularly high-risk for wrist fractures. But they can happen to anyone who takes a fall or gets hit.
In more serious cases, the following may occur:
• The break extends into the wrist joint.
• A piece of broken bone breaks through the skin.
• The bone is broken in multiple places.
• Ligaments may be torn.
These types of broken wrists may be harder to treat.
What Does a Broken Wrist Feel Like?
Symptoms of a broken wrist can include:
• Pain, especially when flexing the wrist
• Deformity of the wrist, causing it to look crooked and bent.
To diagnose a broken wrist, your doctor will give you a thorough physical exam. You may need several sets of X-rays, since the fracture may be hard to see at first. Occasionally, a broken wrist can affect the nerves or blood flow.
You should go to the emergency room if:
• Your wrist is in great pain.
• Your wrist, arm, or hand is numb.
• Your fingers are pale.
What’s the Treatment for a Broken Wrist?
If the broken wrist is not in the correct position to heal, your doctor may need to reset it. This can be pretty painful so it’s usually done with anesthesia. However, painkillers will help afterward.
You will probably also need:
• A splint, which you might use for a few days to a week while the swelling goes down. If a splint is used initially, a cast is usually put on about a week later.
• A cast, which you might need for six to eight weeks or longer, depending on how bad the break is. (You might need a second cast if the first one gets too loose after the swelling goes away.)
• Regular X-rays to make sure your wrist is healing normally.
You will probably also want to:
• Elevate your wrist on a pillow or the back of a chair above the level of your heart for the first few days. This will ease pain and swelling.
• Ice the wrist. Do it every 20-30 minutes every three to four hours for two to three days. Be careful to keep the splint or cast dry while icing.
• Take over-the-counter painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling. However, these drugs have side effects, such as an increased risk of bleeding and ulcers. They should be used only occasionally unless your doctor specifically says otherwise, as this may delay healing.
• Practice stretching and strengthening exercises of the fingers, elbow, and shoulder if your doctor recommends them.
Most the time, these treatments will be enough. But sometimes, people with a broken wrist need surgery. Your doctor might suggest this if the bone is not likely to heal well in a cast. Sometimes, pins, plates, screws, or other devices are needed to hold the bone in place so it can mend.
When Will My Broken Wrist Feel Better?
Of course, what you really want to know is when you can get back in the game after breaking your wrist. There’s no easy answer.
Here are some things to keep in mind during recovery from a broken wrist:
• It might take eight weeks or longer for your wrist to heal. More severe breaks may not fully mend for six months. You and your doctor will decide when you are fully recovered.
• Don’t rush back into your activity too soon. If you start working out before your wrist is healed, you could cause more serious damage.
• You may still have discomfort and stiffness in your wrist for months, or even years, after the injury.
• Follow your doctor’s instructions for taking care of your cast. Remember that casts cannot get wet.
• See your doctor if the pain or swelling keeps getting worse after you get a cast or if you experience numbness in your fingers.
How Can I Prevent a Broken Wrist?
A broken wrist is tough to prevent, since it usually happens during an accidental fall. But it can help to use wrist guards during risky sports, like inline skating. Sometimes, a broken wrist can indicate osteoporosis, especially in women. Talk to your doctor about your risk factors for osteoporosis and fractures. There are steps you can take to improve your bone health.
We GET To Do This Work - real stories, real life....
This comes to us from a Dynasplint Neurological Sales Consultant, Nic Proenza. Dynasplint Consultants spend their day marketing to healthcare providers and fitting and following up on patients who are wearing Dynasplint Systems. Dynasplint lives by its purpose statement: “We seek to help restore people, business and life the way it ought to be.” Neurological patients often have sustained a life altering event and have to redefine a “new normal,” which is not the way they imagined it ought to be.
From Nic Proenza:
Obviously our main goal is to help improve patients’ lives and to make life easier for the families involved, so I wanted to send you a quick success story of a patient of mine. R is a patient I received in an assisted living facility, who has contractures in his right wrist and hand. We first got him situated with a Wrist Extension Dynasplint and since have upgraded to a MCP Extension and 2 PIP (finger) extensions. He now can have his fingers passively opened up all the way, which is a huge improvement from where he started from.
The most powerful part of this story comes from what he told me after my last follow up with him last week. I was there to make some adjustments needed and right before I left he stopped me and said he wanted to tell me something. He said, “I can’t thank you enough for helping me and showing a genuine concern for my health. About 4 months ago I was on the verge of taking my own life, but with the help of you and J (his OT), I have never been happier since my injury.” I almost fell over when he told me that and I told him to never give up and to keep doing what he is doing because he has been making huge strides!
I always knew what we did makes a difference in patients’ lives, but to hear that made a big impression on me and makes me proud to be a part of Dynasplint.
I wanted to pass this along because it really puts things in prospective.
Stroke victory- from hardly working to working out!
Many thanks to our guest blogger, Dr Nicholas C. Ketchum
Assistant Professor, Department of Physical Medicine and Rehabilitation Medical College of Wisconsin Milwaukee, WI
When I first met GB, it had been 3 months from his stroke. “My leg has gotten better, but it’s this darn hand that keeps giving me trouble.” The biggest focus during BGs stroke recovery had been getting him walking again. The biggest impairment now was his wrist and hand. It wasn’t necessarily the weakness. “I can open it early in the morning,” he said, “but at the end of the day, it seems to get stuck.” His strength had improved, but his function was still limited. He was now noticing the effects of increased tone, or problematic spasticity. Spasticity is defined by Lance as “a velocity-dependent increase in muscle tone…as one component of the upper motor neuron syndrome.” Clinically, spasticity can manifest as muscle tightness, difficulty with hand opening, trouble with lifting up the wrist, difficulty with overall use of the hand, just to name a few examples. Spasticity in and of itself is not necessarily a problem, but when it begins to interfere with a patient’s active or passive function, it may then need treatment. Initial treatment was with botulinum toxin injections into his wrist and finger flexors. The injections help to decrease the muscle over activity, and combining these with therapy, stretching and strengthening can help improve his excessive wrist and finger flexion. He was doing occupational therapy once per week, and was doing his stretches and exercises at home every day, but this was only for an hour each day, at most. These helped somewhat, but he still had trouble at the end of the day. What to do next? What he needed was something he could do for a longer amount of time. A Wrist Extension Dynasplint was exactly what he needed. Combining the botulinum toxin injections with the Dynasplint to provide a prolonged, low-torque stretch was what ultimately helped improve GB’s hand and wrist range of motion and, ultimately, his function. Most recently, GB had asked to have his Dynasplint adjusted to provide even a greater degree of stretch. “For what?” I asked.
Wow. A few months ago, GB was having difficulty extending his wrist and opening his hand. Now, with the right combination of treatments, he is working out on a daily basis.
Once upon a time, Denise stood on a chair and fell....
. . and the damage to her shattered wrist was epic. In her own words:
Click HERE for video.
Sweet 16 and a Fractured Wrist
What can happen when you take a hard fall on your outstretched palm, UNC point guard, Kendall Marshall? Meet your scaphoid- one of the small bones in the wrist. Of all of the bones in the wrist, it is the one that is most likely to break, especially when you are knocked to the basketball court floor. Not to be ignored, Marshall took the free throw from the foul, made it, and played 7 more minutes, before taking a seat.
Located on the thumb side of the wrist, the scaphoid is found in the area where the wrist bends, and can be felt when you extend your thumb as if hitchhiking. To repair the fracture, Marshall had surgery on Monday to have a pin inserted, was in a cast until Wednesday when physicians removed it and put him in a removable splint. He is questionable to return for Friday night’s NCAA round of 16. Is this typical treatment and return to sports? Probably not, but it’s NCAA basketball and when you play for the #1 seed in the tournament, things move quickly. Go TarHeels!
Dynamic Splint for Pediatric Contracture Reduction of the Upper Limb
The patient in this case report was a five year old boy who was a victim of “shaken baby syndrome.” As a result, he suffered from right spastic hemiplegia, was non-ambulatory and displayed severe wrist and elbow flexion contracture. The patient was completely dependent for all activities.
Treatment history spanned over three years and included multiple out-patient modalities. These treatments included soft and thermoplastic splinting, Botox and phenol injections and a home exercise regimen. When none of these treatments provided satisfactory results, a Dynasplint representative was added to the therapy team. The patient was fitted with an elbow and a wrist Dynasplint. Both of the Dynasplint Systems were used to provide a low-load, prolonged-duration stretch in conjunction with a home exercise program and regular occupational therapy.
Within six months, the patient’s passive wrist extension progressed 90° and ulnar deviation improved by 15°. After five months of using the Elbow Extension Dynasplint® System, the patient gained 60° in elbow extension and also improved his elbow resting position by 45°. Dynamic splinting contributed over 900 hours of end-range, home therapy for wrist extension and 700 hours in end-range home therapy for elbow extension. It is hypothesized that this prolonged duration of passive stretching at the end-range is responsible for the substantial gains in ROM.
A "New Normal" following TBI
One moment you are on the sidelines watching your son compete in the sport he loves, and then next you are bed-side in the ICU watching him cling to life. Such was the drama with McKinley Milligan and his parents when one dirt bike crash completely changed their world. Micky sustained a traumatic brain injury which resulted in severe tone and wrist contractures. His wrist and hand were so tightly clenched that his fingernails dug into his palm. They needed some hope.
Dynamic Splinting in Wrist Extension Following Distal Radius Fractures
study authors: Stacey H Berner and F Buck Willis
Journal of Orthopaedic Surgery and Research 2010, 5:53 doi:10.1186/1749-799X-5-53
Published: 6 August 2010
Wrist flexion contracture is a common pathology which presents secondary to distal radius fractures. Joint stability, restoration and early mobilization are frequently achieved through surgical treatment after such an injury. The purpose of this retrospective study was to evaluate the initial effect of dynamic splinting on wrist extension (active range of motion), in both surgical and non-surgical patients following distal radius fractures.
Records were obtained from 133 patients who were treated with a Wrist Extension Dynasplint (WED) following distal radius fractures, between May 2007 and May 2009. Forty-two of these patients received surgical treatment for their fractures. This study specifically examined the initial usage of the WED as a home therapy. The retrospective analysis included categorization of patients who received the WED exclusively vs. patients who received WED treatment with concurrent hand therapy; surgical categorization included surgical patients vs. nonsurgical patients.
There was a significant improvement in maximal active range of motion (AROM) for all patients (P < 0.0001) after a mean duration of 3.9 weeks of dynamic splinting. Patients showed a mean 62% increase in active extension. There was not a significant difference between patients who had received surgical treatment for the fracture vs. nonsurgical.
This dynamic splinting modality contributed 138 to 185 hours of stretching at the end range of motion for these patients in their first month following fracture. This unique regime is considered directly responsible for significant gains in AROM.
March Right On In - It's Wrist Month!
Poll question: Have you ever fractured your wrist? Colles’ fracture sound familiar? How about Smith’s or Barton’s fracture? Does distal radius ring a bell? If you have had a severe enough displaced break, you may even know the term ORIF, or open reduction internal fixation. Fracture always requires immobilization, and often times when the cast comes off, you are off to physical therapy to regain range of motion in your wrist.
Why is Dynamic Splinting a fit for Neurological Patients
Jonathan L. Schopp graduated in 1998 with a Bachelor of Science in Occupational Therapy from Louisiana State University Medical Center in New Orleans, Louisiana. While attending Louisiana State University he completed numerous internships including a Traumatic Brain Injury Internship at Touro Infirmary in New Orleans. After graduation he joined the staff of Charity Hospital in New Orleans where he focused on adult and adolescent neurological rehabilitation. While working at this level one trauma center for 6 years he also attended the University of New Orleans and received a Masters in Business Administration in Finance. After completing his graduate studies at UNO he joined Dynasplint Systems as the company's first Neurological Consultant. He worked as a consultant in the New Orleans area for 3 years and, because of increased demand, he helped start the Neurological Division of Dynasplint Systems in January 2006. Currently he resides in Lafayette, Louisiana and he holds the position of National Neurological Sales Manager for Dynasplint.
To hear Jonathan's interview click here.
DSI Neuro Milestone
The Neurological Division began in January, 2006 with 15 people to specialize in the growing demand in the brain injury and disease population. Today, led by National Sales Manager, Jonathan Schopp, LOTR, MBA and Managing Director, Gail Smith, the division numbers 115 consultants and support staff and serves most of the United States. Mr. Schopp stated, “I would like to take this moment to thank the hundreds of colleagues at Dynasplint Systems who are dedicated to helping the Neurological Division restore people, business and life the way it ought to be. Without everyone’s support and expertise our mission and patient outcomes would not be possible.”
George R. Hepburn, PT, founder and president of Dynasplint Systems, Inc., said, “ The Neurological Division’s achievement of helping patients with 100,000 units is a good example of what we at Dynasplint strive for everyday- to help those suffering from joint stiffness and contracture by restoring their range of motion back to what it ought to be. Our Orthopedic, Carpal Tunnel, Jaw, Veterinary and Ankle and Foot divisions all combine to reach countless numbers of people suffering from debilitating conditions which rob them of living life to their fullest potential. We hope to reach all those in need and are determined to help them. “
Since its founding in 1981, Dynasplint Systems has served over a half-million patients and has become a trusted home treatment for range of motion rehabilitation for Orthopedic Surgeons, Neurologists, Physiatrists, and Physical and Occupational Therapists. Dynasplint offers more than 80 rehabilitation devices and provides a therapeutic solution for most ROM issues.
Dynasplint Systems corporate and manufacturing headquarters are in Maryland, and local sales consultants and fitting specialists are strategically located throughout the U.S., Canada and Western Europe.
Dynasplint Systems Celebrates 30th Anniversary
(Severna Park, MD) – Dynasplint Systems, Inc. (DSI), the industry pioneer and leader in Range of Motion therapy equipment, celebrates its 30th anniversary on May 19, 2011 with a year‐long campaign, “30 Great Years‐30 Great Deeds.” The 750 colleagues of Dynasplint have been divided into 30 teams, each of which has been challenged to do one great deed this year. The only parameter is that the activity line up with the company’s purpose of “restoring people, business and life the way it ought to be.” All community outreach will be chronicled on www.dynasplint.com and blog, Dynasplint Cares www.dynasplint.org
George R. Hepburn, PT, founder and president of Dynasplint Systems, Inc., said, “We at Dynasplint care not only just about our clients, but also about our colleagues and the surrounding communities in which we work. Restoring people, business and life the way it ought to be encompasses many aspects of how we go about doing our work. For our clients using the Dynasplint System, we want it to result in the best possible clinical outcome. For our colleagues, we desire people to be inspired, healthy and prosperous. For the surrounding communities, we aspire to leave a good footprint wherever we are to help make the community a better place. I invite you to look at the chronicle of activities over the next year that will help to achieve these objectives. “
Since its founding in 1981, Dynasplint Systems has served over a half‐million patients and has become a trusted home treatment for range of motion rehabilitation for Orthopedic surgeons, Neurologists, and Physical and Occupational Therapists. Dynasplint offers more than 80 rehabilitation devices and provides a therapeutic solution for most ROM issues.
Dynasplint Systems corporate and manufacturing headquarters are in Maryland, and local sales consultants and fitting specialists are strategically located throughout the U.S., Canada and Western Europe.
For more information about Dynasplint Systems, Inc., contact (443) 261‐1701, or email@example.com, or www.Dynasplint.com
Dynasplint offers a range of motion solution during external fixation.
Did you know that Dynasplint Systems are available that attach to the external fixation frames that you may be using for trauma healing or limb lengthening? Available in Adult and Pediatric sizes, Tibial, Femoral and Humeral splints are available for Knee, Ankle, and Elbow for extension and flexion. Stop joint contractures before they start and avoid interruption of limb lengthening due to loss of range of motion in the joints proximal and distal to the bone you are treating with Dynasplint External Fixation Systems.
Race Across America
(Severna Park, MD)- Dynasplint Systems, Inc. is proud to announce their sponsorship of Team4Mil in the 2010 Race Across America. “To support the Wounded Warrior Project by sponsoring this special team in this year’s RAAM is an honor,” said George Hepburn, PT, the founder, president and CEO of the company. “Dynasplint has been serving service members in and through VA hospitals for many of its 28 years in business, so this sponsorship is a natural extension of our purpose to help restore people, business and life the way it ought to be.”
Dynasplint designs, manufactures and sells dynamic splinting rehabilitative devices that help restore patients’ range of motion in the peripheral body joints. With more than 740 colleagues, Dynasplint corporate offices are located in Severna Park, MD with a production facility in Stevensville, MD, and a national sales force with a presence in Canada and Europe.
Dynasplint Supports Service Members This Spring
First, DSI is a team sponsor for Team4Mil in the 2010 Race Across America. “To support the Wounded Warrior Project by sponsoring this special team in this year’s RAAM is an honor,” said George Hepburn, PT, the founder, president and CEO of the company. Next, on May 24th, DSI is a Tee Sponsor for the Wounded Warrior Project’s Golf Tournament at Chartwell CC in Severna Park. Finally, on June 15, a team of DSI Corporate colleagues is preparing and serving dinner for recovering soldiers at Walter Reed Army Center in Washington, DC. “Dynasplint has been serving service members in and through VA hospitals for many of its 28 years in business, so our outreach to our veterans is a natural extension of our purpose to help restore people, business and life the way it ought to be.”
The House That Love Built
When families have traveled many miles to receive specialized medical care, looking for temporary accommodations in an unfamiliar place only adds to their stress and anxiety. The Ronald McDonald House of New Orleans not only offers them a place to stay, but a built-in support system where families help each other. Together, they face and overcome some of the most trying times in their lives.
These children and their families have come from 63 out of 64 parishes in Louisiana, many states across the country and all over the world.
When our Neurological Managers came together for their meeting in January, they were surprised with a group building exercise that would be fun and help families of children experiencing serious illness at Ronald McDonald House. They were given ingredients, aprons, no recipes and set loose in the kitchen to prepare dinner. Have a look at how beautifully they did.
Donation Matching Campaign for Haiti
Severna Park, MD, January 14, 2010
Images of the devastation in Haiti from the earthquake have touched all of our hearts and we are anxious to help. We have chosen to donate to "Doctors Without Borders" with their relief efforts. Doctors Without Borders, (http://doctorswithoutborders.org/) primary concern at the moment is the overwhelming numbers of people who need immediate treatment and major surgery. A team is beginning to work in the operating theater of a major public hospital in the capital's Cite Soleil district, while other staff are trying to identify additional medical structures that remain intact.
An inflatable MSF field hospital, equipped with two operating theatres, is expected to arrive by air in the next 24 hours. Crucial personnel, including surgeons and anesthetists, and supplementary stocks of medical supplies are on the way as well. George has committed to Dynasplint matching the first $10,000 raised by our colleagues and families. Please make your contribution check out to Doctors Without Borders, and in the memo write Haiti Earthquake Response and send to Corp, att: Suzi Pitts. We will tally all of the donations and Dynasplint will match. Let's try to raise all of the $10,000 and be able to send $20,000 to the relief efforts.
Update: Company match ended on Friday, January 29th. You can continue to donate online here or follow the instructions above to donate via check.
Anne Arundel picks four developments for $32M in stimulus bonds
Severna Park, MD, December 8, 2009
The project was one of four tapped by Anne Arundel County Executive John R. Leopold to receive a combined $32 million in federal stimulus funds, Leopold announced in a statement.
Merritt Properties, AJ Properties, and Fortis Development were also selected to receive financing under the Stimulus Recovery Zone Facility Bonds program.
“In order for the federal stimulus dollars to have a real economic impact by creating new jobs, the funding must be targeted to the right projects,” Leopold said. “These four projects will generate economic activity around them because of their diverse offerings of jobs in construction, retail, technology and health care.”
The county received a dozen proposals seeking $153 million in tax-exempt Recovery Zone bonds. The county estimated its awards will generate more than 1,700 new jobs.
In addition to Dynasplint:
• Merritt Properties was awarded $5 million for its Buckingham development in Hanover. The $68 million project, expected to create 325 jobs, includes two four-story office buildings, four retail and restaurant buildings, an athletic club and 106 townhouses;
• Fortis Odenton LLC was awarded $7.4 million for Meade Center, a 65,000-square-foot, $14 million development in Odenton. The project, slated to create 220 jobs, includes 25,000 square feet of office space, 17,000 square feet of retail, and 18,000 square feet for corporate apartments;
• And AJ Properties was awarded $8.8 million in Recovery Zone bonds for its $12.7 million Odenton Health/Tech Campus. The project, projected to create 370 new jobs, includes the construction of two new buildings; a 32,000-square-foot structure and a second 25,000-square-foot building.
Dynasplint® to Host Runners Club of America Event
Severna Park, MD, September 03, 2009
Dynasplint® is going to get in the action with the Runners Club of America by hosting a 5k run/ 1 mile walk on September 18th, 2009. This will encourage people to incorporate exercise walking, jogging or running into their daily lives. Dynasplint® strives to lead by example and combat the national inactivity and obesity crisis that is gripping the nation.
Incorporating exercise into one's daily routine can remarkably improve one's overall physical health. The US Centers for Disease Control and prevention (CDC) National Health and Nutrition Examination Survey estimates that 64% of US adults are either overweight (33%) or obese (31%). Cardiovascular exercise elevates one's heart rate and gets the endorphins kicking. The body produces endorphins as natural fighters to ward off pain and stress. Exercise is proven to make us feel better, increase energy, live longer, prevent chronic health conditions and enhance sleep. Regardless of ability, everyone can reap the benefits!
If you live in the Severna Park area and want to join the fun, Dynasplint® colleagues plan to meet on the corner of Evergreen and B&A Blvd. at 8am and 5pm on Friday, September 18th.
Dynasplint colleagues restore oysters to the Chesapeake Bay
Severna Park, MD, August 17, 2009
Twenty four Dynasplint® Colleagues set out on Monday, August 17th to join hands with the Chesapeake Bay Foundation in preparing oysters for the larvae-setting process.
Following a quick introduction to the LEEDS Certified CBF building, colleagues boarded the work boat for the 40 minute trip to the Restoration Center. Upon arrival, a staffer explained that a single oyster filters 50 gallons of water a day and is crucial in cleaning up not only the Chesapeake Bay, but the rivers and creeks that flow into it. . Without hesitation, colleagues pulled on gloves, grabbed shovels and began the hard work of scooping up oysters mixed with other particulate and shaking them to screen out excess matter. The shells are used to house the larvae, or spat, allowing it to attach securely and grow into mature, water- filtering oyster.
In the end, over 14 tons of shells were prepared that will create approximately 1.5 million baby oysters used on a restoration reef in the local area. Tired, and beyond sweaty from the shimmering heat, colleagues left with a sense of community and accomplishment for giving back and helping to restore water of the Chesapeake and its tributaries the way it ought to be! Way to go DSI colleagues.
Dynasplint Systems, Inc. Gets Behind Home Plate at Camden Yards
Severna Park, MD, May 11, 2009
This year at Camden Yards, Dynasplint® Systems is taking advantage of an offer they just cannot refuse. Throughout the entire baseball season, Dynasplint will have an advertisement behind homeplate in Camden Yards for a half inning each game. As an add-on to our ballpark exposure, George Hepburn, PT and CEO, will also have a one hour presentation with the Orioles trainer to discuss how Dynasplint® Systems may be appropriate for some of their players. In addition, DSI is the first company EVER to have literature on our dynamic splints in the opposing teams locker room. So tune in to a game this season to see Dynasplint® on the big screen. Go O's!!
New research: Case Report of KFD used to treat a Dancer with Iliotibial Band Syndrome
Severna Park, MD, March 19, 2009
Biomechanics has published a new case study demonstrating how prolonged stretching can improve range of motion in dancers suffering from knee injuries related to iliotibial overuse. Iliotibial overuse is also common in other athletes and many runners. The Knee Flexion Dynasplint® System provides a low-load prolonged-duration stretch to allow the connective tissue to effectively lengthen and reduce a contracture. For more details and to read the case study yourself, view the PDF.
Dynasplint® To Upgrade Sales Consultant Capabilities
Severna Park, MD, October 17th, 2008
Over the past year Dynasplint® has been developing a solution to help its Sales Consultants become more connected with the information they need to be successful. This new communication system allows a mobile staff of over 300 to easily connect with the home office through an integrated system that brings messaging and communication environments together into one system.
The new system combines the benefits of Microsoft Office Communications Server 2007 with the telephony features of the Avaya Definity G3 PBX phone system and will provide DSI field consultants additional tools for helping doctors, physical therapists, occupational therapists, and patients receive as high a level of service as possible.
For more information on the technical details of this improvement, visit Microsoft's Case Study of the upgrade.
Southeast Texas Hurricane Update
Severna Park, MD, September 18th, 2008
Like many in Southeast Texas, the Dynasplint Sales Consultants of the region were greatly affected by this devastating storm. Some were lucky enough to only be without basic services, others have suffered more devastating losses. The good news is that all are safe and secure, and we are pulling together as a company and as a community to help restore people and life the way it ought to be. We remain committed to assisting our existing clients as quickly as possible, and seeing that they get the very best service and support. Communications are difficult at this time due to the various problems in the area. Any of our clients needing assistance that cannot reach their Consultant directly, are asked to call our main number (800) 638-6771 and they will be directed to the voice mail of the regional manager. Calls will likely be returned within 24 hours. Please lend us your support and patience as we recover and get back to work. Our prayers and thoughts are with you and your families at this trying time.