Posts Tagged ‘Houston’

ADA and More: Limitations of ADA Law With Respect to the Home Environment

Wednesday, October 19th, 2011

By Adam Horton,
Home Access Division Manager
Active American Mobility

The American’s with Disabilities Act (ADA) was passed July 26, 1991. It was created to prevent discrimination against individuals or groups that have disabilities, either mental or physical. While the ADA was passed to prevent discrimination against individuals in the workplace, public settings, buildings, restaurants, etc., it did not cover anything in the home environment. There are, however, guidelines that are put in place that in the event that a home is being built to ADA guidelines. The problem with this is that it is a mere guideline and not a requirement that can be enforced by code specifically for ADA.

The ADA guideline for a finished door opening is 32”. Most doors in a home are 24”-30”. Exterior doors do have to be wider with one exterior door a minimum of 36”. Other doors in the home are sometimes wide enough, but this is typically the master bedroom and master bathroom doors. A typical hallway is 36” wide, but should be 48” wide to meet ADA requirements. Also, most homes come with a concrete entry walk that joins to a porch with a step up to the porch and also a step into the home. ADA requirements call for a minimum of one no-step entrance into a home for ease of access for mobility equipment. Light switches and thermostats should be a minimum of 48”-54” from the floor and 40” if they are over a counter top. The list of changes goes on and on. The problem with all of this is none of it is required in a typical home setting. It is recommended but not required.

Most home builders will make the changes to a home to meet ADA standards, but it all comes at a cost. Builders will charge a fee most of the time they deviate from the original plan. However, these changes don’t cost much money at all, and if managed properly will only make the home more accessible and accommodating living area.

On a positive note, one organization is making a mark in becoming the “ADA” of the home environment. Accessible Home Improvement of America™ is a new organization that addresses the gaps for home owners that ADA leaves behind. AHIA™ consists of a nationwide network of independently owned and operated , certified providers and contractors dedicated to providing accessible home modifications and related services.

AHIA™ also offers the CEAC (Certified Environmental Access Consultant) credential. This credential brings professionalism and diversity to current businesses. The CEAC™ credential certifies that the consultant is a specialist in independent living strategies, universal design, barrier free access and design, assistive technology, retrofitting, home modifications, and medical remodeling.

Active American will be CEAC certified in the coming months and we look forward to supporting AHIA™

For more information contact Active American Home Access and Construction.


TIRR Hospital Houston Offer Many Treatment Modalities

Wednesday, October 19th, 2011

Specialized Treatment Modalities

TIRR Memorial Hermann has numerous specialized treatment modalities. These specialized programs are offered for both inpatients and outpatients. Links to more information are also provided.

•Wheelchair Seating and Mobility Program
•Enhanced Therapies
•Spasticity Management


1. GAITRite: Changes in a person’s gait pattern can lead to an increased risk for accidental falls and fall-related injuries. A normal gait pattern helps to prevent injury and maintain independence. The GAITRite system records timing and distance parameters on a portable electronic walkway connected to a computer.

As a patient walks across the walkway, the system inputs data into the computer to document walking patterns, including both step time and step length. This captures abnormal walking patterns persons have adopted to compensate for muscle weakness, pain or limb shortening.

Patients using assistive devices and ambulatory aides such as crutches, walkers or canes, use these during their gait analysis. Therapists can use this data to assist with interventions and treatment designed to improve balance and gait. The data also helps to show progress.

2. Locomotion Training: Locomotion therapy supported by an automated gait orthosis on a robotic treadmill has established itself as an effective intervention for improving over-ground walking function impaired by neurological diseases and injuries.

Patients with neurological movement disorders are benefiting from intensive robotic rehabilitation therapy delivered at TIRR Outpatient Services Center at Kirby Glen, using the Lokomat®, the world’s first driven gait orthosis. The Lokomat assists walking movements of gait-impaired patients and is used to improve mobility in individuals following stroke, spinal cord injury, traumatic brain injury, multiple sclerosis or other neurological diseases and injuries.

The Lokomat is the first in Houston, the second in Texas, one of 30 in the United States and one of 100 in the entire world. It was provided for use at TIRR by a grant from the Medallion Foundation.

3. NeuroRecovery Network: TIRR is one of seven specialized member centers of the Christopher and Dana Reeve Foundation (CDRF) NeuroRecovery Network. The CDRF has launched the NeuroRecovery Network grant program to provide support for the translation of basic science and applied research into intensive, activity-based rehabilitation treatments.

It will also support the establishment of specialized centers to provide standardized care based on current scientific and clinical evidence. The program is funded by a joint agreement between the CDRF and the Centers for Disease Control and Prevention.

The therapy regimen includes highly specialized treatment strategies while using a body weight support system to optimize sensory cues to facilitate recovery of the nervous system. This treatment is provided daily during two-hour sessions and includes an hour of treatment on a treadmill followed by overground treatment time to increase carryover of the therapy session. Learn more about the NeuroRecovery Network.

Specialized Treatment Modalities

Wheelchair Seating and Mobility Program
The Wheelchair Seating and Mobility Program at TIRR provides assessments for inpatients and outpatients requiring the use of wheeled mobility in their home, work and community environments. The program enables the patient to try a wide variety of manual and power wheelchairs, seating and positioning accessories and environmental challenges. This allows the patient to trial the device and make accurate and informed decisions based on its performance.

The Seating and Mobility Program is designed to:

•Maximize independence and safety in the home and community
•Improve posture and function in the wheelchair
•Prevent secondary medical, orthopedic and skin problems caused by improper seating
•Provide demonstration equipment, simulation of the seating system and diagnostic tools, such as pressure mapping, to optimize comfort and function
With so many products in the market to choose from, information on the latest technology can be overwhelming.

TIRR keeps abreast of new and innovative technologies and monitors federal guidelines in the area of seating and mobility. We also work closely with local, certified and credentialed durable medical equipment providers and manufacturer representatives to provide comprehensive, patient-focused options.

For more information or to schedule an assessment, call 713-797-7386.

Specialized seating and mobility assessments include the projects below.

SMARTWheel® assessment – The SmartWheel is a clinical tool that assists clinicians with:

•Wheelchair Selection and Set-Up: The SmartWheel quantifies patient ease or difficulty in propelling different chairs or chair set-ups.
•Propulsion (momentum/propel) Training: Real-time visual feedback assists wheelchair users to reduce force and repetitive stress on their arms by using longer, less frequent strokes.
How a person propels a wheelchair is analyzed by a TIRR therapist specially qualified to perform the assessment by measuring every push on the hand rim. The SmartWheel then puts the data into easy-to-use automated summary reports to give clinicians better data to help manual wheelchair users improve quality of life.

The SmartWheel is for people with good hand function and has the following benefits:

•Eliminates pushing on the tire
•Gives a better grip for better performance with every push
•Eases pain in hands and wrists
•Provides greater control when braking
•Retrofits to your existing wheels
TIRR is one of 60 sites in the United States and the only site in Texas to have the SmartWheel clinical tool. It is offered on an inpatient and outpatient basis.

Enhanced Therapies

Animal-Assisted Therapy
TIRR utilizes Caring Critters, a nonprofit, all-volunteer, Houston-area organization. Caring Critters enhances the lives of TIRR patients by providing them opportunities for interaction with animals in a positive, nurturing environment.

Music Therapy
A music therapist’s role is to address the cognitive, speech/language, physical, and psychosocial needs of a patient, using Neurologic Music Therapy techniques. Music therapy is often requested to co-treat with other therapies, such as physical or speech therapy, and to facilitate functional movements and/or cognitive and speech behaviors.

•When co-treating with a physical therapist, music therapy may provide rhythmic stimulation to normalize a patient’s gait cadence, velocity and stride length.
•Music therapists address verbal expression in co-treating with speech therapists.
Music therapists also use song writing and lyric analysis activities to help address coping and adjusting issues. In addition, music is extremely helpful as a mnemonic cue in orientation and learning strategies for memory deficits.

Music Therapy is neurologically based and backed by more than 10 years of research at TIRR. Music therapists at TIRR:

•Hold a bachelor’s degree in music therapy
•Have passed the National Board Certification Exam for Music Therapists
•Are trained and certified in Neurologic Music Therapy (NMT)
Therapeutic Pool
The inpatient therapy pool offers aquatic therapy for patients with orthopedic and neurological disorders who experience symptoms such as pain, weakness, weight bearing restrictions after surgery, swelling, and/or changes in muscle tone. This therapy combines traditional exercise with the water’s buoyancy to enhance and accelerate the rehabilitation process. The pool is kept at a therapeutic 92 degrees and is accessible by stairs or chair lift.

Therapeutic Recreation
Therapeutic recreation specialists use recreational modalities and experiences to:

•Improve functional abilities in therapy
•Provide education and training in recreational skills and attitudes for healthy recreation participation
•Promote social interaction and healthy living through group and community recreational and leisure experiences
Therapeutic recreation therapists at TIRR have the training and unique ability to combine a group of people with a wide range of disabilities and functional levels who share a common interest or focus. Therapeutic recreation:

•Promotes social interaction and appropriate recreational participation
•Encourages creativity
•Helps with coping and adjustment while the patient works on enhancing functional abilities
TIRR therapeutic recreational therapists have four-year degrees and national certification training.

Spasticity Management

Spasticity is a form of muscle overactivity which can result in contractures, abnormal postures, and pain and stiffness in the muscles of the body due to damage to the central nervous system. Spasticity can result from traumatic brain injury, stroke, cerebral palsy, multiple sclerosis, spinal cord injury and other diseases associated with the brain.

Spasticity frequently impairs one’s mobility, positioning, comfort, care and ability to perform activities of daily living. Commonly used management strategies for spasticity include oral medications, intrathecal baclofen, orthopedic procedures, bracing and splinting, and medications which are injected directly into the muscle. Successful management of spasticity in patients with central nervous system disorders requires the expertise of a well-integrated team of clinicians.

Traditional therapeutic approaches, such as muscle stretching, positioning and movement exercises, are basic components of a management program.

Research has proven the value of new treatment options in maximizing the benefits of therapy. These options include:

•Medications that are injected directly into the spastic muscle, such as phenol and botulinum toxin (Botox®), are used in conjunction with casting, splinting and orthotic management.
•The intrathecal baclofen pump, a mechanical device, is surgically implanted and delivers medication directly into the brain and spinal cord. This treatment targets the lower limbs and can affect the upper limbs as well. The pump is the first new treatment for spasticity of cerebral origin approved by the FDA since 1981. Patients who could potentially benefit from the pump undergo a trial to assess their response to the therapy. If there is a favorable response during the trial, patients are admitted for surgical implantation of the pump.
Oral medications may be beneficial for some patients, particularly those individuals with spinal cord injury.

Some patients may be candidates for orthopedic surgeries to correct deformities resulting from spasticity or to augment the effects of other anti-spasticity treatments.

Patients or families interested in spasticity management for inpatients and outpatients may call 713.797.5942 or toll-free 1.800.44.REHAB (73422).

Evaluate your Evaluations: Catching Critical Data for Seating Evaluations

Wednesday, October 19th, 2011

By Jeff McDaniel ATP
Active American Mobility

“I have a patient that needs a foam cushion, can you send one over?” This is a recent phone call I received from a case manager, she had heard about Active American Mobility through another case manager and needed some help with her patient. I probed a little further asking why she was requesting the cushion. “I’m not sure; the daughter called me and said that she needed one.” I asked her to send over the demographics for the client and told her that I would bring one out but that I would like to call the daughter first. After speaking with the daughter, it was revealed that her mom had a stage II and III pressure wound, one on each ischial. I informed the daughter of the seriousness of a pressure wound and setup an appointment to meet her mom’s therapist at the house.

This is a very common occurrence and for those of us in the mobility industry, it is an opportunity. It is an opportunity to educate and gain the trust of our client and our referral. Ultimately, as an ATP, this is our goal. If I had had fulfilled my referral’s original request, the foam cushion could have easily been delivered and maybe would have helped as the client was sitting directly on the wheelchair sling. But I see my job as more than just providing equipment. Actually, as an ATP, it is my job to scrutinize, interrogate, investigate, and then to help provide solutions. Evaluating the client for his or her needs is inarguably the most important step in the process of providing assistive technology. Whether it is a cushion, a wheelchair, or a stander we must utilize our knowledge to provide recommendations and equipment that truly helps our client with their needs. So, I would like to share a brief summary of my processes in performing an evaluation and ultimately providing appropriate equipment.

First, it is important to identify the needs and goals for the client. Interviewing the client, the caregiver, and the therapist can readily identify these needs and goals. What are the health concerns? Are there any changes foreseen in the near future? What are the needs of the caregiver? What concerns does the therapist have? Is the client experiencing any pain or discomfort while using the current equipment? What goals are not being met? I also find it useful to ask what is good about the current equipment and does it need to be duplicated with the new equipment? It is important to LISTEN. It is easy to do “what is best for the client” but often times what is best for the client is what is best for the caregiver. For example, a cushion that meets all of the client’s needs doesn’t really meet all of the client’s needs if the caregiver is unable to maintain and care for the recommended equipment. Anyone that has been providing assistive technology has fallen into this trap, myself included.

Additionally, a mat exam is essential. It is not possible to provide proper equipment without knowing pain thresholds, range of motion, and strength. This information is imperative to provide proper equipment and adjustments. A thorough mat exam will provide this information and will often prevent common mistakes when recommending equipment. Keep in mind that the mat exam is both time consuming as well as physically taxing for the client so be sure to prepare the therapist, client, and caregiver of this before your evaluation.

Finally, be prepared. Bring demo equipment, tools, and literature. It is important that the process be efficient, as this will benefit your referral, the therapist and you. For example, if your client has a history or current pressure ulcers, you may want to show up with multiple cushions and a pressure mapping device. Being prepared is essential to our job will save you time, money, and future grief.

I have found that a thorough evaluation and asking the right questions will usually provide appropriate equipment for my clients. This typically results in a happy client, a happy therapist, and an impressed referral source. And hopefully, it will result in future referrals.

Jeff McDaniel, ATP