Physical Therapy

Woodrow Wilson Physical Therapy aims to help persons whose lives have been changed by injury or illness that has resulted in movement-related disability or painful conditions. Examples of these conditions include:

• Brain Injury
• Stroke
• Cerebral Palsy
• Multiple Sclerosis
• Muscular Dystrophy
• Amyotrophic Lateral Sclerosis
• Spina Bifida
• Neurological Disorders
• Spinal Cord Injury
• Limb Amputation
• Balance Disorders
• Back and Neck Disorders
• Post-Polio
• Arthritis
• Orthopedic Surgeries/Injuries

Our physical therapists will work with clients to meet the challenges they are facing with their injury or illness. Our goal is to help them regain functional independence so that they can get back to living their lives at home and in their community. Physical therapists and other rehabilitation team members, including the client's physician, will design a therapy program that focuses on meeting their goals for recovery.

The client's physical therapist will evaluate and measure their abilities in areas of strength, flexibility, balance, mobility (walking or using a wheelchair), movement coordination and speed, cardiovascular and respiratory endurance. We also help clients consider ways to improve their fitness and wellness for a long life of good health. We will also look at their functional skills and needs for moving around within their home and community. The client's therapy program will focus on helping them to improve in those areas found to have potential for increasing their abilities to live a productive and satisfying life. Their program will also introduce them to assistive technology devices that may be needed to help them reach their goals. Treatments will aim to improve the client's…

Ability to “Get Around”:

• Gait (walking) training with or without orthotics (braces) or prostheses (artificial limbs)
• Partial weight bearing or suspended gait training
• Standing programs to prepare for walking
• Bed mobility and transfer training
• Balance training including computerized balance platform
• Electrical stimulation exercise and gait/walking programs (ERGYS2 and ParaStep®)
• Lower extremity orthotic (brace) trials and training
• Muscle re-education and motor control training (including EMG biofeedback, functional electrical stimulation, and functional taping)
• Wheelchair mobility skills training

Strength, Flexibility, Skin Care, Pain Management and Fitness:

• Strengthening programs
• Stretching programs
• Casting to increase flexibility
• Modalities for pain control, joint motion and soft tissue healing
• Pool therapy
• Transition from WWRC therapy program to community wellness programs
• “Weigh To Go” weight management program
• Wound management program
• Wheelchair-accessible strength & conditioning equipment

Use of Assistive Technology:

• Wheelchair Evaluations with many manual and power chairs or scooters to try
• Wheelchair mobility training including outdoor terrain skills training in the Garden of Hope
• Seating evaluations to help client's sit comfortably and in a position that enables the continuation of daily functions
• Pressure mapping to evaluate skin pressures with wheelchair seating and cushion evaluations
• Working with other team members to make sure that all utilized technology works well together

Ability to Return to Work:

• Instruction in proper body mechanics, lifting techniques and lower back care, along with guidelines for safe work performance
• Work injury prevention education
• Ergonomic workstation evaluations and recommendations for work accommodations
• Physical Work Performance Evaluation
  • Evaluation Test Demonstration (PDF Version - 1,414 KB)
• Work conditioning
• Work site evaluations (going with client's to a job site to determine how to help them do that job)

WWRC Physical Therapy is proud to offer LITE GAIT™--a partial weight bearing gait therapy device. We use LITE GAIT™ to help client's regain a more normal walking pattern after lower extremity paralysis or weakness from a stroke, brain injury or spinal cord injury. The harness suspension supports as much body weight as needed to allow the legs to move in a walking pattern without fear of falling. The client's physical therapist can start them at a very slow speed on the treadmill while helping them to move their legs correctly. As they get stronger the LITE GAIT™ device can provide assistance as they move from treadmill walking to walking across the ground.

  

WWRC Physical Therapy offers several options for persons needing to develop an ability to stand. This is an important therapy option used to either prepare the legs and body for the upright position of walking or to reduce the side effects of not being able to stand alone.

  

Individuals may need help with improving one's ability to balance and not be fearful of falling when standing to perform daily activities or during walking. WWRC physical therapists have many options to help develop these abilities in a safe and progressive fashion.

  

Justin using the ERGYS® 2 to exercise the paralyzed muscles in his legs. One of the big benefits that he has noticed is that his leg spasticity is much less for up to a day after using the ERGYS® 2.

View a short video clip of Justin pedaling (768 KB)

The ERGYS® 2 Rehabilitation System uses computerized functional electrical stimulation (CFES) to allow persons with little or no voluntary leg movement to actively pedal a stationary leg-cycle ergometer. The clinician can choose from a number of workload regimes and biphasic stimulus waveforms to tailor the ERGYS® 2 to a client’s specific therapeutic needs.

Computer generated, low-level electrical pulses transmitted through surface electrodes cause coordinated contractions of leg muscles. Sensors located in the ERGYS® 2 provide continuous feedback to a computer which controls the sequence of muscle contractions as well as the resistance to pedaling. The result is smooth and natural pedaling, with leg muscles supplying the power.

  

The Parastep® system is an FDA approved form of assistive technology that enables some persons with spinal cord injury to stand and walk limited distances. It involves the use of neuromuscular electrical stimulation (NMES) to deliver low-voltage electrical impulses to excite peripheral nerves causing skeletal muscle contraction. The Parastep® System includes a stimulator that generates sequences of electrical pulses which are sent to targeted peripheral nerves through surface electrodes placed on the skin over muscles and sensory nerves of the lower extremities. The user is in control of the timing and intensity of the stimulus application. Through a specially adapted walker, the user pushes buttons on the walker to tell the stimulator to send signals. Stimulation of the hip and knee extensor muscles allows the user to stand. Stimulation of the flexor muscles of one leg at a time allows a user to take steps.

WWRC physical therapists will work with individuals to determine what type of leg brace will best help them walk. We can use our evaluation braces or make temporary braces and shoe inserts for them to try before we prescribe a “real” brace that will be made by a certified brace specialist. Once the brace is made, the specialist will work with the client's therapist to make sure that it fits comfortably and works well for them. Their physical therapist will train them in using the brace.

  

After an injury, muscles often need to learn how to function properly again to be able to use them. There are many ways for physical therapists to retrain muscle function. Functional electrical stimulation, or FES, is one method used that involves using safe forms of electrical stimulation to “excite” the muscles into working. These electric signals can substitute for weak or absent signals between the brain and the muscle. This may allow the brain and muscles to develop new lines of communication. It also can increase the strength in the muscle while the individual works on recovering the ability to control the movement on their own.

  

For persons using wheelchairs, special attention is given to skills needed to negotiate various challenges in their environment. The goal is to help them feel comfortable getting around in their home and community using a wheelchair when this is necessary. This may include teaching a family member or friend how to best assist them when needed.

           

Building adequate strength in muscles to enable client's to do the activities they desire to do is an important part of what the physical therapist will focus on during their rehabilitation program. WWRC offers a variety of exercise options for persons with a wide range of strength—from very weak as they start exercising on up to challenging them as they get stronger. If a client desires to continue a strength program in their community through a local fitness center, we have equipment that is similar to that available in many communities so that we can help clients feel safe as they return to their community to exercise.

Tight muscles and stiff joints can interfere with one's ability to move easily and comfortably. Following certain injuries such as a stroke, head injury or spinal cord injury, it is very important to develop a good routine for stretching out those muscles and joints that are more likely to get tight and interfere with mobility or activities.

In some cases of very tight muscles, a doctor might recommend special procedures to relax the muscles. These will allow the muscles to be stretched over a longer period of time than what can be done with stretching exercises. One way to get a prolonged stretch to a muscle is to use a splint or a cast that holds the muscle in a slight stretched position while it's being worn. This lets the muscle gradually “grow longer” to allow more freedom to move that part of the body. A physical therapist will fit the splint or cast and make sure that clients have clear instructions as to how to use it properly.

WWRC physical therapists may use certain therapeutic modalities (devices) that will allow for improved comfort during exercise or to reduce pain from an injury or following surgery. Devices that create a deep heating of the muscles and tissues around joints (such as ultrasound or moist hot packs) will help with increasing flexibility and speed up healing after an injury. Certain electrical stimulation devices can assist with healing open wounds. A physical therapist will use these devices in combination with the rest of the client's program activities, such as exercise or mobilization (joint or tissue movement created by the therapist’s hands), to meet their goals.

           

The warm water of the WWRC Therapeutic Pool offers the physical therapist another option for helping clients to regain strength and mobility. Many people who have a hard time moving on dry land (due to weakness, spasticity or pain) may find it easier to move and begin exercising in the pool.

     

The WWRC Physical Therapy gym is equipped with a wide array of exercise equipment that is accessible from a wheelchair. This includes weight lifting stations as well as exercise “bikes” that are pedaled with the arms.

     

WWRC Physical and Occupational Therapy staff work together to assist people who need to be fitted with a wheeled mobility device. We have a wide range of manual (push) chairs, power scooters and power wheelchairs. Therapists will work with clients to determine which type of chair will best meet their needs then have them try using several options to see which one actually works best. The occupational therapist provides assistance in choosing the best wheelchair cushion to work with the chair that is chosen. Our Durable Medical Equipment staff is available to help clients understand insurance coverage and payment options for purchasing the recommended equipment. If a client chooses to order equipment at WWRC, we will schedule them to be seen by their therapists when the new device arrives. We want to make sure that the new chair is properly fitted to that person and to instruct them in the proper use and maintenance of the device. At times, we may need to involve WWRC Rehabilitation Engineering staff to do custom modifications or fittings to the equipment.

There are situations that require special attention to the seating system that is used in a wheelchair. For example, a client may have special concerns with sitting comfortably or with having enough support to keep their balance in a wheelchair. Or they may have had problems with skin breakdown (pressure sores) because they do not have good feeling or sensation in parts of the body where pressure builds up during sitting. WWRC has an excellent seating program involving a team of physical and occupational therapists, rehabilitation engineers, physician and nursing when needed. The team will work with each client to evaluate the cause of their particular seating problem then suggest options for improving seating comfort, support and skin protection.

  

The example pictured shows a young lady who was having difficulties with her present seat because of the gap (highlighted line drawn) between her trunk and the back of her chair. A custom shaped foam cushion was fabricated to fill in this gap and give her better support and comfort. With these improvements, in addition to being more comfortable, she had better balance to enable her to use her arms.

WWRC is proud to have a computerized pressure mapping system that gives us another tool to help identify the seating system or cushion that will help clients avoid complications of skin breakdown or pressure sores. If someone has had skin pressure problems, we can use a very thin mat laid over their cushion to “see” on the computer screen any areas of unsafe pressure between that person and their cushion. Then we can continue to look at this computer picture as we make changes to how they are positioned or as we try new cushions and seating supports. This helps us to decide what we can do to improve skin protection.

  

One of WWRC’s claims to fame is the creative and innovative solutions that our teams come up with to help persons with disabilities conquer their daily challenges. When technology needs span many areas of an individual's life, our team works together with them to either find existing technology that will work with or without special modifications. If none exists, fear not …our team of rehabilitation engineers and therapists will custom-design a solution just for that person!

In the first picture , Joey’s team fits him with a special seating system to use with his chair that he drives with head movements. In front of him is mounted a communication device that he programs to speak for him again using head movements to enter his words into the device. He has delivered a sermon at his church using this set-up!

In the next picture , Dawn needed a way to carry her new baby around her home. She uses a power chair and wanted to be able to have her baby with her as she moved about her home in the chair.

     

If a person is preparing to go back to work after an extended time away from work due to an injury or illness, they may have some concerns about what they can do physically. WWRC offers many vocational evaluation and training programs to assist individuals with disabilities who want to go to work. The Physical Therapy department offers specialized evaluations of a person's physical ability to perform work activities such as lifting, carrying, pushing and pulling. We will also evaluate each person's ability to get into and work in different positions like sitting, standing, kneeling, squatting and stooping. Other areas tested are mobility (walking, climbing stairs and ladders and crawling), balance and fine-motor coordination. Finally, we evaluate the client's endurance to work a full 8-hour day. From this testing, we can make recommendations to help clients regain the strength needed to return to work safely.

Sharon Russo MS, PT
Physical Therapy Director