Atlantic view

A message from the ceo.

Greetings from the main office! We hope everyone is staying warm and coping with the last of the winter weather as we look forward to spring. As usual, we have more news to announce regarding the state of Atlantic Health Services. Specifically, we have some new faces at the main office: A Director of Clinical Services, a Human Resources Specialist, and an Office Manager.

Our new Director of Clinical Services is Michael Bohman. Michael has been with us since January and has been busy organizing and running several new projects, both locally and nationally. We are fortunate to have him on our team as he will play a major role in our expansion and drive to keep growing.

Our new Human Resources Specialist is Len Carlos. Len has been with us since February and has been busy working on recruiting new employees, organizing employee databases, and becoming an expert on our benefits package. We are happy to have her join our team and expect that you will be hearing from her and meeting her in the very near future.

Finally, our new Office Manager is Maritza Aviles. Maritza has been with us since December and has been busy organizing the office, assisting with numerous proposals, and keeping the office running smoothly. She has filled the void left by our previous Office Manager and we are very happy to have her on board.

Please join me in welcoming these new individuals to our team. We are lucky to have them, as well as, each and every one of you. Thank you for continuing to provide a quality of service for which we are proud.

Sincerely,Don Gladstone, CEO, Atlantic Health Services, Inc.

Stand Up

by: Alexandria Ramirez, PT

Benefits include: improved digestion, improved muscle activity, decreased muscle contractures, improved bone density, decreased risk of fractures, improved bladder drainage and kidney function, improved circulatory and cardiovascular systems, and improved skin integrity through relief of pressure sores caused by prolonged sitting.

The three main standing devices include:

1. Prone stander which supports the front of the body and is used for people with good head control by enabling weight bearing through the arms. This type of stander promotes use of extensor muscles to remain upright and thus promote head elevation.
2. Supine stander supports the person along the back of the body and has several adaptations to facilitate improved function. Most of these standers have trays or are placed against a table to provide a work space.
3. Vertical or upright stander is used to gain maximal weight bearing through the body as it mostly consists of support around the trunk using a table or box.

STANDERS IN THE CLASSROOM

In the school setting, wheelchair-bound children are not at the same height as their peers, which can have a negative psychological effect on them. While in a stander, a nonambulatory person will be much taller and can improve their social interactions and their self-esteem. The stander with a tray can be used to eat lunch, work on class projects, and play games and can support improved upper body function and control. The stander without a tray can be used to work on ball skills-throwing and catching-groom hair, brush teeth, and perform other daily living activities.

Standing also provides several physiological and medical benefits. . The human body was designed to weight bear on two limbs, and thus most of our internal organ function is enhanced through standing.

Standers can be used during several settings within the school day and are meant to be integrated into the classroom with the students' peers. These standers should not isolate the child, but bring them to the level of their peers and improve peer and social interaction.

ROLE OF THE THERAPIST

The therapist in any setting needs to consult with the entire team to obtain the appropriate standing device. This team may include the school case manager, parents/caregiver, group home, physician, vendor, therapists, and anyone else involved in assessing the standing need.

The team needs to assess the indications and contraindications to standing:

Clinical Indications include risk for any immobilization dysfunctions including paralysis, prolonged sitting, and impaired mobilization.

Clinical contraindications include physician-declined referral, orthostatic intolerance, and impaired skeletal structure that will not tolerate weight bearing. These syndromes could include diagnoses such as orthostatic hypotension, postural tachycardia syndrome, osteogenesis imperfecta, osteoporosis, and other brittle bone diseases, as well as hip or knee flexion contractures greater than 20°.

Clients need to obtain proper alignment with necessary braces to promote increased function and interaction. Teams need to think about the appropriate stander. Therapists need to assess the frequency of and compliance with the standing program to obtain optimum functional performance within the school and home settings.

STANDER JUSTIFICATION

After we know the benefits of standing, how do we convey this information to insurance companies and justify payment for this equipment?

As clinicians write more and more justifications for standers, reimbursement has improved. Insurance companies are realizing it is often cheaper to buy a piece of equipment, rather than risk surgery, postural abnormalities, or other physiological dysfunctions.

After you determine the need for the stander, the evaluation begins to determine which stander will maximally benefit the client. We need to assess the diagnosis, range of motion, tone, sensation, skin integrity, functional status, and living and school environments. Is the client going to use the stander only at school or only at home? How accessible and feasible is the classroom or home for standing with this equipment? We also need to consider the age and size of the person. Are they going to outgrow this stander or have difficulty transferring into the stander? Often as the child grows larger, transfers into the stander become more difficult. We need to account for these factors during the evaluation.

Other information that needs to be gathered includes documenting how long and often the stander will be used, medical necessity, and home compliance; the kind of stander needed is also important to rule out other types of equipment. It is sometimes necessary to discuss and perform a trial of several types of standers to enable appropriate fit and ease of standing. It is always necessary to document these trials, as well as to justify why this stander is the most effective for the client and to rule out the lesser priced models. It is also necessary to determine if the funding source has a dollar limit. These factors need to be documented to support justification of any type of stander.

Despite our best efforts, we can get our equipment denied even if we deem it medically necessary. If, after appeals, phone calls, letters, etc, we still have not received insurance authorization, keep in mind that other local organizations are often willing to assist in purchase of medical equipment. These could include adult civic groups, such as Lions Clubs; the Knights of Columbus or similar church groups; diagnosis-specific organizations; or school systems. Loaner programs also exist in schools or Goodwill organizations that receive donated equipment, loaning it to families for short durations.

When looking to obtain a stander for a person of any age, consider all of the benefits-medical and psychological-and, finally, document all of these criteria for justification to the insurance company.

(Excerpts from Rehab Management Journal article by Kirsten Becker, PT of March 2005)
Standing 101. SMART Educational Seminars.
www.abledata.com
Rehab Management Journal
Altimate Medical. Available at: www.easystand.com.
Taking a stand. Advance for Directors in Rehabilitation

Autism and Augmentative and Alternative Communication Systems

By Eva Gustafson, CCC-SLP (Based on DCSHA presentation by Jennifer Bilyew, CCC-SLP, February 25, 2005)

As speech-language pathologists, we all know that Augmentative and Alternative Communication (AAC) systems can help non-verbal children with autism communicate in a functional way. However, utilizing an aided approach (e.g. devices that are external to the individuals who use them, such as, communication boards/books and voice output communication aids) as opposed to manual signs can enable even those with severe autism (e.g. individuals who communicate using pre-linguistic behaviors such as reaching or grabbing) to communicate functionally. The establishment of functional communication may also result in a decrease in severe behavior problems.

The reasons for which an aided approach might work better with this population include the following: Graphic symbols used with aided devices require less memory recall, take less physical effort, require less use of fine motor skill, and do not require communication partners to understand signs. Research has also indicated that the ability to learn/use picture symbols can sometimes help develop verbal communication later on.

With this information in mind, consider using picture symbols before using manual signs when working with autistic children who have severe communication disabilities. Your students might achieve quicker, more meaningful communication that parents, teachers, and other individuals will be able to relate to, understand, and respond to.

SPEAK UP OT!

By: Mags Baguio

How to use these Tips on Talking to the Public:

Very often we are called upon to explain what we do to people who are unfamiliar with our profession. Although it can seem a daunting challenge, people will actually welcome your comments. They consider you the expert. These pointers will help you master any conversation.

Keep it Simple

When talking to the public, speak simply, without using professional jargon. People will appreciate your effort to put complex thoughts into words they can easily understand.

Think About What You'll Say

Every time you go before the public, whether it is just one person or a roomful of people, think beforehand about the messages you want to drive home to your audience, and the best ways to communicate those messages. In most cases, making just three main points will be plenty. It allows you to focus the audience's attention on the things that are really important.

Relax, You're the Expert

Although style isn't everything, people will respond best to what you say if your delivery is relaxed and confident. Remember, when it comes to occupational therapy, you're the expert! Chances are slim there'll be questions you can't answer. If a question arises you're not comfortable answering, acknowledge the question and either promise to look into it or refer the questioner to another source.

What to Say When Someone Asks "What Is Occupational Therapy?"

Occupational therapy is a health profession that focuses on an individual's ability to participate in daily activities and lead a purposeful life.

There are times when a health problem or injury can prevent you from participating in life's daily activities - things such as learning, working, socializing, driving, shopping, fixing dinner, or phoning a friend - or doing any number of important daily tasks. Occupational therapy can help a person to do all of these things, and more.

Each year occupational therapy helps millions of people of all ages learn or regain skills that enable them to lead independent, purposeful lives. Research shows when people are able to participate in the world around them, they live happier, healthier, more productive lives. It also helps keep healthcare costs lower. Whether it's teaching a newborn to swallow, or helping a senior driver remain as safe driver, occupational therapy helps individuals participate in the world around them.

Occupation therapy has proven effective in rehabilitation, mental health, community health, and education settings. Specialized practice areas include low vision therapy, stress reduction, ergonomics and safe workplaces, consultation to foster aging in place, community mobility and driving, and wellness coaching.

What to Say When Someone Asks "What do Occupational Therapists and Occupational Therapy Assistants Do?"

Occupational therapists are trained in many areas to work with individuals and in the community to promote wellness and increase participation in all aspects of daily life. Occupational therapists help people with physical and mental challenges to maximize their ability to perform the activities of daily living (ADLs) such as eating, dressing, bathing, toileting, and "Instrumental ADLs" that require thinking skills such as managing medications.

In addition to working with individuals, occupational therapists and occupational therapy assistants conduct research, advise businesses, and influence public policy in their ongoing effort to promote wellness, participation, and well-being in society.

Nearly one-third of all occupational therapists work with children in schools. A significant number work in hospitals, rehabilitation facilities, and nursing homes, helping people recover from injury or illness

From AOTA.org

Announcement for SLPs: FREE CEUs ON THE WEB!

Are you interested in learning more about Passy-Muir speaking valves? Or are you interested in obtaining free CEUs? If so, go to the Passy-Muir website (www.passy-muir.com), click on "education" and register for FREE Continuing Education Credits.

APRIL IS NATIONAL OCCUPATIONAL THERAPY MONTH!

OT Month observances can be simple or grand. They can showcase a clinic, a particular therapy, or a particular person. You can design your observance for clients, colleagues, referrers, or the general public. The important thing is to get involved and share your love for the profession with your community.

Now is your chance to earn an instant $500 referral bonus! Atlantic Health Services is inviting all employees to participate in searching for job applicants to occupy various vacant positions (Physical Therapists, Occupational Therapists, Physician's Assistants, Speech Language Pathologists, Psychologists, Dentists and Nurses). The company has acquired new contracts with the federal government and this created many new positions just waiting to be filled! For more information about this offer, please contact Len Carlos at (301) 838-3430.

ATLANTIC VIEW VOLUME 2, ISSUE 1

600 E. Jefferson Street
Suite 305
Rockville, MD 20852
Telephone: 301-838-3430
Facsimile: 301-838-3063

111 South Calvert Street
Suite 2700
Baltimore, MD 21202
Telephone: 410-385-5651
Facsimile: 410-385-5201

Mission Statement

Atlantic Health Services Incorporated (AHS) is dedicated to the provision of quality health and professional services to children and their families. AHS is dedicated to the delivery of comprehensive trans-disciplinary intervention services to clients from diverse cultures in medical facilities, in their natural environments or in special education programs in the Washington and Baltimore Metropolitan Areas. The company (AHS) is dedicated to the delivery of comprehensive evaluations and design and implementation of medical/educational programs for clients/students to enhance their ability to realize their optimal potential of achieving happiness and becoming contributing members of society. It is the primary goal of AHS to improve the quality of life for all of its clients and their families.

Editor-in-Chief: Alexandria Ramirez, PT

Contributors: Mags Baguio, Eva Gustafson, Alexandria Ramirez