Physical Rehabilitation

Why is Paired Vagus Nerve Stimulation Effective for Stroke Recovery ?Throughout her esteemed career as a board-certified neurological physical therapy specialist, lecturer and researcher, Kay Wing, PT, DPT, NCS, has always been interested in new technology that has the potential to benefit stroke survivors in her practice, SWAN Rehab (Phoenix, Arizona). When she learned about the Vivistim Paired VNS System, Wing was eager to enroll stroke survivors in the clinical trial based on the research supporting vagus nerve stimulation for ischemic stroke recovery. The results are clear; stroke survivors who participate in paired vagus nerve stimulation in conjunction with their physical therapy improve their hand and arm mobility two to three times more than those who had physical therapy alone. In this post, Wing explains how the FDA-approved Vivistim System works and why its a gamechanger for stroke recovery.By Kay Wing, PT, DPT, NCSWhat is the Vivistim Paired VNS System?The FDA-approved Vivistim Paired VNS System is a vagus nerve stimulation device that stroke rehabilitation therapists pair with rehabilitation exercises to help improve outcomes (or gains) for stroke survivors even years after theyve had a stroke, potentially generating two to three times more hand and arm function for ischemic stroke survivors than therapy alone.The small pacemaker-like device is placed just under the skin in the upper left chest area during an outpatient procedure. Soon after, the stroke survivor will begin physical or occupational therapy. The therapist will have the stroke survivor repeatedly perform specific rehabilitation exercises designed around each persons specific needs and goals to help them improve their function. During these exercises, the therapist will be sending signals to the persons Vivistim device to send a pulse through the vagus nerve to the brain that helps tell the brain what to relearn.This highly repetitious pairing of vagus nerve stimulation with stroke rehabilitation helps to increase what is known as neuroplasticity , the process of engaging other undamaged parts of the brain to take over the work that had previously been done by the parts of the brain damaged in the stroke.Surviving an Ischemic StrokeAbout 60% of stroke survivors experience persistent upper limb issues for 6 months or more. This fact has both inspired and challenged me personally and professionally. My grandfather survived a stroke when I was in high school but never fully recovered. The feeling that more couldve been done for my grandfather to regain function has guided me throughout my career specializing in neurological physical therapy. The passion that inspired me to open my private practice clinic, Southwest Advanced Neurological Rehabilitation (SWAN Rehab), 25 years ago has consistently been reinvigorated throughout my career as technology evolves and new medical devices are developed that make stroke rehabilitation more effective.My goal is to help stroke survivors experience a better quality of life, especially as it helps them regain the ability to do activities of daily life, such as brushing their teeth, getting dressed, cooking or enjoying a meal. Beyond that, I know its equally as important for stroke survivors to get back to the hobbies that are important to them.Like Joe, who came to SWAN Rehab through Vivistim and really wanted to be able to play his guitar again, restore his antique cars, swing a hammer, squeeze a screw gun and pull a tape measure for his construction projects.Kay performing Joes first assessment.Getting Back to Doing What You LoveThe Vivistim Paired VNS System enabled our SWAN Rehab team to help make these gains, that were so important to Joe, a reality. In traditional physical therapy, we concentrate on improving motor function in the hand and arm with repetitive tasks, such as reaching, buttoning, flipping, stacking, grasping and releasing. With Paired VNS Therapy, however, we incorporate these tasks as we signal the Vivistim device to send an electrical pulse through the vagus nerve to the brain.We repeat these specific repetitive movements over and over again. This repetition is continued with a home exercise program to help achieve the large number of repetitions required to help induce neuroplasticity and relearn how to move. The Vivistim Systems repetitive simultaneous pairing of hand and arm therapy with vagus nerve stimulation is a gamechanger in helping stroke survivors get better results faster because it directly stimulates the brain.Ive seen it firsthand in my clinic. Stroke survivors engaging in traditional therapy see incremental improvement in their hand and arm function over several months. For comparison, stroke survivors who do traditional therapy in conjunction with vagus nerve stimulation get greater improvement in their affected hands and arms within just six weeks.To help Joe get back to doing the things that are important to him, we dedicated some sessions to practice picking up, grasping and using a guitar pick while his therapist signaled the vagus nerve stimulation device with each hand and arm motion. We also had him practice picking up, grasping and swinging a hammer.As a car enthusiast, Joe didnt immediately recognize the correlation between practicing opening jars or cleaning the windows in our clinic as we signaled the Vivistim device during activities that he wanted to get back to, but when he was able to get in his garage and open the gas caps on his car or wash and polish the cars, he was excited about how the benefits of Paired VNS therapy related to his personal goals.Joe will tell you, though, its not an overnight change and doesnt just happen with a couple of hours of in-clinic therapy a few days a week. The Vivistim System also requires stroke survivors to engage in stroke therapy at home, using a magnet that activates the VNS device for 30 minutes at a time while theyre cooking, washing dishes, folding laundry, playing with their children, getting dressed, or any other daily activity.Video PlFirst Success, Then ProgressFirst Success, Then ProgressIts always been my philosophy that therapy has to be challenging to keep stroke survivors motivated. I like the Vivistim Paired VNS System because it fosters this philosophy by helping stroke survivors first achieve success by completing tasks in therapy and then continuing to make progress toward their functional goals with the at-home therapy. With Vivistim, stroke survivors are actively engaged, challenged and motivated throughout the recovery process.Paired VNS Therapy is such a breakthrough medical technology for stroke rehabilitation because it helps stroke survivors improve their hand and arm function two to three times more than traditional stroke rehabilitation alone. Of the hundreds of medical devices and innovative therapy techniques Ive implemented in my practice, nothing else has been clinically proven to help stroke survivors achieve this level of improvement in such a short timeframe and in the chronic phase of stroke.If youre a stroke survivor who wants to improve your level of hand and arm mobility even if its been some time since you had your stroke, I hope my experience, Joes improvements as well as those of other stroke survivors encourage you to take the Vivistim survey to see if Paired VNS Therapy is right for you.About Kay Wing PT, DPT, NCSKay Wing, PT, DPT, NCS, is the founder of Southwest Advanced Neurological Rehabilitation (SWAN Rehab) and an adjunct professor at Northern Arizona University and A.T. Still University. As a board-certified specialist in neurological physical therapy, Dr. Wing is passionate about working with clients recovering from strokes, traumatic brain injuries and other neurological diseases. Keen on innovation and advancing whats possible in neurological physical therapy, Dr. Wing has authored several peer-reviewed journal articles and led numerous clinical trials. As such, shes won prestigious awards throughout her 40-year-career, leading her peers to regard her as an esteemed physical therapist.

Navigating Hospital Stays and Rehabilitation for Parkinsons Patients. This article is part of The Parkinsons Care Compass: A Caregiving Roadmap Guiding Families Through Every Stage, an educational series presented by At Your Home Caregiving of Texas. We are honored to walk beside families, offering specialized in-home care solutions to support every step of the Parkinsons journey. Hospital stays are a stressful experience for any family, but for individuals living with Parkinsons disease, hospitalization poses unique challenges that can significantly impact recovery and long-term health. When a Parkinsons patient requires surgery, treatment for complications, or recovery after a fall, family caregivers must act as advocates, organizers, and partners in care. Being prepared and informed is the key to ensuring a safe hospital stay and a smooth transition back home.At Your Home Caregiving of Texas understands these complexities and stands ready to help families through every step of the journey, providing expert support for rehabilitation and home-based recovery.Unique Hospitalization Challenges for Parkinsons PatientsParkinsons disease complicates hospital care in several critical ways: Medication Management: Parkinsons medications must be administered on a strict schedule to manage symptoms effectively. Delays or missed doses can lead to severe motor symptoms, confusion, and even hospitalization complications. Mobility and Fall Risks: Hospital environments are unfamiliar, and Parkinsons patients face an increased risk of falls due to balance issues and muscle rigidity. Cognitive Changes: Hospitalization can sometimes trigger or worsen confusion, memory problems, or delirium, especially in older adults with Parkinsons. Communication Difficulties: Some patients experience soft speech (hypophonia) or facial masking, making it difficult to express needs clearly to hospital staff unfamiliar with Parkinsons care. Being aware of these risks allows families to take a proactive role during the hospital stay, minimizing complications and ensuring the best possible outcome.Preparing for a Hospital Stay: Advocacy and PlanningIf hospitalization is scheduled (for surgery or planned treatments), preparation can make a significant difference:1. Create a Hospital Parkinsons PlanPrepare a simple one-page document outlining your loved ones: Current medications and exact times for administration Mobility limitations and fall risk status Communication needs Cognitive changes or dementia symptoms Preferences for therapy, rehabilitation, and home care after discharge Provide this information to the hospital staff immediately upon admission.2. Bring Medications to the HospitalBring a full list and ideally the actual medications in their original containers. In some hospitals, families can administer Parkinsons medications if theres a risk of delays.3. Assign an AdvocateDesignate a family member or professional caregiver to be present as much as possible, especially during medication times, shift changes, and physician rounds. Having a consistent advocate can prevent critical mistakes and advocate for the patients specialized needs.The Importance of Medication TimingOne of the biggest risks for Parkinsons patients in the hospital is missed or mistimed medications. Parkinsons medications like carbidopa-levodopa must be administered exactly as prescribed, sometimes multiple times a day, to prevent a sudden worsening of motor and non-motor symptoms.Tips for ensuring proper medication administration: Clearly document the medication schedule and insist it be incorporated into the hospitals care orders. Politely but firmly remind nursing staff of the critical importance of on-time dosing. Advocate for medication self-administration if allowed by hospital policy. Watch for any substitutions generic or alternate medications can sometimes affect symptom control. Families should feel empowered to respectfully advocate for their loved ones medical needs. Delay in Parkinsons medication can lead to avoidable setbacks in recovery.Understanding Rehabilitation OptionsAfter hospitalization, rehabilitation is essential for helping Parkinsons patients regain strength, balance, and function. Depending on the situation, rehabilitation may occur in: Inpatient Rehabilitation Facilities (IRFs): Specialized centers offering intensive physical, occupational, and speech therapy. Skilled Nursing Facilities (SNFs): Short-term stays focused on medical monitoring and therapy. Home-Based Rehabilitation: Therapy provided at home, which may be the best option for patients with significant mobility challenges or those at high risk of hospital-acquired infections. At Your Home Caregiving of Texas partners with rehabilitation therapists to support continuity of care at home, ensuring that exercises, safety measures, and care plans are followed consistently.Key Rehabilitation Goals for Parkinsons Patients Improving strength and flexibility Reducing fall risk through balance and gait training Enhancing fine motor skills (handwriting, eating, dressing) Improving swallowing and speech if affected Maintaining independence as much as possible Early rehabilitation after hospitalization is crucial for Parkinsons patients. Without it, the risk of decline, injury, and readmission significantly increases.Transitioning Safely Back HomeThe transition from hospital to home is a vulnerable time. Planning ahead is critical to prevent setbacks.Steps for a Successful Transition: Arrange Home Care Services Early: Schedule in-home caregiving services to assist with mobility, medication reminders, and personal care. Conduct a Home Safety Evaluation: Adapt the home environment to minimize fall risks remove tripping hazards, install grab bars, ensure proper lighting, and use assistive devices. Coordinate Medication Management: Update prescriptions, confirm medication supply, and create a clear medication schedule. Schedule Follow-Up Appointments: Ensure post-discharge physician and therapy visits are scheduled before leaving the hospital. Implement a Rehabilitation Plan: Continue physical therapy and exercise routines at home, guided by professional caregivers and therapists. At Your Home Caregiving of Texas specializes in providing comprehensive transitional care for Parkinsons patients. Our caregivers work alongside families and healthcare professionals to ensure that recovery continues safely and effectively at home.How At Your Home Caregiving of Texas Supports RecoveryFamilies managing Parkinsons care dont have to do it alone. Our services are designed to ease the burden of post-hospitalization recovery by providing: Personalized Care Plans: Tailored to the individuals stage of Parkinsons and rehabilitation needs. Medication Reminders and Assistance: Helping maintain the critical medication schedule. Mobility Support: Assisting with walking, transferring, and exercises to rebuild strength and prevent falls. Nutrition and Meal Support: Preparing nutritious meals that support energy and healing. Companionship and Emotional Support: Reducing anxiety, confusion, and isolation during the recovery process. Coordination with Healthcare Providers: Keeping families informed and ensuring therapy recommendations are carried out at home. We work hard to create an environment where patients can heal comfortably, maintain dignity, and reduce the risk of hospital readmission.Final ThoughtsHospital stays are never easy, especially when Parkinsons disease adds another layer of complexity. But with the right preparation, strong advocacy, and a smooth rehabilitation plan, families can help their loved ones achieve the best possible recovery.At Your Home Caregiving of Texas stands beside you every step of the way from hospital bedside to a safe and healing home environment. Our specialized Parkinsons care services ensure that patients get the compassionate, expert support they need to regain strength, confidence, and independence.When its time to transition home after hospitalization, trust At Your Home Caregiving of Texas to be your partner in care and recovery. At Your Home Caregiving of Texas is proud to support families living with Parkinsons disease through compassionate, expert care. For more resources and personalized caregiving solutions, explore the full Parkinsons Care Compass series or contact us today at 469-830-8414. Together, we can create a safer, stronger path to recovery one step at a time.  If someone you care about is facing the challenges of Parkinson's, know that you're not alonewe're always here to help.                                          

Many Colorado Seniors and Disabled Adults are concerned about the recent funding discussions about Federal, not State, Medicaid changes, and how they might impact Long-term Care Medicaid benefits here in Colorado. There are 40+ different Medicaid programs in the State of Colorado alone, which are funded differently. Some of these Medicaid programs will be impacted by Trumps changes.At this time, it is important to know that the Medicaid changes imposed do not affect Long-term Care Medicaid in Colorado. If you are currently receiving Long-term Care Medicaid benefits or considering applying, you can rest assured that your eligibility, services, and coverage remain intact. Long-term Care Medicaid has already been funded for 2025, therefore nothing will change this year. In addition, there have not been any major changes to Colorado Long-term Care Medicaid in 20 years, and we dont foresee any changes now. In the meantime, if you have any questions about your coverage or need assistance navigating the Long-term Care Medicaid process, please dont hesitate to reach out to Beneficent. www.DoingGoodForOthers.com/contactus