Tai Chi & Qigong for Health, Fitness & Well-Being

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.

Pennsylvania offers Medicaid waiver programs under the Community HealthChoices (CHC) umbrella and the Pennsylvania Department of Aging (PDA) Waiver (often referred to as the PA Council on Aging Waiver). These programs help older adults and individuals with physical disabilities remain in their homes or community settings instead of entering nursing facilities. CHC and the PDA Waiver provide long-term services and supports (LTSS) based on assessed functional needs, emphasizing assistance with ADLs and IADLs. Covered services may include personal care assistance, adult day services, home-delivered meals, transportation, home modifications, assistive technology, and respite care for family caregivers. In addition, Pennsylvanias CHC Waiver offers Participant-Directed Services that allow participants to hire and manage their own caregivers, including family members. To qualify, applicants must be Medicaid-eligible, at least 60 years old (for PDA Waiver) or 21+ (for CHC), and require a nursing facility level of care as determined through a standardized functional assessment of ADLs/IADLs. In this article, we explain what Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are and how needing help with these tasks is central to qualifying for Pennsylvanias Medicaid waivers like CHC and the PDA Waiver.What Are ADLs (Activities of Daily Living)?Activities of Daily Living (ADLs) are fundamental self-care tasks that a person must perform daily to maintain independence. Difficulty with ADLs often signals a need for supportive services. Core ADLs include: Mobility (Ambulating/Transferring): Safely walking, getting up from a chair, or transferring from a bed to a wheelchair. Dressing: Selecting and putting on appropriate clothing (including handling fasteners) without assistance. Eating: Feeding oneselfusing utensils to get food from a plate to the mouth and consuming it. Personal Hygiene: Bathing or showering and performing grooming activities like shaving, brushing teeth, and combing hair on ones own. Toileting (Continence): Independently using the toiletgetting to the toilet, transferring on and off, and cleaning oneself afterward. When someone can no longer perform several ADLs without help, it indicates that ongoing care or support is likely needed.What Are IADLs (Instrumental Activities of Daily Living)?Instrumental Activities of Daily Living (IADLs) are more complex tasks that allow a person to live independently in the community. While not necessarily performed daily, they are essential for managing ones household and life. Key IADLs include: Shopping for Essentials: The ability to shop for groceries, pick up prescriptions, or purchase clothing and other necessities. Meal Preparation: Planning and cooking mealsgathering ingredients and safely using kitchen appliances. Housekeeping: Keeping the home clean and livable tasks like cleaning, laundry, and taking out the trash. Money Management: Handling finances, such as paying bills on time, managing bank accounts, and budgeting. Transportation: Getting around or arranging transportationdriving oneself or using public transit or rides to run errands and attend appointments. Medication Management: Managing and taking medications properly remembering to take the correct medicines at scheduled times and refilling prescriptions. Communication: Using the phone or computer to communicatelooking up phone numbers, making calls, sending emails, and staying in touch with others. Trouble with IADLs is often one of the first signs that someone needs more support, even if basic ADLs are unaffected.Why ADLs and IADLs Matter for Medicaid Waiver EligibilityIn Pennsylvania, needing help with ADLs and IADLs is a central eligibility criterion for the CHC and PDA Waiver programs. These waivers serve individuals who would otherwise qualify for nursing facility care but prefer to remain in their own homes or community settings. Eligibility is determined through both financial and functional assessments. The functional assessment evaluates whether an individual requires hands-on assistance with ADLs and/or significant help with IADLs, thereby meeting a nursing facility level of care. Pennsylvania uses standardized toolsoften the Pennsylvania LongTerm Care Assessment System (PaLTAS) or the Minimum Data SetHome Care (MDSHC)to score independence in ADLs and IADLs.During the functional evaluation, an assessor reviews abilities such as transferring from bed to chair, walking safely, eating, toileting, meal preparation, housekeeping, medication management, and managing money. Cognitive issuessuch as memory problems due to dementiaare also considered since they impact daily functioning. If an individual cannot perform multiple ADLs without assistance or has significant deficits in IADLs, they are likely to meet the level-of-care requirement and become eligible for waiver services.Community HealthChoices (CHC) WaiverCommunity HealthChoices (CHC) is Pennsylvanias comprehensive HCBS waiver program for individuals aged 21 and older who require a nursing facility level of care. Administered by the Office of Long-Term Living (OLTL), CHC is a managed care program that combines physical health, long-term services and supports, and pharmacy benefits under a single plan (with behavioral health carved out). To qualify for CHC: Be age 21 or older. Meet Medicaid financial eligibility guidelines. Require a nursing facility level of care (confirmed through functional assessment). Live in a setting that meets HCBS requirements (e.g., home, apartment, assisted living). Be a Pennsylvania resident. Once enrolled, participants receive a comprehensive package of services tailored to their needs. Covered services may include personal assistance, home-delivered meals, adult day services, behavioral support, professional nursing, home modifications, assistive technology, transportation, and respite care. CHC also offers Participant-Directed Services, allowing participants to recruit, hire, train, and supervise their own caregiversoften family membersto assist with ADLs (bathing, dressing, toileting) and IADLs (meal preparation, medication reminders).PDA Waiver (Council on Aging Waiver)The Pennsylvania Department of Aging (PDA) Waiver, also called the Council on Aging Waiver, serves seniors aged 60 and over who require nursing facility level of care but choose to remain at home or in other community-based settings like domiciliary care homes. To qualify: Be age 60 or older. Meet Medicaid financial eligibility requirements. Be assessed as requiring nursing facility level of care (through the functional assessment). Live in a qualifying community setting. Covered services under the PDA Waiver may include personal care assistance, home-delivered meals, homemaker services, personal emergency response systems, respite care, adult day services, minor home modifications, and transportation. Like CHC, the PDA Waiver emphasizes managing ADL and IADL needs to keep participants safely in their homes.Participant-Directed ServicesBoth CHC and the PDA Waiver offer Participant-Directed Services, which empower participants to choose and manage their own caregivers, including family members, friends, or neighbors. Under this model, participants develop a service plan with guidance from a care coordinator, set schedules, and handle payroll tasks. This flexibility helps ensure that personal care and IADL support align with participants preferences and routines.Signs That Your Loved One May QualifyBelow are practical indicators that someone may be eligible for Pennsylvanias CHC or PDA Waiver due to difficulty with ADLs and IADLs: Trouble with Personal Care: Skipping showers, unkempt hair, or wearing dirty clothes may indicate difficulties with bathing and dressing (ADLs). Malnutrition or Weight Loss: An empty fridge or significant weight loss suggests issues with meal prep or feeding oneself (ADLs/IADLs). Mobility Decline and Falls: Struggling to walk without assistance, needing help to stand, or experiencing frequent falls signals reduced mobility (ADL: transferring/ambulating). Medication Errors and Memory Problems: Missing doses, mixing up pills, or forgetting appointments point to challenges with medication management and scheduling (IADLs). Household Neglect: Piles of mail, unpaid bills, or a cluttered home reflect trouble with housekeeping and money management (IADLs). A combination of needing help with several ADLslike bathing and toiletingand difficulties with IADLssuch as meal prep and housekeepingstrongly indicates a nursing facility level of care. Document these challenges for the functional assessment to demonstrate eligibility.Were Here to Help: Next Steps and Contact InformationNavigating Pennsylvanias Medicaid waiver programs can be complex, but you dont have to go it alone. At Passion to Care, we specialize in guiding Pennsylvania families through the CHC and PDA Waiver application processesfrom the initial functional assessment of ADLs and IADLs to completing paperwork and coordinating services once approved. If you notice your loved one struggling with daily tasks or if a professional has recommended nursing facility care, it may be time to explore CHC or the PDA Waiver. Our compassionate, family-first team ensures your loved ones needs are met with dignity and respect. Call us or contact us today to learn how to get started with Pennsylvanias Medicaid waivers for home and community-based services.

 Seniors Helping Seniors In-Home Care Recognizes Alzheimers and Brain Awareness MonthSeniors Helping Seniors Southwestern PA in-home care underscores the importance of compassionate support for those living with Alzheimers and the families who care for them.  PITTSBURGH, PA June marks Alzheimers and Brain Awareness Month, a time to shine a light on the more than 7 million Americans currently living with Alzheimers or other forms of dementia a number projected to nearly double by 2050. In honor of this important month, Seniors Helping Seniors Southwestern PA in-home care is raising awareness about the role compassionate in-home care can play in improving the quality of life for those affected by the disease. According to the 2024 Alzheimers Disease Facts and Figures report, nearly 12 million Americans provide unpaid care for people with Alzheimers and other dementias. These caregivers often experience high levels of emotional, physical and financial stress. Seniors Helping Seniors in-home care offers relief through peer-based, non-medical services designed to help seniors remain safely and comfortably in their homes while easing the responsibilities placed on caregivers. Our mission is to provide support, dignity and companionship to seniors including those facing memory challenges, said C.J. Girod, President of Seniors Helping Seniors Southwestern PA. By matching seniors who need care with active, compassionate older adults, we create a connection that enhances quality of life for both the caregiver and the care recipient. Seniors Helping Seniors in-home care provides flexible support with tasks such as meal preparation, transportation, medication reminders, light housekeeping and, perhaps most importantly, companionship a service that can be especially meaningful for those navigating memory loss. With new treatments for Alzheimers emerging and awareness on the rise, we believe its vital to offer families the support they need to navigate this journey, said Namrata Yocom-Jan, president of Seniors Helping Seniors in-home care. We are proud to be part of the care solution, providing personalized, respectful services that promote dignity and connection. ABOUT SENIORS HELPING SENIORS: Seniors Helping Seniors franchise system was founded by husband-and-wife duo Kiran and Philip Yocom. Kiran, who grew up in India, later worked to advance humanitarian efforts alongside Mother Teresa. After moving to the U.S. in 1995 and marrying her husband Philip, the Yocoms felt called to provide loving care to seniors and to cultivate an exchange of gifts at every generational level. Together, the Yocoms founded Seniors Helping Seniors in-home services in 1998, opening the brand up to franchising in 2006. With a mission to be the most respected and rewarding home care provider in the U.S., Seniors Helping Seniors locations stand apart from competitors as the only company that prioritizes hiring active seniors to provide care services to their less-active counterparts. Seniors Helping Seniors service aligns caregivers and care recipients based on the abilities and needs of both by offering a wide range of care services. Seniors Helping Seniors network has grown to 400 territories nationwide and over 200 franchise partners in 37 states. For more information on Seniors Helping Seniors in-home care, visit https://seniorshelpingseniors.com/.