Rehabilitation Services Blog

April 23, 2018

April is Occupational Therapy Awareness Month

“Good Morning, Mrs. Jones. My name is Elizabeth and I am here for your occupational therapy session this morning.”

It was 8:30 a.m. and I had just walked into the hospital room of a woman recovering from a hip replacement. She was sitting up in bed eating her breakfast and looked at me skeptically.

“Oh, honey, I don't need your help,” she replied. “I retired a long time ago.”

This was certainly not the first time I had a conversation that started like this. Many people have never heard of an occupational therapist. April is Occupational Therapy Awareness Month and an opportunity to showcase the profession and the work they do.

Mrs. Jones's comment is completely understandable. The title “occupational therapy” is enough to confuse most people. Naturally we all think of “work” when we use the word “occupation,” but occupation also refers to “an activity in which a person is engaged,” per An occupational therapist, therefore, is someone who helps you to improve and restore your daily activities. They are health care professionals requiring a master's degree and a license by the state to practice.

Occupational therapy has been a recognized profession in the United States since 1917 when five founders of the profession gathered together in Clifton Springs, New York to create what is now known as the American Occupational Therapy Association. The profession's roots are based on the “moral treatment” movement in mental health in which a humanitarian approach and “habit training” became preferred practice in mental health hospitals during the 19th century. Occupational therapy became a recognized profession during WWI and WWII when it was used to rehabilitate and reintegrate wounded soldiers into the community and work environments. The profession grew after the 1960s as it became research based and sought closer ties with the American Medical Association. Its practitioners began to specialize in physical disabilities, mental health or pediatrics. Today, occupational therapists may also specialize in vision, driving, ergonomics or hand therapy. No matter what area an occupational therapist specializes, the goal is always helping people to live life to its fullest.

Think of all the activities you do during the day to occupy your time, both fun and mundane. Did you get out of bed by yourself? Did you make your own breakfast and eat it? Did you take your medication correctly? Did you lift your child out of her crib and give her a kiss? Did you pay your electric bill? Did you spend all day following the stock marked on the computer? Did you play games with your grandkids? We do so many things every day without thinking about it. Add a new hip surgery, a stroke, a mental illness, chronic pain or an arm fracture to the mix and the things we take for granted become difficult. This is when your doctor may refer you to an occupational therapist.

Occupational therapists work with people of all ages and in almost any environment you can think of, including hospitals, homes, schools, outpatient centers, prisons, community centers and homeless shelters. They customize their treatments to fit the unique needs of each individual person. They do this by looking at the person needing the treatment, their environment, and the activities that the individual needs to accomplish. Some examples of occupational therapy practice include providing adaptive equipment recommendations and a home exercise program for a person with arthritis who wants to continue gardening and cooking, providing strategies to a person with schizophrenia for managing their symptoms and an apartment, helping a student with attention deficit disorder find ways to tolerate sitting in a busy class room and concentrate during a test, and teaching the family of a person with a stroke how to help with self care and arm exercises.  

Occupational therapy is used to help people of all ages live life to its fullest by helping them promote health, prevent—or live better with—injury, illness, or disability. If you think you or someone you know might need occupational therapy services, consult with your doctor. For more information on occupational therapy, visit the American Occupational Therapy Association website at
Elizabeth Doherty, OTR/L, CHT 
Elizabeth Doherty is an Occupational Therapist and Certified Hand Therapist at Palomar Health Outpatient Rehabilitation Center in Poway, CA. She is a 2005 graduate of San Jose State University with a Master in Science. She has a special interest in neurological rehabilitation.

April 16, 2018

From Dysfunction to Function: Tips, Tricks, and Fixes for the Sacroiliac Joint

Have you ever heard someone mention their SI joint and had no clue what they were referring to? No worries, today’s blog post will provide information about what the SI joint is and how we can implement exercises to strengthen and stabilize this joint to optimize daily activities and keep them pain free! 
Where is the SI joint? The sacroiliac joint (SIJ) is the joint is the connecting point between the spine and pelvis. The SIJ connects the sacrum, the triangular shaped bone AKA the tailbone, with the pelvis, specifically the iliac bone in the hip, on each side of the spine. There are many ligaments and tendons located at the spots where the bones meet to help keep the pelvis sturdy. 
The SIJ is known to be a stiff or rigid link where the spine and pelvis meet with limited degrees of movement to promote stabilization for our bodies. In some cases, our bodies may have increased or decreased mobility to one of both SIJ joints leading to SIJ dysfunction. This can occur for many reasons from trauma or excess mobility and lead to more stress to the joint. It is also important to note that discomfort of the SIJ joint doesn’t also mean it’s solely related to the SIJ, it may be occurring because of deficits in mobility or strength in other areas of your body. It’s important see a Physical Therapist to help discern where the SIJ discomfort could stem from. 
Let’s review the different types of SIJ dysfunction:
  • Hypomobility = stiffness
  • Hypermobility = laxity, loose
Both can be lead to discomfort or negatively impact our day to day movements such as walking, sitting and stairs if irritated. It is common for pregnant women to experience SIJ pain or discomfort due to the increased ligament laxity during pregnancy due to hormonal changes. Also, people who favor one side in standing or have job requirements placing their body, specifically pelvis and hips in compromised positions can also be at risk.
Don’t worry though, we, Physical Therapists, are here to help! There are many ways to strengthen and stabilize the SIJ to successfully function. Included below are some helpful tips to promote safe body mechanics and positioning for daily activities to promote SIJ stability. Our intention is to provide you with the tools and information to make your SIJ joint bulletproof so you can feel empowered to pursue your daily activities safely with confidence and pain free. 
  • Bend your knees slightly
  • Distribute your weight evenly on both legs, avoid favoring one side
  • Point your toes slightly outward
Rolling Over in Bed:
  • To roll over from your back to your side, bend one knee, placing your foot on the bed. Push the heel down, slightly lifting your bottom and turn towards the side on which the leg is still extended straight. The top arm helps the turning motion.
  • When sitting (whether you are driving a car, riding a bicycle or sitting on a chair), press your chest upward and let your shoulder blades relax and drop.
  • Sitting crossed legged with your feet crossed underneath your legs on the floor or on a very firm bed; use your hands to pull your knees gently back towards your hips and lift your chest, and keep your shoulders low.
I frequently tell my patients, the next posture is the best posture, for example, if you have been sitting in this position for a while, stretch forward as far as you can and touch the floor in front of you while keeping your spine straight. At the same time, look up. Practice this stretch as often as it feels necessary and good.
Static Sitting Positions:
  • Sit on a chair with your knees apart and slightly turned out.
  • Sit in positions that relax your lower back while it remains supported, using a cushion or a rolled towel behind your back; sit upright when the back is not supported.
  • You can also stretch your hips by sitting high enough so that your knees are lower than your hips or by crossing your feet under your chair.
  • Use a ball cushion while you are sitting, or sit on a therapy ball; sitting on a ball cushion allows your tailbone to be free. When you use a ball cushion or ball, you develop active stomach and back muscles over time as a result of trying to maintain your balance.
  • A good posture for resting is lying on your back on the floor, putting your feet up on the couch or bed, with a small pillow to support your back and/or head.
Now that you’ve learned some tips for safe positions for the SI joint with standing and sitting postures, we’ll go over five exercises to improve stabilization of your SIJ for stabilization and strengthening to promote active lifestyles with daily activities, hobbies and job duties.  
5 exercises to improve stabilization of your SIJ:
1. Hip ABD isometrics 
2. Glute bridges with band 
3. Quadruped hip extension
4. Clamshells
5. Bridge with alternating march
*Exercises and photos courtesy of MedBridge Education*
To access videos and further descriptions please go to 
Enter in the Access Code: LTHF3CWC

Lindsey Paczkowski, PT, DPT
Lindsey graduated in 2016 from Carroll University in Waukesha, WI with her Doctorate in Physical Therapy. She is a LSVT BIG certified clinician and specializes in treatment of musculoskeletal and neurological diagnoses, in addition to an interest in women's health patient population. Lindsey currently works as a Physical Therapist at Palomar Health Outpatient Rehabilitation in San Marcos California. In her free time, Lindsey enjoys spending time at the beach and hiking with her husband, cooking new recipes and learning to surf.

April 2, 2018

My Speech is Fine, So Why Would My Doctor Recommend Speech Therapy?

When clients come to outpatient rehabilitation for physical therapy or occupational therapy, they usually come with specific goals in mind, such as reducing pain, regaining lost function or improving mobility. I have found that many clients who come for outpatient speech therapy, enter the office and the first thing they say to me when we sit down is, “I have no idea why my doctor sent me here, I can speak just fine.”

A common misconception is that speech therapists (speech language pathologists) are limited to the school setting and work on sound production, such as helping with a “lisp” or “stutter.” In fact, speech therapists get a two-year master’s degree focusing on a much larger scope of practice across the life span from childhood to adults. Speech therapists who work in the adult setting evaluate and treat communication disorders, cognitive disorders, voice disorders and swallowing disorders. Referrals for speech therapy often come from primary care physicians, neurologists, ENTs, pulmonologists and GI doctors. Changes in communication, cognition, voice and swallowing often occur after a neurological event, such as a stroke, but can also occur with progressive neurological disorders or often occur over time due to aging.  

If you have noticed mild changes with communication, cognition, voice and swallowing, many times it is part of the normal aging process; however, if these changes occur suddenly or get to a point where it impacts daily life, consider speaking with your physician. Speech therapists can often help with educating individuals about compensatory strategies, modifying behaviors or even exercises to improve muscle strength with voice and swallowing. 

Michelle Nandipati MS CCC-SLP
Michelle Nandipati has a masters degree in Speech Language Pathology from the University of Washington with a certification in Lee Silverman Voice Therapy. Michelle works with a wide variety of patients in outpatient, inpatient and at the skilled nursing facility for swallowing, voice, speech and cognitive therapy. Outside of work Michelle enjoys traveling, dancing and outdoor activities.


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