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Electronic medical records help the surgeon stay up to date on the most recent information concerning the patients well being, response to new medications and general all around care they may well be getting. It is proven that there are a lesser amount of serious errors made by using electronic medical records, partially because they can be accessed by more then one individual at a time, where paper records can only be viewed singularly. Several paper records could be imperfect when the physician seeks information from them, such as Lab or X-ray results that haven’t been entered yet. Data entry delays such as these can be cause likely errors in the patients care and therapy plan.

Various doctors state that changing to the electronic medical records system has improved the care they are able to give their patients tremendously. On previous count more then fifty percent of private doctors had switched to using electronic records. Of the ones that remain who haven’t yet purchased a system, they stated the reasoning is that the price is too high at the current time, but that they had intentions of switching in the near future.

An added benefit of using electronic medical records is that it saves space. The medical office will no longer have to be overflowing with filing cabinets packed of patients paper records. Since it doesn’t take very long for the patient care provider to place new information onto the patients electronic record, it also saves staff time. The drop in usage of paper is also a capital saver. Not only do physicians office and hospitals conserve space and use much less paper, the insurance companies also reap the benefits of electronic medical records. Because the doctors office can remit records immediately to the insurance company, any claims are handled in a much faster method.

Since some patients might have multiple medical problems that cause them to see several different types of physicians the electronic system allows every doctor to keep track of what is happening in the patients all around medication course.

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A result of stroke is that muscles may not remember how to perform tasks that were once simple, like sitting and cycling. A stroke patient needs to, with the help of a physical therapist, relearn these skills. Muscles will be retrained and be reminded how cooperate again with physical therapy.

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Regaining mobility with physical therapy
Physical therapy focuses on getting the stroke patient to use arms and legs that have been affected or paralyzed by the stroke.

While occupational therapy concentrates on helping post-stroke patients learn to feed themselves, chew and swallow, and groom themselves, the main goal of physical therapy is mobility. Physical therapy goals are making the stroke patient able to walk, sit, stand, and get in and out of bed, a chair, and a car all on their own.

The procedure in the Frazier Rehab Institute, a service of Jewish Hospital and St. Mary’s HealthCare in Louisville, Ky is explained by Mary Ann Owsley, PT, supervisor of the physical therapy stroke team for inpatient rehab. Physical therapists evaluate and treat the dysfunctions that stroke patients are coping with, the musculoskeletal deficits. Therapy will start in acute care, with early mobilization training and exercises.

They get them out of bed and moving around as soon as possible, even if initially all they are able to do is sit up on the side of the bed and train sitting balance. They progress to being more independent with all of their basic mobility, from getting in and out of the wheelchair to the bed, to walking with different types of aids, like canes and walkers.

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Success through strength
Physical therapy involves using the muscles and strengthen them, even before the patient can do this on his own. Therapy contains both active and passive range-of-motion and strengthening exercises. Active exercises are ones the patient performs on his own strength; passive exercises are performed by the physical therapist or with help from the therapist. Both types of exercises help to make the muscles stronger.
The physical therapy contains an exercise plan for the patient which makes sure that muscle strength can be maintained and new skills will be repeated..

Educate the family
Training the family members and caregivers is also a part of physical therapy.. Start working with the families as soon as possible. So the family can help with any of the techniques for positioning and range of motion. Educate the family togehter with the stroke patient as far as the limitations that they may be left with.”

Follow a plan
Physical training often starts while the stroke patient is still in the hospital. It is useful to continue to work with the same physical therapist once you return home or move to the inpatient stroke rehab centre as in the hospital. However, if your initial rehabilitation was not at a primary stroke centre with health providers specifically trained in stroke, try to find a physical therapist to help with your stroke recovery at a certified stroke rehab centre.

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Cost management
Often, private health insurance plans will not cover all of your expenses. Health insurance often cover either a percentage of the therapy costs or a set number of therapy sessions. Usually Medicare pays for post-stroke physical therapy. Check out your coverage before physical therapy begins so you understand what costs you will be responsible for yourself.
Physical therapy works best when it starts in an early stage and is continued regularly. Follow sessions a few times each week. Your muscle will start to remember and respond and your body will repair the damage done by stroke, but it takes time.

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Become Active!
The best medicine you can get without a prescription may be physical activity. Frequently exercising can reduce stress and help relieve depression. It improves the strength of your heart. Even your blood pressure will drop. Always talk with your doctor before you start a new exercise. Make sure the new exercise is suitable for you. The risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke can be increased by being inactive, obese or both.
So go on a brisk walk, take your bicycle out, and do whatever you can to make your daily routine more active for a total of at least 30 minutes every day.

How to start?
Even moderate exercise, such as strolling or cycling, can improve your health. Here are three simple ways to start with, for a more active life.
• Do, throughout the day, small amounts of activity. For example, stretch your arms and legs while sitting. Or, wash the dishes in a standing position.
• To start, add each day a 10-minute walk to your actual level of activity. After two weeks, add on a few minutes more. You can build this overtime up to walking 30 minutes per day.
• Join scheduled courses or participate in sports.

How to stick with it
• Find a group of activities and exercises you like. Choose activities which are fun and that you enjoy. Add variety. That makes that exercise won’t seem boring or routine.
• Ask your physical therapist or doctor to prescribe muscle-strengthening exercises.
• Find a favourable time and place to exercise. Try to make it a habit to exercise, but stay flexible.
• Wear decent and properly fitted footwear and comfortable clothing. Make sure you adjust your shoes and clothes to the weather and the activity.
• Keep yourself entertained and motivated with music while you do home exercises.
• Surround yourself with supportive people and share your activities with others. Make a date with family members, friends or colleagues. Decide what type of support you need. Do you need others to remind you to do your exercise? Inform about your progress? Join you with your exercises regularly or occasionally? Allow you take your time to exercise by yourself?
• Record your activity in a chart. Reward yourself for accomplishing a special milestone, such as three weeks cycling without missing a day.
• Join a health and fitness club or centre. A proper fitness centre should have qualified instructors who can help you find the best exercises for accomplishing your specific goals. But remember to ask your physical therapist or doctor before starting a new exercise program.

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It is for your own good to get at least 30 minutes of moderate physical activity on every day of the week. You can start cycling 10 minutes at a time, working your way up to 30 minutes a day.
Besides helping you control your weight, cycling may…
• Help you giving up smoking..
• Decrease your blood pressure.
• Raise your HDL (“good”) cholesterol value.

Along with cardiovascular benefits, regular physical activity such as cycling can help you feel and look better. You’ll probably feel better because regular physical activity…
• makes you energetic.
• improves your self-image en self-esteem.
• reduces fatigue and exhaustion.
• helps you to relax and loose tense.
• helps you to fall asleep quickly and sleep well.

You’ll look healthier and better because regular physical activity…
• Tones your muscles nicely.
• Helps you to control you weight.
• Helps you to control your appetite.

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Get up and get moving! If you are more active, you are more likely to recover fully and quickly.

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• Exercise plan. To prevent deep vein thrombosis the Veteran’s Administration recent guidelines recommend that patients get back on their feet as soon as possible. Post-stroke patients should try to walk at least 50 feet a day. Assisted devices or bracing are sometimes used to help support the legs. For patients with mild-to-moderate dysfunction, treadmill exercises can be very useful. Physical activity should be adapted to the stroke survivor’s physical condition and can include aerobic, strength, flexibility, and neuromuscular (coordination and balance) exercises.

• Muscle retraining. Helpful exercises to treat spastic muscles are stretching and range-of-motion exercises. A new approach is Bilateral Arm Training with Rhythmic Auditory Cueing a.k.a. BATRAC that may benefit patients who a paralysed arm. It may even help people who have had stroke paralysis for many years. The BATRAC method involves moving a bar with both arms in a sustained rhythmic pattern. The Journal of the American Medical Association reported that BATRAC helped patients get back use of their affected arm. The study also showed that patients who received BATRAC had more activity in the motor cortex region of the brain. The patients in this study had a stroke at least 4 years before taking part..

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• Therapy for speech and sign language. People who have experienced a stroke are often seen with aphasia, a brain condition that makes it hard to speak and understand language. There are many different forms in which aphasia may come. A person may have difficulty saying the right word or may even be unable to speak at all. Intensive speech therapy after a stroke is essential for recovery. Some specialists recommend nine hours a week of therapy for three months. A study in 2005 indicated that a shorter period (three hours a week for ten days) also works well. Language skills improve the most when the patients environment help reinforce the speech therapy lessons.

• Biofeedback methods combined with physical therapy. In certain cases this combination has been beneficial. For example, electrical stimulation of the throat, may help post-stroke patients with dysphagia recover their ability to swallow faster. Wrist and finger stimulation also shows a promise for improving motor capabilities.

• Exercises for swallowing. A promising research reported that swallowing improved when patients performed a simple exercise three times a day for six weeks. They lay flat and raised their heads, holding them up for 1 minute with a 1 minute rest in between, and repeated this three times. The following exercise was thirty consecutive head lifts.

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• Concentration training. Problems in concentration are very common stroke effects. Direct retraining teaches patients to perform specific actions using repetitive drills in response to a certain stimulus. (For example, each time they hear a specific number they have to ring a bell.) Other variants of this approach trains patients to relearn real-life skills, such as cycling, making conversation, or other daily tasks.

• Occupational therapy. Occupational training is essential and improves participation in daily living and social activities.

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The scientists realized that this would certainly increase recovery time, then they strapped the monkey’s good arm to its body, which motivated the monkey to use the free, but affected arm. This improved the recovery. The scientist called this “forced therapy.”
Since then, new names were adopted for this therapy, including constraint induced therapy (CIT) and constraint induced movement therapy (CIMT). The positive effects of CIMT were shown in a randomized control trial which was published in the Journal of the American Medical Association at the end of 2006

CIT for who?
The clinical experiment (EXCITE), which proved the effectiveness of CIMT, revealed that it performed best for persons with moderate strokes affecting the arm and hand. In the experiment, the patients moderate strokes affecting the arm and hand showed functional improvement whether their stroke occurred 3 or 9 months before the therapy started, which implies that CIMT might be effective even for patients who suffered a stroke years ago. Preserved cognition is another possible requirement, as this was a requisite for participation in the EXCITE experiment. However, as of early 2009, there has been no studie whether CIT can be used in patients with mild to moderate cognitive impairment.

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How is CIT actually performed?
As you can read from the above, the main intervention in CIMT is forcing a person to use a affected limb as much as possible. In fact, in stroke survivors who are left with a dysfunctioning arm, the goal is to “force them” to use only the dysfunctional arm to perform routine activities such as feeding or getting dressed.
The use of mittens and arm slings prevents patients from using the intact arm for at least 90% of a person’s active time. The program goes on for several weeks. In addition, patients take part in intensive physical therapy sessions of the dysfunctional limb for at least six hours per day, up to seven days a week.
That this rigorous program improves function by inducing a functional reorganization of the brain, has been shown by several studies.

Where can I receive CIT?
Not every rehabilitation centre offers CIMT, neither
does every health insurance policies cover it. Start by asking a local rehabilitation centre whether they offer CIT. You should then ask your physician whether he thinks this therapy is suitable for you. Once you get a referral (or prescription) for therapy, you should then find out if your insurance policy will cover it.

Don’t be discouraged when you are kept from the rehabilitation centre because your insurance policy doesn’t cover the costs. Specialists in this subject are now advocating for home programs with the sporadic guidance of a physical therapist. And in theory, you could do this on your own while you are doing your daily activities.

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Do you the best you can. The more time and effort you put in doing it, the better it will be for your rehabilitation. A mitten or a sling is all you need. Just discuss with your doctor about it before you start to make sure that this is a suitable therapy for you.

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February 2001, Swain was diagnosed with Multiple Sclerosis (MS). The doctors told that she had been battling this disease for more than 20 years without a diagnosis. At the time, she worked as a senior director of human resources for sixty hours a week at Wyeth Pharmaceuticals in New York. She was always on the go, she was such a busy person, and she wasn’t finished with her career yet when it hit. Within months, her career was over. It turned her world upside down, going from being overly busy to nothing.

Before she had been diagnosed, Swain had experienced; bouts of numbness, migraine headaches, tingling sensations and balance issues. However, these symptoms weren’t persistent enough for her to contact a doctor, they would come and go. In 2001, the symptoms grew more intense and became more consistent.

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She had numbness in her left side and weakness particularly in her arm. She was tripping a lot, had tremors in her left side and was experiencing dizziness. She noticed that when she used her cars turn signal, she reached across to turn it on with her right hand because her left arm was too weak to lift.

Everything happened really fast. She tried to go back to work but about a month after she was diagnosed, she woke up and her entire left side was numb. She was in the hospital for a month, and the doctors told her it would be next to impossible to go back to work. They thought she would keep getting worse until she would eventually be confined to a wheelchair.”

Swain made up her mind and was determined not to let that happen. She actively followed physical therapy and did activities which kept her body moving. Through her physical therapist, she became involved in many adaptive sports programs including kayaking, horseback riding, sailing and hand cycling. The program also included a golf class; however, Swain never got around to participate in it before she and her husband moved to Aiken a year ago.

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Upon moving to this area, she discovered there weren’t as many adaptive programs offered as in New York. She still hand cycles and kayaks on a regular basis as these have become independent sports.

A few weeks ago, Swain discovered a story, while reading the Aiken Standard, on an adaptive golf program offered at Walton Rehabilitation Health System in Augusta and she decided to participate.

If she had to describe the overall experience in one word, it would be liberating. It is nice to be able to go out and act like normal people do. It is absolutely fun. If anybody wants to try and has doubts about their skills, then don’t. Everybody is nervous to do this the first time. Swain had never picked up a golf club, but there are people with all a different level of skill.

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Swain worked with a volunteer, during her first visit. She learned how to swing and has since seen her skills develop.

She has to hit with one arm because she has to hold herself up with a crutch. After a couple of good hits, she told James (a volunteer) that she wanted to hit the flag. James was encouraging, but Swain doubts whether he thought she was serious. When Swain hit the flag, James was as happy as I was.”

During the second visit, Swain and others were helped with their putting skills. This time, she worked with a physical therapist and a belt. The therapist squatted behind her attached by the belt to offer her balance while she learned to putt.

She had never played golf before, and thought; since I live in a golf community, I should learn how to play. She liked it. Although she can’t do many things she did before, and she has lost a lot of friends because they didn’t know how to react. But now she has new friends and new activities. She is happy these activities are available for her as they help her cope with struggles physically and emotionally. She gets up every day and puts one step forward.

Sports can also be a solution to your problems. Find out which type of sport you like and whether it is suitable for you. There are loads of device that can help you to do these activities.

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Here are 15 ways how you can fight against fatigue. All the little things you do each and every day can make a difference.

1. Be aware of side effect of medications. There are medications which are well known to have a side effect of fatigue, like anti-depressants. Talk with your doctor and determine what side effects each medication your on has, and whether there is a substitute.

2. Drink water, always in sufficient amount.: Fatigue can be caused by dehydration Many people with MS don’t like to drink large amounts of water because they suffer from an over active bladder. But water is need to energize our bodies and to remove toxins.

3. Proper breathing: Shallow, short breathes will reduce the amount of oxygen coming into your longs, what leads tot less oxygen in your cells, therefore it makes you feel fatigued.

4. Exercise: It is commonly known that exercise increases energy. There are no excuses regardless of what level you are at with your MS for not exercising.

5. Being depressed: When you don’t accept multiple sclerosis, when you are unhappy about your current life you will be depressed and this causes the by product fatigue. Using techniques to change your mental state, will allow you to relive all the good memories that happened to you in the past and therefore remove depression out of your life.

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6. Heat: To much heat increases your disabilities and fatigue and just makes you feel bad. Anytime I go out in hot weather I can go from walking normally to barely walking at all. Don’t go out in the heat, use a cooling vest or look for activities that keep you cool like swimming.

7. Simple carbohydrates: White bread, white pasta, and sugar slow you down and fatigue you, because they contain simple carbohydrates. Follow a diet of whole foods consisting of fruits and vegetables.

8. Vary in your routine: turn around your normal daily schedule. Variety is something we all need every day. And make sure you plan something enjoyable for the future that you can look forward to.

9. Aromatherapy: Peppermint and jasmine essentials oils are known to be energizing experiment with these and other oils. Put a few drops on the collar of your pullover to smell jasmine during the day, or take the bottle of peppermint with you and sniff when your feeling fatigued.

10. Sleeping routine: Go at the same time to bed every night. Not getting enough sleep troubles most people, this may be caused by leg spasticity, what can keep you up at night.

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11. Weight reduction: feeling fatigued can be causes by being overweight. Watch what you’re eating pattern and activity to maintain a healthy weight.

12. Pacing, planning and prioritizing your life: Having balance in your life is important. It’s important to balance rest and fatigue. Form a plan on what needs to be done and organize your tasks so that they are manageable.

13. Eat Breakfast Everyday: Your blood sugar is low when you wake up, eating a decent breakfast is an energy booster. Not eating breakfast drains your energy contributing to fatigue.

14. Control your iron value: when you don’t get in enough iron, you will feel fatigued. Eat fish, eggs, fortified cereals, and beans to keep up your iron levels and be able to fight against multiple sclerosis fatigue.

15. Asking for help: Fatigue is a symptom of Multiple Sclerosis and therefore you should not feel bad when asking for help. Spend your energy wise and useful. Determine what you can and ask others to help you conserve your valuable resources.

The AccessIDSM Card will help reduce the margin of error in an emergency by providing critical information to doctors and other health professionals when a patient is unable to speak for himself. Immediate access to your valuable health records will be available through our secure website or by calling a 24/7 toll free hotline.

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