You Can’t Stop The Clock, But You Can Slow Its Tick.

By: Rachel Marin, Master of Clinical Exercise Physiology

As you get older, an active lifestyle becomes even more important for your health and to ensure you maintain independence, recover quickly from illness and reduce the risk of disease.

As an exercise physiologist, new clients will often ask me, “Isn’t it better for older adults to ‘take it easy’ and save their strength?”

And the answer to that is an emphatic ‘NO’. Regular physical activity is very important to the health and capabilities of people as they age. In fact, studies show that ‘taking it easy’ is the riskier path to take, and that people who are physically active have increased overall health and longevity compared with physically inactive people[1].

What do we mean by physical activity?

Regular physical activity can be something as simple as a brisk 30-45min walk nearly every day. It’s about choosing what’s right for you to keep you fit and well for the long term.

Some older people may be affected by chronic health conditions such as arthritis or osteoporosis, which may limit their exercise options, in most cases these physical limitations don’t rule out all activities.

The best approach to take is to talk to your physiotherapist or exercise physiologist who will work with you to create a personalised exercise program that is healthy and safe.

It’s never too late!

There have been a number of studies that have shown that it is never too late to start exercising, and that physical activity is the main contributor to longevity even if you don’t start exercising until your senior years.

As you age, exercise is one of the best things you can do to keep the effects of ageing at bay. In fact, exercise has the ability reverse the symptoms experienced by those with heart disease, diabetes, hypertension, some cancers (breast and colon cancer), depression, osteoporosis, and dementia[2].

No matter your age or physical condition, it’s never too late to get your body moving. Dedicating just 30 minutes of time each day to exercise can ensure your body will continue to benefit well into your 80s.

Get strong and reduce your injury risk

Imagine if there was a form of exercise that could strengthen bones, benefit your heart, help you lose weight, improve your balance AND help prevent injury. There is! Strength (or resistance) training will do all that as well as help you look and feel better.

What is strength training?

Strength training is moving the joints through a range of motion against resistance, requiring the muscles to expend energy and contract forcefully to move the bones.

Strength training is not just about body builders lifting weights in a gym. Regular strength or resistance training will benefit anyone and also helps prevent the natural loss of lean muscle mass that comes with ageing. Being able to move well and with good control over your body will reduce the risk of serious injuries.

Other benefits of strength training

  • Protects bone health and muscle mass

  • Helps keep weight off

  • Helps with chronic disease management

Types of strength training

No single approach to strength training is best for everyone. The choice you make should be based on your physical fitness level, your fitness goals and past injuries. Strength training can be done using various types of resistance, with or without equipment:

  • Machine weights – an effective weight training tool that is safe when used with the proper technique

  • Free weights – versatile and inexpensive, they are generally safe when used with the proper technique

  • Own body weight – with the right technique this is mostly safe and requires no equipment or gym membership, meaning they can be done anywhere, anytime

 

How does strength training prevent injury?

There have been a number of studies that have shown how effective strength training is for injury prevention and management.

This applies to joint injuries, muscle injuries, tendon pain, running injuries... and more!

Strength training improves the strength of muscles, tendons, and even ligaments and bones. Stronger muscles and tendons help hold your body in proper alignment and protect your bones and joints when moving or under impact. Your bones become stronger due to the overload placed on them during training and the ligaments become more flexible and better at absorbing the shock applied to them during dynamic movements.

For example, strengthening the quadriceps muscles in the leg and the gluteal muscles in the hip will improve the movement and control of the knee joint, which is a common instructive in the management of anterior knee pain.

Things to keep in mind

  • A good warm up is critical to prepare your muscles for exercise

  • Ensure you allow enough rest time in between sessions to give your muscles a chance to recover

  • Use the correct form of the exercise, ensuring your body is in proper alignment.

It’s important to build your strength in a gradual and controlled way, and over a period of time as doing too much too soon is actually a significant contributor to injuries and injury risk.

Getting started

If you want to get started with a strength training program, it’s a good idea to get an individualised program that has been designed for you, and to work with a physiotherapist (or other appropriate health professional) to ensure you are executing the exercises properly.

Overall, the idea is for you to integrate exercises that build strength all over, ideally by doing moves that use more than one body part (like push-ups, or squats). Keep things simple at first and time-efficient, since the more convenient your exercise routine is, the more likely you are to stick with it.

Former POW, Arthur Legget, on turning 100!

HomeCare Physiotherapy patient and former POW, Arthur Legget, shared his secrets to a long life with our physiotherapist Lincoln Smith on turning 100. What a legend!

When did you start with HomeCare Physio? Can you remember why you started?

“2 or 3 years ago Mount Lawley rehab centre thought it would be a good idea so I thought ‘Yes, it will keep a man in line and make him do a bit of exercise here and there.’”

What advice would you give others that want to live to 100 years old?

“I’ve always listened to my Doctors and physios. I make sure I eat well – meat and vegetables for dinner, custard and fruit salad for sweets. And I have always stayed active. I have run marathons, completed the Avon Decent and a few other crazy things. - I’ve done all the things males do as they strut around the garden of life to show off their feathers – I also don’t drink to excess, but I still enjoy a drink when with friends. Oh, and don’t die!”


What does your normal routine involve?

“I’m always up around 7:30 in the morning, have breakfast, do my morning exercises and then see what crops up for the day. I’m always trying to stay busy. I watch TV with dinner and try to be in bed at 9:30 each night.”

How much exercise do you do per day?

“I’ve timed this, I normally do 35 minutes of exercise in the morning and 35 minutes in the afternoon. I try and at least do at least an hour every day.”

So, at 100 years old, you’re doubling the daily recommended exercise?

“Yes, I guess I am.”

What is the most amazing invention in your lifetime?

“I’ve seen the first man fly the Pacific Ocean and the first man to fly on the moon. I’m not quite up to date on all of the modern gadgets, I have a mobile phone but it normally stays in my bedroom draw. I can send emails but you won’t find me on Facebook, I’ve been left behind!”

What is your greatest achievement?

“Leaving behind a legacy that will last at least another 100 years, I raised $40 000 for the Ex-Prisoners of War memorial in Kings Park which has been adopted by Mount Lawley Senior High School. I also managed to convince my wife to marry me, she was a wonderful woman who helped shape my life.”

What was your first memory?

“Starting school, I lived in NSW and dad was the town bootmaker. I remember walking to school every day. It was a great place to grow up!”


When you were a prisoner of war, did you ever think that you would live to be 100 years old?

“No – I only focused on living through the next day. I unsuccessfully tried to escape a couple of times but there was no-where to go that wasn’t occupied by the Germans.”

What does a 100 year old do for fun?

“I like to write poems, I’m a member of the Bush Poets and Yarn Spinners Club. I like to phone my friends up to talk to them and keep in touch.”

What do you do to stay mentally active?

“I’m aware of the possibility of becoming mentally dull and uninteresting. I want to start another project to keep myself on my toes. I’m thinking of trying to learn the keyboard, I’ll have to find a tutor.”

What is the plan for the next 100 years?

“Still endeavour to be an interesting old man, I still want to challenge myself mentally and physically and maintain my health as best I can. I don’t want to become a problem for anyone! I’m not frightened of dying though, I want to make the most of the time I’ve got left.”

Diabetes and Lower limbs

What is Diabetes and how can it affect you?
By Farhanah Ho, Podiatrist

Diabetes is a lifelong serious health condition in which the body’s levels of blood glucose and the hormone insulin are out of balance. It is the fastest growing chronic disease in Australia. There are many complications associated with diabetes; particularly if it is poorly managed.

Foot complications are common and account for more hospital admissions than any other diabetic complication.

How diabetes affects the feet?
1. Neuropathy: Uncontrolled diabetes can damage the nerves. Damaged nerves in legs and feet results in a lack of feeling called "sensory diabetic neuropathy." This means that you might have reduced sensation to heat, cold, or pain; which could lead to a lack of treatment and risk of infection.

2. Peripheral vascular disease:  Poor circulation to the feet, due to blockage of the blood vessels.

Under these circumstances, even a minor foot problem of little significance to other people can be hazardous for people with diabetes.

Getting it checked by a Podiatrist
The consequences of diabetes manifest slowly over a period of time. As a result, by the time they are noticed it is often too late to prevent and the focus of treatment becomes the prevention of ulceration and the subsequent consequences.

Therefore diabetics are advised to have an assessment done by a Podiatrist. Diabetic Foot Assessment (DFA) consists of checking the:
o   Circulation: pedal pulses via palpation and doppler ultrasound.
o   Skin condition: anhidrotic, corns, callous, fissures, ulcers, infection, etc.
o   Nerves: Sensation and reflexes.
o   Toenails.

A DFA will determine if you have already developed diabetes complications in your feet. DFA is usually done annually for low risk cases (good sensation and circulation) or more frequently for high risk cases (signs of neuropathy &/or PVD problems).

Then foot and nail care can be effectively managed to prevent potentially serious complications.

If you have diabetes and would like a diabetic foot assessment please call us 9424 0233

Are You Concerned About Your Memory?

Memory is the ability of the mind to store and recall past sensations, thoughts and knowledge. Memory plays a key role in helping us plan for future events. Changes in memory can be caused by several factors such as age, chronic illness, disuse, anxiety, medications, alcohol, sensory problems, poor diet, depression and grief. There are strategies that can be used to reduce the impact of memory loss on daily activities and the stress and anxiety this can cause. 

These can include:
1. Using assistive devices that help to substitute for memory, such as  
    • Webster packs for medication
    • Diary/Day books/Wall hanging calendar
    • Electronic reminder devices e.g. medication alarm
    • Post-its      
    • Watches with multiple alarms
    • Clocks with date displays

2. Learning strategies, such as
    • Writing memos to self
    • Leaving post-it notes around the home
    • Making to-do lists
    • Placing objects together at the point needed ahead of time

3. Developing habits, for example:  
    • Carry out frequent tasks at the same time each day

4. Carrying a notebook or tape recorder with you to record things that you need to remember wherever you are

5. Keeping a notepad and pen next to the phone to write down messages straight away

6. Concentrating on one task: Avoid doing two things simultaneously and minimise external distractions  e.g. turning

. Doing important activities when you are not tired, as stress and fatigue can impact on your concentration and memory

8. Pre-planning events: use diaries, calendars, timetables, checklists or noticeboards to trigger things that need to be remembered or done
    • Cross off the previous day on the calendar first thing in the morning
    • Prepare things the night before
    • Tick things off as they are completed
    • Use an alarm to move onto the next thing

9. In the kitchen, laundry, bathroom and bedroom: always keep items in the same place.
      • Group like items together so that they are easier to find e.g. house keys and car keys       
         together
      • Use labels to remind yourself where items are kept

10. Organising information so that it is easier to remember; cue or prompt only when absolutely necessary

11. Teach yourself or family member to repeat information out loud as you will remember it more easily

12. Teach yourself or family member to ask for information to be repeated, clarified or given more slowly

13. Capitalise on strengths- Is your visual memory better than verbal memory? If so use pictures to identify objects used often


If you would like a memory assessment and further advice on how to maintain your independence, an Occupational Therapist can help you with this. Call us on 9424 0222

There is no place like home; but is it safe as you age?

A home isn't just the place where you live; it is also the place where you feel safe and comfortable. It is a place where you have freedom and independence. However, as we age, these are the very values that can be a challenge to maintain.

When should you acknowledge or your adult children or carers step in to ensure you have the support you need? It's important to recognise the signs that indicate more help is needed, so the right assistance can be provided to keep living independently for as long as possible.

Here are five things to consider about living at home as you, or a loved one, ages:

Home delivery

Medical and allied health specialists can visit you and provide complete care in the comfort of your own home. Physiotherapists, podiatrists and occupational therapists and other Allied Health Services, can all provide home treatment, which removes the stress of having to travel to appointments and the inconvenience of arranging transport, parking hassles and waiting times. 

You can receive one-on-one attention for the whole visit, with no interruptions or having to share treatment time with other patients. Exercises and plans are likely to be better tailored to your own home, using features of your house, such as steps, chairs and benches.

Groceries and other shopping can also be delivered to home, without all the hassles of having to travel to and around shops. Shopping online can be empowering; you (or a loved on) can choose all the items you want and have them delivered direct to your door.

A safe home

Research related to healthy ageing suggests that living at home has many social, economic, physical and psychological benefits. However, it's important to first determine a person's ability to safely care for themselves across a wide range of daily living tasks.

An Occupational Therapy (OT) service can provide environmental assessments and physical rehabilitation for clients at home to maximise independence and safety. An OT might then recommend a range of equipment, home modifications, services or rehabilitation services that might help. Some common changes the OT might suggest include installing rails, lowering pantry shelves, adding more lighting and removing potential floor hazards. These are changes that are relatively simple but can provide greater confidence and safety.

Medication reminders

As we age, we are more likely to have a range of medication that needs to be taken at particular times each day. It is important to remember to maintain your medication regimen to help avoid potential adverse side affects of missing (or over) doses. Using smart pill-boxes is one way that can help simplify this important process. Ultimately, it’s important to be aware of changes in health or behaviour to help monitor whether this process is working successfully or whether other reminder methods are needed.

Falls or emergencies when home alone

A fall can become a major crisis if no one is present to help assist if you fall. When falls or acute medical events (such as a stroke or heart attack) occur, each second that passes matters. Personal emergency response systems enable users to easily and quickly call for help and can provide great peace of mind; they strike the perfect balance between care and freedom. To help prevent falls, podiatrists and occupational therapists can help you eliminate hazards, assess footwear and other matters of the feet to help you maintain better balance.

Feelings of loneliness or isolation

Feelings of loneliness can have significant health consequences for the elderly. Meaningful emotional contact is essential; even simple gestures such as having others listen and share words of encouragement can positively influence morale. Helping an elderly person to video chat with loved ones outside the local area can be very rewarding emotionally. An occupational therapist can help you continue to lead a productive lifestyle by helping you connect with hobbies and activities that help nourish a sense of belonging and purpose; something we all need!

Almost everything that can be done for a person in an aged care facility can also be done at home. Everyone deserves the opportunity to live life to the fullest extent they can and to feel joy. The best way we can support the wishes of our ageing family members is by enabling safe, high quality care at home.

Today's seniors have resources available that can make life easier as they continue enjoying the freedom of living independently. With today's innovative approach to the way we can communicate and provide resources, remaining at home as long as possible can be a reality; not just a dream.

Talk to the team at LifeCare about the home visit services we offer.

Massage Therapy for the Aged

Massage therapy is a non-invasive way of helping to manage many conditions associated with ageing, especially when complimented with traditional medical and allied health services.

Massage has many well-documented benefits which have an overall effect of improving quality of life. The effects of massage can assist in maintaining activity levels which is vitally important for older people to maintain mobility and independence.

Some of the many benefits of massage include:

-          Alleviation of aches and pains

-          Improved mobility

-          Improved blood and lymphatic flow

-          Improved sleep length and quality

-          Reduction of stress and anxiety

-          Improved mood

-          Improved mental alertness and energy levels

-          Social interaction

-          Improved digestion

 

Massage is great for:

-          Pain associated with osteoarthritis – osteoarthritis is an extremely common condition in the aged population, and is characterised by pain and stiffness of joints. Massage can help with reducing muscle tension, improving joint mobility and reducing pain.

-          Parkinson’s Disease – clients report massage is very helpful in managing the pain and rigidity associated with Parkinson’s disease

-          Depression, stress and anxiety – it has been postulated that the mechanism by which massage reduces stress is through the reduction of cortisol (otherwise known as the ‘stress hormone’) levels in the body.

-          Dementia, including Alzheimer’s disease – through achieving a physiological response of reducing heart rate, blood pressure and stress levels, massage can result in the reduction of physical expressions of dementia such as pacing, agitation and resisting care.

All our massage therapists are trained to tailor the massage to the individual, taking into account medical conditions, age and personal preferences. They all have police clearances and appropriate insurances.

If you would like to know more about massage or arrange for a therapist to visit you, or your facility, please get in touch on 9424 0200.

Assistive Technology

Technology is advancing at a rapid rate, and more and more solutions are becoming available to assist people in maintaining independence. This is great news, as it enables us to live independently for longer in our own homes with reduced levels of care, as well as providing peace of mind for family members and carers. Our Occupational Therapists prescribe assistive technology devices and systems to aid independence and functional capacity. Examples of monitoring Technology for safety currently used are fall detectors, passive infra red motion sensors, epilepsy monitors and temperature monitors. Depending on the needs and the situation, such equipment could be stand alone for example if there was a carer in the same house, or it could be connected to an emergency call system.

Other examples of assistive technology include devices to aid in communication, use of the internet, reading and even talking clocks (to remind someone of any number of events, such as taking medication).

Call us on 9424 0222, to discuss with our OTs how we can assist your independent living with assistive technology.

Aids to Assist Daily Living

Do you know anyone who is having difficulty performing activities of daily living such as dressing, washing, food preparation?

There are a wide range of products available, and new ones coming on to the market all the time, to assist people with daily living tasks. Occupational Therapists are the health professional that are trained to assess for and prescribe items to help maintain independence in the home.

Clever items exist to help with all sorts of tasks including:

·         Putting socks and stockings on

·         Washing hair

·         Doing up buttons

·         Washing feet

·         Turning taps

·         Pouring a kettle

·         Turning keys

·         Getting in/out of a car

·         Cutting food

·         Opening jars

·         Eating

·         And many more

Our OTs can help find the right aids to help maintain independence in the home and in the community. Call us on 9424 0222 to discuss how we might be able to assist you.

Challenging Exercise Myths For Older People

There is indisputable evidence that exercise and activity produces a myriad of health benefits. Yet, health professionals get often get a fair bit of ‘push-back’ from clients when it comes to encouraging exercise, and compliance amongst older people is particularly poor. There are a number of reasons (excuses even) for this, most of which though are not valid. Here, we debunk some of the common myths about exercise for older people.

I’m too old

Despite what the old saying says, you can teach an old dog new tricks. The body is a remarkable thing. No matter what you age, muscles will still grow in size and strength if they are trained, soft issue will regain length with stretching and joints will gain range of motion with movement. In addition to this, with recent advances in the understanding of how the brain works and ‘neuroplasticity’, new neural connections can be formed with training at any age, meaning we can learn or re-learn skills!


I can’t do much

Many people may be limited with the amount of exercise they can do because of fatigue or aches and pains. This does not mean you should do nothing! Marathon runners don’t train by running marathons, they run smaller distances regularly and build up over time. Likewise, you should choose an amount your body can cope with, even a small amount, but do it regularly. This way, the body will adapt to this new load you are placing on it, and you will then be able to build up gradually over time.


I have sore joints

Joint degeneration and arthritis go hand in hand with aging unfortunately, and some people suffer from this pain more than others. Exercise actually lubricates joints and maintain movement and strength around joints. This has been shown to actually reduce pain levels over time if an appropriate amount of exercise is performed.


I’m too weak, I’ve just been in hospital

This is the time you need to exercise arguably more than ever. Your strength just doesn’t come back on its own after a period of illness or hospitalisation. You need to challenge your body and get it used to loads again through exercise. Otherwise, you are at risk of never getting back to your previous level of function. The body atrophies very quickly with inactivity, but the flipside is, you can regain strength and function by appropriately stressing your body with exercise.

I don’t have time

Be creative! Try and incorporate exercise into your day. Do some seated exercises in your chair whilst you watch the evening news. Balance on 1 leg while you brush your teeth. When you are reaching down into the bottom drawer, squat down 10 times instead of just the once. That way you are exercising without needing to set aside a specific time.


I’m afraid of falling and hurting myself

A fear of falling is very common in older people, particularly if you have had a previous fall. Avoiding exercise will actually increase your fear and risk of falling. Appropriate exercise, will improve your strength and balance and reduce your fear of falling.


I’m sick / I have health problems

No matter what health condition you have, some form of exercise will benefit you. The type and amount of exercise may need to be carefully prescribed, but exercise is not contraindicated outright for any health condition. From heart, lung, joint or muscular conditions, to neurological conditions such as Parkinson’s disease or stroke to amputations, some form of exercise will give you significant health benefits. It often just needs to be tailored to your needs.


I get too short of breath

If you have a lung condition, such as emphysema for example, that leaves you short of breath and unable to do very much, an exercise program designed specifically for these conditions will benefit you. In fact, it has been shown to be the most effective intervention for this problem.

I’ve never been an exercise person

For some people it may seem a chore. Like most things, getting started is the hardest part. Once you have got a bit of momentum behind you, it’s much easier to continue. Try and commit yourself to doing exercise every day for 3 weeks. By setting yourself a time frame, it will be more achievable. After 3 weeks, you will likely find it far less of a chore, and you may actually start to like it! Exercise releases endorphins which make us feel good about ourselves, which will also have a positive effect on any pains you may have, as well as your mental health.


It’s boring

Try and find an exercise buddy. Maybe someone you can regularly walk with, or join a local exercise group. By making it a social event, you won’t even remember you are exercising.

Remember, you may need to seek the advice of a physiotherapist to tailor an exercise program to your needs, particularly if you are elderly, have had falls, or have a disability or health problems. Call our physiotherapy team on 9424 0200 to discuss how we may be able to help you.

Lymphoedema Management

What is Lymphoedema?

Lymphoedema is the accumulation of excessive amounts of protein-rich fluid resulting in swelling of one or more regions of the body. This is due to a mechanical failure of the lymphatic system and occurs when the demand for lymphatic drainage exceeds the capacity of the lymphatic circulation.


The lymphatic system is a network of vessels and nodes throughout the body that transports fluid (lymph) from the body tissues back to the bloodstream. The functions of the lymphatic system are to maintain the volume and protein concentration of the extracellular fluid in the body and to assist the immune system in destroying pathogens and removing waste products from the tissues.

 

What causes lymphoedema?

Lymphoedema may arise because the lymphatic vessels or nodes have been damaged or were not formed correctly.

Secondary lymphoedema is the most common type developing following damage to the lymphatic system. The damage may occur as a result of some cancer treatments including the removal of lymph nodes, following radiotherapy to lymph node groups or with the progression of malignant disease. The onset of lymphoedema may be at any time. It may occur within months of the damage or it may appear years later.

Secondary lymphoedema may also arise without a cancer diagnosis when one or more of the following conditions occur:

  • Trauma and tissue damage
  • Venous disease
  • Immobility and dependency
  • Factious – self harm
  • Infection such as cellulitis
  • Filariasis
  • Obesity

Primary Lymphoedema in comparison to Secondary Lymphoedema is the result of a congenital condition that affects how the lymph vessels where formed. This may result in hypoplasia of lymphatic vessels (a reduced number of lymphatic vessels), hyperplasia of lymphatic vessels (vessels that are too large to be functional) or aplasia (absence) of some part of the lymphatic system. This form may be presents at birth (congenital), develop at the onset of puberty (praecox), or not become apparent for many years into adulthood. It may be associated with other congenital abnormalities/syndromes.

Primary and secondary lymphoedema can occur together.

 

What are the risk factors for developing lymphoedema?

The consensus document suggests that patients at risk of lymphoedema will be encountered in a wide variety of health care settings, primary, secondary and tertiary. Key risk factors for secondary lymphoedema include, the extent of surgery, lymph node dissection and radiation treatment. Other factors involve trauma, infection, increased body mass index (BMI) and immobility. Any major damage to the lymphatic system causes a lifelong risk of lymphoedema.

 

What are the early warning signs of lymphoedema?

Subjectively these may include transient swelling of a limb or other region of the body. Other symptoms may include aching, heaviness, stiffness, limitation of movement, tightness or temperature changes. Clothing, jewellery or shoes may feel tighter. Lymphoedema is not usually a painful condition but some people report pain and tension in an affected limb or body part.

Clients report that the swelling associated with lymphoedema is often aggravated by heat, at the end of the day, with overuse, with sustained positions and prolonged inactivity. They report that gentle exercise, elevation, massage and compression can ease their symptoms. Many conditions may cause these symptoms to occur and any of the changes described will need to be assessed by a doctor in order for an accurate diagnosis to be achieved.

 

How is lymphoedema diagnosed?

An accurate diagnosis is essential for appropriate therapy. This is determined from the clinical history and physical examination. Co-morbid and confounding conditions of morbid obesity, lipoedema, cardiac disease, renal disease, metabolic disorders, infection, and venous insufficiency will require thorough medical evaluation.

Lymphoedema usually has a gradual onset. However, when lymphoedema has an acute onset appropriate tests to exclude, deep venous thrombosis (DVT), recurrence of cancer and infection may be necessary.


Whether primary or secondary, lymphoedema develops in stages, from mild to severe. Methods of staging are numerous and inconsistent. They ranged from three to as many as eight stages. In Australasia, the most commonly used stage scale is that adopted by The International Society of Lymphology (ISL), which identifies the following stages:

  • Stage 0 – A latent or subclinical state where swelling is not evident despite impaired lymph transport.
  • Stage I – This represents early onset of the condition where there is an accumulation of tissue fluid with higher protein content, which subsides with limb elevation. The oedema may be pitting at this stage.
  • Stage II – Limb elevation alone rarely reduces swelling and pitting is manifest. In later Stage II the limb may or may not pit as fat and fibrosis supervenes.
  • Stage III – The tissue is hard (fibrotic) and pitting is absent. Skin changes such as thickening, hyperpigmentation, increased skin folds, fat deposits and warty overgrowth develop.
  • Stage III – Encompasses lymphostatic elephantiasis. At this stage, the swelling is spontaneously irreversible and usually the limb is very large.

 

Are there any complications that can arise with lymphoedema?

Lymphoedema is understood to be a progressive disease and early intervention is recommended to minimise time and age-related changes. The swelling may progress without treatment. The skin is prone to thickening and the development of fibrosis and other secondary changes.

When the lymphatic impairment causes the lymph fluid to exceed the lymphatic system's ability to transport it, an abnormal amount of protein-rich fluid collects in the tissues of the affected area. Left untreated, this stagnant, protein-rich fluid causes tissue channels to increase in size and number, reducing the availability of oxygen. This interferes with wound healing and provides a rich culture medium for bacterial growth that can result in infections: cellulitis, lymphangitis, lymphadenitis, (in severe cases sepsis) and skin ulcers.

It is vital for lymphoedema patients to be aware of the symptoms of infection and to seek treatment at the first signs, since recurrent infections, in addition to their inherent danger, further damage the lymphatic system and set up a vicious cycle.


What can be done to cure or treat lymphoedema?

Lymphoedema cannot be cured but it can be reduced and managed with appropriate intervention. The stage, location and severity of the lymphoedema together with the individual circumstances of the client will influence the most appropriate intervention. Early intervention is recommended.

Best practice management has a holistic multidisciplinary approach and is provided by qualified lymphoedema therapists. The treatment method is conservative and in Australasia is termed Complex Lymphoedema Therapy (CLT).

CLT consists of the following components

  • Education
  • Skin care
  • Exercise
  • Manual Lymphatic Drainage (MLD)
  • Compression therapy

Treatment is individualized for each client and not all components of treatment may be necessary in all cases. Those with mild lymphoedema may only require education, exercise and skin care whereas for more severe cases treatment may be longer and require two phases. Phase I is an intensive treatment provided by a trained lymphoedema therapist followed by Phase II, which is self-management that the client continues at home. With improved health education people are reporting early limb changes promptly and this is contributing to a reduction in the need for intensive treatments

 

Phase I – Intensive treatment consists of daily

  • Skin care to optimise the condition of the skin, reverse skin changes and treat infections.
  • Manual Lymphatic Drainage (MLD) to enhance lymph flow;
    • This precedes bandaging and directs lymph fluid to functioning lymphatic territories and helps to establish collateral drainage pathways;
  • Application of multi-layer compression bandaging;
  • Exercises to increase lymphatic and venous flow;
  • Psychosocial support;
  • A compression garment is prescribed, following a successful reduction;
  • This is essential to preserve the reduction achieved by treatment and to help prevent progression of the lymphoedema;
  • Education is incorporated to ensure that the client understands their condition and all parts of the intensive treatment as well as the importance of phase II.

Phase II - Home maintenance programme

  • Clients are educated by their therapist in the need for self-management to maintain the results achieved in Phase I;
    • Without the active involvement of the client, the successful outcome of treatment may not be sustained;
  • The routine adopted may vary from person to person but will usually include daily skin care and prevention of infection, regular self-massage, exercises and the wearing of the prescribed compression garment(s);
  • Clients will be encouraged to practice self-monitoring and adopt a healthy lifestyle that includes attention to diet, fitness and weight management;
  • At times this treatment may be offered in a modified form to accommodate particular individual needs.

 

Vascular Compression Pump

Sequential Intermittent Pneumatic Compression Therapy (SIPC) is the process of applying external pressure to the limbs to promote the circulation of blood and lymphatic fluid to and from the extremities of the body. It is used for the prevention and treatment of various vascular issues such as:

  • Lymphoedema
  • Chronic venous insufficiency
  • Venous ulceration
  • Lipoedema
  • Diabetic complications

Intermittent pneumatic compression mimics the body’s manual lymphatic drainage. By applying pressure to the surface of the limb it promotes the circulation of blood/fluid throughout the body. Each chamber inflates and deflates sequentially starting from the extremity and moving towards the centre of the body.

 

If you have lymphoedema, please call us to discuss how we can help you.

Knee Osteoarthritis

What is Osteoarthritis (OA)?

 

Arthritis is a general term that describes inflammation of the joints. Osteoarthritis (OA) is a form of Arthritis that is associated with the wear and tear of the joint cartilage and commonly occurs in the large weight-bearing joints of the body such as the knee, hip and spinal joints.

 

What causes Knee OA?

 

The most common cause of Knee OA is aging. As you get older, the cushioning layer between the two bones of the knee joint degenerates due to repetitive use. This can lead to swelling, stiffness and pain in the joint. A majority of people will develop some degree of Knee OA. However, several other factors can increase the risk of developing significant arthritis at an earlier age. These include:

 

·         Obesity/Overweight – Being heavier increases stress on your knee joint

·         Repetitive stress – Repetitive loading of the knee joint during activities such as long-distance running, kneeling, squatting can increase the risk of joint degeneration. This may be exacerbated by incorrect posture as this leads to abnormal loading on the joint

·         Previous injuries and damage to the knee joint

·         Heredity

·         Gender – Women aged 55 or older are more likely to develop Osteoarthritis of the knee

 

Symptoms of Knee OA:

 

•      Stiffness especially first thing in the morning or when you have been sitting for a while but gets better after movement

•      Pain that is worse after activity and towards the end of the day

•      Feeling of warmth in the joint

•      Creaking, crackly sound when the knee moves

•      Decrease in function of the knee, making it difficult to get in and out of chairs or cars, climb stairs, or walk

 

How is Knee OA diagnosed?

 

Your doctor or physiotherapist can make a diagnosis of your Knee OA based on your symptoms and physical examination. X-Ray Imaging is also used to observe structural changes such as narrowing of joint space and bone spurs. It is important to be aware that extensive changes on X-Ray does not always mean a person will experience high level of pain and vice versa. Beside physical changes that occur within the joint, other factors such as your mood, levels of stress and anxiety, quality of sleep, fatigue and too much focus on your knee pain can have an affect on how much pain you are feeling. Therefore, learning to manage all of these factors will help you combat your Knee OA more effectively.

 

Management of Knee OA:

 

For a majority of people, OA is characterised by stable periods interspersed with flare-ups. It is important to understand that not all Knee OA will worsen over time and there are positive, active things that you can do to help manage the pain and carry on with your normal life.

 

During flare-ups you should have a short period of rest for the pain to settle. Long period of rest, however, has been shown to be detrimental to a person’s joint health and their ability to return to activities and therefore should be avoided.

 

The goal of managing Knee OA is to minimize pain, improve joint flexibility and the ability return to daily activities and hobbies. It usually requires a multi-faceted approach and your healthcare team will be able to assist with this.

 

·         Weight-loss – This is achieved through maintaining a healthy diet and regular exercise habit.

·         Individualized exercise program – Resistance exercise is critical in strengthening the muscles around your knee and help unload the burden on the joint. This will help reduce pain and improve your ability to carry on with normal daily activities. Your physiotherapist can assist with prescribing an exercise program that works for you.

·         Medications – Generally pain relief medication such as PanadolOsteo and Non-steroidal Anti-inflammatory medication can help relieve symptoms of knee OA. Your local doctor or pharmacist will be able to assist with this.

·         Aids or support – braces or walking aid may help unload the knee joint. Your physiotherapist can assist with prescribing you with the correct aid.

·         Counseling – as we know stress, anxiety and low mood can affect your level of pain and therefore talking to a clinical psychologist may be useful.

 

In cases where conservative approach shows no improvement, and symptoms are not well managed, Total Knee Replacement surgery performed by an Orthopedic surgeon may be considered.

 

David Phan

Physiotherapist

 

Physiotherapy and Mental Health in the Ageing Population:

Traditionally, people consider physiotherapists to be solely focused on the ‘physical’ aspects of rehabilitation however, we as physios know how important it is to think holistically for the best outcomes for our patients. This is why our physiotherapists, Caitlin and Stacey, attended the Mental Health First Aid course in October 2015, and are now accredited mental health first aiders. This course discussed many different aspects of mental health including common problems such as depression, anxiety and psychosis. 
Depression is a common condition, which can effect up to 6.2% of Australian’s in any one year (Kitchener, Jorm & Kelly 2013). Depression can manifest in many different ways including;
• A low/sad mood
• Loss of enjoyment and interest in activities that used to be enjoyable
• Lack of energy and tiredness
• Feeling worthless or feeling guilty when they are not really at fault
• Thinking a lot about death or suicide
• Difficulty concentrating or making decisions
• Moving more slowly or sometimes becoming agitated and unable to settle
• Having sleeping difficulties or sometimes sleeping too much
• Loss of interest in food or sometimes eating too much
Did you know that as you age you are likely to experience more risk factors for depression? These include (Kitchener, Jorm & Kelly 2013);
• Adverse events in your life including crime, death or illness in the family or having an accident such as a fall
• Separation or divorce
• Long term physical illness
• Caring full time for a person with long-term disability
• Medical conditions such as Parkinson’s disease, stroke, hepatitis, Vitamin B-12 deficiency or hypothyroidism
• Side effects of certain medications
• Lack of exposure to bright light in winter
We know that some older adults tend to feel as through depression is a sign of weakness rather than a real and treatable condition. Early intervention is important to ensure the best outcome, so what should you do if you or a family member is showing signs of depression?
• Make a time to talk to someone you trust about how you are feeling where you both feel comfortable and safe
• Speak to your doctor or encourage your family member to speak with their doctor about a mental health care plan
• Discuss your concerns with your physiotherapist who will be able to assist you in liaising with other health professionals and who will be able to individualise your rehabilitation based on your needs/goals
• Exercise!! It has been shown that exercise is moderately more effective than no therapy for reducing symptoms of depression (Cooney et al., 2013)
• Know who to call;
o Ambulance- 000
o Lifeline- 13 11 14
o Crisis care- 9223 1111 (24 hour metro)
o Mental health emergency response line- 1300 555 788
If you or someone you know would benefit from a holistic review and individualised treatment plan from one of our physiotherapists to assist in your rehabilitation at home call (08) 9242 0200.
References
• Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE. Exercise for depression. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub6., 
• Kitchener BA, Jorm AF, Kelly CM. Mental Health First Aid Manual. 3RD ed. Melbourne: Mental Health First Aid Australia; 2013.

The Incidence of Falls

Did you know one third of over 65s will have a fall every year, and the rate increases with advancing age? About 10% of falls will result in serious injuries such as fractures, affect confidence and accelerate frailty and a loss of independence. Despite being common, falls are not a normal consequence of ageing. Studies show a physio program can reduce the risk and incidence of falls by 35%!
If you have a parent or grand parent who is getting unsteady on their feet or has already had a fall, have the conversation with them as to what they plan to do about it. Seeking the right help to improve their balance will greatly improve their quality of life and independence. Call 9424 0244 to speak to us about how we can help.

Dizziness, Vertigo and Falling

Falls are a major health issue for people over the age of 65 and they can have devastating effects including injury, reduced mobility, social withdrawal and decreased independence with daily activities. Symptoms of dizziness or vertigo may be a major contributor to falls in the older population.

What is dizziness and what can cause it?

Dizziness is a word that can have a lot of different meanings to different people including:

·         Lightheadedness

·         Disorientation

·         Unsteadiness

·         Feeling faint

·         Giddiness

·         Spinning (vertigo)

Causes may include:

·         Benign paroxysmal positional vertigo (BPPV)

·         Meniere’s disease

·         Infection in the inner ear- vestibular neuritis

·         Migraines

·         Side effects of certain medications such as anti-hypertensives, sedatives, antidepressants

·         Postural hypotension (a drop in blood pressure when moving from lying/sitting to standing)

·         Neurological disorders- Parkinson’s Disease, Multiple Sclerosis, head injury

What can you do if you are feeling dizzy?

It is important that you contact your healthcare professional about your symptoms of dizziness as soon as possible as identifying the underlying cause is paramount to determining the right course of treatment. Physiotherapy can play a major role in treating vertigo caused by BPPV and some other disorders of the vestibular system (inner ear), in conjunction with your doctor. Following treatment of your vertigo, your physiotherapist may go through some specific vestibular rehabilitation exercises as well as balance and strengthening exercises to help you reduce your risk of falling.

Look out for the next blog on Benign Paroxysmal Positional Vertigo and how your physiotherapist can help you if you have this disorder!

 

Caitlin McDonald

Physiotherapist with special interest in dizziness and vestibular disorders

 

Image courtesy of tiverylucky at FreeDigitalPhotos.net

 

Lifestyle-Integrated Functional Exercise

Recently, four of our physiotherapists, Anthony Imms, Meagan Moyle, Helen Stillitano and Lynsey Ross, attended the LiFE Instructor Course, and are now qualified instructors of this program. ‘LiFE’ stands for “Lifestyle-integrated Functional Exercise” and is a newly researched program shown to reduce the prevalence of falls. This program is more specifically for those people who struggle to complete exercises in the traditional manner or who find it difficult to adhere to exercise programs. In this program, exercises are linked into everyday activities like brushing your teeth or sitting down to eat lunch.  The idea being that you incorporate exercise into normal daily activities. This way, you complete small bits of exercise at a time, not a full set of exercises. However, over the whole day, you end up completing all the exercises required. 

At HomeCare, we are constantly upgrading our skills and knowledge base to be able to assist the wide range of people’s needs in our community.

Please ask your physiotherapist or call us at HomeCare for further information if you think this program is suited to you or a loved one.

Image courtesy of tiverylucky at FreeDigitalPhotos.net

A New Model for Community Care – Wellness and Reablement

A new approach to community care has emerged in recent years, and continues to gain traction in Australia. The traditional model for community care services has a focus on illness and dependence through providing passive support for individuals. The concept of ‘wellness and reablement’ (or ‘enablement’) replaces this with a model of care centred around ‘capacity building’, whereby independence in performing activities of daily living is encouraged and facilitated. There is an increasing body of evidence that this shift in focus produces more favourable outcomes for consumers with improved wellness, through achieving greater independence, and consequently reducing the amount and cost of care. So here exists a true win-win situation, where we can achieve better client outcomes at a reduced financial cost.

 

What is ‘Wellness’?

Wellness is the optimisation of a person’s physical and mental health and well-being. In the context of community care, wellness centres on the understanding that an individual, despite increasing frailty and decreasing health, has the capacity to improve their physical, social and emotional well-being. This is achieved through a flexible and tailored approach to delivery of care, taking into account the individual’s unique set of circumstances and goals.

 

What is ‘Reablement’?

Reablement is closely linked, but distinct from wellness. It is the process of helping people regain, or re-learn, skills required for daily living which have been lost due to deteriorating health or advancing frailty. It is distinct from addressing specific health care issues. Reablement programs are led by Allied Health professionals and are time-limited (6-12 weeks) with specific goals set around activities required for daily living. The focus is on engaging individuals in a program designed to improve their ability to perform specific activities of daily living, and minimise the amount of care required for these activities. For example, making a cup of tea, dressing themselves or independent showering.

 

Benefits to the Individual

·         Increased feelings of independence, empowerment and autonomy in managing their health and abilities.

·         Improved physical and emotional well-being

·         Improving their ability to self care and to perform everyday activities of daily living

·         Reducing the need for ongoing home care services

·         Reducing the risk of falls and falls related injuries

·         Avoiding hospital admission for reasons directly addressed by this program, for example, falls, medication or chronic disease mismanagement

 

The Evidence

Lewin et all (2008) found consumers on a Reablement program had:

·         71% had less difficulties with IADLS

·         33% no longer needed ongoing care services

·         and 39% needed a lower level of service.

 

A study on Reablement programs in the UK found:

·         53-68% of people left the reablement program not requiring any immediate homecare

·         36-48% of that group still required no homecare at 2 years

·         34-54% had maintained or reduced their levels of care 2 years after reablement.

 

In keeping with this evidence-based best practice, LifeCare has developed its Wellness and Reablement Program for individuals receiving community care.

What Exercise for Older People?

Most people accept that it is important to remain active as we age. In fact, exercise is the most effective action we can take to improve our life expectancy and well-being. What is the best form of activity to do though? It can be a challenge to know what is appropriate and ideal, particularly if you have health problems. There are 3 things to consider:

(1) What are you trying to achieve with exercise? Different exercise has different effects. Exercise that raises our heart rate is good for cardio-vascular health and our general level of fitness or endurance. Lower limb strengthening with improve our ability to walk, climb stairs and get out of a chair. Weight-bearing exercise is good for bone strength, particularly those with osteoporosis or osteopenia. Understanding what you want to get out of exercise is important in choosing what to do.

(2) What health problems do you have? Appropriate exercise will depend on what health problems you have. Arthritis, osteoporosis, lung problems, poor balance and diabetes are examples of health problems which will affect your ability to do certain exercises. For example, swimming or hydrotherapy is a great form of exercise for those who suffer from arthritis. If you have poor balance, walking might not be appropriate as it can actually increase your likelihood of falling.

(3) What do you enjoy? To get the benefits of exercise, it should be done regularly. It is regarded that a minimum amount is 3 times per week, but some evidence suggests it should be daily to get significant benefit. So it needs to be something you enjoy so you will stick with it. Find something you think you’ll like, and give it a go!

If you need advice on appropriate exercise for you, particularly if you have a health problem, a physiotherapist can help you with this.

Stay active!

Anthony Imms

Physiotherapist and advocate for healthy ageing

Image courtesy of stockimages at FreeDigitalPhotos.net 

Exercising with Chronic Lung Disease

                Chronic lung conditions such as Chronic Obstructive Pulmonary Disease, bronchiectasis and interstitial lung disease are very common in the community. In fact, about 5% of the population live with a chronic lung disease. These conditions are characterised by poor airflow, often with a cough and sputum. They generally worsen over time, leaving patients with increasing breathlessness, and can result in death. Exposure to irritants such as smoking and poor air quality are the main factors which lead to obstructive lung disease.

                As there is no known cure for obstructive lung disease, management is the main aim of treatment. Drug therapy such as bronchodilators, corticosteroids and long-term anti-biotic use, and oxygen supplementation can play a role in managing symptoms. The most effective evidence-based intervention however, is pulmonary rehabilitation. Pulmonary rehabilitation is a comprehensive intervention program which includes exercise training, education and behavioural change. It is individually tailored to each patient based on their unique assessment findings, the aim of which is to:

·         Reduce and manage symptoms

·         Improve understanding of the condition

·         Promote self-management

·         Reduce acute flare-ups and hospitalisation

·         Reduce the length of hospital stays

·         Improve tolerance to activity and exercise

·         Maximise independence with daily activities

If you have, or know someone with a chronic lung disease, speak to a physiotherapist with expertise in this area about how they can help you manage your symptoms and improve your quality of life.

 

Stay active!

Anthony Imms

Physiotherapist and advocate for healthy ageing 

Image courtesy of dream designs at FreeDigitalPhotos.net