Monthly Archives: February 2012

Balance Difficulties and Dizziness Require Individualized Attention

February 28,2012

Balance difficulties can affect individuals of all ages. Younger children can be affected with gaze stabilization impairments which can cause blurred vision and make activities such as reading or walking through large crowds difficult. Children, teenagers, and adults can suffer injuries from motor vehicle or work accidents, and/or sporting and outdoor activities which can lead to mild head injuries, often labeled as concussion, that if not addressed appropriately can lead to significant balance dysfunction, disequilibrium, and dizziness. Typically, but not necessarily, older individuals can have several problems which can affect balance and overall function. Blood pressure irregularities, visual impairments, neuropathy, stroke and central nervous system dysfunction, and peripheral nervous system impairments can all lead to difficulty with balance. People of all ages can be affected by the number one cause of vestibular (inner ear) disturbance,  which is Benign Peroxismal Positional Vertigo (BBPV). This problem can be nauseating and can range from a mild disturbance to totally debilitating. It occurs when a salt crystal inside of structures of the inner ear disturbs normal fluid flow leading to a sensation of movement when you are holding still.

Prevention of a balance problem can be somewhat difficult to accomplish. Folks can wear appropriate safety equipment and use proper technique in sports, but accidents can and do happen leading to concussion and post-concussion symptoms. It is important to undergo routine physical examinations and also undergo preseason concussion screening for athletes and routine standardized physical therapy well-visits (which can be done at Professional Rehab Associates). The screens allow for capturing data points with regard to memory, balance, range of motion and strength, and also the presence of symptoms during exertional activity to then be compared to identical standardized testing following an injury. This produces a comparative measure against a patient’s normal function instead of having to compare against simply age- or sex-based norms. Seat belts should be worn when riding in cars. Dietary guidelines should be followed if you have common risk factors for high blood pressure, heart disease, diabetes, history of migraine as each can cause or contribute to balance problems. Exercise can be crucial in maintaining and enhancing strength and mobility and routine walking can be important to maintain a higher level of overall health. Patients taking prescription medications should ask about and be aware of potential side-effects or medication interactions which can lead to dizziness or other disturbances (ask your prescribing physician and also your pharmacist). Some research shows that there is the potential for electrolyte and salt imbalances within the bloodstream and inner ear to cause balance problems and may contribute to the formation of crystals in the inner ear leading to BPPV. Alcohol use can lead to imbalance, falls, and injury. Prolonged alcohol and drug use can lead to neurologic system damage leading to memory difficulties, poor judgement, tremor, and gait unsteadiness which can lead to injury.

Most balance and dizziness disorders respond better to early detection, diagnosis, and treatment. Falls can be prevented and injury risk rates can be reduced. The Vestibular Disorders Association states that individuals with symptomatic vestibular dysfunction have a 12 fold increase in the odds of falling and credits falls as the leading cause of fatal and non-fatal injuries in those aged older than 65. Thus, the earlier a problem can be detected, treated, and optimally corrected or compensated the lower the risk of falls and the lower the rate of injury.

Each of our physical therapists have training in Vestibular Rehabilitation. Contact us for more information regarding balance and dizziness as physical therapy can help provide solutions for improving gait and postural stability and can use exercises to compensate for and even correct the source of the balance or dizziness problem. Exercises to safely challenge balance can improve strength, endurance, and confidence and walking ability. Eye and head movement exercises tailored specific to the patient and diagnosis can help improve vestibular loss symptoms, motion sensitivity, and improve gaze stability. Gradual advancement of exercise intensity and complexity are used to best return an athlete to sport following a concussion. Postural exercises can be beneficial for patients who suffer neck pain associated dizziness. For the most part, exercise is a great treatment for balance and dizziness and Professional Rehab Associates can help meet your individual needs to provide optimal success.

Help Us Celebrate 25 Years!

February 20,2012

Help us celebrate turning 25! Professional Rehab Associates was established in 1987. From our humble beginnings we have grown to what we believe to be the best rehab offering in the NRV. Log onto or to twitter @ProRehabAssoc to tell us how we have done over the past quarter century. Post photos, quotes, stories or comments of what we have done well or even what you think we could do better to serve you and your family.

Resources for Caregivers

February 16,2012

According to a Woman’s Day and article from their March 2012 issue 65 million Americans are now taking care of a loved one. There can be several challenges in transitioning to a multi-generational home including the physical, emotional, and financial burdens. Many elderly Americans are living longer, but also have higher incidence and frequency of significant medical needs, ailments, and illness. The good news for caregivers is that you are not alone in your pursuit of caring for your loved ones and that there are also several agencies who can provide needed information and assistance.

Woman’s Day author Richard Laliberte stresses in his article “You’re a Caregiver Now” the importance of communication and planning. While catastrophic life events cannot be foreseen, steps can be taken to avoid situations that have to be made worse by a lack of thoughtful preparation. Talk with your loved ones, obtain from them information and confirmation that they have received their routine check-ups, be sure that medications are appropriate, attend physician and rehab visits if able to see for yourself their blood pressure, blood glucose levels, and balance and relative falls risk. Encourage safe, routine exercise. Ask your loved ones about their insurance coverage and about their financial preparedness.

For help on assessing the day to day abilities and safety of your loved one and to help determine their ability to live in their home or to organize appropriate care utilize the help of their physician to get a good picture of their overall health status and to assess any progression of known diseases and to detect the relative risk of cardiovascular disease, bone or joint related problems, and neurological status. Use their physical therapist to assess balance and falls risk, walking abilities, range of motion and posture, strength, endurance, and mobility status to help determine things such as a need for an assistive device and the relative intensity and safety to maintain during exercise. Seek out an occupational therapist to determine your loved one’s ability to engage in their day to day activities of daily living (ADLs) as well as their ability to perform instrumental activities of daily living (IADLs) and to help determine the amount of care your loved one needs for dressing, bathing, and meal preparation as well as their ability to perform more complex and cognitive related tasks.

If a life-changing event does occur it is understandable to have all sorts of mixed emotions. Just remember it is never to late to change plans or to even make plans and arrangements. There are several agencies and help organizations that can offer advice and practical solutions to help make the best of the situation for you and for your loved ones. offers guidance on assessing what help a loved one may need and discusses in-home options. or the National Association for Home Care and Hospice can provide information and offers a listing of agencies that may be available to provide help if you need help in providing care for a loved one.

The Family Caregiver Alliance’s Family Care Navigator can be found at which offers answers to common questions and can also offer listings of government, nonprofit, and private services that may be available in your area.

The U.S. Administration on Aging also offers a website with information and also has a phone number for assistance. 1-800-677-1116

We support your freedom of choice

February 14,2012

Freedom of choice within health care has been a hot topic of debate since the 1990s when managed care systems became more popular. The “Consumer Bill of Rights” was established to allow for protection within health care plans, networks, and also at the individual provider level. It was established in 1997 and put into law in 1998 by President Bill Clinton. Under the “Consumer Bill of Rights” patients enjoy a more competitive marketplace as ability of choice places a demand for the provision of higher quality care upon practitioners. It also outlines the importance of direct access to providers limiting costly delays and details the importance of quality primary and specialty care. Physical Therapists in Virginia now can offer direct access to care to their patients when certified by the Board of Physical Therapy. This allows for improved speed of access to care, which thereby improves recovery time. A recent study also demonstrates the cost effectiveness of direct access to physical therapy services. Private practices become encroached upon by larger systems, but you can help by requesting from your health care providers lists of qualified professionals when being referred for services. You have the ability to maintain continuity of care as well, if you have been to a provider before, demand to be referred there again. If you are happy with the care you have received from a health care provider do not let your freedom of choice be taken away. Speak up for yourself and also for your loved ones.

Today, with Federal health care legislation pending and unknown effects to the healthcare system yet to take place it becomes more important to demand continued freedom of choice from your Federal, State, and Local legislators, demand a freedom of choice from your health insurance provider as well as health care providers.

We hope that when given a choice for your Rehab and Wellness Services needs you choose PRA.

Tell Congress To Act

February 9,2012

Medicare utilizes the Physician Fee Schedule which establishes the amount paid to a health care provider for a given service. Rehabilitation services fall under the fee schedule and in outpatient settings particularly private clinics (non-hospital based) are also placed under a payment cap. The fee schedule sets the rate of reimbursement to providers and the therapy cap sets an arbitrary limit on the  yearly coverage that can be allotted to a beneficiary. Congress uses the fee schedule to adjust the rate of reimbursement to control cost, but to also control competition, meaning there is relatively equal payment without any consideration to the quality of the provider. Meaning good providers typically cannot be paid more and poor quality providers typically cannot be paid less. The schedule is set to avoid fraudulent price gouging, but the schedule also removes many elements that would create a competitive healthcare market. The cap was established to also control cost, setting a limit to again avoid fraudulent charges from over utilization of therapy services. The cap, though, significantly limits the care that can be provided to patients who need the care most, those with complicated injuries, progressive disorders, or those who suffer ailments to multiple body systems or body regions. Congress as a result has since instituted an exceptions process to the cap to allow for certain, but not all diagnoses, to receive care that is deemed necessary by the health care team of the patient, physician, and therapist(s).

Each time Federal budgets are determined through committees and subcommittees whether or not to keep the exceptions process, whether or not to undo the process of the cap, and also the amounts of reimbursement covered on the fee schedule are determined. This typically is done on a longer term basis with appropriations bills or budgetary bills lasting for a year or two. Recently, Congress only passed a two-month extension of the exceptions process and two-month time frame to cover the fee schedule. If Congress does not act at the end of February, the fee schedule will expire in its current form, which will enact an over 27% cut to the reimbursement amounts provided to healthcare practitioners. Also due to expire is the exceptions process which will have profound negative repercussions on those who need healthcare the most. Cost containment at the individual provider level is ineffective at controlling the cost of healthcare and does not help to foster optimal decision making, care delivery, and best-practice patient management at the patient/practitioner level.

Congress has spent numerous sessions over recent years debating whether or not to do away with the cap and has spent even more time debating the “doc fix” to prevent substantial and harmful cuts. Congress has had effective legislation drafted and introduced to address many of the issues, S 569/H.R. 1125 were introduced in 2003 over eight years later S 829/H.R. 1546 were introduced to address ongoing concerns and to put a stop to ongoing short term solutions that have large effects on the health system. Tell your Congressmen and Congresswomen that you demand a more competitive healthcare system and demand optimal coverage and access to rehabilitative services. Urge them to promote Medicare Access to Rehabilitation Services Act. Health care providers are trained to provide cost-effective and timely care, the health care system is not.


Click here for more information regarding Medicare Access to Rehabilitation Services Act as well as to find out more regarding healthcare legislation and its impact on physical therapy.