A Sunderland, DJ Tinson, EL Bradley, D Fletcher, R Langton Hewer and DT Wade
Stroke Research Unit, Frenchay Hospital, Bristol, UK.
Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia. A detailed study was carried out of recovery of arm function after acute stroke, and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning. In a single-blind randomised trial, 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups. At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength, range and speed of movement. This effect seemed concentrated amongst those who had a milder initial impairment. More work is needed to discover the reasons for this improved recovery, and whether further development of this therapeutic approach might offer clinically significant gains for some patients.
Wednesday, March 14, 2007
Skills Training Versus Psychosocial Occupational Therapy for Persons With Persistent Schizophrenia
Robert Paul Liberman, M.D., Charles J. Wallace, Ph.D., Gayla Blackwell, R.N., M.S.W., Alex Kopelowicz, M.D., Jerome V. Vaccaro, M.D. and Jim Mintz, Ph.D.
While the efficacy of social skills training in schizophrenia appears well established (1–8), most studies have been conducted in medical school departments of psychiatry with augmented staff who were specially prepared as trainers. Moreover, most of the efficacy trials have used "customary treatment" as the control group. Three major questions that remain largely unanswered are, Can social skills training be effectively conducted by paraprofessionals in an ordinary clinical setting? Do the skills learned in clinic training sessions generalize to the outside world? and Are the effects of skills training discernible when an active comparison group is used?
In most psychiatric hospitals and day hospitals, the prevailing psychosocial treatment is occupational therapy in which expressive art and crafts and recreational activities are the media through which therapists build self-esteem and productivity. However, there have been few empirical evaluations of the efficacy of this approach (9). At the West Los Angeles Veterans Administration (VA) Medical Center, hundreds of patients with serious mental disorders receive this modality each year. In 1981, the VA Central Office established a new form of psychosocial treatment by funding a demonstration program, at the West Los Angeles VA Medical Center, for training in social and independent living skills. Subsequently, a health services research study was begun at this medical center to compare the relative impact of occupational therapy and skills training on persons with persistent and long-term schizophrenia. We shall report the first results from this study in the present article.
Subjects
Cohorts of 10–12 outpatients with persistent and unremitting forms of schizophrenia were entered into the study through a randomization procedure that assigned half to psychosocial occupational therapy and half to skills training at the West Los Angeles VA Medical Center. A total of 84 male patients were assigned to receive 6 months of intensive, clinic-based treatment 3 hours per day, 4 days per week. They were seen approximately once per month by psychiatrists who were blind to the psychosocial treatment assignment and who prescribed antipsychotic medication and adjunctive medications by "doctor's choice." Medication tended to produce some stability in patients' symptoms, but few went into full remission during the study; thus, the assessment of discrete episodes of symptom exacerbation or relapse was not feasible.
Almost all of the subjects were never married; were living in community-based, board-and-care homes; and had one or more persisting psychotic symptoms (i.e., suspiciousness, unusual thoughts, hallucinations, grandiosity, conceptual disorganization) rated as moderate or higher on the Expanded University of California, Los Angeles (UCLA), Brief Psychiatric Rating Scale (BPRS) (10). The average age of the subjects was 37.1 years (SD=8.8), their average education amounted to 12.3 years (SD=1.9), and the average duration of illness was 14.8 years (SD=8.0). Sixty-six percent were Caucasian, 25% were African American, and the remainder were either Hispanic or Asian. There were no significant differences in these background variables between the patient cohorts assigned to the two psychosocial conditions (p values ranged from 0.14 to 0.41; all comparisons were by t test except ethnicity, which was by chi-square).
Written informed consent was obtained after the procedures were fully explained to the subjects and repeated back by them to the investigators. The research procedures were approved by the Medical Center's Research and Human Subject Protection Committee according to the appropriate institutional guidelines. Subjects were free to withdraw from the research protocol at any time without prejudicing their access to treatment elsewhere. Attrition was minimal; only 14 of 84 subjects dropped out during the 2-year period (four in the control group and 10 in the social skills training group; 2=2.44, df=1, p=0.12). Almost all of the dropouts were accounted for by individuals moving to new geographical areas of the state or country and becoming unavailable for assessments. Attrition was minimized by the continuing care contacts provided by the clinical case managers and the availability of van transportation, lunches, and a "drop-in" socialization center for subjects.
Psychosocial Treatment Conditions
Psychosocial occupational therapy was led by three certified occupational therapists and comprised expressive, artistic, and recreational activities that mediated supportive therapy (9, 11). Patients participated individually and in groups, with encouragement by the therapists to individualize their interests and abilities through arts and crafts, discussion of feelings, and articulation of personal goals.
The skills training was conducted by an occupational therapist and three paraprofessionals who took turns in leading four modules of the UCLA Social and Independent Living Skills Program—basic conversation, recreation for leisure, medication management, and symptom management. Each module consisted of a trainer's manual, a participant's workbook, and a demonstration video; these are described in detail elsewhere (12).
Each module consisted of segments or "skill areas," and each skill area included specific educational objectives. For example, in the medication management module, the skill area on "identifying benefits of antipsychotic medication" focused on teaching participants to make polite requests of their doctors regarding the type, dose, and benefits of medication. Appendix 1 lists the skill areas for the four modules used in this study.
The faithfulness and consistency of the module leaders to the procedures in the trainer's manuals were rated weekly by their supervisor through use of an observational checklist, and feedback was given as needed to maintain high levels of fidelity. In addition, tests of knowledge and skill related to the modules were administered after training to a subset of subjects from both treatment conditions to assess learning during the intensive phase. There was a highly significant posttraining difference across the 2-year follow-up period (main effect: F=21.05, df=1,56, p<0.0001) favoring the subjects in the skills training condition. Mean scores on the knowledge test were 21.4 for the social skills training group and 13.8 for the control group (both standard errors=1.2). The interaction of treatment by month (6, 12, and 24 months) was not significant (F<1, df=2,54, p=0.47), indicating that knowledge differences were stable across the follow-up period.
There were no significant differences between the chlorpromazine equivalents of antipsychotic drugs prescribed by the psychiatrists for the subjects in the two treatment conditions over the 2-year follow-up period; doses averaged 375.8 and 392.4 mg of chlorpromazine equivalents for the skills training and occupational therapy conditions, respectively. A wide variety of antipsychotic drugs and doses were used, with doctor's choice liberally used to facilitate optimal symptom control in these persistently psychotic outpatients. Treating psychiatrists were asked to identify the psychosocial treatment conditions for each patient under their care at the end of the 2-year study. None of the psychiatrists was able to designate patients at a better than chance level; their cumulative correct and incorrect ratings were 48 and 32, respectively.
Case Management
At the end of the intensive phase, each subject was assigned to a community case manager; case managers received subjects at random from the two psychosocial treatment conditions. The case managers' role and responsibilities included 1) establishing a therapeutic alliance, 2) providing crisis intervention and liaison with the treating psychiatrist, 3) encouraging the continued use of the patient's intensive treatment in community life (i.e., the skills training subjects were encouraged to use their skills in everyday life, and the occupational therapy subjects were encouraged to continue expressive activities in the community), and 4) consulting with social service and other community agencies (e.g., housing, entitlements) to facilitate the tenure and successful survival of the individual in the community. Each episode of interaction between case manager and subject was coded on a contact sheet that assigned times to the various domains of interaction. Post hoc analysis of the contact sheets revealed that most of the case managers' time was spent on responsibilities 1, 2, and 4. There were no differences in the domain-specific or total contact times between the two psychosocial conditions.
In designing this treatment trial, we were faced with the choice of having the same case managers providing services to patients from both intensive psychosocial treatment conditions (in which case the personalities of the case managers would be controlled) or having different case managers providing services to patients representing each of the two intensive psychosocial treatments (in which case bias for the respective psychosocial treatments might have been minimized). We chose the former design element because of cost constraints and because we wanted the crisis intervention skills, general relationship counseling skills, and other clinical competencies to be as similar as possible across the two psychosocial treatment conditions. We realize that bias may have played a part in this design, but the case managers were chosen for their commitment to clinical versus research values (13), and they were accountable to the clinical psychiatrists on this study who were blind to the psychosocial treatment conditions of the patients. In addition, the investigators wanted to give priority to the "services research" aspects of the study, making it as realistically applicable to "real-life" clinical settings as possible (14).
Assessments
The major assessment instrument for utilization of skills in everyday life was the Independent Living Skills Survey (15). With this instrument, the subject is queried about specific activities engaged in during the preceding 6-month period. Dimensions that are tapped by this survey include use of public transportation, money management, job seeking, and social relations. These dimensions were not all isomorphic with the skills targeted for training; hence, the Independent Living Skills Survey is best viewed as a measure of utilization of skills, not necessarily reflecting on a one-to-one basis the training goals. This instrument, as well as others, was administered at baseline, after the 6-month intensive phase, and at 6-month intervals thereafter.
Other, more general, instruments of social functioning were used, such as the Social Activities Scale, the Profile of Adaptation to Life, and the Global Assessment Scale (GAS). The Expanded BPRS (10), Brief Symptom Inventory, Rosenberg Self-Esteem Scale, and Lehman Quality of Life Scale were also administered. Blindness of the prescribing psychiatrists and assessors was promoted by geographically distancing the treatment program from the locales for pharmacotherapy and ratings of outcome and by repeatedly instructing the subjects to refrain from mentioning their psychosocial treatment to their psychiatrist and assessor.
The principal statistical design for the comparison of group outcomes was a mixed model, repeated measures analysis of covariance. When baseline data were available, the dependent variables were raw change scores from baseline. The analytic design was a 2x3 factorial, including main effects of treatment condition (social skills training versus occupational therapy) and follow-up phase (6, 12, and 24 months) and their interaction; baseline level and cohort differences were controlled. Because the dependent measures were change scores (adjusted for baseline), treatment group main effects indicate stable group differences in the amount of change during follow-up. Interactions of group by time would indicate lack of stability of those differences during the follow-up period. Separate subscales were analyzed in separate statistical analyses. As a follow-up to any finding of statistically significant treatment effects, t tests were computed to compare treatment groups at each follow-up point. Separate within-group t tests were used to assess significance of change over time (these within-group effects were estimated at the follow-up midpoint, or at approximately 1 year).
While the efficacy of social skills training in schizophrenia appears well established (1–8), most studies have been conducted in medical school departments of psychiatry with augmented staff who were specially prepared as trainers. Moreover, most of the efficacy trials have used "customary treatment" as the control group. Three major questions that remain largely unanswered are, Can social skills training be effectively conducted by paraprofessionals in an ordinary clinical setting? Do the skills learned in clinic training sessions generalize to the outside world? and Are the effects of skills training discernible when an active comparison group is used?
In most psychiatric hospitals and day hospitals, the prevailing psychosocial treatment is occupational therapy in which expressive art and crafts and recreational activities are the media through which therapists build self-esteem and productivity. However, there have been few empirical evaluations of the efficacy of this approach (9). At the West Los Angeles Veterans Administration (VA) Medical Center, hundreds of patients with serious mental disorders receive this modality each year. In 1981, the VA Central Office established a new form of psychosocial treatment by funding a demonstration program, at the West Los Angeles VA Medical Center, for training in social and independent living skills. Subsequently, a health services research study was begun at this medical center to compare the relative impact of occupational therapy and skills training on persons with persistent and long-term schizophrenia. We shall report the first results from this study in the present article.
Subjects
Cohorts of 10–12 outpatients with persistent and unremitting forms of schizophrenia were entered into the study through a randomization procedure that assigned half to psychosocial occupational therapy and half to skills training at the West Los Angeles VA Medical Center. A total of 84 male patients were assigned to receive 6 months of intensive, clinic-based treatment 3 hours per day, 4 days per week. They were seen approximately once per month by psychiatrists who were blind to the psychosocial treatment assignment and who prescribed antipsychotic medication and adjunctive medications by "doctor's choice." Medication tended to produce some stability in patients' symptoms, but few went into full remission during the study; thus, the assessment of discrete episodes of symptom exacerbation or relapse was not feasible.
Almost all of the subjects were never married; were living in community-based, board-and-care homes; and had one or more persisting psychotic symptoms (i.e., suspiciousness, unusual thoughts, hallucinations, grandiosity, conceptual disorganization) rated as moderate or higher on the Expanded University of California, Los Angeles (UCLA), Brief Psychiatric Rating Scale (BPRS) (10). The average age of the subjects was 37.1 years (SD=8.8), their average education amounted to 12.3 years (SD=1.9), and the average duration of illness was 14.8 years (SD=8.0). Sixty-six percent were Caucasian, 25% were African American, and the remainder were either Hispanic or Asian. There were no significant differences in these background variables between the patient cohorts assigned to the two psychosocial conditions (p values ranged from 0.14 to 0.41; all comparisons were by t test except ethnicity, which was by chi-square).
Written informed consent was obtained after the procedures were fully explained to the subjects and repeated back by them to the investigators. The research procedures were approved by the Medical Center's Research and Human Subject Protection Committee according to the appropriate institutional guidelines. Subjects were free to withdraw from the research protocol at any time without prejudicing their access to treatment elsewhere. Attrition was minimal; only 14 of 84 subjects dropped out during the 2-year period (four in the control group and 10 in the social skills training group; 2=2.44, df=1, p=0.12). Almost all of the dropouts were accounted for by individuals moving to new geographical areas of the state or country and becoming unavailable for assessments. Attrition was minimized by the continuing care contacts provided by the clinical case managers and the availability of van transportation, lunches, and a "drop-in" socialization center for subjects.
Psychosocial Treatment Conditions
Psychosocial occupational therapy was led by three certified occupational therapists and comprised expressive, artistic, and recreational activities that mediated supportive therapy (9, 11). Patients participated individually and in groups, with encouragement by the therapists to individualize their interests and abilities through arts and crafts, discussion of feelings, and articulation of personal goals.
The skills training was conducted by an occupational therapist and three paraprofessionals who took turns in leading four modules of the UCLA Social and Independent Living Skills Program—basic conversation, recreation for leisure, medication management, and symptom management. Each module consisted of a trainer's manual, a participant's workbook, and a demonstration video; these are described in detail elsewhere (12).
Each module consisted of segments or "skill areas," and each skill area included specific educational objectives. For example, in the medication management module, the skill area on "identifying benefits of antipsychotic medication" focused on teaching participants to make polite requests of their doctors regarding the type, dose, and benefits of medication. Appendix 1 lists the skill areas for the four modules used in this study.
The faithfulness and consistency of the module leaders to the procedures in the trainer's manuals were rated weekly by their supervisor through use of an observational checklist, and feedback was given as needed to maintain high levels of fidelity. In addition, tests of knowledge and skill related to the modules were administered after training to a subset of subjects from both treatment conditions to assess learning during the intensive phase. There was a highly significant posttraining difference across the 2-year follow-up period (main effect: F=21.05, df=1,56, p<0.0001) favoring the subjects in the skills training condition. Mean scores on the knowledge test were 21.4 for the social skills training group and 13.8 for the control group (both standard errors=1.2). The interaction of treatment by month (6, 12, and 24 months) was not significant (F<1, df=2,54, p=0.47), indicating that knowledge differences were stable across the follow-up period.
There were no significant differences between the chlorpromazine equivalents of antipsychotic drugs prescribed by the psychiatrists for the subjects in the two treatment conditions over the 2-year follow-up period; doses averaged 375.8 and 392.4 mg of chlorpromazine equivalents for the skills training and occupational therapy conditions, respectively. A wide variety of antipsychotic drugs and doses were used, with doctor's choice liberally used to facilitate optimal symptom control in these persistently psychotic outpatients. Treating psychiatrists were asked to identify the psychosocial treatment conditions for each patient under their care at the end of the 2-year study. None of the psychiatrists was able to designate patients at a better than chance level; their cumulative correct and incorrect ratings were 48 and 32, respectively.
Case Management
At the end of the intensive phase, each subject was assigned to a community case manager; case managers received subjects at random from the two psychosocial treatment conditions. The case managers' role and responsibilities included 1) establishing a therapeutic alliance, 2) providing crisis intervention and liaison with the treating psychiatrist, 3) encouraging the continued use of the patient's intensive treatment in community life (i.e., the skills training subjects were encouraged to use their skills in everyday life, and the occupational therapy subjects were encouraged to continue expressive activities in the community), and 4) consulting with social service and other community agencies (e.g., housing, entitlements) to facilitate the tenure and successful survival of the individual in the community. Each episode of interaction between case manager and subject was coded on a contact sheet that assigned times to the various domains of interaction. Post hoc analysis of the contact sheets revealed that most of the case managers' time was spent on responsibilities 1, 2, and 4. There were no differences in the domain-specific or total contact times between the two psychosocial conditions.
In designing this treatment trial, we were faced with the choice of having the same case managers providing services to patients from both intensive psychosocial treatment conditions (in which case the personalities of the case managers would be controlled) or having different case managers providing services to patients representing each of the two intensive psychosocial treatments (in which case bias for the respective psychosocial treatments might have been minimized). We chose the former design element because of cost constraints and because we wanted the crisis intervention skills, general relationship counseling skills, and other clinical competencies to be as similar as possible across the two psychosocial treatment conditions. We realize that bias may have played a part in this design, but the case managers were chosen for their commitment to clinical versus research values (13), and they were accountable to the clinical psychiatrists on this study who were blind to the psychosocial treatment conditions of the patients. In addition, the investigators wanted to give priority to the "services research" aspects of the study, making it as realistically applicable to "real-life" clinical settings as possible (14).
Assessments
The major assessment instrument for utilization of skills in everyday life was the Independent Living Skills Survey (15). With this instrument, the subject is queried about specific activities engaged in during the preceding 6-month period. Dimensions that are tapped by this survey include use of public transportation, money management, job seeking, and social relations. These dimensions were not all isomorphic with the skills targeted for training; hence, the Independent Living Skills Survey is best viewed as a measure of utilization of skills, not necessarily reflecting on a one-to-one basis the training goals. This instrument, as well as others, was administered at baseline, after the 6-month intensive phase, and at 6-month intervals thereafter.
Other, more general, instruments of social functioning were used, such as the Social Activities Scale, the Profile of Adaptation to Life, and the Global Assessment Scale (GAS). The Expanded BPRS (10), Brief Symptom Inventory, Rosenberg Self-Esteem Scale, and Lehman Quality of Life Scale were also administered. Blindness of the prescribing psychiatrists and assessors was promoted by geographically distancing the treatment program from the locales for pharmacotherapy and ratings of outcome and by repeatedly instructing the subjects to refrain from mentioning their psychosocial treatment to their psychiatrist and assessor.
The principal statistical design for the comparison of group outcomes was a mixed model, repeated measures analysis of covariance. When baseline data were available, the dependent variables were raw change scores from baseline. The analytic design was a 2x3 factorial, including main effects of treatment condition (social skills training versus occupational therapy) and follow-up phase (6, 12, and 24 months) and their interaction; baseline level and cohort differences were controlled. Because the dependent measures were change scores (adjusted for baseline), treatment group main effects indicate stable group differences in the amount of change during follow-up. Interactions of group by time would indicate lack of stability of those differences during the follow-up period. Separate subscales were analyzed in separate statistical analyses. As a follow-up to any finding of statistically significant treatment effects, t tests were computed to compare treatment groups at each follow-up point. Separate within-group t tests were used to assess significance of change over time (these within-group effects were estimated at the follow-up midpoint, or at approximately 1 year).
Tuesday, February 27, 2007
Award Winning Public Education Campaign Of American Speech-Language Hearing Association To Hit Airwaves Anew
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Award Winning Public Education Campaign Of American Speech-Language Hearing Association To Hit Airwaves Anew
2/25/2007
TV, Radio PSAs To Warn About Hearing Loss Risk From
Misuse of Personal Audio Technology
One Depicting A Tattoo Session Gone Bad Uses Humor To Convey A Serious Message
Rockville, MD - January 29, 2007 - In the wake of reports that the 2006 holiday shopping season included record sales of personal audio technology products like the iPod, the American Speech-Language-Hearing Association (ASHA) has produced and disseminated nationwide television and radio public service announcements (PSAs) about the importance of safeguarding one's hearing when listening to the technology.
Set in a fictionalized tattoo parlor, fifteen and thirty second TV spots depict humorous unintended consequences from listening to an MP3 player at high volume. A young man receives the wrong tattoo due to miscommunication between him and the tattoo artist. The whole time, both are listening to MP3 players set at high volume.
Meanwhile, the radio spots compare the sound levels produced by personal audio technology with that from other sources–a soda can, a tattoo gun, a motorcycle and a chain saw. By doing so, they make a compelling point about the amount of noise that goes into the ear when the technology is played too loudly.
The PSAs are the latest phase of "America: Tuned in Today…But Tuned Out Tomorrow?", an ASHA public education campaign about the potential risk of hearing loss from unsafe usage of personal audio technology.
To date, key campaign elements have included www.listentoyourbuds.org, an interactive bilingual website for young children, parents, and educators; two national polls on usage habits and attitudes and subsequent video news packages; and, a presentation at the first ever national conference on noise induced hearing loss in children. The campaign has drawn global media coverage, and was the reason why ASHA won a 2007 Associations Advance America Award of Excellence from the American Society of Association Executives.
Award Winning Public Education Campaign Of American Speech-Language Hearing Association To Hit Airwaves Anew
2/25/2007
TV, Radio PSAs To Warn About Hearing Loss Risk From
Misuse of Personal Audio Technology
One Depicting A Tattoo Session Gone Bad Uses Humor To Convey A Serious Message
Rockville, MD - January 29, 2007 - In the wake of reports that the 2006 holiday shopping season included record sales of personal audio technology products like the iPod, the American Speech-Language-Hearing Association (ASHA) has produced and disseminated nationwide television and radio public service announcements (PSAs) about the importance of safeguarding one's hearing when listening to the technology.
Set in a fictionalized tattoo parlor, fifteen and thirty second TV spots depict humorous unintended consequences from listening to an MP3 player at high volume. A young man receives the wrong tattoo due to miscommunication between him and the tattoo artist. The whole time, both are listening to MP3 players set at high volume.
Meanwhile, the radio spots compare the sound levels produced by personal audio technology with that from other sources–a soda can, a tattoo gun, a motorcycle and a chain saw. By doing so, they make a compelling point about the amount of noise that goes into the ear when the technology is played too loudly.
The PSAs are the latest phase of "America: Tuned in Today…But Tuned Out Tomorrow?", an ASHA public education campaign about the potential risk of hearing loss from unsafe usage of personal audio technology.
To date, key campaign elements have included www.listentoyourbuds.org, an interactive bilingual website for young children, parents, and educators; two national polls on usage habits and attitudes and subsequent video news packages; and, a presentation at the first ever national conference on noise induced hearing loss in children. The campaign has drawn global media coverage, and was the reason why ASHA won a 2007 Associations Advance America Award of Excellence from the American Society of Association Executives.
Nature as an Occupational Therapy Modality
By Jane Sorensen, PhD, OTR, ND
I am planning on getting a naturopathic degree from a distance learning college. Would you tell why you decided on getting that degree, where you did your ND degree, and how that practice fits in with OT?
Sure! I've received a number of emails asking about OT and naturopathy. Glad to know you have heard of naturopathic medicine!
I had not heard of naturopathy or naturopathic doctors until about 18 years ago, when I had been in my OT practice over 20 years. It turns out that was, in part, because I was in New York, which did not license (and still doesn't) naturopathic medicine. It is only licensed in 13 states.
I called the New York OT Board to ask about learning to use herbs and incorporate them in my practice. They explained that recommending herbs to ingest would be practicing medicine without a license, and I could lose my OT license.
That information ruled out my idea of attending the University of Bridgeport in Connecticut, a two-hour commute from New York City, for a four-year clinical ND degree and becoming a naturopathic physician. Naturopathic physicians have primary practices, but only in the 13 states where they are licensed.
I am planning on getting a naturopathic degree from a distance learning college. Would you tell why you decided on getting that degree, where you did your ND degree, and how that practice fits in with OT?
Sure! I've received a number of emails asking about OT and naturopathy. Glad to know you have heard of naturopathic medicine!
I had not heard of naturopathy or naturopathic doctors until about 18 years ago, when I had been in my OT practice over 20 years. It turns out that was, in part, because I was in New York, which did not license (and still doesn't) naturopathic medicine. It is only licensed in 13 states.
I called the New York OT Board to ask about learning to use herbs and incorporate them in my practice. They explained that recommending herbs to ingest would be practicing medicine without a license, and I could lose my OT license.
That information ruled out my idea of attending the University of Bridgeport in Connecticut, a two-hour commute from New York City, for a four-year clinical ND degree and becoming a naturopathic physician. Naturopathic physicians have primary practices, but only in the 13 states where they are licensed.
Innovative Physical Therapy Relieves Back Pain
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Innovative Physical Therapy Relieves Back Pain
Monday, April 18, 2005
By Charlene Laino
E-MAIL STORY PRINTER FRIENDLY VERSION
An innovative physical therapy technique may relieve back pain even when all other treatments fail.
The technique, called Souchard's global postural re-education -- or GPR for short -- employs a series of gentle movements to realign spinal column joints and strengthen and stretch muscles that have become tight and weak from underuse.
"GPR corrects the patient's posture and decompresses the spinal canal," says Conrado Estol, MD, PhD, of the Neurologic Center for Treatment and Rehabilitation in Buenos Aires, Argentina. He presented his study at the American Academy of Neurology 57th Annual Meeting.
Aging
Arthritis
Cancer
Diabetes
Headaches & Migraines
Heart Disease
HIV / AIDS
Medication & Herbal Remedies
Mental Health
Neurological Illnesses
Nutrition & Fitness
Pharmaceutical & Medical
Pregnancy / Fertility
Sexual Health
Substance Abuse
Things You Should Know
Ask Dr. Manny
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SEE MORE - Arthritis News - Bird Flu - Cancer - Heart Disease - Diabetes - Neurological Illnesses - Mental Health - Nutrition and Fitness - Medication and Herbal Remedies - Pregnancy / Fertility - Sexual Health - Aging - HIV / AIDS - Substance Abuse/Addiction - Things You Should Know
Send news tip to FOXNews.com
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FOXNEWS.COM HOME > HEALTH
Innovative Physical Therapy Relieves Back Pain
Monday, April 18, 2005
By Charlene Laino
E-MAIL STORY PRINTER FRIENDLY VERSION
An innovative physical therapy technique may relieve back pain even when all other treatments fail.
The technique, called Souchard's global postural re-education -- or GPR for short -- employs a series of gentle movements to realign spinal column joints and strengthen and stretch muscles that have become tight and weak from underuse.
"GPR corrects the patient's posture and decompresses the spinal canal," says Conrado Estol, MD, PhD, of the Neurologic Center for Treatment and Rehabilitation in Buenos Aires, Argentina. He presented his study at the American Academy of Neurology 57th Annual Meeting.
Linking the therapist to the employer shouldn't have to be that hard.
Linking the therapist to the employer shouldn't have to be that hard. www.therapyemploy.comWith hundreds of thousands of therapists in the country www.therapyemploy.com is bound and determined to get themlisted in their resume database. Linking the employer to the employee is not that hard, they both just need the right tools./24-7PressRelease/ - SALT LAKE CITY, UT, October 09, 2006 - Therapyemploy.com is pleased to announce the release ofits new therapy jobs website that links therapists to employers in simple easy to use steps. This therapy employmentwebsite is one month old and already has received over fifty (50) therapist users and twenty (20) employer/recruiter users that are linking together.
Physical therapists all the way to massage therapists, therapyemploy.com has it all.What is therapyemploy.com? - Job seekers are able to register for free and have instant access to either upload their resume file from their computer orfill out a three step process that helps them write a great and easy to read resume. Job seekers/therapists can then searchjobs throughout the country (USA) and respond to the job post which links them to the employer instantly.- Employer/recruiter users register for free and then can automatically get one free job post and one free resume view. Theythen have the choice to buy unlimited postings for only $15. In the therapy job posting world this is unheard of.- Advertising is also available for Employer/Recruiters for low prices.
Therapyemploy.com will also help the employer withthe graphics of the advertising that is found on the homepage.What is therapyemploy.com? - Job seekers are able to register for free and have instant access to either upload their resume file from their computer orfill out a three step process that helps them write a great and easy to read resume. Job seekers/therapists can then searchjobs throughout the country (USA) and respond to the job post which links them to the employer instantly.- Employer/recruiter users register for free and then can automatically get one free job post and one free resume view. Theythen have the choice to buy unlimited postings for only $15. In the therapy job posting world this is unheard of.- Advertising is also available for Employer/Recruiters for low prices. Therapyemploy.com will also help the employer withthe graphics of the advertising that is found on the homepage.
Physical therapists all the way to massage therapists, therapyemploy.com has it all.What is therapyemploy.com? - Job seekers are able to register for free and have instant access to either upload their resume file from their computer orfill out a three step process that helps them write a great and easy to read resume. Job seekers/therapists can then searchjobs throughout the country (USA) and respond to the job post which links them to the employer instantly.- Employer/recruiter users register for free and then can automatically get one free job post and one free resume view. Theythen have the choice to buy unlimited postings for only $15. In the therapy job posting world this is unheard of.- Advertising is also available for Employer/Recruiters for low prices.
Therapyemploy.com will also help the employer withthe graphics of the advertising that is found on the homepage.What is therapyemploy.com? - Job seekers are able to register for free and have instant access to either upload their resume file from their computer orfill out a three step process that helps them write a great and easy to read resume. Job seekers/therapists can then searchjobs throughout the country (USA) and respond to the job post which links them to the employer instantly.- Employer/recruiter users register for free and then can automatically get one free job post and one free resume view. Theythen have the choice to buy unlimited postings for only $15. In the therapy job posting world this is unheard of.- Advertising is also available for Employer/Recruiters for low prices. Therapyemploy.com will also help the employer withthe graphics of the advertising that is found on the homepage.
Saturday, November 04, 2006
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