The on-ramp to the road to recovery

By Loren Barnes
Naval Hospital Jacksonville Public Affairs

''Our focus is on how we can help get you better, how we can keep you better and how we can prevent future injury,'' said Lt. Denise Milton, Naval Hospital Jacksonville Physical and Occupational Therapy Department head, in describing how her staff rehabilitates patients' injuries.

Milton's department handles an average of 100 outpatient visits per day mainly from referrals. That's almost one tenth of the Naval Hospi-tal's total daily average of 1,142 outpatient visits. The injuries seen are extremely varied. For instance, Milton said over the last couple of weeks in just wound care referrals alone they've treated a patient who had stepped on a sea urchin, someone who fell out of a tree getting a cat, a case of poison oak, someone who had a motorcycle fall on his foot, as well as post-surgical wounds.

''That's just five off the top of my head,'' she said, ''all very unique, different events that have led to wounds and they ended up coming here.''

''It's a busy place,'' she said, explaining that her staff is comprised of four officers including two physical therapists, Milton and Lt. j.g. Carrie Dreyer and two occupational therapists, Lt. Sarah Goldman and Lt. Jonathan Colon. Also on staff is civilian Tonya Sauls, also a physical therapist. These therapists hold various certifications with national professional associations for various specialized services. The enlisted hospital corpsmen staff includes four physical therapy technicians, one occupational therapy technician and three general duty corpsmen. Rounding out the team are a civilian clerk and three Red Cross volunteers.

''The idea,'' Milton said ''is to shift people to self-management. They may come into the clinic for treatment initially but we're always working towards getting them independent so they can take care of themselves.''

This idea fits perfectly with the Surgeon General's emphasis on ''Force Health Protection,'' specifically his mandate for Naval Medicine to ''create a healthy and fit force'' ensuring that our Marines and Sailors are physically, mentally and socially able to accomplish any mission our nation calls upon them to perform.

The department includes two divisions, Occupational Therapy and Physical Therapy.

Occupational Therapy primarily evaluates and rehabilitates injuries to the upper extremities, below the shoulder issues such as the elbow, wrist and hands. The division works with injuries ranging from carpal tunnel syndrome (wrists) and cubital tunnel syndrome (elbow) to broken fingers, sprains, arthritis and traumatic injuries such as cut or torn tendons. The highly skilled staff is also trained and equipped for custom splint fabrication. Occupational Therapy also works collaboratively with the hospital's Orthopedics Department to hold ''Hand Clinics,'' a couple of times a week. In these sessions an occupational therapist and an orthopedic surgeon sees patients together.

''It's kind of one-stop shopping,'' Milton explained.

''Physical Therapy sees patients with any kind of neuromusculoskeletal injury,'' Milton said, ''aches and pains from head to toe.''

She said, ''We get people with minor maladies, things that kind of creep up on them with no specific injuries. And we get folks who are post-operative or post-injury to hips, knees, ankles, shoulders, necks, backs and we provide their rehabilitative services. We treat anything from simple ankle sprains to neck, back and radicular (nerve) problems. Some come in wheelchairs and eventually leave on crutches or less, which is nice to see.''

Patients with suspected nerve prob-

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lems such as carpal tunnel syndrome and patients with pain radiating down arms or legs are referred to Physical Therapy for clinical electrophysiological testing to assist the referring doctors with diagnosing the source of the problem. These specialized services are provided by Milton, a board certified specialist in clinical electro physiology.

The department also sees to the physical therapy needs of inpatients. Dreyer deals with a wide variety of rehabilitative issues for inpatients ranging from general debilitation resulting from extended stays in the Intensive Care Unit to previously ambulatory patients having to relearn to walk after recovering from broken hips and femurs.

What might you expect following referral to the Physical and Occupational Therapy Department?

''The first thing we do is set the patient up for an initial evaluation with a physical therapist or occupational therapist,'' Milton said. ''That evaluation usually lasts about 30 minutes. During the evaluation we not only try to identify what's going on right now but also what brought them to that point,'' she explained.

The evaluation involves a review of the patient's medical history, an interview and a physical exam that includes multiple systems. We talk to the patient about what their job is, what they do in their leisure time, what positions they sleep in, basically what they do to their bodies within a 24-hour period. This information is used to not only treat their current condition but to start teaching them better habits. Some may just go into a home program and then come back in a couple of weeks for follow up. Others may be set up with clinic treatment sessions three or four times a week for up to a month. At that time they would be reevaluated and their sessions might taper down to twice or even once a week. It's very unique to each patient, it's based on their response and on their needs,'' Milton explained.

Lt. Jeff Hurley, a VS-24 aviator who recently ejected from an S-3 Viking as it crashed in Southeast Georgia is undergoing physical therapy for injuries to his knee as he awaits Magnetic Resonance Imaging (MRI) results and a doctor's determination of further treatment.

Hurley said the staff ''has been great.'' He's been coming to the clinic for therapy three times a week since Aug. 18.

''When I first walked in I had a flexibility range from about 45 to 90 degrees and that was it,'' Hurley said. ''After just my fourth visit, I can now straighten my leg out and bend it past 90 degrees. It's gotten rid of my limp when I walk and everything.'' Under the care of HM2 Dariamara Vasquez, Hurley's therapy has consisted of ''steamboats'' (pulling against a restraining cord placed around the ankle), leg presses, and interferential and functional electrical stimulation which uses electrical pulses to reduce pain and swelling and strengthen the muscles.

Some patients also benefit from the department's gym program either as their initial treatment program or after working up to prescribed level in a clinic program. The gym program is run by Sauls at NAS Jacksonville's Fitness Source. The program was initiated two years ago with five patients and now has an average of 25 patients working with Sauls every Thursday morning. The patients have varying diagnoses; from lower back pains to knee pains, shoulder pains or general disability.

''I teach them basically how to work out without further injury, to get them to a more independent program,'' Sauls said. ''I try to get them to continue it. I tell them you can't treat physical therapy like antibiotics. People take them, feel better and they quit taking them. People can't just feel better and stop working out because they will just incur more injuries.''

She also teaches them to vary the types of apparatus and repetitions they use and the speed of their workouts. That not only keeps the interest and motivation levels up but also balances the effects of the workouts on various muscle groups of the body. She said that the intensity of the workouts is personalized to each patient depending on their injury, physical condition, etc.

''It's very important to do things correctly or you're going to hurt yourself even more. With people who already have a history of injuries it's even more important they use the proper form, she said.''

Air Force Senior Master Sgt. Philip Gainey was prescribed physical therapy after MRI tests indicated he suffered from a degenerated disk in his spine. The problem caused him to shift his weight resulting in pain his legs. Gainey said his doctor told him surgery could give him temporary relief but realigning the spine and strengthening his lower back through physical therapy would be better in the long run.

''Since I've been coming to the gym and working out with my physical therapist I feel like I'm getting stronger and I'm having less pain,'' Gainey said as he finished trunk strengthening exercises using 70 lb. weights on the cable system. Gainey's program has consisted of workouts on the back extension machine, abductor and adductor machines, the cable machines, gluteal extension machine, sit-ups and lunges. The program works the muscles of the trunk, pelvis and legs, as they work together to support the spine in day-to-day functional activities,'' Sauls explained.

''Pretty much everything is dedicated to the lower back, building the muscles and aligning the disks properly. I know that this is probably going to have to be part of my life in the future to continue to try and keep my back strong,'' he said.

Milton said that a major emphasis in the clinic is education. A good example is the Healthy Back Clinic that is offered for patients and any interested hospital beneficiaries - no consult required. The class is offered once per month and consists of education of spine anatomy and causes of pain, awareness of posture and proper body mechanics, self-treatment and prevention techniques, and exercise instruction. For more information on times and dates call 542-7375.

Putting people solidly on the path to a healthy recovery from debilitating injuries and teaching them habits that keep them that way is the mission of Naval Hospital Jacksonville's Physical and Occupational Therapy Department. It's one more example of how the Naval Hospital Jacksonville family cares for the Navy family.