| A Multi-Disciplinary Approach | ||||||||||
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You've often heard about the wisdom of getting a second opinion. At Advantage, you get a third
and fourth. That's because our method of diagnosis is multidisciplinary - a team of Doctors,
Therapist, and Counselors each with different and specialized skills, evaluates your condition.
Together the doctors decide on your appropriate course of treatment and rehabilitation, which
may call for a combination of therapies. | ||||||||||
| Our Philosophy of Treatment | ||||||||||
Our philosophy of treatment is conservative - which means finding a non-surgical solution, if
possible. Simply stated, here's how we'll approach your care:
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| Services at Advantage | ||||||||||
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The World Health Organization defines health as "...a state of complete physical, mental and social
well-being...". In order to address the many factors that contributes to each patient's unique
definition of well being, professionals skilled in all aspects of rehabilitation staff at Advantage
Healthcare Systems. These professionals work together as team members to ensure the best treatment
possible. Team members may include: Physical therapists Chiropractors License Professional Counselors Licensed Social Workers Case managers Vocational Counselors Psychologists In all settings, patients and their family members work together with our rehab teams to improve function, learn techniques to manage daily activities, and identify ways to return to meaningful living. Because we believe that education is key to effective rehabilitation, our patients receive the following information as part of the rehabilitation process: Medical diagnosis and its implications for functional ability Ways to compensate for impairments Ways to prevent further impairment Adaptation to changes in level of function Strategies for an active, healthy lifestyle Our program philosophy and progressive clinical practices help our patients achieve higher goal to increase quality and years of healthy life. Our patients are assisted with regaining independence, pursuing active, healthy lifestyles and resuming participation in community life. | ||||||||||
| Treatments and Diagnostics Offered | ||||||||||
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Family Practice
Physical Therapy
Chiropractic Manipulation
Physical Performance Exams
Functional Capacity Exams
NCV/EMG Testing
Weight Loss Assistance and Planning
Relaxation Therapy
Work Conditioning/ Hardening
Independent Medical Exams/ MMI
Psychological Evaluations/ Counseling
Biofeedback
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| E & T - Evaluation & Treat |
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Multidisciplinary Team of Specialists Advantage Healthcare Systems offers the benefit of a multidisciplinary team approach to the diagnosis and treatment of pain. The team includes highly experienced physicians, psychologists, rehabilitation specialist, licensed professional counselors, social workers, and chiropractors. Comprehensive Evaluation Unless your physician refers you to the Advantage Healthcare Systems to undergo a specific procedure or a series of procedures, you will be scheduled to undergo a comprehensive evaluation. During this evaluation, a member of the multidisciplinary team will conduct a full physical and psychological assessment of your condition, including a review of your medical records and X-rays. In some cases, supplemental diagnostic tests may be necessary to further pinpoint the cause of your pain. (We will, however, avoid unnecessary duplication of tests wherever possible.) Once the evaluations have been completed, the specialist will determine whether or not treatment holds potential benefits for you, and to develop an individualized treatment plan. Individualized Treatment Plan The treatment plan developed by the Advantage Healthcare Systems team will be specially tailored to your condition and degree of pain, your needs, and your personal objectives. Your treatment plan may include a single approach, or a combination of different types of therapies: medical therapies, including both medications and special procedures; psychological therapies; and rehabilitation therapies. A brief overview of these different therapies follows. Other Therapies Your treatment plan also includes a number of "non-medical" techniques; all the therapies we offer are: Your progress will be carefully monitored throughout the course of your treatment. Personal measurement goals will be set up at the onset of your treatment. An example of a personal measurement goal for a patient with migraine headaches would be to lower the number of work days missed due to pain. Goal attainment will be measure at regular intervals by your treatment team. |
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Chronic Pain Management (CPM) / Interdisciplinary Pain Management |
| Chronic Pain Management The Advantage Healthcare Systems approach to pain and disability reflects the belief that work-related musculoskeletal disorders result from the interaction between environmental and individual factors. Included among these factors are the worker's psychological and behavioral reactions to pain. Research has clearly established that everyday stress and negative mood can contribute to physical pain. Unrelenting pain may, in turn, become a stressor in and of itself. Advantage Healthcare Systems Chronic Pain Management Program helps the individual take control for his or her well being, in order to break out of the stress-pain cycle. The program begins with a Psychosocial Clinical Evaluation, which is a comprehensive assessment conducted by a licensed professional counselor specializing in pain management. The comprehensive evaluation includes a medical, psychological, social, work, and psychiatric history. The evaluation allows the counselor to identify obstacles to recovery that may not be readily apparent. After the evaluation, the counselor holds his or her findings to meet with the other team members to discuss an appropriate treatment plan. Chronic pain can have profound psychological effects, including feelings of hopelessness, anger, sadness, and even despair. These feelings can interfere with your ability to perform your job or your normal daily activities. Psychological therapy can help you to cope with the effects of pain on you and those around you. There are also specific psychological techniques that can actually help to reduce pain. Your treatment plan may include the following psychological therapies: What can Psychological Treatment do for my physical pain? Pain is a "whole person" experience. Most people experience pain physically, emotionally, socially, and intellectually. Pain can inhibit a normal productive life: it can limit your ability to concentrate, participate in physical activities and enjoy social interactions. Psychological evaluation and treatment can help many individuals develop specific skills that relieve the suffering of pain and thus increase their quality of life. What happens during a clinical interview? During your evaluation, we hope to gain an understanding of your situation so that we can provide you with some relief from the psychological consequences of your pain. A psychological evaluation is an efficient way of obtaining the necessary personal and historical information to assist you in getting effective medical care and pain relief. Combined with a personal interview, psychological testing helps you and your physician understand and plan the best possible multidisciplinary treatment. Professional recommendations are normally made after the initial evaluation is completed. We will discuss with you the results of your evaluation and your individualized treatment recommendations prior to your agreement to enter treatment at the Center. What the clinical interview is not Some patients are concerned that the evaluation might imply that their pain is imagined rather than felt; this is not the case. In fact, pain that is delusional cannot be alleviated through psychological treatments. Physical pain is normally recognized by the brain and, thus, has many effects on your well-being. It is these effects that we hope to identify during the evaluation. What psychological techniques are used? Psychological therapy offered at Advantage Healthcare Systems addresses both the physical and the emotional suffering associated with pain. We offer psychotherapy in both individual and group settings. Specific techniques include: Psychophysiological techniques Biofeedback/Relaxation Training: Many patients benefit from learning how to control their responses to chronic pain. Biofeedback and relaxation training teach you how to release the tension and anxiety that often make painful physical conditions more excruciating. Behavioral Techniques Self-Monitoring: Most patients will be asked to keep a diary of their pain, observing how pain levels increase or decrease over time. By monitoring your pain, you can develop an appreciation of your ability to control and manage levels of pain using skills you have learned. By encouraging the slow and steady introduction of or increase in activity, we can help patients start to feel an improvement in their quality of life. Pain can be very debilitating, and Advantage Healthcare Systems is committed to helping patients improve their social, occupational and recreational activity levels. Cognitive Techniques Self-Hypnosis and Visual Imagery: These techniques help you control pain that interferes with your occupational and sleep patterns. Through self-hypnosis, many patients report reduced levels of pain and an increased ability to concentrate on meaningful pursuits. Emotional Management: Over time, pain can be very distressing, leading to depression, anxiety and social turmoil. Psychological therapy can assist you in reducing the emotional distress associated with chronic pain. By learning these techniques, your pain can be transformed and your suffering reduced. Home Treatment Aids Office visits also include many helpful self-aid materials that enable patients to maximize the effects of treatment in the shortest time possible. Professional materials instructing you in the self-management approach to chronic pain and professionally produced relaxation and self-hypnosis tapes can be provided. Are sessions with the counselor confidential? In almost all situations, you control who has access to the information disclosed during your interview sessions with your counselor. There are some unusual exceptions to this rule, however, and you need to be aware of them. Information regarding child abuse, elder abuse or the need to protect you and others from physical harm or immediate danger must be reported to the appropriate persons by state law. |
| I/C - Individual Counseling |
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At Advantage Healthcare Systems, treatment is a mental, physical, and emotional process of growth and development.
Individuals attending Individual Counseling at Advantage learn the current medical facts about their disease.
They also receive an intensive combination of therapy, education and social conditioning. It is concentrically
focused on a lifetime of recovery and creating a brighter, more productive future. |
| W/C - Work Conditioning |
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Clients who are beyond the initial acute stage of modalities and strengthening may be candidates for Work
Conditioning. Typical clients are de-conditioned post injury and their work requires heavy job demands.
This is an intensive 4-8 hour program, 5 days a week, which is both work and goal-oriented. This service
is offered at all of Advantage Healthcare Systems facilities. This program helps restore physical capabilities that are required for work. Programs typically are 2-4 weeks depending on the functional levels needed before full return-to-work but can last longer based on the patient's treatment plan. Physical Modalities Included in the program consists of: |
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W/H - Work Hardening |
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Advantage Healthcare Systems has helped hundreds of clients sufficiently improve their physical
capabilities for return to work after an injury. The functional, physical, behavioral, and vocational needs of injured workers are addressed by involving all parties who have an interest in a rapid, stable, and safe return-to-work. Much attention is paid to work behaviors, education and safety. The highly structured, goal-oriented program involves intensive strengthening and conditioning, cardiovascular training, behavioral and psychological counseling, and work simulation that reproduces the physical demands of the job in terms of work heights, weights, postures, and tolerances. Many cases require on-site evaluation of the job. Daily programs typically progress from 2-4 hours in length over a four-week period, with many clients released early after meeting their program goals. Dove-Tailed Work Hardening If a client is released to return to work in a modified/limited duty fashion, a dove-tailed work hardening program may aid the individual in gaining the ability to return to full duty status. This "dove-tailed" program would typically be provided in a 2-4 hour sessions, 3-5 days a week in conjunction with the client's limited duty work day. This program helps increase functional capabilities while allowing the client to return to the working environment. The ultimate goal of this program is to progress the client to full duty status. |
| Bio - Biofeedback |
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Biofeedback is used for the treatment of many common pain problems, most notably headache and back pain.
Using a special electronic machine, the patient is trained to become aware of, to follow, and to gain
control over certain bodily functions, including muscle tension, heart rate, and skin temperature. The
individual can then learn to effect a change in his or her responses to pain, for example, by using relaxation
techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects.
Similarly, the use of relaxation techniques in the treatment of pain can increase the patient's feeling of well-being. |
| EMG - Electromyogram |
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Procedure Overview What is EMG? Electromyography (EMG) measures muscle response or electrical activity in response to a nerve's stimulation of the muscle. The test is used to help detect neuromuscular abnormalities. During the test, one or more small needles (also called electrodes) are inserted through the skin into the muscle. The electrical activity picked up by the electrodes is then displayed on an oscilloscope (a monitor that displays electrical activity in the form of waves). An audio-amplifier is used so the activity can be heard. EMG measures the electrical activity of muscle during rest, slight contraction, and forceful contraction. Muscle tissue does not normally produce electrical signals during rest. When an electrode is inserted, a brief period of activity can be seen on the oscilloscope, but after that, no signal should be present. After all of the electrodes have been inserted, you may be asked to contract the muscle, for example, by lifting or bending your leg. The action potential (size and shape of the wave) that this creates on the oscilloscope provides information about the ability of the muscle to respond when the nerves are stimulated. As the muscle is contracted more forcefully, more and more muscle fibers are activated, producing action potentials. Interpretation of the test results: A healthy muscle will show no electrical activity (no signs of action potential) during rest, only when it contracts. However, if the muscle is damaged or has lost input from nerves, it may have electrical activity during rest. When it contracts its electrical activity may produce abnormal patterns. An abnormal EMG result may be a sign of a variety of muscle or nerve disorders, including polymyositis (an inflammatory muscle disease that causes decreased muscle power), muscular dystrophy (a chronic genetic disease that progressively affects muscle function), myasthenia gravis (a genetic or immune disorder that occurs at the point where the nerve connects with the muscle), and myotonic (stiff) muscles. Reasons for the Procedure EMG is often used along with nerve conduction velocity (NCV) to differentiate a muscle disorder from a nerve disorder. NCV detects a problem with the nerve, whereas EMG can detect diseases stemming from problems with the muscle itself, as well as other problems that result from influences on the muscle from other systems, such as nerves. EMG may be done to identify the cause of symptoms, such as muscle weakness, deformity, spasticity, atrophy, and stiffness. It may be used to detect whether someone is experiencing true muscle weakness or weakness because of pain or psychological reasons. EMG may be used to evaluate many problems/disorders including, but not limited to, the following: Risks of the Procedure Some discomfort, similar to the feeling of an injection or an acupuncture needle, may be felt when the needle electrodes are inserted into the muscle. Afterwards, the muscle may feel sore for a few days and a bruise may appear at the needlestick site. The insertion of the electrodes may also cause false results on a muscle biopsy or during blood tests in which muscle enzymes are measured. EMG is usually contraindicated in persons receiving anticoagulant therapy (blood thinning medication such as Coumadin) because the needle electrodes may cause bleeding within the muscle. It also may be contraindicated in persons with extensive skin infections due to the risk of spreading infection from the skin to the muscle. There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure. Certain factors or conditions may interfere with EMG test results. Swelling, bleeding, or obesity may interfere with the transmission of electrical waves to the electrodes, and thereby alter the EMG results. Medications such as skeletal muscle relaxants, cholinergics, and anticholinergics may also interfere with EMG test results. Before the Procedure During the Procedure An EMG procedure may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices. The EMG is usually performed immediately following a nerve conduction study (a test that measures the flow of current through a nerve before it reaches the muscle rather than the response of muscle itself). Generally, an EMG procedure follows this process: 1. You will be asked to remove any clothing, jewelry, hairpins, eyeglasses, hearing aids, or other metal objects that may interfere with the procedure. 2. If you are asked to remove clothing, you will be given a gown to wear. 3. You will be asked to sit or lie down for the test. 4. A neurologist will locate the muscle(s) to be studied. 5. The skin will be cleansed with an antiseptic solution. Next, a fine, sterile needle will be inserted into the muscle. A metal plate will be positioned under you. 6. Ten or more needle insertions may be necessary for the test. You may experience slight pain with the insertion of the electrode, but it is usually painless. 7. If the test is painful you must tell your examiner because this can interfere with the results. 8. You will be asked to relax and then perform slight or full-strength muscle contractions. 9. The electrical activity from your working muscle will be measured and displayed on the oscilloscope. 10. An audio-amplifier may also be used so that both the appearance and sound of the electrical potentials can be evaluated. If the recorder is attached to an audio-amplifier, you may hear a sound like hail on a tin roof when you contract your muscle. After the Procedure Pain medication may be administered and warm compresses may be applied to the affected area immediately following the procedure. Some muscle soreness may persist for a day or so following the procedure. Notify your physician if you experience increasing pain, tenderness, swelling, or pus at the needle insertion sites. Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation. |
| NCV - Nerve Conduction Variance |
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Procedure Overview What is nerve conduction velocity? Nerve conduction velocity (NCV) test is a measurement of the speed of conduction of an electrical impulse through a nerve. NCV can determine nerve damage and destruction. During the test, the nerve is stimulated, usually with surface electrode patches attached to the skin. Two electrodes are placed on the skin over the nerve. One electrode stimulates the nerve with a very mild electrical impulse and the other electrode records it. The resulting electrical activity is recorded by another electrode. This is repeated for each nerve being tested. The nerve conduction velocity (speed) is then calculated by measuring the distance between electrodes and the time it takes for electrical impulses to travel between electrodes. A related procedure that may be performed is electromyography (EMG). An EMG measures the electrical activity in muscles and is often performed at the same time as NCV. Both procedures help to detect the presence, location, and extent of diseases that damage the nerves and muscles. Please see this procedure for additional information. Anatomy of the nervous system: The nervous system is a complex, sophisticated system that regulates and coordinates body activities. It is made up of two major divisions, including the following: Interpretation of the test results: The speed of nerve conduction is related to the diameter of the nerve and the degree of myelination (a myelin sheath is a type of "insulation" around the nerve). A normally functioning nerve will transmit a stronger and faster signal than a damaged nerve. In general, the range of normal conduction velocity will be approximately 50 to 60 meters per second. However, the normal conduction velocity may vary from one individual to another and from one nerve to another. Abnormal results may be caused by some sort of neuropathy (damage to the nerve) that can result from a contusion or traumatic injury to a nerve. Various diseases can also cause the impulses to slow down. Reasons for the Procedure Nerve conduction velocity is often used along with an EMG to differentiate a nerve disorder from a muscle disorder. NCV detects a problem with the nerve whereas an EMG detects whether the muscle is functioning properly in response to the nerve's stimulus. Diseases or conditions that may be evaluated with NCV include, but are not limited to, the following: Risks of the Procedure The voltage of the electrical pulses used during NCV is considered very low. There may be risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure. Certain factors or conditions may interfere with the results of NVC test, such as damage to the spinal cord, severe pain before the test, and body temperature. Before the Procedure During the Procedure A nerve conduction velocity procedure may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices. The NCV is performed by a physician who specializes in nerve disorders although other trained licensed professionals may also perform the test. Generally, a NCV procedure follows this process: 1. You will be asked to remove any clothing, jewelry, hairpins, eyeglasses, hearing aids, or other metal objects that may interfere with the procedure. 2. If you are asked to remove clothing, you will be given a gown to wear. 3. You will be asked to sit or lie down for the test. 4. A licensed professional will locate the nerve(s) to be studied. 5. A recording electrode will be attached to the skin over the nerve with a special paste and a stimulating electrode will be placed at a known distance away from the recording electrode. 6. The nerve will be stimulated by a mild and brief electrical shock given through the stimulating electrode. 7. You may experience minor discomfort for a few seconds. 8. The stimulation of the nerve and the detected response will be displayed on an oscilloscope (a monitor that displays electrical activity in the form of waves). After the Procedure The paste used to attach the electrodes will be removed from your skin. After the test, you may return to your previous activities, unless your physician advises you differently. Your physician may instruct you to avoid strenuous activities for the rest of the day. Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation. |
| P/T - Physical Therapy |
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1. What is Physical Therapy? Physical Therapy (PT) is considered a conservative treatment method addressing the treatment, healing and prevention of injuries and disabilities. PT focus primarily, but not solely, on pain relief, promoting healing, restore function and movement, fascilitation and adaptation associated with injury. Other areas that are focused upon within PT are ergonomic (body mechanic) training, fitness/wellness, and especially education. 2. What can a Physical Therapy program do for me that I cannot do on my own? Many patients may think that they know how to properly exercise, manage their pain and rehabilitate themselves. I have commonly been given explanations from patients for why they do not need therapy - for example, "I have had this before and I know what works for me" or "I know what is causing this, because my neighbor had the same thing so I will just do what she did" and attempt to manage themselves. At Advantage, our therapists are specialists who are skilled and educated specifically in proper rehabilitation. We are continually educated as to management for different dysfunctions, differentiation of one dysfunction/injury from another and work closely with the referring physician in the development of a rehabilitation program specifically designed for each individual. The other important aspect to remember with physical therapy is that each individual is different. We all have different types of bodies, different patterns of movement, different alignments and different habits. Our doctors, along with their trained staff, monitor each individual and attempt to correct improper habits, alignments and movement patterns. Most importantly with therapy is education. Because of healthcare guidelines and reimbursement changes, your physician may not have the time that they need to explain to you exactly what your injury/dysfunction/disability is and why/how it occurred. Your therapist is specialized in this and many times will be the one to educate you on the specifics of your problem and what the course of action will be to correct it and hopefully prevent it from reoccurring. PT focuses on education, correction and prevention. 3. How long is it going to take? This is such a popular question. It seems that everyone has to have timelines, which is understandable because we all have lives to lead. Your therapist is aware that rehabilitation can be an imposition. I always reply to these statements by explaining that because each person is different, rates of healing are different. We can usually get an idea of your progression within two weeks. I also explain to my patients that even though they have other things to do, rehab, is important and takes time just as injuries generally have taken a significant amount of time to progress to the point of injury or pain. The other factor that patients must understand is that, even though we are here teaching you and rehabilitating them, it is their responsibility to do their Home Program. This is a major factor in how quickly one recovers. 4. Who benefits from therapy? Many and all can benefit from therapy. As an active therapist, I work out and am always observing others. I very rarely come across individuals with perfect body mechanics, training techniques or movement patterns. This is where wellness comes into play. Typically, the most appropriate patients are those who have been in accidents (work, auto, or falls), athletes with overstress injuries, arthritic patients, pre- and post-operative patients, and those with general deconditioning or strains. 5. What will I have to do in therapy? Therapy generally encompasses pain relief, strength and flexibility training, proper postural alignment, regaining movement or range of motion, improving and correcting posture, endurance training, relaxation and stress relieving techniques, balance and coordination training, proper walking, education, safety awareness and development/implementation of a home exercise program. Remember that each individual is different, so each rehab/physical therapy experience and program is different. Be patient with yourself, your physician and your physical therapy staff. Healing takes time, diligence and compliance. If you think you may be a candidate for physical therapy, speak to your physician or to a therapist. We never will say "no" to questions. |