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Next Steps NOEL VELAZQUEZ

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Next StepsNoel Velazquez

Description of the agencyLocated in Willow Springs, ILOutpatient Rehabilitation Center for patients w/ spinal cord injuries (SPI) and traumatic brain injuries (TBI)Non-profit physical therapy and exercise facilityImplements the latest innovative equipment and medical research for neurological rehabilitation methods Associated with cutting-edge researchers who are involved in clinical trials such as Locomotor training.

Staff members:2 DPTs7 Exercise Therapists (CIFT) ACSM, 1PTA/ Massage Therapist3 Rehab Technicians

The Facility

Next Steps MissionDevoted to offering SPI patients a post-hospital exercise/rehab facility that will aid them in taking their next step towards a more functional, independent, and healthy lifestyle.

Also highly committed to support the advancement of spinal cord specific scientific research that will aid in the treatment of spinal cord injuries.

Types of SPIPatients have experienced car accidents, diving accidents, gun shot wounds, or falls which caused the injury.Most patients transport using a wheelchair.SPI are complex and patients will differ even with same level injury.Quadriplegia: loss of movement/ sensation in all four limbsParaplegia: loss of movement/ sensation in lower limbsC1-C8 level (hands and arms affected)T1-T12 level (normal function of hands/ arms) L1-S5 level (may be able to walk)

Equipment for Treatment: ReWalk Exoskeleton

Exoskeleton suit w/ motorized legs powering knee and hip movement.Changes in center of gravity help mimic a normal gait pattern.

Senses a forward tilt of the upper body to trigger the first step.

System is adjustable for different users of different height/ weight.

*Research studies using ReWalk are still being conducted for improvement/ effects.

TherastrideLocomotor TrainingManual body weight supported treadmill.4 staff members required to run sessionsAllows patients with paralysis to walk w/ BWS while preserving normal kinematics of a gait cycle.Monitored BW, speed (mph), and time on computerAssisted patients w/ guiding legs during step sessions.

Evidence behind Locomotor Training:Clinical trials demonstrated an increase in EMG activity in the lower limbs of individuals during locomotor training.

Lokomat

Used to improve mobility following stroke, SPI, cerebral palsy & multiple sclerosis

Robotic assisted body weight supported treadmill

Hip/ knee joint angles are controlled in real time by software to achieve a physiologically meaningful gait pattern.

Force transducers accurately measure interaction between patient and Lokomat

Internship DutiesTransferred patients from wheelchair to mat.Stretched upper/ lower extremities of patients to increase ROM and decrease spasticity (muscle tone).Guided patients through standing and sitting exercises.Focused on trunk stability/ postureLed patients through resistance, balance, cardio exercises.Guided patients during OG walking bouts.Guided patients hips, lower extremities during Therastride session.Monitored computer Setup body measurements for patient using Lokomat System.Changed leg cuff sizes, monitored computer, harnessed patient Documented exercise sessions using SOAP notes.

Problems EncounteredStrained back from being in abnormal positions for long periods of time.Spotting patients for timed bouts.TherastrideTransferring, lifting, spotting, maneuvering patients throughout sessions/day.

Deciding on which exercises patients could perform.Patients had limitations due to medical conditions.Some patients preferred regular routine which was comfortable for them.

Became aware of positions that could cause stress on myselfRead through patient files and short/ long-term goals to think of most beneficial exercises.

Self-Analysis of Performance Taking initiative was crucial.StrengthsQuick learner took on more responsibilities in the first few weeksAble to handle maneuvering/transferring patients (technique)Never hesitant to complete tasks assignedWeaknessesImplementing own ideas earlySOAP notes (meeting)

Leaving my Mark

Created an informational poster to educate patients on lower and upper motor neurons.

LMN / UMN are affected once a person experiences an injury to the spinal cord.

Immediate & Future GoalsContinuing to complete prerequisites for Doctorate of Physical Therapy program.After graduation, work at Next Steps or in similar setting to utilize skills learned and gain more experience in physical therapy.Volunteer/ Shadow in PT settings (neuro & ortho).

Gain Acceptance into DPT program.