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 Oak Tree PT Newsletter . Volume 1, #2 
October 2003 
. . . . . . . . .

The Oak Tree PT Newsletter presents information that is in some way related to physical therapy and health- related issues. We hope that you find it interesting, informative, topical, and timely.

We would like your feedback on any of the topics presented here, and on any topics that you would like to see addressed in the future. Please feel free to send in questions that are relevant to our focus, and we will try to answer as many as we can in our "Readers' Forum"

in this issue
  • Featured Article

    Can a 75-year-old who keeps falling attain the balance of a healthy 25-year-old? Researchers at Boston University think that just might be possible. Wearing shoe inserts that generate random vibrations at levels that cannot be felt by the wearer may keep many elderly at risk for falls out of hospitals and nursing homes longer.

    Standing balance depends in part on the brain's ability to adjust the body's posture in response to pressure changes in the feet. Older people are less sensitive to touch, so pressure signals in the feet are often too weak to trigger a message to the brain.

    The vibrating insoles improve postural stability due to a phenomenon called stochastic resonance, in which random noise enhances the detection of weak signals. As Charles Choi at Scientific American writes, "Imagine a frog in a jar: by itself the amphibian might not be able to jump out, but if the jar is in a rumbling truck the frog might get the boost it needs to make it."

    In this case, the nerves in the feet become more sensitive and better able to detect the pressure changes that occur in various parts of the feet when the body goes slightly out of balance. The brain then receives more frequent sensory messages from the feet, and in turn it sends more frequent motor messages to the postural muscles in order to maintain the body's standing balance. The vibrations must be randomly generated because neurons quickly get used to regular signals.

    One way to predict risk for falls is to measure the amount of postural sway in quiet standing. Some amount of sway is normal--everyone does it, but as balance decreases, sway increases. All of the subjects in this experiment stood for 30 seconds with their eyes closed, and generally the lack of visual feedback markedly increases postural sway. The researchers demonstrated that the older cohort (average age 73) decreased their their sway while using the vibrating insoles to the same levels as the younger group (average age 23) who did not have the benefit of using vibrating inserts during that particular trial.

    Further research is needed to address the efficacy of subsensory randomly vibrating insoles during normal walking, especially with subjects who have serious balance problems, but the current results look promising. Commercial production of the vibrating shoe inserts could dramatically reduce the number of hip fractures and other serious consequences of falls that now plague our elderly population.

    Boston University
    Professor, Biomedical Engineering
    Co-Director, Center for BioDynamics
    Director, Applied Biodynamics Laboratory
    tel: 617-353-0390
    fax: 617-353-5462
    email: jcollins@bu.edu

    View Abstract...

    Lawrence Keleman, author of a parenting book called To Kindle a Soul, reports about some interesting research on television viewing. He writes:

    "Psychologists and epidemiologists at the University of Tennessee and Memphis State University monitored metabolic rates in eight- to twelve- year-old children under two conditions: Lying down in a dark room, and sitting up watching television. In every case, the child's metabolic rate while sitting and watching television was far lower than his metabolic rate while lying down in the dark. Watching television is worse than doing nothing (emphasis mine).

    Kelemen recounts another study in which Harvard University Professor T. Berry Brazelton "hooked newborn babies up to electroencephalographs and then exposed them to a flickering light source similar to a television but with no images. Fifteen minutes into their exposure, the babies stopped crying and produced sleep patterns on the EEG, even though their eyes were still open and observing the light. Brazelton's experiment revealed that the medium itself, with no content (italics mine), acts directly on the brain to suppress mental activity.

    Keleman cites 159 separate references in his highly revealing and informative chapter on the effects of watching television.

    It's not a new idea, but nursing homes offering computer and internet access and training to their residents seem to be few and far between.

    The testimonials from residents and others involved in such programs reveal tremendous practical and therapeutic benefits. The seniors begin to stay in touch more often with friends and relatives; they can perform online banking and shopping; they use the computers to write their personal histories and to draw up family trees; and they even find relaxation playing computer games.

    All these activities stimulate the residents' minds, raise their morale and improve their emotional well-being, and (OT's--pay attention!) it improves finger dexterity and fine motor skills, as well as hand-eye coordination.

    There are some organizations that offer assistance with the logistics of acquiring computers for nursing home seniors (see www.IN2L.com or click on the link below), and others that help establish computer training programs for the residents (see www.seniorsonthenet.org.au/about.html). If anyone is interested in participating in a project of this kind, please contact Jon Ruttenberg M.S., PT at Oak Tree PT.
    e-Mail: pt@oaktreept.com.

    THE HOTTEST ISSUE IN HEALTHCARE TODAY is the affordability of prescription drugs. More and more Americans are getting their prescriptions filled online in Canada, where the drugs are substantially cheaper. In fact, according to the October issue of the AARP Bulletin, "In defiance of federal regulations, officials in Massachusetts and Illinois are looking at ways to help their residents buy less expensive prescription drugs from Canada." AARP also reports that the Justice Department is trying to shut down Rx Depot, a national chain of stores where Americans can go to order Canadian prescription medications. The complaint against the chain was initiated by the FDA, which claims the action was "driven by public health concerns."

    I discovered the following paragraph while surfing through some Blogs. Read it at a normal pace without stopping to think about it:

    "Aoccdrnig to rscheearch at an Elingsh uinervtisy, it deosn't mttaer in waht oredr the ltteers in a wrod are, olny taht the frist and lsat ltteres are at the rghit pcleas. The rset can be a toatl mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae we do not raed ervey lteter by ilstef, but the wrod as a wlohe."

    My wife Tanya takes American Sign Language (ASL) classes, and after reading this she told me that her sign language teacher also tells his class to pay attention only to the first and last letters of each word, especially when the signer "speaks" quickly. (Just make sure to disable your spell-check!)

    It's Never 2 Late: Connecting Seniors & Caregivers with Technology

    This spot features answers to questions from our readers. Send your physical therapy-related questions to: pt@oaktreept.com.

    If we answer your question in this column, we will send you an Oak Tree PT ergonomic pen. Please be sure to include your mailing address, to be used strictly for mailing the pen only, and no other purpose.

    I will also be happy to publish in this Readers' Forum any original, relevant, well-written articles submitted by readers. Just forward your material to:

    Maria M. asks:
    I am a PT graduate from Philippines. How can I take the board exam in Maryland? What are the requirements?

    10.38.06 of the Board regulations lists "Foreign- Educated Licensure Requirements". In addition to filing the application and fees (and subsequently passing the exam), you must provide evidence that your education is equivalent to that of an accredited U.S. PT program. You must also prove oral and written competency in the English language.

    Furthermore, if you have not previously been licensed in any state, you must serve a preceptorship equivalent to 6 months at a minimum of 35 hours per week under the direct supervision of a Board approved licensed PT in a Board approved facility. During that time you must demonstrate skill in patient evaluation, program planning, therapeutic practice, and ethics. You must also demonstrate the "Potential ability to practice safely, unsupervised, and with sound professional judgment".

    The Board may also require you to attend an interview.

    Assuming all goes well, the Board will issue you a temporary license that is valid for 90 days before you receive your examination results. If you fail the exam, the temporary license expires immediately upon posting of the results. If you pass the exam, and you have satisfactorily completed your preceptorship, the Board will issue you a physical therapist license.

    http://ww w.dhmh.state.md.us/bphte/

    NOW I HAVE A QUESTION FOR ALL OF YOU! I have asked many M.D.'s this question, and not one has ever been able to give me an answer (I do not know the answer).

    What is the physiological cause of the dark circles people get under their eyes when they go for prolonged periods with little or no sleep?

    An Oak Tree PT ergonomic pen will be sent to the first person who sends me a reasonable (if not verifiable) answer based in physiology.

    Maryland Department of Health and Mental Hygiene Board of Physical Therapy Examiners

    Featured Article
    Researchers at Boston University have published an exciting study demonstrating improved motor control in both young and elderly individuals who wear subsensory randomly vibrating shoe inserts. The findings offer hope to many elderly patients who are at risk for falls. See the main article for more details.

    Save 20% on fitness and therapy products by logging on to
    and using Oak Tree PT's discount code: 10877.

    $1.00 of every order from TherapyZone is donated to the "TherapyZone Foundation for Children's Fitness". The Foundation provides fitness products and education to underserved preschools around the U.S. If you know of a non-profit day care or childcare program that may qualify, please contact us at
    Oak Tree PT.

    The TherapyZone founders were the motivators behind the recently published Guidelines for Early Childhood Movement called "Active Start" by the National Association of Sport and Physical Education (NASPE). The Guidelines state all children ages 3-5 require 1 hour of structured movement or exercise every day to fully develop their strength, balance, coordination, and endurance. These activities can include walking and other types of structured play utilizing their muscles in repetitive patterns in a fun, non-competitive manner. For more information on the Foundation, link to their website from TherapyZone's home page.

    Find out more....

    . Quick Links...

    More About Us

    Oak Tree Physical Therapy BLOG


    Vibrating Soles Abstract: The Lancet; October 4, 2003

    It's Never 2 Late: Connecting Seniors & Caregivers with Technology

    Maryland Department of Health and Mental Hygiene Board of Physical Therapy Examiners


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