Vestibular Rehabilitation Continuing Ed Synopsis

Posted in Centrex University, Continuing Education at May 7, 2014

Becky Olson-Kellogg, PT DPT GCS CEEAA presented a great course on Vestibular Rehabilitation on May 3rd. Here are some highlights:

1. Benign Paroxysmal Positional Vertigo or BPPV is the most common peripheral vestibular disorder. Because of its anatomic position, the posterior canal is involved 80-90% of the time in BPPV. Treatment using a canalith reposition maneuver can often improve patient symptoms in 1-2 visits.

2. For other vestibular disorders, there are 3 main treatment theories. They can be combined to meet individual patient needs.
a. Adaptation – Long term changes in response to input. The best exercises incorporate head movement and visual input. Just like progressive resistive exercise, the vestibular system needs continuous progressive challenge to improve. If the exercises are easy, the patient won’t get better. Exercises may include head movements, with fixed gaze or with gaze moving from object to object. Consider taping a playing card or list on the wall and having the patient turn their head from one side to the other, focusing and refocusing on the object. Vary head movements (turns, nods, circles), and speed of movement. The patient must focus on the exercise (no distractions), perform 1-2 minutes at a time.
b. Habituation – repetitive exposure to a provocative movement will gradually reduce the adverse reaction. Select 3-4 movements that cause the most increase in symptoms. Perform 10-20 times , 2-3 times per day. Must be performed quickly enough and through sufficient range of motion to produce moderate symptoms. Rest between exercises. Example: begin with static standing, add arm or head movement; change to compliant surface or eyes open/eyes closed to progress.
c. Substitution – when there is a complete bilateral loss of vestibular function, the visual and somatosensory system input needs to be increased to compensate for the loss. Examples: Heel walking or toe walking to increase somatosensory input; use a walker or cane for ambulation; add nightlights to increase visual input at night.

3. If your patient does not have a vestibular disorder, can you use the vestibular treatment strategies with the older adult who has a balance problems? Absolutely! Postural control is maintained through sensory information provided from the visual, vestibular and somatosensory systems. Normal age related changes include diminished visual, vibratory and proprioceptive input so enhancing and strengthening intact systems is a great strategy. And many of our older adult patients to not move around like they used to or perform the same activities or chores. So they may have less opportunity to practice or use their balance skills. Practice improves performance!
You might consider:

  • Static standing
    o With and without upper extremity support.
    o Eyes open/eyes closed
    o Narrow base of support
    o Tandem stance
    o Semi tandem stance
    o Single leg standing
  • Standing on compliant surfaces
    o With upper extremity movement
    o Head turns
    o Perturbations
  • Dynamic balance:
    o Gait drills
    o Fast/slow
    o Heel walking
    o Toe walking
    o Side stepping
    o Grapevine
    o Obstacle courses
    o Box step, dance steps
    o Figure 8, start/stop, circles
  • Dual Task training/Walking with:
    o Head turns
    o Talking, counting, naming objects
    o Carrying objects
    o Path finding
Becky Olson-Kellogg, PT DPT GCS, presenter of Vestibular Rehabilitation CE.

Becky Olson-Kellogg, PT DPT GCS, presenter of Vestibular Rehabilitation CE.

An Access Solutions Continuing Ed Synopsis

Posted in Centrex University, Continuing Education at Apr 22, 2014

On March 22, 2014, Alissa Boroff, BA, COTA/L, MN-AS, CAPS, our Director of Access Solutions presented a continuing education titled “Universal & Accessible Design: Promoting Aging in Place”.

So, you probably want to understand a couple of things like what exactly is Access Solutions, and what is meant by Universal Design

     1. Centrex Rehab’s Access Solutions is a service created by Alissa in 2006.   Access Solutions is a consultation service that Alissa and her staff provide to assess and recommend redesign to create a livable and accessible home environment for those where the environment creates barriers due to a person’s current and progressive functional decline and impairments.  Access Solutions not only designs the environment for today’s challenges, but for challenges that are likely to occur going forward as a person experiences decline or general changes in aging.  It is a fee based service which may be private pay or covered through such programs as a grant, or for payors such as medical assistance.

     2. Universal Design is an approach to design of all products and environments to be as usable as possible by as many people as possible regardless of age, ability or situation without the need for adaption or specialized design.  In general, it refers to “smart design for long term living”.  Some very basic examples of a universal design product are a comfort height toilet, wider doorways and hallways and lever handles.

As a PT or PTA, there are 3 takeaway messages:

     1. Consider if your patient/client wants to remain living at home when you evaluate them and find out if they can fully access their home.  They may require specialty products or features in their home to promote safety and access.

     2. Think about the 7 basic principles of Universal Design that Access solutions will address to help achieve your patient’s  ability to age in place goal:
a)  Equitable Use – the product or features is useful and marketable to people with diverse abilities
b)  Flexibility in use – the product or design accommodates a wide range of individual preferences and abilities
c)  Simple and Intuitive – use of the product or design is easy to understand, regardless of the user’s experience, knowledge, language skills, or current concentration level
d)  Perceptible information – the product or design communicates necessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities
e)  Tolerance for error – the product or design minimizes hazards and the adverse consequences of accidental or unintended actions
f)  Low Physical Effort – the product or design can be used efficiently and comfortably with a minimum of effort or fatigue
g)  Size and Space for Approach and Use – appropriate size and space is provided for approach, reach manipulation, and use regardless of the users body size, posture or mobility

     3. Who you should contact: If you have a patient/client who may benefit from Centrex Rehab’s Access Solutions, you can contact Alissa Boroff at

Alissa Boroff, presenter of Promoting Home Safety Through Universal and Accessible Design CE.

Alissa Boroff, presenter of Promoting Home Safety Through Universal and Accessible Design CE.


Centrex Featured in “All Together Now” article

Posted in Centrex University, Published Articles at Feb 1, 2014

Centrex Rehab and Kristy Brown, CEO, were featured in the article “All Together Now” in the McKnight’s Long-term Care & Assisted Living blog.

Long-term care therapy providers have undergone a long episode of rehabilitation of their own in recent years. And many feel they’ve evolved into a stronger, more resilient profession as a result.

The injury came after periods of billing practices that government regulators viewed as problematic. What ensued was a near tsunami of government regulations and reimbursement policies aimed at transforming care delivery across all types of long-term care settings.

Click here to read the full article.

Debbie Hanka serves as a clinical mentor for the University of Minnesota Geriatric Clinical Residency Program

Posted in Centrex University at Jan 23, 2014

Debbie Hanka, PT, DPT, GCS, CEEAA, Clinical Program and Education Specialist at Centrex Rehab, has served as a clinical mentor for the University of Minnesota Geriatric Clinical Residency program.

The residency program was recently featured in the fall issue of GeriNotes, the Geriatric Section magazine.

Click here to read an excerpt of the article, including Debbie’s reflections on the experience.

Centrex Rehab and integrated therapy featured in Minnesota Physician article

Posted in Blog, Centrex University at Jan 7, 2014

Minnesota-Physician-December-2013-1“The Integrated Therapy Model: A response to changing trends in health care,” written by Centrex Rehab president and CEO Kristy Brown, MS, CCC-SLP, was featured in the December 2013 issue of Minnesota Physician.

The article highlights the changing trends in health care and the need to innovate and collaborate across medical disciplines. It also cites specific examples of integrated therapy solutions provided by Centrex Rehab.

Click here to read the full article.





Massage & Well-Being

Posted in Blog, Centrex University at Nov 4, 2013

The following article is excerpted from American Massage Therapy Association (AMTA):


Stress is an inevitable part of life.

No matter how organized your schedule, laid-back your attitude or carefree your lifestyle, very few people escape stress. And, the more we learn about the physical effects of stress, the more we begin to understand how important it is to find ways to deal with stress.

From meditation to regular exercise, people have found a wide variety of ways to combat stress and stay healthy. Now, some research is beginning to piece together the benefits massage therapy can add to your health and wellness program.


Power of Touch

In a 2010 study, scientists at Cedars-Sinai investigated the physical effects of massage therapy, finding that the 29 subjects who received 45 minutes of Swedish massage had an immune boosting response when compared to the 24 participants who received 45 minutes of light touch. Hormones and blood cells were measured before and after the massage, and at regular intervals up to one hour after the massage was done.

“This research indicates that massage doesn’t only feel good, it also may be good for you,” explains Dr. Mark Rapaport, chairman of the Department of Psychiatry and Behavioral Neurosciences and lead author, in a report in the Los Angeles Times. “People often seek out massage as part of a healthy lifestyle, but there hasn’t been much physiological proof of the body’s heightened immune response following massage until now.”

The blood tests of participants who experienced Swedish massage showed changes indicating a benefit to the immune system, including a sizeable decrease in arginine vasopressin, a hormone that contributes to aggressive behavior. Scientists also noted a small decrease in the stress hormone cortisol. Interestingly, lymphocytes—cells that help the immune system defend the body from disease—also increased in the Swedish massage participants. Of important note is that these results were seen after a single massage. So, consider making massage therapy a regular part of your health and wellness regimen.


Talking to Your Doctor

Unlike in the past, more and more physicians are beginning to explore the benefits that massage therapy can offer their patients. Also, more and more patients are beginning to proactively take the reigns of their own health care outcomes, investigating and asking about complementary therapies on their own. According to the results of a recent survey conducted by the American Hospital Association’s Health Forum and Samueli Institute, a nonprofit research organization, 40 percent of hospitals indicated they offer one or more alternative therapies—up a full 37 percent from 2007.

“Today’s patients have better access to health information and are demanding more personalized care,” says Sita Ananth, study author and director of knowledge services for the Samueli Institute. “The survey results reinforce the fact that patients want the best that both conventional and alternative medicine can offer, and hospitals are responding.”

Of the hospitals that responded to the survey, 64 percent reported using massage therapy as part of outpatient care, and 44 percent use massage therapy as part of inpatient care.

WHO MOVED MY PIZZA?: A Basic Understanding of Leading

Posted in Blog, Centrex University at Oct 17, 2013

The following article was written by Matthew Mesibov, a Clinical Physical Therapist Specialist with Centrex Rehab. The article was originally published in the September 2013 issue of GeriNotes.


When asked to write an article about leadership for GeriNotes, I took a step back and thought about what I would want to read if I were the reader. As all engaging speakers and writers do, in my opinion, I thought I would write from experience. The hope is that it might serve as a path or example to someone reading this article who has yet to step up and lead, yet knows they would like to lead on some level. For those of us that are already leading, it is always good to reflect back on some of the more basic concepts as a way to ground oneself.

Why call this “Who Moved My Pizza?” Well, first, if you have never read the very quick read, Who Moved My Cheese, by Spencer Johnson, you ought to! Coming out of a divorce some years ago, this book was a light bulb moment for me. It teaches one of the most critical lessons, to look objectively at what is not working for you, and change it. This is a great principle of leadership as well. It taught me to be honest with myself, learn from my errors, and adapt. The sole purpose was and is to correct you from the frustration of repeating the same mistake over and adapting a new and winning strategy. So why pizza? Well, as a recent arrival to the beautiful state of Minnesota from New Jersey, I soon learned they do not seem to make pizza the way I am used to. Believe me that if you are from the Northeast or Midatlantic, having to have pizza as if it is flatbread is somewhat disappointing to say the least! Enough said, let’s get on track with leadership.

What is leadership? According to the Webster online dictionary, one definition includes: “The quality of character and personality giving a person the ability to gain the confidence of and lead others.” I like this definition as it provides a lot of room to define a person’s character and personality and, therefore, what type of leader you can be. Let’s look at personality qualities by way of a do-it-yourself exercise. First think of two different people you have come across in positions of leadership. The first type of person is someone who you found was able to influence others, and the second is someone who had trouble influencing others. Under each type of leader, list 5 adjectives to describe that person. Now put your lists to the side, as we delve into other aspects of leadership, and we will return to this exercise later.

Leaders, both good and bad, have two attributes…influence and power. Failure of leadership happens when the leader is unable to influence others to “own the vision” or influence comes in various forms:

• the act or power of producing an effect without apparent exertion of force or direct exercise of command,

• the power or capacity of causing an effect in indirect or intangible ways,

• the power to change or affect someone or something, or

• the power to cause changes without directly forcing them to happen.


Power includes the following:

• the ability to influence others to perform, behave, or accomplish tasks; or

• a person or organization that has a lot of influence over other people or organizations.

In a nutshell, I believe successful leadership is not derived from job specific influence (ie, it is not dependent on a job title), rather it is situation specific (ie, when an event occurs, how you handle the situation and what kind of example are you to others).A natural question is, “how do I attain the power to influence?” My quickest answer is first, you must know yourself. Are you comfortable in your own skin? Know where your power comes from. Of course if I ended with that, it would be only part of an answer and a very short article. Next we need to understand what forms of power exist and how they impact the people that would follow you. Choosing your sources of power will define your ultimate success. As you read through the following power sources, write down which two types of power produce the most effective leader with long-term, committed followers.


1. Legitimate Power (Position dependant)

• Leader’s position in an organization

• Leader’s level of authority that is inherent in that position

• Being the supervisor, manager, or boss.


2. Reward Power

• Leader’s ability to give the staff something of value


Tangibles: salary, benefits, promotion

Intangibles: recognition, respect, special privileges3.


3. Coercive Power (Punishment)• Leader’s ability to take something of value away

Tangibles: no raise, loss of job
Intangibles: reprimand, loss of respect, embarrassment, loss of status


4. Expert Power

• Leader’s knowledge, skill, and expertise so that others have confidence in the leader’s ability

• The amount of power is related to the level of expertise


5. Personal Power

• Leader’s personal charisma and personal characteristics

• Relates to the likeability of the leader

• Relates to the leader’s emotional intelligence

When looking at these 5 types of power, we find that the least effective sources of power are Legitimate and Coercive. People are most willing to follow, and commit to following on a long-term basis, when a leader derives power from the Expert and the Personal power realms. The other realms generally will not create strong, longterm leadership.

Stephen Covey surveyed 54,000 people about characteristics of an effective leader and found the top answers to be:

1. Integrity (Personal Power)

2. Communication (Personal Power)

3. People Orientation (Personal Power)

4. Vision (Expert Power)

5. Caring (Personal Power)

Now look back at your adjectives list of two types of leaders. You should be able to start connecting the dots as to why you see one person as a more effective leader than the other.

The grooming and development of a strong leader is a life-long endeavor. One must be willing to be proactive, have the strength to stick with achieving the vision while being cognizant of where one derives power from. In my travels, I once asked a successful restaurant franchisee, who earlier on in his career was on the brink of bankruptcy, what lead to his success. He answered, “No matter what, I never took my eye off the goal.” In other words, you can’t let yourself become a victim of the road bumps that happen now. Rather, keep working towards the destination that you set for yourself.

Another exercise in self-awareness that has helped me is coming to understand my communication style, and effectively assessing the style of others. The tool that I have used most frequently is the DISC profile ( I am aware of one leader who has a DISC profile for all of his direct reports. When having face-to-face meetings, he will quickly refer to the profile to make sure his communication style adapts to his employee’s style. He finds this ensures the employee is engaged in the conversation and fully receives the communication.

Now that we have discussed some of the building blocks of being an effective leader, it is time to set your wheels in motion. Knowledge is power, but it means nothing if you do not apply and experience it. How will you step up to leadership roles?

• Will it be clinically, on a day-today basis, as you choose to provide evidence-based services and practice with integrity?

• Will you seek out a form of leadership training within the APTA structure?

-HPA: The catalyst section has leadership trainings through the institute for Leadership in Physical Therapy Leadership (

• Will you step up and volunteer within the APTA framework?

-Volunteer for the APTA Section on Geriatrics (

-Volunteer for your APTA chapter

-Sign up on the APTA “Volunteer Interest Profile” (

In closing, I would like to share some of myself and my leadership journey. I had to first look within myself during a darker period of my life in order to get comfortable in my skin. It was not an overnight process, and is one that is ongoing. I then chose to step up at an APTA chapter meeting and say, “here are my skill sets and interests; is there a place for me to volunteer and help?” I met people who were willing to give me a chance and mentor me along the way. I mentored others and learned from my mentees as much and more than I gave. Having said that, I offer myself up as someone you can reach out to if you ever want to have a conversation about yourself and leadership. My contact information is available at the APTA member listings page and with this article.


In the meantime, I have not found the pizza of the southern NJ area but that is OK, I enjoyed Walleye fish for the first time.


Wishing you a successful leadership journey!


1. Kummer AW. The Art of Influencing Others (Without Twisting Any Arms!). ASHA Health Care & Business Institute, April 27, 2013, Orlando, FL.

2. Johnson J, Demand Media. 5 Types of Power in Businesses. Houston Chronicle. Accessed August 15, 2013.

3. Covey S. The 8th Habit: From Effectiveness To Greatness. Free Press; 2004.M


Matthew Mesibov is a Clinical Physical Therapist Specialist with Centrex Rehab headquartered in Minneapolis, MN where he serves as a mentor to Physical Therapists and Physical Therapist Assistants. Matt has served in various leadership roles of APTA NJ, is a member of the LAMP, and Government Affairs and Practice Committees of the “HPA: The Catalyst” Section of APTA, and serves on the APTA Task Force for an Alternative Payment System (Physical Therapy Payment & Classification System).

St. Anthony Village partners with Access Solutions and GMHC to help older adults stay at home

Posted in Centrex University at Oct 9, 2013

The following article was originally published in the Lille News newspaper. Click here to read the full article.

Are you an older adult who wants to stay in your home—and do you need a little help doing it? What changes can you make to enhance your home’s comfort and safety?

The city of St. Anthony Village, Access Solutions, and the Greater Metropolitan Housing Corporation (GMHC) Housing Resource Center are working together to provide resources and support to older adults in St. Anthony Village. A grant from the Minnesota Department of Human Services will provide funds to 25 local older adults who want to continue living independently.

With just a few simple, cost-effective home modifications, you can lower the risk of falls and promote active living and enhance the quality of life for older adults. Each participant will receive project management assistance and up to $500 to implement home modifications that promote safety and accessibility. Participants will also receive assistance identifying and securing resources for implementing aging-in-place modifications.

St. Anthony Village residents aged 65+ who own their own home. There are no income qualifications.

The 25 grants will be given on a first come, first served basis. The grants cover modifications that improve safety and accessibility for the user such as grab bars, handrails, increased lighting, and comfort-height toilets.

A landlord can apply on behalf of a tenant, but the landlord must meet the age requirements.

The city of St. Anthony Village and GMHC have additional programs that may be used to help implement aging-in-place modifications if they cost more than $500. Participants will receive help identifying which programs meet their needs. Income qualifications may apply to some additional programs.
To get started, contact Alissa Boroff: call 612-238-5429 or email

Centrex Field Notes: Is it time for a new wheelchair?

Posted in Blog, Centrex University at Oct 3, 2013

Is it time for a new wheelchair?

There are a number of factors that may indicate it’s time to get a new wheelchair or see about some wheelchair modifications. These factors include any new pain or discomfort, legs or back touching wheelchair frame, leaning in the chair or any recent change in condition.

If you have any new pain or discomfort, it may be due to your cushion reaching its life span or not repositioning yourself as frequent as you need to (it’s recommended every 1-2 hours to change positions or relieve pressure). Legs or back touching the wheelchair frame can be caused by the wheelchair being too small or too large and is usually an easy fix an Occupational Therapist can make. Leaning in the wheelchair is usually caused by decreased trunk and back support due to a loss of muscle mass or strength or it can be caused by pain in the back or trunk. More commonly, a recent change in condition can cause fatigue when self propelling or you may find yourself being more uncomfortable in the wheelchair.
Some easy changes to try would be testing out a new cushion, getting the wheelchair parts cleaned or contacting an Occupational Therapist.

If any of the above sounds familiar for you or a loved one, please feel free to contact Centrex Wheelchair Solutions to see what may be some options.

Centrex Field Notes are articles written or compiled by Centrex Therapists. This article was produced by Nicci Andersen, OTR/L, Director of Wheelchair Solutions.

Centrex Field Notes: “Hydration….good for me and good for you”

Posted in Blog, Centrex University at Aug 26, 2013

Everyone knows good hydration is essential all the time but especially in hot and/or humid weather. Your body requires hydration which allows you to think and function at your best. Did you know that adequate hydration is also a key factor in keeping your voice and vocal cords in top notch shape for speaking and communicating? Your vocal cords and the throat in which they are contained consist of many layers of tissue. This tissue loves hydration and requires it. Limiting caffeine and increasing water consumption and electrolytes is a simple way to increase hydration levels in your body which in turn can increase your vocal hygiene and quality of voice for speaking. So, drinking enough water and keeping your body hydrated is a good way to increase your overall function. Here’s to you and your voice….CHEERS!

Centrex Field Notes are articles written or compiled by Centrex Therapists. This article was produced by Tamara Althoff, M.S., CCC-SLP Clinical Speech Pathology Specialist.