Bladder Health

November is Bladder Health Month!  Here are some bladder health facts for you, as well as an explanation of the common misconceptions that come up.

Bladder Health Facts

The general recommendation for water consumption is drink ½ of your body weight (convert pounds to ounces) in water per day. For example, if you weigh 150 pounds, you should drink approximately 75 ounces of water per day

Tip: Carry a water bottle with you everywhere you go – know how many ounces a full bottle carries so you can figure out how much you drank in a day

Most people empty their bladder approximately 5-8 times in 24 hours. Some of the most common bladder irritants include coffee, tea, carbonated beverages, citrus juices, and many fruits. This does not mean you have to avoid them altogether, just be conscious of the effect on your bladder

Caution: These are general facts about bladder health, but may vary from person to person. This should be discussed with your physician prior to making any changes to your bladder management!

Neurogenic bladder is common following a neurological diagnosis such as Spinal Cord Injury, Traumatic Brain Injury, Stroke, Parkinson’s Disease, and Multiple Sclerosis.  Neurogenic bladder results from the inability of the brain to send/receive messages to and from the bladder often resulting in incontinent episodes.  This function can often be treated through re-education of the pelvic floor!

Bladder Myths

It is normal to leak urine as you age or after you have had children

False! Leaking urine is not normal.  It may indicate issues with your pelvic floor or an underlying medical concern- talk to your physician if you leak urine

It is normal to get up a couple of times per night to empty your bladder

False! Nocturia (getting up at night to empty your bladder) is not typical. Your body needs that time to ‘rest and digest’ and getting up to use the bathroom disrupts your bodies natural rhythms. Getting up at night to use the bathroom also increases risks for falling, especially in the elderly population

Kegels are the only way to fix issues with incontinence

False! There are many factors that go into someone experiencing incontinence. It could be due to muscle imbalances, neurological deficits, weakened musculature, pain or behavioral factors. The best way to figure out a plan is to speak with your physician and be evaluated by a pelvic floor therapist

Pelvic floor therapy is just for the female anatomy

False! The male anatomy can also experience pelvic floor dysfunction which can lead to incontinence, pain, sexual dysfunction and can benefit from pelvic floor therapy. Pelvic floor therapy can even be considered post prostate surgery.

While bladder health is often overlooked, it is an important aspect of your overall health and wellness. Reach out to your primary care provider/urologist/therapist about bladder concerns, and ask to be evaluated by a pelvic floor therapist!

~Amanda Brennan, OTRL

Posture and Breathing

Posture and breathing are important for every living person and these two topics are intertwined.  The “Soda Pop Can Model” proposed by Mary Massery, is a nice way to visualize these systems.  The soda can represents the trunk of a person and one that is intact with no openings or leaks is strong (cannot crush a closed soda can).  However, if the can is open or the trunk has a leak, then the can loses its strength and can be easily crushed.

This is similar to how our bodies work.  We need to be able to maintain pressures within our trunk to allow for balance and force production of our limbs.  The three valves/muscle groups that assist with maintaining trunk pressures are: the vocal folds, diaphragm, and pelvic floor.  These valves/muscle groups work together to support postural stability, breathing, limb force production, balance, and continence.  After a neurological injury, a person may have issues in one or more of these areas – a physical, occupational, and/or speech therapist may be able to help!

~Sara Roach, PT, DPT, NCS, CBIS

Traveling by Airplane with a Wheelchair

Here are some tips to make air travel easier and safer if you are a wheelchair user:

  1. Purchase your airfare tickets online so that you can provide info about assistance and equipment.
  2. Call 48 hours before your flight to alert the airline again about assistance needed and equipment that will be brought.
  3. When going through TSA, there is a separate entrance for those that cannot go through electronic scanning station. Make sure you let the TSA agent know if you have any physical limitations that limit your ability to get scanned, i.e. lifting your arms, leaning forward.
  4. Alert the ticket agent and flight crew that you will be bringing equipment that will need to be stowed and that you will require assistance (items needed for wheelchair or medical devices do not count towards carry on limit in most airlines). One manual chair can be stowed in the main cabin. Power chairs, scooters and tilt in space chairs must be stowed in the baggage area.
  5. Label clearly where the chair can be lifted from to prevent damage.
  6. Alert the airline to the weight of the chair and which parts will be staying on the wheelchair during travel (i.e. joystick, footrests, etc.). Make sure the ground staff knows how to lock and unlock the wheels so that the chair does not roll to prevent risk of falling to ground.
  7. Alert the airline what type of batteries are on aircraft, as they are required to know. Gel/dry cell batteries do not need to be removed (typically found on power chair).

Additional tips to keep your chair safe while traveling:

  1. Take a picture of the chair from the front, sides and back before leaving it in the jetway so that you can assess for damage.
  2. Remove any accessories that can be easily removed from the chair and brought onto the plane (i.e. arm rests, joystick); bring extra tires or patches in case of damage.
  3. Bring tools to dissemble and reassemble chair, zip ties if needed to manage cords. Store it in a duffel bag so that you do not lose anything.
  4. Look into purchasing a cover for the joystick.
  5. Wrap your chair in plastic wrap to prevent scratches during transport.

Tips for boarding/sitting during flight:

  1. Most aircrafts will require a transfer to a boarding chair to fit down the aisles. A mechanical lift should be available to assist in transfer if needed.
  2. Request that the transfer to the boarding chair occurs RIGHT before boarding the flight to decrease the amount of time you are in the boarding chair as it is not pressure relieving.
  3. Bring your cushion to sit on during the flight. Bring an air pump, if it is an air-filled cushion. Take caution that the cushion may inflate or deflate during the flight due to pressure changes.
  4. If sitting on cushion makes it so that your feet do not touch the ground; place your feet on a backpack or additional cushion to provide support.

If you have questions or concerns about traveling by airplane,  reach out to your Occupational or Physical Therapist for additional support.

~Amanda Brennan, OTRL

Keep It Fun In The Sun

Environmental parameters and personal factors influence one’s ability to transfer and store heat. However the weather report will report the ambient temperature (temperature of the air) or the the heat index (temperature and humidity), which are more limited means of reporting heat.

Using the Wet Bulb Heat Index, available through the National Weather Service, is considered the most comprehensive and safest means of reducing the risk of heat illness when planning for outdoor activities.

Having a neurological condition can make you more sensitive to heat. With some neurological conditions there is a lack of thermoregulation, and signs/symptoms of being overheated may not be as obvious. Certain medications can also affect sensitivity to heat.

How do you protect yourself against the heat and sun?

Planning outdoor activities during the cooler parts of the day is most ideal. The hottest part of the day tends to be between 11 am and 3 pm. Keeping the following points in mind may help your ability to continue safely enjoying the warm and sunny days!

Watch and protect your skin!

  • Use sunscreen with appropriate SPF, protective clothing.
  • Inspect your skin for burns and skin breakdown, watch changes in moles and freckles. Increased exposure to heat and moisture may cause heat rash or other means of skin irritation/breakdown.

Keep your area and items cool!

  • Find a well ventilated place in the shade to get out of the direct sun. Examples: Umbrellas, pavilion, or tree covered area.
  • Use of iced garments and towels, fans and skin wetting provide a localized cooling effect.

Stay hydrated and cool your skin!

  • Drink 2000-3000 mL of water or 8-12 8-ounce cups of water per day, unless contraindicated by another health condition.
  • Total immersion is generally the preferred method for substantial or quick cooling, such as a cool shower.

Know the symptoms of a heat stroke! Per the Centers for Disease Control and Prevention (CDC) seek medical attention immediately if you or someone experience these symptoms:

  • Body temperature of 104°F or higher
  • Altered mental state such as confusion, agitation, irritability, disorientation, delirium
  • Altered behavior such as slurred speech, staggering
  • Seizures, coma
  • Alteration in sweat leading to dry skin
  • Headache
  • Dizziness or lightheadedness
  • Nausea and/or vomiting
  • Flushed or reddened skin
  • Rapid or fast breathing and heart beat
  • Muscle weakness or cramps

Most importantly, have a plan to avoid the extreme heat!

~ Dereck Chavis, MS OTR/L


Meditation and Chronic Pain

Meditation is a single-pointed focus, which in this case means focusing our attention on our breathing or relaxation. Pain has physiological effects on structures of the brain. This means that if an injury heals, but the structure of the brain does not, you will continue to experience a pain response. HOWEVER, research shows that practicing yoga and meditation can have the opposite effect on the brain and can relieve chronic pain. Here is something that YOU can do at home!

~ Haley Zietz MS, OTRL


Four-Point Meditation

Complete this sequence with a 4-point chant, pairing one part with each of the 4 movements pictured below. For example, “I am safe. I am healthy. I am happy. I choose to live with ease.”


Start with both hands on your knees.

This will also be the position you will end the sequence in.

Raise one of your hands while inhaling and turning your gaze towards that hand.

State the first part of your phrase in your head.


Exhale and cross your hand to your opposite shoulder, bowing your head in that direction.

State the second part of your phrase.


Inhale, raising your hand and gaze to follow.

State the third part of the your phrase.


Exhale and release your hand back down to your knee, stating the last part of your phrase, as you bow your head.


Repeat with other hand if able.


For a printable version: Meditation Handout


Setting Goals for 2021

To say 2020 was quite the year would be a major understatement. 2020 challenged us in ways that we never thought we would be challenged – a global pandemic, multiple lockdowns, missed holidays, just to name a few. As we transition into the new year, there is no better time to regroup, refresh, and revitalize ourselves! That all sounds great in theory but can seem a little overwhelming to know where to start. Goal setting should be at the forefront of our lives, yet so many individuals struggle to do so. Goal setting and milestones are traditionally built into our younger years, as there are often many timetables we look forward to achieving – preschool/kindergarten graduations, making the basketball team, getting a driver’s license, up to graduating from high school. Next, some set goals to find meaningful work, while others set goals to attend college. These goals are often more milestone and age-based, but they teach us to work towards an outcome. An outcome is sort of naturally shaped for us in some societal/cultural capacity. The challenge often lies in setting goals outside of this.

Goals can be big, and they can be small. They come in all shapes and sizes, and manifest our wildest dreams, thoughts, and desires. In the therapy world, we learn to break down goals further, which helps us achieve our outcomes with clients. These skills are not just for therapists though! You can set goals that are attainable and achievable. While it will take practice, the following are some thoughts and considerations that may be helpful to you in setting goals moving forward:

  1. Reflect on the past: The past is the key to the future! This is not always an easy place for us to go, however when we revisit past experiences to see where our direction changed, it can help us recognize habits or thoughts that may have gotten in the way of achieving a goal. When doing this, setting a timer may be helpful to ensure you do not reside in the past after reflection, but use details of the reflection to help you move forward.
  1. Complete a “Task Analysis”. As rehabilitation therapists, we are trained in task analysis, which means breaking down all the steps required to complete an activity or task. Breaking down the steps to an activity or task can be helpful in establishing all the necessary parts of making a goal become a reality. When we can see what needs to happen to achieve a goal, it often makes the goal seem more doable!

Example: Make a Peanut Butter and Jelly Sandwich

  • The first step is to find all the ingredients – 2 slices of break, peanut butter, jelly, a paper plate, and a butter knife.
  • The second step requires us to spread the peanut butter onto the bread, followed by the jelly.
  • Thirdly, we need to put the two pieces of jelly and peanut butter-filled bread together.
  • Lastly, we cut the sandwich (if you so desire) and enjoy!
  1. Establish long- and short-term goals. Once you’ve written down the steps required to achieve a goal, it can be helpful to sort them into short- and long-term goals. Think: How long do I need to achieve this goal? A short-term goal may take a matter of hours-days-weeks, whereas the long-term goal may take weeks or months to achieve. This provides structure to keep you on task.

Example: Using the peanut butter and jelly sandwich example from earlier, you might structure your long and short-term goals like this:

  • Long-term Goal: I would like to make a peanut butter and jelly sandwich.
  • Short-term Goal #1: Gather all the ingredients.
  • Short-term Goal #2: Assemble the sandwich with the peanut butter and jelly.
  1. Make your goals specific and measurable. Research has shown that when you add realistic timeframes to your goals, it holds you accountable, helping you to be more intentional and thoughtful about all that is entailed in achieving your goal(s). These goals are broken down into steps with timeframes to give you something to measure your success by.

Example: PB & J Analogy continued.

  • Long-term Goal: I would like to make two peanut butter and jelly sandwiches for my father and myself before noon tomorrow.
  • Short-term Goal #1: I will gather the ingredients for my peanut butter and jelly sandwiches after breakfast.
  • Short-term Goal #2: I will assemble the peanut butter and jelly sandwiches and put them in the refrigerator so my father and I can eat them at lunch.
  1. Create a visual goal board. Display your goals at home and/or at work as a reminder of what you are working towards! You can bedazzle a poster board or simply create sticky notes, placing them in common places such as the bathroom mirror, refrigerator, dining room table. These visual reminders can make all the difference in helping you change habits and routines as you work towards your goals.

As Tony Robbins says, “Setting goals is the first step to turning the invisible into the visible”. Don’t be afraid to challenge yourself and celebrate each success, as well as the bumps in the road. When you come to roadblocks, don’t give up. This is the perfect time to reset, modify your goals. It doesn’t have to wait until next year.

-Kyle Medearis, MS OTRL, CBIS


Wellness for Parkinson’s

Breathing is a function easily taken for granted as it usually occurs without us having to think about it. While breathing is most known for supplying our bodies with oxygen while clearing out carbon dioxide biproduct, it also plays a pivotal role in speaking, coughing, swallowing, posture, relaxation and even physical activities such as walking and transferring.

In people with Parkinson’s Disease, changes in their breathing or respiratory function may be able to be detected as one of the first signs of progression of their condition. Respiratory dysfunction has been found to be the result of both central and secondary peripheral causes, and is the main cause of death in Parkinson’s Disease.

Central causes include neurodegeneration affecting respiration related neurons at the brain level in the basal ganglia. These result in decreased cough reflexes, problems with regulating breathing with the body’s decreased response to high carbon dioxide levels in the blood, failure to energize muscle up to the necessary level to perform a fast cough, increased rigidity and fatigue of the throat muscles causing stridor (wheezing) and upper airway obstruction. Rigidity and bradykinesia of the vocal cords leads to slurred or soft speech.

Peripheral causes of respiratory dysfunction become worse as Parkinson Disease progresses including axial skeleton rigidity, decreased chest wall compliance, weakness and tremor of inspiratory muscles, weak core and trunk extension muscles. Sedentary lifestyle also strongly contributes to worsening of peripheral causes of respiratory dysfunction. Peripheral causes contribute to low lung volumes, which then reduces ability to clear carbon dioxide out of the body, contributes to speech challenges with reduced breath support, and reduces the ability to produce a strong cough.

Physical therapists are well equipped to assess and treat respiratory dysfunction in neurologic conditions like Parkinson’s Disease. Spirometry evaluation and circumferential measures of chest and abdominal cavities can be utilized to collect data on lung volumes and compare to age based normal values. This can assist in treatment planning and tracking progress. Inspiratory muscle trainers can be utilized in any position for strengthening respiratory muscles and can be paired with certain exercises to maximize chest and lung expansion. Parkinson specific exercises such as Parkinson Wellness Recovery (PWR!) can be paired with breathing exercises to improve coordination, strength, and speech production. PWR! exercises are also designed to reduce the peripheral dysfunctions of axial skeleton rigidity, decreased chest wall compliance and weakness of proximal muscle groups such as trunk and hip extensors. Respiratory intervention as part of a well-rounded treatment plan for neurologic conditions can enhance function, improve quality of life, and promote neurological recovery or slow neurologic degeneration.

~ Anna Semelbauer, PT, DPT

Fall Prevention

September 22, 2020 is the first day of Fall and more importantly National Falls Prevention Awareness Day!

Here are some Fall Prevention Tips to consider:

  1. Wear sensible, supportive shoes and clothing.
  2. Remove tripping hazards, such as rugs.
  3. Lighten up and organize your living space to allow for clear paths from room to room.
  4. Use assistive devices as recommended.
  5. Utilize grab bars and handrails as instructed by your therapist.
  6. Slow down. Be aware of your surroundings, including different terrains and facilities.
  7. Be proactive with your health needs, such as regular vision check ups, healthy eating habits, quality sleep, and regular exercise.
  8. Be mindful of your medications, know the potential side effects.
  9. Have a plan in place: what do you do if you experience a fall? How do you get help?

These are great points to discuss with your provider to come up with a plan that is tailored to you.

For more information on Falls Prevention Awareness Day, visit the NCOA Web site and the AOTA Web site.

~Haley Zietz, MS, OTRL

What Will Live Through You

How many of us have recently found ourselves in the midst of a chaotic and uncertain season of life? As a therapist, I witness this scenario countless times over. Individuals fighting for their lives, their dreams and aspirations and in doing so, silencing words of doubt, when all they need is support. Yet, despite the most challenging circumstances with their worlds shifted, the clients I work with are showing up daily to knock down barriers literally and figuratively.

Right now, a global division of change is on the heels of our nation, forcing us to navigate unchartered territory amidst fear, bitterness, mental and physical fatigue, depression, and loneliness. A pandemic takes, never gives. In this time, all of us have had something taken from us that has upturned our worlds even to a halt. Recently, in my day to day happenings, I’ve felt a sense of understanding and humanity peek through cautious smiles of support for each other. It feels like an opportunity. It is my hope that as we rediscover our new routines and daily lives, this common understanding remains recognizable in each other.

Most of us have already made lists and plans, anxious for what we will attempt first when given the green light. But should we prioritize our desires based on the challenges we’ve faced during this time and the change we hope to see for our futures? I came across a quote that halted me in the moment.

“Try not to resist the changes that come your way. Instead, let life live through you. And do not worry that your life is turning upside down. How do you know that the side you are used to is better than the one to come?”

– Jalal ad-Din Muhammad Rumi

“Let life live through you.” This is such a powerful line, suggesting we let these changes filter through us, extracting the negative and dispersing the positive. Many of us may have been ‘wronged’ in some way by the upturn of events.

“And do not worry that your life is turning upside down. How do you know that the side you are used to is better than the one to come?” Hardship is inevitable. We don’t get to choose when, where or to what extent. Will our culture and social interactions ever return to the way we remember? Perhaps not. But what other growth and prosperity do we have waiting to unfold before us? What barriers can we knock down?

Together, we can BE the collective change we seek and let those changes live through us.

-Lorena Reyes, PTA

Sitting Around A Campfire This Summer?

It’s that time of year, when many enjoy sitting around a campfire/bonfire. We often hear about safety considerations when having a fire, but what about safety considerations when sitting around the fire? In our community, many individuals experience different sensation or no sensation in parts of their body due to a neurological injury or condition. We must consider taking additional precautions to prevent burns.

  1. Sit at least 4 feet from the contained fire pit, keeping all body parts to self. i.e. don’t rest your feet on the fire pit enclosure.
  2. Use a fire pit spark screen that fits the fire pit enclosure.
  3. Avoid burning wood types that tend to spark, such as pine, cedar, hemlock.
  4. Talk to your therapist about other adaptations that can be made to keep you safe. i.e. extended roasting sticks
  5. Find out if there are “flammable” warnings on your equipment and follow the label recommendations.
  6. Consider getting a flameless/simulated fire pit.
  7. Make sure you are up to speed on general safety recommendations for having a fire. Check with your local fire department on recommendations and the daily fire danger forecast.
  8. Be sure to inspect your skin immediately following exposure to campfire/bonfire, as well as the day after. Seek medical attention if you observe changes in your skin health.