Outcome Measures for Physical Therapy – what are they, and why are they important?

You’ve gone faithfully to your physical therapy appointments, and you can feel the positive effects of your treatment.  Now it’s time to pay the bill.  And because your therapist is required to provide documented proof of your treatment and its outcome to Medicare in order to receive payment, you can rest assured that every “i” will be dotted, and every “t” crossed, in your treatment plan.

Medicare and other payers closely scrutinize claims for all providers, especially in the area of medical necessity for all physical medicine claims. Part of that scrutiny is the requirement, since 2013, that physical therapists report what is called “functional outcomes” on claims they submit for payment. Medicare will use the data received to determine the need for services, the quality of care, and the value of the service received by the beneficiary.

The requirement has shown the importance of using functional outcome measures – actual tests and measures that can be used to grade your overall function.  They are important tools to prove your therapist with a simple and effective way to measure your mobility.

Functional outcome measurement tools may serve many purposes, including but not limited, to:

  •  Aiding in goal setting
  • Helping to provide motivation
  • Guiding treatment
  • Providing a prognosis for your specific condition, and
  • Providing justification for treatment 

Besides these basic tools, your Blue Sky physical therapist may use other measurements to help assess your progress in physical therapy. He or she may measure your strength and range of motion. Balance and posture may be assessed as well. But functional outcome measures are also important to help track your progress in physical therapy.

To be effective, functional outcome measurement tools must meet certain criteria of usefulness in the physical therapy clinic. First, they must be reliable, which means that the results must be consistent with each patient and within groups of patients. They must also be valid. Validity in an outcome measurement test means that it measures exactly what it is intended to measure.

Busy physical therapists want the test to be practical and simple to perform. Outcome measurement tools must also be purposeful -- a test of your balance must reflect your current function related to your balance ability, for example.

There are six measures that physical therapists can use to determine the efficacy of their treatment:

  •  Mobility: walking and moving around
  • Changing and maintaining body position
  • Carrying, moving and handling objects
  • Self care 
  • Other primary functional limitation, and
  • Other subsequent functional limitation.

It is more important than ever before to objectively measure outcomes by specific, standardized measures that are used consistently throughout treatment period.   Repeated use of the same outcome measure at the initial evaluation, each re-evaluation or progress report, and again at discharge allows a provider to clearly demonstrate the medical necessity of the care provided. Outcome measuring can enhance patient communication and help determine the plan of care.

Blue Sky Therapy has a continued commitment to patient-driven quality, excellence, integrity and innovation in everything that we do. That’s why we are scrupulous about planning the treatment of each and every client, and carefully documenting the outcome!

Pulmonary Rehabilitation

“Like a fish out of water, gasping for air” is how one asthma patient described it.

For the estimated 115 million people living with chronic pulmonary conditions such as emphysema, persistent asthma, COPD or lung cancer, every breath is a battle. Even simple tasks like getting dressed or climbing the stairs can be exhausting.  If they aren’t managed properly, these diseases can lead to repeated trips to the doctor or extended stays in the hospital.

The Blue Sky Pulmonary Program is designed to improve the overall conditions and respiratory status of patients who have one or more pulmonary conditions. By reducing the tendency of these conditions to worsen, we help residents to become more confident in participating in activities that may have once caused them anxiety. In addition, re-hospitalizations may be avoided.

Pulmonary rehabilitation is a program that uses exercise and education to put people with chronic lung conditions back in charge of their breathing.  Patients in this program find that they are less short of breath, less tired and more independent. And to top it off, research has shown that people with chronic lung conditions who exercise just generally feel better! If they are hospitalized, they are usually admitted for a shorter period of time than those who don’t exercise.

While almost everyone can safely engage in exercise, deciding what’s “safe” needs to be individualized. This is where Blue Sky Therapy’s pulmonary rehabilitation specialists can help. We provide one-on-one instruction: our therapists will help you adjust your level of exercise to your own needs, spend extra time educating you about your condition, and give you personalized feedback on performance and progress. The final result: an improved quality of life.

Who benefits from our pulmonary rehabilitation program? Pulmonary rehab patients are suffering from one or more of the following:

  • COPD
  • Persistent asthma
  • Interstitial lung disease
  • Bronchiectasis
  • Pulmonary Fibrosis
  • Obstructive/restrictive lung disease
  • Lung transplant

After having received pulmonary-respiratory services as a hospital inpatient, many will enroll in our pulmonary rehabilitation program upon return to their skilled nursing facility or assisted-living facility. Others are referred from their doctor. The program is designed to help patients increase stamina, decrease breathlessness and reduce the risk of disease progression.

After an initial evaluation, our clinicians will work with the physician to design an individually tailored exercise plan that promotes increased pulmonary efficiency.   Patients are monitored closely by a respiratory therapist as they maintain a specific activity regimen.

Pulmonary rehabilitation is covered by insurance and recognized by Medicare. A physician referral is required.

So … take a deep breath, and know that we are here for you!

Heart Failure

Your doctor says you’ve got a heart problem, and you know he must be right, because right then your heart skips a beat. It’s a scary diagnosis. But there are things you can do offset its progress.
Taking an active role in your care will help you enjoy a healthier future. Know your goals, make changes in your health habits and take your medicines correctly. You can reduce future problems if you react quickly to new or worsening symptoms.  And for right now, Blue Sky Therapy’s team is here to get you back on the right track.

Blue Sky's Cardiac Therapy Program was designed in response to an increased need for the rehabilitation of cardiac patients in long-term care facilities. The program enables therapists to successfully rehabilitate residents suffering from cardiac conditions in the safest, most optimal manner. The program focuses on patients with post-acute cardiac events, as well as patients with acute and chronic congestive heart failure.

Most heart disease patients can help lower their risk of future heart problems if they make changes to improve their health. Building a healthier future is a partnership between the patient and the healthcare professionals who can help you change your health habits. You can play an active role in making these changes.

Our Cardiac Rehabilitation program is a professionally supervised program to help people recover from heart attacks, heart surgery and percutaneous (through-the-skin) coronary intervention procedures such as stenting and angioplasty. We provide education and counseling services to help heart patients increase physical fitness, reduce cardiac symptoms, improve health and reduce the risk of future heart problems, including heart attack.

Many people of all ages who have heart conditions can benefit from a cardiac rehab program. You may benefit if you have or have had a:   

  • Heart attack
  • Heart condition, such as coronary artery disease, angina or heart failure
  • Heart procedure or surgery, including coronary artery bypass graft surgery, percutaneous coronary intervention (including coronary angioplasty and stenting), valve replacement, or a pacemaker or implantable cardioverter defibrillator.

Programs are individualized and can include a medical evaluation to determine your needs and limitations, a physical activity program tailored to your needs, counseling and education to help you understand your condition and how to manage it. You may work with a dietitian to create a healthy eating plan. If you smoke, you may get counseling on how to stop. Counseling may also help you cope with depression, anger and stress during your recovery.

Your rehabilitation plan is designed to meet your needs. You may need six weeks, six months or longer; many programs last only three months. Others can continue for years.
When you work with Blue Sky Therapy professionals to turn back the effects of a heart condition, you’ll get:

  • Regular physical activity that helps your heart and the rest of your body get stronger and work better. Physical activity improves your energy level and lifts your spirits. It also reduces your chances of future heart problems, including heart attack.
  • Counseling and education that can help you quit smoking, eat right, lose weight, and lower your blood pressure and cholesterol levels. Counseling may also help you learn to manage stress and to feel better about your health.
  • Advice and close supervision to help you improve your health and lower your risk of future problems. These professionals can also communicate with your primary care doctor or cardiologist.

So … take heart! Blue Sky’s ahead — We’re here for you!

 

Where did it come from, anyhow, this “Alzheimer’s” that has suddenly invaded our consciousness? Part 3

We still don’t know everything about Alzheimer’s, but researchers are unflagging in their attempts to treat and cure it.  Here’s something to remember:  No single test can tell you if it is or isn't Alzheimer's disease.

To rule out other possible causes of symptoms during the evaluation, the doctor or health care professional may:

  • Conduct a complete physical exam.
  • Take urine or blood samples, or both.
  • Carry out memory and psychological tests to see how well the brain is working.
  • Order a brain scan, such as a computerized tomography scan.

All of the prescription medications currently approved to treat Alzheimer’s symptoms in early to moderate stages are from a class of drugs called cholinesterase inhibitors. Cholinesterase inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes.

Three cholinesterase inhibitors are commonly prescribed:

  • Donepezil (Aricept) is approved to treat all stages of Alzheimer's.
  • Rivastigmine (Exelon) is approved to treat mild to moderate Alzheimer's.
  • Galantamine (Razadyne) is approved to treat mild to moderate Alzheimer's.

A second type of medication, memantine (Namenda) is approved by the FDA for treatment of moderate to severe Alzheimer’s. Memantine is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. It can be used alone or with other Alzheimer’s disease treatments.

So, the wisest thing to do is to see your doctor. Early Alzheimer's diagnosis provides several benefits :

  • It could mean earlier access to medical professionals and Alzheimer's treatment options.
  • It lets those with Alzheimer's make plans regarding their care and finances ahead of time, so that their wishes can be carried out when they're no longer able to make such decisions for themselves.
  • It helps Alzheimer's patients and caregivers get counseling to address safety issues related to later stages of Alzheimer's ahead of time, helping to prevent unnecessary stress.
  • It gives more time to develop a routine around a loved one's medication.
  • It might reveal a form of dementia not attributable to Alzheimer's with a potentially reversible cause, such as depression or a Vitamin B12 deficiency.

You can rest assured that when therapies are developed to help treat Alzheimer’s, Blue Sky Therapy will be on the front lines to provide them!

Where did it come from, anyhow, this “Alzheimer’s” that has suddenly invaded our consciousness? Part 2

At Blue Sky Therapy, we’re concerned about the total wellness of our clients. Among the diseases that threaten that wellness is Alzheimer’s.  In our last blog, we promised to share some of the symptoms of Alzheimers, as the experts know them.  So here are some of those signs:

One of the most trusted resources for the disease is the Website www.alz.org/, offered by the Alzheimer’s Association.  Here are some of the things the Association wants you to know:

  • Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases.
  • Alzheimer's is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer's are 65 and older. But Alzheimer's is not just a disease of old age. Up to 5 percent of people with the disease have early onset Alzheimer's (also known as younger-onset), which often appears when someone is in their 40s or 50s.

Alzheimer's disease is a progressive brain disorder that damages and eventually destroys brain cells, leading to memory loss and changes in thinking and other brain functions. It usually develops slowly and gradually gets worse as brain function declines and brain cells eventually wither and die. Ultimately, Alzheimer's is fatal, and currently, there is no cure.

The fight against Alzheimer’s involves neuroscience research efforts that are under way to develop effective treatments and ways to prevent the disease. Researchers are also working to develop better ways to care for affected people and better ways to support their families, friends and caregivers.

The Internet is a valuable source of information. Just type the word “Alzheimer’s” into your browser, and you’ll find a wealth of knowledge about the symptoms and treatments for the disease. For instance, you’ll find a comparison of the signs of Alzheimer’s against the normal signs of aging, like these:

1. Memory loss that disrupts daily life
One of the most common signs of Alzheimer's is memory loss, especially forgetting recently learned information, or important dates or events; asking for the same information over and over; increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.  A  typical age-related change: Sometimes forgetting names or appointments, but remembering them later.


2. Challenges in planning or solving problems
Some people may experience changes in their ability to develop and follow a plan or work with numbers, follow a familiar recipe or keep track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. A  typical age-related change:  Making occasional errors when balancing a checkbook.

3. Difficulty completing familiar tasks
People with Alzheimer's can find it hard to complete daily tasks. They may have trouble driving to a familiar location, managing a budget at work, or remembering how to play a favorite game. A  typical age-related change: Sometimes needing help to use the settings on a microwave or to record a television show.

4. Confusion with time or place
People with Alzheimer's can lose track of dates, seasons, and the passage of time. Sometimes they may forget where they are or how they got there.  A typical age-related change, for example, would be getting confused about the day of the week but figuring it out later.

5. Trouble understanding visual images and spatial relationships
Vision problems can be a sign of Alzheimer's. They may have difficulty reading, judging distance and determining color or contrast, which may cause problems with driving. A  typical age-related change: Vision changes related to cataracts.

6. New problems with words in speaking or writing
People with Alzheimer's may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a "watch" a "hand-clock"). A typical age-related change: Sometimes having trouble finding the right word.

7.  Misplacing things and losing the ability to retrace steps
A person with Alzheimer's disease may put things in unusual places. They may lose things and be unable to retrace their steps to find them again. Sometimes, they accuse others of stealing. A typical age-related change: Misplacing things from time to time and retracing steps to find them.

8. Decreased or poor judgment
People with Alzheimer's may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. A typical age-related change:  Making a bad decision once in a while.

9. Withdrawal from work or social activities
A person with Alzheimer's may start to remove themselves from social activities, work projects, or sports. They may have trouble remembering how to complete a favorite hobby, and they may also avoid being social because of the changes they have experienced. A typical age-related change: Sometimes feeling weary of work, family and social obligations.

10. Changes in mood and personality
People with Alzheimer's can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends, or in places where they are out of their comfort zone. A typical age-related change: Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

Research into the disease is ongoing.  In our next blog, we’ll talk about the treatment possibilities for Alzheimer’s.

Where did it come from, anyhow, this “Alzheimer’s” that has suddenly invaded our consciousness? Part 1

We used to refer to “senility,” and thought of it as a normal characteristic of old age.  Then, slowly, this new word took over. More and more, we began to hear about this “new” disease that was so incredibly frightening simply because there was no stopping it.

 We  watched as a former President said his goodbyes to us and began his lonely walk down the Alzheimer’s path; we agonized with his wife whose love and strength was strained to the limits as she strove to provide care for him.  And we began to wonder, will it happen to me, or to my loved ones?

Now we know the answer: it can.  We still don’t know everything about Alzheimer’s disease, but we’ve come a long way in treatment. We know there are symptoms that are recognizably different from the common and normal signs of aging; we know that when we get to the stage when we need care, whether at home or in a licensed care facility, there are medications that will help to slow the progress of our ailment. 

The 5.4 million people suffering from Alzheimer's in the United States make it the most common type of dementia, destroying brain cells and causing confusion, anger, mood swings, language breakdown and long-term memory loss.

Blue Sky Therapy wants you to know there are resources to turn to – organizations that are dedicated to the research and treatment of the disease.  There are ways you can tell if you are a loved one are showing symptoms of Alzheimer’s. In our next blog, we’ll talk about some of those signs.

 

Re-Hospitalization: What is it, and why is it so worrisome? Part 2

When doctors suggested in 2009 that nursing homes and hospitals might be guilty of inadequate coordination of care and poor discharge planning, resulting in the rehospitalization of about half their patients within 30 days, nursing facilities were quick to take up the gauntlet, revising their programs to meet the challenge.  

An example is Revera Health Systems, which includes 30 skilled care centers across the United States offering subacute and short-stay rehab care, as well as long-term care.
Brian Karstetter, regional VP of operations for Revera, has this to say in an article printed on the Web:  

“The ‘revolving door’ of rehospitalization from nursing facilities is a growing problem in the U.S. A study conducted by the Medicare Payment Advisory Committee found that up to two-thirds of these readmissions are unnecessary and avoidable, with potentially serious health risks for patients — and significant financial implications for both hospitals and nursing facilities.

In 2010, researchers at Brown University examined the frequency of patient readmissions from skilled nursing centers.  Karstetter writes: “They focused on Medicare recipients who were transferred from a hospital to a nursing home and rehospitalized within 30 days of discharge. The study found that readmission rates increased by 29% between 2000 and 2006. In 2006, Medicare expenditures for rehospitalized patients totaled $4.3 billion. Today, that cost is closer to $17 billion.

“Numbers like these tend to get the attention of government policymakers, and with health care reform on the minds of legislators and consumers alike, the issue of rehospitalization has come under close scrutiny. “

“The Patient Protection and Affordable Care Act of 2010 specifically addresses the problem, and starting in 2013, allows Medicare to levy financial penalties for hospitals based on readmission rates,” Karstetter cautions.

 Medicare is also considering “pay for performance” incentives and new payment models for hospitals that may require changes in how hospitals make discharge decisions.

There are fiscal threats for hospitals and nursing homes as well. As a result of health care reform legislation, hospitals with higher-than-average rates of readmission may soon face financial penalties. The Patient Protection and Affordable Care Act allows the Center for Medicare and Medicaid Services (CMS) to withhold a percentage of inpatient Medicare payments based on a hospital’s aggregate Medicare payments for all discharges.  In today’s economy, no hospital can afford such losses.

And there’s a reputational cost to rehospitalization as well. High readmission rates imply poor quality of care, communication and coordination, and can have a negative effect on an institution’s image and ability to attract patients. For all these reasons, a growing number of health care executives and analysts are working to develop systems and policies that will reduce readmission rates.

Blue Sky Therapy is known for 28 years of resident-centered care. We’re a therapist-owned provider of contract rehabilitation services, and we have set the standard in the rehabilitation industry, providing physical, occupational, and speech therapy to residents and our partners.

Re-Hospitalization: What is it, and why is it so worrisome? Part 1

It’s a fact: nursing facility residents sometimes experience potentially avoidable inpatient hospitalizations. These hospitalizations are expensive, disruptive, and disorienting for frail elders and people with disabilities. Nursing facility residents are especially vulnerable to the risks that accompany hospital stays and transitions between nursing facilities and hospitals, including medication errors and hospital-acquired infections.

Even more troublesome are the re-hospitalizations that occur when recovery doesn’t happen the way it should.  

Nursing facilities care for two distinct patient populations – short-stay patients who are recuperating following an acute episode and long-stay residents with complex medical needs. Short-stay patients receive intensive medical or therapeutic care and rehabilitative
services following a hospitalization, and their services are generally covered by Medicare or private payers. Long-stay patients often have complex medical conditions and limitations in activities of daily living and may, in some instances, be cognitively impaired.

Care for long-stay patients is funded principally through Medicaid or individual and family expenditures. As rates of Medicare rehospitalizations have increased, so have hospitalizations of long-stay patients. The average hospitalization rate for long-stay nursing facility residents by state increased from 18.9 percent in 2000 to 20.9 percent in 2004, an increase of almost 11 percent.

Rehospitalization exacts significant costs from patients, particularly elderly patients. The stress of a transfer can lead to medical and emotional setbacks that can delay and extend recovery.

For this reason alone, reducing the rate of readmissions is important.

In an article published in 2009, The New England Journal of Medicine took a look at the problem:

“When legislation was enacted in 1983 establishing prospective payment for hospitals, the incentives for hospitals changed dramatically,” the article begins.  “Cost-based payments for hospital days and services were replaced with a set payment per admission that was based on the patient's diagnosis-related group. The goal of the legislation was to encourage shorter lengths of stay and more efficient care, but policymakers were also concerned about possible increases in readmissions. Higher rates of readmissions, they thought, might be a consequence of the legislation either because patients might be prematurely discharged from the index hospitalization or because services might be “unbundled” by hospitals in an attempt to receive two separate payments for what could have been a single clinical episode. Although little evidence emerged to substantiate either concern, today — two and a half decades later — policymakers are focused on readmissions again, albeit for very different reasons.”

For their study, doctors analyzed Medicare claims data from 2003–2004 and found that  “Readmissions are common, with 20% of hospitalized patients readmitted within 30 days and 56% within a year, and vary considerably, with rates ranging from 13% in Idaho to more than 23% in Washington, DC.”

The doctors wrote in the Journal story that they estimated the cost to Medicare of unplanned rehospitalizations in 2004 was $17.4 billion.

What they deduced was worrisome: “These high rates may result in part,” they said, “from inadequate coordination of care and poor discharge planning, since half of the patients who were readmitted within 30 days had no ambulatory (doctor’s) visit before the rehospitalization.” Those figures back up a “substantial body of other evidence that shows suboptimal coordination of care at the time of discharge.”

Communication is crucial, they noted: “The evidence of … failure to provide close patient follow-up, and of inadequate communication between doctors and patients and among doctors at the time of discharge, has raised concerns that many readmissions may be preventable and has pointed to policy changes that might both improve health outcomes and substantially lower costs.”

Nursing homes are close to our hearts at Blue Sky.  We know the valuable work they do, so in our next blog, we’ll discuss how these facilities have reacted.

 

Blue Sky Therapy: nearly 30 years of compassionate caring

You’re likely to meet us, sooner or later.

Even the healthiest, most active and physically fit among us ages.  And with the years come changes that affect how much our bodies can do – it’s just the nature of life.

But today’s “seniors” are like none we’ve seen before.  They insist on getting the very best out of life and they don’t let a few obstacles get in the way.  They’ve worked hard for these retirement years as a chance to finally realize their lifelong dreams: they start new businesses, they become skilled at a beloved sport — some of them become models. Many become caregivers for loved ones.

When the time comes to enter a skilled nursing facility or an assisted-living facility, these elders don’t leave their independence behind. Determined to stay in optimum condition, they expect their new home to offer programs to help keep their bodies and minds functioning — programs such as socializing, activities, games — and therapy to aid in recovery from any setbacks. That’s where Blue Sky Therapy comes in.

The federal Department of Health and Human Services sets out guidelines that all skilled nursing facilities must follow: All therapy must be “reasonable, necessary, specific, and effective treatment for the patient’s condition.” The therapy must be ordered by a physician, require the skills of a qualified therapist, and be dictated by a written treatment plan that includes “specific and measurable functional goals” and a reasonable estimate of when those goals will be attained. It should describe specific therapeutic services, the frequency of visits, and the duration of therapy.

 We’re happy to say that  Blue Sky Therapy’s more than 500 healthcare professionals  — Physical Therapists, Occupational Therapists, and Speech Language Pathologists— providing services under these guidelines in 50+ skilled nursing facilities, assisted and independent living centers, and outpatient therapy clinics in Ohio, Michigan, Pennsylvania, Indiana, Kentucky and Florida.

Blue Sky’s rehabilitation services include physical therapy, occupational therapy, speech therapy and outpatient therapy. Each partnership is assigned a Regional Operations Manager and Rehab Manager, whose tasks/ primary responsibility is to oversee/ensure appropriate care through screening, planning, and tracking outcomes. They clinically and financially manage the entire therapy program.

In a random sampling of 24 skilled nursing facilities nationwide, the DHHS found that most skilled nursing facility patients were appropriate candidates for physical and occupational therapy, and they benefited from therapy.  

Most patients received appropriate therapy interventions for their initial medical conditions, the study found, and at least two-thirds of patients achieved their treatment goals. Most patients would not have achieved similar levels of function without therapy, the study also found.

Our therapy team continually receives training through in-house education programs-the Blue Sky Institute. Our sky high employee retention rate helps to ensure a personal and productive partnership.

Renée Halfhill, our President and CEO, says, “Our core values of patient-driven quality, excellence, and integrity drive us in everything we do. As our name implies, our overriding goal is to provide clients and patients with a ‘Sky’s the Limit’ approach.”

Halfhill is a Licensed Physical Therapist who established Blue Sky Therapy in 1986 as a way to combine her training with care for her family.  The business grew even beyond her expectations, but it never grew away from its people-centeredness. 

That’s because, in Renée’s own words, “At the heart of all of our work is compassion and a sincere hope to make individuals stronger, maintain independence and improve their quality of life.”

So if the time comes when you meet us, remember our name, and what we’ll strive to help you achieve. The sky’s the limit.

How do you spell Rehab- SUCCESS!

One of the greatest gifts a therapist can give to a resident is the ability to function as normal after under-going short-term rehab treatments. Recently, one of our therapy teams received high remarks from an Orthopedic Surgeon about the progress that his patient was making while receiving therapy through one of our facilities.

A patient came to our Blue Sky Therapists after tearing his quadriceps tendon for the third time. The goal was to put him through regimented therapy treatments and get him back to where he was before his last injury. In as little as three weeks, he was able to bend his knee to 110 degrees and could walk independently, transfer, and care for himself with some adaptive equipment. When this patient's orthopedic surgeon saw him for his follow-up appointment, he was amazed at his progress and personally congratulated the Blue Sky Therapy staff on a job well done!

There is no better feeling than to hear a success story such as this!

For the full story, visit http://www.shepherdofthevalley.com/wp-content/uploads/2013/11/Bob-Streb.pdf