Outpatient Physical Therapy Services and Programs

Low Back Pain—SLEEK (Stronger Living through Exercise, Ergonomics, and Kinesthetics) Core Movement Retraining

• Goal: setting a good foundation for healthier movement habits to prevent low back pain
  • 4-week-long once weekly small group physical therapy for each level (I and II)
    
    
• 3 main sections:
  • gentle full body stretches
  • core strengthening in all directions
  • walking

Pelvic floor physical therapy is a non-surgical approach to rehabilitation of musculoskeletal dysfunctions in the pelvis. Dysfunctions can contribute to bowel, bladder, sexual health, and pain complaints. The pelvic floor program is also designed to treat patients who are pregnant and postpartum to meet the needs of the physiologic changes during pregnancy and after delivery.

UC Davis Health’s outpatient physical therapy offers two treatment options for patient’s with Parkinson’s Disease, LSVT Big and PWR. LSVT Big is a high intensity protocol that includes four-hour treatment sessions, four days a week, for four weeks. Patients are taught seven exercises and uses a single target of amplitude to improve and maintain ability to complete functional mobility tasks chosen by the patient. PWR is a patient specific treatment that utilizes high physical effort, cognitive engagement, attentional focus, and emotional engagement. It is delivered with a frequency chosen based on patient’s needs and the exercises are adapted to fit the patient’s tolerance and availability. A Parkinson’s Disease physical therapist evaluates the patient and together they decide on the appropriate treatment option

We have Independent Gym Physical Therapy

Vestibular rehabilitation is a special form of therapy that treats problems associated with vestibular dysfunction, including imbalance, dizziness, vertigo, nausea and gaze instability by using compensatory techniques and habituation exercises prescribed by a therapist. Specific diagnoses treated at UC Davis include:

• Benign Paroxysmal Positional Vertigo
• Vestibular weakness due to
  • vestibular neuritis
  • labryntitis
  • cerebrovascular accident
  • autoimmune disease
  • antibiotic toxicity
  • acoustic neuroma resection
• Cervicogenic dizziness
• Post concussion syndrome

Gait Training:  Specialty Equipment

• UC Davis Health Physical Medicine and Rehabilitation Outpatient Therapies is a clinic dedicated to get its patients up and moving. To keep stride with this vision, the department utilizes specialized equipment to provide the safety and support necessary to work to restore one’s ability to more independently mobilize.
• In addition to traditional gym equipment including upright and recumbent stationary bikes, multiple treadmills, recumbent steppers and an elliptical trainer, we have an extended set of fully adjustable parallel bars for unilateral and bilateral upper extremity support for gait training and lower extremity training.
• Additionally, we house a Lite Gait harness system, allowing a patient to safely and securely stand upright and take steps on either a specialized treadmill or flat ground without the fear or risk of falling.
• For patients with weakened muscle function from central or peripheral nerve damage, we can employ a Restorative Therapies Functional Electrical Stimulation cycle to both the upper and lower extremities capable of providing customizable levels of muscle activation. This device delivers patterned variable amounts of electrical stimulation to activate the weakened muscle tissue in a cycling motion to help improve muscle function, spasticity as well as blower and bladder function.
• For patients with a spinal cord injury that still maintain strong triceps and hand grip function, we can trial a ReWalk exoskeleton suit which mimics a functional natural gait of the legs with the assistance of forearm crutches. After initiating the first step with a forward body tilt, this battery powered exoskeleton utilizes motors at the hip and knee joints to control movement using subtle changes in the wearer’s center of gravity. According to Rewalk, gait training in this manner can significantly improve both mobility and other quality of life measures including risk of falling, motor skills and control of bladder and bowel functions.

Prehabilitation is physical therapy program designed improve the function of clients preparing for upcoming surgeries. UC Davis therapists design specific programs to improve the strength, range of motion, and cardiovascular health of patients who are to undergo total joint replacement and spinal surgeries.

• Orthotics and Prosthetics
  • Orthotics and Prosthetics (O&P) professionals combine art, science, engineering, and medicine to evaluate, fabricate and fit orthopedic braces (orthoses) and artificial limbs (prostheses). O&P is a critical part of health care teams, O&P professionals work not only with patients but as part of an interdisciplinary team involving physicians, occupational and physical therapists and other care providers.  Additional information on O&P can be found at: http://www.opcareers.org/
• PT/OT/ST Therapies:  Pediatric, Neurological, Orthopedic
• Wound Care
• Lymphedema

Complete Decongestive Therapy (CDT) or Complex Lymphedema Therapy is provided at UC Davis Health by two Certified Lymphedema Therapists. The goal of CDT is to decrease and manage swelling caused by lymphedema.

Each CDT treatment consists of four steps:

• Meticulous skin and nail care, including any eradication of any infection.
• Manual Lymph Drainage, a manual treatment technique that stimulates lymph vessels to contract more frequently and that channels lymph and edema fluid toward adjacent, functioning lymph systems.
• Compressive Bandaging is applied immediately after Manual Lymph Drainage to ensure even pressure distribution or to increase pressure in areas that are particularly fibrotic. This prevents any re-accumulation of excavated edema fluid. Bandaging is done in conjunction with series of decongestive exercises with the muscles and joints functioning within closed space to increase lymphatic flow throughout the body.
• Custom garments and / or devices need to be fitted to keep the limb reduced. UC Davis Health uses an outside professional fitter to provide these garments.

Clinic Support: Neuromuscular Disease, Amyotrophic Lateral Sclerosis, DMD, Amputee, OB/Gyn, Feeding

• Neuromuscular Disease—For patients with degenerative neuromuscular diseases, we work together in a team approach to assist to meet each individual patient’s mobility needs. Our physical therapists collaborate with the PM&R medical doctors, respiratory therapists, dieticians, and social work to assist these patients in our multi-disciplinary clinic. If further education or training is recommended for a patient with neuromuscular disease then a referral can be made for physical therapy to work on improving balance, mobility, gait, and for additional assistive equipment recommendations. The physical therapist can also  educate clients on safe exercise with a neuromuscular disease and help to develop an individualized exercise program to maintain function.
  
  
• Amyotrophic Lateral Sclerosis
  
  
• DMD
  
  
• OB/Gyn
  
  
• Feeding

Our rehabilitation program for individuals with amputees is designed to meet the needs of the patient and their unique mobility goals through real time collaboration of multiple disciples such as the medical doctor, prosthetist, and the physical therapist. Each of these disciplines come together to offer their expertise to make the patient as high functioning as possible for below knee and above knee amputees.  Physical therapy will primarily focus on gait training, fall recovery, contracture prevention, and stump/edema management.  Additionally, we provide patient education for proper use / management of the prosthesis and its accessories. Patients are generally trained in the parallel bars for safety and confidence, then progressed to level ground walking, and then eventually to varied terrain, when appropriate, in order to prepare for real world scenarios.

One year after being diagnosed with terminal brain cancer, Dr. Mark Wineinger created and self-funded the Jireh Foundation to improve the quality of life of his underserved patients. An Associate Professor of Physical Medicine and Rehabilitation at UC Davis Medical Center, Dr. Mark personally funded equipment and services for many physically disabled adult and pediatric patients who had no other means to obtain these items vital to their quality of life and essential to their ability to function in their homes and communities. Rather than be recognized for his incredible generosity, Dr. Wineinger remained anonymous by stating that the funds came from the "Jireh Foundation.” It was not until after his death in 2004 that the truth became known – Mark was the foundation and his premature death left a permanent void in the hearts of his family, friends and colleagues.

Formally established as a nonprofit in 2006, The Jireh Foundation is a volunteer-driven and donation-funded non-profit organization made up of current and retired UC Davis Health employees dedicated to continue Dr. Wineinger’s mission and build upon his legacy by providing equipment, supplies and services to help physically impaired UC Davis rehabilitation patients reach their optimal level of independence and improve their quality of life.

You can read more about Dr. Wineinger, the foundation and the community we serve at www.jirehfdn.org.

Speech-language pathologists at UC Davis Health specialize in helping infants and children who have difficulty eating and drinking through comprehensive feeding and swallowing assessments and interventions in our outpatient clinic. Our speech therapists are certified by the American Speech-Language-Hearing Association (ASHA) and have specialized training in pediatric feeding and swallowing disorders.

Our program’s goal is to maximize feeding and swallowing skills and improve each child's well-being through treatment, education, training, and parental support. Treatment plans take into account structural, physiological, motor, sensory, behavioral, nutritional and underlying medical conditions related to your child's feeding and swallowing problems as well as the family/child's experience of mealtimes. Safe and efficient feeding and swallowing skills are important to allow infants and children to meet their nutritional requirements as they grow; it is also an important social activity.

The terms feeding disorders or feeding difficulties are frequently used to refer to infants and children who have problems with eating enough and/or an appropriate variety of foods, while swallowing disorders are used to refer to difficulty infants or children may have difficulty protecting their airway and swallowing safely, placing them at risk for aspiration.

Our speech pathologists work with patients and their families to identify your child’s current needs in the areas of feeding and swallowing to promote safe and developmentally appropriate feeding skills while building variety and volume

We address a wide range of feeding concerns, from infancy through adolescence, including:

• Difficulty with breast or bottle feeding (trouble coordinating sucking, swallowing and breathing)

• Coughing, choking, and/or throwing up with feeds

• Looking uncomfortable with feedings

• Feeding aversion

• Oral motor delays

• Sensory challenges impacting mealtimes and oral intake

• Feeding difficulties as a result of medical challenges (neurological, cardiac, pulmonary)

• Supporting for children who have neurological impairments and developmental delays that hinder oral feeding

• Failure to thrive (FTT) — low rate of increase in weight as a result or poor food and liquid intake

• Gastroesophageal Reflux (GER) — when stomach contents flow back up into the food pipe (esophagus), impacting children's’ desire to eat

• Children working on oral feeding skills while they have gastrostomy tube/nasogastric tube feeding
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Structural abnormalities of the mouth and throat that affect eating
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Infants and children who are at high risk for aspiration

• Maladaptive mealtime behaviors

• Prolonged meal time (greater than 30 minutes)
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Restricted variety and volume of food and drink intake
• Poor interest in eating and drinking


Extreme pickiness and food refusal( limit the types of food and liquid that they are willing to eat based on consistency, texture, color, shape, size, etc)
Trouble chewing, swallowing food and/or transitioning to foods of different textures

During our assessment, our speech pathologists may recommend a formal evaluation of swallow or, a Videofluoroscopic Swallow Study (VFSS), to see the anatomy and physiology of your infant/child's swallow and inform recommendations and intervention.

Wheelchair Assessment

Hand Therapy

The Hand Therapy Program is staffed by experienced therapists, including certified hand therapists (CHT), who specialize in the treatment of hand and upper extremity injuries. The goal of therapy is to address each individual's goals and needs, decrease/manage pain, diminish deficits due to injury/condition and promote healing and return the individual to an optimal functional status.

Conditions Treated:

• Our therapists provide one on one treatment for a variety of hand and upper extremity injuries. Typical types of injuries seen in our program include but are not limited to:
• Complex regional pain syndrome (CRPS)
• Cumulative trauma disorders (CTD)
• Dislocations and sprains
• Fractures of the hand, wrist, forearm and humerus
• Repetitive strain injuries (RSI), including carpal tunnel syndrome and other nerve compressions
• Tendinitis
• Tendon and nerve lacerations
• Various types of arthritis including rheumatoid, osteoarthritis, scleroderma and psoriatic arthritis

Treatments:

• A holistic approach to evaluation and assessment of each individual's condition and needs will result in a customized treatment approach and plan. Therapists work closely with the referring physician to ensure continuity of care.
• The personalized therapy program may consist of custom fabricated orthotics to promote healing and /or functional use of the hand, manual therapy techniques, modalities, exercises, instruction in adaptive equipment, time management, joint protection techniques.
• The therapy program may also consist of instruction in ergonomics which may include proper set up of the computer, i.e. proper posture and positioning of the individual with respect to the workstation, keying techniques, and use of various types of pointing devices.

• Thousand Strong
  Thousand Strong is an exciting program run by the City of Sacramento. The mission of Thousand Strong is to” work together as a community to boost Sacramento’s economic prosperity by working with local businesses to create a pool of skilled, experienced young talent”. As a participant in this program, UC Davis Health employs a high school student in our outpatient physical therapy clinic. The program is a “win-win” as the student receives invaluable work experience and our department receives an eager and inquisitive learner. For more information, please contact https://www.cityofsacramento.org/Mayor-Council/Districts/Mayor/Initiatives/Investing-in-Our-Youth/Thousand-Strong/AboutThousandStrong

• Volunteers
  Volunteers for outpatient therapies can observe different therapists as they implement treatment plans with their patients.  In addition, they are encouraged to ask questions and try out interventions they have observed so they can better understand various interventions.  They also provide valuable assistance to therapists and patients in maintaining clean treatment areas.

• Student Therapy Education Program
  The Student Therapy Education Program (STEP) is a novel program created and conducted by U C Davis Health, PM& R Therapies that provides valuable work experience experience to Sacramento area high school students, allowing them to refine professional skills and observe a variety of health care professions in action.