Beware the Innocent Flip Flop

RVNAhealth wellness alert, education programs

When you think of the scourges of summer, mosquitoes, ticks and dizzying heat are probably among the first annoyances that come to mind.

But another health hazard that affects countless individuals during the warmer months are … drumroll, please… flip flops, according to Gigi Weiss, MSPT, RVNAhealth’s Director of Rehabilitation Services.

Flip flops are breezy and cool, so what makes them so dangerous?

Explains Weiss: “Their appealing characteristics – lightweight, minimally structured, easy to slip in and out of – often lead to debilitating conditions, including back pain, knee pain, plantar fasciitis and Achilles tendonitis.”

Your aching back

For starters, says Weiss, many flip flops have thin soles and minimal arch support. “This can wreak havoc on your kinetic chain – the muscles, connective tissues, joints, bones and nerves that work together – and cause back or knee pain.”

Heel and lower-leg pain

Another threat unique to flip flops is that tiny thong that separates your big toe from the rest of its partners. While this design allows your feet plenty of room to breathe, it also means that the tendons in your toes need to work constantly to grip the bottom of your footwear.

This, says Weiss, often leads to plantar fasciitis – a painful condition resulting from inflammation of the fibrous tissue along the bottom of your foot that connects your heel bone to your toes.

Traveling a bit farther up the leg, another area where you might experience discomfort is in the Achilles tendon. This largest tendon in your body connects your calf to your heel bone, notes Weiss. “Flip flops that lack support and structure cause the Achilles tendon to strain in unnatural ways, particularly if you have low arches or flat feet.”

What to do?

Patients who visit RVNAhealth Rehab with the conditions described above are generally prescribed a routine that includes biomechanical stretches to address the underlying symptoms, says Weiss. But, she adds, prevention is the best medicine. “If you must wear flip flops, purchase a pair with good orthotic support. And try to avoid wearing flip flops exclusively.”

Injuries: When to Say When

It’s always fun to meet a physical therapist (PT) at a party and ask them all the nagging questions that have been building up over the years. Since October is National Physical Therapy month — cheers! — we decided that rather than wait for you to happen upon a PT, we’d bring one to you.

Gigi Weiss, MSPT, is the Director of Rehabilitation at RVNAhealth, managing both in-home therapy services as well as Rehab by RVNAhealth, our outpatient center in Ridgefield. Weiss is also a licensed physical therapist and no stranger to receiving PT questions at parties and elsewhere.

Two of the most common questions Weiss and her colleagues hear have to do with timing: “When do I know it’s time to have surgery? and “How do I know when it’s time to treat an injury?”  And while there is no one easy answer to either question, it generally comes down to pain.

“Pain is a sign that something is wrong. And when you have pain, it’s important to address it before it creates new problems,” says Weiss.

“When surgery has been recommended to address a condition, you want to be certain it’s the right choice and timing for you. When your pain is compromising the quality of your life — mobility, sleep, comfort — it’s time to take care of it. Physical therapy can often buy you time and help reduce discomfort prior to surgery, but waiting too long can cause compensatory injuries and can reduce your strength, making recovery longer.”

Regarding injuries, Weiss says that any injury or pain that’s with you for more than a few days should be assessed. What is it? Why did it happen? How can it be treated? How can it be prevented in future? These questions are all part of an evaluation (frequently covered by insurance) that aims to identify and treat the root cause, not the symptoms.  “The sooner you do that,” says Weiss, “the better.”

To learn more or ask follow-up questions, please contact RVNAhealth at 203-438-5555.

RVNAhealth Launches Otago to Prevent Falls

Once you’re past the age of playing Ring Around the Rosy, falling down isn’t much fun. In fact, falls can be dangerous and are among the leading causes of injury to those age 65 and older. Approximately one third of healthy people in this age group will have at least one fall per year, which can result in often serious complications ranging from loss of independence and function to broken bones and other trauma. While falls can be the result of a variety of inter-related factors, leg muscle weakness and poor balance are often to blame. Enter the Otago Fall Prevention Program.

Recently launched by RVNAhealth, Otago is a strength and balance retraining program that reduces the risk of falls and related injuries by 35 to 40 percent. The program focuses on muscle strength, balance, flexibility, and reaction time — the contributing factors to falls that are most easily improved.

All RVNAhealth physical therapists are trained to deliver the program in the home setting, as well to outpatients at Rehab by RVNA. The program is already being integrated into the care plans for many RVNAhealth home health patients. Otago became RVNA’s fall prevention program of choice not only because of its proven effectiveness, but also because it can be easily customized for individuals at all stages of life and health.

“A fall can be dangerous at any age,” says Gigi Weiss, Director of RVNAhealth Rehabilitation Services. “But we’re all at greater risk of falling as we get older. What most people don’t realize is how easy it is to prevent. We know Otago works to improve a patient’s balance, stability, and strength so falling is much less likely.” Weiss stresses that even younger adults in the 55+ set can benefit from Otago in order to prevent a decline in balance as they age.

Otago involves a series of 20 progressive exercises that are performed in conjunction with a walking plan. After an initial balance skills assessment, a trained therapist tailors the program to each patient’s level of functioning, moving the patient to more advanced exercises when appropriate. The therapist works with a patient three times a week to start, tapering off over six to eight weeks. While comprehensive, each Otago exercise session takes only 30 minutes to complete. When patients are able, they also walk up to 30 minutes three days a week. After working one-on-one with the therapist, patients continue the exercises independently for maintenance, and see the therapist for a follow-up evaluation after six months.

“Apart from the fact that Otago works, the beauty of the program is that it is suited for a variety of settings to address patients of all walks of life,” says Weiss. “We can introduce Otago to our home health patients in their homes and continue the program as they transition to Rehab by RVNAhealth as an outpatient. We can also offer it as a stand-alone outpatient program for people concerned about falling, whether or not they’ve had a fall in the past.” Weiss notes that Otago may be covered by Medicare and other insurance plans when provided in conjunction with other prescribed home health and outpatient services.

RVNAhealth also has plans to offer Otago as a group program in community-based settings later this year. For more information, contact RVNAhealth at 203-438-5555.

From Hospital to Home to Rehab — All with RVNAhealth

One Patient’s Recovery from Joint Replacement Surgery

If you had spoken with Danbury resident Diana Barchi in early May, she probably would not have imagined she’d soon be walking laps around the RVNAhealth grounds — relatively pain free. Her knee was that bad. But on May 9, the active 90-year-old had total knee replacement surgery. And with RVNAhealth’s help, she’s made steady progress on her recovery.

Barchi’s story began earlier this year at her part-time residence in Florida. While walking to the mailbox one morning, she was suddenly unable to bear weight on her leg and walk. As she explains it, her arthritis, which had previously been manageable, had finally caught up with her. Fortunately, with family visiting from Connecticut, she was able to return home to take care of it. The solution was a total knee replacement followed by physical therapy. Instead of going to an inpatient rehabilitation facility after the hospital, Barchi decided to go home to start her therapy there. And RVNAhealth was right there with her to meet all her needs – from physical therapy and extra assistance at home while she recovered, to outpatient PT at Rehab by RVNA.

“I was afraid going home from the hospital would be awful at first,” she says, referring to both her pain and limited mobility. “Then (RVNA physical therapist) Tricia showed up the next day and started encouraging me. I kept saying ‘No, I can’t do it,’ but she helped me, and I did it.”

All told, Barchi received at-home physical and occupational therapy, as well as skilled nursing services to assist her when she first returned from the hospital. She then made a seamless transition to Rehab by RVNA where she continues her therapy as an outpatient.

“Following a patient right from the time they get home from the hospital is incredibly important to the therapy process,” says RVNAhealth Director of Rehabilitation Services, Gigi Weiss. “The patient benefits from the continuity of having one agency provide all of their treatment and therapists who understand the patient’s complete medical history and path to recovery.”

Barchi’s progress is a case in point. “I started with exercises on my bed. Pretty soon, Tricia had me up and walking, and doing even more exercises.” Now, at Rehab by RVNA, Barchi is working on more advanced skills such as increasing her knee range of motion and strength, improving her balance, walking up and down stairs, and getting around outside independently.

As her therapy progresses, Barchi is looking forward to getting back to some of her favorite activities – cooking, baking, and gardening.  A Danbury native, Barchi and her siblings, ranging in age from 88 to 97, regularly get together for family gatherings. After years as a stay-at-home mom, she began her career as laundry supervisor for a local nursing home at age 50, retiring 30 years later. Along the way (in her 70s), Barchi broke both wrists in a fall. Determined, she went back to work as soon as she recovered. It wasn’t until age 80 that Barchi finally decided to retire. Still, she says she loved working and sometimes thinks she’d like to go back.

In the meantime, Barchi will continue her therapy at RVNAhealth, which is scheduled to conclude on July 10, just 2 months from the day of her surgery.

“I have nothing but accolades for the RVNAhealth physical therapists and staff at Rehab by RVNA,” she says. “I love the people I’m working with here. That’s sincere, you know. I’m so glad I didn’t go to a nursing home!”

What is Arthritis and Who Gets It?

Arthritis is very common and refers to joint pain or disease. It is the leading cause of disability in the United States. Risk factors include age, gender (more women than men experience it), genetics, weight, joint injuries or overuse, and infection. Common arthritis joint symptoms are swelling, pain, stiffness and decreased range of motion.  Symptoms can be mild to severe and can come and go. In some cases, the disease can progress and become debilitating over time.

Often thought of as a disease that affects the elderly, sixty percent of the American adults with arthritis are of working age, 18-64 years old. There are many different types of arthritis, the most common being osteoarthritis, a wearing away of the cartilage that cushions joint bones and can result in chronic pain and the potential need for joint replacement. Other forms of arthritis include rheumatoid arthritis, psoriatic arthritis, gout and lupus.  Some forms of arthritis can affect other organs and cause widespread symptoms. Arthritis often occurs with other chronic diseases like heart disease, diabetes and obesity, and together they can make disease management challenging.

Appropriate treatment to reduce symptoms of arthritis depends on proper diagnosis as determined by a physical exam and other testing. At a minimum, a self-management education program, physical activity like walking or swimming, and maintaining a healthy weight can help to reduce symptoms and preserve joint function, mobility and quality of life. In more serious cases, additional treatments can include medication, physical and occupational therapy, and surgery. Rehab by RVNA at 27 Governor Street provides physical, occupational and speech therapy on site.

For more information call 203-438-5555.

What Do Occupational Therapists Do?

Occupational therapists (OTs) treat injured, ill, or disabled patients through the therapeutic use of everyday activities. They help patients develop, recover, and improve skills needed for daily living and working. OTs can treat patients of all ages from young children to the elderly.  Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing support for older adults experiencing physical and cognitive changes to help them stay as independent as possible. Treating the elderly, an OT can assess a patient’s abilities and environment and make appropriate recommendations. For example, a therapist may identify potential fall hazards in a home and recommend their removal, or easier ways for a patient to prepare meals or shower.

Occupational therapy services can include comprehensive evaluations of homes and other environments (e.g., workplaces, schools), recommendations for adaptive equipment and training in its use, and guidance and education for family members and caregivers. Occupational therapy practitioners have a holistic perspective, focusing on adapting the environment to fit the person, with the person being an integral part of the therapy team.  Occupational therapists at RVNAhealth who provide treatment in the home work as part of a healthcare team along with doctors, registered nurses, and other types of therapists. They may treat people with chronic conditions, such as diabetes, or help rehabilitate a patient recovering from hip replacement or shoulder surgery.  Once patients are no longer homebound, RVNAhealth occupational therapists can provide outpatient care in our Rehab by RVNAhealth facility at 27 Governor Street.  For more information about occupational therapy services, call 203 438-5555.

Becoming BIG and LOUD

RVNAhealth Offers Unique Therapy Programs for Patients with Parkinson’s Disease

RVNAhealth has introduced two new therapy offerings —
LSVT* LOUD (*Lee Silverman Voice Treatment) and LSVT BIG. Both are geared toward improving function in those with Parkinson’s disease.

Often referred to as “the incredible shrinking disease,” Parkinson’s is a degenerative condition characterized by a progressive loss of motor function, impacting both speech and movement. Parkinson’s affects nearly a million Americans today.

The LSVT LOUD and LSVT BIG programs are designed to improve patients’ quality of life and confidence by addressing their diminishing vocal and physical capabilities. As Parkinson’s progresses, a patient’s voice becomes quieter and movement becomes smaller, although the patient does not necessarily recognize these changes. “There is a disconnect in how a patient perceives his or her voice,” says RVNAhealth speech pathologist Cheryl Rafferty, MS CCC-SLP and LSVT LOUD therapist. “They hear it as louder than it is.” The same is true of movement.

LSVT LOUD and LSVT BIG address this disconnect through structured activities that re-train patients’ brains to amplify their vocal range and exaggerate their movements.

Both programs follow follow the same essential model and both require a strong commitment from the patient.  Therapists describe it as a “lifetime commitment,” though the program itself lasts for just four weeks.  “When patients commit to the program and see an improvement in their ability, it’s a big motivating factor,” says RVNA’s Casey Sarmiere, PT and LSVT BIG therapist. “Often, friends or family see the improvement first and comment on how much better the patient is moving or how much louder his voice sounds. It really makes the patient want to put in the time to keep up the work.”

Each program involves one hour of therapy four times a week for four consecutive weeks. During these weeks, the patient also has daily homework exercises. At the conclusion of the program, the patient is given a maintenance plan of exercises to complete every day in order to maintain their function. The ultimate goal behind both programs is for patients to make enough progress during the four weeks of therapy that they continue the work on their own.

In order for LSVT LOUD and LSVT BIG to be truly successful, early intervention is key. Ideally, patients will begin therapy before symptoms even emerge so function is not yet diminished.

“Part of our job is to educate patients so they know to ask their doctors to refer them for BIG and LOUD sooner rather than later,” adds Sarmiere.  “The sooner a patient begins therapy, the better the outcome.”

RVNAhealth currently offers both LSVT BIG and LSVT LOUD in the homecare setting. Rehab by RVNA also offers LSVT BIG in our facility at 27 Governor Street in Ridgefield, and plans to offer LSVT LOUD on site in the future as well.  Please check with your insurance provider to determine your coverage for these programs.  For more information, call 203-438-5555

The Specifics: How BIG and LOUD Really Work


Common speech problems that Parkinson’s patients experience include a soft voice, mumbled speech, monotone speech, and a hoarse voice. LOUD tackles these issues with structured activities that work the patients’ vocal range and teach them to increase volume without straining their voices.  In each session, the therapist takes the patient through a series of rigorous vocal exercises that alternate between loud and soft.

The patient brings his or her voice to a high/loud level 15 times, followed by 15 vocal “lows.” The patient also holds a vocal “ahhh” at each level, and repeats 10 specifically-designed sentences. The ultimate goal is to improve loudness, improve speech intelligibility, increase facial expression, and improve confidence.


Developed under the same principles and used in conjunction with LOUD, the LSVT BIG program addresses the issues that Parkinson’s patients experience relative to movement. As with their vocal ability, patients’ movements become smaller and more tentative as their disease progresses.  Here again, their perception of their movement is vastly different from reality. Often, a patient needs to be shown a video of their movement in order to understand how limited it has become.

As with the LOUD program, LSVT BIG aims to retrain a patient’s brain so their perception of their movement is more accurate and so they become able to move with more amplitude. In each session, the therapist takes the patient through a series of seven whole-body exercises that involve reaching up and down, and moving side to side or back and forth. Basic walking with big steps is also a component. Exercises are all exaggerated to reinforce that the patient needs to make his or her movements bigger.

LSVT BIG also incorporates training in any daily task that causes the patient difficulty. This can be something as simple as picking up a hairbrush or buttoning a shirt to more involved tasks such as doing laundry or getting in and out of a car. Therapists can also simulate complex scenarios, like shopping in a busy store, by placing obstacles in the patient’s way and working on how to navigate around them.

Balance Exercises to Keep You Steady

Every winter, RVNAhealth treats dozens of patients — both at home and at Rehab by RVNAhealth — who are recovering from winter falls. Falls can cause broken and fractured bones, head trauma, and other significant issues.

The following progression of balance exercises, recommended by RVNAhealth physical therapists, can help you improve your lower body strength and your ability to control your body’s center of gravity — which are both very important to avoiding slips and falls.  Start with the Single Leg Stance, and add the others as you improve.  In addition to the exercises below, fun activities like Tai-chi and yoga are great ways to improve balance for some people.  Everyone’s risk of slipping and falling increases with icy winter weather.  But exercising to improve balance is a smart year-round practice for us all.

RVNA’s physical and occupational therapists can adapt exercises to fit a patient’s needs and medical history. If you have any questions or would like to schedule a balance consultation, please contact RVNAhealth at 203-438-5555

1. Single Leg Stance
Stand on one leg and maintain your balance. (You can use a sturdy chair for support.) Then repeat with the other leg.

  • Repeat:            1 time
  • Hold:                10 seconds
  • Complete:       1 set
  • Perform:          Once a day

2. Single Leg Stance Variations
Stand on one leg and maintain your balance.  Next, hold your free leg out in front of your body.  Then return to original position.  Maintain a slightly bent knee on the standing leg.  Repeat with the other leg.

  • Repeat:            1 time
  • Hold:                10 seconds
  • Complete:       1 set
  • Perform:          Once a day

Stand on one leg and maintain your balance.  Next, hold your free leg out to the side of your body.  Then return to original position.  Maintain a slightly bent knee on the standing leg.  Repeat with the other leg.

  • Repeat:            1 time
  • Hold:                10 seconds
  • Complete:       1 set
  • Perform:          Once a day

3. Tandem Stance and Walk
Stand with one foot directly in front of the other so that the toes of one foot touch the heel of the other.  Progress forward by taking steps with your heel touching your toes with each step.  (Use a counter for support.)  Maintain your balance.

  • Repeat:            3 times
  • Hold:                1 second
  • Complete:       1 set
  • Perform:          Once a day

4. Sit to Stand

Sit down in a firm chair.  Align your feet, knees, and hips so you’re sitting up tall with a small arch in your lower back.  Put your hands on your thighs.

Stand without moving your feet.  Engage your leg muscles and lift yourself up from the chair  in one fluid motion.  Once you’ve risen to the point that your knees are straight but your back is still arched, slowly lower yourself back down into your original seated position.

  • Repeat:            8-10 times
  • Hold:                3 seconds
  • Complete:       1 set
  • Perform:          Once a day