TMJ Injury Results in Substantial Pain and Suffering Award

By John Hochfelderon May 23, 2012 Posted in Facial Injuries

On April 20, 2004, Caridad Cuevas underwent surgical removal of a stone from her salivary gland. Afterwards, she was left with a severe temporomandibular joint (TMJ) injury.

Ms. Cuevas, a 21 year old medical assistant, contended that her TMJ injury was the result of her jaw being hyperextended by the anesthesiologist when administering general anesthesia via endotracheal intubation:

Ms. Cuevas brought a successful lawsuit against the doctor and the hospital and a Manhattan jury awarded pain and suffering damages in the sum of $1,250,000 ($250,000 past – six years; $1,000,000 future – 55 years).

The defense successfully argued that the award was excessive and the trial judge agreed that the award should be reduced to $750,000($250,000 past, $500,000 future).

The hospital appealed both the liability verdict and the damages award, even as reduced. Now, in Cuevas v. St. Luke’s Roosevelt Hosp. Ctr. (1st Dept. 2012), the appellate court has affirmed on all counts and the pain and suffering award stands at $750,000.

As set forth in the appellate court decision, due to the TMJ injury Ms. Cuevas had to wear a mouth guard at all times (causing a lisp) and she could not:

• open her mouth more than 15 milliliters without pain
• eat without pain or cutting her food into very small pieces
• kiss her husband normally

What was not mentioned in the decision is the fact that plaintiff suffered from pre-existing multiple sclerosis (an autoimmune disease that affects the brain and spinal cord) and as a result she was not a candidate for any surgery to correct her TMJ injury and could not take anti-inflammatory medication.

Inside Information:

• The loss of consortium and services verdict for plaintiff’s husband in the sum of $250,000 ($50,000 past, $200,000 future) was reduced to $150,000 (50,000 past, $100,000 future). This aspect of the verdict included consideration of the fact that the married couple could not kiss normally.
• The defense contended that plaintiff’s multiple sclerosis showed a pre-disposition for a TMJ injury.
• The hospital had sought summary judgment dismissing the complaint before trial claiming that it could not be held liable for the negligence of an anesthesiologist who was an independent contractor not employed by the hospital. The motion was denied.

POSTED BY ATTORNEY RENE G. GARCIA:

· For more information:-Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866-SCAFFOLD or 212-725-1313.

EPIDURAL

Steroid shots come up short in back-pain study

Older adults who get steroid injections for degeneration in their lower spine may fare worse than people who skip the treatment, a small study suggests.

The research, published recently in the journal Spine, followed 276 older adults with spinal stenosis in the lower back. In spinal stenosis, the open spaces in the spinal column gradually narrow, which can put pressure on nerves. The main symptoms are pain or cramping in the legs or buttocks, especially when you walk or stand for a long period.

The treatments range from "conservative" options like anti-inflammatory painkillers and physical therapy to surgery. People often try steroid injections before resorting to surgery. Steroids calm inflammation, and injecting them into the space around constricted nerves may ease pain -- at least temporarily.

In the new study, researchers found that patients who got steroid injections did see some pain relief over four years. But they did not fare as well as patients who went with other conservative treatments or with surgery right away.

And if steroid patients eventually opted for surgery, they did not improve as much as surgery patients who'd skipped the steroids.

It's not clear why, said lead researcher Dr. Kris Radcliff, a spine surgeon with the Rothman Institute at Thomas Jefferson University, in Philadelphia.

"I think we need to look at the results with some caution," he said. Some of the study patients were randomly assigned to get steroid injections, but others were not -- they opted for the treatment. So it's possible that there's something else about those patients that explains their worse outcomes, Radcliff said.

On the other hand, he said, steroid injections themselves might hamper healing in the long run. One possibility is that injecting the materials into an already cramped space in the spine might make the situation worse, once the initial pain-relieving effects of the steroids wear off, Radcliff explained.

"But that's just our speculation," he said.

A pain management specialist not involved in the work said it's impossible to pin the blame on epidural steroids based on this study. For one, it wasn't a randomized clinical trial, where all patients were assigned to have steroid injections or not have them, said Dr. Steven Cohen, a professor at Johns Hopkins School of Medicine, in Baltimore.

The patients who opted for epidural steroids "may have had more difficult-to-treat pain, or a worse pathology," Cohen said.

He also noted that there is evidence from other research that epidural steroids can help some patients delay spine surgery.

"Epidural steroids won't work for everyone, but they're going to work for some people," said Cohen, adding that he would "absolutely" suggest patients give them a shot if they want to put off surgery.

Epidural steroids should be seen as a "tool in the toolbox," said Dr. Eric Mayer, of the Center for Spine Health at the Cleveland Clinic, in Ohio.

If the goal is to get some symptom relief and possibly delay surgery, then patients may want to try the injections, according to Mayer.

"This study is interesting," he said. "But it really does nothing to inform medical practice."

Epidural steroids have been the subject of some press recently. U.S. officials are currently investigating a deadly outbreak of fungal meningitis linked to epidural steroids produced by one Massachusetts pharmacy.

The patients in the current study came from 13 spine treatment centers in 11 U.S. states. Radcliff said there was no evidence of infections or other serious side effects from the treatment. "So, it did appear to be safe," he said.

Radcliff said he wouldn't discourage the use of steroid injections for patients who want to try them. "It's still reasonable to offer this as an option," he said. "These patients did improve; they just didn't improve as much as the others."

He also pointed out that spinal stenosis is just one cause of low back and leg pain. Other conditions can pinch a nerve and cause similar symptoms, such as a herniated disc.

Cohen said that in general, patients with a herniated disc respond better to steroid injections than those with spinal stenosis -- though people with a herniated disc also have a good shot at getting better with no treatment.

Unlike a herniated disc, spinal stenosis is a progressive condition, and it won't be "cured" with any treatment. Even after surgery, Cohen said, your symptoms may well come back at some point.

With epidural steroid injections, there's no consensus on how long you can keep getting them.

But the general guideline is to have no more than three to six injections in a year, Cohen said -- though that's based on expert opinion rather than hard evidence. And just one injection at a time seems to be enough, Cohen noted. Some doctors are in the habit of doing three in one go, but there's no evidence that it benefits patients.

If you do go for epidural steroid injections, it would be wise to make sure your insurance covers it: in the United States, one injection can cost a few hundred dollars.

The study was funded by the U.S. National Institutes of Health and the U.S. Centers for Disease Control and Prevention.

POSTED BY ATTORNEY RENE G. GARCIA:

For more information:- Some of our clients have suffered injuries that require Epidural Steroid Injections due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313

Court Rejects Defense Claims that Back Injury Pain and Suffering Awards Excessive

By John Hochfelder on December 21, 2011Posted in BackInjuries

Luis Ramos was sitting in a parked car in the parking lane, on Claremont Parkway in the Bronx on September 24, 2001. He had been waiting for his son when he decided to exit the car. After opening the driver side door about six inches, his car was struck by a passing city bus.

Ramos was sitting in a 1987 Ford Thunderbird:

Ramos was thrown to the other side of the car and claimed he hurt his back.

Ultimately, Ramos sued the transit authority and on May 21, 2009, a jury found the bus driver 100% at fault for the accident and awarded plaintiff pain and suffering damages in the sum of $595,000($270,000 past – 8 1/2 years, $325,000 future – 9 years). Both the liability finding and the damages award were upheld on appeal last week in Ramos v. New York City Transit Authority(1st Dept. 2011).

As indicated in the decision, plaintiff was 59 years old at the time and he sustained multiple herniated discs in his lumbar spine that required a combined discectomy, laminectomy and spinal fusion four years later.

In a laminectomy, the surgeon removes the bony back wall of the affected spine, called the lamina and then in a discectomy, the surgeon removes the disc itself:

And here’s what the spine looks like after the lumbar fusion surgery with the insertion of a metal plate and screws:

In the appeal, the defense argued, unsuccessfully, that (a) the liability verdict should be reversed because plaintiff should have seen the bus before he opened his car door into traffic and (b) in the alternative, the jury should have apportioned some of the fault to plaintiff because they found he was negligent (but that his negligence was not a proximate cause of the accident).

As to damages, the defense argued that the jury award was excessive in view of plaintiff’s preexisting conditions:

• degenerative disc disease (when aging discs become stiff and dry out)
• scoliosis (a sideways curvature of the spine)
• syrinx (a cavity in the spinal cord formed by cerebrospinal fluid)

Plaintiff successfully countered each of the defense arguments as to damagesthrough the testimony of his expert neurologist who stated that:

• both the scoliosis and the syrinx were in plaintiff’s cervical spine and the likelihood that either of these conditions affected plaintiff’s lumbar spine was extremely remote
• plaintiff showed no symptoms of preexisting low back pain problems and the fact that he had been diagnosed with degenerative disc disease two years before the accident was of no consequence because there was no evidence (such as an MRI) that Ramos had a herniated disc before the accident

Inside Information:

• Ramos refused medical treatment at the scene, reported to work that night as a doorman in an apartment building, continued to work for a few more days and did not seek any medical attention at all until three days later when he presented to a neighborhood clinic complaining of significant lower back pain.
• There were only three witnesses at trial – plaintiff, a police officer and plaintiff’s medical expert, neurologist Ringa Krishna, M.D. The defense produced neither its bus driver nor any medical expert to rebut plaintiff’s claims and proof as to causation, pain, disability and permanency.
• Unfortunately, the surgery failed and plaintiff’s condition got worse. He was diagnosed with chronic nerve damage and arthritis in his spine causing permanent low back pain and making it difficult to walk. Ramos never returned to work.
• Plaintiff was granted a missing witness charge as to the defense physician who was engaged before trial but did not testify at the trial – the jury was told that it may infer that the defense doctor would not have supported the defendant’s position with respect to the medical issues and would not contradict the plaintiff’s medical evidence.

POSTED BY ATTORNEY RENE G. GARCIA:

For more information:- Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

Court Rejects Defense Claims that Back Injury Pain and Suffering Awards Excessive

 

By John Hochfelder on December 21, 2011Posted in Back Injuries

 

Luis Ramos was sitting in a parked car in the parking lane, on Claremont Parkway in the Bronx on September 24, 2001. He had been waiting for his son when he decided to exit the car. After opening the driver side door about six inches, his car was struck by a passing city bus.

Ramos was sitting in a 1987 Ford Thunderbird:

Ramos was thrown to the other side of the car and claimed he hurt his back.

Ultimately, Ramos sued the transit authority and on May 21, 2009, a jury found the bus driver 100% at fault for the accident and awarded plaintiff pain and suffering damages in the sum of $595,000 ($270,000 past – 8 1/2 years, $325,000 future – 9 years). Both the liability finding and the damages award were upheld on appeal last week in Ramos v. New York City Transit Authority (1st Dept. 2011).

As indicated in the decision, plaintiff was 59 years old at the time and he sustained multiple herniated discs in his lumbar spine that required a combined discectomy, laminectomy and spinal fusion four years later.

In a laminectomy, the surgeon removes the bony back wall of the affected spine, called the lamina and then in a discectomy, the surgeon removes the disc itself:

And here’s what the spine looks like after the lumbar fusion surgery with the insertion of a metal plate and screws:

 In the appeal, the defense argued, unsuccessfully, that (a) the liability verdict should be reversed because plaintiff should have seen the bus before he opened his car door into traffic and (b) in the alternative, the jury should have apportioned some of the fault to plaintiff because they found he was negligent (but that his negligence was not a proximate cause of the accident).

As to damages, the defense argued that the jury award was excessive in view of plaintiff’s preexisting conditions:

• degenerative disc disease (when aging discs become stiff and dry out)
• scoliosis (a sideways curvature of the spine)
• syrinx (a cavity in the spinal cord formed by cerebrospinal fluid)

Plaintiff successfully countered each of the defense arguments as to damages through the testimony of his expert neurologist who stated that:

• both the scoliosis and the syrinx were in plaintiff’s cervical spine and the likelihood that either of these conditions affected plaintiff’s lumbar spine was extremely remote
• plaintiff showed no symptoms of preexisting low back pain problems and the fact that he had been diagnosed with degenerative disc disease two years before the accident was of no consequence because there was no evidence (such as an MRI) that Ramos had a herniated disc before the accident

Inside Information:

• Ramos refused medical treatment at the scene, reported to work that night as a doorman in an apartment building, continued to work for a few more days and did not seek any medical attention at all until three days later when he presented to a neighborhood clinic complaining of significant lower back pain.
• There were only three witnesses at trial – plaintiff, a police officer and plaintiff’s medical expert, neurologist Ringa Krishna, M.D. The defense produced neither its bus driver nor any medical expert to rebut plaintiff’s claims and proof as to causation, pain, disability and permanency.
• Unfortunately, the surgery failed and plaintiff’s condition got worse. He was diagnosed with chronic nerve damage and arthritis in his spine causing permanent low back pain and making it difficult to walk. Ramos never returned to work.
• Plaintiff was granted a missing witness charge as to the defense physician who was engaged before trial but did not testify at the trial – the jury was told that it may infer that the defense doctor would not have supported the defendant’s position with respect to the medical issues and would not contradict the plaintiff’s medical evidence.

 

 

 POSTED BY ATTORNEY RENE G. GARCIA:

 

For more information:- Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

NIGHTMARE REMEDIES: RESCRIPTING BAD DREAMS

Alan Siegel, Ph.D.

Copyrighted Excerpt from Dream Wisdom: Uncovering Life’s Answers in your Dreams
by Alan Siegel, Ph.D. (Berkeley: Celestial Arts, 2003)

During a crisis or after a traumatic event, it is important to know nightmares are more common and upsetting. We experience each nightmare as a traumatic event and for those who have experienced violence, a natural disaster, accident or other trauma, posttraumatic nightmares rub salt on our emotional wounds. Keep in mind that moderately upsetting nightmares may actually be a positive sign of normal coping but very graphic nightmares that are repetitive and unchanging may signal an emotional impasse.

Nightmare remedies are self-help techniques that can help adults and children break the spell of their bad dreams and use them for personal growth and creative inspiration. A simple method for transforming nightmares is to use the 4 R’s of nightmare relief. Reassurance, Rescripting, Rehearsal, and Resolution.

Reassurance is the first and most important step. This breaks the spell of the nightmare by giving emotional reassurance and for family members or children, physical comforting may help as well. Once you feel reassured and the nightmare’s reign of terror has been overthrown, you can relax, become curious about the nightmares meaning and message and begin to approach the dream in a more playful manner.

Knowing that occasional nightmares are normal and their frequency and intensity may increase during crises may also be reassuring. A key factor, especially for children, is not to dismiss or ignore the nightmare with a message that “it’s just a dream” or you should just ignore it. Nightmares, especially during a life crisis are very hard to ignore.
Reassurance paves the way for Rescripting the dream. Rescripting uses discussion, fantasy, writing, art, or drama to re-experience and revise different parts of the dream narrative with the goal of opening up new endings and directions. You can use techniques from the Experiential Dream Menu in Chapter 11 of Dream Wisdom, to transform and tame the most threatening interactions and moments in the nightmare. This can be as simple as experimenting with rewriting one or more new endings for the dream or may involve more elaborate free associations to link the conflicts in the nightmare to unresolved life issues.

The third R needed to implement a nightmare remedy is Rehearsal. This involves multiple forays and trials of rewriting and re-enacting the dream. If you are having nightmares about an auto accident or serious physical injury, imagining one new ending may only be the beginning. Depending on your creative inclinations, you may need to write out one or more new endings, sketch or paint the threatening elements in the dream or role play with a friend or with a psychotherapist or dream group. Creating new endings does not have to involve killing your dream adversary. The terrorist or robber or wild animal can be frozen or shackled. Walls, cages, force fields, or even magic wands can be made available as you rehearse dream solutions. Adults may need to loosen up their imagination but children take to this easily especially with adult guidance. And for children, non-violent strategies for subduing dream villains can model creative problem-solving strategies that do not necessarily emphasize violence.

Rehearsal is somewhat parallel to the phase of psychotherapy, called“working-through” which involves taking breakthrough insights and testing them out in a variety of ways with people and situations. When nightmares are extremely painful or repetitive or related to a profound trauma, rescripting and rehearsing dream solutions may need to be repeated before the nightmares subside. It is important to keep in mind that conjuring up one new fantasy ending for a dream is not going to solve a deep problem that may be causing the nightmares. However, even if dream rehearsals must be repeated for people who are suffering more severe trauma, even initial efforts at rescripting may in some cases, dramatically reduce the incidence of posttraumatic nightmares.

The final Nightmare Remedy “R” is Resolution. Discussion and various trials of rescripting and rehearsing solutions usually trigger insights about what life issues are causing the nightmares. At this point, the dreamer on her own or with the help of a friend or psychotherapist is ready to resolve the nightmare. Resolution occurs when the dreamer brainstorms and identifies behaviors they can further examine or try to change. Examples of resolution would be Lisa’s work-related nightmares series in Chapter 6, of Dream Wisdom, which included the dream, ‘Too Many Chefs Spoil the Stew”. After rescripting the dream, she realized, she had denied her assertive side and was being taken advantage of by the employees in her restaurant. After rehearsing various dream assertiveness strategies for rescripting the attacks of her wayward employees, she made a series of changes that led to exerting more clear authority at work and being more aware of her tendency to deny her assertive side.

We do not have to suffer nightmares in silence. Using the menu of techniques in this section and chapter 11 of Dream Wisdom, you can detoxify your nightmares, and use them as a source of insight and personal growth. In more acute situations, resolving nightmares can create breakthrough in dealing with the aftermath of a traumatic situation.


WHEN TO SEEK HELP FOR CHILDREN’S NIGHTMARES


Whereas moderate nightmare activity may be a potentially healthy sign that the unconscious mind is actively coping with stress and change, frequent nightmares indicate unresolved conflicts that are overwhelming your child. When children’s nightmares persist, when their content is consistently violent or disturbing, and when the upsetting conflicts in the dreams never seem to change or even achieve partial resolution, it may be time to seek further help from a mental health specialist or pediatrician. Especially if there is no obvious stress in your child’s life, repetitive nightmares could also be caused by a reaction to drugs or a physical condition, so it is advisable to consult a physician to rule out medical causes when nightmares do not appear to have a psychological origin.

A further issue to consider is whether your child may be suffering from a sleep disorder. Many parents may confuse sleep disorders like sleepwalking and talking with nightmares which are more psychological in origin. Sleep disorders may or may not be accompanied by nightmares and are generally organic in origin. They are surprisingly common affecting over 15% of the United States population with 95% of all cases going undiagnosed. The International Classification of Sleep Disorders published in 1990¹⁰, lists 84 conditions that interfere with sleep including Primary Snoring, Jet Lag, Restless Leg Syndrome, Narcolepsy and Sleep Apnea. Many sleep disorders such as Jet Lag will go away on their own. Others such as various forms of insomnia may reduce children’s ability to learn, lower their resistance to disease, and increase accident-proneness. Some sleep disorders may even be life-threatening such as sleep apnea. If you suspect that your child is having a sleep disorder¹¹, speak to your pediatrician to determine if he or she needs to consult a board certified sleep specialist or to be evaluated in a sleep center^{12 13}.

The current diagnostic manual of the American Psychiatric Association (DSM-IV) includes Nightmare Disorder as an officially recognized affliction of both children and adults. Those who suffer from this disorder have “extremely frightening dreams, usually involving threats to survival, security, or self-esteem” that “generally occur during the second half of the sleep period,”and may cause “significant distress or impairment in social, occupational, or other important areas of functioning.”

Repetitive nightmares are often accompanied by other symptoms especially fears of going to sleep, anxieties or phobias. Increased nightmares can usually be linked to a recognizable stress in the child’s life such as absence or loss of a parent, suffering abuse or violence, marital or custody disputes in the family, social or academic difficulties at school, such as being teased or having an undiagnosed learning or attention problem.

Nightmares are more often like a vaccine than a poison. A vaccination infects us with a minute dose of a disease that mobilizes our antibodies and makes us more resistant to the virulence of smallpox or polio. As distressing as nightmares can be, they offer powerful information about issues that are distressing your child. When children share their nightmares and receive reassurance from their parents, they feel the emotional sting of the dream, but also begin the process of strengthening their psychological defenses and facing their fears with more resilience.


Gradually, a parent’s empathic response to their child’s nightmares can break the cycle of bad dreams and transform intensely negative experiences into triumphs of assertiveness and collaborative family problem-solving.

POSTED BY ATTORNEY RENE G. GARCIA:

For more information:- Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

http://dreamwisdom.info/library/nightmare_remedies_dw.htm

Appellate Court Slashes Pain and Suffering Verdict in Ankle Injury Case

By John Hochfelder on September 24, 2012 Posted in Ankle Injuries

On December 27, 2002, Massoud Micky, then  47 years old, was walking to the subway in the Bronx, on his way to work, when he fell stepping onto a sidewalk sustaining a severe ankle fracture that he ultimately claimed was caused when his foot was caught in a large gap that created an uneven, misaligned and broken sidewalk curb.

 In his ensuing lawsuit against the City of New York, Micky had to prove that the city had prior notice of the sidewalk defect. He showed the jury a map created by the Big Apple Pothole and Sidewalk Protection Committee that identified as defective the area where Mr. Micky fell. Since the map had been provided to the city long before the accident, the jurors found the city liable.

Micky was awarded pain and suffering damages in the sum of $750,000 ($250,000 past – 8 years, $500,000 future – 21 years).

The city appealed, arguing both that there was no liability (plaintiff had originally stated he fell due to snow and ice, not because of any defect) and that the damages award was excessive.

In Micky v. City of New York (1st Dept. 2012), the liability verdict against the city was affirmed but the damages award was reduced to $250,000 ($100,000 past, $150,000 future).

Here are the details of plaintiff’s injuries:

• comminuted bimalleolar ankle fracture
• open reduction internal fixation surgery with insertion of metal plate and screw
• three day hospitalization, casted one month, physical therapy for five weeks (after which plaintiff never had any more medical treatment for this injury)
• unable to return to work (machine operator) for three months (working as security guard at time of trial)
• post-traumatic arthritis (that plaintiff’s expert said is progressive, permanent and will likely require future surgery)
• continuing pain, significant range of motion loss,  antalgic gait (limp) and inability to resume previously very active recreational soccer

The appellate court judges based their very significant damage award reduction on case precedent. Without discussion, the decision merely mentions four prior cases, each dealing with ankle fractures.

 

POSTED BY ATTORNEY RENE G. GARCIA:

 

For more information:- Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

http://www.newyorkinjurycasesblog.com/2010/07/articles/back-injuries/lumbar-compression-fracture-from-trip-and-fall-results-in-20000-pain-and-suffering-verdict-increased-on-appeal-to-90000/

Physical therapy

Physical therapy (or physiotherapy), often abbreviated PT, is a health care profession primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention carried out by physical therapists (known as physiotherapists in some countries) and physical therapist assistants (known as physical rehabilitation therapists in some countries). In addition to clinical practice, other activities encompassed in the physical therapy profession include research, education, consultation, and administration. Definitions and licensing requirements in the United States vary among jurisdictions, as each state has enacted its own physical therapy practice act defining the profession within its jurisdiction, but the American Physical Therapy Association (APTA) has also drafted a model definition in order to limit this variation, and the APTA is also responsible for accrediting physical therapy education curricula throughout the United States of America. In many settings, physical therapy services may be provided alongside, or in conjunction with, other medical or rehabilitation services.

Overview

Physical therapy involves the interaction between physical therapist, patients/clients, other health care professionals, families, care givers, and communities in a process where movement potential is assessed and diagnosed and goals are agreed upon. Physical therapy is performed by a physical therapist (PT) or physiotherapist (physio), and sometimes services are provided by a physical therapist assistant (PTA) acting under their direction. Physical therapists and occupational therapists often work together in conjunction to provide treatment for patients. In some cases, physical rehabilitation technicians may provide physiotherapy services. PTs are healthcare professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions, illnesses, or injuries that limit their abilities to move and perform functional activities as well as they would like in their daily lives. PTs use an individual's history and physical examination to arrive at a diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g., electromyogramsand nerve conduction velocity testing) may also be of assistance. PT management commonly includes prescription of or assistance with specific exercises, manual therapy, education, manipulation and other interventions. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles, providing services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services in circumstances where movement and function are threatened by aging, injury, disease or environmental factors. Functional movement is central to what it means to be healthy.

Physical therapy has many specialties including sports, wound care, EMG, cardiopulmonary, geriatrics, neurologic, orthopaedic and pediatrics. PTs practice in many settings, such as outpatient clinics or offices, health and wellness clinics, inpatient rehabilitation facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial and this workplaces or other occupational environments, fitness centers and sports training facilities.

Physical therapists also practice in non-patient care roles such as health policy, health insurance, health care administration and as health care executives. Physical therapists are involved in the medical-legal field serving as experts, performing peer review and independent medical examinations.

Education qualifications vary greatly by country. The span of education ranges from some countries having little formal education to others having doctoral degrees and post doctoral residencies and fellowships.

 Physical Therapists

The primary physical therapy practitioner is the Physical Therapist (PT), who is trained and licensed to examine, evaluate, diagnose and treat impairments, functional limitations and disabilities in patients or clients. Currently, most Physical Therapist education curricula in the United States culminate in a Doctor of Physical Therapy (DPT) degree, but many currently practicing PTs hold a Master of Physical Therapy degree and some hold a Bachelor's degree. The World Confederation of Physical Therapy (WCPT) recognizes there is considerable diversity in the social, economic, cultural, and political environments in which physical therapist education is conducted throughout the world. WCPT recommends physical therapist entry-level educational programs be based on university or university-level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduates full statutory and professional recognition. WCPT acknowledges there is innovation and variation in program delivery and in entry-level qualifications, including first university degrees (Bachelors/Baccalaureate/Licensed or equivalent), Masters and Doctorate entry qualifications. What is expected is that any program should deliver a curriculum that will enable physical therapists to attain the knowledge, skills, and attributes described in these guidelines. Professional education prepares physical therapists to be autonomous practitioners, that may work in collaboration with other members of the health care team.^{[citation needed]} Curricula in the United States are accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE). As of 2011, APTA reports that 222 out of 227 entry-level professional degree programs accredited in the United States are at the doctoral level. According to CAPTE, as of 2012 there are 25,660 students currently enrolled in 210 accredited PT programs in the United States.

The physical therapist professional curriculum includes content and learning experiences in the clinical sciences (e.g., content about the cardiovascular, pulmonary, endocrine, metabolic, gastrointestinal, genitourinary, integumentary, musculoskeletal, and neuromuscular systems and the medical and surgical conditions frequently seen by physical therapists).

Specialty areas

Because the body of knowledge of physical therapy is quite large, some PTs specialize in a specific clinical area. While there are many different types of physical therapy, the American Board of Physical Therapy Specialties list eight specialist certifications.

Cardiovascular& pulmonary

Cardiovascular and pulmonary rehabilitation respiratory practitioners and physical therapists treat a wide variety of individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing endurance and functional independence. Manual therapy is used in this field to assist in clearing lung secretions experienced with cystic fibrosis. Disorders, including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis, treatments can benefit^{[citation needed]} from cardiovascular and pulmonary specialized physical therapists.^{[verification needed]}

Clinical electrophysiology

This specialty area encompasses electrotherapy/physical agents, electrophysiological evaluation (EMG/NCV), physical agents, and wound management.

Geriatric

Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physical therapists specialize in treating older adults.

Integumentary

Integumentary(treatment of conditions involving the skin and related organs). Common conditions managed include wounds and burns. Physical therapists utilize surgical instruments, mechanical lavage, dressings and topical agents to debride necrotic tissue and promote tissue healing. Other commonly used interventions include exercise, edema control, splinting, and compression garments.

Neurological

Neurological physical therapy is a field focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, Charcot-Marie-Tooth disease (CMT), ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common impairments associated with neurologic conditions include impairments of vision, balance, ambulation, activities of daily living, movement, muscle strength and loss of functional independence. Physiotherapy can address many of these impairments and aid in restoring and maintaining function, slowing disease progression, and improving quality of life.

In layman's terms, neurological massage is directed toward correcting and healing out-of-normative body systems, unlike traditional massages, such as Swedish massage, that are directed toward comfort and relaxation.

Orthopedic

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions, and amputations.

Joint and spine mobilization/manipulation, dry needling, therapeutic exercise, neuromuscular reeducation, hot/cold packs, and electrical muscle stimulation (e.g., cryotherapy, iontophoresis, electrotherapy) are modalities often used to expedite recovery in the orthopedic setting.^{[verification needed]} Additionally, an emerging adjunct to diagnosis and treatment is the use of sonography for diagnosis and to guide treatments such as muscle retraining. Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons will benefit from assessment by a physical therapist specialized in orthopedics.

Pediatric

Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, or torticollis may be treated^{[citation needed]} by pediatric physical therapists.^{[verification needed]}

Sports

Physical therapists can be involved in the care of athletes from recreational to professional and Olympians. This area of practice includes athletic injury management, including acute care, treatment and rehabilitation, prevention, and education. Physical therapists are also active in sports medicine programs. Physical therapists who work for professional sport teams often have this specialized certification.

Women's health

Women's health physical therapy addresses women's issues related to child birth, and post-partum. These conditions include lymphedema, osteoporosis, pelvic pain, prenatal and post partum periods, and urinary incontinence.

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For more information:- Some of our clients have suffered injuries that require Physical Therapy treatment due to a serious accident. The Garcia Law ease call us at 1-866- SCAFFOLD or 212-725-1313.

http://en.wikipedia.org/wiki/Physical_therapy