Rusk Institute of Rehabilitation Medicine

The Rusk Institute of Rehabilitation Medicine is the world's first and largest university-affiliated center devoted entirely to inpatient/outpatient care, research and training in rehabilitation medicine. It is part of the NYU Langone Medical Center and operated under the auspices of the Department of Rehabilitation Medicine of the New York University School of Medicine. The Rusk Institute is named in honor of its founder, Howard A. Rusk.

The Rusk Institute has been voted the best rehabilitation hospital in New York and among the top ten in the country since 1989, when U.S. News & World Report introduced its annual "Best Hospitals" rankings.

Steven Flanagan is the current Chairman of Rehabilitation Medicine and Medical Director of The Rusk Institute.

The Rusk Institute of Rehabilitation Medicine

[1] Leading the Way in Rehabilitation Medicine Yesterday, Today and Tomorrow The Rusk Institute of Rehabilitation Medicine, has been voted the best rehabilitation hospital in New York and among the top ten in the country since 1989, when U.S. News & World Report introduced its annual "Best Hospitals" rankings. The world’s first university-affiliated facility devoted entirely to rehabilitation medicine, the Rusk Institute is the largest center of its kind for the treatment of adults and children with disabilities—home to innovations and advances that have set the standard in rehabilitation care for every age of life and for every phase of recovery.

Options for Care At Rusk, we understand that patients want to return to their homes and communities able to lead full, satisfying lives. Our mission is to provide patients with the necessary physical, social, emotional, vocational, and recreational skills to reach the highest possible levels of independence and quality of life. To that end, the Rusk Institute Rehabilitation Network provides patients with access to treatment across a continuum of care depending on their individual medical needs: acute hospitalbased inpatient programs, and outpatient programs.

Inpatients The Rusk Institute is accredited for comprehensive inpatient adult and family-centered pediatric rehabilitation services by the Commission on the Accreditation of Rehabilitation Facilites (CARF) and by the Join Commission on Accreditation of Healthcare Organizations (JCAHO). Patients who require hospitalization and can tolerate an intensive therapy schedule of three hours or more daily are admitted to a specialized inpatient program. Comprehensive and carefully coordinated rehabilitation services are offered at two inpatient locations—34th Street at First Avenue, and 17th Street at Second Avenue.

Please call the Rusk Admitting Office at (212) 263-6034 to help facilitate a patient admission

The Rusk Institute Brain Injury Rehabilitation Program @ 17th Street is a center of innovation and excellence for the treatment of disabling neurological and neurocognitive disorders. We are accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) as an inpatient specialty program in Brain Injury Rehabilitation and offer highly effective, interdisciplinary, individualized care for people recovering from:

Brain Injury Traumatic Brain Injury Acquired Brain Injury Stroke Aneurysms Brain Hemorrhage/Hematoma Brain Tumors Anoxic Encephalopathy Hydrocephalus Coma Multiple Sclerosis Neuromuscular Disorders Gait Disorders Parkinson’s Disease Neurosurgical Procedures Other Brain Disorders

Cardiopulmonary Rehabilitation and Prevention Designed to promote strength, function and wellbeing, the comprehensive cardiac programs at the Smilow Cardiac and Pulmonary Rehabilitation and Prevention Center focus on monitored, personalized exercise therapy. Also featuring nutrition and lifestyle management, they encompass:

Primary prevention and wellness promotion: screening and treatment of risk factors — through education, peer group support, exercise and medical supervision—before the onset of cardiovascular disease;

Secondary prevention: help with improving identified cardiac risk factors once heart disease has been diagnosed.

Inpatient Program The inpatient cardiac rehabilitation program, with an average length of stay of seven to 12 days, provides over three hours of therapy daily, including:

90 minutes of monitored aerobic exercise in the cardiac gym Individual treatments with occupational and physical therapists Educational seminars Nursing intervention for medication and diabetic education Psychological evaluation for behavioral changes and emotional support Psychosocial evaluation for community reintegration Nutritional counseling Cardiac Conditions Treated

Angina Arrhythmias, pacemaker and defibrillator placement Cardiomyopathy Cardiac valve repair / replacement Congestive heart failure (treatment includes the Living with Heart Failure Program — support, therapy and supervision for patients and their caregivers to enhance physical and emotional health, wellbeing, and overall ability to function in society) Coronary angioplasty and stenting Coronary artery bypass (CABG) surgery Myocardial infarction Peripheral vascular disease Pulmonary Rehabilitation The goals of the Pulmonary Rehabilitation Program are to improve function, reduce symptoms such as breathlessness, reduce stress and anxiety, teach patients the proper techniques of taking their medication, and enhance their quality of life.

Inpatient program The inpatient pulmonary rehabilitation program, with an average length of stay of 10-14 days, provides over three hours of therapy daily, including:

90 minutes of monitored aerobic exercise, with oxygen supplementation as needed Pulmonary physical therapies, including secretion clearance and breathing exercises Energy conservation, pacing and task simplification techniques Individual functional training with occupational and physical therapists Psychological interventions for stress management, relaxation and smoking cessation Psychosocial evaluation for community reintegration Nutrition management. Pulmonary Conditions Monitored Chronic obstructive pulmonary diseases - emphysema and chronic bronchitis Asthma • Bronchiectasis Restrictive diseases—kyphoscoliosis, sarcoidosis, pulmonary fibrosis Neuromusculoskeletal diseases— spinal cord injury, muscular dystrophy, polio Lung volume reduction, lobectomy and pneumonectomy Lung transplant

Limb Deficiency The Rusk Institute of Rehabilitation Medicine offers specialized rehabilitation programs targeted to the needs of patients who have undergone amputations (pre-prosthetic and prosthetic training programs). A physiatrist, who coordinates the medical care of the patient, leads these programs. In the pre-prosthetic program, the physiatrist monitors medical stability of the patient as well as the healing of the residual limb and institutes measures to reduce swelling and prevent contractures. Pain management, including residual limb pain and phantom pain, is coordinated by the physiatrist. A therapy program, focusing on building strength and endurance, improving mobility and enhancing functional activity of daily livings skills is prescribed. The physiatrist also coordinates discharge planning. In the prosthetic training program, the physiatrist, working closely with the rehabilitation team, supervises the custom fitting and adjustment of prosthetic devices. An intensive rehabilitation program focusing on proper prosthetic use for transfers, ambulation and activity of daily living skills is prescribed by the physiatrist.

The Limb Deficiency Rehabilitation Team

Nursing Care The Nursing Staff has excellent functional assessment skills and takes a comprehensive approach to the care of the patient and their families during both the pre-prosthetic phase and prosthetic program. They provide orientation into the program and environment of care as well as carry out treatments and procedures associated with the management of pain, surgical wound care, stump-wrapping, skin management, safety and infection control practices. The goal of Rusk's Nursing Staff is to facilitate meeting patients' self-care needs to allow as much independence as safely possible. Nursing takes a lead role in patient and family education in anticipation of discharge.

Social Work Social workers complete psychosocial evaluations of patients and their family to assess concerns related to adjustment to disability and living with prosthesis. They also provide ongoing emotional support to patient and family, both individually and in groups. The social workers help to coordinate discharge planning with the patient, family and rehabilitation team, and assist patients with any plans regarding post-hospital care, including home care, equipment, transportation from the hospital, and securing entitlements and benefits.

Pediatrics

Rusk Instutue of Rehabilitation Medicine offers a wide range of specialized therapy programs for newborns, children, and young adults including communication programs, educational services, occupational therapy, physical therapy, psychology, and speech-language pathology services.

Stroke Rehabilitation William Randolph Hearst Foundation Stroke Rehabilitation Unit

Stroke Rehabilitation Unit The philosophy of patient centered rehabilitation allows the stroke team to create specific interdisciplinary treatment plans that address all aspects of stroke rehabilitation, enabling each patient to return to a maximum level of function.

The Stroke Rehabilitation Team All members of the Rusk Stroke rehabilitation team have specialized training to treat and provide health care to stroke patients. Under the leadership of a physiatrist (a physician who specializes in physical medicine and rehabilitation), patients and family members work with an extensive multidisciplinary team.

Nursing With a long history of providing specialized care to stroke patients, the Nursing Staff has excellent functional assessment skills and takes a comprehensive approach to the care of the stroke patient and their families. With a significant number of Registered Nurses possessing certification in Rehabilitation Nursing (CRRN) they demonstrate expertise in the management of incontinence, pressure ulcer prevention, medication administration as well as carry out treatments and procedures associated with the management of pain.

Social Work As professional counselors with a Master's degree in Social Work, social workers assess concerns related to adjustment to illness and disability, as well as provide emotional support to patient and family. The social workers help to coordinate discharge planning and assist patients with any plans regarding post-hospital care, including home care, equipment, financial aid, transportation from the hospital, and continuing care at other healthcare facilities. Social workers meet with patients and families individually, and facilitate psycho-educational groups.

Therapy Programs

Therapy Programs Clinical assessments begin at the time of admission and an individualized and comprehensive plan of care is established within the first two days. Every stroke patient participates in at least 3 hours of therapy daily. Programs may include:

Occupational Therapy: Occupational therapists are trained to help people regain their functional independence. Often patients' strength, coordination, vision and functional problem solving skills are affected by a stroke which may impact the patient's ability to perform activities of daily living such as dressing, bathing, and managing a household or job. The occupational therapist can provide modification to make a person's activities of daily living easier or possible.

Physical Therapy: Physical therapists work on restoring a person's ability to move his/her body (i.e. sit up in bed, stand up, sit down, walk or climb stairs). Multiple treatment techniques can be used to optimize a person's return to functional mobility including bodyweight support treadmill training for early ambulation training and the use of specialized balance equipment.

Speech-Language Pathology: The speech-language pathologist is trained to diagnose the specific communication disability present, evaluate its impact on everyday functioning, and develop an individualized treatment plan. This may include treatment geared to restoring vocabulary or problems understanding spoken and written language for patients with aphasia, or addressing muscle weakness, coordination of the processes of producing speech and the intelligibility of speech for patients with dysarthria, or focusing on cognitive problems of speaking for patients with a difficulty concentrating, remembering or reasoning.

Psychology and Neuropsychology: Psychologists address the natural stress associated with stroke and with hospitalization. Through the use of the Brief Neuropsychological Examinations developed at Rusk, the assessment helps to specify the cognitive areas of functioning that may have been affected by the Stroke. Support and therapy is provided to patients through a broad range of individualized treatments that match the patient's needs, views and values. Cognitive remediation is available, as indicated, to provide patients with new and compensatory techniques to manage cognitive changes.

Swallowing Center: Following a stroke, individuals may experience difficulty swallowing (dysphagia) which can result in a variety of impairments including difficulty chewing, coughing or choking and unexplained respiratory infections. These difficulties can have consequences such as pneumonia, malnutrition and dehydration. The dysphagia rehabilitation program offers a comprehensive evaluation with both clinical and instrumental assessments to determine the scope of the swallowing disorder and to aid in treatment planning. Treatment is evidence-based and involves patient specific treatment protocols. The goal is to achieve safe and functional oral feeding and swallowing.

Nutrition: A patient's diet after a stroke will be determined based on the type and extent of the problems caused by the stroke. Dietitians work closely with patients, families and medical staff to assure a proper plan is being implemented to help all patients' achieve and maintain optimal nutritional status. One-on-one and group counseling is also provided.

Therapeutic Recreation and Creative Arts Therapies: Recreation therapy integrates the patient's interests with leisure activities that incorporate therapeutic interventions specific to stroke survivors, caregiver and family members. Individual and group sessions are held six days a week and on holidays to address psychosocial and emotional issues of stroke patients and their families. Issues such as depression, anxiety, fatigue, apathy and frustration are addressed through art therapy, recreation therapy and music therapy

Horticulture Therapy: Taking place in the Enid A. Haupt Glass Garden, therapy is specifically designed to help restore individuals from mental fatigue, reduce stress, enhance mood, and provide a supportive treatment setting. Patients practice skills achieved in other therapy areas while they participate in nature-based group activities. Groups are designed to practice and stimulate cognitive abilities while exercising memory, sequencing, and attending skills, increase activity tolerance and endurance while practicing fine motor skills and coordination, enhance social interaction in a nonthreatening relaxing setting.

Vocational Rehabilitation: A Diagnostic vocational evaluation is performed to measure vocational potential in stroke patients by assessing aptitudes, interests, academic achievement, skills and work tolerance. An individual rehabilitation plan is developed collaboratively by the stroke patient and the counselor and may include a referral for specific skills training and placement services. Unique components of the evaluation include: Comprehensive learning assessment, development of compensatory strategy and decision making skills, situational assessment and career exploration

Family and Caregiver Participation Patient/family education begins immediately with either 1:1 education provided by the rehabilitation staff or participation in stroke patient and family education groups. These educational sessions address a variety of topics including: signs and symptoms of a stroke; stroke risks factors; prevention and risk factor modifications related to diet, behaviors and physical activity; community and leisure resources; and psycho-social issues related to living with a stroke. In addition, family/caregiver training is provided by nursing and individual therapy departments when it is appropriate to support and facilitate continued rehab gains after discharge.

The Rusk Institute of Rehabilitation is proud to announce that it has achieved CARF accreditation for its Stroke Specialty Program. The Rusk Institute is among the first 20 rehabilitation facilities to ever achieve this credentialing. Our interdisciplinary approach and innovations in stroke education were two of the many areas that were highlighted as strengths on our stroke rehabilitation program.

Outpatients

Adult Physical Therapy The outpatient unit offers evaluation and treatment for musculoskeletal and neurological disorders through both individual and class programs. Individualized programs are developed to maximize strength, endurance, mobility and function. Comprehensive services are provided for patients with decreased function or mobility from a wide range of conditions, including:

Muskuloskeletal problems (e.g. arthritis, post- fracture care, joint replacements, muscle tears and strains, low back and neck pain for non-operative and post-surgical care, ligamentous injuries, osteoporosis and others) Amputations Neurological disorders (e.g., Stroke, Multiple Sclerosis, Parkinson's Disease , Guillan-Barre, Traumatic Brain Injuries, Spinal Cord Injuries and others) Treatment may include:

Therapeutic Exercises Functional Training Balance Training Neuromuscular Re-education Gait training, including Light Gait Training Aquatic therapy Manual therapy Core Stabilization/Pilates Posture, Body mechanics and Ergonomic instruction Sports Specific Programs Pain Management

Brain Injury Day Treatment Program Rehabilitation following a brain injury does not, and should not, be expected to, follow the usual medical model. When physiologic damage to the brain occurs (e.g., shearing/stretching of neuronal matter, con tusions, ruptured blood vessels, creation of scar tissue, etc.), the damage is usually permanent and irreversible. Rehabilitation, therefore, is the amalgam of remedial interventions that are designed to deal with the residual functional and interpersonal consequences of the brain injury.

Treatment is thus aimed at enabling the individual to regain, to the highest degree possible:

competence and independence in living arrangements, self-care, and managing one’s personal affairs; competence and reliability in relating to others (interpersonal and social adjustment); competence and reliability in performing academic and/or work- related activities, which are relevant to determining future vocational/ academic poten tial; a stable emotional adjustment to the disability, including the calm acceptance of the permanence of one’s brain injury, a positive, hopeful outlook on the future, and the improve ment of one’s self-esteem. The Brain Injury Day Treatment Program addresses systematically and in an integrated fashion, the cognitive remedial, behavioral/emotional, interpersonal, and vocational aspects of the neuropsychologi cal rehabilitation of the brain-injured individual.

The Theraputic Milieu Setting The program is conducted as a therapeutic community. This creates conditions that facilitate the functional rehabilitation of the individual. It provides:

a safe and structured environment which optimizes learning; a supportive peer group to help individuals learn to modify maladaptive behaviors, practice newly acquired compensatory strategies, build empathy for others and adopt realistic expectations; involvement of significant others to achieve the desired transfer of learning from the remedial setting (program) into functional life. Treatment is on an outpatient basis, Mondays through Thursdays, from 10am - 3pm. The treatment cycle is 20 consecutive weeks, for a total of 400 hours; there are two cycles per year (September-February and March-July). There are three phases of treatment: intensive remedial; pre-vocational/ work trial; and follow-up. Significant others (e.g., parents, spouses, siblings) are required to participate regularly.

Staff The program staff, under the leadership of Yehuda Ben-Yishay, Ph.D., consists of 2 Senior Psychologists, 5 Resident Psychologists and 1 Vocational Rehabilitation Counselor. The patient to staff ratio is 2:1 (there are 12-15 patients per treatment cycle).

Admission Criteria The program serves individuals, age 18-65, with mild to severe acquired brain-injuries of differing etiology (e.g., open/ closed head injuries, strokes, aneurysms, tumors, post- encephalopathies). As patients require sufficient stamina for a 5 hour treatment day, participants are post acute or several months to several years post-injury or illness. Importantly, all participants must be capable of voluntarily committing to the 20-week cycle and willing to have their significant others become partners in the rehabilitation endeavor.

Referral Process A physician referral is required for both a comprehensive neuropsychological evaluation and intensive neuropsychological rehabilitation if indicated. Fees for assessment and treatment are available upon request. Patients from out-of-state or abroad will be helped to find accommodations.

Cancer Rehabilitation Women and men diagnosed with cancer often undergo treatment including surgery, radiation therapy, and chemotherapy. In some cases, side effects from these treatments may include pain, limited mobility, decreased strength, swelling, and fatigue. Physical therapy interventions beneficial in counteracting the above-mentioned side effects may include:

Postural awareness for retraining affected muscles and joints Therapeutic exercises to improve flexibility and strength in the involved area Aerobic conditioning to combat cancer related fatigue Education on skincare, scar management, lymphedema precautions, and safety during daily activities For a referral form for Breast Cancer treatment, click here.

Lymphedema Rehabilitation Lymphedema is an accumulation of lymphatic fluid that causes swelling, and can develop when the channels and ducts that transport lymph are missing, impaired, or damaged. Secondary lymphedema (acquired lymphedema) commonly occurs following surgeries that require the removal of lymph nodes. Lymphedema can develop immediately following surgery or months to years following cancer treatment. In addition to swelling, symptoms of lymphedema may include a feeling of heaviness and tightness, skin changes, infection in the affected area, and cosmetic deformity.

Although lymphedema is a chronic condition, specially trained physical therapists can provide invaluable rehabilitative care. Early intervention and learning lifelong management techniques are essential to allow patients to lead full, normal lives. Rusk Institute employs a comprehensive care approach that emphasizes the importance of the patient's understanding of the condition and treatment. In addition to learning about precautionary measures that reduce the risk of developing lymphedema, patients benefit from a rehabilitation program that increases range of motion, flexibility, strength, and endurance. Treatment may include the following:

Manual lymphatic drainage to mobilize fluid and protein from an affected area by a non-invasive, manual therapy technique Multi-layer bandaging to reduce swelling and assist in softening of skin and tissue in a swollen limb Therapeutic exercises to improve lymph drainage through a program of flexibility, strength training, and aerobic activities Patient education to allow patients to take control of their own lives. In addition to learning how to manage lymphedema at home, patients may receive guidance on specific questions from nutritionists, social workers, support groups, or other health professionals Compression garments to help minimize swelling during daytime daily activities Compression pumping (in select cases) to assist with circulation through the use of state-of-the-art pneumatic pumps

Joan and Joel Smilow Cardiopulmonary Rehabilitation & Prevention Center With the recent expansion of the Rusk Institute of Rehabilitation Network, the world renowned Rusk Institute of Rehabilitation Medicine is proud to offer a continuum of cardiopulmonary patient services. In addition to the acute inpatient and outpatient cardiac and pulmonary rehabilitation provided at the Joan and Joel Smilow Cardiac and Pulmonary Rehabilitation and Prevention Center, the Cardiopulmonary Care Management Program designed by the interdisciplinary clinical team at Rusk, is now available at seven subacute member facilities.

Cardiac Rehabilitation Outpatient Program This 12-week program includes:

36 hour-long sessions of individualized monitored aerobic exercise to promote endurance, health and wellbeing, and to teach patients to assess their tolerance for exercise by developing selfmonitoring skills Weekly educational seminars on all aspects of cardiac wellbeing Nutritional guidance towards a hearthealthy diet Individual monitoring, by a specialized Nurse Educator, of patients with diabetes. At the end of the program, in addition to receiving a recommended maintenance program for ongoing exercise and lifestyle modification, patients are encouraged to participate in a cardiovascular disease support group, such as the Mended Hearts Association. Cardiac Conditions Treated

Angina Arrhythmias, pacemaker and defibrillator placement Cardiomyopathy Cardiac valve repair / replacement Congestive heart failure (treatment includes the Living with Heart Failure Program — support, therapy and supervision for patients and their caregivers to enhance physical and emotional health, wellbeing, and overall ability to function in society) Coronary angioplasty and stenting Coronary artery bypass (CABG) surgery Myocardial infarction Peripheral vascular disease Pulmonary Rehabilitation The goals of the Pulmonary Rehabilitation Program are to improve function, reduce symptoms such as breathlessness, reduce stress and anxiety, teach patients the proper techniques of taking their medication, and enhance their quality of life.

Outpatient Program

The outpatient program includes:

Up to 24 one-hour sessions of one-on-one monitored therapy with a physical therapist in the pulmonary gym. Sessions are divided into secretion clearance techniques, breathing exercises, progressive aerobic and functional training, and strengthening exercises. Individual and group patient education on the proper use of peak flow meters, nebulizers, ventilators, and acapella devices Individual or group classes on smoking cessation, stress reduction and nutritional counseling Pulmonary Conditions Monitored

Chronic obstructive pulmonary diseases - emphysema and chronic bronchitis Asthma • Bronchiectasis Restrictive diseases—kyphoscoliosis, sarcoidosis, pulmonary fibrosis Neuromusculoskeletal diseases— spinal cord injury, muscular dystrophy, polio Lung volume reduction, lobectomy and pneumonectomy Lung transplant

As part of their individualized treatment plans, both cardiac and pulmonary patients have access to a broad array of services that address specific physical or psychological challenges:

Acupuncture: a complement to traditional treatments for conditions such as muscle and skeletal disorders, stress, smoking, overweight, fatigue etc. Anger Management: individual or group services that teach participants to identify and anticipate situations that trigger feelings of anger, an emotion now recognized as a risk factor for heart disease. Most importantly, participants learn several skills to diffuse reactions of anger and promote more adaptive methods of problem-solving and coping. Diabetes Management: culturally sensitive individual and group approaches that educate patients in skills of blood glucose monitoring, skin and foot care, adjustment of dietary intake as it relates to glucose levels, and knowledge of medication for optimal diabetic care. Fitness Consultations: an in-depth review of an individual's medical and fitness profile to design a customized exercise program based on specific goals (endurance, weight loss, etc.) This enables individuals not eligible for the monitored exercise programs to follow a safe and effective program at home. Individual Psychotherapy: a shortterm, problem focused, cognitive– behavioral approach that typically targets the anxiety and depression that often accompany heart disease and other medical diagnoses. Family and significant others can be included in the treatment if appropriate. Massage Therapy: techniques to minimize symptoms associated with anxiety, chronic and acute pain, constipation, fatigue, headache, insomnia, joint stiffness, strained muscles and stress. Nutrition: a comprehensive nutritional evaluation, goal-setting and strategy review to encourage healthy dietary changes and help patients understand the impact of diet on diabetes, hypertension, high cholesterol, obesity, heart disease and pulmonary disease. Occupational Therapy/Cognitive Therapy: a program for patients who are transitioning back into their homes and communities and who are experiencing residual cognitiveperceptual impairments (memory, spatial/perceptual, concept- formation and problemsolving dysfunctions, etc.) that can disrupt independent living and magnify patient safety risks. Such impairments are commonly found in cardiopulmonary patient populations, (e.g. CHF, COPD) and patients with diabetes. The program provides onsite individual and group therapies, a community reintegration and vocational skills program, and family/ caregiver training on how to elicit and maximize their loved one's cognitiveperceptual abilities—helping many patients redefine and fulfill the meaning of “independent and productive living. Smoking Cessation: a multi-faceted program to help patients stop smoking and prevent relapse. This includes an assessment of smoking behavior and history, cognitive therapy and group or individual sessions promoting behavioral change, explorations of the functions of cigarettes and smoking, and a discussion of stop-smoking medications. Stress Management: individual or group sessions over six weeks, beginning with a thorough evaluation of each individual's experience of stress, that help patients understand the health impact of stress and learn behavioral techniques and relaxation skills to help manage it. Tai Chi: the traditional Chinese martial art combining deep breathing and mind relaxation with low-impact aerobic movements. Patients learn the 13 movements of the modified basic style of Tai Chi over 11 one-hour classes. Weight Management: Individual and group approaches to weight loss through cognitive behavioral therapy, selected on the basis of an initial indepth nutritional and psychological interview that explores each patient's experience with the stress of weight management. Women's Heart Health: culturally sensitive individual and group approaches that educate women about their risk for heart disease and help them adapt hearthealthy behaviors to reduce their risk. Comprehensive cardiac risk assessments are provided by the multidisciplinary team of the Center, and referrals can be made for further diagnostic evaluations for comprehensive cardiovascular follow up.

Chest Physical Therapy Programs Chest Physical Therapy provides individualized, skilled, one on one treatment programs to individuals whose lung conditions result in lung congestion, secretion retention or areas of lung collapse/atelectasis. Upon completion of this program, patients will receive comprehensive, personalized exercise programs to guide self treatment in the home setting.

Secretion Clearance Program is recommended for patients who have been diagnosed with lung conditions that result in increase mucus production (e.g., Bronchiectasis, Mycobacterium infections, Cystic Fibrosis, Exacerbation of Chronic Bronchitis or conditions resulting in abnormal CT scans).

Patients will be treated with advanced secretion clearance techniques and instructed in a self treatment program to improve their pulmonary hygiene. Instruction in the best techniques for each individual to facilitate secretion removal and resolve mucus impaction will help to reduce uncontrolled coughing and improve quality of life. The ultimate goal of the secretion clearance program is to control lung congestion and reduce the incidence of respiratory infections in susceptible populations.

Advanced Secretion Clearance Techniques include:

Acapella® Secretion Clearance Device Postural Drainage Active Cycle of Breathing Autogenic Drainage Manual Self treatment techniques

This program is also available for patients scheduled for elective surgery who are demonstrating secretion retention or lung infections prior to surgery. Individualized treatment is provided to improve patients' preoperative lung status.

Lung Re-expansion Program provides individualized treatment for patients with atelectasis lung collapse related to mucus retention, neuromuscular weakness, or skeletal deformity. Patients with reversible restrictive lung conditions, such as Right Middle Lobe Syndrome and scoliosis are excellent candidates for this program.

Re-expansion Techniques include:

Breathing exercises Incentive Spirometry Thera-PEP®

Breathing Retraining for Individuals with Severe COPD provides individualized treatment and instruction in controlled breathing techniques for patients not yet ready to begin a formal pulmonary rehabilitation program. Patients may have COPD, Emphysema, or Chronic Bronchitis. Instruction begins in the resting position and later is combined with functional activities such as ambulation and stair climbing.

Techniques include:

Pursed lip breathing Diaphragmatic breathing Paced breathing Positions for recovery from shortness of breath Energy conservation strategies Outpatient Physical Therapy Department

External links

• Rusk Institute of Rehabilitation Medicine official website

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