Bacharach. Institute for rehabilitation

James O. Aboderin, PT is the new clinical director of Bacharach’s recently opened physical therapy center in North Cape May, where he will manage the day-to-day operations. The Center offers a full range of outpatient physical and occupational therapy services and treatment options, including one-on-one individualized care, anda joint day rehabilitation program, an intensive five-day outpatient post-surgery program for hip and knee replacement patients.

With 25 years of experience as a physical therapist, James’ expertise is in sports medicine, orthopedic and neurological injuries, balance and vestibular issues and fall prevention. He employs a variety of techniques for the treatment of back, neck, knee, ankle and shoulder conditions including: the Maitland approach; Mulligan concepts; the McKenzie method; and myofascial release. He previously worked as a staff physical therapist in orthopedics and sports for several physical therapy centers in the region.

James shared, “My philosophy is to empower patients to overcome injuries through education, exercise and postural awareness. I believe in providing one-on-one, evidence-based physical therapy in an atmosphere of trust and respect.”

Outside of work, James enjoys walking and kickboxing, but most of all, spending quality time with his wife and three teenage children.

James attended the University of Lagos in Nigeria and was born in Ibadan, Nigeria. He has lived in Mays Landing for the past 20 years and considers it his home. 

Welcome, James!

The Graston Technique is an advanced method of soft tissue mobilization using specially designed stainless steel instruments. These instruments are used by physical and occupational therapists, hand therapists, chiropractors and athletic trainers to aid in the detection and treatment of soft tissue dysfunction. There are seven physical therapists at Bacharach who are using the Graston Technique to successfully treat joint replacements patients, increase range of motion and improve scars.

Patients with any type of soft tissue dysfunction can benefit from the Graston Technique which is being effectively utilized for conditions resulting from soft tissue injuries and overuse such as lateral epicondylitis (tennis elbow), medial epicondylitis (golfer’s elbow) and rotator cuff tendinosis (shoulder pain) and patellofemoral disorders. The Graston Technique has also shown positive results for treatment of fibrotic conditions of the tissues such as myofascial pain syndrome, and carpal tunnel syndrome (wrist pain). In addition, it is being used to treat lower extremity conditions such as plantar fascitis, shin splints and Achilles tendonitis.

The Graston Technique is based on the principals of James Cyriax, MD, a British physiatrist who is the father of soft tissue mobilization and manual treatment methods such as deep tissue massage.

Laura Lee Smith OTR/L, CHT, is an occupational and certified hand therapist in Bacharach’s outpatient department. She has been successfully treating patients with the Graston Technique and explained, “There are six instruments used to detect and amplify the feel of soft tissue restrictions. The first step is to assess where the restrictions are. Next, various tools are used to mobilize these restrictions. Patients frequently follow-up with an exercise program.” She continued, “Every instrument is designed for a different area of the body based on contour and specific tissue needs. The instruments are very smooth and look like a cutlery set. My patients who have been treated with the Graston Technique have become more mobile in less time than they would with using traditional massage and stretching methods.”

Laura Lee has also had positive outcomes with patients who have scarring issues. “I frequently work with patients who have scars resulting from surgery, wounds or muscle tears. Scars form in a random fashion and we work to remodel the scar through stretching, exercise and massage modalities. Graston helps remodel the fibers of scar tissue providing better mobility,” she said.

The Graston Technique is often used during hand therapy helping to free up tendon adhesions, which occur when there has been a wound, tear or amputation where tendons no longer glide freely to work in full motion. Laura Lee said, “Graston helps free up the tendon from the scar tissue. We can desensitize patients by using a gentle approach that gradually becomes more aggressive. We can also begin by using the tools and follow-up by using our hands, based on what will work best for our patients.”

Bacharach’s Christina Jones PT, DPT, ATC, has found the Graston Technique to be an effective instrument in combination with other treatment techniques. She recently treated a patient with plantar fasciitis, a painful inflammation of the connective tissue on the sole of the foot. Her treatment program included: warming up the tissue, Graston Technique to the plantar fascia and calf musculature followed by stretching, strengthening and ice.

Christina Jones’ patient, Mary Beth Kraft, shared her experience with the Graston Technique, “I am on my feet all day and my plantar fasciitis was so painful that I was no longer able to exercise after work. After two months of working with Christina, my pain has eased greatly and I am back to my regular exercise routine. Christina was great, and although I am glad my condition has improved, I will really miss working with her.”

Another of Christina’s patients, a young athlete, is responding well to a combination of the Graston Technique and Kinesio Taping, a rehabilitative taping method.

She shared, “For the patient, the Graston Technique is a more tolerable treatment then other forms of soft tissue mobilization and allows them to return to play/activity quicker. I have often found a decrease in symptoms in one to two treatments. As a clinician, I have found it better helps me to detect restrictions and allows for a more precise treatment, providing the results that my patient and I are looking for.”

Enhanced External Counterpulsation, or EECP, a treatment that stimulates growth of new blood vessels to the heart without surgery, can decrease chest pain and increase heart function for angina patients who are unable to undergo surgery. The typical EECP patient has already had bypass surgery and/or stents implanted and continues to have recurring angina but is not able to tolerate additional surgery. Patients who have heart failure with recurring chest pain benefit from this treatment as well.

During EECP treatment, patients lie on a table and special cuffs, similar to blood pressure cuffs, are placed on their hips, thighs and calves. They are hooked up to an EKG machine to monitor their heart rhythm and synchronize with their heartbeat. In between each heartbeat, the computer-controlled EECP machine inflates and deflates the cuffs in a carefully orchestrated sequence, pushing blood to the coronary arteries. As the blood flow to the coronary arteries increases, newly grown arteries form and branch off around the blockage, allowing additional blood to reach the heart.

Ron Franceschini, clinical exercise physiologist (CEP) and director of cardiac services at Bacharach, has been conducting EECP treatments at Bacharach since 2002. He explained, “Once a patient is recommended for EECP treatment by their cardiologist, we do an evaluation to determine any risks that might occur so we can monitor everything very closely. For example, if a patient is diabetic, which many EECP patients are, we will do a blood sugar reading before and after each treatment.”

Ron continued, “Patients treated with EECP begin to have decreased angina symptoms and can gradually begin to do more. This starts a snowball effect and the patient becomes more active, their blood pressure improves, their heart rate lowers and, many times, they are able to transition to a monitored exercise program called cardiac rehabilitation, which they would not have been able to manage before EECP.”

In addition to the treatment, EECP patients at Bacharach are educated about diet and exercise, providing them with insight on activities they should avoid and those they can pursue. Ron shared, “One patient started to develop chest pain – an indicator that the heart is starving for blood. We talked about his recent activities and I learned that he regularly walked his dog against the wind. I recommended that he always warm up to get the blood flowing to his heart before walking and that he change his route so that he walked with the wind at his back. His condition improved.” 

John Defeo, (left, patient Kathy Tomasello) a senior exercise specialist at Bacharach, also works with EECP patients and has seen great success with the treatment. He said, “It is a demanding regimen and most patients are here five days per week. However, after a few weeks, we absolutely begin to see an increase in a patient’s energy level. Patients who couldn’t even walk in the front door are able to go to the mall or grocery shopping when they have completed their treatment.”

Ralph Liberatore, an EECP patient at Bacharach, had his second bypass surgery in early 2000. Two years later he developed serious cardiovascular problems when all but one of his vessels closed down. The only option seemed to be a heart transplant, but there was not enough time. His doctor, in consultation with Bacharach, determined that Ralph would be a good candidate for EECP. 

Ralph remembers, “At that time, I could not walk without tremendous chest pain.  After just two or three weeks on the program I started feeling relief and was able to walk and breathe better. By the end of my EECP treatment I was able to play 36 holes of golf with my wife and carry my own clubs.”

Ralph has repeated the EECP program as needed throughout the years and is about to begin a cardiac rehabilitation program. He shared, “I am grateful to be here. I think the EECP at Bacharach is a great program and I appreciate the personal interest that Ron and John have taken in me.”

For more information on EECP call the Cardiac Rehab Center at 609-748-2091 or click here.

Abe Alfaro, Ph.D., D.O. (left) is the director of Bacharach’s Spasticity and Dystonia Clinic. At the Spasticity and Dystonia Clinic, patients receive injections for abnormal movements due to spasticity after a stroke, brain or spinal cord injury. Conditions such as multiple sclerosis and cerebral palsy as well as conditions of the neck (cervical dystonia), of the arms and legs (limb dystonia), and of the face and eye muscles (hemifacial spasm and blepharospasm) are also treated at the Clinic. Dr. Alfaro has unique expertise in this area and is one of few doctors in the Philadelphia and South Jersey region offering this type of treatment.

Patients with abnormal movements are treated with nerve and muscle injections. Nerves are injected with phenol, a substance that removes protein around the nerves, which relaxes muscles by reducing excess electrical activity. Muscles are injected with Botox, a botulinum toxin, that relaxes them by reducing the amount of a substance called acetylcholine that is released from nerves to stimulate muscles. Although many people think of Botox as a cosmetic treatment, it is also FDA-approved for other medical problems such as excess drooling (sialorrhea) and perspiration (hyperhydrosis), and for migraine headaches.

Dr. Alfaro also treats patients with Parkinson’s Disease, injecting their muscles and nerves to help their uncontrolled arm movements and improve walking. Patients who receive injections often have fewer abnormal movements, and as a result, they have improved function and an increased ability to do physical and occupational therapy.

The injections can also help reduce pain. Dr. Alfaro shared “Injections to relax nerves and muscles may help people who have severe neck and shoulder pain after an injury that limits movements of the head, neck and shoulders. One of my patients, a 53 year-old man, had a heavy object fall on his neck while he was at work. The pain persisted for four years, despite numerous treatments including spinal surgery, and pain medications. I examined the patient and noted that one neck muscle was contracting involuntarily, and prevented the patient from turning his head to the left. After a test injection with lidocaine to the nerve to stimulates the neck muscle, the patient could turn his head to the left without pain. Since a lidocaine injection is a test injection and only lasts for a few hours, the patient returned for an injection to the nerve with phenol which relaxed the muscle and lasts for months and possibly longer. Steroid injections eliminated his shoulder pain and enabled him to perform daily activities that he was not able to do before the injections.”

Eating is traditionally an enjoyable experience as families and friends share meals together.  However, children who lack the skills necessary to feed correctly find eating difficult, often making mealtime a struggle. The recently launched Bacharach Pediatric Feeding Skills Program offers families facing this challenge a solution, providing comprehensive feeding evaluations for children who are picky eaters and problem feeders. 

According to Pamela Modugno (right), OTR/L, of the Feeding Skills Program at Bacharach,“Our program is open to children of all ages, from infants to teenagers. Every child is different – some children avoid certain colors or textures, some can’t tolerate food being on their plate and others will only eat a very limited number of foods.”

Using the Sequential, Oral and Sensory (SOS) approach to feeding, the program encourages children to become more comfortable with food through a process of systematic desensitization. Pamela shared, “By allowing a child to learn more about the qualities of food, they become more comfortable with those qualities, gradually moving up the steps of a food hierarchy. The first step is to visually tolerate the food. The next step is to interact with the food. The more we can encourage a child to see, touch, smell and feel their food, the more at ease they will become with the idea of eating that food.”

After a feeding evaluation is completed, the child will be referred for either individual or group therapy. Children attend a weekly feeding school where they learn that food and mealtime can be a positive experience. The goal of the program is to increase tolerance for food variety, smell, consistency, texture and taste, resulting in better food acceptance. According toPamela, “We play all kinds of games with food such as painting our nails and putting on chapstick with purees, helping children to progressively move the food closer and closer to their mouth. The clinic is a fun and playful environment full of exploration, which sometimes gets quite messy!”

The clinic offers specialized feeding chairs as positioning is very important for successful feeding. Pamela explained, “Sometimes, if a child has posture or other physical problems they might not be supported correctly while they are feeding, making it difficult for them to eat."

"It is important for children with feeding issues to have their hips, knees and ankles supported correctly during mealtime. The proper positioning allows them to be more stable, resulting in better oral, motor and hand-eye coordination,” she said.

Family involvement and education is a critical part of the program, as well. According to Pamela, “We teach the parents a variety of different things. The family mealtime is essential as a routine helps a child feel comfortable and provides structure to facilitate learning. This is the time when a child eats preferred foods and learns about new foods. When the child is having a family meal, it is important that everyone at the table eats the foods that the child will eat. It is also important that the child is encouraged to try new foods when they are ready.”  

The Bacharach Feeding Skills Program is committed to helping children achieve the skills necessary to master feeding so that all children will have the adequate nourishment they need to thrive. 

For more information on the Feeding Skills Program, call Pamela Modugno at 609-652-7000 extension 5468.