“The Clinical Advantage”™“The Clinical Advantage”™

1-800-224-6339Int’l 631-924-9000

www.biodex.comBIODEX

FN: 09-154 5/09

South Port Square in Port Charlotte (FL) is anSHP Senior Living Services facility. They havefour large senior living facilities in Florida; SouthPort Square is the first to get a Balance System.

Smita Shinde,Wellness Director at South PortSquare quickly states, “It is an amazingmachine…we have had terrific results… 99%success rate, they all improve. The BalanceSystem picks up small problems before they arenoticed in traditional exams and we can beginto address the problems before the fall.” Theresidents actually line up in the morning to usethe Balance System with 70% of those in thewellness program using the Balance Systemthree-five times per week. It is being used forboth Fall Screening as well as training. Toquote Smita Shinde – “believe in it (theBalance System), work with it... it works.” Injust four to six weeks she has seen markedimprovements in her residents “...the scoresjust keep getting better”. She continued… “theadjustable skill levels allow the clinician tocontinually challenge the patients in theirefforts to improve. Random Control Mode isthe most popular trainingmode for all patients,helping improve reaction time along withstrength and balance.”

Residents, most of which are in their eightiesor nineties, are seeing great results. “Seeing isbelieving,” said Smita. “They see others

getting better, they see their resultsimproving, they work harder and they too getbetter.” She also added that it buildsconfidence and self-esteem, two factors thatare vital for continued independence.

Margaret Parker (age 86) has progressed injust three-four months, from a failing FallRisk Screening Test score of 3.5,which is onthe high side of the 72-89 age range, totoday’s score in the 1.2 range, which placesher on par with scores from patients 36 yearsold. She has improved so much that recentlywhile preparing for a social event shesurprised herself when she realized she hadbeen walking without her walker for the firsttime in a long time. “I am excited andextremely happy with the results; it has addedto my life and increased my confidence andindependence; the Balance machine, and ourprogram, is terrific.”

Bob Miller – improved from failing the FallScreening test to becoming the mostimproved and being crowned “King ofBalance”. “People comment on how muchbetter I am walking. The whole program hasbeen well worth the time and effort. TheBalance System gives comprehensiveevaluation of my condition and thesubsequent progress of our entire exercise andtherapy program.”

JoyWilson (age 85) went from a poor score of2.8 in November to 1.9 in March and 1.2 inApril crowning her, along with Jeanne Millerthe “Queens of Balance”. “I am much moremobile, more active, and overall it has been agreat experience thanks to the Balance Systemcombined with great clinicians andprograms.” Joy stated. Jeanne, who uses theBalance System each morning five days a weekcould not climb stairs or walk any distance.Today, she scores 0.9 which puts her withinthe 17-35 age range on the normative data.

Ann Freeman (age 87) a frequent faller (4-5times per day) has worked on the BalanceSystem for six months - today she is Fall-Free.She had been using a four-wheel walker andnow simply uses a cane for extra “steadiness”.Another exciting success is Jean Hoskins (age

91) She uses the Balance System 3 times aweek. When she first entered the program shecould not take a single step without herwalker, today she comes to the wellness centerparks her walker and spends her time walkingindependently.

MiriamMiner reports that after just six weeksof balance training she went from off the chartfailure on the Fall Screening Test to showingsuper improvement. “I have progressed fromusing a walker all the time to only using acane if I have to walk a long distance.” Sherelated the following story… “Recently I hadto attend a graduation ceremony for mygrandson at the Superdome in New Orleans.I was able to walk up the stairs and throughthe Superdome with only the arm of myson…I am so pleased with my results; it hasbeen amazing. Before the Balance System Iwould have never been able to attend.”

South Port Square also has a second BalanceSystem in their Harbour Health Systemsrehabilitation/nursing home facility on thecampus. This Balance SD is just now gettingup and running but already is seeing use intotal knee patients as well as strokerehabilitation. Jennifer Cooley PD/COTA isthe Program Director, she states “Right now,in the skilled nursing facility, we are using itto screen any long term care residents thathave had falls and may have balance issues.The therapist will test first, and then ifdeficits are noted we will get treatment ordersfrom the doctor. Then we use it as a treatmenttool to show progress with balance deficits.With the acute patients we mostly use it as atreatment tool. Obviously not everyone isappropriate (for the Balance System), but inthe geriatric population balance is a hugeissue and we plan to use the Biodex to reducefalls and to maximize patient outcomes toreturn home safely.” The Balance System isbeing offered to the community at-large foroutpatient Fall Screening programs.

South Port Square23023 Westchester Blvd.Port Charlotte, FL 33980

South Port SquarePort Charlotte, FLBuilding Confidence and Self-Esteem in SeniorsWhile Improving Strength and Balance

A 104 bed facility located on South Beach,Miami, FL is part of the larger Plaza HealthNetwork made up of seven facilities in theSouth Florida region.

Founded by a loving group of elderly Jewishwomen, this nursing home opened its doorsin 1954 as a not-for-profit facility. Theseladies formed the “Women’s Auxiliary” andworked diligently to provide housing for theneedy and impoverished elderly Jewishindividuals. Today, the facility is truly multi-cultural with a large Latin patient population.Offering both skilled nursing and assistedliving facilities, it is among the leadingfacilities in rehabilitation advances in thesouth Florida area. By providing residentsaccess to advanced rehabilitation testing andtraining equipment “we can offer unsurpassedtreatment to even our most debilitatedresidents. With the addition of the BiodexGait Trainer 2, the Balance System and theUnweighing System, we have gone beyondmost senior facilities and are breaking newground in the care of our residents. No longeris the nursing home a place where we simplystore the elderly. At Hebrew Homes we carefor their needs in extraordinary ways andstrive to return them to active, independentlives back in their community.”

Joel Kuttler, the senior therapist at HebrewHomes said about the Biodex equipment “wecan show progress to patients, patient'sfamilies and doctors... progress is paramount,often patients are depressed and in need of theconfidence to move forward. This equipmentdoes that, it shows them they CAN safely getbetter and live better lives. With earlyhospital discharge becoming the norm, theneed for more advanced rehab techniques andequipment is growing. The reports generatedby the Biodex equipment aid us in providingdocumented progress reports to insuranceproviders and referring physicians, enablingus to procure needed approvals forcontinuation of care.”

The progression in most cases of rehab,according to Kuttler, follows a basic path. “Thepatient usually begins in a non-ambulatory ordebilitated condition and is progressed tostanding, using the Unweighing System alone.Then they move on to the Gait Trainer, whilewearing the Unweighing System, and finallyon to the Balance System and Gait Trainerwithout the assistance of the UnweighingSystem. It is an integrated system. People havea natural, basic need to progress, they want toimprove; this equipment allows them to dojust that and see “written proof” that they are

in fact improving”. Kuttler noted that in thepast, patients had to take the word of theclinician as to their progress; he noted with thenew Biodex equipment they can see the resultsfor themselves on the screen and in reports.One example is Hermenez Torres, presented asa non-ambulatory stroke victim. After just twoweeks on the Gait Trainer he is beginning towalk. “The results are almost unbelievable”said Kuttler, “patients progress at a faster ratethan before and gain confidence faster.”

“Many hospitals are looking to facilities suchas ours as “Step-Down-facilities.” Once thepatient is well enough, they are moved to rehabfacilities for continued care. Hospital stays aregetting shorter and patients at the rehabfacility in need of concentrated care…weprovide that care.” From a financial position itmakes sense. Once the hospital has exhaustedMedicare payments or insurance coverage, thepatient can move to a “step-down facility”where the “insurance clock is restarted” andcare is resumed under medical coverage.

Hebrew Home of Miami Beach320 Collins AvenueMiami Beach, FL

Hebrew Home of Miami BeachMiami Beach, FL

Utilizing the Biodex Balance , Unweighing and GaitTrainer Systems in a Coordinated Program for Seniors

Continuing care retirement communities areacknowledged as the ideal long-term localefor many seniors, allowing a continuum ofcare from full independence to advancedskilled care,as needed. Taking a “balanced”approach to reducing fall risk over thatcontinuum, Regency Oaks in Clearwater,Florida is providing state-of the art balanceexercise and rehab to all its residents, withtwo Biodex Balance Systems – one in itsSylvan Health Center SNF, and one in itsIndependent Living wellness center.

“Regency Oaks has 388 independent livingcare units,” explains Chelby Clarke, directorof rehabilitation services, “and a 60-bedskilled nursing facility in our Sylvan HealthCenter. We also have a 25-room assistedliving facility, Sylvan Terrace, attached to ourSNF.” According to Clark, the great majorityof the acute patients at the Sylvan Center SNFare referred for rehabilitation followingorthopedic procedures – mostly hip and kneereplacement. “We also get referrals of patientsfollowing abdominal surgery, and generalizedweakness. Most of our nonresident acutepatient referrals come from physician referrals,followed by word of mouth,” she says. Clarkexplains that much of that rehab centersaround helping patients to normalize theirweight bearing on the affected limb.

Most, she believes, have developed alteredweight bearing in response to their arthriticpain prior to surgery, and postoperativediscomfort after surgery. That places them atincreased riskof a fall.

“The Biodex Balance Systemshows them when they’re notapplying full weight bearing totheir leg, and – when they are,without pain – it gives themthe confidence to walk withoutfear of pain.”

Many surgeons have a specific protocol – howlong to apply only 25% weight bearing, then50% weight bearing, and finally full weightbearing. Even after they are capable of fullweight bearing, many are still – consciouslyor subconsciously – avoiding full weightbearing on the affected leg. The graphicdisplay on the Biodex Balance System helpsto persuade them it won’t be painful to applyfull weight bearing when they’re not on theBalance System.”

Typically, patients with hip or knee implantsspend between four and six weeks at SylvanCenter, the exact period depending in part ontheir ambulatory and cognitive status prior tothe surgery.

“If they come in capable of significantweight bearing and otherwise normalhealth, it could be as little as four weeks. Andif there are significant other health issues, itcould be as long as 8 to10 weeks. Clark says that the daily Medicarerate averages $400-450 a day.“ That’s ablanket reimbursement. If they have IVs,

their reimbursement will be a bit higher. Thatincludes all their charges – room, board,therapy, nursing, medication. However, ifthey need to see their orthopedist orneurologist during their stay, theirtransportation and medical service fees alsomust be paid out of their $400-450 perdiem.”

Our residents love the BioStep®

In addition to the second Biodex BalanceSystem, the Regency Oak Wellness Center,directed by therapist Zelko Ratkovic, alsohas a Biodex BioStep semi-recumbentelliptical cross-trainer. “Our residents love theBioStep,” Ratkovic says. “Many of our ILFresidents have little or no history of exercise.They are easily intimidated by most exerciseequipment, but not by the BioStep. Thosenew to exercise typically come in about threedays a week. They don’t have to work hard, asthey would with a leg press. Between 7-10people a day use BioStep.” Ratkovic believesthe graduated protocols and display areimportant to resident acceptance. “TheBioStep offers five levels of exercise. Thedisplay is very encouraging. After a fewweeks, at one level, they want to move tohigher levels, maybe exercise longer. Theymeet other exercising residents, and theybegin motivating each other.

“They love the BioStep – it gets theminto the exercise habit.”

Regency OaksClearwater, FL

Regency OaksClearwater, FLClearwater’s Regency Oaks Uses BiodexBalance &Mobility Programs to Enhance the Qualityof Life of SNF and ILF Residents

South Pointe Plaza is a 230 bed skillednursing facility located in the heart of theSouth Miami Beach Art DecoDistrict, just one block fromthe ocean. At South PointePlaza the comprehensiverehabilitation programs aredirected towards assistingresidents to reach theirmaximum level of functionfollowing a hospital stay. Alltherapy programs are gearedtowards rehabilitation ofresidents who may havesuffered a stroke, brainaneurism, a hip or otherfracture, or major and minorsurgeries. South Pointe offersphysical, occupational, andspeech therapy services, in afully equipped therapy area,which encompasses an entirefloor at the facility. It is herethat the new Biodex Balance System, alongwith the Biodex Unweighing and GaitTraining Systems are located.

According to Jose Rodriquez - Director ofRehabilitation for South Pointe... “the patientcan actually see results on the screens... in thepast it was very subjective - they had tobelieve me when I told them how they were

doing... now they can see the results forthemselves... and they like that.” Rodriquez

also notes the increased safetyfactor when using the GaitTrainer and the UnweighingSystem together. “The fear offalling is uppermost in residentsminds and by utilizing the GaitTrainer with the UnweighingSystem we can remove much ofthat fear and concentrate onrehabilitation. Buildingconfidence along with strengthand balance speeds the recoverytime and improves results”. Anadditional feature noted byRodriquez is the built in heart-rate monitoring on the GaitTrainer. “Before I would have tostop the exercise to check theresident’s pulse, with the GaitTrainer they are monitored asthey exercise. In the case of

cardio-rehab it allows me to easily record pre-and post-exam heart rate withoutinterrupting the program.”

The Biodex Fall Risk Screening Program isalso being utilized here. Rodriquez recountsthat “we had a 93 year old patient whoseemed fine, she walked on her own and hadno history of falls. However, she complained

that she bumped her arm often while walking.We did a Biodex Fall Risk Screening Test onthe Balance and she failed. Her balance wasvery poor... we began a balance trainingprogram and she was quickly able to returnto normal activities... all BEFORE she fell.”

Rachel Schuster - Facility Administrator callsthe results from using the Biodex Equipment“amazing... the Biodex equipment has enhancedthe quality of our Rehabilitation program atSouth Pointe Plaza. Our therapists haveassurance that our residents are safe while thisequipment is in use and our residents are moreinclined to participate in their exercises and fora greater length of time because they feelcomfortable and fully supported. I truly feelthat this equipment has enabled us tomaximizeour residents’ potential by building strength,mobility, and endurance which we hope willultimately help to prevent recurring injury.”

South Pointe PlazaRehabilitation and Nursing CenterMiami Beach, FL

South Pointe Plaza Rehabilitation and Nursing CenterMiami Beach, FL

South Pointe Plaza TakesMajor Step TowardMaximizingTheir Residents Potential... Safely and Effectively.

Plaza Health Network is a state-of-the-artnetwork of eight not-for-profit 501(c)3rehabilitation and skilled nursing centerslocated in the neighborhoods throughoutMiami-Dade County, Florida. Each of thenetwork’s centers has a Biodex Balance Systemand a Biodex Gait Trainer. Five with therapydepartments are also equipped with BiodexUnweighing Systems – affording those sites acomplete “Biodex Balance & Mobility”assessment and rehabilitation package “We’vefound the Biodex balance and mobilitysystems to be valuable marketing as well asclinical assets,” explains Epstein. “Properlypromoted to area hospital discharge planners,physicians and the community, they’ve helpedPlaza Health to be the leading providers ofMedicare paid short-term inpatientrehabilitation in our area.” The HebrewHomes network gets its name from its Jewishfounders who opened its first Miami facilityin 1954. Today, its residents reflect theethnicity of the region.

Balance System helps attract profitableMedicare patients.In the experience of Plaza Health Network, apatient referred for 30 days of post-arthroplasty rehab generates about $15,000in gross Medicare revenue, Epsteinreports.“After one such patient, a BiodexBalance System is essentially ‘free,’” Epsteinsays. “The Biodex system enables us to

provide referring orthopedists with anobjective assessment of their patient’s precisebalance issues upon admission to a HebrewHome.”Over the succeeding weeks, as PlazaHealth Network therapists follow surgeonorders in increasing weight bearing on theoperated limb, and challenging patientbalance, the Biodex system generates progressreports that enable Plaza Health Network toprovide surgeons with similarly objectiveevidence of their patients’ progress.

“The surgeons love this kindof care, and make theirpreferences known to bothpatients and dischargeplanners,” Epstein claims. “We regularlyget referrals from as far away as BrowardCounty, explained by ‘The doctor wants thepatient rehabilitated on your equipment.’”According to Epstein, the Biodex Balance andMobility system can have a significant impacton a skilled nursing service’s bottom line.“Inour case, we’ve been able to improve our ratioof Medicare to Medicaid population,” hereports. “It helps us achieve higher RUG(Resource Utilization Groups) scores, givingrise to higher average per day Medicare rates.And it lets us compete for privately insuredpatients, who often have restrictions onlengths of stay, because we can showdemonstrable, objective outcomes.”

Because Jackson Plaza is one of the five PlazaHealth Network facilities with Biodex GaitTrainers and Unweighing Systems, Moore andthe nurses attempt to identify bed- andwheelchair-bound residents whose quality oflife might be improved with aggressive use ofthese optional instruments. “We have one300-pound resident who’d been bedridden fortwo years, and was afraid even to try to stand.Finally, we were able, with use of the Biodex

Unweighing System, to give her theconfidence to attempt steps over ground. Assoon as she can safely stand on her own, weexpect to begin training her on the BalanceSystem, and then on the Gait Trainer. She’snow motivated to lose weight – “I’m going towalk again!” she tells us. “Only perhaps 10 or20% of our wheelchair residents can achievethat degree of mobility, even with asignificant training effort,” Moore reports,“but I believe such mobility training paysdividends to both residents and facilities, evenif it results just improved strength andbalance in transfers from bed and chair, inshowering, and other activities of daily living.Such residents require fewer aides, and haveincreased confidence that improves theiroutlook and cooperation, and certainly theirquality of life.”

Plaza Health NetworkMiami Beach, FL

Plaza Health NetworkMiami Beach, FLMiami’s Plaza Health Network Uses Biodex Fall & MobilityProgram to Reduce Falls and increaseMedicare Referrals

“...we’ve been able toimprove our ratio ofMedicare toMedicaid population.The Biodex systemshelp us achieve higherRUG (ResourceUtilization Groups)scores, and thus, higheraverage per dayMedicare rates.”

The Gardens Court is a 120 bed facilitylocated on the east coast of Florida, part of theLife Care Centers of America. Besides TheGardens Court, Life Care operates more than200 skilled nursing, assisted living,retirement, home care and Alzheimer's centersin 28 states - from Boston, Massachusetts toHilo, Hawaii. The Gardens Court has theBiodex Balance SD, as do sister facilitiesDarcy Hall Nursing and Rehabilitation inWest Palm Beach and Lakeside Health Centeralso in West Palm Beach.

After meeting Rita Zukerman PTA, BeaScafidi LPN/BHS and rehabilitation patientJosephina Ruf at The Gardens Court facility,it was immediately obvious that the BalanceSystem has been successfully integrated intothe rehabilitation/wellness programs at thisfacility. They use the Balance System SD inconjunction with the aquatic training andstandard rehabilitation protocols in a cohesiverehab program. Rita notes that “the BalanceSystem helps show the patients theirinstability... IT PROVES IT TO THEM inblack and white, which allows us to beginworking with them before they fall.”

The patient that was in rehab during my visitwas Josephina Ruf, a spunky resident of 65+;she had a severely broken leg caused by anaccident with two large dogs and underwentsurgery in January 2008. Doctors insertedpins and a plate into Josephina’s leg andreleased her to The Gardens Court forrehabilitation. Josephina was non-ambulatoryfor over eight weeks prior to beginning rehab;she was depressed and anxious to “get better”.To quote Josephina “I can walk again, thismachine is amazing, a miracle...it is hardsometimes, but that is good, it makes mework and I can see myself getting better.” Shewanted me to walk with her to her surgeon'soffice (across town) to tell him about theBalance System “he should see this – heshould put all his patients on it.”

The Gardens Court3803 PGA BlvdPalm Beach Gardens, FL

The Gardens CourtPalm Beach Gardens, FL

Integrating The Biodex Balance Systeminto their Rehabilitation Programs

What percentage of your 128 skillednursing beds are occupied by long-termcare verses short-term rehab?Kathleen Mack, Director ofAdmissions: About 70% of thepopulation is long-term care, and 30%short-term rehab patients.

Where do most of your short-term rehabpatients come from?Mack: We’re right on the border ofMassachusetts and Connecticut, so we workwith Bay State and Mercy Hospital inMassachusetts, as well as Johnson MemorialHospital, Hartford Hospital, Saint FrancisHospital, and Rockville in Connecticut.

Is there significant competitionfor short-term rehab patients?Mack: Yes, because there are quite a fewfacilities around us that provide short termrehab in addition to palliative as wellas long-term care, so we’re all competingfor those same individuals.

What mix of clinical diagnosesdo you typically see ?Mack: We have a strong orthopediccomponent. As a result, we haveorthopedic surgeons who directly referpatients to us from both Hartford Hospitaland Saint Francis. Our relationship withthose surgeons is so strong that mybusiness cards and Suffield Housepackets of information are at the doctors’

offices. And so, when one of thesesurgeons is getting a patient ready for theprocedure, they’re informed that they’regoing to have a very short stay at thehospital, followed by a period ofrehabilitation at Suffield House, until it’ssafe for them to return home.As a result, we have “pre-books” – so weknow in advance that, for example, aparticular surgeon’s patient will undergo aknee procedure on Monday, and thatthey’ll be here Thursday. So we’re able tokeep the momentum going and hopefullynot have a lot of beds down.

Are all Medicare patients, or aresome privately insured?Mack: The majority are Medicare. Wehave just become providers to severalprivate insurers, such as HealthNet. Upuntil now, we have worked with Medicare asthe primary insurer, with the secondaryinsurers being Blue Cross, AARP, Cigna,Aetna, U.S. Healthcare etc. We also workwith Workers’ comp.

How do you staff your physicaltherapy department here?Anthony J. Zukowski, Director ofPhysical Therapy: Here at SuffieldHouse, we have three physical therapists,one physical therapy assistant and onerehab aide here throughout the week. Wealso have two occupational therapists andtwo contract speech therapists. Both PT

and nursing students from CentralConnecticut State University and Universityof Connecticut rotate through thedepartment.

We have a varied patient mix. Beyond ourorthopedic patients,we see patients withstrokes, recent amputees, and cardiacrecovery patients who need to buildendurance. We see patients with neuromotordiseases such as Parkinson’s, COPD, andpost-op complications patients, too.

At the current time, how are you using theBiodex Balance System?Zukowski: We’re working witha lot of orthopedic patients, aswell as our general population of residentswho are having gait and balancedisturbances.

The Balance System is being used as anadjunct to our standard physical therapy.We enjoy using it to stimulate patients todo work harder than they might otherwisewish to do. First of all, it gives them avisual feedback on how they’re doing atnormalizing their balance.(continued on the web)

Read the rest of this story and other case studies atwww.biodex.com/seniorliving

Suffield House Uses Biodex Balance System& BioStep®

to Enhance Rehabilitation of Diverse Acute-Care andAssisted Living Residents and increaseMedicareReferrals

Suffield HouseSuffield Connecticut

“Now we use theBalance System toprepare Parkinson’spatients foroccupational therapy,where they stand atthe kitchen sink andhave to reach forthings…”