Get Your Skills Back with Occupational Therapy

Frannie Bienvenu, OT

When more than 70 million Americans rely on cellphones to help manage their lives, it’s to be expected such a technology phenomenon would affect more than how we communicate with one another. Keeping your eyes on the mobile screen forces repetitive movements to your shoulders, neck, elbows, and thumbs—causing pain and even structural damage to joints, muscles, and tendons, not to mention eyestrain.

Enter the occupational therapist. These practitioners can arm you with ways to modify your smartphone use, as just one example, so you can avoid or decrease discomfort or pain.

Help for Daily Activities

See, that’s the thing with occupational therapists. They treat patients who are injured, ill, or disabled, not simply because there is a problem, but rather because the problem has thrown a wrench into the patient’s daily activities that matter most to them. Occupational therapists take a holistic approach to evaluate why your life has been affected while helping you develop, recover, and improve the skills you need every day.

Occupational therapists treat patients with a wide range of conditions. For example, they’ll:

  • Teach a stroke victim how to get dressed
  • Demonstrate stretching exercises for arthritis relief
  • Help label kitchen cabinets for an older person with poor memory
  • Educate patients with cerebral palsy on how to use leg braces, wheelchairs, or eating aids
  • Modify classroom equipment to help children with disabilities more easily participate in activities
  • Adjust patients’ work environment to prevent computer-related issues like carpal tunnel syndrome or eyestrain
  • Provide strategies for time management, budgeting, or using public transportation to patients with mental illness, emotional problems, or addiction

Technology Harm and Help

Although technology can contribute to the reasons you might seek occupational therapy, it can also play a role in your recovery. For example, if you have cellphone elbow—caused by too much bending of the elbow to hold your phone to your ear—you may experience tingling and numbness in your pinkie finger and possibly weakness in the hand. An occupational therapist will educate you on why these movements are causing discomfort, recommend different ways to use the phone, and arm you with ways to help the elbow heal (such as providing a splint).

Some practitioners even use gaming devices, such as the Nintendo Wii, to provide rehabilitative activities. Research over the past 10 years has suggested that Wii games, such as boxing, fishing, and brain teasers, increase motivation, decreased depression, and improved quality of life and mobility among patients with Parkinson’s disease. Practitioners can also use smartphones and tablets to facilitate fine motor skills and sequencing, and to run text-to-speech programs.

Frannie Bienvenu, Occupational Therapist, graduated from LSU Medical Center with a Bachelor of Science degree in Occupational Therapy. She is NDT certified, LSVT BIG certified, and STAR certified for cancer rehabilitation. Frannie has been LSVT BIG certified for over 2 years and during this time has helped many clients with Parkinson’s disease achieve their goals. She enjoys being an integral part of their rehab process, finding how rewarding it is to help each client identify their challenges, then to help them overcome these challenges.

Top 5 Stretches to Minimize Back Pain

Robbie Banta, PT, DPT

When trying to manage low back pain, people often discount the many benefits of simple stretching to help relieve pain.  You want your stretches to stay moderate in intensity to achieve pain relief without worsening symptoms.  You should never push yourself through heavy pain because you can make your symptoms worse.

I recommend performing a short 5 to 15 minute warm up to increase blood flow, which can help improve tissue extensibility.  A brisk walk around the neighborhood or a quick spin on your stationary bike can help reduce the risk of injuring yourself further by overly stretching cold tissue.

Five stretches to try:

  1. Posterior hip

Your glutes and piriformis have a close proximity to your lumbar spine, so stretching these out can help the spine move more naturally.  By lying on your back, pull a single or double knee to your chest to get the job done. You will be stretching some of your low back muscles as well.  You can also cross one leg over the other while sitting and push forward to stretch your glutes.

  1. Hip flexors

Considering these muscles are attached to the anterior surface of the lumbar spine, tightness here can directly affect your lower back pain. A runner’s stretch in the lunge position will work, but be careful not to overdo this or you make your back pain worse.  Keep it right, and keep it light! You could choose to perform this stretch in a standing lunge or a kneeling lunge, depending on how it feels.

  1. Hamstrings

If your hamstrings are tight, this muscle will pull on your pelvis, which creates a bit of a tug o’ war with your parapsinals.  Many people stretch their hamstrings by reaching down to touch their toes, but you can also use a strap around your foot to pull your leg up while lying on your back. This stretch can be a bit uncomfortable since the hamstrings are a large group of muscles, but it will be worth your time.

  1. Calves

Even though your calves are not lumbar adjacent, they share a myofascial pull with the hamstrings. They are also required to support your weight all day long.  A simple calf-stretch using a wedge or the edge of a step can create a stretch all the way up to the back of your leg. This can help reduce your back pain and help you get a little pep back in your step!

  1. Your back

You have to be very careful when stretching your back because it is the most direct stretch of all that we discussed.  You are trying to push your back into a reasonable amount of extension.  The best way to stretch your back is by lying on your stomach while pushing up on your elbows. This is often referred to as a cobra stretch in yoga. The more advanced and flexible people can try a full cobra by keeping your arms completely straight, but make sure you increase your range gradually in order to work up to this.

Back in Action

Touro’s Back in Action Center provides comprehensive physical and occupational therapy services to adolescent, adult, and geriatric patients, as well as case management for patients with orthopedic diagnoses, therapeutic wellness and women’s health. Click here to learn more.

Touro Back in Action

1525 St. Charles Ave., New Orleans, LA 70130
Phone number: (504) 897-8157
Fax number: (504) 897-7041

BackInActionProgram@lcmchealth.org

Robbie Banta, PT, DPT received his Doctor of Physical Therapy from Louisiana State University Health Sciences Center. He has more than 5 years of experience in physical therapy.

Prehab Before Rehab for Joint Replacement

Monique Serpas, PT, DPT, OCS

It may seem like the pain of arthritis comes out of nowhere. Many people are surprised by it, trying to make sense of “why now?” as there is usually not a specific event or injury that can account for it.  Rome wasn’t built in a day.  Similarly, arthritis doesn’t just happen overnight.  It takes many years to develop.  Some research indicates the process begins in our forties but doesn’t become painful until our sixties.  At some point, especially those who have knee and hip arthritis, surgery through joint replacement is inevitable. Recovery time takes a few months. But exercising before joint replacement can speed the process and make the surgery more effective. Physical therapy before joint replacement surgery is called “prehab.”

Help for hurting muscles

What is Prehab?

During prehab, a physical therapist will evaluate your condition, which includes taking measurements like range of motion, strength, and flexibility.  They will teach you exercises to prepare your body so you can have the best improvements after surgery.  Research shows that preoperative range of motion predicts range of motion after surgery.  The more range of motion you have prior to surgery, the more you will have after surgery, which means walking and going up and down stairs will be easier.  You will also learn about arthritis and how to make lifestyle changes to continue to live a full and active life.  If there are any questions you have about recovery and the rehab process following replacement, a therapist can answer those questions during prehab.

Prehab Benefits

Benefits extend beyond just familiarizing yourself with your condition and learning exercise. The outcomes of surgery are improved in those who have had prehab. Patients who exercise prior to surgery have improved strength and functional mobility after joint replacement compared to patients who did not exercise before joint replacement.  Three months after total knee replacement, patients who received prehab have improved quality of life compared to those who did not. Prehab can even save you time and money.  In a 2014 study published in the Journal of Bone and Joint Surgery, patients that used even as little as 1-2 sessions of prehab saved 29% cost after knee replacement.

Though there seems to be such a benefit, prehab still isn’t standard care everywhere.  Luckily, at Touro Infirmary, we have a one-day prehab program that people attend prior to their joint replacement.  Our therapists describe the procedure and rehab, answer questions about recovery, and go over exercises that can be done in preparation for surgery.  If joint replacement is in your future, consider doing a few sessions of prehab at Touro’s Back In Action Center at least 4 weeks prior to surgery in order to prepare your body and joint for improved post-operative outcomes. Establishing care with one of Touro’s Back In Action Center therapists will make the transition after surgery go more smoothly. You will be familiar with the exercises, and the therapist will be familiar with your situation and your goals that you would like to achieve.  Just ask your physician to refer you to Touro’s Back In Action Center for prehab.

Patient after knee injury

Back in Action

Touro’s Back in Action Center provides comprehensive physical and occupational therapy services to adolescent, adult, and geriatric patients, as well as case management for patients with orthopedic diagnoses, therapeutic wellness and women’s health. Go to http://www.touro.com/rehab-backinaction to learn more.

1525 St. Charles Ave., New Orleans, LA 70130
Phone number: (504) 897-8157
Fax number: (504) 897-7041

BackInActionProgram@lcmchealth.org

Serpas-MoniqueMonique Serpas, PT, DPT, OCS is a physical therapist and board-certified Orthopaedic Clinical Specialist practicing at Touro Infirmary in New Orleans, LA. Monique realizes how difficult it can be to overcome an injury or manage a chronic condition and is focused on helping her clients achieve wellness through a physically active lifestyle. Monique treats orthopaedic, balance, and vestibular disorders using a combination of hands-on manual therapy, therapeutic exercise, and education. This enables patients to assist in their own recovery and injury prevention. Monique holds a Doctor of Physical Therapy from Concordia University Wisconsin (2008) and a Bachelor of Science in Kinesiology from Louisiana State University (2004). She is am a member of the American Physical Therapy Association (APTA), Louisiana Physical Therapy Association (LPTA), and the Orthopaedic and Neurology sections of the APTA.

Arthritis Myths

5 Arthritis Myths Busted

Monique Serpas, PT, DPT, OCS

NumbnessThere are many types of arthritic conditions, including rheumatoid arthritis, psoriatic arthritis and osteoarthritis to name a few.  The most common type, and the one most people refer to as “arthritis,” is osteoarthritis.  Osteoarthritis, also known as OA, is the most common form of arthritis, affecting more than 80% of people older than 75 years old.  50% of adults will develop painful arthritis in the knee.

Though arthritis is a common condition, there are a lot of misconceptions about it.  In my practice as a physical therapist, I spend a fair amount of time helping my patients dispel some of the myths about this condition. Here are a few of the most common myths that need to be busted.

1. Arthritis is a condition that only affects older adults.
Juvenile arthritis affects 300,000 children in the US.  People can develop “traumatic arthritis” after an accident or injury at any age.  Research has found that people who are obese or have certain occupations develop arthritis earlier. Though most of my patients that have arthritis are in their fifties or older, I do see patients with the above mentioned forms as well as other rheumatic diseases that develop early in life.

2. The best way to protect your joint’s cartilage is to rest more.
Research has actually found that being sedentary can cause cartilage to thin and become less resilient, tolerating less impact before damage. Weight bearing exercise helps to maintain bone health. Also, cartilage can maintain its health through weight bearing exercises, which squeezes nutrients through the tissue.

3. Running causes arthritis.
Many people believe “all that pounding on your joints” isn’t good for them.  There is no research that shows running to be a risk factor for developing arthritis. Considering how cartilage gets its nutrition and stays healthy, this may make sense, as running is a weight bearing exercise. Though runners aren’t at increased risk of developing arthritis, research has found an increased risk in soccer players and weight lifters.

4. Arthritis is genetic and there’s not much you can do for it.
Although research has found a genetic component to osteoarthritis, there are also lifestyle factors that can impact a person’s risk for developing the condition.  Smoking, sedentary lifestyle, obesity, and poor diet all play a role in increasing risk for developing arthritis.  These are all risk factors that you can control!

5. Exercise will make arthritis worse.
It makes sense that people with arthritis might think this, because exercise can be painful when you have arthritis.  Though it can be painful, exercise is the most effective way to manage arthritis without the side effects of medication.  Arthritis causes muscle wasting, making exercise even more important to maintain strength needed to do everyday tasks.  The key is to learn how to properly exercise in order to have the least amount of pain while reaping the exercise benefits of increased flexibility and strength.  Exercise in fact improves mobility needed for everyday tasks, for example, opening jars, getting out of a chair, or squatting to pick up things from the floor.

Physical therapist with patient

Back in Action

Unfortunately, there is not a cure for arthritis, but there are ways to manage the condition to live a full life.  The Back in Action (BIA) therapists are knowledgeable about arthritis and can teach you how to care for your joints. We design and instruct you in a customized exercise program. Our therapists are also trained to relieve your pain through the use of modalities and hands on techniques to improve joint and muscle mobility.

Touro’s Back in Action Center provides comprehensive physical and occupational therapy services to adolescent, adult, and geriatric patients, as well as case management for patients with orthopedic diagnoses, therapeutic wellness and women’s health. We offer aquatic therapy and have a large heated pool available for patients, including a lift chair for those who cannot easily negotiate the stairs to get into the pool. Patients can improve mobility, strength, and function during the healing process through an aquatic exercise program.

For more information, call Back in Action at (504) 897-8157 or email BackInActionProgram@lcmchealth.org.

Serpas-MoniqueMonique Serpas, PT, DPT, OCS is a physical therapist and board-certified Orthopaedic Clinical Specialist practicing at Touro Infirmary in New Orleans, LA. Monique realizes how difficult it can be to overcome an injury or manage a chronic condition and is focused on helping her clients achieve wellness through a physically active lifestyle. Monique treats orthopaedic, balance, and vestibular disorders using a combination of hands-on manual therapy, therapeutic exercise, and education. This enables patients to assist in their own recovery and injury prevention. Monique holds a Doctor of Physical Therapy from Concordia University Wisconsin (2008) and a Bachelor of Science in Kinesiology from Louisiana State University (2004). She is am a member of the American Physical Therapy Association (APTA), Louisiana Physical Therapy Association (LPTA), and the Orthopaedic and Neurology sections of the APTA.

Is that pain in your neck coming from a Smartphone?

“Text Neck” – what it is and what you can do to prevent it

Could I live without my smartphone?

Monique Serpas, PT, DPT, OCS

I personally use my phone several times a day, and way more than just for making and receiving calls.  It’s where I store my family’s calendar and grocery lists.  It’s my dashboard navigator, giving me turn-by-turn directions and alerting me to traffic.  I check the weather and news on it, send and reply to email, and take video and pictures of my two boys.
Continue reading

Rotator Cuff Tears can be Treated Effectively with Physical Therapy

Rotator Cuff Tears

Monique Serpas, PT, DPT, OCS

Rotator cuff tears can be common, affecting up to 40% of the population over 60 years old. For many the pain slowly begins without an apparent cause. A rotator cuff injury can be very painful, not to mention make simple tasks like putting on a shirt or picking up a gallon of milk very difficult.

Many have thought surgery was the only good option for treatment of rotator cuff tears.  Though research suggests up to as much as 75% of those with a large rotator cuff tear retear the muscle after surgical repair.  Research is showing that tears that are not related to a specific trauma, or “nontraumatic” rotator cuff tears can be treated effectively with physical therapy.

rotator-cuff-tear-image

What is the rotator cuff?

The rotator cuff is a group of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis.  The muscles form a cuff around the humerus (long bone of the arm) to keep the ball of your shoulder joint seated properly in the socket.   The muscles attach the shoulder blade to the humerus and act to elevate the arm and rotate it back and forth.

The rotator cuff maintains shoulder stability.  The main joint of the shoulder is shaped like a ball and socket. The socket is relatively small and shallow when compared with the ball end.  A good analogy is to picture how a golf ball sits on a tee.  The deltoid is a large and powerful muscle that pulls the arm up when you reach up above your head.  It pulls on the top of the “golf ball” in an upward direction.

Golf-ball-image

The rotator cuff muscles help to counteract the upward pull of the deltoid, by producing a force that pulls in the opposite direction.  The rotator cuff pulls on the “golf ball” on the side resting on the tee. This force keeps the ball in the socket, or the “golf ball” from rolling up and off the “tee.”

When the arm is raised and these forces are balanced, the golf ball rotates on the tee. When the deltoid pull is not balanced out by the pull of the rotator cuff, it rolls off the tee and can result in painful conditions.  It can cause impingement, rotator cuff disorders, and early shoulder joint degeneration.

Why Do Rotator Cuff Tears Develop?

People may develop rotator cuff tears because of:

  • poor posture
  • muscular weakness
  • joint stiffness

All of these symptoms can be addressed in physical therapy with hands-on techniques as well as exercise.  In many cases, surgery can be avoided with good improvements in pain and shoulder motion.  If you have shoulder pain or have been diagnosed with a rotator cuff tear and would like to have physical therapy, call Touro’s Back In Action Center to schedule an appointment.

References

  1. Kukkonen et. Al. (2014). Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. Bone Joint J2014;96-B:75–81.
  2. Khair, M. M., & Gulotta, L. V. (2011). Treatment of irreparable rotator cuff tears.Current Reviews in Musculoskeletal Medicine4(4), 208–213. doi:10.1007/s12178-011-9098-3
  3. Kuhn, Dunn, Sanders, et al. (2013). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study.J Shoulder Elbow Surg. 2013 Oct;22(10):1371-9. doi: 10.1016/j.jse.2013.01.026. Epub 2013 Mar 27.

Serpas-MoniqueMonique Serpas, PT, DPT, OCS. is a physical therapist and board-certified Orthopaedic Clinical Specialist practicing at Touro Infirmary in New Orleans, LA. Monique realizes how difficult it can be to overcome an injury or manage a chronic condition and is focused on helping her clients achieve wellness through a physically active lifestyle. Monique treats orthopaedic, balance, and vestibular disorders using a combination of hands-on manual therapy, therapeutic exercise, and education. This enables patients to assist in their own recovery and injury prevention. Monique holds a Doctor of Physical Therapy from Concordia University Wisconsin (2008) and a Bachelor of Science in Kinesiology from Louisiana State University (2004). She is a member of the American Physical Therapy Association (APTA), Louisiana Physical Therapy Association (LPTA), and the Orthopaedic and Neurology sections of the APTA.

Brain Injury Awareness Month

Natalie Pilie, MPT

Traumatic brain injury is the leading cause of death and disability in children and adults from ages one to 44.  Traumatic Brain Injury (TBI) changes the way a person thinks, acts, feels, and moves the body. Brain injury can permanently or temporarily change the complex functions of the body.

Each year, an estimated 2.4 million children and adults in the U.S. sustain a TBI – resulting in 52,000 deaths each year. Another 795,000 individuals sustain an acquired brain injury from non-traumatic causes. Currently more than 5.3 million children and adults in the U.S. live with a lifelong disability as a result of TBI. The leading causes of TBI are: falls, motor vehicle-traffic crashes, struck by/against events, and assaults.

464446298

Trauma can happen in a fraction of a second and your life can be drastically changed forever.  A brain injury is devastating and the degree of recovery is never certain.  A brain injury affects each person’s body differently.   Injury to the brain may result in changes in behavior, varying levels of consciousness as well as one’s ability to remember. An individual’s ability to speak, reason, and make good judgment can also be compromised. Each of one’s senses may be altered after an injury to one’s brain.  Caring for a person with a traumatic brain injury requires a highly specialized medical team as well as patient, caring loved ones to aid in their recovery.

Caring for a person with a brain injury can be one of the most challenging situations.  However, helping a person to return to work, go to college, play with their kids again or walk their daughter down the aisle makes all the rehabilitation processes gratifying. A strong team approach is required when working with someone with a brain injury.  The team may consist of: physicians, nurses, physical therapists, occupational therapists, speech language pathologists, neuropsychologists, therapeutic recreational therapists, rehab counselors, case managers, dieticians and respiratory therapists.

A brain injury not only affects the person, but everyone in their family and their community.   Life is turned upside down, daily routines are altered and every ounce of energy is directed towards the patient and their recovery.  A brain injury is a lifelong disease process; therefore, family members are encouraged to participate throughout the rehabilitation process in order to gain an understanding of the injury.  They must learn how to assist their loved one in order to further maximize their potential.

Learning of the resources that are available to the patient and their family will also aide in the recovery process.

Always remember, the brain is remarkable and as professionals who have the special responsibility of assisting our patients back to function; we are constantly astonished and amazed by what our patients are able to achieve.

Brain Injury Rehab at Touro

The Touro Rehabilitation Center is a CARF accredited facility with specialized rehabilitation services for brain injury.  We improve the quality of life for adolescents and adults by enhancing function, increasing independence and facilitating community re-entry.

> Click here to learn more.
Click here to visit Touro’s online health library for more about rehabilitation for brain injury.

Pilie,NatalieNatalie Pilie, MPT, graduated from the University of New Orleans with a Bachelor of Science degree in Exercise Physiology, Human Performance and Health Promotion. In 2007 she graduated from Louisiana State University Health Science Center with a Masters in Physical Therapy. She began her career as a Physical Therapist in 2007 at Touro’s Rehab Center. In 2009, she was promoted to Brain Injury Program Supervisor. She is a member of the Brain Injury Association of Louisiana and the American Physical Therapy Association.

Start Moving and Stay Moving with Arthritis

Monique Serpas, PT, DPT, OCS

As a physical therapist, I see a fair amount of people with arthritis, particularly osteoarthritis. Osteoarthritis is a condition in which the healthy space in a joint diminishes. The cartilage, a natural shock absorber, has torn or thinned, and the joint becomes stiff and achy. Most people with arthritis have a hard time moving because of this stiffness and pain, and although people with arthritis tend to avoid moving due to the pain, movement is exactly what their achy joints need!

joggersInactivity is a risk factor for developing arthritis. Why is inactivity so bad for arthritis? Doesn’t less movement mean less “wear and tear?” In reality, inactivity causes cartilage to get thin and weak, increasing its risk of tearing and reducing its ability to be a natural shock absorber. Cartilage actually gets its nutrition from the pressure caused by weight-bearing activities. Arthritis causes movement to hurt, but movement is what actually will restore motion to the joint and help to prevent further deterioration to the joint’s cartilage. Movement is like the oil can for the tin man. It gets our joints’ natural lubricants moving and circulating. It helps to keep our cartilage healthy. Also, staying active keeps our muscles stronger so that they are supporting and stabilizing our joints as they should and helping to absorb shock so that our cartilage doesn’t take a beating. Objects at rest, tend to stay at rest. Bodies in motion tend to stay in motion. If you’re a physics geek, you’d know that Newton described this in his first law of motion, and I think it applies to arthritis as well. People who have arthritis and are inactive, tend to stay inactive. If you want to get moving and stay moving, start moving!

There are some simple things you can do to prevent and manage arthritis. Move the joints and stretch periodically during the day. Exercise. It doesn’t have to be anything too crazy or complicated. Simply, just start walking more. You can get a pedometer to keep track of how many steps you take in a day. If you’re healthy, shoot for 10,000 steps a day, however, research suggests that as little as 6,000 steps a day can reduce disability related to knee arthritis.1 This amounts to about an hour of walking, though it varies depending on your height and step length.2 The walking doesn’t have to be continuous either. It can be spread out over the course of the day. With a little extra walking here and there, you’ll be at 6,000 steps before you know it.

Although walking is a good start, in order to have a complete plan for preventing or managing arthritis, you should also incorporate strengthening and stretching. It’s a good rule to strengthen all of the muscles surrounding a joint to keep it supported and protected. When stretching, follow this same rule, or for a good whole body stretch, try yoga.

If you have arthritis or think you have arthritis, ask your doctor about physical therapy. A physical therapist will be able to give you a customized exercise plan to address a loss of strength, flexibility, or joint range of motion. Physical therapists also utilize hands-on techniques to improve the glide of the joint, to loosen the muscles around the joint, and to help manage the pain. Physical therapy can help you preserve your ability to function independently and to continue doing the things you love, all with less pain.

Monique Serpas, PT, DPT, OCS. is a physical therapist and board-certified Orthopaedic Clinical Specialist practicing at Touro Infirmary in New Orleans, LA. Monique realizes how difficult it can be to overcome an injury or manage a chronic condition and is focused on helping her clients achieve wellness through a physically active lifestyle. Monique treats orthopaedic, balance, and vestibular disorders using a combination of hands-on manual therapy, therapeutic exercise, and education. This enables patients to assist in their own recovery and injury prevention. Monique holds a Doctor of Physical Therapy from Concordia University Wisconsin (2008) and a Bachelor of Science in Kinesiology from Louisiana State University (2004). She is a member of the American Physical Therapy Association (APTA), Louisiana Physical Therapy Association (LPTA), and the Orthopaedic and Neurology sections of the APTA.

References
1 Daniel K. White, Catrine Tudor-Locke, Yuqing Zhang, Roger Fielding, Michael LaValley, David T. Felson, K. Douglas Gross, Michael C. Nevitt, Cora E. Lewis, James Torner, Tuhina Neogi. Daily walking and the risk of incident functional limitation in knee OA: An observational study. Arthritis Care & Research, 2014; DOI: 10.1002/acr.22362
2 Tudor-Locke C, Craig CL, Aoyagi Y, et al. How many steps/day are enough? For older adults and special populations. The International Journal of Behavioral Nutrition and Physical Activity 2011;8:80. doi:10.1186/1479-5868-8-80.