Presented By: CDR Michael LaPlante PT, DSC, ECS Physical Rehabilitation Director Tuba City Regional Health Care Corporation

 The evolution of health care provided by the Indian Health Service.  Understand the basic framework of a rehab/wellness program.  Introduction of outcome measures documenting possible impact of program.

 Currently, the incidence rate of diabetes continues to rise, as does the rate for obesity.  Higher numbers of children at ever-younger ages are being diagnosed with Type II diabetes.  Native American four year olds are twice as likely to suffer from obesity compared to their non-Hispanic white peers.

 During the date range for data collection in the Rehab/Wellness program, the incidence rate for Diabetes rose to a total of 16.5% of all the Native American population, compared to a level of 12% in  Comparatively, the incidence rate for the overall American population in 2007 was 7.8%.  Neel (1962) proposed the "thrifty" genotype model to explain why diabetes mellitus occurs at such high rates in some populations.

 During the date range for data collection, from June 2007 to June 2009, there was a 28% increase in the incidence rate of obesity among the Native Americans in our service area.

 Medications  Counseling  Dietary Education  Exercise Recommendations

 Rehab/Wellness could be called ‘DPP Light’, which has as a primary goal manageable lifestyle change.  Successful goal setting can be moderate weight loss and decreased percent body fat.  Successful goal setting can also include prevention of weight gain and stable body fat – for certain ‘age and weight’ patient groups.

 Available for those having the risk of, and the diagnosis of, Diabetes.  Patient receives a full musculoskeletal examination by a physical therapist.  Therapeutic exercise program is introduced to patient which helps meet their functional and measurable goals, and addresses weaknesses and accommodative requirements.

 If patients can see the changes in their body, they can appreciate the positive impact it has on their lives.

 Time Period Data Collected: 2 Years  N = 43  Mean Weight Change: -4.1lbs  Change in Percent Body Fat: -1.1%

 A place to ‘graduate’ high-level patients who are quite independent but will benefit from continued intervention.  Don’t wince – Chronic Pain  Provides a option for pain management that can reduce the amount and strength of pain meds needed by patients on a daily basis.

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