Info on Bed Bugs

**I just recieved these resources to increase awareness and knowledge on bed bugs (Unfortunately a problem many of our clients face in the ADCs). Feel free to share with ADC staff and patients! The below info is copied directly from the Hopkins email I received from Johns Hopkins Hospital. **

Bed Bug Information

What are bed bugs?

Bed bugs (Cimex lectularius) are small, flat, parasitic insects that feed solely on the blood of people and animals while they sleep. Bed bugs are reddish-brown in color, wingless, range from 1mm to 7mm (roughly the size of Lincoln’s head on a penny), and can live several months without a blood meal.

Where are bed bugs found?

Bed bug infestations usually occur around or near the areas where people sleep. These areas include apartments, shelters, rooming houses, hotels, cruise ships, buses, trains, and dorm rooms. They hide during the day in places such as seams of mattresses, box springs, bed frames, headboards, dresser tables, inside cracks or crevices, behind wallpaper, or any other clutter or objects around a bed. Bed bugs have been shown to be able to travel over 100 feet in a night but tend to live within 8 feet of where people sleep.

Do bed bugs spread disease?

Bed bugs should not be considered as a medical or public health hazard. Bed bugs are not known to spread disease. Bed bugs can be an annoyance because their presence may cause itching and loss of sleep. Sometimes the itching can lead to excessive scratching that can sometimes increase the chance of a secondary skin infection.

What health risks do bed bugs pose?

A bed bug bite affects each person differently. Bite responses can range from an absence of any physical signs of the bite, to a small bite mark, to a serious allergic reaction. Bed bugs are not considered to be dangerous; however, an allergic reaction to several bites may need medical attention.

What are the signs and symptoms of a bed bug infestation?

One of the easiest ways to identify a bed bug infestation is by the tell-tale bite marks on the face, neck, arms, hands, or any other body parts while sleeping. However, these bite marks may take as long as 14 days to develop in some people so it is important to look for other clues when determining if bed bugs have infested an area. These signs include:

·       the bed bugs’ exoskeletons after molting

·       bed bugs in the fold of mattresses and sheets

·       rusty–colored blood spots due to their blood-filled fecal material that they excrete on the mattress or nearby furniture, and a sweet musty odor.

How do I know if I’ve been bitten by a bed bug?

It is hard to tell if you’ve been bitten by a bed bug unless you find bed bugs or signs of infestation. When bed bugs bite, they inject an anesthetic and an anticoagulant that prevents a person from realizing they are being bitten. Most people do not realize they have been bitten until bite marks appear anywhere from one to several days after the initial bite. The bite marks are similar to that of a mosquito or a flea -- a slightly swollen and red area that may itch and be irritating. The bite marks may be random or appear in a straight line. Other symptoms of bed bug bites include insomnia, anxiety, and skin problems that arise from profuse scratching of the bites.

Because bed bug bites affect everyone differently, some people may have no reaction and will not develop bite marks or any other visible signs of being bitten. Other people may be allergic to the bed bugs and can react adversely to the bites. These allergic symptoms can include enlarged bite marks, painful swellings at the bite site, and, on rare occasions, anaphylaxis.

How did I get bed bugs?

Bed bugs are experts at hiding. Their slim flat bodies allow them to fit into the smallest of spaces and stay there for long periods of time, even without a blood meal. Bed bugs are usually transported from place to place as people travel. The bed bugs travel in the seams and folds of luggage, overnight bags, folded clothes, bedding, furniture, and anywhere else where they can hide. Most people do not realize they are transporting stow-away bed bugs as they travel from location to location, infecting areas as they travel.

How are bed bugs treated and prevented?

Bed bug bites usually do not pose a serious medical threat. The best way to treat a bite is to avoid scratching the area and apply antiseptic creams or lotions and take an antihistamine. Bed bug infestations are commonly treated by insecticide spraying.

Tenant and Homeowner
Bed Bugs Baltimore Resources

Bed bug control problems that have been spreading through Baltimore and other major cities. In Baltimore, the number of bed bug related 311 calls grew from an average of 0.16 per month in 2004 to 8.5 per month in 2008. The increase in calls has precipitated the government response indicated below.

Government Resources

If you have a Bed Bugs Baltimore problem, and live in the City of Baltimore, dial the free 311 service. The Baltimore City Health Department will send an inspector as part of their "Healthy Homes" initiative. This service is FREE and will confirm that you in fact have a bed bug problem. They will also provide advice on how to get rid of bed bugs in your home. Renters of single family homes are responsible for the bed bugs and should call 311 for help.

If you live in an apartment, contact the building's landlord in writing. They have an obligation to treat for bedbugs.

Often bed bugs are brought into an apartment building by visitors or when a used mattress or furniture is picked up from the street. Even rented furniture has been known to carry some risk or a new mattress that arrived on a truck that is also transporting older mattresses. Bed bugs do not appear because a person has clutter or isn't clean. They either travel from an adjoining apartment, or are carried into a household.

The Maryland Attorney Generals office has a hot line for Landlord and Tenant rights issues. The hot line number is toll-free (800) 487-6007.

You can also review the Baltimore City Health Department Bed bugs Baltimore information website (http://health.baltimorecity.gov/node/2026).

Bed Bug Advice for Baltimore Tenants - What to do

If you cannot afford Bed Bugs Baltimore treatment, and if you are a tenant that has requested bed bug treatment in writing (must be in a dated later sent registered mail), and have not gotten a bed bug inspection or treatment, we suggest:

1.     Calling the above Attorney General’s office number for help and advice. If you are still not satisfied then...

2.     Contact the firm described below (Whitney & Boris) to see if they will handle your case on contingency, which means that they will get a percentage of the settlement.

3.     As an alternative, if you are a low income resident. You can contact Maryland Legal aid for assistance at (410) 951-7777.

Do not navigate the law without the help of an attorney.

Bed Bug Advice for Baltimore Home Owners

The best approach is to call in an experienced bed bugs Baltimore based exterminator. Bed bug populations grow rapidly, and as they spread they could become more expensive to treat. We suggest starting by calling a national network such as Service Magic (1.877.233.1145). Members of the network are per-screened, licensed and insured.

So don't wait. We also have a list of pest control companies that are specifically qualified to treat bed bugs.

Go to http://www.bed-bugs-handbook.com/bed-bug-exterminator.html to find a qualified local bedbug exterminator near you. Please keep in mind that if the bed bugs are not treated correctly, insects missed will begin to multiply and the problem will return. Don't use a pest control company unless they have extensive experience treating bed bugs.

Tip: Be sure to ask about any costs, and ask if they provide a written guarantee as multiple treatments (2 to 3) are often needed.

Do It Yourself Treatment Advice

Some home owners prefer a do it yourself approach to bed bug treatment. This will work, although be prepared for some hard work.

Do it yourself kits are available that contain organic products (Bed Bug Patrol) or you can buy an insecticide based bed bug kit. The choice is a matter of preference. A kit is the best way to go as they provide the combination of products required to effectively end the infestation. No single spray alone will do the job. At minimum, be sure to purchase a knock down or contact spray which kills bed bugs on contact, and a residual spray that provides lasting protection. Kits also contain bed bug dust (also called diatomaceous earth or fossil dust) which is applied after spray treatment to provide another layer of protection.

It can take an entire day to do the job right. If bed bugs reappear after 2 to 3 treatments, consider hiring a professional. See the rest of this site for step by step directions on how to kill bedbugs.

Do not use foggers or bug bombs as these are not effective against bed bugs Baltimore problems. They just drive the bed bugs into the walls, only to have them return in 1 to 2 weeks.

http://www.bed-bugs-handbook.com/Bed-Bugs-Baltimore.html

Week 5 EBP article: E. Gaylor

A study published in 1983 in The American Journal of Occupational Therapy examined the effects of 5 different exercises on finger extension of CVA patients.  Ten post-CVA patients were recruited for the study from the outpatient population of Braintree Hospital, in Braintree, Massachusetts.  The five exercises that were used were resisted grasp, resisted extension, rapid extension, unresisted slow extension, and unresisted grasp/release.  Electromyography of the extrinsic finger muscles and electrogoniometry of the wrist and finger joints were used to measure motor unit recruitment and ROM. 

The results showed that resisted and rapid exercises recruited the highest percentages of output of the extensor digitorum, flexor digitorum profundus, and the flexor digitorum superficialis.  Slow, unresisted exercises preferentially recruited the extensor digitorum.  None of the exercises caused immediate significant changes in ROM flexor/extension balance, time required to open the hand, or level of activity of the extensor digitorum during the opening of the hand.  Resisted grasp did not limit finger extension. 

The original hypothesis that resisted extension would recruit the highest level of motor output of the extensor digitorum than any of the other exercises was not supported by the data.  Higher levels were seen during resisted grasp and rapid, unresisted extension.  The use of slow, unresisted extensor activity or release of large objects selectively recruited the extensor digitorum over the flexor muscles the most. 

                                                                                                                           

Trombly, C. A., & Quintana, L. A. (1983). The Effects of Exercise on Finger Extension of CVA Patients. American Journal of Occupational Therapy, 37(3), 195-202. doi:10.5014/ajot.37.3.195

Article

Week 4 Y. Wooten EBP Article

Gilmore, H. (2015). Chronic pain, activity restriction and flourishing mental health.  Health Reports, 26(1): 15-22.

       Studies of the past twenty years document the association between pain and depression.  Recent studies are now exploring the mediation factors that may explain this relationship such as age, intensity, and activity restriction. In this study the Activity Restriction (AR) model hypothesizes that pain intensity affects mental health by limiting activities of daily living (ADLs), work, leisure, and family roles. The study uses the Mental Health Continuum-Short Form (MHC-SF) to evaluate a sample 26,420 respondents from the Canadian Community Health Survey (CCHS) that report having chronic pain.  The MHC-SF consists of 14 questions that ask participants how they felt in terms of three factors: emotional, psychological, social well-being. Responses are given to one of five categories ranging “almost always” to “never”.

       Using this data as well as other information from the CCHS, the study concludes that participants with higher pain intensity are less likely to be in flourishing mental health than those with lower pain intensity.  Second greater pain intensity increases activity restriction.  This activity restriction mediates in large part the relationship between pain and mental health.  However, since age is also a mediator of pain intensity, further investigations are needed to determine whether it has more or less impact.  This is especially true for the older population.  Implications of this research call for an increase in occupational therapy (OT) practitioners.  OT practitioners are skilled in treating those patients with chronic pain conditions to participate in desire daily activities through rehabilitation, adaptations, and/or modifications.

Article

Week 4 EBP: Erin Gaylor

      A study published in the 2015 in Manual Therapy examined the effects of graded activity versus physiotherapy in patients with chronic low back pain in a randomized controlled trial.  66 patients with chronic nonspecific low back pain were recruited from Specialized Rehabilitation Services at Taboão de Serra in Sao Paulo, Brazil.  The participants were all between the ages of 10 to 65 years, and had a minimum pain intensity score of three in the 11-point Pain Numerical Rating Scale.  Before the intervention treatment, the patients were screened by a physiotherapist who assessed pain intensity and disability, along with secondary outcomes such as quality of pain, quality of life, global perceived effect, return to work, physical activity, physical capacity, and kinesiophobia. 

             For the intervention, the patients were randomized into either the Graded Activity Group or Physiotherapy Exercise Group.  Both groups went to hourly sessions twice a week for six weeks, for a total of 12 1-hour sessions.   The physiotherapy group performed stretching exercises that focused on the erector spinae, hamstrings, and triceps surae as well as strengthening exercises focusing on the rectus abdominus, abdominus obliques internus, and abdominus obliques externus.   They also performed motor control exercises focusing on the TrA and lumbar multifidus muscles. 

            The Graded Activity Group followed a program that consisted of individual sessions of progressive and sub-maximal exercises that aim to improve physical fitness and stimulate changes in behavior and attitude.  They performed aerobic training on a treadmill and lower limb and trunk strengthening exercises.  The patients also selected one or two activities that they considered difficult and received guidance on these throughout the treatment.  They also received an educational booklet with information on how to take care of the spine. 

            The results showed significant improvements in all outcome measures of both groups, with a non-significant difference between the groups. This study provided evidence that both graded activity and physiotherapy were effective for patients with chronic nonspecific low back pain.

Article

Week 3 Y. Wooten EBP Article

Alajbegovic, A., Alajbegovic, S., Djelilovic-Vranic, J., Nskicevic, A., Todorovic, L. (2014). Post stroke depression. Medical Archives; 68(1): 47-50 

Post stroke depression is one of the most frequent and important psychiatric consequence of stroke.  It has been shown to effect cognitive function, functional recovery and survival.  This study investigated prevalence of this depression after different types of strokes as well as gender, age, and severity comparisons.  This study included 210 stroke patients who were followed through the acute phase (first 2 weeks) of the disease.  Patients were equal numbers of male and female. All patients were evaluated using the Beck Depression Inventory which contains 21 items rated on 4 point scale.  Results show that post stroke depression was significantly more common in women than men. It was also more prevalent among younger patients (52-60) and patients experiencing a more severe stroke. Finally this study also found that post stroke depression was more frequent in patients with stroke legions in the left hemisphere of the brain.  However insufficient evidence is available to determine whether LCVA increases the risk for post stroke depression.  Past research has been contradicting in terms of lesion location. Some of this research wasn't clear as to phase post stroke or whether patients have experience single stroke versus recurring stroke or have had past history of depression.

It is important for clinicians to understand this condition for stroke patients.  Post stroke depression has been shown to have adverse effects on the rehabilitation process. It can also increase fatigue, a major symptom of both stroke and depression which can make it difficult for patients to participate in therapy session.  This suggests that occupational therapy practitioners should put great focus on increasing of ADL and functional independence when treating stroke patients which may help to combat their depression.

Article

Suliman Week 1 EBP: Low vs. Medium Frequency Electrical Currents

This is Sam's week one EBP: Low vs. Medium Electrical Currents in the context of short vs. long term pain reduction. I've noted a trend between the students with the unanimous interest in physical agent modalities, so perhaps we should set up some time to really go over all of the modalities!

Now, here's Sam:
The article reviewed: Application of Low Frequency and Medium Frequency Currents in the Management of Acute and Chronic Pain-A Narrative Review focused on the pain management physical modality of TENS treatment. TENS which stands for transcutaneous electrical nerve stimulation is a physical modality which uses electrical pulses to relieve pain. The concept of electrical pulses to relieve pain is a fairly dated concept which dates as far back as 2500 B.C. There have been cave drawings depicting species of catfish with organs producing electrical charges to treat pain. (S.Samuels, 2015). Electrical impulses or TENS units work in reference to pain management by inhibiting pain-related potentials acting like as a gate control for nerve synapses. Low frequency currents or LF TENS takes longer to achieve relief in pain whereas HF TENS or high frequency currents relieves pain more quick but loses that effect more rapidly than LF TENS. This article supports the use of TENS in treating chronic, neuropathic, fibromyalgia, as well as musculoskeletal pain, as more than adequate. In fact, this study recommended TENS be used as a primary treatment for pain relief.

Thanks, Sam!

Suliman Week 2 EBP: Dry Needling and Adhesive Capsulitis

Hey guys! This is Sam's second week article about Dry Needling and Adhesive Capsulitis - he has seen me do quite a bit of needling in the pain management environment, which has been an excellent way to demonstrate many clinical aspects of anatomy, muscle pathology and how muscle pain can (and usually is) a primary limitor of ADL function. He had asked me a question about the current literature on frozen shoulder treatment in regards to multiple modalities based upon this article, which I was very pleased with! He, along with the other students, appear to be very interested in the physical agent and manual therapy side of OT (which makes me personally very happy). This is his summary on his recent find:

Sam:

As I continue my fieldwork and develop better understandings of treatment, one treatment in particular has stuck out. I was unaware largely of the treatment option and effects behind dry needling but was assured by patients of how helpful dry needling has been for them. The article reviewed is based from a view point of dry needling as a primary modality for adhesive capsulitis, better known as frozen shoulder. There are too many factors that can lead to frozen shoulder to pinpoint a singular cause but in general, frozen shoulder occurs from lack of use of the shoulder. In general, this lack of use comes primarily from pain, injury, or physiological ailments such as diabetes. These physical and physiological ailments can lead to stiffness of the glenohumeral joint which is termed frozen shoulder. It is recommended that stretching as well as heat modalities be used to loosen the joint and if results are not achieved, move to surgery. I was interested in this article to find other options to resolve frozen shoulder other than surgery. Dry needling is where that inquisition leads me. In this article, dry needling was used as a primary modality to relieve the symptoms of frozen shoulder. Since currently majority of occupational therapist cannot achieve licensure to needle, I was interested to find out if this option was viable to achieve greater range of motion to assist patients in ADLS/IADLS as it relates. This article concluded that dry needling was a useful option and viable modality to be used to achieve greater range of motion for frozen shoulder. 

Thanks, Sam!

References:

TREATMENT OF NONSPECIFIC THORACIC SPINE PAIN WITH TRIGGER POINT DRY NEEDLING AND INTRAMUSCULAR ELECTRICAL STIMULATION: A CASE SERIES

Jodie M. Rock, Charles E. Rainey. Int J Sports Phys Ther. 2014 October; 9(5): 699–711. PMCID: PMC4196334

Trigger point dry needling as an adjunct treatment for a patient with adhesive capsulitis of the shoulder. Derek Clewley, Timothy W. Flynn, Shane Koppenhaver, J Orthop Sports Phys Ther. 2014 February; 44(2): 92–101. Published online 2013 November 21. doi: 10.2519/jospt.2014.4915