Meet Ann Hightower

Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Ann Hightower, Vice President of Internal Operations, and hear her story of her time with Tx:Team!


Falls Prevention Week

Each September, we recognize Falls Prevention Week to raise awareness of the impact of falls. The good news is that most falls are preventable.  Tx:Team’s Teaming Up Against Falls Program incorporates the components of the Otago Exercise Program including balance, strength, flexibility, vestibular, and proprioception evaluation and treatment to tackle balance issues and help prevent falls.

According to

  • Falls are the leading cause of injuries in older adults. One out of five falls result in a significant injury such as broken bones or a head injury.
  • Each year, three million older adults go to the emergency room because of falls. Over 800,000 need to go into the hospital.
  • Older women are twice as likely to fall and break a bone as older men. Men have a higher risk of dying after a fall. 


What can I do to decrease my risk of falling?

  • 75% of falls occur in the home. You can decrease your chance of falling by keeping your home safe for you to move around.
  • Make sure you have good lighting in every room. Include night lights in your bedroom, hallways, and bathrooms.
  • Rugs should be firmly fastened to the ground, especially at the corners. Electrical cords should be kept off the walking areas.
  • Add handrails to your bathrooms for support for your bath, shower, and toilet use.
  • Always use the rails on stairs on both sides and ensure that each stair is well lit or has a visual cue.
  • Wear shoes with firm, nonskid, non-friction soles. Avoid wearing loose slippers that could cause you to trip.
  • Keep kitchen items within easy reach to avoid using step stools.
  • Place the bed at a proper height to allow for feet to be flat on floor while sitting at bedside.

Taking good care of your body will also keep you strong, mobile, and more independent.

  • See your eye doctor once a year.
  • Care for your feet and see a doctor if you have pain or corns.
  • Use assistive devices if they are recommended to you.
  • Sit on the bed for a few minutes before getting up to go to the bathroom at night. This will prevent dizziness in the dark.

If you notice that you may have some trouble with your balance or mobility in general, talk to a physical therapist and find out how they can help you to stay on your feet and prevent falls.

You Take that First Step and OUCH

You get out of bed and go to take that first step. OUCH! 

A sharp pain hits your foot. You limp a few steps but before you are out the door, the pain is gone. After sitting at work for a couple hours, you get up for another cup of coffee and the pain returns. 

It’s possible you are dealing with plantar fasciitis.

But what exactly is plantar fasciitis and what can we do about it? 

The suffix -itis indicates inflammation. Plantar fasciitis is inflammation of the plantar fascia. This leads to the next question, what is the plantar fascia? Plantar is the bottom side of the foot and fascia is a thin casing of connective tissue. Putting those two together, the plantar fascia is a band of connective tissue that runs from your heel to your toes, and it helps support the arch of your foot, stability of the foot, and is involved with normalized foot mechanics. Unfortunately, through a series of microtears from overstress and over stretch, the fascia can get inflamed and plantar fasciitis occurs.

Why exactly does plantar fasciitis occur is a great question. There are a few common risk factors to look at first. Generally, it will occur in people 40-70 years old. Activities such as running and dancing can increase the risk of developing plantar fasciitis. Occupations that keep you on your feet also increase the risk for developing it. People who are overweight or obese place more stress on their feet and this can cause plantar fasciitis. Lastly, if you have abnormal foot posture or walking pattern, e.g. flat feet, high arches, this can increase risk as well.

Now what to do about it? 

  • It is important to keep your calves loose. When the calf muscles become tight, they will pull up on the achilles, which pulls up on the heel, which stresses the plantar fascia.
  • Improving the strength of the arches of the feet can also reduce stress placed on the plantar fascia.
  • Stretching your big toe backward (toward the top of your foot) can provide an excellent stretch on the plantar fascia and rolling your foot on a lacrosse ball is another great option.
  • Orthotics can also help to normalize your foot if you have high arches or flat feet, thus reducing the stress on the plantar fascia.

Although plantar fasciitis can be a painful way to start the day, it is certainly treatable through a variety of stretches, exercises, and lifestyle modifications. If you feel you are suffering from plantar fasciitis, make an appointment with your local Physical Therapist and get back on your feet and  walking pain free.

Alex Strahle, PT, DPT, CSCS graduated from the University of Evansville with a Bachelor of Science in Exercise Science and a Doctor of Physical Therapy.  He is currently a Physical Therapist in the Employer-Based Clinic setting for Tx:Team.  Alex enjoys seeing patients return to an active lifestyle after treatment for their pain and dysfunction.

August is Spinal Muscular Atrophy Awareness Month

August is Spinal Muscular Atrophy Awareness Month!

Spinal Muscular Atrophy (SMA) is a hereditary neurodegenerative disorder that negatively affects the motor control of 1/10000 people across the lifespan depending on type with which diagnosed. A decline in muscle strength is common affecting an individual’s ability to contribute and participate in society, increasing their economic burden, and in extreme cases, results in death. Hospitalization costs an average of 100k annually for these individuals. Therapy can help reduce hospitalizations, burden on caregivers, and provide education on how to manage this progressive chronic condition to improve these outcomes.

How Physical Therapy Can Help

Physical therapists screen for neuromuscular delays while monitoring gross motor developmental milestones as part of their SMA assessment. They reduce fall risk by slowing the decline of range of motion, endurance, and strength to maintain and possibly increase mobility (walking, standing, sitting etc.) through therapeutic exercise and neuromuscular electrical stimulation. Seating/mobility device and orthotics recommendations may be made. Preventing the worsening of scoliosis may be included in treatment.

How Speech Therapy Can Help

Speech therapists screen for oral/laryngeal/pharyngeal motor delays as part of their typical assessment. Communication devices and vital stim to aid in breathing and swallowing function may be recommended to aid the individual with SMA in returning to social and mealtime participation.

How Occupational Therapy Can Help

Occupational therapy can assist people with SMA in becoming more independent in their daily activities, including with basic self-care, work, or hobby pursuits through the use of therapeutic activities. A screening for fine motor and self-care developmental milestones is part of the typical assessment for SMA. Home and lifestyle modifications, adaptive equipment and assistive technology recommendations, energy conservation strategies, and basic mental health care may be provided.

Therapy has been associated with reduced anxiety/depression and increased hopefulness for the future. Early intervention and collaboration with physicians is the key to comprehensive care. Help facilitate access to therapy services for individuals you may know with SMA today!

Alita Borkar MA, OTR/L, CPAM is an Occupational Therapist in the outpatient setting.  Alita believes everyone deserves access to therapy services that improve the ability to live a happy, meaningful, and productive life.  She believes in ethical, evidence based, high quality services and is passionate about developing evidence based programs, advocacy, and mentoring students for effective family services.



Ch’ng, G.S., Koh, K., Ahmad-Annuar, A. et al. A mixed method study on the impact of living with spinal muscular atrophy in Malaysia from patients’ and caregivers’ perspectives. Orphanet J Rare Dis 17, 200 (2022).
“Cure SMA, Novartis Publish Economic Burden of SMA Analysis in Journal of Market Access & Health Policy – Cure SMA.” Cure SMA, 20 Dec. 2020. Accessed 26 July 2023.
“List of Treatments for Spinal Muscular Atrophy.” MySMAteam, 2023.
“Spinal Muscular Atrophy (SMA) | CDC.”, 20 Dec. 2021.

Ask an Expert: I Was Diagnosed with Moderate Hip Arthritis, Can PT Help?

I recently got diagnosed with moderate hip arthritis, but the Doctor does not recommend a hip replacement yet. Can Physical Therapy help?  

Physical therapy is a form of treatment that helps to alleviate pain and improve movement in those who have mild to moderate hip arthritis. It is a non-invasive and drug-free approach that can be very effective in managing the symptoms of this and other arthritic conditions.  Physical therapists are trained to work with people who have arthritis and can develop a personalized plan of care to help alleviate your pain and improve your mobility. They may use a combination of techniques, such as exercises, stretches, and hands-on therapy, to help you regain strength and flexibility in your hip joint.

Exercises are an important part of physical therapy for hip arthritis. Your therapist may prescribe exercises that are specifically designed to help improve the strength and flexibility of the muscles around your hip joint. These exercises may include range of motion exercises, leg strengthening exercises and balance exercises.  Stretching is also an important component of physical therapy for hip arthritis. Stretching can help to increase the flexibility and range of motion in the hip joint, which can help to reduce pain and improve your ability to move around.  Hands-on therapy, such as massage and manual therapy, can also be used to help alleviate pain and improve mobility in people with hip arthritis.

Physical therapy can also help you learn how to move and do everyday activities in a way that puts less stress on your hip joint. This can help you to reduce your risk of injury and further damage to your hip joint.   It is important to note that physical therapy can be an effective treatment option for hip arthritis, but it is not a cure. However, it can help to alleviate symptoms, improve mobility, and reduce the risk of further injury. It is always best to consult with a physical therapist to discuss if physical therapy is right for you.

Jeremy Dunker, PT, DPT, OCS

Get In Tune with Dementia

The National Institutes of Health (NIH) defines dementia as the loss of cognitive functioning — thinking, remembering, and reasoning to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living. It affects millions of people, and while more prevalent as people age, it is not a normal part of aging. It is caused by damage to brain cells, which in turn interferes with the ability of brain cells to communicate with each other affecting an individual’s thinking, behavior, and feelings.

My background in Sensory Processing gained from my pediatric days taught me not to forgo looking at dementia with a sensory lens, often there are changes with sensory processing that arise along with the other symptoms. From a sensory perspective, the brain will seek out what it needs, but not always appropriately. One aspect of the Sensory Integration approach is finding ways to provide the individual with what their brain/body is seeking, while at the same time training them to seek this input in an appropriate and safe manner. Developing a keen awareness of patterns in behavior is important in determining if these behaviors are of a sensory processing nature or simply a method to garner attention behaviorally. Being in tune with the various senses of the body including vestibular and proprioception (which I refer to as the grounding sense) are important in helping individuals to better modulate their sensory system.

Finding the reason for a behavior can promote increased safety and quality of life for the individual. Knowledge of how the sensory system works along with observation of how an individual interacts can provide valuable feedback about a given behavior, and by asking simple questions we can better understand and provide appropriate recommendations based off the information about how a person is processing sensory input.

For example: Are they having a tough time sitting still? Do they pace? Are they clumsy? Do they crave touch? Do they avoid touch, textures, or busy/noisy places? Do they hum? Do they bang their hands on hard surfaces?

I could spend all day talking about various tools and interventions utilizing a sensory processing approach, but the tool I wish to spotlight is music.

Music and Dementia

Music has the ability to break through cognitive barriers, where memories are locked away and thought to be forgotten and evoke feelings of comfort and happiness from an earlier time or event in the life of an individual.

Music and memories have a special connection with Dementia. Often, when all else fails, music prevails! It’s a beautiful thing to witness when someone who can no longer walk or engage in the most basic activity, listens to a song, and instantly lights up and starts singing, often verbatim the lyrics of a beloved song. For a moment in time, gone is that person who sits and stares into space, and we are privileged to catch a glimpse of the true person hidden behind a locked door that is called Dementia. Music is powerful and is invaluable to our therapy toolbox! It can help increase attention, improve cadence in walking, calm anxiety, and it can even brighten up even the worst of moods!

I’ve acquired quite the eclectic playlist over the years in working with seniors: hymns, Mozart, jazz, classic country, 1940s war songs, swing, Elvis and even some Beatles, but no matter what style of music, the common thread is that they were each a key that unlocked a door of hidden, once forgotten memories that lead to happiness!

“Oh, simple thing, where have you gone? I’m getting old and I need something to rely on…so tell me when you’re gonna let me in, I’m getting tired and I need somewhere to begin…and if you have a minute, why don’t we go? Talk about it somewhere only we know, this could be the end of everything. So why don’t we go? Somewhere only we know?” –Keane

I was listening to the lyrics of the song above one day, and the beauty of the words brought tears to eyes, as I was reminded of the sweet memories of time spent with my grandfather, who was diagnosed with early onset Alzheimer’s when I was a young girl. I can still recall his contagious smile, his quiet sense of humor, and his love for roasted peanuts. I also remember knowing a moment in time when something shifted abruptly. Gone was his smile to be replaced with eyes that reflected confusion rather than recognition. Suddenly I was not allowed to see him as often, I was told he was sick and needed rest, but I know now this was said to protect not just him but me from the things I was too young to understand. Dementia is not for the faint of heart. The song, “Somewhere Only We Know” may mean something different to others, but for me, it is a haunting reminder of what life is like for those living with dementia. I believe that if they could express what it’s like, it would sound quite like the lyrics above.

If I could give any advice on their behalf, it would be this: slow down, embrace the moment, find joy in the simple things together. Be present with them, listen to them, even if it doesn’t make sense, and smile often. Doing so gives them purpose and helps them feel needed. Isn’t that what we all long for?

Hope is the byproduct of compassion and quality care. By giving just the right amount of challenge to meet each individual where they are, we give them the chance to live a life of joy and purpose even in the later stages of the disease. We set them up for success by familiarizing ourselves with resources and utilizing tools such as the Tx:Team Living Well with Dementia program, which is designed to provide therapists with the necessary tools needed in determining the stage the individual is performing at and further aid in providing staff/caregivers the best methods for intervention and communication with the individual at their level.

In the end, those with dementia will not remember that they have it, but they will remember how we made them feel in the moment. So, smile, have fun, and in the words of Bing Crosby, “Accentuate the positive, eliminate the negative, and don’t mess with Mr. In-Between.”


Rebecca, “Christon” Cardell, MHS, OTR/L received her Bachelor of Science in Occupational Therapy in 2004 and her Master of Health Science Degree in 2005 from the Medical College of Georgia.  Christon has experience working in both the pediatric and geriatric settings. Since her early years as an OT student, Christon has been interested in pursuing more knowledge in the area of Sensory Integration and Processing. She is so excited to see that this area is starting to become more widely used as a treatment approach not only with pediatrics but in the adult population as well.  Christon is a certified provider of “The Listening Program” and has been utilizing this therapeutic technique in some of her treatment plans with great success. She has been a champion for the Tx:Team Living Well with Dementia Program.

Meet Mike Holway

Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Mike Holway, Director of Senior Living, and hear his story of his time with Tx:Team!

Is Aquatic Therapy Right For Your Patient?

Physical therapy, historically, has been helping people since the early 1900s. However, the healing benefits of water for the human body date back to ancient Greek and Roman times. After battle, warriors and gladiators would soak in hot springs because they realized they were able to recover faster and get back to battle.

Fast forward, as physical therapists our number one job today is getting patients back to their previous level of function, or ‘back to war!’ We have learned what the ancients already knew, that water has many therapeutic properties including buoyancy, resistance, pressure, and warmer temperatures. These properties allow the patient to exercise with less impact to improve skills at all functional levels:

  • Strength: water is natural resistance, movement patterns allow gentle exercise with buoyancy to allow for improved tolerance to strength exercises.
  • Flexibility: warm water increases tissue temperatures to generate a comfortable environment for mobility exercises and improved range of motion.
  • Endurance: water is denser then air, therefore it is harder to do exercises in water than on land. This can be a stepping-stone to improve tolerance for activity on land.

Aquatic therapy has many benefits for the patient following injury as compared to a traditional land setting by removing gravity. Acute sprains, strains, and fractures with decreased weight baring are great candidates for the pool. Patients can benefit from aquatic therapy or land therapy individually.  They can also benefit from a combination of land and water therapy working together. The plan of care may look different for each patient. Some patients need one visit of land with one visit of aquatics each week, or half the session on land for manual therapy and half on water in the same day for exercises. Patients with poor tolerance to exercises due to chronic pain conditions may thrive in the water to build confidence to perform functional skills on land including; osteoporosis, arthritis, fibro myalgia, and balance disorders.

Aquatic therapy is a modality to aid the therapist in their quest for helping our patients get better faster, and back to their lives…or war!


Meagan Gearhart, PTA, is a Physical Therapist Assistant treating in the outpatient setting.  She has extensive experience in not only aquatics but also in orthopedics, post-surgical and non-surgical diagnoses, and a variety of conditions pertaining to musculoskeletal conditions and injuries.

Tx:Team Company Culture

Tx:Team prides itself on the culture displayed at every level of the company’s infrastructure. Culture has been and will continue to be the driving force behind creating an environment that allows for success over the course of four decades. “From my standpoint, it’s about creating collegiality,” said Scott Benedict, CEO of Tx:Team. “It’s about creating an environment where people truly enjoy doing what they’re doing.” 

In a recent release of Work Wellbeing data from Indeed, Tx:Team scored 84/100. one of the higher rankings among the top therapy providers. Data was driven by surveys on key topics such as Work/Life Balance, Compensation/Benefits, Job Security/Advancement, Management, and Culture. 

“My first job was in a very large corporate environment, and it was somewhat cutthroat,” said Benedict. “It was competitive. And it was very ‘me centric me first.’ You just didn’t have that feeling that we were all pushing or pulling in the same direction and trying to accomplish a shared vision and a shared goal.” 

While culture is emphasized in a variety of businesses, it’s naturally more tangible in the health care sector.  “We’re in the people business,” said Carroll Nelligan, COO of Tx:Team. “Culture is everything. It’s the foundation of what we believe in and it’s those beliefs in action. It’s something that’s embodied every day by all of our people and how we deliver the best therapy product possible.” 

Tx:Team’s core values include integrity, camaraderie, vision, responsiveness, resilience, teamwork, flexibility, and continuous learning. These values are consistently referred to as the guiding principals behind day-to-day decisions. “You have to be able to look at our values, which are up on the wall, and say, ‘yes, I can see those being lived out every day,’” said Benedict. 

“All of our values are really important, but I believe that teamwork is our most important and it’s in our name,” said Nelligan. “I came from a background that looked at people’s unique perspectives as disciplines, OT, PT and speech, and how we could work together to have our own unique perspective on how patients achieve their goals. Teamwork is everything to our company.” 

Understanding the impact of company culture is paramount to the success of the company, the well-being of our employees, and a key component of Tx:Team that won’t change. 

Sam Benedict is a Tx:Team Intern from Wabash College. Going into his junior year, he holds executive positions in his fraternity, is the Editor in-Chief of the college newspaper, The Bachelor, and is both a Class Representative within the student senate and the chairman of the campus Student Events Committee. After college, Sam plans to either pursue law school or a career in business. 

Tennis Elbow? Golfer’s Elbow? I Don’t Play Sports!

My doctor diagnosed me with tennis elbow and/or golfer’s elbow, but I don’t play those sports. How is that possible? 

Tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) are two common injuries associated with the elbow. They are both caused by playing sports or doing repetitive motions (gripping, pulling, grasping, and lifting) with the affected arm. Some common functional activities that could cause these injuries include tennis, golfing, painting, throwing a ball, and heavy lifting.

Over time, these repetitive motions will cause wear and tear of the tendons at the elbow and place strain on the muscles.

What are symptoms that someone may experience that would trigger the problem being tennis elbow? 

With both lateral and medial epicondylitis, the primary symptom is pain at either the lateral or medial elbow. Other common symptoms can include tenderness with palpation to either the forearm extensor or flexor muscle units, aching elbow in the evening, and elbow stiffness in the morning. Sensation deficits are not associated with either of these injuries and is an entirely different injury.

How are these injuries treated?  

A majority of these injuries are treated conservatively. Doctors can prescribe an anti-inflammatory medication along with a steroid injection to the painful area(s). Doctors can also refer a patient to see an occupational or physical therapist to have symptoms addressed.

An occupational therapist or a physical therapist will work with each patient to develop a personalized treatment plan that includes:

  • stretching
  • manual therapy techniques
  • education
  • home exercises
  • activity modification
  • strength training
  • custom orthosis

Are there risk factors for one person to get more than another?

Yes, there are certain activities that can exacerbate symptoms. Those activities include anything that leads to overuse of the forearm extensor and flexors (heavy repetition, poor posture, forceful grasp, etc.).

The incidence for lateral and medial epicondylitis is greatest between 35-55 years old (men and women are affected equally). If an individual is younger than 35 and experiencing symptoms, a screen should be completed for additional causes.

Can you prevent tennis elbow or golfer’s elbow?

There is no way to prevent lateral or medial epicondylitis, but there are ways to decrease your chances of having this injury. Those ways include having proper posture, avoiding repetitive motions, avoiding forceful grasping.

If you suspect Tennis Elbow, Golfer’s Elbow or any problem with your arm, find a Physical or Occupational Therapist in your area to start the program you need to get back to the activities you enjoy.


Joshua Eppinger, MOT, OTR/L received his Bachelor of Arts in Human Performance & Health and his Master of Occupational Therapy from West Virginia University.  Joshua’s professional interests are Orthopedics and Hand Therapy. He has experience and training in the evaluation and treatment of post-surgical and non-surgical diagnoses. Josh’s experience includes a variety of conditions pertaining to the hand and upper extremities including  fractures, dislocations, sprains, torn ligaments, Tennis Elbow, Golfer’s Elbow, as well as multiple other diagnoses of the hand, wrist, arm, and shoulder.