Gladys Libbey, 89, slowly lifted her right arm above her head and planted the palm of her hand on the white wall. Gradually, she moved the hand from right to left, as her intern therapist, Don Zoucha, watched carefully. Libbey repeated the maneuver with the left hand.
Then, with a 3-pound weight strapped around her right hand, Libbey bent over and dangled her arm. Zoucha, holding her shoulder, gently moved the arm in a circular motion. Old age has weakened Libbey's muscles and inflamed her shoulder capsules.
"I'm rotating her arms to loosen up the joints," Zoucha said.
"Good job," he said. "Let's see you reach."
As if on cue, Libbey quickly hoisted both arms in the air, cracking a wide smile at her accomplishment.
"She's made a lot of progress," Zoucha said, surrounded by a team of therapists at the rehabilitation clinic. "A few weeks ago, she could barely lift her arms."
The clinic is operated by Florida Sunshine Rehabilitation, a St. Petersburg-based company that owns more than 100 rehab centers in Florida, Georgia and Texas.
Florida Sunshine expanded into Hernando two years ago, operating its clinic out of the Brooksville Heights assisted-living facility on Howell Avenue in Brooksville. Although the businesses are not related, most of the clinic's patients live at Brooksville Heights.
The growth in Hernando's health-care market in the last decade has spawned more than half a dozen rehab services in the county. Nationwide, such services are growing in response to an aging population, the desire of the elderly to stay home rather than live in an institution, and the health-care industry's push toward preventive medicine.
Florida Sunshine's clinic, which consists of two rooms in the basement of Brooksville Heights, provides occupational, speech and physical therapy to about 30 patients a day. Most treatments are paid for by Medicare, the federal insurance program for the elderly, and supplemental insurance.
Some need help with basic functions, like washing and going to the bathroom. Others, like Libbey, need to strengthen leg and arm muscles weakened from old age or a sedentary lifestyle. Still others are recuperating from orthopedic surgery.
Among the exercise devices: a giant peanut-shaped plastic ball used to improve balance, parallel bars, weights, splints, adaptive equipment and a machine called Isotron III, which uses electrical impulses to stimulate muscles.
"We teach people to live independently," said Karen Mosley, an occupational therapist who is one of eight staff members at the clinic.
Through regular therapy, patients can prevent serious health problems from developing _ problems that can lead to surgery, hospital stays or nursing home care.
"We're shifting the model away from curative to preventive (medicine)," said clinic coordinator and physical therapist Ken Wrench. "Instead of waiting for someone to become injured and then treating them, we're actually trying to discover the root cause" of the injury.
Most of Florida Sunshine's clinics are located in assisted-living facilities so that patients, many of them wheelchair-bound, do not have to worry about transportation to and from sessions.
Florida Sunshine opened the Brooksville clinic because of Brooksville Heights' need for such services, and the county's high concentration of retirees, said John R. Christison, Florida Sunshine's regional administrator.
The company, which last year added almost 80 clinics and now employs 500 people, is negotiating to open a similar clinic at the Heritage, an assisted-living facility on Grove Road west of Brooksville, Christison said.
"The demand for the services in the community has been overwhelming," Christison said. "All of a sudden a light went on, and somebody said, "Hey, why aren't we doing this?' I think it's something where we've literally found a niche in our industry."
At the end of her 10-minute exercise routine, Libbey summed up her feelings about the therapy.
"I'm still alive," she said, grinning and stretching her arms. "I feel kind of accelerated. This is helping me a lot."