StudentPT

Worth Sharing!

2009-12-09T20:34:00.001-05:00

I feel that posting this may violate some of the mentioned issues, oh well :)
Be careful in this ever changing world in which we live in. I certainly thank Dr. Rutledge and Mr. Hua for this service:

Here is an important message from our legal department to tell you about new federal regulations that went into effect this month. We want to help you understand how these new regulations could affect you as a blogger on health topics.

“We are writing to let you know about revised Guidelines issued by the Federal Trade Commission (FTC) on October 5, 2009 relating to endorsement and testimonial advertising. These new Guidelines go into effect on December 1, and reflect the FTC’s interpretation with respect to federal law relating to advertising. These new Guidelines specifically apply to bloggers and could impose liability on bloggers for endorsements or testimonials.

The revised Guidelines state that:

· The Guidelines apply to Bloggers and online word-of-mouth marketers and require them to disclose any material connection to a company when reviewing the company’s products or services (failure to disclose any payment or receipt of free product from an advertiser or someone acting on their behalf could expose you to liability);

· Both advertisers and endorsers can be liable for false or unsubstantiated claims made in an endorsement (if you were given a product for free or were paid to write a review, then the claims you make about the product must be accurate and substantiated);

· Advertisements containing consumer endorsements, or testimonials, must disclose what results a reasonable consumer could expect from the product and can no longer rely on a disclaimer that “results may vary”;

The complete revised Guidelines can be found at http://ftc.gov/os/2009/10/091005revisedendorsementguides.pdf. The FTC has also posted several short videos explaining the Guidelines at http://www.ftc.gov/multimedia/video/business/endorsement-guides.shtm.

It is Wellsphere’s policy that bloggers disclose publicly any interest that they have in any topic that they write about. Transparency is critical to your credibility with your readers and to your relationship with Wellsphere. In addition, you must be careful to confirm the accuracy of any statements that you make about a product or service that you are writing about and are responsible for what you write. Please understand that Wellsphere takes compliance with its policies and these Guidelines very seriously and failure to comply may result in the termination of your relationship with Wellsphere. I am happy to answer any questions you have and work with you to address any concerns.”

Have a wonderful day!

Good Health,
Geoff
--
Geoffrey Rutledge, MD PhD and David Hua
http://www.wellsphere.com

Day 4 of 4

2008-06-29T05:36:00.000-05:00

way too early on a sunday morning, nonetheless, I'm excited to finish up this course. That is not to say I want it to end, but rather I am looking forward to completing the intake of all of the information. Is it just me or am I especially long-winded on minimized sleep?

The instructor has been fabulous, completely engaging and obviously well-versed in the science of healing and her own unique art form of caring. Plus I always love those down south (Georgia) accents/attitudes/idioms ('The dog won't hunt' ain't exactly a Brooklyn thing).

The flow of the course has been great. From concepts to practice as it should be and we finished off last night with a thrillingly entertaining workout session - the idea was to spread this out to our patients. I may just have to take a few more courses with these people :)

Last Post

2008-05-22T13:27:00.000-05:00

http://www.NewProfessionalPT.blogspot.com

Brooklyn Half

2008-05-09T10:02:00.002-05:00

Last Saturday I ran the farthest and fastest I have ever run in my life. Running a race is something I had been talking about for a long while, and boom here I finally decided to do it. I joined NYRR last year in hopes of getting into the NYC Marathon (which I would have trained for real hard), alas the lottery did not smile upon me, so perhaps this year I will try again. There are a number of ways to qualify for the NYC Mar. none of which I met, yet.

But I have been receiving e-mails from NYRR and saw one about the Brooklyn-Half Marathon and saw it was right in my neck of the woods, I just decided to sign up. Up to that point I had been running intermittently on top of my weight training, probably no more than 2 miles at a time. As a soon to be PT I would not have recommended that I run in this event without proper training. After signing up, I began to run with a little more zeal and got in a few 5-7 mile runs. I was able to recruit one of my old high school football buddies to run - Dan has been training to become a fireman and thus has been running a lot, (spoiler alert!) so it's o.k. that he beat me by 5 whole minutes. His goal was 1:45, mine was anywhere from 2-2:15.

The night before I did manage to carb load with a big bowl of whole wheat pasta. On race day I didn't even eat breakfast, but my fireman buddy hooked me up with half an orange and the ever-important band-aids over the nipples, crucial.

As the race began on the boardwalk of Coney Island I tried to keep pace with fireman Dan. Navigating through the thousands of runners at a decent pace was the second greatest challenge of the race (the first being fighting fatigue of course toward the end secondary to my lack of training). At mile 3 right as we got off the boardwalk I was starting to lose ground with my pace rabbit. First I yelled out for him to "slow down!" which he did not, to which I yelled out "I will catch you if it's the last thing I do," to which an older lady yelled back in quality Brooklyn fashion: "It probably will be."

The running route itself is set up very well; after the 3 miles on the boardwalk you begin a long straight away up the gut of Brooklyn. I ran by fireman Dan's brother and cousin to ask how far ahead he was and they told me only about a half block up, so I felt alright with that. It was fun because I was able to try to latch on to someone just ahead of me and try to catch them, have small races which kept me going throughout. A little kid yelled "It's Superman!" (I was wearing my Super PT shirt, seen in my blog profile to the right or below), which gave me an extra little boost. As I kept going I stopped at each water station and did walk a little to enjoy the gatorade, which slowed my pace a little I am sure; I was able to maintain an 8:00 pace for most of the race, however toward the end I slowed down and finished with an 8:26 pace.

As I got more and more tired my PT mind set kicked in a little and I started to think about each muscle movement. I felt my hip flexor, especially in my R leg getting tighter and tighter. I actually at one point did a little lateral shuffle in each direction and backpedal to try to clear the constant repetitive forward running motion, which just made sense at the time and did in fact make me feel a little better. As I pressed on getting passed by people of all sizes and experience levels I wished that I had trained a little more. there were some very short people and females passing me by, which can be a little embarrassing, but I did not mind because I know how much they must have trained while I relied on my natural athletic ability (I hope that doesn't sound too chauvinistic, haha).

It was passed on to me later that at about mile 10, entering THE PARK, a 3-year old child was yelling for everyone to STOP, and his mother said "No, sweetheart you want them to keep going." Quality moment.

I kept stopping at each water station to reflect while I enjoyed the cool refreshing drink, whereas my buddy Dan told me he did not stop for water once (possible 5 minute difference there). I began running alongside a good looking young lady whose name was Amy and works in fashion and was originally from Texas, she was running with a group of red shirts with a foot print on the back. She had fallen behind during the start by literally falling down before the starting line because of the mad rush of people on the boardwalk. As we ran and her pace pushed me she regaled me with her past running experiences, having run the NYC Marathon twice, once being sick and the other time injured and not training properly. That conversation lasted close to 1.5 miles, maybe even 2, until we got to that next dreaded water station where I felt the need to stop and walk with my water, despite my pride I told her to go on without me. I had a pleasant walk for close to 100 yards it felt down to the traffic light after the water station, trying to stay out of everyones way.

I felt rejuvenated as I got to the traffic light and took off for the finish line, hoping there would be no more water stations to distract me. There were some wicked hills in the park but I felt strongest going up hill. I ran by a few people on the floor from exhaustion, and yelled to the EMS there was someone puking about 100 yards back around the bend, but they did nothing, sad moment. As a former EMT and a medical volunteer for the last two NYC Marathons it was a shame how that EMS'r did not respond to me, but maybe he took off after I had continued running. I wish I could have stopped to help that poor gentleman on the floor but alas, I did not... I knew (or at least thought) he could better be taken care of by the volunteers on hand and I had to try to catch Dan.

Coming around one of the last bends at about mile 12.2 I saw one of my professors which gave me an added boost, always great seeing people you know along the path to glory... As I was coming up on mile 13 (the full distance is 13.1 miles - which slipped my buddy Dan, who sprinted to mile 13 but then was tired for the extra tenth of a mile) I too decided to sprint ahead (when I actually got to the 13 mile marker). At about 13.05 I felt my legs giving out from the sprinting that I had not prepared them properly for, but I sprinted on, yelling like a madman and bypassing everyone else just cruising into the finish line and that brings us to the picture below and the official scoring time was different from that displayed in the picture, mine was 1:50:30 which I am pleased with for my first ever race of that length. In fact the only other race I had ever run previously was a 5K turkey trot which I finished in 24 minutes and did on a complete whim with zero preparation.

Afterwards I had a few blisters only on my R foot which is going to require future investigation since I plan on continuing to train and run. I still have to give many amazing kudos to Stanley Paris for what he is attempting to accomplish. We did have a problem finding Dan's father after the race, so if you ever run one, make sure you work out an ideal meeting situation.

That's my recap, hope to see you out there running the next one with me!

Update

2008-05-05T09:35:00.004-05:00

Got a few post ideas floating around, still trying to get settled back into a NY groove... for now enjoy this news story that goes right to the heart of "You got drugs, you got surgery, you got us":

Commonly Used Medications Associated With Impaired Physical Function In Older Adults

from ScienceDaily: Latest Science News

Older adults who take drugs designed to block the neurotransmitter acetylcholine -- including common medications for incontinence, high blood pressure and allergies -- are more likely to be dependent in one or more activities of daily living and to walk slower, according to new findings from researchers at Wake Forest University School of Medicine and colleagues.

Of course this could have some impact on that:

One In Four Disabled Seniors Use Risky Or Ineffective Medicines, USA

from Rehabilitation News From Medical News Today

Roughly a quarter of Americans with disabilities age 65 and older reported using at least one prescription drug deemed inappropriate for persons his or her age, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. Only about half as many (13 percent) of elderly people without disabilities used inappropriate drugs, according to the analysis of 2004 data. Thirty-three medications are regarded as inappropriate for people 65 and older.

Tumors

2008-05-01T18:52:00.000-05:00

May 4-10 is brain tumor action week. Checkout this video I put together with the help of some of my brain tumor friends. Please pass this on to your contacts and ask them to pass it on to their contacts… and so on... Please help us spread awareness about brain tumors. People need to notice! All it costs you is a few minutes out of your day.

http://www.youtube.com/watch?v=YRTQGYiQPJI

TUMORS SUCK! Pass it on!

--
Eric Anthony Galvez DPT CSCS
Author of REVERSAL
www.ericgalvezdpt.com
Executive Director of mAss Kickers LLC
www.masskickers.com
ericgalvezdpt@gmail.com

Aggressive Rehab for SCI

2008-04-30T06:21:00.002-05:00

http://www.sci-therapies.info/Rehabilitation.htm

could be my laziest post yet... yay

2008-04-28T01:03:00.002-05:00

This was an amazing experience to be a part of.

NY to Philly Bloggin'

2008-04-27T10:06:00.001-05:00

Tomorrow begins my last week of clinical affiliation and boy am I excited. Even though I am very much just starting to get into a good groove here, it is time to move forward and culminate the 3 year doctorate program. Many choices as a New Professional: where to work, should I enter a residency program, what other areas will I spend my time on, how the heck will I pay back all these loans, are you gonna eat the rest of that? I will have about until the beginning of July to develop more definitive answers as that is when I take my licensure exam. One of my first ways to celebrate the end of this program will be to run the Brooklyn Half-Marathon with one of my high school football buddies, and I have to be honest in saying I have not prepared the way I should so I don't expect a record time, although since this is my first 'real' race it will be a record for me as long as I finish, which I am at least confident in that. And while this does not even come close to comparing to something like what Stanley Paris is doing (attempting to become the oldest person to swim the English channel - made more impressive by the fact he DOES NOT USE HIS ARMS), I think this run will help get me motivated for future athletic accomplishments. Gonna end here to avoid the chance of losing yet another post on my phone... have a great sunday!

Valid Effort from SA-APTA

2008-04-17T05:14:00.001-05:00

How can we make things better? By asking questions... following e-mail received from the APTA Student Assembly President Nate Thomas... TAKE THE SURVEY IF YOU QUALIFY!:

Greetings from your Student Assembly Board of Directors.

On behalf of the Board of Directors and Nominating Committee, I want to invite you to participate in our Student Membership Survey. It has been developed by students… for students. Our hopes are that the data collected from this online survey will better enable us and the rest of the APTA to serve the unique needs and wants of our generation.

We encourage you to be open and insightful on all questions. Your responses will remain completely anonymous. We believe your honesty will be directly effective at setting the course for how we will operate in the future as a Student Board.

As important as each student member’s answers are, it is also just as crucial that we are able to distribute this survey to non-members in order to hear their issues and ideas for increasing APTA student membership. We are challenging all of you, as student members and appointed liaisons, to disseminate the link of this survey website to all of your classmates, especially non-members.

It is time that we unite our voices to be heard as students. You play an important role in making sure this happens. In a sense, “help us help you.”

Please recruit as many fellow students as you can to participate in this 10-15 minute survey.

The direct survey website is http://vovici.com/l.dll/JGs7261A5C8B5lKDx9U716581J.htm.

A survey link can also be found on the APTA student page at http://www.aptastudent.org. Simply direct students here and tell them to click on the survey logo. (You need not be a student to access the link.)

Thank you all for taking the time to help with this endeavor. Your efforts definitely will not go unnoticed. There truly has never been a better or more exciting time to be a physical therapy student. Let’s keep the momentum going!

Sincerely,
Nate Thomas
APTA Student Assembly President
aptasa_president@hotmail.com

Meat & Potatoes

2008-04-17T03:48:00.002-05:00

I have veered a little from the original intent of this site, which was to share my experiences as a student. It is often easier to simply share interesting news stories, and I plead guilty.

So as of this morning, I have two weeks left of any kind of actual school where I get graded for my performance. This is pretty darn exciting. I will have my doctorate within a month.

At this point of transition it is great to have options. The field is very open and jobs are available left and right all across the land. Which makes it that much easier for me to find an ideal setting. It is my desire at this time to apply for an orthopedic residency to continue my education while gaining "real-world" experience (whatever that is). More on the residency in a later post (when I get my stuff together for application).

So here is the time line:

Today is April 17
April 18 - Clinic
April 19 - Clinic
weekend will include baby showers and participation in a brain imaging study
week 10 of 11 will include my return to school on Wednesday for Discovery Day to present my case study on talar AVN - and take a practice board exam all the while organizing our graduation plans.
week 11 of 11 will include presenting my inservice presentation on neural regeneration after SCI.
the end of week 10 includes two scheduled discharges out of the five main patients I have been seeing, which is exciting. I will miss all the patients and staff...
May 2 - board review day and more grad prep at school
May 3 - Brooklyn Half-marathon and celebration of a college roommates upcoming wedding up in CT
Study for boards and coach some football until May 15th when I graduate!
May 16 - in a wedding
next 6 weeks will be interesting as I have more weddings and baby showers to attend all the while studying for the boards and making sure I am ready, because it takes about 6 weeks after graduation for everything to get processed to allow one to take the board exam to become licensed as a PT.
the residency I want to be a part of starts in January
Job possibilities as I mentioned are vast and I will have to balance them all out to find the best fit
At some point I have to figure out what to do with this blog since I wont be a student anymore (whimper)... perhaps a new professional blog is in order... yea that sounds right...

Health Tip of the Day - Pain in Side

2008-04-15T22:10:00.000-05:00

The appendix is a tube-like organ, with no known purpose, attached to the large intestine. Appendicitis describes when the appendix becomes inflamed, making it prone to rupturing, which is a serious medical emergency.

You should seek medical attention at once if you have symptoms in the following list, provided by the U.S. National Digestive Diseases Information Clearinghouse.

Abdominal pain, particularly pain that starts around the belly button and moves to the lower right side.
Lack of appetite.
Nausea or vomiting.
Diarrhea, constipation or difficulty passing gas.
Low fever that begins after other symptoms start.
Swelling in the abdomen.

Loans

2008-04-12T09:07:00.003-05:00

Fewer options open to pay for costs of college.

Not a good sign for future students, so plan accordingly.
Other than those fortunate enough to receive scholarships, loans are generally the way of the PT student. It is an unfortunate issue that I don't even want to get too deep into, just read the link, get back to me, we can then discuss :-D

Marketing

2008-04-10T20:55:00.002-05:00

Always fascinated by interdisciplinary issues, especially when they are shared... one such issue is apparently marketing.

Here the generalists find it to be a problem.

I won't even link to a specific EIM post, because this is always being brought up over there.

And DB's Medical Rants also covered a topic I wanted to get a little more into: balance.

Balance is such a difficult thing to achieve as DB referred to the balance of personal and professional life; there is also physiological balance which is generally the beginning of any class I have ever sat in regarding physiology: homeostasis. The balance of challenging a patient/client, not doing enough, and going too far or overtraining. The balance of being professional and friendly. Finding that balance is an amazing feeling, losing it stinks... being a student is great because I still have a few weeks to try to correct these balances... after that student status is gone hopefully what balance I have achieved will remain.

Links

2008-04-09T18:31:00.002-05:00

New strength training advice for kids

Interesting post and comment about the relationship between nursing and PT in hospitals. Interdisciplinary care is an amazing aspect of health care that can certainly use a little more attention to bridge a number of gaps and make everyones jobs easier and ultimately improve patient outcomes!

More benefits shown for tart cherries... worth checking out because they are delicious.

Amazing anatomy tattoos.

Wheelchair skills program in Canada.

Exercise During Pregnancy Leads To A Healthier Heart In Moms- And Babies-to-be

Sugar-powered Cars: World's Most Efficient Method To Produce Hydrogen Developed

CPR Standards

2008-03-30T10:56:00.003-05:00

As a former EMT and a proponent for everyone in the world being CPR certified, this recent article caught my attention. You may have even become certified in CPR or First Aid but the standards are beginning to shift more focus on the chest compression:

As described by Bobrow et al, MICR calls for an initial 200 uninterrupted chest compressions over two minutes, followed by a rhythm analysis and, if necessary, a single defibrillator shock, "immediately followed by 200 postshock chest compressions before any pulse check or rhythm reanalysis." Three sequences of 200 chest compressions are required before the victim can be intubated.

Learn CPR in 3 easy steps (the website on this link is not enough instruction, you should take the class to experience and practice the technique with trained professionals). It really is simple and should not be something you are overwhelmed with, and should be worth the investment to learn it as you can save the lives of your loved ones. Don't forget the AED certification too.

There are a number of organizations that offer this life saving instruction, but these 2 are the most reputable:

American Red Cross

Together We Prepare

American Heart Association

Addendum article

Drugs, Surgery, PT

2008-03-29T14:45:00.002-05:00

In the continued debate between these three options for numerous diagnoses, here's a real basic article about drugs with some startling numbers, especially the amount of deaths caused by acetaminophen (1393 from 1998-2005). More and more keeps coming out, so keep on reading.

Physician shortage? Turn to PT's

2008-03-29T12:56:00.003-05:00

Recently there has been much talk in the health blogosphere about the shortage of primary care physicians.

Is there a primary care crisis?

The trends from recent years largely held true in different specialties. Highly competitive programs such as plastic surgery and dermatology filled all of their slots, mostly with U.S. medical grads. Less competitive programs — largely those oriented toward primary care — relied more heavily on graduates of foreign programs and had some unfilled slots.

Unless the best and brightest physicians can master all possible diagnoses, and there are enough of them to cover all patients, you will always need to have some system of filtering and referral.

So if you want a guaranteed job go ahead and try to get into primary care... another option to help alleviate this problem in American health care is to start recognizing Physical Therapy as a qualified first line defense (direct access) for musculoskeletal issues, and recognizing the specialists within the field in their respective areas:

neurology
geriatrics
pediatrics
sports
orthopedics
cardiovascular/pulmonary
clinical electrophysiology
women's health

That referral system that will always need to be in place can (and is taught as such) that when red flags and yellow flags (precautions) are spotted, we as PT's will refer out to the appropriate specialty. PT's are now trained at a doctoral level, there are studies showing the cost-effectiveness of PT (read the comments too, well-summed up), and with the current healthcare crisis (and who knows what will happen in this election year), PT needs to be utilized to help improve the state of healthcare. That's where I stand.

And maybe even with the reduced load on physicians perhaps medical errors can be reduced.

Reimbursement 2

2008-03-25T18:33:00.002-05:00

As a follow up to my recent post on reimbursement, there is a new story of insurance companies providing reimbursement for online consultations... interesting that we still have all these battles in PT even with Medicare enforcing a cap on therapy... here's a quote that captures the situation and frustrations pretty well from this interesting conversation:

"Here in New Jersey our state chapter of APTA has over a number of years attempted to reason with the insurance industry which has only resulted in further diminishment in reimbursement and loss of coverage as evidenced by arbitrary caps, sky rocketing co-pays and unreasonable and capricious visit limitations based solely on the need of insurers and their intermediaries to bolster their bottom lines."

When will health care and insurance companies come to their senses on what they should spend their money on. Hint hint: Skilled PT services :-D

Another Wii Bites The Dust

2008-03-23T19:39:00.004-05:00

Dang it, another Wii article... problem is worth repeating: This is going to become attached to us...

Random person: oh, you are a PT, you have people play Wii to rehabilitate them, that's wonderful...

Not so much... why is it moments like this don't make news... PT is so much more than Wii, I should know based on the ridiculous amount of content I have to study for the licensure exam.

The new APTA marketing campaign can't come soon enough...

John Iams/CAM

2008-03-22T13:13:00.002-05:00

I wanted to publicly respond to an e-mail I received inquiring about my opinion of John Iams.

Here is YouTube video of Mr. Iams discussing the changing times. Other than the circles in which he talks, the most befuddling part of the video starts at about 4 minutes and 22 seconds when he begins discussing evidence-based practice. The problem with guru's such as Mr. Iams and their theoretical models that are not based on any true scientific basis is they want to write off EBP or ignore it. Upon reviewing his website (PRRT) I can only say I was less impressed the more I saw. While we do live in a capitalistic society, the whole money-back guarantee on your magical product.
Here on his "blog", he addresses the EBP issue and claims that this technique is too new to have evidence and "it has been clinically proven to frequently reduce pain by 50% or more, even on the first visit."

While I am in this profession for the patient, and believe any form of pain relief that can be long lasting is worth going through all sorts of unusual treatments, I ultimately have to share in the opinions of the EIM team. Here is another post and comments on the issue worth taking a look at. The idea of CAM will certainly be one of interest in the years to come, which is why EBP is that much more important to continue to improve upon.

In other news:
More support for exercise... as if we really needed it...

Another Wii Story

2008-03-22T08:23:00.003-05:00

The Wii story is in the last 3 or so minutes of this video. The most interesting part of that news piece for me was actually the USC PT introducing herself as Dr. (a whole 'nother bag of worms in PT). The Wii part of it is just another log on the fire that is the debate over "Wii-hab". The PT (and other health related) blogging community has a lot to say about it:

PT Rover

NPA Think Tank

MyPTSpace - EIM

Science to Life

Physio Info-blog - here is the journal article he is referring to.

Other Wii Articles:

Virtual gaming no replacement for real exercise!

Kevin MD - interesting comment on that one as to the OT vs. PT debate... I think we can certainly work together to be more productive, and I will leave it at that for now...

Speaking of OT - this OT student blog post has a Wii mention

A research team was able to extract rich information about a person's reaching movements while they performed a learning task using the Wii. Here is the actual journal article.

Use of Virtual Reality for burn victims.

Surgeons hone skills with Wii.

As a reminder I work with a Spinal Cord Injury population and we do in fact have a virtual reality room with Wii and an upper body ergometer that can be used to propel a virtual car and steer it left and right (although we had more problems with that one than actual play time). We also have recreational therapists on staff and most patients receive 2-30 minute sessions a week of recreational therapy, the TR's (because RT is reserved for respiratory therapist) also go on community outings along with the PT or OT. Through my observations the Wii along with dominoes, connect four and numerous other games are a large part of what the TR's work on.

Anyway, we have group activities every day as one of the three hours of therapy that all patients receive. I work with the action group which consists of patients that have a little more function than others, in particular almost all of our members can stand. We have a different topic every day and once every few Friday's we have "Fun Friday's" where we play some games (including the Wii). While we were playing we had the patients stand supported with a walker and a PT as needed. One particularly quiet patient was having a groggy day and in his complaints added: "he research has shown that the Wii helps people lose weight, I'm skinny, why am I doing this?"

There is a general image problem for PT in the public... how many people really know what we do? Now they start seeing news pieces with PT and the Wii... thats not why I spent 6 figures on 3 extra years of grad school and plan on doing an extra year long residency... PT is the neuromusculoskeletal specialists... we can do SOOOOO much to help peoples bodies feel better from SOOOOO many ailments, but the way PR has been working to date we are known for blackberry thumb, gardening tips, the Wii-hab craze and so much other niche areas that it is starting to get a little upsetting for someone like myself who has gone to schools to promote PT and physical activity to children. Oh brother...

Overall, I completely appreciate the psychological distraction the Wii can provide and the "break from the mundane" that some of the articles refer to (although, a better PT will never allow for a mundane routine). However, the Wii is very limiting in how much physical activity it allows and rarely is going to work on an area of weakness that translates into functional outcomes that are meaningful to a patient/client's activities of daily living. Speaking of which I am going for a run outside :-D

Wii Injury.com

Wii Have A Problem

Wii Injury Report

Reimbursement

2008-03-20T20:15:00.004-05:00

I haven't gotten too much into the entire headache that is reimbursement. I got into PT to treat patients. I chose this profession over most other medical professions because we get to really be one on one. So when we have trouble getting paid by insurance companies for our hard work, it seems a little ridiculous that the latest CPT (insurance) codes for:
"The addition of codes for telephone and online evaluations reflect a reality anticipated in the Future of Family Medicine report - one in which "interactions will not be limited to traditional, individual, face-to-face encounters between the patient and the family physician."

Don't physicians spend too little time with their patients already?
Five minute consultation?

While I love technology and I can see some (albeit minimal) value of this type of "evaluation", face to face treatment is irreplaceable as is the laying on of hands.

Sidenote: Does drinking make for better academia? (Say it ain't so)

Quick Post - No PT...

2008-03-17T21:56:00.002-05:00

Interesting article about HGH... good to see Evidence-Based Medicine getting out there.

Video of me playing paintball this weekend, fun stuff, amazing editing:

Prevention of Diabetes

2008-03-12T21:25:00.006-05:00

"Diabetes care is a poster child for much of what’s wrong with our health-care system, which is good at handling acute crises but bad at preventing them." This is the opening quote of an article about employers in 10 U.S. cities agreeing to waive copays for employees’ diabetes meds, and to fund regular meetings between pharmacists and diabetic employees.

"A similar project in Asheville, N.C., a few years back suggested that employers save money in the long run, because improving diabetics’ health on the front end cuts the rate of expensive hospital procedures that are more common when diabetes is poorly controlled."

Maybe this is just a smart business move by pharamcists in response to recent slowdown of drug sales:
plenty of familiar reasons for the slowdown:

“loss of exclusivity of branded medicines,
fewer new product approvals,
the leveling of year-over-year growth from the Medicare Part D program,
and the impact of safety issues.”

I am thrilled anytime there is a move toward preventive (as opposed to preventative) care . However, in these studies funded by BigPharma, there is clearly no mention of another preventive measure that could be more cost-effective and more efficient in helping fight and control diabetes... a little thing we call exercise... and who is good at dealing with disease and exercise... a little group of people we call physical therapists...

In fact the American Diabetes Association webpage on how to prevent or delay diabetes mentions nutrition and exercise and yet nothing about drugs...

For the record: This is not intended to bash the pharmaceutical profession by any means, just sharing some candor on some interesting articles from today.

Here's another possibly positive story about health care with this great quote at the end:
“It begins with the assumptions that prescribing is one of the most useful and challenging things we doctors do, and that we doctors crave accessible, unbiased data about the drugs we prescribe. If war is too important to be left to the generals, then drug information is too important to be left primarily to the pharmaceutical industry.”

Speaking of exercise I am off to get a late night run in at my 24 hour gym... catch you cats on the flip side... go prevent something bad from happening to you!

More Train Thoughts

2008-03-11T18:31:00.001-05:00

The ideal posture for reading would have your head in an upright position with your eyes aimed straight ahead. Our society has so many situations that almost encourage poor posture, getting into that hunched over look. Over time this is going to cause some musculoskeletal problems. Changing the length-tension relationships of a lot of muscles to a point where they become inefficient should not be ignored. Low back pain - a multi billion dollar problem annually - can be correlated to these poor postures (in theory - no links to any evidence as I'm phone blogging again). Speaking of phone blogging, I'm about to go underground and lose this post, so the message here is SIT UP STRAIGHT!!!

Where I Am

2008-03-11T18:31:00.000-05:00

Currently on the Amtrak train, taking a nice 3 hour trip back home for the first time since I started my last affiliation (It's been 3 full weeks and 2 days). My class is going back to school tomorrow for a board review and to take care of some graduation stuff (exciting).
I have to keep my post shorter (than usual) as I have lost many a deep thought when blogging on my phone.
I don't think that I have shared much about my current setting. I am treating an average of 5 patients per day (each for an hour) plus being involved in one group activity with numerous patients. The rest of the day goes to learning and documenting in as much detail as possible. This is quite a change from my last affiliation where it seemed like I was seeing 5 an hour. I would like to link to a recent post by the 'PT Rover' - another student PT blogger apparently in a very similar setting - who recently posted on a great experience he had with a spinal cord injured patient. I too get very empassioned hearing and now seeing these stories on a daily basis. Before my treo cuts me off I bid you all adieu.

"It's not work if you are having fun."

Yay OARSI

2008-03-05T08:27:00.002-05:00

Latest blog entry from the CAM Report: referral to a PT is one of the recommended strategies to treat OA of the hip and knee. Check out the press release from OARSI... there was no statistical difference between pharmacological and non-pharm. treatments.

Also, I want to agree with red rover's post on cigarettes... I try and step on all the lit buds I see people throw on the ground... here in Philadelphia almost everyone I see on the street is smoking... it's sad to see really with all the EVIDENCE of the horrors for your health.

Right now I am debating on an in-service topic for my last clinical affiliation. I am on a floor where we treat patients with Spinal Cord Injury. I am currently debating on doing an Evidence Based Review on SCI, a look into acute/emergency care and long-term effects (but this has low PT treatment implications), weaning off of a respiratory vent, or just about anything else that is SCI-PT treatment related. Let me know if you have any ideas. Thanks in advance!

Have a great day people...

PT Online

2008-03-02T13:27:00.003-05:00

Just wanted to do a quick roundup of all the useful PT sites I visit (along with some other good stuff)...

About PT
Physical Therapy site provides links, student information, exercises, and general information about physical therapy. It is updated very often with a lot of great general info.
APTA Message Board
A great way to communicate with other PT students around the country. This is way
underutilized so get on there and start chatting.

Blog.Evidence In Motion: Could be the best PT related site out there... Some great PT's talking about everything PT...
Evidence Based Rehab: Posts on physical therapy, health care, rehabilitation, health care politics, and any other subject that strikes me as interesting that day! He seems to have a few links to other PT blogs that I need to get to sooner or later...
MyPTSpace.coy: My Physical Therapy Space - from the Evidence In Motion guys - a great way to network and I recommend utilizing the message boards for great topics on your area of interest.
Myspace.com: Check out the "groups" section for more great networking opportunities. Unfortunately, these get a lot more traffic than the APTA message boards.; http://groups.myspace.com/physicaltherapy; http://groups.myspace.com/physicaltherapystudents

http://groups.myspace.com/PTnerds: Great thoughts, another site that does not get much traffic though...

NPA Think Tank: NPA Think Tank is a blog dedicated to critical observations of health, wellness, and the physical therapy profession.
NYPTA Student Resources: Many states have special interest groups for students that serve as yet another great networking opportunity along with many other potential benefits.
Orthopedic Physical Therapy: This blog is dedicated to the practice of orthopedic physical therapy. It is intended for licensed health care providers only. This blog is not intended for patients or consumers as a substitute for medical advice from a licensed health care provider.
Physical Therapy - Health/Fitness - AllExperts.com: I haven't spent much time on this site but it seems to generally be a way for people to ask questions and have them answered by a group of PT's.
Physical Therapy - The Web Space (Physiotherapy): Another site I don't spend much time on but seems to offer general PT related article links.
They had a link on this site to a new social network for PT's: http://physicaltherapy.ning.com/
Rehab News: The latest rehabilitation news headlines published daily
Sports Medicine News: The latest sports medicine, fitness news headlines published daily
Sports Physical Therapy Section: One of the many APTA sections that offers a ton of great resources from evidence based links to open discussions on focused topics or even special interest groups.
Training and Conditioning Magazine: Updates on some of the topics regarding well...training and conditioning.
UBC Physio Info-blog.: Unfortunately, the main author has just recently announced he will not be continuing his great work with this blog, but hopefully someone will pick up where he left off.
Physical Therapist Rover: Another student PT that has had a lot of very insightful posts in his short time as a blogger.

Physiospot Musculoskeletal: Assisting health practitioners with evidence based practice and continued professional development
PT Diagnosis: Use simple measurements to make better clinical decisions and demonstrate medical necessity for physical therapy.

Overwhelmed? Seem like a lot of information out there? There certainly is a lot... so whats a great way to keep up with it? RSS feed readers allow you to subscribe to many different sites and keep it all in one convenient location, plus they automatically update. I just started using Google Reader recently and have been enjoying the time it saves. There are a ton of different ways to organize all these sites, do what works best for you...

Here's some other cool stuff I check a little less often:

American Sports Medicine Institute: ASMI'S MISSION: To improve the understanding, prevention, and treatment of sports-related injuries through research and education
Daily Healthbeat Tip: Launched on July 11, 2005, this service provides health promotion and disease prevention tips 5 days a week in audio and text formats.
FIMDM Health News Review: FIMDM Health News Review is a website dedicated to improving the accuracy of media reports.
Healthfinder - Daily: Daily news stories about health.
HowStuffWorks: HowStuffWorks explains hundreds of subjects, from car engines to lock-picking to ESP, using clear language and tons of illustrations. We do the research so you don't have to.
Medscape Today: Features medical journal articles, Free CME, MEDLINE, case reports, medical news, major conference coverage, and comrehensive drug information. You can subscribe to their newsletter to get a great abridged version of articles/links once a week.
The C.A.M. Report: Complimentary and Alternative Medicine Blog

The View from Sports Center: Sports related injuries blog...
They Call Me Galvez: He was diagnosed with a Brain Tumor. He is a physical therapist that became a patient. He became someone he’s always tried to help.
There are 96 posts and 104 comments so far.
Gothamist..: Great way to keep up with happenings in NYC... there is a link to other cities at the top if NYC isn't your biggest interest.
NeuroPT : Neurology Section - APTA: NeuroPT Message Board, many other message boards out there through yahoo among other sites.
Plaxo 3.0 Beta: A decent networking site, convenient way to keep your contacts updated.

Who Am I?

2008-02-23T17:38:00.002-05:00

...as a blogger who am I? Blog's used to be an online journal to document what you were up to. Most of the more interesting ones tend to deal with bigger issues that focus on an entire profession (such as Physical Therapy). I have always tried to blend the two; often being cautious about discussing outright my feelings on some controversial topics so as not to offend anyone or bring a negative image upon the profession I am associating myself with.

As I transition into becoming an entry-level clinician and a New Professional I have been reflecting a little... in addition to the wealth of fascinating blog's related to PT out there (which I hope to list in an upcoming post) I feel I need to step my "blog-game" up. I have received little feedback from my readers and I thrive on feedback. All I have been told is I provide a decent amount of "noteworthy" topics. I was recently interviewed by PT Magazine about Web 2.0 and it's use in PT (apparently now there is a Web 3.0). In this interview I stated that my objective with this blog was to help disperse information about my view of the profession as a student and to help other students compare and contrast their programs. I haven't achieved the results I was quite looking for but have no regrets. At this point I hope to bring you even better material based on any and all feedback I receive.

Personally, this is an amazingly exciting time for me and the profession as a whole. I think we are growing in leaps and bounds with many more miles to go to achieve our ideal place within the medical community. I am at the verge of this huge transition with many many possibilities all of which will seemingly lead to a number of great results, now to figure out which will provide the most for me and my future patients...

Focus man...

Update

2008-02-23T13:36:00.002-05:00

Just finished my first week of my last clinical affil. - 10 more to go.

I am still trying to get settled in here in Philly. Trying to map out the Rocky run because I love that movie. I just need to find that high quality outfit he has on and develop a fan base so people cheer me on as I run the streets and try to keep up...

Otherwise, I am enjoying my actual PT work... I am on the Spinal Cord Injury floor and have a great group of patients and co-workers. I am learning a great deal about all things related to SCI.

I am trying to get a jump on the licensure exam I will have to take after I graduate in May while looking into some residency programs to get more specialized in either sports or ortho after I graduate. But for now I have to focus on taking things one day at a time... so I am off to the gym, then to eat, and to study... I hope you all have a fabulous weekend!

NPA Think Tank

2008-02-16T13:22:00.002-05:00

I just wanted to say NPA Think Tank is a great blog, worth checking often... that's all :-D

I am moving to Philly within the next 36 hours to do my last affil, yay.

When I get down there I think I will get a little more serious about my blog, studying for the boards, obviously my clinical experience, working out (self-preservation), and my various roles through the PT world. Transition phases are fun... there are just about a million things going on in the area of PT, a lot of it is so promising. Last night we here in NY had a great Student Special Interest Group meeting, even though there were only 4 of us present. I look forward to see how it all plays out and what role I (and you) can serve.

Hope you have a great weekend!

YouTube Vids

2008-02-05T00:51:00.000-05:00

There is a ton of interesting stuff on YouTube... here are two fun health related spoofs... med students + no sleep + a lot of studying gets you these:

Choosing A Text

2008-01-31T22:35:00.000-05:00

I just found out that my last affiliation is going to be at a Spinal Cord Injury center. This is admittedly not my strongest area of expertise so I just purchased a text to get caught up. That's all for today, hope all is great!

Our Healthcare System

2008-01-25T16:15:00.000-05:00

I wanted to share this experience from a few days ago...

I had an initial evaluation of a 76 y/o female

The prescription had a diagnosis of bilateral radiculopathy of the shoulders and a box checked off for "evaluate and treat"

She had a fairly extensive past medical history that I will leave out as well as a few clinical findings secondary to lack of relevance.

As I went through the patient interview, radiculopathy was less and less a likely culprit in her shoulder pain. Although she had a positive neer, hawkins-kennedy, and yocum special test, they simply created pain in the same location where just about any movement caused her pain. Moreover there was no radiation of pain which can be common in "radiculopathy". Distraction and Spurlings tests were negative. Also, the Yergason and Speed test were positive and the bigger piece to the puzzle was the fact that the only area of tenderness was on both biceps tendons.

She went on to describe that when she had pain in her hips and knees about three months ago she would use her arms to help her get up out of chairs. Her shoulder pain developed in conjunction with this other pathology.

Her MRI report from two weeks ago showed that she had minor tears in the infraspinatus, suprapinatus, and subscapularis along with minor arthrosis. She said her doctor mentioned only a possibility of bursitis and she claimed he never looked at the MRI report. NSAID's and aleve provided little to no relief.

Ultimately all signs point to bicipital tendonitis. Now we must call up the MD to report our findings. Ideally, there was no need for the MD visit. The patient could have saved herself that trip and extra payment that accomplished nothing more than referring her to us. We were able to screen for any red flags and are certainly able to refer elsewhere if there is an issue present outside of our scope of practice. For musculoskeletal issues PT should be the first line of defense aka the practitioner of choice. Unfortunately, this patient is one of many such cases and the situation will be one big speed bump to overcome, but it certainly is worth the fight.

PT - Poetic Therapy

2008-01-25T05:53:00.000-05:00

Tried to pull an all-nighter to finish up some revisions
due right about now
ended up watching a lot of def poetry jam on youtube
i am by no means a poet as you will soon be able to tell
but i got tired of always being inspired
and always saying "i could do that"
so i may not have something as powerful to talk about
i may not be able to wordsmith or rhyme
as well as those guys with all that time (see)
but i realize they dont rhyme all the time (dang)

i figure let me not delete anything in my "poem"
let it flow
thats the way to go...
plus its all in the delivery right?
granted this is via blog
so the delivery doesnt add much
instead of def poetry you get flat words with no emotion
but trust me its coming from the heart

like the heart of my patients
who all have patience
for a youngster learning the ropes
but they all seem to get better
so who really is clever :-D

but thats what i really wanna talk about
my patients
i went to a career day recently
not to change my own career path
but to speak to high school kids
about what i want to do with the rest of my life
and see if they may wanna join

one young girl
asked about my payroll
after revealing the median salary info i knew
i added something to clue...
her in on the reality of why i do what i do
i said
we do not do it for the pay
we do it to make the patients gay
and not gay the way you as high schoolers will giggle
but how it used to be used when literature meant something
i get paid with a smile
of patients who hadnt been able to walk for a while
you act as a teacher, a motivator, a friend, a confidant
one that molds the clay that is the human body
back to its optimal form
its a powerful thing
changing lives one motion at a time
one exercise, one soft tissue mob, one love

i choose not to rhyme for sake of time
but moreso because i cant
what i can do is help give patients
the tools to heal
hopefully
not everyone is a success story
not all will be pleased
i wont always be pleased
but for now i go to do my passion

because if its something you actually like
its not work
and if you can get paid and live a good life
isnt that all that we can hope

so forgive me for my semi-prose style
i hope it brought you a smile
at one point or multiple
all i know is im triple
as happy as i was 3 years ago
before i knew all there is to know about the elbow...
theres always more to know, dont lie to yourself
anywho, off to get an hour or so of rest
before i put on my best
for my friday patients
who have patience
with this sleep deprived
passionate child
who has so much to learn all about life
and cant think of a clever way to end this phrase
so here he stops
and wishes you all a quick rise to the top

ill try to do better next time... :-D
have mercy

Vocabulary energizers

2008-01-18T03:12:00.000-05:00

cic·a·trize (sk-trz)

To heal by forming scar tissue.

Fabella

Popliteus muscle

In situ

prn

Saw my first spinal cord stimulator in action yesterday. Interesting stuff; the patient reported that it provided relief along the left side of her spine but not the right following a spinal fusion 2 years prior.

A rebar acts to prevent collapse.

Curettage

Radiculopathy

Spondylosis

Spondylolysis

Spondylolisthesis - A straight leg raise may be uncomfortable or painful
Symptoms

Lordosis
Lower back pain
Localized tenderness over the spine just above the pelvis
Pain in thighs
Pain in buttocks
Tight hamstrings
Stiffness in back

Recent Articles

2008-01-10T22:59:00.001-05:00

In order to make access to a bunch of random interesting articles easier for me to access on my phone while I travel I am posting them here... feel free to enjoy them for yourself, there is a lot of good stuff in here!

ACP Addresses Potential Outcomes of Pay for Performance: New recommendations by the American College of Physicians to offset the potential adverse effects of pay-for-performance programs center on redirecting the focus to the patient.
ADVANCE for Directors in Rehabilitation | Archive Viewer: Advance for Directors in Rehabilitation is a trade publication offering content relevant to all rehabilition professionals, including practice management, new treatments, marketing, regulatory information and salary surveys.
Analyzing Easy Energy
Are You Too Cool To Work Out? - HealthNews Story - WDSU New Orleans: Are You Too Cool To Work Out?
As Martha Stewart Attests, Physical Therapy Plays Key Role In Recovery From Hip Replacement Surgery: As Martha Stewart continues her recovery from recent surgery to replace her left hip, periodic and progressive physical therapy will play a key role in her successful rehabilitation, says the Amer
British Journal of Sports Medicine - Abstract: Volume 41(11) November 2007 p 745-749 Muscle activation in coupled scapulohumeral motions in the high performance tennis serve.
Checklist May Help Cut Sudden Death in Athletes - healthfinder.gov: 12-step screen can spot underlying heart problems, experts say
Clinical decision making in physical therapy: a practitioner's perspective - Free Online Library: Free Online Library: Clinical decision making in physical therapy: a practitioner's perspective. by "Physical Therapy"; Health, general Physical therapists Practice Physical therapy Research
Concepts in Human Factors Engineering (8): Human Body Energy - Human Factors expert article by Dennis R Andrews PhD, PSP, CECD
Contraception Journal Free Online Editorials
Cyber Structure
Daily Herald | Lessons learned: Exercises for older athletes can benefit others: daily herald is suburban chicago's largest daily newspaper. the daily herald provides a local perspective with local content such as the northwest suburbs most comprehensive news on the web. your source for updated news from local to national.
Desert Dispatch : News: What Ails You: Role of physical therapist more complicated than some understand | physical, therapist, therapy: News: What Ails You: Role of physical therapist more complicated than some understand | physical, therapist, therapy, treatment, massage, chiropractic, doctor, therapists, chiropractor, soft
Diet and Exercise - Losing Weight - Jane Brody - Medicine and Health - New York Times: The way to lose weight in 2008 is the same as it has been every other year, because the basics of good nutrition have not changed.
Difference between Olympic sprinters and you could be a gene - livemint: The scientists say they want to downplay the role of genes in determining athletic abilities
Dr. Andrews pays claim
ESPN - Lone Star State signal-callers sprouting up among title contenders - College Football: College football coaches know Texas has always been ripe for the picking of prospects. Now the nation will get to see the Lone Star State's wealth of quarterbacks in the nation's best bowls.
ESPN - Tiger's trainer gives insight into Woods' workout routine - Golf: Tiger Woods now has to tailor practice sessions around being a father and find time for workouts that can last up to three hours as many as six days a week.
EXCITE: Beneficial Effects of Constraint Therapy Retained Long Term: Improvements in upper limb function and quality of life in patients who have had a stroke with mild to moderate impairment are retained 2 years after a unique, intensive program of movement therapy.
Exercise and Obesity: Their Interaction and Implications for Disease Risk: Abdominal obesity may better predict cardiovascular disease, metabolic syndrome, and type 2 diabetes than BMI or measures of overall adiposity. How does exercise affect obesity-related disease risks?
Exercise as Good as Surgery for Knee Pain - Articles: Before considering knee surgery, you HAVE to read this.
FAQ: The McKenzie Approach Vs. Traction: Visit thesaundersgroup.com for back exercises, physical therapy equipment, physical therapy education, cervical traction, rehabiliation product, chiropractic supplies and equipment, and exercise software.
Finding Alzheimer’s Before a Mind Fails - New York Times: Though Alzheimer’s disease seems to strike suddenly in old age, scientists think it begins long before symptoms occur.
High Altitude Soccer Teams Have Significant Advantage Over Lowland Teams: Football teams from high altitude countries have a significant advantage when playing at both low and high altitudes, finds a study in this week's Christmas issue of the BMJ.In con
High Schools Try Teamwork to Put Trainers on Site - New York Times: Some high schools around the United States are using novel, and even unorthodox, methods to get trainers at a reduced cost into their sports programs.
Hyperforin--a key constituent of St. John's wort s...[FASEB J. 2007] - PubMed Result: PubMed is a service of the U.S. National Library of Medicine that includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.
I’m Not Really Running, I’m Not Really Running... - New York Times: Using mental tricks, or dissociating, can get you to the finish line faster.
Mechanical Low Back Pain: Progression of Treatment
Medical News: Any Football Helmet Hit Can Cause Potential Concussion - in Neurology, General Neurology from MedPage Today
Multidisciplinary Treatment May Benefit Patients With Chronic Low Back Pain: In a prospective trial, multidisciplinary treatment aided patients in all stages of back pain chronicity, suggesting that this should not be given only to those with lower grades of chronic pain.
MyPyramid Dietary Guidelines Modified for Older Adults: In the Modifed MyPyramid for Older Adults, nutrient- and fiber-rich foods are emphasized, as well as food sources of nutrients rather than supplements and the use of fluid and physical activity icons.
New tool advances injury care
Newswise Medical News | Message to the Elderly: It's Never Too Late to Prevent Illness!
NPR : Bad-Disk Reboot: Back Pain May Not Mean Surgery: James Weinstein, M.D., chairs Dartmouth College's orthopedic-surgery department; he's considered one of the nation's leading experts on low-back pain, and he says a multi-year study shows little difference in results after surgical and non-surgical treatment approaches.
NPR : Study: Surgery Just One Option for Herniated Disk: A new study looking at treatments for herniated disks found that non-operative remedies, such as physical therapy and pain-killing drugs, are almost as effective as surgery to remove the disk.
nwi.com :: Healing made to 'seem like fun'
Pain threshold too low for torture: Please don’t tell me any national security secrets. Pass along no military troop movement information and refrain from alerting me to where our nuclear weapons are stored. And don’t ever grant me top-secret clearance.
Pediatric Environmental Tobacco Smoke Exposure and Allergic Reactions: In a prospective birth cohort study, children who were exposed to environmental tobacco smoke in early infancy had a higher incidence of allergic reactions to food and indoor inhalants at age 4 years.
Peer Publicity
Physical therapy comes to front line: Day in and day out, troops patrol the streets and countryside of Iraq for hours at a time; many carrying up to 100 pounds of gear. Over time, this excessive wear on the troops may lead to back or other injuries later on in life.
Physical Therapy Modalities Helpful for the Family Clinician to Know: The authors of a review suggest various treatments and modalities that a family clinician should know and include in the physical therapy prescription.
Presentation at ISSN Highlights Soy Protein Advantages for Endurance Athletes :: News :: Natural and Nutritional Products Industry Center
PT Magazine | In Sickness and in Wellness: Acknowledged experts in managing rehabilitation from illness and injury, physical therapists also are perfectly suited by their education and skills to helping healthy people stay that way. PTs who offer wellness and fitness services share their perspectives and give tips to peers who may want to follow suit.
PubMed - Direct Access: PubMed is a service of the U.S. National Library of Medicine that includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.
Recommendations Issued for Treatment of Nonspecific Low Back Pain: A review provides recommendations for treatment of occupational nonspecific low back pain to promote early return to work.
Researchers discourage use of rehab after spinal decompression surgery: Patients randomized to two rehabilitation programs or a control group following lumbar spinal decompression surgery experienced no further pain relief beyond that reported immediately postoperatively.
Respectful Insolence: A chiropractic "adjustment" in New Jersey
Sports head injury bill refiled - Framingham, MA - The MetroWest Daily News: Sports head injury bill refiled - Framingham, MA - The MetroWest Daily News
STLtoday - News - St. Louis City / County
The effect of moderate resistance strength trainin...[J Geriatr Phys Ther. 2007] - PubMed Result: PubMed is a service of the U.S. National Library of Medicine that includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.
Walk, Don't Run, to Prevent or Reverse Metabolic Syndrome: A new study shows that at-risk overweight or obese individuals can obtain health benefits to reverse or prevent the metabolic syndrome with moderate exercise, such as brisk walking.
What You Don't Know Can Hurt Your Patients: Linda Casebeer, PhD, of Outcomes, Inc., teaches us how online CME excels in outcomes.
Yoga is no universal cure: The online source for Montreal news, business, sports, entertainment, classified ads, horoscopes, weather, local news and more.

PT in ICU can help reduce hospital stay

2008-01-06T08:26:00.000-05:00

So here I am on my way to a CPR/AED re-certification class on a Sunday morning. Sitting on the bus I am perusing the latest PT Magazine (January 2008) and wanted to share this from the PT Bulletin Digest in the back (check page 70 if you have it).

One of my classmates is currently doing an affil in an Intensive Care Unit and this is yet another study adding support to PT being a very efficient first line of defense. Furthermore, the blurb about the article has this:

"The project confirms that it is safe to administer early mobility to ICU patients and that it is of benefit. Further studies are planned in order to clarify the optimum number and duration of exercise sessions."

This last sentence brings me to my latest project. In my very sport oriented current practice setting I am preparing a Powerpoint presentation regarding exercise prescription in regards to proper sets, reps, order, and progression. There is a lot of different theories out there and there is a lot going on in PT in general.

PS, the freakin' CPR class was canceled and no one informed me... what a waste of a Sunday morning, ah well, I get to hang out with my nephew and niece.

New Year, New Opportunities, New Food Pyramid

2008-01-02T22:20:00.001-05:00

With a new year everyone gets to have a new beginning. It is a great time for evaluation as people make resolutions.

Within clinical practice we have to fill out a Clinical Performance Instrument. This is a blue book that has 24 performance criteria that you have to judge yourself on and the clinical instructor (the professional working with you) also ranks you on each criteria. There are options if there are significant concerns and a ranking between novice clinical performance and entry-level performance, possibly with distinction. The evaluations are performed at the midterm and also at the conclusion of the affiliation.

Also wanted to share that there is a new food pyramid for older adults (in order to access the article you likely need to join Medscape which is free and a great way to keep up to date on a lot of the developments going on in the medical field).

"In the Modified MyPyramid for Older Adults, nutrient- and fiber-rich foods are emphasized, as well as food sources of nutrients rather than supplements and the use of fluid and physical activity icons."

Access to Articles

2007-12-26T07:04:00.000-05:00

As much literature review as we can do in the PT field, it doesn't mean so much when you do not have full access to the article of interest.

I was able to find this article for a particular patient of mine who is a tennis instructor, but have not been able to gain access to it. If anyone out there can share access with me I would greatly appreciate it, as would my patient.

It is kind of ridiculous to be asked to pay 30 bucks or so for an article. Unfortunately, I cannot access my Universities databases from home and with the hours I put into clinic now I don't have the chance to get over there. I need to get over there so I can get my bar code re-done to re-gain access to some of these journals...

Back To Basics

2007-12-18T07:32:00.001-05:00

Muscle of the week, at some point I was actually trying to make this a regular segment...

Serratus Anterior

Innervation: Long Thoracic Nerve

Just to be fair, there is also a serratus posterior inferior and superior.

I know this doesn't make for the best blog post, but I just put together a pretty good powerpoint on this muscle with a whole lot of literature review regarding the SA - available upon request :-D

Monday

2007-12-09T23:22:00.000-05:00

Two great quotes I just saw and wanted to get down somewhere... what better place than here

"Clear minds - full hearts - can't lose." Friday Night Lights

"You got three kinds of people in football, those that make it happen, those that wait for it to happen, and those that say what just happened" Just saw that in a commercial.

and walking by another PT clinic after clinic today I saw in the window the slogan "The art of healing, the art of science." This is a sad thievery of the APTA slogan.

Clinic was good today, I have some great patients, and am getting more and more comfortable with the flow of the clinic. We get a lot of patients at any given time but there is a good system setup to give them all their needed attention. Seeing the patients get great results fairly quickly is a great thing. Back to reading more articles... eventually I will start posting summaries of some of these more relevant articles.

Have a great day.

Prevention

2007-12-08T18:28:00.000-05:00

In theory, prevention will decrease the amount of patients and thus money PT's will see. However, as musculoskeletal (and then some) specialists there will always be a reason for PT's to be around, so prevention is a great thing that should become a standard in health care. I am just starting to look into some of the research out there about how prevention can in fact prevent injuries.

Being in clinic now though, I see so many injuries that could have been easily avoided had the patient/client spent some time strengthening certain muscles. The hip stabilizes the lower extremity and the shoulder does a very similar job for the upper extremity. The core, specifically the transversus abdominis and multifidus, is oft neglected and can go a long way in preventing low back pain. More and more evidence is coming out to support these ideas, moreso these make biomechanical sense. Poor posture is another very common culprit in causing pain and visits to the doctor. Your mother was right when she told you to sit up straight...

I am studying in clinic more than I used to when I had classes, it is a little odd, but again makes sense. Speaking of which I am gonna go read something.
Stay strong.

Caught Up

2007-12-03T23:24:00.000-05:00

I have just been busy, no excuses just results...

So I finished my last final of my academic career (hopefully) the Wednesday before Thanksgiving. Started clinic last Monday and have been greatly enjoying it. The patients are all very pleasant, the staff is a lot of fun, and I am learning a great deal. I hope to have more detailed posts in the future, but it is truly an exhausting experience. Along with everything else in life, I get to pretty much work 50 or so hours a week while not getting paid and still paying tuition... puts a bit of a strain on finances. Just as a side note, there are programs where you get paid for these final affiliations.

I have been keeping up with journals and other blogs and PT related websites and the info borders on overwhelming. But what keeps me going is seeing patients get better and knowing that the more I learn the better I will be able to get them better... very eloquent, eh? My brain is a little tired.

Other topics worth discussing from clinic are:

My case report topic will likely be a patient who had fractured his talus and after about 2 months of PT treatment was not getting better. It was radiographically confirmed that he had AVN of the talus. I first saw him when he returned to PT after having retrograde drilling done to fix the AVN.
My CI has used the Functional Movement Screen with a minor league pitcher from my favorite baseball team (shh) that we are working with. There has been some recent evidence in support of this as a predictor of injury. This is a very interesting concept in my opinion and I think this will be something I will be following as more comes out about it.
There is a lot of Pilates work
There is a huge focus on biomechanics

I look forward to updating you all on the many concepts and ideas that I will be picking up in the coming weeks. This is such an exciting part of the PT process. Hope you are all happy and healthy!

Goodness Gracious

2007-11-21T09:45:00.000-05:00

These last two weeks have been nutty. A whole lot of tests, papers, practicals... I have one final left later today so this will be my review. I just want to make it out of this alive, so let's go...

Health Care Delivery is the class, management, marketing, PTA's are the main topics. This could be one of the topics that is least PT related yet. Most of this info comes from Managerial & Supervisory Principles for PT's.

Work teams consist of individuals brought together for a specific function, whereas work groups are more about individualized assigned tasks.
6 steps to aide a successful transition from an individual to a team focus:

open and honest communication
clear performance expectations
make barriers and constraints understood
adopt work rules
structure and position the team within the organization to achieve expected performance
make sure members are qualified to completed the required tasks

Information exchange strategies

set performance expectations
ongoing performance evals
understanding and addressing work barriers
obtaining the resources necessary to meet performance expectations

Performance expectations start with a well-written job description including:

applicable work standards
decision-making authorities
job duties
methods by which work will be coordinated
minimum job requirements
organizational relationships
responsibility for the work of others

Performance standards define how the organization expects duties to be performed and how performance will be measured
There is a 5 point scale to rate performance, 5 being exceptional and 1 being unsatisfactory
Job competencies are a form of performance standard that usually incorporate knowledge, skill and professional behaviors.

3 basic models of management theory (Miles)

Traditional - those with superior ability should be in charge
Human Relations Model - based on Hawthorne effect, managers encouraged to allow employee input but the employee ultimately does not play any substantial role in decision making.
Human Resource Model - Greater focus on the employees need for recognition, inclusion, attention and contribution. Workers are satisfied from personal sense of accomplishment. In order to get the most out of employees, managers need to create an environment where they can maximize productivity by maximizing ability of the employee to be involved.

The Contingency Model functions under the interplay of

the situation (the organization, job characteristics),
the employee (acceptance of responsibility),
and the manager (competencies).

The life cycle theory branches off of this model to suggest that management style should be determined by employee maturity.

Employee development takes planning, management effort, and money for time and resources. The ultimate goal is to maximize employee potential.
All employee development approaches are designed to train employees so they can do the following:

adapt to change in job duties/performance expectations
do their job well today and better tomorrow
do a different job in the future
keep pace with new technology
fulfill professional goals
meet continuing education needs to maintain licensure

Varying approaches include:

training programs from external sources
rotations - to a variety of work settings, apply new skills in new ways, gain advanced expertise
mentoring programs - pass on expertise, act as a resource, provide ongoing direct feedback
internal/external consults

4 types of formal presentations and the common process suggested for their development

Persuasive - convince the audience you are credible. Then lead your audience to take a desired action (invest in what you are "selling")
Exploratory - used to introduce new information or provide an update.
Instructional - teach the audience something. Shared info is very detailed.
Oral report - very common in business setting; used to bring audience up-to-date on a topic of interest. i.e. monthly management reports.

Key steps in preparing a quality presentation

set clear objectives
know your audience
plan your presentation
identify resource materials to support the presentation
practice and reorganize when necessary to maximize effectiveness - be comfortable and confident

Parts of a formal presentation

INTRO - what is this all about
BODY - main ideas and supporting info
CONCLUSION - restate the main points and objective of the presentation
take questions to clarify anything left unsaid

SPECIAL NOTE: FOR THOSE OF YOU LESS FAMILIAR WITH THE INS AND OUTS OF MICROSOFT POWERPOINT AND WHO WANT TO INSERT A VIDEO INTO THE PRESENTATION, PLEASE KNOW YOU HAVE TO HAVE THE VIDEO FILE IN THE SAME FOLDER AS THE .PPT FILE IF YOU WANT IT TO PLAY WITHIN THE PRESENTATION - IT ACTS AS A SHORTCUT IN THE PRESENTATION - SHORTCUTS NEED SOMEWHERE TO LINK TO. IN RECENT WEEKS I HAVE ENCOUNTERED MANY PEOPLE WHO DID NOT KNOW THAT AND I HOPE THIS IS HELPFUL TO SOMEONE OUT THERE :-D

PTA's are regulated by state practice acts.
Amount of supervision/direction from a PT is based on education, experience, potential risk, practice setting, federal/state regulations.
Level of supervision as defined by APTA are general, direct, or direct/personal.
By law, they are the only individuals permitted to assist a PT in selected interventions.
Joint mobilizations/manipulations & selective sharp debridement are exclusively performed by the PT.
Medicare recognizes supervised PTA's as "qualified professionals."
Within the APTA House of Delegates (the highest decision-making body in the profession), there is a PTA Caucus of 5 PTA's that serve as an advisory council to the House without voting rights.
PT Aides are only allowed to perform tasks related to operation of PT services

Happy Thanksgiving to all, and to all a healthy day...

Stony Brook Conclave

2007-11-11T08:52:00.000-05:00

Yesterday I got to present at and enjoy the 2007 Downstate Student Conclave at Stony Brook University. I helped organize last years and Stony Brook did a great job feeding off of that one. It was truly an honor and privilege to be invited to speak on the same stage as the other amazing speakers. I just hope that my presentation on ways to be involved in the APTA and different events going on around the profession was informative and will inspire a few of those present to get more involved.

Now back to the reality that is my last two weeks of classes in the DPT program. Tomorrow I have a case report due and will finally present the group project on the video analysis of the power clean. Tuesday we have a written final exam in our musculoskeletal elective and I will be presenting in the CAM class about Qigong. Wednesday we have our final for clinical decision making 2 in which we have to go through our thought process of treating the diagnosis of "multi-level disc herniations." All the while my grandfather has been going in and out of the hospital and the other mini stressors of life are all around as well.

Here's a quote I enjoy;
I once heard that Frank Sinatra's tombstone read: "The best is yet to come"

Marathon/200th Post

2007-11-04T21:05:00.000-05:00

Yay 200th post!

Today I got to be a medical volunteer at the ING NYC Marathon for the second year in a row. Another great time, great people, and I want to run the marathon more than ever... I entered this year into the lottery to run but did not get in (I have heard close to 100,000 people apply and only 38,000 get to run - a lot of which are guaranteed based on certain requirements).

Also, I found out that at my upcoming clinic has their students try to "stump the therapist" meaning that I have to come up with probably close to 11 odd case studies or in depth questions... so if anyone who happens to read this has anything good, I would greatly appreciate you sharing that with me.

Here's to running the marathon next year! Cheers to all those who ran today!

Rewind

2007-11-01T20:48:00.000-05:00

I did not get a chance to send a special shout out to my homie ericgalvezdpt.com last Thursday October 25 for hosting the inaugural Tumors Suck Day. I was wearing my Tumors Suck shirt but did not have a camera to prove it... I hope that his efforts are helping others and I certainly look forward to seeing him when he comes through NYC in two weeks. Before that happens I better get all my work done though...

Have to finish up my power clean instrumented movement analysis project, come up with a case study on the labral tear of the shoulder (I was not supposed to share that diagnosis with my classmates but I am almost certain not a single one of them read this :P, still have to finish up my presentation on Qigong, got some tests, a DEXA scan to observe, practicals, etc.

Also, two days ago I underwent a metabolic rate treadmill test to help determine how effective my body is at burning fat and breathing oxygen (not the most technically sound definition of it, but stay with me). Below is the graph of the exam which consisted of being on a treadmill with a mask on and HR monitor. The treadmill was at 3 mph and went up by 1 mph every minute or so, up to 9 mph, then the incline went up by 2% every stage (I got up to 8% before I got to 19 on the RPE). Gotta do better next time :-D

NSC Mobilie Recap

2007-10-29T06:18:00.000-05:00

It was an amazing conference, a great way to finish up my career as a student and unfortunately the end of my role on the nominating committee. There were over 1300 students from around the country and over 600 of them voted in the elections for new Student Assembly officers. The election process was a huge success with a great new board coming in and hopefully the highly qualified candidates who were not elected will not be discouraged and find their way to make a difference because they all had so much potential. Through gathering feedback, apparently communication between the apta and the students out there needs some improvement, and I am confident it will. The future looks very bright. There were so many positive things going on at the conclave from programming (including the one the board members from this year and I presented), to mock interviews, resume critiques, great vendors in the exhibit hall, making connections from all across the country and so much more. I cut this short because I am about to go underground, so as my nom com buddy ms. crawford so eloquently put it: 'I am going to make like a joint and mobilize.' Have a phenomenol day!

SO Much Info Out There

2007-10-23T22:58:00.000-05:00

Here is another great website for keeping up to date with Rehab News:
http://www.medicalnewstoday.com/sections/rehabilitation/

Here are two recent articles from there that are of interest to this Student PT:

1.

Soreness After Exercise Not Prevented By Stretching Out

Studies show that stretching before or after exercise has little or no effect on muscle soreness between half a day and three days later, a team of Cochrane Researchers has found.
...
"The data were remarkably consistent," says lead researcher Robert Herbert from the School of Physiotherapy at the University of Sydney, Australia, "The available evidence suggests that stretching before or after exercise does not prevent muscle soreness in young healthy adults."

The researchers do, however, believe that there is a need to see whether stretching can have an effect on people in the community who have reduced levels of flexibility.

2.

Sports Concussion Education Campaign Being Developed By National Athletic Trainers' Asociation And National Academy Of Neuropsychology

"Often, brain injuries initially go unrecognized," said NATA president Chuck Kimmel, ATC. "The goal of this program is to educate individuals on the importance of rapid recognition and treatment of concussions and to ensure the athlete is ready to return to play."
--
This program is going to be vital in helping many athletes out there. In recent weeks I have unfortunately seen a number of concussions occur in sport and felt that everyone involved could use a little more education on the subject.

On another note, part of the reason I sometimes neglect to post for a few days has to do with the overwhelming amount of knowledge I get exposed to on a consistent basis. Just in the last few days I have been exposed to Tai Chi, Business Planning, a CAPTE accreditation review board, people e-mailing me about various topics in PT in response to previous blog posts, getting stuck in 3 hours of traffic trying to get to a continuing education course in Long Island, a NYPTA Board of Directors meeting where a number of bylaw changes for the NYSSIG I proposed were accepted, preparation for the National Student Conclave, an aerobic capacity/metabolic test on a treadmill (which was very cool and I will be a subject for later today...possibly) the list goes on and on... I stay fairly busy. This often leads to a lot of blog ideas but I am never sure which ones to include, which to filter out, so often times I just choose sleeping, studying, or working out instead of posting :-D sorry...

But I hope the content I do add is a benefit to someone in some way... if we can just change one person for the better... insert additional cliché here

And now it is raining outside so I must start my long wet commute, hope you have a great day and thanks for letting me get a little bit of PT off my chest...

Two Stolen Articles

2007-10-20T06:57:00.000-05:00

I had to post these two for the respective reasons:
1. To help me study for an upcoming exam dealing with health care delivery.
2. To spread the word about this great idea by Google Inc. They seem to be at it again with great ideas that make sense and will seemingly help society all the while making them much richer I am sure.

Thank you APTA Bulletin for being so useful (hopefully they don't accuse me of theft :)

United States Continues to Have Highest Level of Health Spending

The United States continues to spend the most on health care when compared with other Organization for Economic Cooperation and Development (OECD) countries. Health care prices and higher per capita incomes are major factors for higher US spending, according to a study by Johns Hopkins Bloomberg School of Public Health and Princeton University.

Compared with the average OECD country in 2004, the United States has fewer health resources -- physicians, nurses, and hospital beds -- and lower utilization of these resources. Health care spending for chronic health issues, such as obesity, alcohol consumption, and smoking, also contributes to high health care spending in the United States, says a Johns Hopkins news release.

Key study results, based on 2004 data, show the following about US health care spending:

• Per capita expenditures were 2.5 times greater than those of the median OECD country.

• The United States spent 15.3% of its gross domestic product on health care, which is substantially higher than any other OECD country.

• US growth in health care spending per capita from 1994 to 2004 was similar to the OECD median.

• The United States has promoted policies to reduce the number of hospital days as a way to contain costs. It is now ranked fourth highest among OECD countries for hospital spending per capita.

• The United States spent 3.6 times what the median OECD country spent in 2004 for outpatient care. Most of the difference is attributable to higher spending on physician services.

Results were published in the September/October issue of Health Affairs (Vol 26, No 5).

Google Announces Plans for Health Initiative at Web Summit

Google Inc plans to launch a health initiative in 2008 that will include improved search experiences, data storage, and organization of patient records, the company announced this week at the Web 2.0 Summit in San Francisco.

Marissa Mayer, Google's vice president of Search Products and User Experience, told Internet industry leaders that "…people are already using Google more than any other tool on the Web to find health information. And the health care industry generates a huge amount of information every year. It's a natural core competency for us, to understand how to organize all that data."

The company has developed a prototype online platform for its health offering that incorporates personal medical records, health care-related search features, diet and exercise regimens, a localized "find a doctor" application, and other elements.

Microsoft Corp introduced its electronic health record service called Microsoft Health Vault earlier this month.

Update on Low Back Pain (LBP)

2007-10-20T06:38:00.000-05:00

In case you did not know this, LBP is big. A large percentage of the population will experience it sooner or later; "Low back pain is the fifth most common reason for all physician visits in the United States." Close to 85% of it is non-specific, meaning no one can really figure out what is causing the pain. Thus, there are many efforts to try to bring the positive outcomes associated with LBP into a much higher percentage bracket.

The latest issue of Annals of Internal Medicine has a few articles looking at LBP (open access is great). Very quick guide to interpreting this literature is that: it comes from a journal with a great reputation and is highly peer-reviewed and these studies use a review of current evidence making them higher up on the hierarchy of evidence than most other research.

The first (Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society) attempts to establish guidelines for clinicians who deal with the issue. They are even nice enough to have a summary for patients of the information contained in the article which is an excellent strategy in patient education.

The next article in the issue is looking at nonpharmacologic approaches to treating LBP and finds the following: Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation. For acute low back pain, the only therapy with good evidence of efficacy is superficial heat.

The last one is looking at pharmacological treatments and finds NSAIDs amongst the "useful" group. Startling statistics show that use of these medications leads to more than 100,000 hospitalizations and 16,000 deaths each year in the United States—equaling more deaths than from AIDS and more than four times as many deaths as those from cervical cancer.
The study authors conclude that: "Evidence is insufficient to identify one medication with a clear overall net advantage because of complex tradeoffs between benefits and harms."

The American Pain Society will publish the comprehensive guideline including invasive procedures for low back pain in 2008.

Acupuncture

2007-10-19T12:33:00.000-05:00

This past Tuesday we had a class that covered Acupuncture. The lecturer was both a PT and Acupuncturist. The experience of having needles pierce my skin to alleviate something in my body was something I had been curious about moreso for possible referral purposes in the future.

I was used as a subject for my 'tight' (some call it 'short') hamstrings. The needles going into the skin di not hurt, well some felt a little sharper than others as they probably went into much 'tighter' areas. She also used me to demonstrate 'cupping' - which involves taking clear plastic cups and creating a vaccum between the cup and my skin. This serves (in theory) to clear the meridians further. It reminded my of previous myofascial releases that I had received. Also, when I was younger my mother had taken me to a 'european' doctor to use cupping to treat my bronchitis and asthma. Back then they used oil and matches to create the vaccum. Back then a mixture of therapies seemed to help me clear my lungs up.

To review, acupuncture involves placing needles into points along the bodies meridians (which are likened to veins and arteries except are filled with chi aka life energy). At times these meridians can have blockages so the insertion of these needles helps clear the flow.

Case Reports

2007-10-13T16:48:00.000-05:00

We are in "mid-term" week. One part of one exam deals with case reports. In the hierarchy of evidence based practice (EBP) the case report as pretty much at the bottom - aka it is a very basic form of evidence (it is amazing how hard it was to find a link to this hierarchy, perhaps it is not as widely accepted as I thought - perhaps just the specifics are not as generalizable?). But it's place in the pecking order is no reason to look down on these very important studies.

The following info comes from my interpretation of Writing Case Reports (I have decided not to cite anything, but just to link to it, I believe that is acceptable, you let me know...):

Case reports...

..."illustrate EBP" through the therapeutic alliance as described by Sackett and colleagues. They integrate clinical experience as the author describes their decision making process, the qualitative aspect that patient choice exemplifies and lastly with the use of the best available research evidence through the citations used throughout the study.
..."help develop hypotheses for future research" by providing a unique clinical question or observation that may not otherwise have been brought up. Because the case report cannot test cause and effect relationships it can discuss the current thinking about a possible relationship between research variables and hypotheses that may be carried out in randomized controlled trials (the higher level of studies, trumped mainly by systematic reviews). There are numerous instances where case reports are written in response to a lack of current literature on the topic of interest.
..."build problem-solving skills" as a reader or as an author. As a reader it is valuable to follow a colleagues process of problem-solving and possibly pick-up a skill or two. To write a successful case report requires that your problem-solving skills be at a high level. From researching the literature on your topic to reflecting on your process of problem-solving to lastly accepting and utilizing the feedback that the peer-review process provides you will in fact build tremendously on your skills.
..."support, enhance, or cast doubt on theory underlying practice" by describing the application of theory thus shedding light on how the theory holds up in a clinical situation. In relation to this, the case report can then challenge the existing theory and hopefully spark a respectful debate on the topic to ideally lead to optimized patient/client outcomes.
..."help develop guidelines and pathways" by providing examples of specific patient populations with greater accuracy and a time frame of reference. The practice variation is vital for a profession to be aware of as there may be techniques available that may be more efficient. Furthermore, an accumulation of case reports can be a stronger level of evidence than a single case report as trends begin to emerge and informal conclusions can begin to formulate and thus lead to new thinking.

"Unrelated to the rest of the post" quote:
"Indecision may or may not be my problem" - Jimmy Buffet

Yoga Patanjali's Eight Fold Path

2007-10-09T15:30:00.000-05:00

My abridged study version of Patanjali's Eight Fold Path, an integral part of therapeutic yoga...

Yama - moral precepts
Niyama - qualities to nourish
Asana - postures/movements
Pranayama - breathing exercises
Pratyahara - withdrawal of the senses, such as in meditation
Dharana - concentration
Dhyana - uninterrupted meditation
Samadhi - "in the zone"

The three postures we learned to focus on (I may not spell these correctly):

Tadasana - helps extension and standing posture
Buddha Konasana
Sukasana - one I had a lot of trouble doing

Just a quick FYI... sort of not really... sorry, had a lot of coffee... off to take this exam now

Frustration

2007-10-09T00:56:00.000-05:00

I am probably more frustrated than I have ever been in my life right about now... and not just because the yankees blew it today, or the jets are in line for a great draft pick... but along these lines, people (in so many facets of life) seem to be letting me down as of late... I do not want to make this too personal a blog but I just wanted to vent right there... all done

Life is too short for the negativity, so trying to stay positive (although yoda says: "do, or do not. there is no 'try'.")

Speaking of doing... A lot to do, part of the reason for my lack of blog contributions. So now I must 'do' more blogging...

Doing a presentation next week on the use of the Nintendo Wii for Rehab aka wii-hab and a video analysis of a power clean.

Another presentation on an article about the lack of mental health services provided to college students that uses the Virginia Tech incident as an example. I just found an audio interview in relation to this article, good supplement to use.

"A cohort is worth defining here as a group of people who share a common characteristic or experience within a defined time period (e.g., are born, leave school, lose their job, are exposed to a drug or a vaccine, etc.). Thus a group of people who were born on a day or in a particular time period, say 1948, form a birth cohort." This is all from wikipedia which is a questionable source to use more often than not, but there are times when it provides information in such a great way that other sources do not, so be cautious in using this site.

Have an exam tomorrow on psychoneuroimmunology, complementary and alternative medicine in general, and yoga therapeutics.

Will be doing a presentation about Evidence Based Practice as part of VISION 2020 at the end of the month at the National Student Conclave.

Will be presenting different ways to get involved in the profession of PT at the NYPTA Downstate Student Conclave.

Have to present a lot of case studies, plan of cares, interventions, etc.

Have to present a 10 year professional plan.

Must fill out my last generic abilities assessment (it's more complex than the linked version).

A few more exams along with finding a place to live in Philadelphia for February-May 2008... I am certainly forgetting a few assignments... overall, it's all manageable... I certainly am not complaining but it could all be so much simpler - and just to clarify it is not any of these bullets that frustrates me at all... could be a lot worse too so for all those canadians... Today I give thanks for what I DO have!

Just Another Tuesday

2007-10-02T22:29:00.000-05:00

Hi... seems like forever since I have posted... blogger withdrawal.

I have been busy looking for a place in Philly for when do my clinical there, or alternative locations or... just a mess. Every day I get home and want to blog but I either am so ready to go to sleep or just can't decide which of the multitude of possible topics that I covered throughout the day I should post about. Sometimes I think about too many things and am left with nothing. Jack of all trades and master of none? I hope not, have to try to avoid that scenario.

Tomorrow I am going to do a presentation to the 1st years about evidence-based practice that I will also be presenting in Valley Forge, PA at the National Student Conclave, you should come by! It is a very interesting presentation if I do say so myself...

Clinical Changes

2007-09-27T08:38:00.000-05:00

So I had my last two clinical experiences all set up, it was gravy... yesterday I get an e-mail from my Academic Coordinator of Clinical Education (ACCE) telling me she has to speak to me about one of these placements. As I feared she informed me that it was canceled, the reason being under-staffing and an inability to provide a quality clinical instructor for me. I appreciate their honesty but now I have to scramble a little.

There are two clinics within the NYC area that are available, however they require an immense amount of travel time and do not have great reputations for providing quality clinical experiences. I can also go to Philadelphia, PA to Magee Rehabilitation Hospital but I would need to find a place to live which is not the end of the world, and also find a means of transportation... so that is a strong possibility right now. Since I found out yesterday I have been calling around trying to find out if anyone I know has some kind of connection to Philly that would be willing to house me for 11 weeks (middle of Feb.-beginning May 2008).

Another option, which the ACCE is not very fond of, is finding a rehab hospital (it is required that I have a "rehab setting" experience) that we do not have a contract with. There seems to be a lot of logistics involved, but I am willing to try for the sake of having a better learning experience.

So if anyone out there knows of a place in Philly where I could stay or of a rehab hospital that I could affiliate with please shoot me a comment or e-mail.

Thanks in advance.

I am Guilty

2007-09-19T07:29:00.000-05:00

...of not voting in my boroughs primary elections. What's worse is I did not take advantage of the opportunity to help PT. I am writing this to remind myself to do this in the upcoming elections and to hopefully inspire other PT/PTA students, professionals and most importantly PATIENTS to follow suit.
In voting for candidates my main concern is their stance in regards to PT related issues. Now I am sure many politicians are not exactly experts on healthcare issues but when they are running for an office this could be a great time to make them aware and vote accordingly.
So in the future, I (and I hope you) will be writing a letter or e-mail or going to public appearances to inquire about the candiates stance on healthcare and specifically what they can do for PT and our patients.
I want you... to go out and vote... and visit ww.apta.org/advocacy to find out more.
Dealing with politics can be streamlined and APTA has done a great job so far. Unfortunately we still have an uphill climb to make... it gets easier when we all unite (see unions and majority voters).
To conclude I am going to try to remember this great quote: "Democracy is not a government of the people, it is a government of the people who participate"... I'm pretty sure I butchered that but I hope you get the idea.

Falling through the Cracks - VT and the Restructuring of College Mental Health Services

2007-09-16T21:07:00.000-05:00

The following is more related to health care delivery than directly to PT...

I recently read an interesting article about the tragedy at Virginia Tech (VT) that occurred earlier this year and the state of college mental health services. The author begins by presenting the accounts of the young man who gunned down 27 students and 5 faculty members. She presents a number of situations that show his disturbed nature in his interactions with his peers and with a professor. He had a few incidents that led him to be admitted to a psychiatric hospital but it remains unclear if there was any follow up after this. What appears clear is "there was no clear way to screen [Cho] for reentry to VT" after his release from the psychiatric hospital.

This extreme case highlights what the author found to be recurring themes through a number of interviews with campus mental health experts from a number of universities: a lack of communication within the campus mental health system and a lack of understanding of privacy laws. "Experts differ about whether and when HIPAA applies" and the The Family Educational Rights and Privacy Act seems to often be misinterpreted to be more restricting than is intended. Hopefully, this unfortunate incident can serve as a catalyst to improve what is presented as a very broken system and help save lives in the future.

The article is a perspective piece that serves to point out a problem that needs to be fixed. Some suggestions are presented to avoid allowing students to "slip through the cracks" but it there are few current systems shown to be very effective. One such effective suicide prevention program was designed for the U.S. Air Force. Some of its success can be attributed to being championed by top generals which helps to overcome the possible stigma associated with mental health.

No matter which system is implemented at universities around the country it is clear communication needs to be more defined. One person should be responsible for each patient in the system, more staff is necessary to handle the magnitude of issues, and the privacy laws have to be made clearer. These gaps in the campus mental health system seem to reflect what is described by many as a broken medical system in the U.S. Personally, I believe there is no excuse for such a poor system and based on the research presented in this one article the politics need to be thrown out of the window to help create a system that works because it seems to be right at our fingertips.

Shuchman, M. (2007). Falling through the cracks - Virgina tech and the restructuring of college mental health services. The New England Journal of Medicine, 357 (2), 105-108.

There are now a few less uninsured people in America

2007-09-14T17:40:00.000-05:00

Check out this New York Times Article... kudos to San Francisco...what a treat

San Francisco to Offer Care for Uninsured Adults

This is part of the cost breakdown from the article:
"Those from families with incomes below the federal poverty line pay nothing. Those who earn more pay quarterly fees that range from $60 to $675, which is the rate for those with incomes above 500 percent of the poverty level ($51,050 for a single; $103,250 for a family of four). That is where the subsidy ends. The co-payments range from $10 to $20 for a clinic visit and from $200 to $350 for an inpatient stay."

Legislative Action Needed

2007-09-12T17:34:00.000-05:00

This is from an e-mail I received from the APTA today... help out... even if you are not a PT and can understand where we are coming from please contact your legislator... it makes a difference (if you do not know how to contact your legislator please send me a message and I will try to help you out)

DON’T LET PHYSICAL THERAPY BE CAPPED AND CUT –

CONTACT CONGRESS NOW

Physical therapists, physical therapist assistants, and the patients we treat must tell their Members of Congress to act now on the Medicare therapy cap and proposed fee schedule cuts! If Congress doesn’t take action, beneficiaries will lose the exceptions process that protects them from the Medicare therapy cap and PTs will face a nearly 10% cut in payments starting January 1, 2008.

Currently, leaders of House and Senate health committees are discussing options to resolve the impasse on legislation to reauthorize the State Children’s Health Insurance Program (SCHIP). The House passed bill includes important Medicare provisions and expands children’s health coverage while the Senate version does not have any Medicare provisions. The President has also indicated that he will veto either bill if it arrives on his desk. Passage of health care legislation this year is clearly uncertain.

It is imperative to communicate now with your Members of Congress to cosponsor HR 748/S 450 to repeal the Medicare therapy cap and to pass legislation to prevent the 9.9% cuts in the 2008 Medicare physician fee schedule. Please contact your Members of Congress and their staff about the importance of physical therapy to your Medicare patients and the harmful results if a “hard” therapy cap is reinstituted and payments are cut in 2008.

What You Can Do

It is important that you send a strong message to your Members of Congress to request that they become cosponsors to repeal the therapy cap once and for all. Please contact your Members of Congress and ask them to cosponsor HR 748/S 450 and support legislation to prevent the 9.9% cuts in the 2008 physician fee schedule. You can contact your Members of Congress by calling 202/224-3121 or by utilizing APTA’s Legislative Action Center to Ask Congress to Repeal the Therapy Cap & Prevent Fee Schedule Cuts. You can write a letter or e-mail to your Members of Congress regarding this important issue.

In your call or letter to your Members of Congress, include specific examples of your patients that will be affected if the therapy cap is imposed again. Also, have your patients contact their legislators. Provide them with a letter they can sign and you can mail or have them access APTA’s Patient Action Center on the therapy cap . If you have any questions please contact APTA at 1/800-999-2782, ext. 8533.

First week of classes

2007-09-11T22:17:00.000-05:00

The semester is a little different than I thought... but in a good way... except there is more reading than usual which I need to get back to... but I also want to share with you...

One article we had to read is Blau, 2002 (PT Journal) <--not proper referencing format, but I am tired so :P

This article involved interviewing 5 PT's (all female) who worked at a hospital for 4 years where there was a large amount of systemic change... five main themes emerged (four of them negative): loss of control, stress, discontent, disheartenment, and yet a "silver lining" in their work lives. There was increased patients (up to 18 a day), increased documentation, and a lack of support staff were the main factors leading to a negative outcome, while the love for the profession and their colleagues seemed to be the "silver lining." There was a lot of mention of burn-out but the experiences at this one clinic (and those mentioned in the lit review) should not reflect the state of PT clinics.

Off to read the other few articles for tomorrow... I am freakin' tired

Mobile Update

2007-09-08T06:35:00.000-05:00

So after I finished clinic, I had almost three weeks off and I spent most of that time coaching high school football and watching movies...among other things. But not too much PT dedicated time. All that is about to flip... except the football coaching.
My last 5 classes of PT school start on Monday so I will be focusing the majority of my time on that. In defense of my extracurricular activities they tend to relate back to my PT education in some capacity. For instance as a football coach I get to see a lot of interesting injuried and get to use some of the skills I have been taught as a PT or even as a former EMT... and man do I just love the game of football, I have as much passion for football as I do for PT...
I should start a football coach blog... that may have too much profanity in it though...

SMART

2007-09-06T18:49:00.000-05:00

This is a great idea I signed up for today and I think many other students should take part in as soon as they get a chance.

Seeking Students to Mentor Fellow Students

APTA's Members Mentoring Members program has a new student-to-student mentoring component, SMART (Student Mentoring: Achieving & Reaching Together). Peer mentoring is a noncompetitive alternative to traditional mentoring that provides greater understanding of day-to-day problems, experiences, stresses of protégés. We are hoping that components will encourage their student members to sign up to be a SMART mentor! Interested students can find out more about the SMART program online. Both SMART mentors and protégés must be APTA members.

And I want to thank Lloyd for the kind comments in the "people" post.

Course

2007-09-06T10:46:00.001-05:00

Title: Low Back Pain Examination: A Classification Approach Using Current Evidence

Sponsored by the NY Student Special Interest Group

Presenter: Michael Masaracchio PT, DPT, MS, OCS
Assistant Professor/Coordinator of Anatomy Lab
Long Island University, Division of Physical Therapy

Place: Long Island University, Division of Physical Therapy
1 University Plaza, Brooklyn NY, 11201 Room 230

When: Thursday, September 20, 2007

Time: 5:30-7:30

Description: Low back pain (LBP) continues to be a prevalent and costly problem in our society. Clinicians use a variety of examination techniques and approaches to evaluate individuals with LBP. Recently, an updated classification system has been presented to try to identify subgroups of patients likely to benefit from certain interventions. The purpose of this course is to understand the current classification system that exists for LBP and try to group patients into an appropriate category using scientific evidence.

Contact studentpt@gmail.com for more info or directions (or for directions go to: http://www.brooklyn.liu.edu/location/directions.html ).

People

2007-08-23T22:05:00.000-05:00

A lot has happened since my last post. There has been death and birth, marriage and break-ups, injuries and healing. I have also finished my second (of 4) clinics. Learned a lot, been very busy and now am packing for football camp. I am looking forward to relaxing up in nature. Have a lot of PT to catch up on and digest but for now I leave you with this quote:

“Learn avidly. Question repeatedly what you have learned. Analyze it carefully. Then put what you have learned into practice intelligently.” - Confucius

Getting It In

2007-08-14T05:41:00.000-05:00

Sorry for my delay in posting... to all my loyal readers...

Things get pretty busy around here... that is all I am really writing to say...

I am going to be discharging a patient or two today, evaluating a patient who has mastocytosis (a systemic condition with abnormalities in the mast cells), finishing up my case study and in-service... I am not going to go into all of the extra-curricular stuff at this point, just know I am highly motivated to get it all done somehow...

I leave you with the quote off of Frank Sinatra's tombstone... "The best is yet to come"

TA & Ankle DD

2007-08-07T05:23:00.000-05:00

It's felt like a long time... but the summer seems to really slow things down...

Muscle of the week is the Transverse Abdominus. The main core muscle. It originates from the deepest layers of the thoracolumbar fascia and will come forward to pass deep to the rectus abdominus (the 6-pack muscle).
It's action is to compress and support the abdominal viscera (your guts and such :).
In 'activating your core' this is the first muscle to fire during trunk flexion and extension for stabilization.
Strengthening this muscle can help with a multitude of diagnoses including low back pain.

Speaking of diagnoses I will be evaluating a patient with complaints of ankle pain. While her symptom that it hurts most in the morning is usually very indicative of plantar fascitis, we will still be going through as thorough an eval as is possible in the hour we have.
Differential Diagnosis (DD) can be very tricky mainly because there are so many things that can go wrong. There are generally four categories that many musculoskeletal pathologies can fall under: connective tissue issue, inflammatory process, a combined 'disorder,' or fractures. Just for the ankle and foot in a very simplified DD approach we can break those 4 categories into about 30 possibilities. That's when we start playing detective.
I am almost at the end of my morning commute so I bid you adieu and look forward to sharing more with you :)

Mobile Muscle

2007-07-27T05:43:00.000-05:00

I am enjoying mobile blogging. The main problem is I cannot link to other sites or add pictures with any ease.... ah well

Today's muscle is the subclavius. You have one of these under each clavicle (L/R). It lies underneath the pectoralis major in your chest. In some patients/clients this muscle being tight can cause restrictions in shoulder mobility. When this happens we (the PT or the patient) can mobilize the muscle (aka move it around) to loosen it up and get rid of that restriction.

The muscle originates on the 1st rib and costal cartilage.
It inserts on the inferior middle 1/3 of the clavicle.
It is innervated by a very well named nerve: 'the nerve to the subclavius'
It's actions are to:
1) Aid in respiration
2) Anchor and depress the clavicle
3) Prevent lateral displacement of the clavicle

Runnin' Late

2007-07-26T06:05:00.000-05:00

I am sitting on a delayed train that is going to make me a little late to clinic. Always a strange feeling to know I will be late... I really don't like being late, but it is kind of out of my control here...

So even though I have approximately 282 days left until I graduate many people are asking me what area I would like to work in when I get there.
I still have two 11-week clinicals to experience and five classes to help guide my decision. My ideal job would be to work with the Jets or Yankees as they are my favorite sports teams and I enjoy working with athletes. I would also enjoy being able to treat the kids I coach in high school football.
Another option is working in a hospital setting (probably acute care) because there seems to be more stability and a very nurturing nature inherently.
Anyway, the train is getting goin, I'll keep thinkin as the time takes me closer to graduation... off to learn!

Train Post

2007-07-25T08:42:00.000-05:00

On my way to clinic, thought I'd check in...

Muscle(s) of the week:
I Love Spinach

This is the mnemonic we used to remember the divisions of the erector spinae (ES). The ES is the main group of back muscles that extends from the base of the skull to all the way to the sacrum. The main action of the muscles workin together is extension of the back (moving backwards). I wish I could include pics but I'm just on my treo but I will try to find some when I get full internet access.

Iliocostalis (lateral)
Longissimus (middle)
Spinalis (medial)

Reviewing anatomy 2 yrs after first learning it is very useful... I go now... happy Wednesday!

Yay CityTri

2007-07-20T21:55:00.000-05:00

Last Saturday I had a great time (despite how early it was) being a medical volunteer for the CityTri event: Coney Island Adult & Kids Aquathlon. As a med. volunteer I was looking out for anyone with any musculoskeletal complaints and was ready to handle most other medical emergencies with my EMT background (or to refer them to the ambulance down the street :) Fortunately, there was not a single need for me, thus making me a little upset I did not participate in the quarter mile swim and two mile run...
I am still trying to enter any athletic competition in the tri/bi-athlon sphere... one of these days... for now I will keep training and volunteering while I continue to learn all about what I am doing in PT school.

Just wanted to say thanks to CityTri for having me and I look forward to participating in future events in any capacity...
I Tri / I Du / I Did

So go do it!

Yay Advance :-D

2007-07-19T21:16:00.000-05:00

On May 11 of this year I erred and wrote a relatively negative response to what I thought was a snub of my quotes that were given for an article about the The Physical Therapist Student Loan Repayment Eligibility Act (H.R. 1134). The text of the article can be seen here as the last article on the web page. The confusion on my end is that there are multiple ADVANCE magazines. While I subscribe to ADVANCE for PT's & PTA's and was upset when I saw an article on the same topic without my quote there, I failed to realize the reason for this was that the article was published in ADVANCE for directors in rehab... so I apologize to ADVANCE for my confusion and would like to thank them again for their giving me an opportunity of being able to speak out on a very important issue in the world of PT. Furthermore, I highly encourage anyone who is a director in rehab or a PT/PTA (or students) to pick up either version of ADVANCE as their content is always excellent.

In other news, I had a day off today and have a lot more to talk about than usual.

Today I finished reading Reversal: When a Therapist Becomes a Patient by Eric Anthony Galvez, DPT, CSCS and friends. The book was excellent and I highly recommend it to anyone. It is useful for preparing you for dealing with a medical condition in which you lose a lot of your former everyday function and dealing with a very staggering diagnosis such as having a golf ball sized brain tumor. The book is also very useful for giving a patient's account to health care professionals. I certainly wish that this was assigned or even recommended reading for the "Psychological Issues" class that I took my first year in PT school.

I feel the book has made me better suited at dealing with patients who have gone through numerous medical procedures that threaten their livelihood and have lost the ability to perform many daily tasks and even have trouble walking. Best of all it was an easy read and filled with delightful candor and very emotionally warming stories. I have more to say about it but I am tired and have to be up real early in the AM.

I worked out today, which is part of the reason for my current state of being tired... I need to go make some PB&J and get my clothes ready for tomorrow... and maybe even make sure I plan my treatments for the patients I have a responsibility to... :-D

Hope everyone is smiling...

Physical Therapy vs. Therapist Assistants

2007-07-13T23:32:00.001-05:00

I recently had a discussion with a PTA about this particular topic: why do some sources refer to the position as a "physical therapy assistant" vs. a "physical therapist assistant"? My general understanding is that the latter is the preferred and accurate term, especially since the APTA says so :) but also because in speaking with a number of PTA's the "therapist" title was preferred and more accurate in nature.

This led me of course to google (the ultimate research tool - don't tell that to my EBP professor's). I typed in "physical" and "assistant" to see what came up more. While the first result was for "therapy" the other 6 of the top 7 displayed were for "therapist". I visited the one site that was for a "therapy" assistant and ended up sending them the following message to the "contact us" section of their website:

I recently came across your page about the "Physical Therapy Assistant".

I would just like to point out that according to the American Physical Therapist Association (APTA) and numerous "PTA" programs and PTA's that I have spoken with, the correct phrase for their position is the "Physical Therapist Assistant". The emphasis of course on changing the "therapy" to "therapist".
Please take this change into consideration as it is more reflective of the true nature of the position and more accurate with industry standards.
Thank you.

Keep in mind that this is from allalliedhealthschools.com and I would imagine is a fairly popular website as it was the first result in my google search (this could just mean google found it to match my search phrase - not 100% up on google search results). For further informal research, I googled the terms "physical therapy assistant" and "physical therapist assistant" with the following number of results:

"...therapy..." - 889,000
"...therapist..." - 1,260,000

So this was fairly close. Looking through some of the results, the "therapy" group had some results due to some kind of error because (for instance) I searched through the APTA linked result for "therapy" thinking this was interesting but there was no mention of "physical therapy assistant" on the page just a mixture of those three words, which I thought was not supposed to pop up on google if you put the phrase in quotation marks... Also, I discovered that if you hit the "search" button more than once, you actually get a very different number of results. From my random number of clicks, it fluctuates between only two numbers, but I am not sure why or even how this can happen with such a wide range.

At the same time, I feel like two or three insignificant letters shouldn't be a big deal... but alas they can be very significant and when taken to meaning can mean very different things. In the end I support the APTA's stance and believe in consistency throughout the medical field to help alleviate some confusion and to avoid upsetting people such as the wonderful PTA's in this case who may be offended by a false characterization.

That was that, this is now... sleep...

"Day off"

2007-07-12T21:31:00.000-05:00

NYC had some amazing weather today... the kind of weather cities like San Diego probably have 80% of the year... but I took advantage by riding my bike 12 miles to school (and back). Since I had a day off I took my time at school to work out, did some weights, ran on the treadmill, stretched out, and swam 72 laps (1800 m). I finished up just in time to go to a continuing education course.

Now why would a student go to a continuing ed. course? To learn! Even though this is considered a fairly advanced course, in my 3 hours there today I learned a good deal. Greg Johnson was kind enough to let me audit - so I take this forum to thank him again. The name of the course is Functional Mobilization [of the] Upper Quadrant (check out the link for course description and some reading for the course). There was a good deal of lab that I could only observe but the lecture was very informative. Greg Johnson spoke about dural restrictions and axial elongation to un-inhibit a central inhibition that is causing a peripheral weakness... ya dig? They were going to begin talking about vestibular issues when they returned from supper, but I had to take my 12 mile ride back home before it got dark and to prepare for clinic Friday... the course will go strong until Sunday so hopefully I will have a chance to stop by more of it. As a student there are many chances to "audit" these kinds of courses and I strongly encourage you all to take advantage, because once you are a "professional" it costs a lot of money to get this kind of info (especially at the high level that Greg Johnson offers).

Off to sleep, bye kids :-D

My Day

2007-07-11T20:02:00.000-05:00

Prelude: "we" refers to either me and my CI or me and the patient/client... and generally we call everyone "we" work with a client...

I was in from 10:15 AM-6 PM

Started at 10:15 with a client who has MS and some hypertonicity mainly in her right hip. We worked on some manual resistance for upkeep with some patient education and she came to use our UBE which she can't access in too many other locations as they are rare and she also gets around with a scooter.

10:45 I had a client s/p a RC repair. We have been working on increasing his ROM through loosening up the restrictions around his shoulder from the injury (including the surgery). He had adhesions and tender points that we have been able to almost eliminate. He is still very tight in the periscapular area probably because of the muscle guarding he tends to have in the right shoulder to minimize the movement of that shoulder which we try to get at with some PNF scapular patterns. We warmed him up with some moist heat before we started treatment. He had some real tender points in the teres minor and supraspinatus on the side of the repair that were worked out with SCS.
Then we went and did a lot of shoulder exercises... I won't go into details here...

My CI was treating the next patient so I caught up on my paperwork, then had lunch, ran to the registrar to get some loan stuff done... I don't complain about loans enough but BOO LOANS!!! (another entry, another day)

Got back at 1:15 for a client who sprained her L ankle and had some RSD symptoms but nowhere near a true RSD, she was just sensitive to deep pressure on the area of the injury. She mainly had some remnants from the ankle injury, some tight peroneals (or fibularis muscles as some "official" tried to change it to --> check out this site that I just found - pretty cool). We are working to get her ankle stronger, increase proprioception, all for a better gait and future prevention of further injury. The ankle was also starting to go up the kinetic chain and affecting her knee, hip and back, so we are making sure we minimize that and prevent it the best we can.

As I finished up that client I took over the exercises for another client who had cervical, lumbar, and knee pain. We did plenty of work on the reformer including squats, heel cord stretching, bridging, etc; worked on the recumbent bike; to finish up we put IFC e-stim on her cervical and lumbar spine, moist heat over the back, and ice on the left knee.

My CI was treating pt's that I observed in between some paperwork.

At 4 my hopeful tri-athlete client came in who recently had arthroscopy on her right knee to repair her meniscus. She is a little more aggressive than she should be, but we keep preaching to her to ease up. Her patellar joint mobility was a little less in the R than the L today so I did a few patellar glides to free that up before we worked out. We then went over to the reformer for similar exercises to that last pt. with more focus on the VMO with External Rotation squats. One of the important ideas we stress with this client is to avoid how deep she squats in any aspect of life, even tying her shoes as deep squatting puts a great deal of weight on that just repaired meniscus and could reverse the positives. The benefit of the reformer is it places the individual in a gravity minimized position thus lessening the forces on the joints and allowing for movement that is less stressful on the body. We then moved over to the cable column to do some resistive walking which is very functional and helps build strength and proprioception. We then got on the treadmill which was pseudo-emotional for the client as it was her first time back on one since before the surgery. We only did 3 minutes fwd, and 3 bwd at 2 mph and 1.5 mph respectively. She jumped on the bike for 10 minutes and then we put some ice on that knee to help the healing process along.

The rest of the time I met with my CI to talk about the day and the overall progress I am (or am not:) making. Good day. I know it is a lot slower than a few of my classmates are used to, but I am learning a great deal every day. 'Till the morrow...

On a side note kudos to espn, and mike and mike in the morning for their support of the V foundation... cancer is an ugly word and in order to erase it we need more research which needs more money... keep fighting.

My favorite muscles

2007-07-09T19:35:00.000-05:00

First to the trivia...

Longest muscle in the body... Sartorius
Strongest muscle in the body... read the wikipedia explanation...
# of muscles in human body... 639 (some sources say 640)
# of bones in human body... 206

Smallest muscle in the body... The stapedius...

The Stapedius is located deep in the ear. It is only 5mm long and thinner than cotton thread. It is involved in hearing.

Nate's original question was what is the muscle with the most amusing name..

While I enjoy reciting some of the names out loud... especially with unique accents...

the zygomaticus, politeus, sartorius, anconeus, buccinator (teres minor - you know you are a PT geek when muscles have sentimental value to you)...

Staying away from the "immature" ones, I think the funniest is the (extensor) digiti minimi, but not by much... also what's funny is the variation in how people say the muscles, that takes the comedy to a whole new level

Off to treat some sway-back posture, peace

Back in Brooklyn

2007-07-03T20:21:00.001-05:00

Denver was energetically exhausting. The conference had so many great PT ideas flying around, so many 'celebrities of PT' that sleep becomes secondary. So all that energy I gained is slightly counteracted by the sleep debt I have to my body. But well worth it... See you in valley forge, PA...

Anatomy review:

Teres mInoR
-O: superior lateral border of scapula
-Ins.: inf. Facet of greater tubercle
-Inn.: Axillary n., C5-6 (5 is primary)
-Action: ER

Teres Major
-Origin: inferior angle of scapula
-Insertion: medial lip of interteburcular groove
-Innervation: lower subscapular n., C 6-7 primary and C8
-Action: IR, Sh. Add.

I list minor before Major b.c minor is superior to Major in the body... Not that it is better than, simply that it lies closer to the head... Also I generally try to capitalize Major and keep minor lower cased to help distinguish TM from Tm when abbreviating in my notes... Lastly and most importantly mInoR does External Rotation-ER despite having an I and R in it, so the opposite letters help me remember... With a lot of things in the body one needs some silly mnemonics to help remember...

Next time I will respond to Nate's comment and list the funnest named muscles...
This entry written on the Treo

Retroactive Taxi Post

2007-07-01T17:12:00.000-05:00

Just ran out of clinic and am on my way to denver in the cab (to the airport...not a cab to denver)... thought I would blog some thoughts into my treo 650 to get to you-the reader.

I've been following two interesting debates over the past few days:

1) The advertisement of PT. On blog.evidenceinmotion.com, there was a good discussion that was sparked by a display in rockerfeller center in NY that promotes PT's role in diabetes prevention/management. A major issue with PT is how wide our scope is. It can be confusing to not have a specific area associated with us (as it should be 'bones and muscles'). But the nature of PT makes us not want to pigeon hole ourselves since there are so many 'niche' parts of the profession. We have 18 specialty interest sections that combined have around 43 special interest groups which get more specific into 'niche' areas... Bottom line is it is still difficult to define PT because we can do so much... But I will elaborate further when I'm not in a taxi

2) This is one I have been exposed to through my current clinical experience. As I have previously mentioned there is a large focus on myofascial work and positional release therapy (these both have many names from what I can tell). Today, my clinical instructor was explaining to me her rationale for using fascial work to correct an anteriorly rotated left hip. The main manual therapy technique we had received at this point of my education for such a condition was a muscle energy technique. My CI explained her thinking that the MET would not 'cure' the problem and it would likely return whereas with the myofascial work it would be a much more lengthy release thus being a longer term fix... Anyway it got me thinking about the timeliness and effectiveness of various PT interventions which I would love to get more into but I just got to the airport and have to catch my flight...

I do not currently have the ability to hyperlink you to some of the phrases in this entry so if you want elaboration on any of the phrases I mention always feel free to shoot me a comment or e-mail and I would be glad to field each question as best I can.

Denvah... (spencah?)

2007-06-28T17:09:00.000-05:00

so PT 2007 is goin great, I wrote a long entry while in the cab to the airport that I haven't been able to publish so these may end up backwards. I spent 14 hours getting to denver from ny, which is about 8 hrs more than it had to be but could have been much worse...
right now I am in a lecture about defensible documentation (not so much by choice...) but it has many interesting and vital points that all PT's need to be aware of.
These conferences are always such an enegy boost even though they tire me out because of the intense pace that ends up happening. So much to learn...
Being here has again made me realize how bad I am at remembering names... I recognize so many of the faces but the names just slip my mind... guess I need some brain room for PT stuff... as a note to self I want to add a 'muscle of the day/wk' to the blog, stay tuned for that... back to my ushering duties... if you aren't at this conference make sure you go to valley forge for nsc or nashville, TN next feb. for CSM, all the best... I hope this goes through :)

Denver...

2007-06-25T22:01:00.001-05:00

In week 2 of my 9 week clinical affiliation I will be leaving half way through to go to Denver for the APTA's Annual Conference. There is a lot of great programming and I hope to meet some great candidates for next years student assembly board and nom com.

It has been rough writing entries whilst in clinic due to the physical and mental time commitment this requires. I had a similar decline in the frequency of posts during my last clinic affiliation as well. I hope to keep up with it as best I can for all your sakes :-D

I received a comment today on my last post and it was in what appears to be Portuguese, so I hope to translate it before allowing it to be on the site. The individual had a link to what appeared to be a blog of unique t-shirts... perhaps, we shall see.

In clinic I feel I am progressing well. Still seeing a lot of myofascial work, strain counterstrain, proprioceptive neuromuscular facilitation, and using various electrical modalities along with heat and ice. Each patient gets a minimum of 45 minutes and I certainly enjoy the time we are given. I really enjoy the care I am taking part in for these patients/clients and as cliche as it may sound it may sound I am excited for the day every morning when I wake up. Speaking of which I have to be up in less than 6 hours so I bid you all adieu.

Hope to see some of you in Denver for Annual Conference, and if you are a student PT or PTA I strongly urge you to consider running for a student assembly position as the deadline is really closing in on us (July 1st!). Election information, it's not too late... even if you aren't a big fan of the APTA, this is actually a great way to get involved and try to influence it to meet your vision of what the PT field should be doing. Have your voice heard and run!

I apologize for the bad photo editing and for those of you that don't know the face is of the current APTA Student Assembly President...

Clinic 3 days in

2007-06-20T21:46:00.001-05:00

Need to go to sleep, but wanted to get this down...

Clinic is going great, learning a lot, seeing interesting patients...

Big focus in this outpatient ortho clinic on fascial release and the use of the very interesting strain counterstrain (mentioned in the last post)...

Most interesting patients in terms of diagnosis thus far have had a partial tear of the medial head of their R gastroc in a surfing injury and another patient had a fairly rare condition called meralgia paresthetica.

I am really focused, grateful and enjoying the experience.
Hope you are all staying healthy!

SFTR and SCS

2007-06-14T20:40:00.001-05:00

Firstly, as you can tell by the title there is a lot of alphabet soup in the health care community...

Secondly, here are two interesting things I read about today...

Range of motion (ROM), which is how many degrees of motion a joint in the body allows in a particular direction, is normally given in regards to one movement at a time (i.e. the shoulder starts at 0 degrees and can flex aka move forward to 180 degrees [normally], this would be documented as R shldr flex 0-180).
An alternative method of documenting, which according to the Norkin text is not used very often in the United States, is the Sagittal-Frontal-Transverse-Rotation (SFTR) recording method. These 4 words describe the different planes of motion (note that coronal is another name for the frontal plane and rotation involves multiple planes). So in the sagittal plane, which is pretty much forward and backward, shoulder movement would normally be 60 degrees of extension, neutral would be 0 degrees, and flexion as stated previously would be 180... this would be documented S: 60-0-180 degrees).
As another note on ROM "normal" is very variable and usually the most important "normal" is to compare the amount of motion to the other side of the body (the "normal"/healthier side). As an example, shoulder flexion has been found to be "normal" anywhere from 150-180 degrees which is a fairly large discrepancy).Moving along... on Monday I start my 2nd clinic and my clinical instructor has recently had a case study published in JMMT. The focus of the case study was a patient with complex regional pain syndrome I (CRPS I - previously knowns as RSD) that was treated mainly with Strain Counterstrain (SCS). This technique in my brief understanding consists of locating tender points and placing the patient in positions of comfort (POC's) for a period of time (usually 90 seconds) to help "release hypothesized fascial restrictions" or "shorten the muscle tissue containing the involved hyperactive muscle spindle" (refer to this article - .pdf).

Off to rest before the 9 weeks of clinical learning... lookin forward to it...
hope you are all doing great out there and thanks for reading :-D

Take My Pulse

2007-06-13T19:40:00.000-05:00

Here's an article I wrote for the APTA student assembly PULSE:

A few years back Al Gore invented something called the internet*. Since then it has grown a little. Now the internet has information on almost every topic. So what about “Physical Therapy”?

Hopefully we have all been to www.apta.org, which provides a wealth of PT related information and offers students a chance to interact through the “message board.” Another way to utilize resources on the internet is by accessing the numerous websites where you can search for literature related to PT, such as pubmed.gov and PEDro. Hooked on Evidence and Open Door are tools that can be accessed through the APTA website to search for literature. There are also numerous Web 2.0 tools that help bring PT into focus.

Web 2.0 is an interesting concept. It refers to a perceived second generation of web-based communities and hosted services — such as social-networking sites, weblogs, and wikis — that facilitate collaboration and sharing between users. People interested in PT can come together in groups such as MySpace.com, Facebook.com, Yahoo Groups, and even MyPhysicalTherapySpace.com. This last website was created by the EvidenceInMotion team to facilitate PT communication in a Web 2.0 way. Their other website evidenceinmotion.com is another very useful resource for our profession with a strong emphasis on evidence based practice. On the blog section of this site you can join in or follow along with some of the most innovative PT’s around as they discuss the issues we face in today’s health care environment. Another very good “evidence based” focused PT blog is can be found at http://weblogs.elearning.ubc.ca/physio/.

Feeding off this blog craze I myself decided to start such a blog as a student: http://studentpt.blogspot.com. My intent was to share my experiences with my program and get feedback from other students on similarities and differences with their programs. As I have continued updating my blog I have realized the mass of information available on “the net” and that students already have enough to read with lecture notes, textbooks and tuition bills, so how will they ever get to some of the vital information out there when it is scattered in so many places? More often than not there will be information missed, but careers will go on and the most pertinent information will find its way to where it needs to go.

One solution that the APTA Student Assembly Board and Nominating Committee have implemented is the Student Liaison Network. Information is filtered for the most urgent topics and disseminated to those in the network. Any student or faculty member can join the net work and become a liaison. All who are interested are encouraged to join to help share the information provided with their fellow students. To learn more and become a member of this network go to the APTA website, click on “students,” then “student assembly,” and then “student and faculty liaison network.”

As we move towards VISION 2020 the internet will obviously play a vital role in numerous aspects of our profession. How you choose to utilize this tool is up to you. For more technical support come join the discussion on the APTA student message board.

*Al Gore did not actually invent the internet despite what he may be yelling below...

Vacation all I ever wanted...

2007-06-11T22:21:00.001-05:00

I didn't mean to quote the Go-Go's there...

I had a date with the boardwalk at sunrise the other day... it was a good run at 5:25 AM... did the boardwalk back and forth in 43 minutes (it's just over 5 miles supposedly)... Sopranos series finale was decent, it made sense to me, and I didn't mind them leaving it open-ended... hearing all the slack about the episode is a little disheartening as people just need to enjoy it! But it's a free country and so on and so forth... The Yankees are getting their act together, luckily the season is 162 games long so they still have some time...

So this is my week off before a 9 week clinical in an outpatient site. Just taking the week to relax and get mentally prepared. It is supposed to rain all week here which puts a damper on my vacation, but I suppose people in Seattle (the picture changes) deal with it right?
(Although it actually rains more in NYC than in Seattle...)

If anyone is in NYC in July-August you should check out this fantasy fitness speed camp... I will be there, so should you :-D

That's all for now,
Good night and good luck

Pre-Final Post

2007-06-06T22:40:00.000-05:00

Warning: This post lacks a focus...

In my procrastination of studying/cramming I happened upon the EIM blog and there was a great quote I wanted to share (it perfectly expressed a few feelings I had in my head). These guys are doing such a great job and I wish them all the success in their endeavors cause it means so many great things for so many patients.

We believe that physical therapists are the heretofore unrecognized solution to many of our health care system's woes when it comes to managing musculoskeletal conditions. We are about 2-3% of the health care dollar and dwindling due to other things getting bigger. Despite what people think about our growing profession, we are actually shrinking relatively speaking compared to overall medical growth.

In other news, I swam 100 laps freestyle today, with only two breaks to adjust my goggles. My technique's and endurance are getting better every time I go out there.

So what of this final and class I have been taking? In addition to valuable manual techniques that we were taught, the ultimate goal of the class is to help us improve our clinical decision making abilities. In parallel to what will happen to us very soon, we are given a patient with a history and we have to rule out certain conditions, make sure they are appropriate for PT (within our scope of practice), come up with our own initial diagnosis, explain some treatments for it, and give a prognosis. I am grateful for classes like this as they are the meat and potatoes of what I want to be doing as a PT.
Furthermore, recently I have had a good deal of time to be reflective and would like to say how grateful I am for the gifts I have in my life and that we as humans have. Obviously some have it worse than others but it is necessary to be thankful for what we do have. And I also want to say "thank you" to anyone who is a good parent. From my short time babysitting my sister's kids I love them, but could not imagine doing that 24/7 and holding all the responsibilities that come with it. I am sure I will get that chance soon enough and I will rise to the occasion but it is such an amazing feat. So this is my unofficial tribute to the parents out there.

Penultimate

2007-06-05T22:36:00.000-05:00

Had my penultimate class for summer I... lot of case studies... all leading up to the final on Thursday which should be mostly case studies... then a week off, then 9 weeks of clinic... see you all soon :-D

2007-06-01T08:14:00.000-05:00

It's June already... boy, time flies...

I only have two classes left for this semester and then the final. It seems to be case studies the rest of the way and I like it. This gives me a chance to combine the knowledge I have gained from many different classes and apply it to one situation at a time. As a side note to this thought and a reflection on my last post, I have to say that mistakes made on exams and practicals are the ones that stick with me longer and thus I am a lot less likely to repeat them; it is all part of learning...

Moving along, I have been getting in better and better shape as the days go on, and the summer is a great time to get into even better shape... I encourage you all out there to make sure you are getting your AHA recommended minimum of 30 minutes of moderate intensity exercise most days of the week.
As I start to make my way into the world of marathons and triathlons I am just starting to get my name out there to be a medical volunteer. I look forward to the experiences I can gain in this arena with these very interesting athletes.

This post is just a plethora of thoughts...
I wanted to recommend the Hospital for Special Surgery eNewsletter (click on this link to register)

And I leave you with part of the lines I will recite for my niece's naming ceremony this weekend (it is her birthday today, happy birthday love!):

May you live to see your world fulfilled.

May your destiny be for words still to come

And may you trust in generations past and yet to be.

May your heart be filled with intuition

And may your words be filled with insight.

May songs of praise ever be upon your tongue

And your vision be on a straight path for you.

May your eyes shine with the light of holy words

And your face reflect the brightness of the heavens.

May your lips speak wisdom

And your fulfillment be in righteousness

Practical Exam

2007-05-29T23:01:00.000-05:00

So my 5 activities I had to perform earlier today were:

infraspinatus tenoperiosteal deep friction massage (lost 8 points for not being close enough to the tendon - I was a 'lil nervous - our professor is an intimidating 'lil greek man)
mulligan flexion for L3
mid-thoracic "locker room" distraction manipulation - standing
mulligan for lateral epicondylitis
taping for lateral rotation of the patella (lost 8 points for not manually placing the patella into medial rotation or even neutral and not identifying the pre/post tests which would be squatting or climbing stairs, this is pretty bad on my part)

I did good on 2-4, but in the end am not happy with my performance as I should not have lost any points had I been a little bit more confident and better prepared.

But moving along, as I listen to the recorded lecture of the class I missed about the McKenzie concept. We have only 4 more days of this class left, it just flew by. A quiz this Thursday and the final next Thursday (the final is 46% of the final grade) with a lot of case studies in between. Should be a fun ride...

A Memorial Post

2007-05-28T11:32:00.000-05:00

Hope everyone is enjoying their Memorial Day off and hope everyone remembers why it is we have this "holiday."

Last week was very interesting for me. Got down to the end of the House of Delegates of the APTA. My buddy from MGH did a very in depth run down of the proceedings.
Also, the APTA published a few of the results on their ptbulletin.com page. As I have a tendency to do on this blog, I will avoid my opinions directly for or against main decision making body of PT. Generally I support their track, and short of a possible vote and voice I may one day have and the grassroots opinions I may influence, despite all of my "activism" as some may call it, I still have very little influence on any of the motions so for now I am monitoring the process and will hopefully one day have a greater influence on the direction. This brings me to a great quote that I received after attending the Advocacy Academy and PT Day on Capitol Hill down in DC:

We in America do not have government by the majority. We have government by the majority who participate.
Thomas Jefferson, 1787.

The event seemed to be a great success and was a great experience for me personally. Apparently we got 57 co-sponsors on the 3 bills we wanted co-sponsored which is pretty impressive for a one day turnaround. Even more so when you consider that Congress had major votes that same day and a 10 day vacation starting after that vote... hopefully a lot more co-sponsors come around on behalf of our profession and our patients. Very exciting process and I highly recommend the Advocacy Academy experience to anyone who wants to understand how the government works (I am sure APTA will host another one next year).

Now I am off to study for my practical on manual therapy skills for tomorrow... all the best to you all as always :)

Plans

2007-05-22T00:04:00.000-05:00

Whenever I wake up I have to do the following in pretty much this order (gonna try to work eating somewhere in there):

Make my arrangements for Denver, home of PT 2007
Go workout after my hour and change commute to school
Take a quiz that covers the Mulligan techniques, Deep Friction Massage, and the two case studies we walked through last week. After the quiz we have 3+ hours of taping lab (it was recommended that I shave around my ankle, knee, and elbow, but I will just tough it out...)
Run to catch the bus to D.C. --> get to D.C. at midnight

One of my professors (real funny guy, btw) recommended that I start adding videos to this blog, so here is one I found that deals with Mulligan taping techniques which will be part of the lesson tomorrow (I think...). Mulligan techniques are very trial and error and are by nature difficult to support with research thus this makes the techniques difficult to work into my philosophy at this time, but I will still learn all I can about it. Enjoy the video (it's less boring if you don't actually listen to the guy... :) Just kidding, it is pretty darn interesting stuff.

Grad Party

2007-05-19T14:17:00.000-05:00

Ran 11 miles yesterday, it hurt... but I still had a lot of energy when I was done, just wanted to put less stress on my joints. Makes me question if distraction of the joints could help the effect of ground reaction forces after a run.

Going to a graduation party for one of the students who just got their DPT from our program. It should be a good focusing point of how close I am to the end, as if I needed another one of those.

Enjoy the weather wherever ye may be.

Clinical Decision Making 1

2007-05-15T22:11:00.000-05:00

For the next month we only have one class in my program (the title of which is the same as the title of this post). Then we get a week off and have a 9 week clinical, followed by 4 classes in the fall and then 2-11 week clinical experiences. Exciting times.

I would like to congratulate everyone who just graduated not just from PT school but from any level of schooling... congrats!

Back to the present class... It is very musculoskeletal based and the second part of the class in the fall is supposedly very evidence-based. For this class we have done a lot of manual skills including manipulations and mobilizations, very exciting stuff although having so much of it done on me for practice has led to a little soreness in my own spine. But as we tell our patients, this can be a normal result and is more indicative that a change has been made within the tissues around the spine. I'm also sore from my tetanus shot (supposed to get one every 10 years as part of my physical).

Speaking of me :) I recently signed up for the NYC Marathon. I am #171778 so my entry into the event is based on a lottery. I believe they accept about 37,000 people and there are many people that have guaranteed entry so my chances are a little slim, but I am training nonetheless. Updates to come... hopefully.

STAY HEALTHY!

'Vacation' Part Duex aka Patience

2007-05-10T11:50:00.000-05:00

This is a continuation of the entry below entitled 'vacation'... I was giving a run down of what was discussed at Lobby Day in Albany, NY just to catch you up. For the record this is attempt two at this post as I wrote a whole entry but because I did not let the page load all the way when I started the entry I lost it all... hence 'patience'...
- Unfair co-pays was another issue we discussed there. Certain companies consider PT under 'specialist' rates which can be $25-40 per visit for the patient. These are the same co-pay rates that neurologists charge. When you see most 'specialists' it is for around 3 visits for the whole episode of care, whereas with PT it can be 3x/wk for a few months. Not many people can afford to pay $75 a week and thus end up not coming in for the care they need. This co-pay setting is very prohibitive. What's more is many primary care practioners co-pay rates are in the $10 range. We as PT's could be considered a 'practitioner of choice' when it comes to musculoskeletal issues.

Bottm line from Lobby Day is there are a lot of issues with reimbursement. Not getting paid at a reasonable rate leads to people not being able to maintain what they would like to be able to do and many PT clinics end up incurring huge financial losses every year until they go out of business.

So now that the worst semester of my academic career is over, there is a lot to do moving forward, I'll keep you all updated :)

'Vacation'

2007-05-09T14:08:00.000-05:00

I am writing this on my phone (treo 650 - I love technology), thus I am really hoping no one calls me while writing this or I will lose all that I write... anyway...

Yesterday I had a long and productive day. Let's back track the events of the last few days first though...
Saturday night was my programs semi-formal, good times lasted into the night...
Sunday went to Mt. Sinai in the city where my cardiopulm professor works to take my final and practical early...
Monday took my Pediatrics final, finished up the evidence based practice narrative review, handed in my portfolio and then swam...
Monday night signed up for Netflix (that's a big step in my life sadly)...
Tuesday at 4 30 AM left my house to meet the Brooklyn/Staten Island district to leave for Albany. We met with numerous assemblymen/women to 'lobby' for the following:
- support a bill the midwives put forth to give them the ability to refer to PT - this is a vital step as many women after giving birth (or even in preparation for this step) need PT. Women's health is a rapidly growing specialty within the PT world. Currently most of the states in America do have some form of direct access (meaning in order to see a PT you do not need a referral) but there are still many problems within the reimbursmenet aspect of this. Only physicians, nurse practitioners, physician assistants, dentists, and podiatrists are the only medical personnel that can refer to PT now.
- Workers compensation rates for PT's have not changed in over 11 years so we pushed a bill to at least allow for a review of this process yearly.
- Utilization issues with certain insurance companies and their claims. Some companies have an '80 percent rule' that states if the patient has reached 80 percent of their opptimal function that is enough. The example we kept giving is that if someone has to walk 5 blocks to get to the bus to go to work and they have only reached 80 per. of that and can only walk 4 blocks, they will not reach the bus thus not getting to work... Phone won't let me write..

My Own Injuries

2007-05-04T00:30:00.000-05:00

Part of the reason I went into PT was because of an ankle injury in high school. Now that I am almost a PT I am getting injured more and more it seems... In my swimming training I probably jumped back into it too quickly and pushed myself too much and thus have caught a VMO (one thigh muscle) and calf cramp in separate sessions. Last week I sprained my right ankle pretty badly and playing softball this last night I sprained my left one (not as badly). I would diagnose myself as a chronic ankle sprainer... also had some bicipital tendinitis probably from overworking my arms in the last two days. I think I need some more protein in my diet to help my muscles recover faster. I feel the knowledge I have gained about the human body is helping me deal with these injuries and giving me a good perspective. By no means am I asking for sympathy for my minor complaints, just thought it would be good babble for this bloggle (I like making new words).
Anyway, here are some of the topics I am covering for my cardiopulm final/practical:

Reading, interpreting, analyzing EKG strips
Measuring chest wall excursion
Postural drainage, chest PT, vibration/shaking
Assisted cough techniques/facilitation of breathing
Mechanical ventilators...
Max/Sub max exercise testing/prescription/screening, reasons to stop the test or stop exercise (e.g. SBP of 260/DBP of 115), calculations of VO2, target HR, etc.
Precordial EKG lead placement
Auscultation of the lungs (Virtual Stethoscope link), breath sounds
Taking BP & HR (both w/in 45 sec.) while pt. is on bike/treadmill
Examination of the Cardiac pt. (Borg scale, Par-Q), taking a history
Exercise physiology
ACSM guidelines (e.g. contraindications to exercise, risk factor stratification)
Analyzing Lab Values (e.g. ABG's)
and much much more... oy...

Pilates & Children

2007-05-03T12:54:00.000-05:00

The two aren't directly related for this post...

Yesterday I got to try pilates for the first time ever. It is something I had wanted to do for a long time, still haven't tried yoga directly. My university offers fitness classes that are very helpful in getting a good workout in. As a health care professional and soon to be PT especially I find them very helpful for generating new ideas and gaining and sharing new knowledge. So far I have only taken the total body class which was pretty intense and now the pilates class. Pilates has a major focus on core strength which seems to be vital for so many aspects of health and function. Unfortunately I also got bad news yesterday: I was too late in registering for the triathlon I wanted to compete in... but I will continue training (probably not as hard since I don't have a direct goal now... I am lost without a goal...) and I will look for the next best challenge, I will keep you all updated.
Now as a review for my pediatrics course here are the topics we are responsible for on the final:

Developmental Coordination Disorder - "The Clumsy Child"
Muscular Dystrophy and Related Disorders
Child Abuse/Neglect Reporting
Spina Bifida
Orthopedic Management in Pediatric PT
Mental Retardation (MR), Attention Deficit Disorders (ADD/ADHD)
Autism and Pervasive Developmental Disorder (PDD)
Management of Cerebral Palsy
Documentation in the Pediatric Setting
Sensory Integration
Traumatic Brain Injury (TBI)
Treatment Planing and Treatment Approaches

The M.O.V.E Curriculum

Conductive Education

Child Tx Based on NDT principles
GMFM and Gubbay Tests of Motor Proficiency

Gubbay is a standardized test for children btwn. 8-12 y/o and includes the following activities:

Whistle through pouted lips
Skip forward five steps
Roll ball with feet
Throw, clap hands, then catch tennis ball
Tie one shoelace with doouble bow (single knot)
Thread 10 beads
Pierce 20 pinholes
Posting box

And I have cardiopulm. to study for... next few days not so fun... next time gonna spread the studying out more... haha

StudentPT

Worth Sharing!

Day 4 of 4

Last Post

Brooklyn Half

Update

Commonly Used Medications Associated With Impaired Physical Function In Older Adults

One In Four Disabled Seniors Use Risky Or Ineffective Medicines, USA

Tumors

Aggressive Rehab for SCI

NY to Philly Bloggin'

Valid Effort from SA-APTA

Meat & Potatoes

Health Tip of the Day - Pain in Side

Loans

Marketing

Links

Exercise During Pregnancy Leads To A Healthier Heart In Moms- And Babies-to-be

Sugar-powered Cars: World's Most Efficient Method To Produce Hydrogen Developed

CPR Standards

Drugs, Surgery, PT

Physician shortage? Turn to PT's

Reimbursement 2

Another Wii Bites The Dust

John Iams/CAM

Another Wii Story

Reimbursement

Quick Post - No PT...

Prevention of Diabetes

More Train Thoughts

Where I Am

More links

Yay OARSI

PT Online

Who Am I?

Update

NPA Think Tank

YouTube Vids

Choosing A Text

Our Healthcare System

PT - Poetic Therapy

Vocabulary energizers

Recent Articles

PT in ICU can help reduce hospital stay

New Year, New Opportunities, New Food Pyramid

Access to Articles

Back To Basics

Monday

Prevention

Caught Up

Goodness Gracious

Stony Brook Conclave

Marathon/200th Post

Rewind

NSC Mobilie Recap

SO Much Info Out There

Soreness After Exercise Not Prevented By Stretching Out

Sports Concussion Education Campaign Being Developed By National Athletic Trainers' Asociation And National Academy Of Neuropsychology

Two Stolen Articles

Google Announces Plans for Health Initiative at Web Summit

Update on Low Back Pain (LBP)

Acupuncture

Case Reports

Yoga Patanjali's Eight Fold Path

Frustration

Just Another Tuesday

Clinical Changes

I am Guilty

Falling through the Cracks - VT and the Restructuring of College Mental Health Services

There are now a few less uninsured people in America

San Francisco to Offer Care for Uninsured Adults

Legislative Action Needed

First week of classes

Mobile Update

SMART

Course

Title: Low Back Pain Examination: A Classification Approach Using Current Evidence

People

Getting It In

TA & Ankle DD