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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Issues at the Statehouse
by Jon Bassett
LAS VEGAS, NV -- A small but committed group of PTs gathered for “Physical Therapy Issues in the State Legislatures: Challenges and Opportunities to Making Vision 2020 a Reality,” a session at the APTA’s Combined Sections Meeting held Tuesday afternoon Feb. 4 in the Venetian Sands Expo Center in Las Vegas.
APTA Director of State Affairs Justin Elliott, well-known as a state legislative affairs guru and known for his “Jeopardy”-style presentations at APTA, brought attendees up to speed on legislative hot topics such as dry needling, direct access, title protection and the encroachment of other disciplines on PT treatments and scope.
Here is a brief rundown.
Medicaid expansion. Elliott’s co-presenter Angela Chasteen, APTA’s senior specialist of state affairs, relayed that the Supreme Court’s decision on the Affordable Care Act was a game-changer for state Medicaid programs, essentially leaving it up to states to implement their own programs. As a result, 26 states have moved forward on expanding their Medicaid services, said Chasteen. And a state’s government is not always a good predictor of how Medicaid will be implemented in that state.
Case in point is Arizona, where Republican Governor Jan Brewer has availed itself of federal dollars to expand the Medicaid program for its residents. This is good news for PTs working with patients covered by the program, Chasteen said.
“If it can happen in Arizona, there’s a distinct possibility it can happen in most any state,” Chasteen said. Florida and Pennsylvania are other big-population states that may be expanding their programs in 2014 or 2015.
Dry needling. Calling it “one of the hottest issues in terms of scope of practice issues in the states,” Elliott outlined state-level efforts to bring dry needling under the scope of PT practice. Acupuncturists continue to battle the APTA on this issue -- cease and desist letters were received in Arizona, Indiana, and North Carolina, and lawsuits have been threatened in Washington and Wisconsin.
APTA’s stance is that dry needling is a “shared intervention” and not owned by a particular discipline, and APTA will continue lobbying efforts to educate state legislatures in that regard. “2013 was a very busy year on the issue of dry needling,” said Elliott. “2014 is going to be just as busy.”
Athletic trainers. Currently regulated in 48 states, athletic trainers have in the last few years looked at their practice acts and have begun state-level legislative efforts to expand their practice scope language beyond sports medicine and athletic training services. An excerpt of NATA’s profile of athletic trainers makes reference to the fact that in other countries, “athletic therapist” and “physiotherapist” are similar titles.
It becomes a matter of reimbursement. “They’re looking for third-party payment,” said Chasteen, adding that proposed bills in Vermont and Indiana would mandate payments for interventions that fall under the state’s practice act for athletic trainers.
Direct access. All 50 states now allow PT evaluation without physician referral -- a “big milestone for the profession,” according to Elliott. Now, the association turns its attention to an all-50-state policy for PT treatments -- Oklahoma and Michigan are the two remaining holdouts, but 2014 lobbying efforts are underway.
Eighteen states currently have unrestricted PT treatment, meaning no physician referral is required following a given timeline or number of treatments – what Elliott called the “gold standard” practice act. Another 18 plus the District of Columbia have direct access treatment with provisions, and 12 have “limited” direct access.
So though the 50-state milestone was reached, direct access is “still a priority for the association,” said Elliott, adding that future efforts in this area will be directed toward federal (Medicare) direct access and tying quality of outcomes to physical therapy direct access.
“We’re trying to pivot the conversation,” he said.
Other legislative fronts include the South Carolina lawsuit regarding physician self-referral, rising PT co-pays, and encroachment of other disciplines including massage therapists, chiropractors and occupational therapists.

"Real-World" Rehab
by Danielle Bullen

LAS VEGAS, NV--"It's normal physical therapy in a unique environment." That's how Christopher Rabago, PT, PhD, Center for the Intrepid, Brooke Army Medical Center, defined virtual reality rehab. This morning at CSM 2014, Rabago was a co-presenter at "Virtual Reality-Based Rehabilitation For Injured Service Members," speaking before a packed ballroom at the Venetian in Las Vegas. He and his physical therapy counterparts at Walter Reed Army Medical Center and Naval Medical Center San Diego explained how immersing wounded warriors in simulated environments aids their recovery process.

Therapists measure how patients maneuver through their virtual environment and how they react to stimuli in that environment. They can assess kinematics and assess data for future use. One goal of VR-based rehab is to engage all the senses, stimulating as close to real-world scenarios as possible. The PTs at these military medical facilities have access to high-end simulators. The Computer Assisted Rehab Environment, aka CAREN, projects scenarios onto a movie screen 180 to 300 degrees in radius.

The patient is on a motion platform with built-in treadmill in front of the screen. The platform itself in the CAREN moves or the PT can set the platform steady and have the surrounding environment appear to move. Both of these help the patient improve their balance.

Depending on the goal of rehab, patients are placed in different settings. For example, a soldier rehabbing to return to duty could be on a simulated Afghan street, practicing dismantling IEDs and differentiating between insurgents and civilians when shooting. A patient rehabbing to return to civilian life could use the CAREN to engage in sports, like skiing. "We use all of our resources to make their transitions as smooth as possible," said Allison Pruziner, DPT, ATC, Walter Reed Army Medical Center.

Fire arms simulators allow the injured service members to manipulate their weapons. Those situations also test their cognitive and emotional readiness in terms of potential return to action. These fire arms simulators are great for training patients with new lower limb prosthetics to re-establish their proprioception. The scene can be adjusted to react to their movements.

One of the biggest advantages of virtual reality-based rehab is that it doesn't feel like rehab, which increases compliance rates. A study of mild TBI patients at Naval Medical Center San Diego showed that wounded warriors who had VR-based vestibular rehab self-reported a better sense of balance versus those who had regular physical therapy.

Of course, not everyone has access to these multi-million dollar machines. Out-of-the box products, like the Wii or Microsoft Kinnect can be programmed to meet the needs of such patients. The PTs at today's talk explained how they prescribe Wii or Kinnect home exercises for the patients to continue after discharge.

Whether high-end or low end, virtual reality has proven to be useful adjunct to traditional physical therapy in helping these service members return to as close to normal lives as possible.



Outpatient Total Joint Replacements? PT is Key
by Jon Bassett
LAS VEGAS, NV -- In western Pennsylvania, an enterprising group of physicians is performing total knee and hip replacements in a select number of outpatients, and sending them home just hours after the procedure.
How does PT fit into the picture? This game-changing protocol relies on a hefty dose of skilled nursing and physical therapy involvement to be successful.
“This is an exciting topic, and without therapists this doesn’t happen,” related Christopher McClellan, DO, orthopedic surgeon and partner in University Orthopedic Center, a five-physician practice in Altoona, Pa. McClellan, who’s been in practice for 9 years and specializes in total joint procedures, delivered the presentation “Same-Day Outpatient Total Joint Replacement and Treatment” along with Dan Casillo, MPT, at the APTA’s Combined Sections Meeting Tuesday morning Feb. 4.
A nurse and physical therapist are waiting for the patient at home following discharge from the ambulatory surgical center just hours after the procedure, said Casillo, who went on to outline the specialized rehab that follows -- which involves more acute-care responsibilities in the first few days.
McClellan told his audience of mostly home care therapists that the idea came to him after realizing that many of the patients in the hospital after total joint arthroplasty did not need to be there, and would have rather been home.
“It’s just a change in thinking,” he said. “Thirty years ago you couldn’t walk on [a replaced joint.] That changed.” Moving to this new paradigm will require a similar willingness to challenge established protocols.
The program is not for everyone – patients are carefully screened for health status, BMI, home and family support, and other variables critical for success. And Medicare has yet to come on board – the 85 patients that have undergone the protocol to date have all been private-insured.
But once word begins to spread, and greater numbers of surgeons, therapists and insurers realize the cost savings, the safety to the patient (McClellan stressed negligible readmission and ER rates, along with reduced incidence of hospital-acquired infections), and most of all, improved patient satisfaction and scores, outpatient total joint procedures figure to be the wave of the future in medicine.
“This is accountable care at its highest level,” said McClellan. “Isn’t this the goal of health care?”
Look for more details surrounding this program in our next cover story.

Safe at Work
by Danielle Bullen

Las Vegas--How can we keep an aging, changing workforce safe and able to work? That was the question posed at this morning's Combined Sections Meeting session "Workforce Trends and Their Impact on PT Practice." Nicole Matoushak, PT, MPT, CEES, CEAS, and Michelle Despres, PT, CEAS II discussed the physiological struggles faced by the aging workforce--in this case, 55 years and older.

 It's no secret the U.S. workforce is getting older. By 2030, it's estimated 19% of the population will be 65 or older. 80% of 50-year-olds plan to work after retirement. So, keeping this population injury-free will be a growing responsibility of physical therapists. Yet it is easier said than done.

The most common injury for an aging workforce is falls. The most common result of those falls are fractures, which take longer to heal with age. There is a slower recovery as people age. For the 55 or greater population, there is an average of 12 lost work days per incident. Compare that to the 25-34-year-olds, where the average lost work time is 6 days. Those injured, aging workers are being treated by PTs for longer than the recommendation duration of care for specific injuries.

Many factors go into this increased falls risk. Strength is 25-30% lower at age 60; flexibility is 18-20% lower at 65. Reaction speed and manual dexterity reduce with age.

Physical therapists might be unaware that common medications prescribed to the elderly population can have unfortunate physiological side effects. Fatigue, weakness, increased muscle mass, increased injuries, and delayed healing time have all been documented

"Sacropenia," from the Greek, meaning "poverty of flesh," refers to loss of muscle size and strength," and it is a major contributor to age-related injuries. By the time someone is 80, they've lost 1/2 their muscle mass.

Fortunately, that loss can be minimized through strength training programs. Physical therapists need to look beyond the current injury they are treating and examine the patient's total health. "We have great opportunity as PT professionals to work on the wellness aspect," said Matoushak."


Bright Lights, Brighter Therapists
by Danielle Bullen
Each year, physical therapy professionals come together for one of the APTA's showcase events-the Combined Sections Meeting.  From February 3-6, thousands of PTs, PTAs, and PT students will descend upon "Sin City" for a one-of-a-kind educational experiences-CSM 2014 in Las Vegas.

The bright lights of the strip won't be the only thing shining at this conference.  After 2 days of in-depth pre-conference lectures, things kick off in the evening of Monday, February 3 with the annual recognition ceremony for clinical specialists. APTA President Paul Rockar will welcome the crowd. A reception, one of several throughout the conference, will follow, so PTs can start the week by letting their hair down.

Whether your focus is neurology, geriatrics, sports medicine, or one of the 18 other APTA specialty sections represented, CSM has something for everyone. Physical therapists from the Cleveland Clinic will discuss "The Implementation of a Multidisciplinary Concussion Care Path," sharing how their facility standardized treatment approaches. Mike Studer, PT, MHS, NCS, CEEAA  and Robert Winningham, Ph.D will present  a lecture sure to be of interest to PTs working in long-term care, "Motivating Apathetic and Depressed Clients." A panel of sports medicine specialists will present "Rehabilitation Considerations for the Female Athlete," offering evidence-based background for the special considerations needed for this population.

One key event every year is the Cerasoli Lecture. This year, Leslie Portney, PT, DPT, PhD, FAPTA will present "Choosing a Disruptive Path Toward Tomorrow." The lecture honors a physical therapist who has made significant contributions to physical therapy education. Portney, of the MGH Institute of Health Professions, will discuss how general issues affecting all of higher education specifically impact physical therapy programs.

Each Combined Sections Meeting is also home to the Linda Crane Lecture, honoring outstanding contributions to the practice of physical therapy. Dianne Jewell, PT, DPT, PhD, CCS of Arcadia University will talk about "More than a ‘White Hat.' Delivering the Substance of Physical Therapy's Value Proposition." Jewell will ask how physical therapists can stay relevant in our changing healthcare landscape.

And of course, the exhibit hall is a major part of the conference. Approximately 500 exhibitors will be presenting their products and services, so be sure to carve out some time to walk through. ADVANCE will be in booth 631, so stop by to renew your magazine subscription, pick up the latest issue and purchase one-of-a-kind PT gear from the ADVANCE Healthcare Shop. You might even run into staffers Jon Bassett and Danielle Bullen.

Yes, the ADVANCE for Physical Therapy editorial staff will be on site at Vegas. We'll blog about sessions, take photos, and update social media. Be sure to return to the ADVANCE Perspective blog the week of the conference and to follow us on Facebook and Twitter to get the latest news from the Venetian and Sands Expo Center.

Looking forward to seeing you in "Sin City!"

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‘Tis the Season!
by Brian Ferrie

In this season of giving thanks, ADVANCE has so much to be grateful for. Besides the rewarding response we continue to receive for our dedicated print reporting on the rehabilitation profession, our efforts to expand web and social media coverage have engaged record numbers of readers and fans.

Just as the rehab profession is constantly evolving and reacting to new developments, so too is the journalism profession. We at ADVANCE take pride in our ability to push the cutting edge, offering our community of rehab professionals vital information about the profession you love, while providing opportunities to share your thoughts on these developments through our various interactive platforms.

In our year-end print issue coming out this week, we're happy to recognize Coury & Buehler Physical Therapy in Southern California as the recipient of our 12th Annual ADVANCE Practice of the Year Award! On our website this month, keep an eye out for Top 10 lists of the most popular blogs and app reviews from 2013 -- which continue to build followers as two of the most popular departments ever offered by ADVANCE.

Finally, we want to thank you. Without our tens of thousands of dedicated print readers, hundreds of thousands of web fans and talented contributors too numerous to name, none of this would be possible. We rely on you for interviews and freelance contributions, guest editorials and reader comments. Your feedback and participation are what enable ADVANCE to keep our fingers on the pulse of the rehab profession. Your passion for that profession inspires us every day. So to all of our readers and fans across the country and around the world, cheers to a great 2013 and here's hoping for an even better 2014!

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Closing in on 50
by Jon Bassett
Only two holdout states remain in the APTA's decades-long effort to allow patients to directly access the treatment of a physical therapist without physician referral. As of this writing, only Oklahoma and Michigan prohibit direct access to physical therapist treatment on any level, according to the APTA.

In Michigan, efforts are heating up. Senate Bill 690 was introduced on Nov. 14 by Sen. John Moolenaar (Midland) and lobbying is now underway in the state legislature to "remove any unnecessary barriers to safe and cost-effective physical therapy services," according to the Michigan Physical Therapy Association.

MPTA has assembled a Direct Consumer Access Portal with tips and tools for contacting state legislators, including a pre-loaded message to send to representatives that the sender can edit as they like. With just a couple of clicks, physical therapists, patients, family members and friends can demonstrate their support of the bill.

View the tool as well as background information on the issue at the MPTA website

Opponents of direct access for physical therapists frequently cite the issue of patient risk as a reason to deny it. Yet according to the APTA, no state that has enacted a direct consumer access law has ever repealed it.

Three days before the legislation was introduced, ADVANCE published an in-depth examination of the question of direct access and patient risk. Check it out here.

And please encourage your friends, co-workers and family members in the Wolverine State to show their support of SB690. Let's get the number of holdouts down to one. You're next, Oklahoma.

Mission Accomplished!
by Brian Ferrie

I did it. On Sept. 15, I attempted and completed my first-ever 13.1-mile race -- the Philadelphia Rock ‘n' Roll Half-Marathon. Although I've been running since I was 13, this particular accomplishment meant a lot to me because my ability to run has been hampered for about 15 years by recurring iliotibial (IT) band tendonitis in my right knee.

I wrote a guest blog post for Philly.com last week about the origins of my injury and how I've tried to manage it. In a nutshell, for most of the past 15 years my efforts to combat the inflammation have consisted of rest, ice, protective knee straps, Ibuprofen, not running on consecutive days and generally limiting myself to about 3 miles when I did run. That was all well and good if the only races I ever wanted to run were 5Ks. But over the past couple years, I became determined to push my limits and stop letting my knee hold me back.

So after doing some research, I incorporated two new key elements into my training. The first was a shortened stride, because I read that keeping it more underneath my center of gravity would decrease stress on my knee and help soften stride impact. The second was regularly using a foam roller to loosen up my hamstrings, quads and IT bands.

The author Brian Ferrie (left) and his friend Bob Gormley celebrate after finishing the 2013 Philadelphia Rock 'n' Roll Half-Marathon.

Armed with these supplemental tactics, I've been gradually increasing my training mileage and race distances since the spring of 2012. I capped off last year's running season in November with an 8.4-mile loop race along the Schuylkill River in Philadelphia, the first time I had run that far since high school. Then I challenged myself early this running season by taking on a 10-mile race in ADVANCE's hometown, King of Prussia, PA. But all the while, I knew my ultimate goal was to complete a half-marathon -- and that judgment day finally arrived this week.

So how did it go? Well, I can truly say it was the most physically grueling challenge I've ever faced. But not because of my knee, which held up great. The course was beautiful and the weather perfect (about 60 degrees with clear skies). Music bands and cheer squads along the way definitely helped keep me going.

My goal was to not only finish the half-marathon, but also run it at 8-minute-mile pace. I actually impressed myself with how consistent a pace I was able to keep -- almost exactly 8 minutes a mile for each of the first 11 miles. At that point, I found myself staring at 2 miles to go and about 30 seconds overall ahead of goal pace. Mentally I felt very good about the position I had put myself in. Physically, I felt like every muscle in my legs was about to seize up. "Just hold on!" I told myself. "You can do it. You don't have to run any faster -- just maintain." Easier said than done, but I willed myself forward.

By the 13-mile mark, I knew I had lost some seconds and it would come down to the wire whether I reached my time goal or not. So I steeled myself to give every last bit of energy I had for the final 0.1 miles, which turned out to be... uphill. My legs felt like lead weights but I forced them to surge ahead and actually started passing other competitors in the straightaway. As the end loomed, I coaxed one last burst of speed out of my spent body and shot through the finish line. Struggling to walk on wobbly legs in the post-race area, I felt overwhelming relief and satisfaction from having passed such a daunting test. 

But did I reach my time goal? I wasn't sure -- and actually thought I might have missed it by a few seconds. Later that day, I pulled out my smartphone and went to the race website in search of posted results. To run at exactly 8-minute-mile pace or better, I needed to finish with a time of 1 hour, 44 minutes and 52 seconds. So I inputted my name, took a deep breath and hoped for the best. My time? 1:44:51! Incredibly, over the course of 13.1094 miles, I had beaten my goal by a single, solitary second. It was an amazing cap to what I already felt was a terrific accomplishment.

Who knows if I'll ever run another half-marathon again? But finishing this one, especially considering the challenges I had to overcome to even reach the starting line, has to rank as one of the greatest moments of my life.

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Pinpointing POPTS
by Brian Ferrie

On Aug. 1, Rep. Jackie Speier (D-CA) introduced the "Promoting Integrity in Medicare Act," according to a press release from the American Physical Therapy Association (APTA), Alexandria, VA. This measure seeks to remove physical therapy and other healthcare services from the in-office ancillary services (IOAS) exception from the federal Stark lawsalso commonly known as self-referral. If enacted, it would effectively eliminate financial incentives from the physician-referral process. The APTA and its partners in the Alliance for Integrity in Medicare, or AIM Coalition, strongly support this move to exclude these services from the IOAS exception.

The self-referral law generally prohibits physicians from referring Medicare patients to entities in which they have a financial interest. It seeks to ensure medical decisions are made in the best interest of the patient on the basis of quality, diagnostic capability, turnaround time, and cost without consideration of any financial gain that could be realized by the referring physician. Originally intended for same-day services such as X-rays and blood draws, the IOAS exception allows physicians to bill the Medicare program for procedures that are meant to be integral to the physician's services and offered for patient convenience. 

"Unfortunately, using the exception in a manner not originally intended provides physicians with incentive to refer patients for services that may not always be necessary or typically provided on the same day of an office visit," the press release continued. "This not only increases utilization of services but also Medicare costs. Physical therapy services clearly do not meet the intent of the exception and self-referral by physicians has the potential to increase costs. Physicians and physical therapists have a longstanding professional relationship that serves patients well without the need for adverse financial ties or relationships."

The argument over physician-owned physical therapy services (POPTS) has raged in the profession for years now. This latest development is certainly a boost to the cause of those who oppose POPTS. On which side of the issue do you stand? What do you believe the future holds for POPTS?

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'The Next Evolution'
by Brian Ferrie

Last week's PT 2013 conference in Salt Lake City offered what has become an annual institution -- the 44th Mary McMillan Lecture. Promoting the theme "The Next Evolution," this presentation featured honorary speaker Roger Nelson, PT, PhD, FAPTA. Currently vice president of expert clinical benchmarks at MedRisk Inc., based in King of Prussia, PA, Nelson is also professor emeritus at Lebanon Valley College in Annville, PA, and a former professor at Thomas Jefferson University in Philadelphia. Overall, Nelson has served the profession of physical therapy and APTA for more than 45 years, including 25 years as a commissioned officer in the U.S. Public Health Service. 

ADVANCE sat down with Nelson after the presentation for a short interview about the message he sought to convey as McMillan lecturer. 

"I saw it as a daunting challenge, and I wanted to offer a message that would resonate with attendees," he said. "So I emphasized how we as a profession need to evolve, in terms of research, education and practice. That includes identifying the value of physical therapy, emphasizing the role of data collection and analysis, while also understanding the importance of cost efficiency. Practices must act as businesses."

So did he believe that the presentation went well?

"Yes, and that was very important to me. I spent the past 14 months preparing and I tried to offer a cogent set of points that combined to present a vision for the future. In general, I think we need to ensure that PT isn't known as a 'commodity.' For example, in conversation people will say they have an appointment with their doctor or their dentist. But they usually don't say they have an appointment with their physical therapist. Instead they say a 'physical therapy appointment.' We need to develop the concept that we're a profession, not a commodity. Although progress has been slow in that aspect, I think we're making headway."

Utah State of Mind
by Brian Ferrie

SALT LAKE CITY -- For the first time ever, the APTA has brought its Annual Conference and Exposition to Utah, and ADVANCE is here to cover all the action. Coincidentally, this is also my first trip to Utah, and specifically Salt Lake City. For those wondering what the place is like, here's a quick rundown. The scenery is beautiful -- Salt Lake City sits in a valley surrounded by towering mountains. It's also hot. Real hot. The temperature is expected to reach triple digits all four days of the conference. But as they say, it's a dry heat -- and noticeably different from the muggy mid-Atlantic summers I'm used to. Finally, there's a very laid-back vibe to the whole town -- with friendly residents and quiet streets.

Last night's opening ceremonies though were certainly not laid-back. The APTA made a concerted effort to deviate from its traditional format of a succession of podium speakers comprising a lengthy lead-in to the keynote speaker. This year's ceremonies, modeled after the increasingly popular TED (Technology, Entertainment, Design) Talks, featured APTA board members and Utah chapter representatives addressing the audience in quick bursts from the front of the stage. This presentation combined with short pre-taped segments to put an emphasis on fun and entertainment. Keynote speaker Dave Barry then took the stage and drew many laughs throughout his irreverent 45-minute presentation. A well-known humor columnist and author, his work has been syndicated in more than 500 newspapers in the United States and abroad. Barry began by joking how little he actually knew about physical therapy.

"In fact," he said, "you might even get a couple CE credits deducted because you attended this speech."

The Miami-based humorist related tales about the hazards posed by hurricane season in Florida (which "lasts from June until about the following June") as well as the dangers presented by having so many retirees living in the area. He also touched on his own status as an aging Baby Boomer and later brought the house down with his thoughts on the difficulties men and women face in relating to each other. Tongue planted firmly in check, he concluded, "So those are my thoughts on the challenges facing physical therapists in the 21st century," and left the stage to a rousing ovation.

It was a great start to what all attendees hope will be a fun and informative conference. Are you in town for PT 2013 too? Feel free to leave some comments below about your thoughts on the conference so far.

In Vegas at NATA
by Jon Bassett

With temperatures soaring well into the triple digits this week (and a potential to break the all-time record high this weekend), NATA President Jim Thornton, MA, ATC, PES, kicked off the 64th Annual Meeting and Clinical Symposia of the National Athletic Trainers' Association (NATA) the morning of June 25 by moderating a press event to release the association's new Best Practice Guidelines for preventing sudden death in secondary school athletes.

Announcing "significantly record-breaking" conference attendance numbers upward of 15,000 -- which shattered previous numbers in St. Louis and New Orleans the last two years -- Thornton reported that the new guidelines will be published in the July issue of Athletic Training, the association's professional journal.

"This is the most important moment for me professionally," said task force chair Doug Casa, PhD, ATC, FACSM, FNATA, chief operating officer of the Korey Stringer Institute (KSI) and director of athletic training education at the University of Connecticut. The recommendations serve as a roadmap for policy consideration regarding the safety of secondary school athletes. They address the leading causes of sudden death in this population -- head and neck injuries, exertional heat stroke, sudden cardiac arrest and exertional sickling.

LaQuan Phillips, a local football player who sustained a spinal contusion during a 2008 game and who became partially paralyzed from the injury, was on hand to help introduce the new guidelines. Phillips, who was injured as a senior linebacker for Green Valley (Las Vegas) High School, credits the school district's athletic trainer Jeremy Haas for saving his life, keeping him calm during the event and preventing further damage. Phillips underwent surgery and nine months of rehabilitation, and walked at his own graduation the following June.

"That was a very humbling, very gratifying moment," Phillips told the audience.

The full guidelines can be viewed here.

The NATA conference is taking place this week at the Mandalay Bay Convention Center in Las Vegas the week of June 24-27. Stay tuned to updates and comprehensive coverage from ADVANCE!

Swarming to the Beehive State
by Brian Ferrie

Two weeks from today, the APTA's annual conference & exposition will kick off, making its first-ever appearance in the state of Utah. From June 26-29, PT 2013 is scheduled to convene in beautiful Salt Lake City. The exclusive ADVANCE preview article detailing city attractions and conference highlights can be found here.

According to Curtis Jolley, PT, MOMT, president of the Utah Physical Therapy Association, "The conference will come at a beautiful time of year here. There could still be a little snow on top of the mountains. It's only about a half-hour drive from downtown to famous ski resorts like Park City and Snowbird. For any attendees who come from parts of the country that don't really have mountains, I definitely recommend going up there to see how pretty it is."

Salt Lake City has much to offer beyond the natural scenery as well.

"There are all kinds of wonderful restaurants downtown, including a section called Trolley Square, which is a gathering of shops and places to eat," Jolley added. "A huge new indoor/outdoor mall called City Creek Center also just opened. There's been a great resurgence in the downtown area over the past few years, including enhanced mass transit. A light rail line now runs from the airport straight downtown, so conference attendees who fly in can just take the train to within a block or so of the convention center. We're excited to showcase Utah along with its physical therapy profession and we encourage people to come here and enjoy our state,"

Will you be attending the conference? Have you ever been to Salt Lake City before? What are you most looking forward to about it?

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That Makes 50!
by Brian Ferrie

The American Physical Therapy Association (APTA), Alexandria, VA, announced in an April 30 press release that Indiana Gov. Mike Pence has signed HB 1034, granting Hoosiers direct access to evaluation and treatment by a physical therapist without a physician referral. Ensuring a patient's choice of which healthcare professional to see and when has been a longtime goal of the APTA and its state chapters.

Passage of this bill signifies a landmark moment for the profession in that all 50 states and the District of Columbia now allow patients to be evaluated by a physical therapist without a referral. With enactment of HB 1034, 48 states and DC also allow some level of treatment by a PT without a referral. The new law takes effect July 1.

"We are thrilled that Indiana has become the latest state to offer patients the choice of direct access to physical therapist services. Ensuring patient access is a cornerstone of APTA's vision and mission," said APTA President Paul A. Rockar Jr., PT, DPT, MS. "I congratulate our colleagues in the Indiana Chapter for their resilience and dedication in enacting this vital legislation after many years of tough battle. I also want to thank Rep. David Frizzell for authoring the bill and Sen. Patricia Miller for sponsoring the bill in the Senate."

The bill, which was promoted by the Indiana Chapter of APTA, permits patients to be evaluated and treated by a physical therapist for 24 calendar days without a referral from a physician or other provider. However, referrals will continue to be required for spinal manipulation and sharp debridement. After 24 days, the PT must obtain a referral from another, authorized provider to continue treatment. Prior to passage of the new law, a referral was required for all physical therapist services, both evaluation and treatment.

As APTA celebrates this legislative success in Indiana, it will continue to work toward improved patient access across the country. While all states now allow patients to be evaluated by a physical therapist without a referral, there are still significant restrictions in many states that continue to impede patient access to physical therapist services. Only 17 states currently enjoy unrestricted patient direct access.

"We'd like to see unrestricted patient access to physical therapists in all 50 states," Rockar said. "Unrestricted patient access is considered the 'gold standard' for patient care as it does not include arbitrary restrictions, such as time or visit limits."

What do you think about this milestone and the APTA's mission to pursue unrestricted direct access in every state? How has direct access impacted your practice?

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The Volunteer Spirit
by Lisa Lombardo
Are you looking for an opportune time to volunteer overseas? Judging from the number of reports I receive from ADVANCE readers, and from organizations who are continually looking for therapists to join their travel groups, the demand-and desire-for lending a PT hand in parts unknown is growing. Some recent reports:

Michael Tabasko, PT, MSPT, OCS, has been active with HVO since 2006 and has volunteered in Vietnam, Peru and Bhutan. He is currently practicing at Capitol Orthopaedics & Rehabilitation in Rockville, MD.

In "Why We Volunteer," published this month in ADVANCE, Michael wrote: "My assignment through Health Volunteers Overseas (HVO) in Thimphu, Bhutan, focused on teaching physiotherapy technician students, as well as educating and consulting with my local counterparts. We met some wonderful people along the way too, but I wanted to know that my donated time was successful, that it was worth something tangible. 

"We're told the value lies in acknowledging your privileged position in this world by helping a less-privileged one. It's supposed to make you feel good--better, in fact, than if you'd been compensated to do it. Whether it's a weekend helping out in a rough neighborhood or an overseas commitment, at some point all volunteers question how much their presence has actually mattered... Maybe specific outcomes have very little to do with the individual's impact, and the real result is the experience itself, a simple interaction and greater understanding amongst cultures."

I was also recently contacted by Chandi Edmonds, DPT, who presented to a group on training she did in Port au Prince, Haiti several months ago. As a volunteer with Project Medishare, Edmonds trained local physical therapy techs to work with patients, many still suffering with injuries from the 2010 earthquake. Edmonds reported that the nation's only critical care hospital is inadequately staffed and supplied. The facility is small and treatment areas and patients are exposed to sometimes harsh elements.

In her two weeks there, Edmonds witnessed the indomitable spirit of the proud Haitian people, as well as the abject need that resulted in children dying. Chandi plans to continue promoting awareness of Project MediShare and the vast need in Haiti.

Therapy Volunteers Needed in Haiti

And more recently, this request from Donna Hutchinson, PT, co-founder of Global Therapy Group: "We are a 501c3 non-profit, all volunteer organization providing therapy services in the Port au Prince area. We are in need of PT, OT, and ST volunteers for 2013 and wondered if you might assist us in getting the word out?

"Global Therapy Group is seeking physical therapy, occupational therapy and speech therapy volunteers at our clinic in Port au Prince, Haiti, for rotations of two weeks or longer.  Global Therapy Group was created in 2010 to bring sustainable rehabilitation services, therapy education, and employment opportunities to Haiti following the earthquake. Our clinic is staffed with a Haitian clinic manager, a Haitian rehab tech, and PT, OT and ST volunteers from around the world. Our patient population includes children and adults, orthopedics, cerebrovascular accidents, developmental disabilities, trauma and injuries. We arrange for guest housing, transportation and all in-country support."

If you are interested, contact Donna at dhutchinson@globaltherapygroup.org or visit http://www.globaltherapygroup.org/ for more information. Photos courtesy of Chandi Edmonds, DPT.



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