ADVANCE Perspective: Physical Therapy : Patient Care

New Medical Staff Might Be Bad For Your Health

Elizabeth Puliti — Mon, 28 Sep 2009 13:04:00 GMT

Starting a new job in emergency medicine? You may want to be extra careful on your first day. Research from Imperial College London states that the death rate is higher among patients admitted to English hospitals on the first Wednesday in August--the...(read more)

Don’t Be a Weekend Warrior

Elizabeth Puliti — Tue, 23 Jun 2009 19:35:00 GMT

With the shift to warm weather, people of all ages start thinking exercise. Before your older patients take their exercise routine outdoors, The American Academy of Orthopaedic Surgeons this week advised baby boomers not to overdo it. In a press release,...(read more)

CT Nursing Home Lawsuits Involve Lack of PT

Lauren Fritsky — Mon, 15 Jun 2009 15:31:00 GMT

There's an interesting story out of Connecticut from this weekend. It involves a nursing home facing lawsuits for neglecting two patients, both of whom died. In the first, part of the argument is that the client did not receive "medically necessary physical...(read more)

What Do You Resolve to do in 2009?

Elizabeth Puliti — Tue, 06 Jan 2009 18:13:00 GMT

ADVANCE wishes you a happy new year! Several editors and bloggers here have resolved to change for the better in 2009. Her are our resolutions for the new year:

Jason Marketti, PTA:

1. Spend more quality time talking to my children and holding hands with my wife.
2. Stay in contact with friends.
3. Be more flexible with people's faults because I have a ton of my own.

Veronica Haywood, SPT, ATS:

1. Lose 15 pounds.

Lisa Catenacci, SPT:

1. Get to know myself better.
2. Figure out what it means to have a peaceful heart.
3. Gain closure from all of 2008.
4. Stop feeling the need to defend myself, my beliefs, and my actions. I am who I am.
5. Take a vacation. From everything.
6. Enjoy the transition from student to practitioner.
7. Make evidence-based practice a habit.
8. Form good relationships with my co-workers.
9. Start the journey of paying off student loans.
10. Be thankful every day.

Toni Patt, PT:

My goals are to work hard at school and find more time for myself.

Lisa Lombardo, editor:

1. Save more money.
2. Make some home improvements. This might not fit with resolution 1, but I'll work on a budget.
3. Get back on Weight Watchers; it worked last year.
4. Be more outgoing!
5. Try something I never did before.

Beth Puliti, senior associate editor:

1. Take better care of my body by starting a regular exercise routine and eating fresh, natural foods.
2. Stop judging people based on my first impression of them.
3. Figure out what truly matters in life and work to achieve happiness.

Lauren Fritsky, associate editor:

1. To travel more.
2. To work on my writing.
3. To do more things outside my comfort zone.
4. To make more quality time for family and friends.

Did you make a New Year's resolution? If so, tell us!

Are Changes Coming?

Lisa Lombardo — Thu, 06 Nov 2008 19:51:00 GMT

America has elected a new president--an historic event that even other nations are taking notice of. Sen. Barack Obama's election as the first African-American president will rightly be remembered as a turning point in U.S. politics. But without too much prognostication, how will his election affect changes to health care policies? And specifically to issues affecting the physical therapy profession?

As we reported in our Sept. 22 issue previewing the election, the largest component of President-elect Obama's health care plan is his commitment to making affordable health care coverage available to all Americans. This includes 46 million--at least 8 million of whom are children. According to his campaign statements, under Sen. Obama's plan all Americans will be afforded the opportunity to buy a plan--at affordable rates--that mirrors the Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. No American will be turned away from Sen. Obama's plan due to pre-existing diseases or conditions. The plan will cover all essential medical services, even such instances as maternity and mental health.

Aside from major health insurance changes, will the Democrat-majority Congress now decide to make changes to the top issues affecting PT: getting rid of the caps on outpatient therapy under Medicare, pursing a plan for direct access to PT under Medicare or holding the physician fee schedule at its current rate?

What do you think? Will Democrat-managed decisions on Medicare make a difference in the next four years?

October is National Physical Therapy Month!

Elizabeth Puliti — Tue, 21 Oct 2008 13:18:00 GMT

Is your facility or clinic doing something special to acknowledge October as PT Month? If so, ADVANCE wants to know about it! Send us a photo of your staff or of an event with a brief caption and we will include it in an online photo gallery of how PTs and PTAs celebrated the profession this month.

Email information and the photo (720 dpi; .jpeg formats please) directly to Beth Puliti at epuliti@merion.com

See last year's gallery here!

Good News: Senate Passes Medicare Bill

Lisa Lombardo — Thu, 10 Jul 2008 19:23:00 GMT

Pleasing the leadership of the American Physical Therapy Association and PTs and PTAs everywhere, the Senate yesterday passed HR 6331, the Medicare Improvements for Patients and Providers Act.

"We are thrilled that the Senate took action yesterday and passed [the bill]," said APTA president R. Scott Ward, PhD, PT, in a statement. "The senators obviously heard from beneficiaries and providers in their states and recognized the need to take this action to protect Medicare beneficiaries who need rehabilitation services the most-seniors and persons with disabilities.

"This legislation, which includes provisions essential for Medicare beneficiaries to maintain access to needed services, now awaits the President's signature. The APTA urges President Bush to take immediate action and sign this critical bill into law to protect the quality of life and well-being of millions of Americans," Dr. Ward stated.

"Provisions in HR 6331 are critical to avoiding the unsustainable cuts in Medicare payments to physical therapists and to restoring the therapy cap exceptions process that assures that beneficiaries who qualify for the exception will continue to get the crucial therapy care they need," Dr. Ward said.

Other key provisions will delay competitive bidding for durable medical equipment, prosthetics, orthotics, and supplies and restore important payment protections for rural providers.

The signing extinguishes what were growing worries of the APTA that Congress might not make a decision on the Medicare cap on outpatient therapy exceptions process. As of July 1, the exceptions process under the cap ($1,810 for PT and speech therapy combined; the same amount for OT) had expired. Therapists submitting under Medicare for patients who needed the cap exception the most-those recovering from stroke, traumatic brain injury and other long-term conditions-would have had to get a lot more creative in helping their patients continue with necessary therapy.

On a personal note, I know of several people close to my family and friends who have loved ones who had a stroke or were auto accident victims who would qualify for Medicare and will need ongoing therapy. For therapists out there, did the exceptions cap "close call" adversely impact you and your patients?

Physical Agents: In or Out?

Lisa Lombardo — Wed, 25 Jun 2008 19:29:00 GMT

Since becoming the editor of ADVANCE in 2000, the thought has often occurred to me that PTs and PTAs are a surprisingly well-informed and opinionated bunch.

But they are also a lot of fun as well.

This was proved to me on June 13 at the annual APTA conference in San Antonio, as APTA premiered its first Oxford Debate. PT experts on both sides considered whether physical modalities that might not be based on evidence should be used and billed by PTs. Despite the seriousness of the topic, the therapists on hand made being confined to a conference room on a gorgeous sunny day in Texas more entertaining than can be expected!

The debate addressed the question: Should physical therapists remove the use and billing of selected (infrared, laser, diathermy, thermal agents) physical agents from their practice?

The idea behind the debate was to question the appropriateness of the removal or maintenance of use of these interventions, the impact of them on current practice, and how removal of them would affect PT's image and independence as a professional body.

An Oxford debate is similar to British Parliamentary debate, pitting two teams of three making the arguments both for and against the question. Each team selects an opening speaker, a second "rebuttal" speaker and a third "summator" speaker for their respective arguments, and the audience comprises the "floor," allowed to ask questions of each panel before the summator speakers wrap up. Competitors are encouraged to maintain civility but also to debate with "animation, passion and creativity," according to traditional Oxford rules. And the PT panelists certainly rose to the challenge.

The debate was lively, fun and inciteful (thanks to the participants!). In a unique twist, whenever one side gave an argument, the audience could move from one side of the room to the other to show their support for the stated argument. There was a lot of up and down as many therapists switched sides.

This struck me as particularly interesting, because it showed how complex the issue really was. More than one debate attendee mentioned that professional credibility for PT could be at stake if PTs turn too often to unproven agents for treatment.

Should PTs use modalities in the clinic-and bill for them-when patients can find hot packs and other agents in drug stores and use them at home? How much should therapists rely on physical agents when there is little to no solid evidence that they work in the long-term? Are therapists just billing, in effect, for placebos? Or are therapists wrong to reject agents that might work well for their patients' rehab?

What do you think about using physical agents? Do you use them, and how? Do you feel other therapists might rely on them too often?

PT 2008 'Kicks it Up' at the Opening Ceremony

Elizabeth Puliti — Thu, 12 Jun 2008 14:40:00 GMT

SAN ANTONIO—PT 2008 kicked the conference off right last night with a stimulating opening ceremony. APTA President R. Scott Ward, PT, PhD, welcomed the overflowing audience of PTs to San Antonio. He had nothing but praise for the 7^th largest city in the country, a city that, in his words, exudes "world-class cuisine, offers opportunities for fun and adventure, and captures the spirit of Texas while keeping its old-world charm."

"When you're not in sessions--and we won't tell anyone--stroll along the Riverwalk and see all this city has to offer," he encouraged the audience.

Dr. Ward noted there are more than 350 speakers at this conference who represent seven countries. He thanked everyone involved and recognized the newly elected officers (a new treasurer, speaker of the house and directors) of the APTA.

Next to speak was the president of the Texas Physical Therapy Association, Carolyn Oddo, PT. "While you're hear, you will experience typical Texas weather. The moisture you feel while walking the Riverwalk isn't a hot spring shower--but Texas humidity," she joked. "We survive by drinking cold beverages--like margaritas."

She persuaded the audience to visit the Alamo, "which is almost a requirement for Texas citizenship," she said.

President Ward took the stage again to speak about the advantages and challenges to the profession of physical therapy and the work of the Association. He noted the common goal of PTs and PTAs alike is to make lives better for patients. "It's a goal we can--and should--be proud of." He told the audience that the public already recognizes that fact.

"When I tell people I'm a PT, they react favorably. I've never been asked, ‘What is a PT?'" Instead, he relayed, one of two things usually happens: the person expresses their desire for an on-site consult ("I'm sure you're familiar with these encounters, which I call ‘Thanksgiving Day clinics,'" he said), or they ask where he practices and are genuinely interested to find out.

"We tend to think the public doesn't know what we do," but they do, he said. "We are overly humble. Never forget what you do-and never forget to make it clear to others who you are."

He encouraged the audience to view challenges as opportunities not only for the PT profession, but for the patients you are fortunate to serve.

Perhaps the most riveting of all the speakers at the ceremony was the last to talk to the audience. This year's keynote speaker was Lee Woodruff, author, freelance writer, contributing editor of ABC's "Good Morning America"--and wife to Bob Woodruff, the ABC journalist reporting in Iraq when a roadside bomb hit his convoy on January 29, 2006.

Bob suffered a traumatic brain injury from the 155 cm bomb packed with rocks. He remained in a medically-induced coma for five weeks. After much medical attention and physical therapy, he has healed far beyond doctors' expectations.

When Lee took the stage at the Convention Center Ballroom last night, she was met with a standing ovation and thundering applause, to which she responded, "I think it is no surprise that the physical therapists would be getting up and down during all of this."

Transitioning from Dr. Ward's speech, she told the audience, "I'm not a person who forgets what you do. Your profession has healed my husband and my family and I have the utmost respect. The surgeons and doctors may get all of the attention...but you are the wind beneath all of our wings--and you probably don't always get the credit that you deserve."

If Bob had been reporting in a previous war, it is likely he would not have survived, she said. In Vietnam, there were three injured to one dead. In the current war, there are 12 injured to one dead. Fifteen to 30 percent of the 1.6 million servicemen will come back with some sort of brain injury, she recited. "This war is rewriting what we know about brain injuries."

Bob's miraculous recovery wouldn't have been possible without PTs, OTs and speech therapists, Lee acknowledged. PTs never told her "He won't be able to," or "He can't" or "He shouldn't"--common phrases among doctors, she said. "I heard from you motivation; you were giving me that little bit of hope so I could go to bed that night."

Lee and Bob created the Bob Woodruff Family Foundation which raises money to assist members of the military with cognitive rehabilitation and other health care needs following traumatic brain injury.

"We could not have done it without the love of people like you," she concluded.

Guest Blogger: Naomi Aaronson MA, OTR/L, CHT

Elizabeth Puliti — Tue, 10 Jun 2008 13:54:00 GMT

Every Child Left Behind

As a school-based therapist, I see many changes since I was in elementary school. It seems the only thing that has remained are the shelter drills, and even they disappeared for a while!

No Child Left Behind, which was enacted in 2001, is a standards-based education reform law. Success will be due to the high expectations and setting of goals that all schools must adhere to. Progress of all public schools will be measured annually for math, science and reading in grades 3 - 8 through standardized testing. In addition, schools are required to use scientifically-based research strategies in the classroom and for staff professional development.

Unfortunately, states have been forced to make cut backs in necessary areas including education due to rising costs. Thus, subjects such as physical education, music and art have been decreasing in number due to budget restraints and the emphasis upon the above subjects. What is the effect upon children?

A study by the American Heart Association and the National Association for Sport and Physical Education contends that diminishing physical education in schools has contributed to rising levels of childhood obesity. I see many children who are being pushed to read and write way before they are emotionally, physically and cognitively ready. Developmentally they have not achieved the milestones necessary to function successfully in the school environment. These children have weak trunks, shoulders, arms and hands and lack the sitting tolerance and endurance as well as the attention necessary to achieve in the classroom day in and day out.

They are expected to learn with few breaks for movement, which is one of the ways children learn. In effect, we are creating a nation of overweight children who hopefully will be able to read and write--but with unknown health issues down the road. In the future, society will pay a heavy price for not thinking about a well-rounded education approach that includes hands-on activities such as music, physical education and art. It makes me sad to think that these children are missing parts of childhood that were once so treasured.

What’s Your Game?

Lisa Lombardo — Fri, 18 Apr 2008 14:47:00 GMT

I recently got a chance to try something that the rehab community has been buzzing about in some circles: therapy according to gaming.

OK, it wasn't a situation where I needed rehab, I admit. I was just hanging out with friends-one of whom has his entire living room-big-screen TV, speakers, the whole works-dedicated to what you could call an in-house "studio" solely for the purpose of, well, rocking out.

For a few hours, I found myself immersed in "Rock Band," an X-Box game system that allows "players" to assume membership in a rock band either as a singer, guitarist, bass player or drummer and "virtually" play popular rock songs, in sort of a physical Karaoke.

Right away I could see why the system and others like it, including Wii sports, would provide a unique opportunity for rehabilitation. The game was not only fun and diverting, it was also work. Even after one hour I felt my coordination improving-even though I was merely pressing a color-coded button and following the direction on the screen. As I "played" my timing and anticipation of my next move got better and better and I actually got the sense that I could "play" guitar (or at least follow notes and chords) even though I had never previously picked up the actual instrument.

Following traumatic brain injury of any sort, the mind has to go through so much to relearn natural movement, timing, coordination and dexterity. In many ways, the therapy required can resemble gaming-combining specific movements together in a coordinated way to achieve a result.

Patients can actually see that they know how to complete a movement they thought they had never learned-kind of like me and the guitar. Not to mention the fun it can provide. Hitting the right notes on time and making "music" made three hours go by like one.

Are PTs and PTAs out there considering gaming a viable way to incorporate more stimulation and cooperation in patients? If you have used computerized programs for patients and have had success, let us know. It could be a technological trend that brings music to the ears of patients with brain injury in the future.

Mirror Therapy

Elizabeth Puliti — Tue, 25 Mar 2008 18:03:00 GMT

I recently read an article on CNN that described how amputees are benefitting from an unusual painkiller: mirrors.

In the story, Army Sgt. Nick Paupore was traveling in a Humvee in Kirkuk City, Iraq, when a roadside bomb struck his vehicle. The blast ripped out part of Papore's leg (including an artery), and left him with less than two pints of blood. Eventually he was taken to Germany where his life was saved, but his leg was not.

Following his life-saving surgery and subsequent amputation, Paupore experienced agonizing phantom limb pain. When the pain became too much, he joined Dr. Jack Tsao's clinical trial at Walter Reed Army Medical Center to test the mirror therapy theory.

What is mirror therapy? According to the article:

The patient sits on a flat surface with his or her remaining leg straight out and then puts a 6-foot mirror lengthwise facing the limb. The patient moves the leg, flexing it, and watches the movement in the mirror. The reflection creates the illusion of two legs moving together.

The mirror tricks the brain into "seeing" the amputated leg, overriding mismatched nerve signals.

For the amputees who experience debilitating phantom limb pain, mirror therapy may be just the solution that can help them rebuild their lives.

Enraged Actor Sheds Light on Medical Errors

Elizabeth Puliti — Tue, 15 Jan 2008 17:00:00 GMT

Just last week actor Dennis Quaid and his wife, Kimberly, found out exactly what happened to their twin babies mere days after they were born. They have recently made headlines because they are infuriated to learn of the details surrounding the medical error months after the initial incident.

A preliminary report detailed that the Quaid's newborns were given doses of heparin (a high-risk blood thinner) 1,000 times stronger than what was prescribed. However, last Wednesday a second report showed that the children were actually given two vials containing 10,000 units per milliliter of heparin--or 2,000 times stronger than what was prescribed.

How the hospital tackled the issue of medical errors was regrettably left off the front page--and that's something that shouldn't be ignored. In this case, the hospital took steps to review all policies and procedures involving high-risk medication and provided more training to its staff.

Unfortunately medical errors happen too often. So, to help health care providers reduce mistakes, the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) designed 17 free, publicly available toolkits that can be adapted to most health care settings.

Released in December, the toolkits focus on an array of issues, including identifying high-risk practices and reducing medication errors or other patient harms. The following are examples of different toolkits:

The Re-Engineered Hospital Discharge "Project RED" toolkit.
The Medications at Transitions and Clinical Handoffs "MATCH" toolkit.
The Preventing Venous Thromboembolisms in the Hospital and the Interactive Venous Thromboembolism Safety Toolkit for Providers and Patients toolkits.
The ED Pharmacist as a Safety Measure in Emergency Medicine toolkit.

For more information and a complete listing of the 17 toolkits, visit http://www.ahrq.gov/qual/pips.

PT in the ICU

Lauren Fritsky — Tue, 04 Dec 2007 17:17:00 GMT

A study recently cited by the APTA says that patients who begin physical therapy while still in the
ICU often reduce the length of their hospital stays.

The research, conducted by Peter Morris, M.D., associate professor in the Section on
Pulmonary, Critical Care, Allergy and Immunologic Diseases at Wake Forest University
Baptist Medical Center, showed that the length of stay for a group of respiratory-failure
patients who received early mobilization and PT within 48 hours of the insertion of a
breathing tube was reduced by an average of three days compared with the stay for patients
who did not receive the therapy.

In addition to tubes, many ICU patients are connected to other equipment or machines that
can make it hard to perform therapy. How do you work around this paraphernalia
when giving PT to patients in the ICU? Are there any circumstances in which you would
not want to perform PT in the ICU?

It’s That Time of Year Again

Rebecca Mayer — Wed, 28 Nov 2007 19:29:00 GMT

Despite being the most joyous time of year, the holiday season can be tough for many reasons. The biggest trap that most Americans try not to fall into year after year is gaining weight as a result of over-indulging and under-exercising.

According to a recent CNN article, some people may put on five to seven pounds thanks to a steady diet of large meals, high-calorie beverages and irresistible desserts throughout the fall and winter. However, according to government surveys, the average American will gain just more than a pound.

One pound, you say? Big deal! Well actually, it is a big deal. Because most Americans fail to lose the small amount of weight gained each year during the holidays, the weight gain becomes quite significant over time, according to a study conducted by the National Institute of Child Health and Human Development and the National Institute of Diabetes and Digestive and Kidney Diseases.

This study made me wonder. Physical therapy is a treatment method that focuses on pain relief, healing, restoring function and movement and improving body mechanics as well as improving a patient's overall fitness and wellness. On top of ignoring the general rules of health during the holidays, do Americans who require physical therapy neglect that aspect of their health as well? How can you-as PTs and PTAs-help your patients meet their fitness goals or maintain the ones already achieved? Do you feel particularly burdened during this hectic time of year? Are patients continuing to be compliant during the holiday season?