Toni Talks about PT Today

'I Am a Troublemaker'

2013-05-14T13:05:00Z

Last week I described being warned not to make trouble by reporting the nurses watching the baby camera while at work. I've been thinking about that. Why would I be the troublemaker for reporting someone else doing something wrong? Shouldn't it be the other way around? You would think the person bringing it to attention would be thanked. I worked at one SNF where I was considered a bad employee for complaining the CNAs weren't cleaning residents regularly or getting them out of bed. I was told to...(read more)

The Baby Cam is Not Skilled Therapy

2013-05-07T16:42:00Z

There has always been some conflict between therapy and nursing. Each complains about what the other does or doesn't do. Last week I saw something that floored me. I went into the nursing office looking for a chart. I didn't find the chart. I did find three nurses watching someone's grandson through a web cam feed at his day care. It was on the computer screen. They'd apparently been watching a while. They were talking about things they'd already seen him do. OMG! This is a facility that makes me...(read more)

My Horse is a Therapy Animal

2013-05-01T13:59:00Z

The positive influence of animals on healing is well known. Caring Critters now make regular visits to various facilities within the Houston area. Dogs can be certified as therapy animals. Horses are used for hippotherapy with great results. Now I'm going to try to combine the two. Last Friday, my horse Expsychment (pronounced "excitement") made a visit to the SNF where I work. For me it's the best of both worlds. I get paid to play with my horse. But something more important also happens. The residents...(read more)

Return to Manual Therapy... Not

2013-04-24T13:33:00Z

This week a patient was referred to therapy because of neck pain. I quickly determined she had a mechanical derangement of her cervical spine. Something was locked in the upper cervical region that prevented her from rotating. Her complaints were inability to sleep and turn her head. Once a manual therapist, always a manual therapist, I guess. There were several things I could have done, modalities included. Instead I laid her on the mat, positioned her head off the end and did what I used to do...(read more)

Old School and New School

2013-04-16T17:19:00Z

No matter where I am, I hear the old school/new school discussion. In simplest terms, it's a comparison of how we did something years ago compared with how we do it now. In more unkind terms, it can become a condemnation of those who went to school back in the day or new graduates. It came home to me how different the thinking is last Friday. I made a comment about how being slow in writing evaluations results in lower productivity. This was meant with a stunned silence followed by a question. Why...(read more)

Finally Something I Enjoy

2013-04-09T18:31:00Z

Anyone who reads my blog with regularity knows the last year has been a struggle for me. I lost my beloved job. I was fired for being ethical. I encountered more than my share of unethical and self-serving people. During all of that, I hung on and kept going to work. Every so often I made a difference to someone, which kept me going. For the last few months I've been doing something new, teaching. I'm teaching for one of the larger continuing education providers for physical therapy. I teach what...(read more)

How Many Minutes Are Enough?

2013-04-02T15:57:00Z

This morning I was involved in a discussion about getting the most minutes from each patient. This can be taken two ways. Financially more minutes translates into better reimbursement. Therapeutically it results from the belief that every patient should receive as much therapy as possible. If one were to be charitable, you could argue the financial interpretation comes from the therapeutic one. Those arguments are flawed in so many ways. I don't know where the belief that everyone should have as...(read more)

Continuing Education Should Be Evidence-Based

2013-03-28T20:53:00Z

I'm a peer reviewer for the Texas continuing education program. I review submissions for neuro, geriatric, acute and general so I get to see a lot what is being proposed for continuing education. Texas has a specific form that must be completed for each course submitted for review. It includes speaker qualifications, specific goals, a statement of the how the course relates to physical therapy and requests a copy of the certificate to be presented. There's just one thing missing. Where is the evidence?...(read more)

‘I Can't Help, My Back Hurts'

2013-03-19T15:03:00Z

This morning there was a patient on the floor so the request went out for lifting help. Four people responded, including me, a PTA, a male CNA and the patient's nurse. The patient was a big man, weak and in a narrow space so it wasn't going to be easy. As we were positioning ourselves to lift him the nurse stepped away. She said she didn't lift because she had hurt her back and didn't want to be out of work again. The three of us got him into the chair none the worse for the experience. When the...(read more)

Not All Patients Work on the Weekend

2013-03-12T20:03:00Z

This morning while I was walking a patient, I overheard another patient walking behind us. She was telling the CNA taking her to the dining room that she recognized me from the weekend. She was upset with me because I came to take her to therapy and she refused. Her daughter was coming later that day and she didn't want to get up. I don't know what was funnier. She was appalled that I'd even suggest therapy on the weekend. She was also shocked that I didn't immediately understand that her daughter...(read more)

What Do I Include in CEUs?

2013-03-05T15:22:00Z

Recently I took on another challenge, writing a CEU module. When I agreed to do it, I thought no problem. This is what I teach. I already have an outline and references. I can just fill in the words. After I started writing, I realized something. When I teach, I have lots of material to cover so spend little time on any one thing. The CEU module is only one thing. Back to the references I went. Since I hadn't researched the topic in a while, I found a few newer ones. Then I went through the articles...(read more)

Maybe it's a Question of Time

2013-02-26T18:08:00Z

Last week I questioned what the definition of skilled therapy was . I had worked with several patients the previous weekend whose only deficit was the need for supervision. I've realized I wasn't clear in describing those patients. All of them had been on caseload for a while. Previous safety issues, such as Berg and Tinetti scores, had been addressed. The responses to that post made some good points. First, impaired cognition is a need for skilled therapy. Usually that falls under the scope of practice...(read more)

What Is the Definition of Skilled Therapy?

2013-02-19T18:28:00Z

I've been noticing a disturbing trend lately. More and more facilities are considering the need for supervision as a need for skilled therapy. Back in the day, patients referred to SNFs and outpatient had an obvious need. They had trouble walking. They couldn't transfer. They'd recently undergone total joint replacement. The knowledge and skill of a therapist were needed to treat the impairment. Last weekend, I worked at a different SNF than usual. I had nine people on my caseload. Six of those were...(read more)

It's Legal but Is It Ethical?

2013-02-12T15:58:00Z

Someone was fired last week. The rumor is going around that she was fired because she didn't smile. I don't know if that's true or not but in Texas it is legal. Here an employer can fire an employee for any reason, even if they make it up. Nor do they have to prove it's true. There are no laws preventing it. Maybe the woman smiled. Maybe she didn't. She's still fired. Last year I was the victim of something similar. I've become very familiar with Texas labor laws. When I've brought the topic up with...(read more)

Patient Empowerment

2013-02-06T16:46:00Z

One of the presentations I attended at CSM discussed ways to increase motor learning by empowering the patient. They gave an example where one group of patients was asked to help decide which picture to hand in the waiting room prior to assessment. The other group just did the balance test. The patients who participated in picking the picture did much better. The speakers went on to give other examples, including giving patients choices about which exercises and allowing them more freedom to make...(read more)