PTA Blog Talk : Geriatrics

Immigration and PT

Jason Marketti — Wed, 18 Nov 2009 12:45:00 GMT

I spoke with Emily Lopez Neumann, an an immigration attorney at Reddy & Neumann, P.C., Houston, TX, about the immigration process for PTs recently. What follows is a Q&A of our discussion. Question: Are you seeing a change in the way immigration...(read more)

The Legacies Project- Part 2

Jason Marketti — Wed, 11 Nov 2009 15:36:00 GMT

Based in Ann Arbor, MI, The Legacies Project archives self selected memories from the elderly population and categorizes it into videotaped histories. It began as Jimmy Rhoades recounts a personal experience. "My dad was diagnosed with cancer and we were...(read more)

The Legacies Project

Jason Marketti — Wed, 21 Oct 2009 12:28:00 GMT

When I worked in Palm Springs I held a tape recorder for a gentleman during the therapy session who was recounting his time in the war and in great detail his time in Burma. It was fascinating to hear this man's history. He was doing it so his family...(read more)

Moving

Jason Marketti — Tue, 21 Oct 2008 14:09:00 GMT

I recently moved.

What a pain. This is literal, I was in pain for days. My leg muscles ached, my back was stiff and my biceps burned with every movement. I thought about all the lifting techniques I taught over the years that went out the window when maneuvering a solid oak hutch through a doorway that is too small to accomodate anything larger than a shoebox.

How am I suppose to lift the freezer up over three steps and then down two? And why did we buy all this junk in the first place.

Then it hit me, these are obstacles that our patients face everyday. The stairs, the maneuvering through spaces that don't accomodate their assistive devices, and of course sore muscles after a hearty work out from their therapist.

What surprised me after I really thought about it was that my home is not friendly to any assistive device or to any person with a disability. If I was incapable of walking safely around my home I would have to move. And then it hit me, this is what our patients could face; either be unsafe in a familiar environment surrounded by their own things or be placed in an unfamiliar assistive living home or SNF with half or none of their belongings.

Thankfully this is not the case with every patient but for those that fit the senario, I can understand why they would want to be home and not be displaced.

One last note of thanks and that goes to Biofreeze for making me feel better during those painful days and nights after my move.

Rantings of a PTA

Jason Marketti — Tue, 17 Jun 2008 17:09:00 GMT

As much as I dislike complaints about our profession, every once in a while I like to get things off my chest.

Productivity
Until my employee handbook expressly states what my productivity will be, I do not worry about it. My yearly evaluation has nothing about productivity so my work cannot be based on it. If productivity is such an issue why don't our employers put it in writing?

In all the years I have worked and all the jobs I have had, only one employer did and it was for a per diem position to be between 75 and 80 percent. None of the full time positions ever mentioned productivity in their offer letters.

Insensitivity
I have three children. Two of them have disabilities. One has Aspergers and Bipolar Disorder, the other has Complex Partial Seizures affecting her bilateral temporal lobes.

Looking at them no one would suspect it. Even a conversation with them would reveal little in the way of their diagnosis.

I only mention this because some people have a difficult time understanding why I need/want time off. Employers need to recognize that some of us do not live to work. I have appointments I need to attend; I have a family that needs me. And for heaven's sake, let me use my sick time or PTO/vacation time when I need to go.

If employers are not sensitive to my needs and family issues, it is time to look for another position.

Other Employees
We're a team, right? But does everything we say have to be repeated to our managers? Doesn't the manager have enough to worry about? I have told the team I am working with, "What we say in the therapy gym stays in the therapy gym."

I am professional enough to know when an issue is really bothering me and when I just want to gripe about something. If I want the manager to know something, I will tell them. I have even encouraged others to talk to the manager if they have an issue that concerns them.

There are times in my day that I want to question policy issues to get another opinion or two about it. This does not mean I hate the employer. It does not mean I am going to form a union and strike. I only want to get an idea of how others feel about it, that's it.

Insurance Companies
I could go on forever about my dislike of the insurance industry. My big question is "What methods do they use to determine when a patient is ready for discharge?" I know some look strictly at gait distance and discharge when the patient reaches 50 feet, even though they were max assist to stand with a Berg Balance of 20.

Most do not even care about the ADL skills. Some of our patients couldn't get dressed but could walk 100 feet, so they were sent home. We have tried to pin them down by asking what they look for, but we have yet to have a definitive answer from the insurance companies we work with.

My other question is, "When did we as therapists give up on fighting for the patients?" Is it because we know if we argue with them they will not refer any patients to our facility, or did we just get too tired of fighting? Do we only argue certain cases and leave others? And how do you determine that?

Most days are not complete for me until I begin my day with 450 minutes of work, a frantic phone call from my wife about two appointments occurring at the same time and who's going to pick up our son from school, all of us griping about how the facility runs and the insurance companies discharging half our patient load for too much progress or lack of progress. Oh, the humanity!

Must Have PT Equipment

Jason Marketti — Mon, 05 May 2008 14:06:00 GMT

Working in therapy for the last 12 years has allowed me to know what equipment is the most useful as well as equipment that has less value in treating patients in a nursing facility. Although it is not an all inclusive list, this should cover all the equipment one needs to provide care to a variety of patients with the best treatment options.

Theraband. Red and yellow has served me well in every environment. I will usually have the length longer than usual (about four feet) to accommodate for the height of a patient as well as wrapping it around the back of a patient's wheelchair for upper body work. Most of us know the most beneficial activities to do with our patients with the theraband for upper and lower body exercises.
A 12 inch ball. A patient can squeeze, throw, place one foot on it and balance, kick it, etc.
A 32-38 inch ball. The patients can sit on it, bounce it, roll it up a wall, kick it, etc.
Mat table. For rolling, sit balance, transitional activity from supine to sit, sit to stand, etc.
Floor mat. For fall recovery, static and dynamic balance activity.
Stairs. This is a functional activity for patients and can simulate a curb. Going up and down with and without a rail works on balance and stability for center of gravity awareness.
Ramp. This is also functional and works on balance and stability. Having a patient stop in the middle of the ramp can be extra challenging for static balance.
Gait belt. What would therapy be without one? It can also be used to resist patients when they walk as well as provide lateral sway to assist with advancing gait.
Home exercise programs. With pictures and clear descriptions of each activity.
And one of the most important items that I have used is another language. Although my command of another language is not fluent, I do have a list of words such as stand up, walk, right, left, where is the pain, etc. A language guide is definitely a must have in a facility with non-English speakers. There are auto-interpreters on the internet as well but the accuracy is not always 100 percent with the phrases.

I did not include upper and lower extremity weights because the theraband can provide the resistance needed during a therapy session. When multiple patients are seen theraband is also a quick and easy way to facilitate an exercise session.

Before there were machines for resistance or gel centered balance discs there was us, the providers of the therapy sessions. If we can provide care that tests the patient's limits without a lot of equipment, then we know we can give our patients quality care in any environment and make an assessment that can only benefit our outcomes in the care we provide. The equipment used should only be an extension of what we can provide, it should not be the only thing we provide.