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  • I'm Always the Bad Guy

    I'm noticing a disturbing trend. I'm always the one pointing out the bad news. I admit I do better with realistic than cheerfully optimistic, but it seems like it's always me pointing out the flaw with a plan. If I'm not pointing out the obvious, I'm explaining why the obvious isn't going to happen. It feels like everyone else is focusing on ...
    Posted to Toni Talks about PT Today (Weblog) on August 19, 2014
  • How Can This Be a Safe Discharge?

    This morning I was working on discharge planning with one of our case managers. A doctor was ready to discharge a patient and she had asked me for recommendations. I immediately said SNF. He wasn't able to safely transfer out of bed. I had yet to see him walk due to complaints of back pain. And he lacks insight into his limitations. The case ...
    Posted to Toni Talks about PT Today (Weblog) on July 30, 2014
  • We're Not Going to Pay for That Brace

    A few weeks ago, a woman was admitted to our facility with a knee injury. She appeared to have ligamentous damage on top of arthritic deformities. She came to us for medical management and antibiotics prior to surgery. Before she was admitted, her orthopedist ordered a KAFO for the involved leg. I'm not a big believer in KAFOs. In my experience ...
    Posted to Toni Talks about PT Today (Weblog) on July 15, 2014
  • Sometimes It's Hard to Feel Sorry for Patients

    Last weekend I was describing a difficult patient I had worked with earlier in the month. It was someone with several chronic and out-of-control problems, obesity and medical noncompliance. I summarized my statement with, ''I don't feel sorry for him. He created his situation.'' I was immediately taken to task by someone who overheard some of ...
    Posted to Toni Talks about PT Today (Weblog) on June 18, 2014
  • She Loves Her Job

    I always enjoy talking to the therapists who come to my course. Last week I met a PT I'll call Dottie. I don't want to use her real name, but she reminds me of someone named Dottie. Dottie has been a therapist since back in the day. She graduated years before I even thought about PT school and is still going strong. Dottie is a home health ...
    Posted to Toni Talks about PT Today (Weblog) on May 13, 2014
  • ‘Passive ROM Is Not a Skilled Therapy'

    Let me clarify that statement before I go any further. I refer to performing PROM as the only treatment on patients who are sedated, minimally responsive, have significant neurological involvement and the like. I'm not referring to outpatient settings, PROM as part of an overall treatment, stretching and the like. I thought that argument was ...
    Posted to Toni Talks about PT Today (Weblog) on December 11, 2013
  • What's the Purpose of a PM & R Doctor?

    Until recently, I had never worked closely with PM & R (physical medicine & rehabilitation) physicians. When I worked at the ''evil empire,'' I dealt exclusively with neurologists. Some were good. Some weren't so good. Either way, their purpose for being involved in the patient's care was clear. There was a PM & R service. From what I ...
    Posted to Toni Talks about PT Today (Weblog) on September 10, 2013
  • ‘I Can't Wait Until I Can Walk Again'

    Last Saturday, one of my patients at the SNF was a woman with left femoral neck and humeral shaft fractures. She'd undergone an ORIF to repair the hip and the arm was immobilized. She was NWB on both extremities. Like many of our patients, this was not a small woman. She was limited by bilateral knee arthritis and admitted she didn't walk much ...
    Posted to Toni Talks about PT Today (Weblog) on August 20, 2013
  • Group Think Evidence

    When I was at the horse show last weekend, I learned one of the show kid mothers is a PT. I learned this because she was treating another of the mothers using cranio-sacral therapy. I'm not sure what pushed more of my buttons, her treating someone on the fly or using cranio-sacral to do so. This isn't the first time I've said I don't think PTs ...
    Posted to Toni Talks about PT Today (Weblog) on May 29, 2013
  • Return to Manual Therapy... Not

    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. ...
    Posted to Toni Talks about PT Today (Weblog) on April 24, 2013
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