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  • ‘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
  • Being Put on the Spot

    I believe I've mentioned being a certified McKenzie therapist in my former (pre-neuro) life. I still use those skills, particularly when one of my horses needs some work. However, I generally don't talk about it. I like to avoid those ''why aren't you doing that?'' questions. Nor do I want to spend my lunch time fixing someone's back or ...
    Posted to Toni Talks about PT Today (Weblog) on October 16, 2012
  • Putting Up With Bad Behavior

    Today was one of those days. There is a full moon. Healthcare workers often joke about the effects of the full moon on their patients. I believe there is something to that, which means my patients gets more of a workout than usual. I am used to brain-injured people being difficult, making inappropriate statements and being confused. I shrug it off ...
    Posted to Toni Talks about PT Today (Weblog) on September 4, 2012
  • Very Acute Therapy

    This week I found myself at an outpatient orthopedic clinic treating work-related injuries. The clinic was one of several in the area. They have agreements with many local industries to provide medical and therapy services to injured employees. The injured worker sees the doctor at the clinic, is given a script for therapy and starts as soon as ...
    Posted to Toni Talks about PT Today (Weblog) on April 9, 2012
  • Respect for Clinical Judgment

    Once in a while I work with patients who have a diagnosis other than stroke. Two or three weeks ago, I evaluated a young man who'd had a TBI and was in the ICU. I later re-evaluated him following transfer to the rehab unit. Last week his rehab doctor noticed he had some ROM issues and decided to address them. Because I was the evaluating ...
    Posted to Toni Talks about PT Today (Weblog) on December 20, 2011
  • Return Demonstration

    Physical therapists spend a lot of time teaching patients how to do things. We teach home programs. We teach precautions. We teach safety. We teach how to use devices. The list of things we teach is almost endless. And right after we teach it, we document it. That documentation always includes some form of the phrase, ''return demonstration.'' A ...
    Posted to Toni Talks about PT Today (Weblog) on September 6, 2011
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