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 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 ...

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 ...

Now that I'm home from CSM, I've had an opportunity to process all of the information. Most of the presentations were excellent. Those that weren't purely theoretical had a common theme. We have to maximize what we do because we're spending less and less time with patients. We have less time to spend because there isn't money to pay for our ...

Reading Jason Marketti's blog last week reminded me of a discussion we're having here in Texas. It's called RC-3 and is an amendment to the Texas Physical Therapy Practice Act. It proposes unlicensed individuals such as athletic trainers and massage therapists be used as PT extenders. These extenders are to provide care as directed by the physical ...

Last week, I wrote about my experiences teaching my first CEU course. I mentioned how much work it was but didn't go into details. It took me nearly four months to finish, including two months of working at least an hour or two every night. Now I'm going back and revising the content. I'm beginning to think that is an ongoing process. In the ...

I've been using the Nintendo Wii with more of my patients. This has created a dilemma for me. I don't know how much help to give my patients. At first I didn't help them at all but that wasn't successful. Since then I have alternated between verbal cues for strategy, tactile cues to follow the strategy and manually assisting them with playing the ...

Lately I've had the opportunity to work with a wonderful ST. We bounce ideas off each other. We've even managed to co-treat a few times. In the course of working together, we've observed that improvement in one discipline carries over to improvement in the other. Although we're somewhat of a unique pairing, our combined efforts have had great ...

We all have things that annoy us. I have a new one at work, the assisted ergometer. It can be used for the UEs or LEs and programmed to provide either resistance or assistance to whoever is working the pedals. To me it is a glorified restorator. What annoys me so much isn't the machine but the individuals who put every patient on it every day ...

It's been a while since I've had more than a few geriatric patients on my caseload. Now that my caseload is all geriatric, I've had to readjust. It's a good thing I didn't forget the first rule of geriatric care. Elderly patients are people, too. They should be treated that way. It's been a nice change. They complain. They tell me they can't do ...