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 ...

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 ...

I don't know about anyone else but I can't wait for Christmas to come and go. Things need to get back to normal, or what passes for normal. I'm not a holiday person. I don't go out of my way to celebrate them. Holidays are actually my favorite days to work. No one else is there so the day is peaceful and productive. The patients are appreciative ...

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 ...

I'm having a debate with the PTA I work with. We can't agree on the definition of functional. I want to use it to describe activities, as in they are functional. She wants to use it to describe actions as functional, such as in functional ROM or strength. Her position is that a person can perform a functional activity without functional ...