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  • Agitation or Aggression?

    Recently we had an elderly man on caseload with a diagnosis of advanced dementia. It was obvious he was in the later stages of the process. He couldn't follow commands. His swallow was diminished. He was disoriented times three and demonstrated poor motor planning with any voluntary movement. However, he could still move and verbalize ...
    Posted to Toni Talks about PT Today (Weblog) on February 18, 2014
  • Dosage Matters

    There were two common themes at CSM this year: dosage and intensity. Every clinical presentation I attended mentioned one or the other. Intensity was defined as how hard the patient is working. Dosage referred to the number or reps or duration in the case of a static activity. In both cases, more is considered better. Last weekend I worked at a ...
    Posted to Toni Talks about PT Today (Weblog) on February 11, 2014
  • Well-Meaning Relatives

    The first thing I heard when I got to work Monday morning were tales of the well-meaning relatives. We all know the type. They try to help but only make things worse. Or, with the patient's best interest in mind, they interfere with just about everything we try to do. In this case, it was a daughter who hadn't visited all week. Like many people, ...
    Posted to Toni Talks about PT Today (Weblog) on December 5, 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
  • Sometimes Even the Doctor is Wrong

    I had a good laugh this morning. A doctor was ranting and raving that an order he'd written two weeks ago still hadn't been followed. The order was for a pressure-relieving shoe for a patient with a plantar wound. The doctor was very upset. He was making threats. He demanded something be done by 7 p.m. this evening or he would do something. The ...
    Posted to Toni Talks about PT Today (Weblog) on August 6, 2013
  • Secondary Gains

    If you work in physical therapy, sooner or later you're going to encounter a patient, friend or relative who is making secondary gains off the patient's illness. In my experience, this usually revolves around money or special attention. I have a patient now whose wife is behaving this way. We all get the behavior but no one has figured out what ...
    Posted to Toni Talks about PT Today (Weblog) on July 24, 2013
  • Horse Show or TPTA Conference?

    This afternoon I received the monthly email from the Texas Physical Therapy Association. It contained a prospectus for the upcoming annual conference and early registration. This is much smaller than the APTA's Combined Sections Meeting, probably not even a thousand people. But it's a good opportunity to be involved in what's going on here and ...
    Posted to Toni Talks about PT Today (Weblog) on July 3, 2013
  • Volunteering Update

    In past posts, I've expressed frustration at volunteering for various opportunities within the APTA and the Neurology Section. A few months ago, I was nominated for a position on the nominating committee for the stroke special interest group. The results arrived today. I wasn't elected. I wasn't surprised. One of the questions nominees were asked ...
    Posted to Toni Talks about PT Today (Weblog) on June 11, 2013
  • Finally Something I Enjoy

    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 ...
    Posted to Toni Talks about PT Today (Weblog) on April 9, 2013
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