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  • ‘We're All Gonna Need Physical Therapy Soon'

    I spent last weekend at a horse show in San Antonio. Even though I had both show horses with me, there was still a lot of down time. Since everything is close quarters it's easy to overhear conversations. While I was waiting I was surprised to hear someone in the barn next to us say, ''We're all gonna need physical therapy soon.'' I wasn't ...
    Posted to Toni Talks about PT Today (Weblog) on March 25, 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
  • The Declining Census

    In previous posts, I've discussed staffing issues where I work. Those problems continue. So does the return of the frequent flyer. Now we have something even more troubling. Our census continues to drop. The facility is at one-tenth of its capacity. There doesn't seem to be an end in sight. As of the time I left work this afternoon, no admissions ...
    Posted to Toni Talks about PT Today (Weblog) on September 24, 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
  • Unintended Consequences of Cutting Staff

    In recent posts, fellow ADVANCE bloggers Dean and Michael have been discussing how companies cut staff as a measure to lower costs. Neither of them supports the idea. Both make valid arguments against the practice that I'm sure would fall on deaf ears. Anyone who works in patient care sees the foolishness of the practice. The facility I'm working ...
    Posted to Toni Talks about PT Today (Weblog) on September 3, 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
  • My Fear of Maintenance Therapy

    Last week in his post, fellow ADVANCE blogger Dean Metz shared some good news. CMS has ruled the need for skilled intervention, not functional improvement, makes therapy reimbursable. This means, as he pointed out, patients with chronic conditions can receive treatment without first experiencing an exacerbation. This will undoubtedly result in an ...
    Posted to Toni Talks about PT Today (Weblog) on June 4, 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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