SIG

What is a SIG?

It stands for special interest group. This is simply a way of connecting people with similar interests. The APTA has numerous SIG's such as the Performing Arts SIG or the Animal PT SIG (yes PT's can also treat animals).

I was recently named the Chair of the New York Student SIG (NYSSIG). Last year I served as the Vice Chair and we made some strides as a group. This year I look forward, with the aide of our amazing board, to making the NYSSIG a very productive component of the APTA and NYPTA.

In the state of NY there are 21 PT programs and 13 PTA programs. In the 5 boroughs of NYC alone there are 7 PT programs and 3 PTA programs, plus a few just upstate or in Long Island. My driving force with the NYSSIG and this blog is that all of these programs have a lot in common and can certainly learn a lot from each other by simply talking. I am taking it on as my responsibility to help open this path of communication.

If you have any questions about joining the NYSSIG either send me a message (leave a comment) or click here and scroll down.

I hope everyone is enjoying the amazing weather for the beginning of December...

Health Tip of The Day

Here's a real quick way to cool down if you are feeling a little hot for any reason (after a workout, or maybe the heater is just up too high, etc.)... run some cool water over the palm side of your wrists. The blood vessels right there are very close to the skin (superficial) so you can lower the temperature of that blood. This blood then goes into the rest of your circulation and can cool down the rest of your body fairly quickly.Good luck not overheating (I know, I know the winter is starting... it's still useful info).

Happy Tur... Direct Access Day!!!

Yes, today is the day that Direct Access goes into effect here in New York State... I wanted to pass along the message from the president of the NYPTA chapter in regards to this great day:

As most of you know, effective November 23rd, those PTs who have 3 or more years experience will be permitted to treat patients for 10 visits or 30 days without a referral.

We have celebrated this huge victory, but we have more work to do.

READ THIS FIRST BEFORE YOU START PRACTICING WITHOUT REFERRAL UNDER OUR NEW LAW

Direct Access does not Guarantee Reimbursement under Direct Access.
We are reviewing state insurance law now to be sure that there is nothing in the law that would stop an insurance company from paying us. Initial reviews seem to indicate that there is nothing there to stop companies from paying us for direct access services . Once this is completed, we will let you know of our findings.

I have spoken with PT leadership both at APTA and in states that already have direct access as to their experience in getting reimbursed. It appears that they have achieved reimbursement primarily through going to each company and negotiating approval for the reimbursement of services under direct access. We are gearing up now to start this process and will also give you this information as soon as we have it. It is important to note here that these agreements must be made with the decision-makers of these companies. We will be asking everyone's help with this when we start.

New Notice of Advice Requirement.
As you will see when you read the new law, those practicing under direct access are required to give a notice of advice to the patient informing them that their insurance may not cover services when rendered without a physician referral. This will not require a separate form and the notice can be included in current forms you use in your clinics. The chapter is working on sample language for your use and will have that for you very soon.

Regulations and Guidance information from the State Education Department is in process and should be completed and on the NYSED Office of Professions Website very soon.
While we all agree that our new Direct Access law is about as clean a bill as we could have hoped for, the State Education Department has to further clarify wording in the law, essentially defining the intent of the law, in order for the State Board and the Office of Professional Discipline to have a clear understanding in the event that complaints are filed.

The regulations are completed, with many of you seeing them at our Issues Forum at the conference last month. However the guidance information was just completed on Friday, November 17 th at the State Board Meeting that I attended. There are elements of the guidance information on which we will continue to work with the State Education Department. We are in contact with the State Board Secretary and will continue to pursue language that we feel is reflective of our practice.

Before you start to provide care under Direct Access, I urge everyone to do the following FIRST!
Read the Law
Read the Regulations
Read the answers to the Guidance Questions

The last thing our profession needs after this great victory is for our colleagues to go about treating under direct access in a manner that is not consistent with the law, regulations and guidance information from the State Education Department.

Education on the New Law and Regulations.
Your chapter Board of Directors has passed a budget that includes monies for audio conferences in 2007. Some of these will be for presentations from chapter and State Board leadership on the new law and how we need to practice in order to minimize the risk of doing so outside the regulations and guidance information.

If you have any questions, once you read all the material that, again, should be up on the State Education Office of Professions Website in a week or so, please direct your questions or comments to the State Board for Physical Therapy at the contact info below. If you e-mail, please cc your comments to me so we can track the issues you have and include them in our ongoing discussions with the State Board.

I thank you again for your membership and support of physical therapy in New York, and on behalf of the office staff, Officers and Board of Directors, I want to wish you all a safe and peaceful Holiday Season!I thank you again for your membership and support of physical therapy in New York, and on behalf of the office staff, Officers and Board of Directors, I want to wish you all a safe and peaceful Holiday Season!

Jim Dunleavy, PT, MS
President, New York Physical Therapy Association
800 459-4489
jimdpt@aol.com

New York State Board for Physical Therapy
518-474-3817, ext. 180
e-Mail:ptbd@mail.nysed.gov
Website:
http://www.op.nysed.gov/pt.htm

House and the PT

House, MD is a great show. Very entertaining and it is fun to hear about so much of the stuff I am learning in school. Last nights episode was especially entertaining specifically for one scene. House is feeling pain in his shoulder throughout the beginning of the episode and then he is shown in the Physical Therapy office. The PT tells him something that most of us in the PT field who watch the show already knew: it is recommended that you use a cane or crutch on the opposite side of the affected leg. Some people do feel more comfortable with the cane/crutch on the same side, but that would come from a long time of doing it incorrectly or needing to have your dominant hand free. House falls under the former of the two, plus his general disdain to listening to anyone elses advice.

I of course would recommend going with the PT recommendations... but Dr. House shortly after his visit with the PT ignores her advice and his shoulder starts to hurt again. Will he ever stop being ornery?

Head to Toe

My CardioPulm class was cancelled this morning, allowing me some free time to get caught up on, well, everything. One of the things this time has helped me discover the APTA’s brand-new “Head to Toe” health care database, now online. It is designed to help patients find information on illnesses, medical tests, medications, and even support groups. There is also a calorie counter you can use.

Now off to be productive and help with the bake sale we are having this afternoon to raise money for our Physical Therapy club... then to play a little aqua basketball with a few classmates and one of our professors

Have a swell day...

Burglarized

So while I played football this morning on the field where a plane had to emergency land the other day... Someone broke into the trunk of my mother's car, which was parked at the field's lot, and they took my credit cards, cash, and iPod. BOO! But it did lead me to learn this about that field I play on from a post about the field on a website...
"You know I didn't realize that the reason that park is there in the first place is because of the verrazano bridge...the builders of the bridge needed a place to dump all the displaced dirt from its construction, and ended up creating a new hunk of land that jutted out of brooklyn into coney island creek. That land later became part of a city park. I thought that was a cool piece of neighborhood trivia."
Needless to say, filing police reports and trying to do a little detective work myself took up the majority of my day, thus not allowing me to do as much cramming as I would have liked before tomorrows Neuro Midterm... I then decided to drink a Tab to give me study power (wanted to try something other than RedBull, even though I just found it they market Tab towards women... eh).

Whilst I drove around and finished up some work for my mother I was on the phone with some very helpful classmates, having review sessions over the phone. Very helpful, considering I would have been very counterproductive otherwise...

So here are some of the scales that are used to assess some of the patients that present with various Neuro conditions:

1. Kurtzke Expanded Disability Status Scale (EDSS) - This measures disability associated with Multiple Sclerosis (MS). Scored from 0.0-10.0, o.0 indicates a normal neurological exam. After 0.0 is 1.0 which is indicative of minimal signs in one Functional System (FS), after that the scores increase by 0.5 all the way up to 10.0 which is death due to MS. There are 7 FS's that are scored from 0-9 and the totals of these systems are the score for the EDSS.
2. Rivermead Visual Gait Assessment form (link is to the original journal article introducing the form into the literature) - While gait assessment is something we as PT's do very often (even when we walk down the street and watch other people walk), this scale quantifies each aspect of what we see. The scale looks at Upper Limb Position (shoulder and elbow flexion), Stance Phase (11 different items), Swing Phase (7 items), and finally any other deviations noted. Each item gets scored as such: 0=normal, 1=mild, 2=moderate, 3=severe. The highest possible score is a 59, and the closer to this score you get, the more deviation there is in the subjects gait.
3. Modified Fatigue Impact Scale (MFIS) - The MFIS is a structured, self-report questionnaire that the patient can generally complete with little or no intervention from an interviewer. It has 21 items that follow the phrase "Because of my fatigue during the past 4 weeks..." and each item is rated on a 5-point Likert scale from 0(never)-4(almost always). The scoring for the questionnaire is broken down into physical, cognitive, and psychosocial subscales (each subscale totals specific items together). The total MFIS score is the total of the three subscales and can range from 0-84. Higher scores are indicative of "fatigue".
4. Amyotrophic Lateral Sclerosis (ALS) Functional Rating Scale-Revised - ALS is more commonly referred to as Lou Gehrig's Disease (I love the kidshealth website). Lou Gehrig was a great New York Yankee baseball player, he made the famous "Today, I consider myself the luckiest man on the face of the Earth" speech. This scale consists of 12 total items with a score of 4(normal)-0(loss of respective item). The range would then be 48-0, the higher the score the better off the subject is. The ALSFRS-R is an attractive primary outcome measure in clinical trials of ALS because it is validated, easy to administer, minimizes dropout, reduces cost, and correlates with survival. Unlike the other standard outcome measures currently employed, the ALSFRS-R is also a measure of global function.

Neuro Midterm

As a new method of studying I will be putting up some of the test material on this blog, not too in depth of course... enjoy...

Proprioceptive Neuromuscular Facilitation (PNF) - a technique that utilizes sensory input in an attempt to maximize motor output...
characteristics include:
-use of proprioceptors as internal stimuli
-application of carefully measured resistance to patients movements
-exercises concentrating on natural movement patterns
All of the patterns in PNF must 1. Cross midline 2. Involve an arc of motion 3. Elongaate and shorten the trunk.
There are patterns for the extremities, trunk, scapula and pelvis. The extremity patterns go in different diagnols and are named for example as D1 Flexion or D2 Extension. Check out this link (about the middle of the page) that uses PNF as part of a baseball players workout. Of course there is more to PNF, most of which has to be practiced in the lab (and it takes about 6 months of intense classes to get certified in this technique). But moving along...

NeuroDevelopmental Treatment (NDT) - aimed at using repeated active movement (isolated or in pattern), resisted by gravity, body weight or manual pressure, to achieve balance between muscle groups and to decrease the effect of abnormal tonal influence on automatic responses and movement patterns. That is a long-winded way of saying it, as is this article about NDT.
My notes have 6 aims of treatment listed which I won't get into here, and 22 "basic" principles and treatment strategies.
-Of note, is that this is hands on technique, utilizing the idea of "key points of control" (e.g. the pelvis controls the lower extremity [LE], so by controlling or guiding the pelvis you can control/guide the LE)
Keys to Tx: -Head in midline
-Limit deviation anywhere in body
Negatives: -There is little carry over to function.
-Too much hands on, can lead to a dependence on the technique.

Before I lose any on of you who have read this far, I will continue this review later on today... Topics to come:

• Neurological Rehab Models
• Task-Oriented Approach (contemporary)
  
• Muscle Re-Education
• Neurotherapeutic Facilitation
  
• Rood's Approach
• Brunnstrom-Movement Therapy in Hemiplegia
• Manual Facilitation and Inhibition Techniques
• ALS, MS, Postpolio Syndrome, GBS, diabetic neuropathy, bell's palsy and much much more...
  

Circulation & The Elementary School

Currently taking a break from reviewing "Accelerated Longitudinal Decline of Aerobic Capacity in Healthy Older Adults". It seemed like an interesting article at the time when I chose it, but it is way more technical than I anticipated... but alas, I shall make it through as I always do. The main conclusion of the article is that former studies that only looked at "snap-shots" (cross-sectional studies) of age brackets were not very accurate... This study is longitudinal, meaning that it looks at the same group of people over time. The study used the the Baltimore Longitudinal Study of Aging (BLSA) to collect data, this is America's longest-running scientific study of human aging, which has been going since 1958.

What they found was that the rate of decline of peak treadmill oxygen consumption (peak VO2) accelerates markedly with each successive age decade, especially in men, regardless of physical activity habits. Does this mean that exercise is not important? NOT AT ALL!
The authors of the study discuss the fact that this remains highly controversial as some studies provide evidence for this idea and some against it...
If I may be so bold... I doubt that any study will ever find any negative effects from moderate exercise at any age. So make sure you go out and get some exercise at any given point in your life...

Speaking of which this was the main message 3 of my classmates and I tried to convey to 4th and 5th graders at an elementary school in Sunset Park, Brooklyn. The PT on staff and some of the teachers were kind enough to work out some class time for us to talk to their students about what PT is, what we do, and what they can do to stay healthy. The kids had so many questions, albeit not all about PT, but the energy and curiosity was there.
The main things I learned were that the 4th graders at that school do not have gym, it has been replaced by african dance... The school does not have students do the "pledge of allegiance" as I did throughout my schooling... Evolution is a fairly accepted idea... 5th graders apparently learn about sound waves and some physica and the airway system (they were able to recite that air travels from the nasal passage, to the trachea, to the bronchus, to the alveoli, ends up in the lungs, and that the diaphragm is the main muscle of breathing!!!)

They will learn more than we'll ever know... if they can just put down the video games and soda, and as one of my professors says... WHY CAN'T THEY FOUND THE FOUL LINE ON A BASKETBALL COURT?!?!

It was an awesome experience for me and the other 3 student PT's that went and it appeared to be a great experience for the kids... We are planning more school visits and if you or anyone you know has a connection to any students from elementary school all the way up to undergrad in the NYC area, please let me know so we could set something up. It really is a lot of fun. That's my favorite part of this profession, the possibilities of fun...

Now back to reading and analyzing the rest of this Circulation article.

Drowning

This is a pretty rough week as far as exams go... But it won't stop at the end of the week.. it just keeps on trucking...

I just got out of my second midterm of the day and I have to do my last reviews for tomorrows practical of special tests and palpations and such... the third year students are in the room with me now and they have 5 classes left in their entire academic career here... that will be me one year from now (hopefully)

In other news I managed to win a manipulation cd...

Off to the train tracks... to go home... study... bye

Study Some More

A whole lot of material that needs to be studied for next week... and the week after... and projects that have to be completed somewhere in there...

So I am really trying to focus myself <-- bit of a challenge While I feel like this guy at the bottom of this post... I know it is all worth it to learn this vital information...

Before I go enrich my mind, I would like to share the following statistics with you about the National Physical Therapy Examination (information received from National Student Conclave):

• It costs $4,000.00 to develop each question... WHAT?!?
• The Pass Rate for 1st Timers is 83% of PT's and 74% of PTA's
• I won't be taking this exam for another 2 years but I am starting to use the O'Sullivan review book as of a few days ago. (I figure it can help me with my academic career)
  

now I am off to learn :-D

Anatomy Flash Cards

Yesterday evening I went to a developmental dinner. One of the developmental editors of Thieme publishers contacted me through facebook looking for students in the health professions. Shady at first, I ended up deciding to attend this event with one of my classmates. It was a very cool experience. Along with the free Indian food they provided they gave us each a text book of our choosing to keep.

The real interesting part was the development of these flash cards. They dug very thoroughly into how we learn best and what we thought of the current cards on the market. One of their biggest issues was figuring out the order to put the cards and what content to leave in/take out. The whole event was very interesting and I wish the publishers a lot of luck with this arduous task.

Now I wish myself a lot of luck with the 3 midterms I have next week (plus one practical exam). Study On Wayne... Study On Garth...

Being Generic

I forgot to congratulate my classmate that finished the marathon yesterday in her goal time. And a happy birthday to her tomorrow...

For now I am working on my generic abilities form that our program requires us ot fill-out a few times throughout our 3 years here. It is basically a 10-item self-assessment with the following items:

• commitment to learning
• interpersonal skills
• communnication skills
• effective use of time and resources
• use of constructive feedback
• problem solving
• professionalism
• responsibility
• critical thinking
• stress management
  

Of note: tomorrow is the "Moving On" ceremony for the 3rd year students as they finish up their academic portion of their degree. I am looking forward to that...

Fun Day

Woke up this morning... drove my mom to airport, drove to my apartment, got my stuff, got on the train and the real fun began...

I was a part of the "largest medical volunteer staff" for any sporting event ever, according to the medical director of the race. The ING New York City Marathon was an awesome day. Speaking of which I have been using the word "awesome" an awful lot.

There were medical stations set up along the 26.2 mile stretch that the race covered. A bunch of my classmates and I were 15 blocks past the finish line so everyone that we saw ran all those 26.2 miles, which I don't think I can motivate myself to ever complete, so that much more respect for these elite athletes.

Past the finish line we dealt with a lot of fatigue, a bit of cold, cramps, nausea, and the podiatry students dealt with anything below the ankle. We had a great group of my fellow PT students, podiatry students, a Doctor of Osteopathic, an MD, and a few RN's.

I look forward to doing it next year. The best part was using my selective muscle tension test that I learned a few weeks ago. There was a suspected achilles tendon rupture, but the patient was able to hold his foot in a plantar flexed position against resistance with no pain which indicates that the tissue is normal.

Here's some of the volunteers and our "team captain":

MyPhysicalTherapySpace.Com

This is a great website that I need to add to my wall over here to the right. I have always thought there should be a website like this for PT students. In fact, it is part of the reason I started this blog. Check out the website, tell your friends. It is a high energy group that seem to all believe in the power of PT and research. I like it, I love it, I want more of it... but I gotta run now, all the best to you all!

So Tired

Have to drive a friend to the airport in a few hours, just recorded and posted my first video on YouTube... It is pretty bad...
Just wanted to post the picture of the candidates that made it out to Dallas... it was a great group and I feel like the faces you see below will help this profession grow in the coming years... these are passionate people who have so many skills and I hope we all stay connected...