Updates

A lot going on, especially in classes, but even more stuff outside of class.

• If you happen to read this in the next few minutes, flip over to ABC for the Bob Woodruff Iraq Special. It should be very interesting and I believe they will be talking about rehab of soldiers coming back from Iraq, hence the mention here. Here is a link to ABC Video, click on "Bob Woodruff: Re-Learning After Injury" or "Long Journey to Recovery" among others.
  
• On April 20-22 of this year, the APTA will be hosting a Real World Physical Therapy Seminar in Baltimore, MD. This is designed to help the transition from student to New Professional.
  
• Funds and other responsibilities are going to prevent me from going to this event but if you can get there it is definitely worth getting to. WCPT issues a warm invitation to physical therapists from around the world to come to Vancouver from June 2-6 2007 to participate in its 15th International Congress, which will be held at the Vancouver Convention and Exhibition Centre. If you register by the end of tomorrow you can save a decent amount of money (about $145 US).
• Journal Clubs are a great thing to get started at your programs or clinics (or anywhere else). Formats can vary greatly, but the general premise is a group of individuals sharing interesting articles that they have found or all discussing one article. This is something we currently do as assignments in class but with the importance of research due to the ever changing field in which we work in this is something that should be done more often.
• Who has a marathon on a Monday? Boston does... (I'm a Yankee fan if you couldn't tell)... I wanted to volunteer for this marathon but I have classes that day, grr...
  

All the best to you and yours!

Another Review

This is a busy semester, tests left and right, papers in your face at all times, readings that are hard to keep up with... some may suggest I spend less time writing blogs and being active in extracurricular activities... but I argue that these extracurricular activities are vital to my education. A PT once told me to not let school get in the way of my education... at this point in time I must...

Here is a quick/basic review of some cardiopulmonary concepts:

• One major concept is postural drainage. When there is a build up of secretions in the lungs many patients will need help getting them out of their lungs. It is important to determine which portion of the lung needs to be drained.
• This website focuses on cystic fibrosis and breaks down the lungs by segment very efficiently. It also provides the appropriate positions to facilitate drainage.
  
• This website has a video of a quick PT intervention to drain some secretions.
• Hydration is vital to mobilizing secretions and minimizing the risk of bacterial infection.
  
• Muscles of ventilation:
• Diaphragm, intercostals, abs
• Accessory muscles:
• Erector Spinae, Pectoralis, Serratus Anterior, Scalenes, SCM, Traps
• As one ages they go through numerous changes including their lungs increasing in compliance, a decrease in chest wall compliance and decreased lung volumes and expiratory flow rates
• Brainstem lesion patterns of breathing:
• Cheynne Stokes breathing - hyperpnea (rapid paced breathing)
• Central neurogenic hyperventilation - respiratory rate greater than 24 (per minute), continual, regular, deep
• Cluster breathing - irregular spurts of breathing (upper medulla lesion)
• Biot's breathing - completely irregular, unpredictable pattern, deep/shallow random breaths with pauses
• Central apnea - complete CNS involved, increased IntraCranialPressure, req's long term mechanical ventilator
• Mediate percussion - a technique to measure underlying organ/tissue density.
• Tactile fremitus - a technique in which you palpate over the lungs to get a sense of the vibration created by speaking.

That'll do it for this very annotated version of a review as I need to go get a good nights sleep and make sure I eat breakfast in the morning to get the most out of my brain tomorrow... All the best.

Legislation for Students

Always good to see the government working... for students...

On Friday, February 16th, U.S. Representatives Marion Berry (D-AR) and Jo Ann Emerson (R-MO) introduced legislation to enable physical therapists to participate in the National Health Service Corps (NHSC) Loan Repayment Program. 32 bipartisan Members of Congress joined Representatives Berry and Emerson in introducing HR 1134, the Physical Therapist Student Loan Repayment Eligibility Act.

Here is the low down from the NYPTA.

Here is a link to the Legislative Action Center from the APTA that makes contacting your representatives super easy (I hope the link gets you right there). There are pre-written statements that you can just add your name to, which is a good thing (and bad), and send it right off to your reps.

Get Involved! Have your voice heard and make a difference...

Studying (coughcrammingcough)

What I did not mention in my previous post was the phrase that I uttered in just about every conversation I had in Boston: "a lot of possibilities"... this referred to the exactly that in so many different facets, but until I can get started on making some of them into reality I have a test to study for...

Here's a quick review of what I am reviewing for tomorrow's "Specific Systems" exam (a lot of this is from the notes provided by a great specialist in wound care, I would like to acknowledge him for this information but will not be putting his name just yet):

PT in Wound Care:

• The Integumentary system is one of the four main systems we PT's treat (along with musculoskel., neuromuscular, and cardiovascular)
• A&P of Skin (epidermis, dermis, subcutaneous tissue)
• 

Holy jeez... I just lost about 2 hours of work that I had for the rest of this entry... oy vey... boo to you blogspot for not helping me retrieve that draft I was trying to save :(

well, it was a great review for me to type up even if it didn't get put up here for you all to "enjoy"

I was up to talking about specific interventions for wounds, specifically at types of dressings... darn it! stuff like that (losing a lot of work because of internet foolishness) really upsets me... but I have no time to be upset therefore I will try to continue where I left off or jump to something that would actually make sense... dang I am pissed about that though... I bring you to a type of intervention for wounds

• Adjuncitve therapies (all modalities have indications and contraindications not listed here for time purposes:):
• Vacuum Assisted Closure (V.A.C.) - removes interstitial swelling, increases rate of granulation tis. formation
• Non-contact Normothermic Wound Therapy (NNWT) - maintains a warm and moist environment thus helping the body heal the wound
• E-stim
• Ultrasound
• Ultraviolet C
• Hyperbaric Oxygen Therapy (HBO)
• Cold Laser (Low Level Laser Therapy-LLLT) - No contraindications except you need to avoid pointing this into the eyes
• In general, factors that adversely affect wound healing can be remembered by using the mnemonic device DIDN'T HEAL
• Diabetes, Infection, Drugs, Nutritional problems, Tissue necrosis, Hypoxia, Excessive tension on wound edges, Another wound, Low temp.
  
• Dressings:
• Alginate: highly absorbent (made of seaweed extract), can be used to pack wounds
• Foams: useful for absorbing and cleaning wounds with minimal exudate
• Hydrocolloid: used for dry wounds
• Hydrogel: see Hydrocolloid also can add anesthetic element
• Films: used to cover wounds whether it is dry or it is being packed with absorbent dressings
  
• Types of Burns: scalds, flame, flash, contact, electrical (only show small amount of damage externally, most of damage internal), chemical, special consideration for burns in elderly
• Degrees of Burn: 1st-just epidermis, 2nd-partial-thickness (goes into dermis - treated as full thickness), 3rd-full-thickness (through dermis and possibly through subcutaneous layer), 4th-damage extends to bones, muscle, tendon, fascia...
• I would like to reiterate how upset I am about losing so much of this post...
• Extent of Burns: expressed as a percentage of TBSA, Rule of Nines used (different for children, an alternative that is said to be more accurate and age specific is the Lund-Browder Method), another method is the palm method which considers the patients hand on one side to be equal to 1% of TBSA (used for small or irregularly shaped burns)
• Generally important to keep wound clean, infection free (defined as 100,000 bacteria per gram of tissue for normal level immune systems)
• Complications of burns include HO (formation of bone where there wasn't any before), peripheral neuropathy, pathological scars, inhalation injury, metabolic complications, cardiac/circulation complications
• PT Goals of the Burn patient
• Acute stage: limit loss of ROM/prevent contractures - PROM performed, increasing AROM and strengthening, reduce edema, splinting, antideformity-positioning
• Subacute: Functional training (ADL's), AROM/PROM, strengthening, minimize edema, scar management
• Pressure Injuries- often happen at bony prominences and factors include shear, friction, moisture, heat, over compression, medical co-morbidities, malnutrition
• Pressure Injury Classifications (full versus partial thickness):
1. area of swelling
2. partial thickness - can go into dermis but not through it - presents as a blister, abrasion or shallow crater
3. full thickness - damage to subcutaneous, may get to fascia but not through it
4. full thickness through fascia thus damaging muscle, bone, tendons and joint capsules
• Diabetic ulcers/management
• Venous/Arterial insufficiency ulcers (2 separate kinds)
• Review of ABI: 1.2 usually indicates a patient with diabetes and is a false negative for what the test is looking for (secondary to hardening vessels), if it is <0.8 then compression is contraindicated, <0.5 tissue necrosis is present but debridement is contraindicated
  
• PT Implications
• Status Post (S/P) Bypass Sx (Surgery): assess the following: suture lines, skin flaps, pulses, temp, swelling, breathing capabilities, pain... log-rolling indicated for aortoiliac Sx, WBAT (except with foot complications), avoid elevation (above heart)
• S/P Endovascular procedures: complete and strict bed rest for 4-6 hrs., continuous pressure on puncture site, unrestricted activity next day
• S/P Plastic Sx (skin grafts) - complete and strict bed rest for 5 days with dressing left in place for the same length, leg elevation, ambulation based on surgeon's orders
  
• There are cases of amputation with certain wounds/burns bringing me to a whole other part of the exam material...

Amputations... actually at this point I need some sleep... but this is a pretty lengthy subject... there will also be a section of the exam reserved for "Female Genital Issues"... I will direct you to the Women's Health Section of the APTA for more information on this subject...
Good Night (or day or morning, depending on whenever you read this...)
All the best.

Return from Boston

Tired, excited, sleep debt, fun, productive, informational, networking... I need a nap... hope everyone who went had a great time and everyone canmake it out to Denver for Annual Conference or D.C. for the Advocacy Academy and PT Day on the Hill...

CSM in Boston - Here We Come

This is just a copy and paste (for the most part) of the e-mail I sent out to the states I am a liaison for through the APTA Student Assembly. In retrospect, I should have just posted this here and in my e-mail directed everyone here... there's always next time.

What I did not send out to the liaison network was a
reminder to stop by the Student Assembly booth, where
we will have student guides to CSM and tons of other
great stuff.

I won't go too much into how great an experience these APTA
conferences can be, but it is my duty to inform you of the
great events that will be going on. For those of you not
attending I certainly hope to get a chance to meet you in
Washington D.C. between May 21-24 for the House of
Delegates and Advocacy Academy & PT Day on Capitol Hill
and/or in Denver between June 27-30 for PT 2007:APTA's
Annual Conference.

Back to Boston though; here is a quick reference of events
including a lot of social events (All programming can be
found at this link: www.apta.org/csm or leave a comment
for me with questions):

-WEDNESDAY: ABPTS Recognition Ceremony & Opening
         Ceremonies 7 PM-10 PM

-THURSDAY: Only unopposed lecture of CSM: The Globalization
of Physical Therapy During War: Spectrum of Care Across
Different Levels of Medical Care, Settings, Ages, Cultures,
and Disciplines
--Exhibit Hall Open 3:30 PM-6:30 PM
--Student Assembly Meet and Greet
Thursday, February 15
7:00 PM- 8:00PM
Marriott: Salon E
--MA SSIG is hosting a Social Event at Lir (903 Boylston St.)
starting at 7 PM

-FRIDAY: Exhibit Hall Open 10:30 AM-4 PM
--USC will be selling wristbands for a Pub Crawl they have
organized starting at 5 PM. Wristbands are $10.00 and there is a
whole word document about it that I have available upon
request.
--The MA APTA will be hosting a Social Event at "Game On"
(82 Lansdowne St.) starting at 9 PM (There is a .pdf
available upon request)

-SATURDAY: Exhibit Hall Open 10:30 AM-2 PM
--PT-PAC Luncheon 1 PM
--Unveiling 2008 NPTE Content Outline 1 PM-2:30 PM
--The MA SSIG will be hosting a Pub Crawl that will start at
5:30 PM at McFadden's (148 State St.) (There is a .pdf available
upon request)
-The AAOMPT SSIG will be hosting a Social Event at "Cactus"
beginning at 8:30 PM (939 Boylston St.)

There was also mention of a Dodgeball Tournament to be held
by the MGH Institute of Health Professions that was to raise
money for the Foundation, however details are not yet
available. The point is there are going to be tons of ways
to have fun and learn (as a reminder, I left most of the
academic programming off because it is available on the APTA
website; CSM isn't all social events...).
I look forward to seeing most of you at the Student Assembly
Meet & Greet on Thursday from 7-8 in Salon E.

Have a great and safe time (whether you are going to the
conference or not)!!!
All the best.

Cool Trick

For those of you who have gmail accounts, I found this cool filter that will get rid of junk e-mail for the most part. It is a great time saver rather than checking your spam box... just hope no one you know qualifies as "spam."
**the relation to PT is the time saving mechanism of this tip :-D

In your gmail inbox go up to "Settings" (top right) --> click on "Filters" (one of the top tabs) --> click "create a new filter" --> under "choose search criteria" there is a box for "Doesn't Have" in that box type in "is:spam" --> click on "Next Step >" --> a warning will pop up, you can choose to read it, which I encourage you to do for the sake of knowing what you are doing, but I can vouch for the fact that there are no adverse effects of clicking this and you will no longer have spam... --> after clicking "ok" find the check box next to "delete it" and click that... then click on "create filter" and no more "spam" (a few sneak into your inbox ever so often, but they are pretty good at their spamming work...

hope this is useful in saving someone time... if not, sorry... nothing but love to everyone reading this!

Yet something else to read

Publication of “Today in PT”

APTA has received questions regarding a new publication, Today in PT, which is scheduled to launch later this month. Published by Gannett, owners of USA Today, the new biweekly publication is expected to be similar to Advance for Physical Therapists and Physical Therapist Assistants. APTA has not seen a prototype of the publication, nor were we aware of its development until the Public Relations staff began receiving calls from the freelance reporters working for Today in PT. As to whether it will compete with APTA publications, much will depend on its content. If it carries classified advertisements, as we expect that it will, it will compete indirectly with PT Bulletin Online and directly with PT Bulletin Digest. If it carries display advertising, it will compete with both PT Magazine and Physical Therapy. If you have any questions, please contact Lisa Ruane at lisaruane@apta.org.

Pretty Major Proposal

Health Care Programs Face Cuts in Bush Budget

The Bush Administration released its $2.9 trillion spending plan this week calling for Medicare and Medicaid cuts totaling nearly $100 billion over the next 5 years. The cuts would reduce payments to hospitals, skilled nursing facilities, and other providers; reduce the hospital market basket; and freeze home health payments through 2012. Additional details are expected during congressional hearings. Complicating the spending outlook further are the recently passed House measures requiring "pay-as-you-go" for any additional spending. Democrats immediately criticized the Bush budget, making passage of a budget resolution similar to the Administration proposal unlikely.

Keep alert on legislation affecting physical therapists and their patients by joining APTA's grassroots network PTeam.

It's issues like these that you as a student/patient/professional can contact your congressman about and let them know you do not agree with this. I hate getting too political... so I won't say another word on the matter... :-D

Here are some lighter pieces of news...
Patrice Winter, PT, MPT, MS, FAAOMPT, was featured in a Fox 5 interview during the 5 pm newscast on Monday about how wearing baggy pants affects the way the wearer walks, which can throw off hip alignment and cause pain. "Some muscles are working harder, and some not hard enough…" says Winter.

Marika Hartog, PT, one of the New York City Ballet's nine physical therapists, was part of a team featured in a Washington Post article about their work in helping young dancers avoid injury during the ballet company's Injury Prevention for Adolescent Dancers program recently held at the Washington School of Ballet. "During adolescence your body goes through many changes: Your head size doubles, your trunk size triples, your arm size quadruples, your leg size quintuples," Hartog says. "Young dancers are going through these really big changes physiologically as well as hormonally, and they're psychologically maturing. It's a dramatic time in a child's life."

PR for PT

Check out the Power Point Presentation that the APTA put together for those planning on talking to high school students about the profession:

APTA - Member Services
Scroll all the way to the bottom and there you shall find a pretty large .zip file (32 MB). This is because it includes a video file. Enjoy!

Busy

Currently researching Core stabilization versus manipulation for treatment of chronic lower back pain...

So here are some links to recent Medscape articles... you may need to have an account to view them, but I highly recommend getting an account if you don't have one, it is a great resource for medical information...

Goodley Intentions: Why, Orthopaedic Surgery?
In his second reFLEXIONS and rePERCUSSIONS: Goodley Intentions, Paul Goodley, MD, continues his exploration of the state of the state in orthopaedics by simply asking, "Why orthopaedic surgery?"

Get the Word Out: Communication Vital in Healthcare Businesses
What good is a top-notch medical practice or an ambitious healthcare initiative if no one ever knows about it?

What Can I Recommend to Patients Who Want to Lose Weight?
Just about everybody I see in my practice wants to lose weight. What really works for weight loss and what doesn't?

Tired

Just wanted to say hi to everyone... HI!

Although I was quite dissapointed in the Super Bowl this past weekend, I was happy with the turnout to the social event the NYSSIG hosted this past Friday (even if it was a majority of one school in attendance). The SSIG in NY is rolling along with many ideas and people joining us left and right to help out. I think it will be a glorious year... glorious... fare thee well reader, I am off to balance studying/sleeping/24-ing...

Classes

I don't believe that I have once mentioned the classes I am currently taking this semester. So here is a run down of my Spring 07 semester (end of my 2nd year):

• Specific Systems - a class dealing with unique issues such as amputations, wound care/burns, female issues such as pregnancy, etc.
• Pediatric Diagnosis and Management - currently working on an assignment to figure out how to use bubbles to assess a 2 year old child.
• Health Promotion & Wellness - this is a major movement in the PT profession. If we can get people healthier now, it means less work for us later... that's not the real message of the class at all, but there is a focus on being proactive with your health and getting the patients/clients to follow along.
• Evidence Based Practice - how to find, utilize, and sorth through research related to PT practice.
• Cardiopulmonary Pathology - Things that can go wrong with the lungs/heart. Learning EKG interpretation, lung sound auscultation (listening to), chest PT (to clear up lung congestion) and much much more.

Ideally if you are a PT/PTA student, you can leave what classes you are taking and at which point of your curriculum you are as a comment so as to compare and contrast :-D