Sunday, April 29, 2007

Specific Systems

Today was gorgeous outside here in NYC, unfortunately I spent most of the day reviewing for the final I have tomorrow. I think they call it specific systems because that is a nicer way of saying "everything we couldn't fit in any other class goes here." Fortunately, this last exam is focused on orthotics of the lower limb, spine and PVD. Let's review...

AFO's (ankle-foot orthoses) extend downward from the calf and generally attach to the heel via a stirrup (split or solid). These are generally used to prevent deformity and are made of metal, leather and/or plastic. Basic ideas that have come out of these lectures has been to create the most functional orthosis for the patient. While we as PT's very rarely "create" the orthosis, we are a point of information and advice for the patient in having an optimal piece of equipment. There are components that can make things easier, lighter, more/less restrictive, increase stability, durability, more economical, etc. In fact there are a lot of variations available to meet many different needs, which is what makes studying for tomorrow not that fun :( but it is all good to know. Another large part of the PT scope of practice is knowing how the orthosis affects biomechanics, especially of gait.

Something is going on with my internet right now, so I leave you here and go off to finish reviewing, enjoy yourselves :-D

As a side note, although this wasn't that exciting a year for it, the NFL draft is such a great event :-D

Thursday, April 26, 2007

Update

Fun times here in Brooklyn...
Down to 3 finals and one paper revision for this semester... and some other minor things... To make some extra money, I will be bouncing at a bar in Williamsburg for 16 hours this weekend, gotta keep up with the dra... wait, maybe I should be more focused on studying for these finals :-D

At the same time my physical body is trying to find balance in more ways than one. It is not a topic I have broached on this blog much, but when a student gets injured and becomes the patient, that paradigm shift can create a much better PT. So when I sprained my ankle two nights ago (I have diagnosed myself with chronic ankle instability in what appears to be both of my ankles) I tried to use all of the information I have thus far gathered to treat myself... It's as simple as the RICE principle. (Haha, that website with the RICE principle shows stretches that are performed by a Spider-man action figure... funny probably only to me...). I think my ankle heals a little bit faster because of the past injuries, but it is not at 100% and I am trying to train for a triathlon and get my softball career off to a jump start...

But all attention will now go on studying... I hope you are all doing fantastically well

Monday, April 23, 2007

Health Promotion & Wellness

Goodness this week stinks... but it's all good... here is my review for the class that appears in the title of this post :-D

This would be easier if I could make a table, but the following info is adapted from Janet Bezner (who is a great presenter and I hope I do this section of your chapter justice). In Health and Wellness: The Beginning of the Paradigm (2007) she compares and contrasts illness (traditional or medical), prevention, and wellness paradigms. She goes on to break each down into how they stand on 6 parameters: view of human systems, program orientation, dependent variables, client status, intervention focus, and intervention method.

A wellness paradigm approaches the systems as integrative where they all work together and rely on each other. Illness looks at each system by itself, hence all the specialties of neurology, ortho, gyno, etc.). In prevention there is acknowledgment that systems interact but not in the reciprocal fashion as in wellness.

Program orientation in the illness paradigm looks to fix a pathology; in prevention it is normogenic, meaning there is a focus on maintenance; whereas wellness is the most proactive and tries to improve/cause health (salutogenic).

Dependent variables in illness are clinical (e.g. blood tests, tests & measures, etc.). Changes in these variables result in the pt. being more or less ill. Prevention deals with behaviors of people such as smoking, exercise, or safety precautions taken. Wellness focuses on what the individual feels and thinks about him/herself. Studies have shown that how well you THINK you are may be more important than how well you are measured clinically (the power of positive thinking...).

Client status in illness refers to a "patient". In prevention the "person-at-risk" is the one trying to maintain their level of health. Lastly, in wellness the client is a "whole person," thus emphasizing how the multiple systems work together. Most importantly emphasizing that a high-functioning or intact physical dimension, although important, is not necessary to achieve a state of well-being or a high quality of life.

Intervention focus is consistent with client status in illness (focus on symptoms) and in prevention (focus on risk factors). Wellness focuses on dispositions, or the tendency to act in a certain manner under given circumstances, thus having an impact on the psychosocial assessment of the whole person.

Lastly, the intervention method is prescriptive (focused on system affected by symptoms reported or pathology) in an illness paradigm. In prevention the intervention is lifestyle modification to minimize the identified risk. Wellness brings us to the "values clarification" which is aimed at self-understanding to really understand the whole person rather than the disease or condition. A change has to be made from within the person, because they want to make it in order for health to improve.

Another article we read was by Rimmer (1999) from the PT Journal. The major themes covered are that individuals with disabilities need prevention of secondary conditions. This will be cost-effective in the long term and create greater quality of life and greater function for those affected.

What role do PT's play in all of this? We are one of the primary advocates for our patients/clients. Not only can we educate the individual who has the disability about what they can do to help prevent these secondary conditions that include osteoporosis, OA, decreased balance, strength, endurance, fitness, and flexibility; increased spasticity; weight problems; depression; and other conditions. In the case of depression it may be necessary for us as PT's to refer to a specialist in this area, but PT's are one of the few health care workers who spend upwards of an hour with each patient/client and thus need to discuss these vital issues.

Another important point this article brings up is the definition of health. It used to just be "the absence of disease" but recently was redefined by WHO to read: "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

Lastly, on the topic at hand anyway, we discussed sports injury prevention and ergonomics. There is way too much to go into with sports injury prevention, but know that prevention in the off season can keep you going for all of the regular season and much further. Some highlights:
  • ACL injuries Females>Males (for biomechanical reasons), 3 main theories behind this (ligament dominance, quad dominance or straight knee landing theory), 66% of ACL inj's are non-contact, cost America about $850 million/yr. Peak age is 16 in F, 19 in M.
  • Proper technique and plyometrics seem to be two of the bigger prevention strategies that work.
In ergonomics there are a lot of technical details. A good one to remember is when you sit "90-90-90" - as in your hips-knees-ankles in terms of degrees. It is good to constantly remind yourself to not slouch, and tell your kids or friends... it is just saving them back pain and other musculoskeletal problems later on... We are one of the few professions that would actually try to cure patients before they ever come see us to pay us...
I wonder how anonymous is doing... they are probably better than those damn Yankees pitchers.
All the best ya'll.

Sunday, April 22, 2007

And I was Running...

Just a quick update to try to keep my few readers around...

I just got back from two days up in Albany, NY where the passionate and talented PT’s of our state came together to discuss among other things, the 40 motions being put onto the floor of the House of Delegates of the APTA. This is similar to the House of Representatives; except the amount of reps, a.k.a. “votes,” are determined by the amount of PT’s and PTA’s practicing in each state (who are also APTA members).

It is always a great experience to be around people who are this passionate about their patients and the profession of PT. Currently I am missing a board review course because of a multitude of reasons but I am going to go and try to catch the last bit of it as I finish up work on my Pediatric project of a young child who has hypotonic Cerebral Palsy.

I hope you are all doing great, and if you have any thoughts on motions that are within the APTA please send them this way, I love hearing about what people think should be the direction of this profession. I'm off.

Saturday, April 14, 2007

Busy-ness

As the semester winds down, the walls start closing in on me. Projects are closer to their due date, final exams are coming and need studying for, and all that good extracurricular stuff takes up its own share of time. Time management becomes more crucial around the end of the semester. Coffee and energy drinks are big temptations.

Over the course of the next 2-3 weeks I have 2 practical exams, 4 written exams, 3 papers/projects due, and presentation of two of those to the rest of the class... oh and a whole lot of reading.

This is just a quick update of what's going on, as I gather my reviews you can all look forward to some fun material being posted. Have a great weekend!

(The picture is from the Angelo State U. website)

Sunday, April 08, 2007

OIOC

OIOC stands for the Occupational and Industrial Orthopaedic Center and is an affiliate of NYU and the Hospital for Joint Disease. I was fortunate enough to spend a day there over my spring break a few weeks back and would like to share my experiences here.

Firstly, everyone there was very pleasant and helpful. The Acting Associate Clinical Director was kind enough to take an hour out of her day to give me a presentation about the biopsychosocial model for treating low back pain (LBP) which is the main reason I wanted to visit. As a preface to the treatment it is important to know that 60-80% of adults suffer LBP at some point in their life. It is the second leading reason for doctors visits (common cold is 1st). There is a huge fiscal impact of this between medical costs and the cost of lost labor. The basic summary of treatment is as follows:

The main approach being used for a while was the medical model - which looked for pathoanatomy - something was physically wrong and they had to find it. People were generally not getting that much better with this approach. As more research came out they found that almost 85% of LBP is nonspecific (meaning you cant really specify what is causing the problem). As an alternative there was a psychological model that was implemented claiming that the pain was all being caused by your thinking. So if you can change the thinking that would be the solution. Also, didn't work that well.

This brought them to the biopsychosocial model which combines both and adds a sociological perspective to it (Waddell et al., 1984). THis starts with the sensation of the pain itself, moves on to the cognition (how you think about the pain), then your affect (how it translates into your mood), then the illness behavior (i.e. taking a day off work or avoiding certain positions because they hurt), and lastly how the social environment is changed (i.e. problems at work, with family, etc.). At OIOC they are very innovative and on the cutting edge of research. They incorporate numerous sources of evidence including the European and New Zealand Guidelines for treating LBP.

There is a lot more to it, with yellow and blue flags, etc., but this should be hopefully this is enough to get you thinking about back pain and what is involved.

Back to studying, almost done with this semester...

EBP Shldr

Last Tuesday evening, more than 30 students and a few practitioners were on hand at Long Island University to listen to Mike Masaracchio PT, DPT, MS, OCS speak about the evidence based approach to treating the shoulder. It was a great lecture that was hosted by the NY SSIG and LIU. He went in depth on the anatomy, kinematics, and special tests for the shoulder (among other things). I learned/refreshed a lot and everyone who attended seemed to gain something from attending. We plan to host more lectures like this and hope to see you there :)

NYMC Fundraiser

RACE for  REHAB

FUNDRAISER

When: April 11, 2007

Time: 9 pm to midnight

Where: “The Station” (Valhalla Crossing)

$10 cover at the door

Happy Hour Prices & Karaoke!

ALL cover charge proceeds to benefit

The Achilles Track Club

If anyone is interested, let me know, I can get you further details.

New York Medical College is the host and the location is Westchester, NY.

Saturday, April 07, 2007

Anonymous

At the end of this post is another "anonymous" comment with a very negative tone. I certainly didn't mean to offend this anonymous individual nor will I apologize for my posts. What anonymous calls as "anal retentive" I call an attention to detail and think this has vital carryover to PT practice. Too often in our society people become complacent with mistakes. This snowballs and just look at what the American average reading level is for adults - I have hear as low as 4th grade and only as high as 10th grade (supposedly what USA Today uses). When it is one or two mistakes like in Grisham books I may let it slide and enjoy, but Mr. Phillips' book way beyond this. If anonymous really thinks I am what is wrong with the profession of PT for being attentive to detail then there is something wrong with this. If you can read the rest of my posts and not see my passion for the profession then maybe I do need to leave the profession.

I am not sure what problem anonymous really has with me, perhaps it stems from more than just the two posts he has responded to. But I really don't have the time for the negative energy he is trying to bring. I respect that he enjoys the book and I respect the thinking behind the book and hope anonymous can respect that I was upset by the lack of proofreading and the possible reflection it sets on the PT profession.

I'm going to go back to learning as much as I can so as to help my future patients to the best of my abilities and hope my disciples enjoy the rest of my blog. Thank you and good day (Happy Easter).

In your short little review you made a mistake:

"I of course can assume Mr. Phillips is not to blame as more often (that) not there is an editor..."

Another thing; I read the book and I only saw one time where it said her or she so you misrepresent the book when you say "every time it said her or she."

The book is a truthful account and to me that’s all that matters. Your anal retentive spelling issues are found in the best sellers. John Grisham books have problems but it only takes guys like you to point it out, the rest of us just read and enjoy. The only person hurting the profession is you, by pointing out the few simple mistakes you expose the field, you and those like you are the problem with the profession.

If you have to tear down others to feel good about yourself then keep going, you will find life is pretty hard and one day even your little disciples will leave you.

Friday, April 06, 2007

NYTimes

This was a letter that the NYPTA president sent in to the NYTimes today... hope it gets picked up

Dear Editor:

I am writing in response to Lou Uchitelle’s April 1 article, “The End of the Line as Detroit Workers Know It.” In the article Mr. Utchitelle recounts a circumstance in which Jeffrey Vitale, a skilled millwright at DailmerChrylser, finishes his coursework for his bachelor’s degree online and “expects to graduate in December, qualified to work as a physical therapist, a profession not likely to pay as much as he now earns, and certainly not with the same benefits.”

This statement is misleading to your readers.

The minimum educational requirement for becoming a physical therapist is a masters' degree with most educational programs now offering the doctor of physical therapy degree (DPT). Physical therapists complete rigorous academic preparation that includes many supervised hours in a clinical setting. Upon graduation, all physical therapists must take a national licensure examination before they are permitted to practice. Your readers may be interested to know that the median salary for a physical therapist is around $70,000 per year and that in 2006 the profession of physical therapy was named as one of the nation’s top career choices.

Physical therapist assistants (PTAs) provide physical therapy services under the direction and supervision of a physical therapist. PTAs must complete a 2-year associate's degree and are licensed, certified, or registered in most states. The physical therapist assistant graduates with a two-year associate's degree with a mean salary of approximately $40,000.

There are many exciting opportunities available for physical therapists and physical therapist assistants. To learn more, or to find a physical therapist, I invite your readers to visit the American Physical Therapy Association’s Web site at www.apta.org/Consumer.

Sincerely,

James M. Dunleavy, PT, MS

President

New York Physical Therapy Association

Thursday, April 05, 2007

Fight Science

This is just cool stuff, check it out if you've never seen it

Monday, April 02, 2007

Helen Hayes continuing ed.

Thank you to the Eastern district delegate of the NY SSIG for bringing this to my attention...

For further info please contact me so I can get it to you:

Hi,
This is just to let you know that Helen Hayes is offering this TBI symposium
on April 13th and 14th.
Due to recent requests they are now allowing two additional registration
offerings:
1. If you only want to attend for one day, the cost is $150.
2. If you are a student, the cost for the entire symposium is $99

(regular, full tuition is $275)

Good speakers, interesting topics, and fun labs/experiential activities
especially for P.T.'s (make a serial cast, try virtual reality, body weight
support).

Please pass on to students, faculty, and colleagues who may be interested.
Thanks,
~Mary Nish

Sunday, April 01, 2007

Happy April Fools Day

...but there is no fooling around when it comes to PT legislation. I have brought some of this up before but this is all worth bringing up again:

With regard to HR1134, I think any legislation being passed that acknowledges the PT profession as a primary health care service is a vital step towards VISION 2020. This specific bill is a great continuation of the multiple efforts of our profession to reach out to the underserved. In addition, student debt is an overwhelming aspect to becoming a PT and has been cited as a barrier of many potential candidates entering the profession. Short of academic institutions lowering their tuitions, this bill is a vital component in helping to relieve this problem.

With the introduction of HR 748/S. 450 and HR 1552/S. 93
into Congress as well, students really do need to take a more active role in advocating for their profession, and in turn, for their future patients. Having all three bills pass in congress would be a great accomplishment for the advancement of Physical Therapy. If we as future clinicians can assume ownership of professional responsibility and realize the magnitude of this, the progression of physical therapy will be in very capable hands for decades to come. The APTA's Legislative Action Center and PTeam have been great tools in easing many students involvement in the legislative process.

Addendum:
HR 1134 is the Physical Therapist Student Loan Repayment Eligibility Act. This will add PT's to the current list of National Health Service Corps (NHSC) professions. Pretty much what it would provide is an opportunity for PT's who work in underserved areas (as defined by NHSC) to earn $25,000 towards paying off their loans per year. You have to sign a two year contract and can elect to work for a 3rd or 4th year in which you can earn a total of ($35,000 for both the 3rd and 4th year). This is all in addition to the salary you work out with the employer in the underserved area.

Get this stuff passed now, make everything easier later... contact your reps... it's so easy and so vital... alright I am done.