Thursday, January 31, 2008

Choosing A Text

I just found out that my last affiliation is going to be at a Spinal Cord Injury center. This is admittedly not my strongest area of expertise so I just purchased a text to get caught up. That's all for today, hope all is great!

Friday, January 25, 2008

Our Healthcare System

I wanted to share this experience from a few days ago...

I had an initial evaluation of a 76 y/o female

The prescription had a diagnosis of bilateral radiculopathy of the shoulders and a box checked off for "evaluate and treat"

She had a fairly extensive past medical history that I will leave out as well as a few clinical findings secondary to lack of relevance.

As I went through the patient interview, radiculopathy was less and less a likely culprit in her shoulder pain. Although she had a positive neer, hawkins-kennedy, and yocum special test, they simply created pain in the same location where just about any movement caused her pain. Moreover there was no radiation of pain which can be common in "radiculopathy". Distraction and Spurlings tests were negative. Also, the Yergason and Speed test were positive and the bigger piece to the puzzle was the fact that the only area of tenderness was on both biceps tendons.

She went on to describe that when she had pain in her hips and knees about three months ago she would use her arms to help her get up out of chairs. Her shoulder pain developed in conjunction with this other pathology.

Her MRI report from two weeks ago showed that she had minor tears in the infraspinatus, suprapinatus, and subscapularis along with minor arthrosis. She said her doctor mentioned only a possibility of bursitis and she claimed he never looked at the MRI report. NSAID's and aleve provided little to no relief.

Ultimately all signs point to bicipital tendonitis. Now we must call up the MD to report our findings. Ideally, there was no need for the MD visit. The patient could have saved herself that trip and extra payment that accomplished nothing more than referring her to us. We were able to screen for any red flags and are certainly able to refer elsewhere if there is an issue present outside of our scope of practice. For musculoskeletal issues PT should be the first line of defense aka the practitioner of choice. Unfortunately, this patient is one of many such cases and the situation will be one big speed bump to overcome, but it certainly is worth the fight.

PT - Poetic Therapy

Tried to pull an all-nighter to finish up some revisions
due right about now
ended up watching a lot of def poetry jam on youtube
i am by no means a poet as you will soon be able to tell
but i got tired of always being inspired
and always saying "i could do that"
so i may not have something as powerful to talk about
i may not be able to wordsmith or rhyme
as well as those guys with all that time (see)
but i realize they dont rhyme all the time (dang)

i figure let me not delete anything in my "poem"
let it flow
thats the way to go...
plus its all in the delivery right?
granted this is via blog
so the delivery doesnt add much
instead of def poetry you get flat words with no emotion
but trust me its coming from the heart

like the heart of my patients
who all have patience
for a youngster learning the ropes
but they all seem to get better
so who really is clever :-D

but thats what i really wanna talk about
my patients
i went to a career day recently
not to change my own career path
but to speak to high school kids
about what i want to do with the rest of my life
and see if they may wanna join

one young girl
asked about my payroll
after revealing the median salary info i knew
i added something to clue...
her in on the reality of why i do what i do
i said
we do not do it for the pay
we do it to make the patients gay
and not gay the way you as high schoolers will giggle
but how it used to be used when literature meant something
i get paid with a smile
of patients who hadnt been able to walk for a while
you act as a teacher, a motivator, a friend, a confidant
one that molds the clay that is the human body
back to its optimal form
its a powerful thing
changing lives one motion at a time
one exercise, one soft tissue mob, one love

i choose not to rhyme for sake of time
but moreso because i cant
what i can do is help give patients
the tools to heal
hopefully
not everyone is a success story
not all will be pleased
i wont always be pleased
but for now i go to do my passion

because if its something you actually like
its not work
and if you can get paid and live a good life
isnt that all that we can hope

so forgive me for my semi-prose style
i hope it brought you a smile
at one point or multiple
all i know is im triple
as happy as i was 3 years ago
before i knew all there is to know about the elbow...
theres always more to know, dont lie to yourself
anywho, off to get an hour or so of rest
before i put on my best
for my friday patients
who have patience
with this sleep deprived
passionate child
who has so much to learn all about life
and cant think of a clever way to end this phrase
so here he stops
and wishes you all a quick rise to the top

ill try to do better next time... :-D
have mercy

Friday, January 18, 2008

Vocabulary energizers

cic·a·trize (sk-trz)
v.
To heal by forming scar tissue.

Fabella

Popliteus muscle

In situ

prn

Saw my first spinal cord stimulator in action yesterday. Interesting stuff; the patient reported that it provided relief along the left side of her spine but not the right following a spinal fusion 2 years prior.

A rebar acts to prevent collapse.

Curettage

Radiculopathy

Spondylosis


Spondylolysis

Spondylolisthesis - A straight leg raise may be uncomfortable or painful
Symptoms
  • Lordosis
  • Lower back pain
  • Localized tenderness over the spine just above the pelvis
  • Pain in thighs
  • Pain in buttocks
  • Tight hamstrings
  • Stiffness in back

Thursday, January 10, 2008

Recent Articles


In order to make access to a bunch of random interesting articles easier for me to access on my phone while I travel I am posting them here... feel free to enjoy them for yourself, there is a lot of good stuff in here!
ACP Addresses Potential Outcomes of Pay for Performance
New recommendations by the American College of Physicians to offset the potential adverse effects of pay-for-performance programs center on redirecting the focus to the patient.
ADVANCE for Directors in Rehabilitation | Archive Viewer
Advance for Directors in Rehabilitation is a trade publication offering content relevant to all rehabilition professionals, including practice management, new treatments, marketing, regulatory information and salary surveys.
Analyzing Easy Energy
Are You Too Cool To Work Out? - HealthNews Story - WDSU New Orleans
Are You Too Cool To Work Out?
As Martha Stewart Attests, Physical Therapy Plays Key Role In Recovery From Hip Replacement Surgery
As Martha Stewart continues her recovery from recent surgery to replace her left hip, periodic and progressive physical therapy will play a key role in her successful rehabilitation, says the Amer
British Journal of Sports Medicine - Abstract: Volume 41(11) November 2007 p 745-749 Muscle activation in coupled scapulohumeral motions in the high performance tennis serve.
Checklist May Help Cut Sudden Death in Athletes - healthfinder.gov
12-step screen can spot underlying heart problems, experts say
Clinical decision making in physical therapy: a practitioner's perspective - Free Online Library
Free Online Library: Clinical decision making in physical therapy: a practitioner's perspective. by "Physical Therapy"; Health, general Physical therapists Practice Physical therapy Research
Concepts in Human Factors Engineering (8): Human Body Energy - Human Factors expert article by Dennis R Andrews PhD, PSP, CECD
Contraception Journal Free Online Editorials
Cyber Structure
Daily Herald | Lessons learned: Exercises for older athletes can benefit others
daily herald is suburban chicago's largest daily newspaper. the daily herald provides a local perspective with local content such as the northwest suburbs most comprehensive news on the web. your source for updated news from local to national.
Desert Dispatch : News: What Ails You: Role of physical therapist more complicated than some understand | physical, therapist, therapy
News: What Ails You: Role of physical therapist more complicated than some understand | physical, therapist, therapy, treatment, massage, chiropractic, doctor, therapists, chiropractor, soft
Diet and Exercise - Losing Weight - Jane Brody - Medicine and Health - New York Times
The way to lose weight in 2008 is the same as it has been every other year, because the basics of good nutrition have not changed.
Difference between Olympic sprinters and you could be a gene - livemint
The scientists say they want to downplay the role of genes in determining athletic abilities
Dr. Andrews pays claim
ESPN - Lone Star State signal-callers sprouting up among title contenders - College Football
College football coaches know Texas has always been ripe for the picking of prospects. Now the nation will get to see the Lone Star State's wealth of quarterbacks in the nation's best bowls.
ESPN - Tiger's trainer gives insight into Woods' workout routine - Golf
Tiger Woods now has to tailor practice sessions around being a father and find time for workouts that can last up to three hours as many as six days a week.
EXCITE: Beneficial Effects of Constraint Therapy Retained Long Term
Improvements in upper limb function and quality of life in patients who have had a stroke with mild to moderate impairment are retained 2 years after a unique, intensive program of movement therapy.
Exercise and Obesity: Their Interaction and Implications for Disease Risk
Abdominal obesity may better predict cardiovascular disease, metabolic syndrome, and type 2 diabetes than BMI or measures of overall adiposity. How does exercise affect obesity-related disease risks?
Exercise as Good as Surgery for Knee Pain - Articles
Before considering knee surgery, you HAVE to read this.
FAQ: The McKenzie Approach Vs. Traction
Visit thesaundersgroup.com for back exercises, physical therapy equipment, physical therapy education, cervical traction, rehabiliation product, chiropractic supplies and equipment, and exercise software.
Finding Alzheimer’s Before a Mind Fails - New York Times
Though Alzheimer’s disease seems to strike suddenly in old age, scientists think it begins long before symptoms occur.
High Altitude Soccer Teams Have Significant Advantage Over Lowland Teams
Football teams from high altitude countries have a significant advantage when playing at both low and high altitudes, finds a study in this week's Christmas issue of the BMJ.In con
High Schools Try Teamwork to Put Trainers on Site - New York Times
Some high schools around the United States are using novel, and even unorthodox, methods to get trainers at a reduced cost into their sports programs.
Hyperforin--a key constituent of St. John's wort s...[FASEB J. 2007] - PubMed Result
PubMed is a service of the U.S. National Library of Medicine that includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.
I’m Not Really Running, I’m Not Really Running... - New York Times
Using mental tricks, or dissociating, can get you to the finish line faster.
Mechanical Low Back Pain: Progression of Treatment
Medical News: Any Football Helmet Hit Can Cause Potential Concussion - in Neurology, General Neurology from MedPage Today
Multidisciplinary Treatment May Benefit Patients With Chronic Low Back Pain
In a prospective trial, multidisciplinary treatment aided patients in all stages of back pain chronicity, suggesting that this should not be given only to those with lower grades of chronic pain.
MyPyramid Dietary Guidelines Modified for Older Adults
In the Modifed MyPyramid for Older Adults, nutrient- and fiber-rich foods are emphasized, as well as food sources of nutrients rather than supplements and the use of fluid and physical activity icons.
New tool advances injury care
Newswise Medical News | Message to the Elderly: It's Never Too Late to Prevent Illness!
NPR : Bad-Disk Reboot: Back Pain May Not Mean Surgery
James Weinstein, M.D., chairs Dartmouth College's orthopedic-surgery department; he's considered one of the nation's leading experts on low-back pain, and he says a multi-year study shows little difference in results after surgical and non-surgical treatment approaches.
NPR : Study: Surgery Just One Option for Herniated Disk
A new study looking at treatments for herniated disks found that non-operative remedies, such as physical therapy and pain-killing drugs, are almost as effective as surgery to remove the disk.
nwi.com :: Healing made to 'seem like fun'
Pain threshold too low for torture
Please don’t tell me any national security secrets. Pass along no military troop movement information and refrain from alerting me to where our nuclear weapons are stored. And don’t ever grant me top-secret clearance.
Pediatric Environmental Tobacco Smoke Exposure and Allergic Reactions
In a prospective birth cohort study, children who were exposed to environmental tobacco smoke in early infancy had a higher incidence of allergic reactions to food and indoor inhalants at age 4 years.
Peer Publicity
Physical therapy comes to front line
Day in and day out, troops patrol the streets and countryside of Iraq for hours at a time; many carrying up to 100 pounds of gear. Over time, this excessive wear on the troops may lead to back or other injuries later on in life.
Physical Therapy Modalities Helpful for the Family Clinician to Know
The authors of a review suggest various treatments and modalities that a family clinician should know and include in the physical therapy prescription.
Presentation at ISSN Highlights Soy Protein Advantages for Endurance Athletes :: News :: Natural and Nutritional Products Industry Center
PT Magazine | In Sickness and in Wellness
Acknowledged experts in managing rehabilitation from illness and injury, physical therapists also are perfectly suited by their education and skills to helping healthy people stay that way. PTs who offer wellness and fitness services share their perspectives and give tips to peers who may want to follow suit.
PubMed - Direct Access
PubMed is a service of the U.S. National Library of Medicine that includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.
Recommendations Issued for Treatment of Nonspecific Low Back Pain
A review provides recommendations for treatment of occupational nonspecific low back pain to promote early return to work.
Researchers discourage use of rehab after spinal decompression surgery
Patients randomized to two rehabilitation programs or a control group following lumbar spinal decompression surgery experienced no further pain relief beyond that reported immediately postoperatively.
Respectful Insolence: A chiropractic "adjustment" in New Jersey
Sports head injury bill refiled - Framingham, MA - The MetroWest Daily News
Sports head injury bill refiled - Framingham, MA - The MetroWest Daily News
STLtoday - News - St. Louis City / County
The effect of moderate resistance strength trainin...[J Geriatr Phys Ther. 2007] - PubMed Result
PubMed is a service of the U.S. National Library of Medicine that includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.
Walk, Don't Run, to Prevent or Reverse Metabolic Syndrome
A new study shows that at-risk overweight or obese individuals can obtain health benefits to reverse or prevent the metabolic syndrome with moderate exercise, such as brisk walking.
What You Don't Know Can Hurt Your Patients
Linda Casebeer, PhD, of Outcomes, Inc., teaches us how online CME excels in outcomes.
Yoga is no universal cure
The online source for Montreal news, business, sports, entertainment, classified ads, horoscopes, weather, local news and more.

Sunday, January 06, 2008

PT in ICU can help reduce hospital stay



So here I am on my way to a CPR/AED re-certification class on a Sunday morning. Sitting on the bus I am perusing the latest PT Magazine (January 2008) and wanted to share this from the PT Bulletin Digest in the back (check page 70 if you have it).

One of my classmates is currently doing an affil in an Intensive Care Unit and this is yet another study adding support to PT being a very efficient first line of defense. Furthermore, the blurb about the article has this:

"The project confirms that it is safe to administer early mobility to ICU patients and that it is of benefit. Further studies are planned in order to clarify the optimum number and duration of exercise sessions."

This last sentence brings me to my latest project. In my very sport oriented current practice setting I am preparing a Powerpoint presentation regarding exercise prescription in regards to proper sets, reps, order, and progression. There is a lot of different theories out there and there is a lot going on in PT in general.

PS, the freakin' CPR class was canceled and no one informed me... what a waste of a Sunday morning, ah well, I get to hang out with my nephew and niece.

Wednesday, January 02, 2008

New Year, New Opportunities, New Food Pyramid

With a new year everyone gets to have a new beginning. It is a great time for evaluation as people make resolutions.

Within clinical practice we have to fill out a Clinical Performance Instrument. This is a blue book that has 24 performance criteria that you have to judge yourself on and the clinical instructor (the professional working with you) also ranks you on each criteria. There are options if there are significant concerns and a ranking between novice clinical performance and entry-level performance, possibly with distinction. The evaluations are performed at the midterm and also at the conclusion of the affiliation.

Also wanted to share that there is a new food pyramid for older adults (in order to access the article you likely need to join Medscape which is free and a great way to keep up to date on a lot of the developments going on in the medical field).

"In the Modified MyPyramid for Older Adults, nutrient- and fiber-rich foods are emphasized, as well as food sources of nutrients rather than supplements and the use of fluid and physical activity icons."