Monday Memo 1/14/19

The Monday Memo

January 14, 2018                                                                           PITT DPT STUDENTS

 

Clinical Assessment and Cervical Arterial Dysfunction

 

Cervical Arterial Dysfunction (CAD), although rare, is of vital consideration for any patient complaining of neck pain. As experts of the human movement system, physical therapists must recognize symptoms of non-musculoskeletal origin and refer accordingly. This is easier said than done in the case of CAD, as patient symptoms can often mimic the pain distribution of an occipital headache or general upper cervical dysfunction. To make matters worse, many clinical tests for CAD have little diagnostic utility in isolation. Therefore, the clinician must follow an efficient and thorough clinical process to make the best decision regarding patient care.

Taking a detailed patient history is critical in this process. The clinician should identify gaps in subjective data and clarify with the patient to ensure an accurate history is taken. Clinicians should also regularly assess basic vitals such as heart rate, respiratory rate, and blood pressure. Hypertension, when paired with other clinical findings, could be an indication of a vascular event. History of trauma that could lead to possible arterial dissection as well as congenital factors that may contribute to upper cervical dysfunction must be taken into consideration. Table 1 details clinical presentations at varying stages of CAD. The patient should be carefully assessed for these signs and symptoms prior to initiating further physical therapy assessment and intervention.

A. Rushton et al. provided a framework outlining the flow of clinical reasoning (Figure 1). The management of patients with suspected vascular compromise should be a decision derived from all components outlined in the chart as well as the patient’s response – or failure to respond – to previous assessment and intervention. Components of the physical exam may include but are not limited to upper cervical ligament testing, functional positional tests, assessment of upper motor neuron signs, and cranial nerve assessment.

 

In summary, there is no quick and easy assessment for patients with suspected cervical arterial dysfunction. The clinician must judiciously obtain the patient history, plan their examination, evaluate the individual’s presentation, and collaborate with the patient to appropriately manage their condition. As first-contact practitioners, physical therapists are likely to see patients whose chief complaint is head and/or neck pain. It is critical to identify all patient risk factors and initiate timely and appropriate treatment with a graded approach. By following this framework and applying one’s best clinical judgment, these patients may be safely managed.

 

-Joe Dietrich, SPT, ATC

References:

Rushton A, et al., International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention, Manual Therapy (2013)

Kerry R, Taylor AJ. Cervical Arterial Dysfunction: Knowledge and Reasoning for Manual Physical Therapists. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(5):378-387. doi:10.2519/jospt.2009.2926.

 

January 14, 2019 |

Monday Memo 1/7/19

The Monday Memo

January 7, 2019                                                                           PITT DPT STUDENTS

 

Preparing for CSM

 

The APTA Combined Sections Meeting (CSM) is a national conference for both licensed therapists and aspiring clinicians. This year, it will be held in Washington, DC from January 23rd through 26th. It is an excellent opportunity to preview the newest research, connect with other therapists, and learn more about a subject of interest. As a second-year student, it will be my first time attending CSM.

 

There have been many things to consider while preparing for this conference. First and foremost, I needed to handle the logistics such as registration, housing, and travel. The APTA website provides information for each. Next, I started to consider which events I wanted to attend while at CSM. There are a wide variety of activities that will be hosted over the course of three days. Unfortunately, it’s not feasible to attend everything. There are hundreds of educational sessions alone. The comprehensive list of educational sessions can be found here.

 

In order to select which sessions would be of most benefit to me, I searched sessions by keywords and the name of speakers that I am interested in. As we get closer to the conference, If I change my mind, I can also attend a different session.

 

The final thing to consider is things to do while in DC outside of the conference itself. There shouldn’t be a lack of things to do while in DC. I, personally, would like to see the Library of Congress. There are also other events that will be hosted by physical therapy organizations for networking opportunities and to meet other people in the profession.

 

I for one am immensely excited for my first experience at CSM. I look forward to meeting other aspiring clinicians and learning new and interesting information. If you would like to follow our CSM experience, check our Instagram @pitt_pt during the conference for updates!

 

 

More information about the Combined Sections Meeting can be found at http://www.apta.org/CSM/

 

– Layne Gable, SPT

January 7, 2019 |

Monday Memo 11/26/2018

The Monday Memo

November 26th, 2018                                                                           PITT DPT STUDENTS

 

Comprehensive Rehabilitation for Burn Patients

In my recent experiences, I have encountered numerous patients who have suffered from severe burns which have required skin grafts. Think about when you get a big cut and the scab that forms may crack open when you move, this scar formation is similar to the tissue of a patient who had a severe burn. The skin shrinks to have the least resistance possible, a Physical Therapist’s role should guide movement of these joints focusing on tissue extensibility along with reduction of edema and scar management.

In regard to the rehabilitation plans for a patient with a severe burn, the primary focus is prevention of contracture. Begin by educating the patient and their caregivers on positioning and postural management. Burns that are on the flexor aspect of a joint are at greater risk of contracture because it will reduce tissue stresses and feel more comfortable for a patient. During the early stages of rehabilitation, advise the elevation of an affected limbs to reduce edema. If a burn is located over a joint, it is good to consider splinting the affected joint to provide prolonged tissue stretch and facilitate the formation of scar tissue while maintaining anatomical contour.

Often, Physical Therapists aid in scar management with scar massage. This intervention increases the moisture of tissue and the pliability of skin while enhancing the remodeling process of a scar. When performing a scar massage use non-scented lotion and massage in a circular pattern to avoid shearing forces. Increasing the length of a patient’s tissue range of motion range of motion must be a component of rehabilitation incorporated early. Both active and passive ROM are beneficial. For example, a patient with a burn on the posterior aspect of their lower extremity will work with a Physical Therapist on gait training focusing on proper heel strike – a functional task that is improving the extensibility of new tissue.

These patients require intense rehabilitation programs, but movement can be immensely painful. While working to enhance their functional independence remember their phycological state should be addressed as well. Create a safe and productive work environment for these patients by being empathetic. Simply listen to the patient about possible fears and anxieties then discuss how you can help them progress.

 

-Jennifer Hadfield, SPT

 

References:

https://health.ucsd.edu/specialties/rehab/Pages/burn-injuries-program.aspx

http://www.rehabmedicine.pitt.edu/about_us/docs/Rehab%20of%20the%20Burn%20Patient.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038404/

November 26, 2018 |

Monday Memo 11/19/2018

The Monday Memo

November 19th, 2018                                                                           PITT DPT STUDENTS

Exercise in the Daily Life

The profession of physical therapy identifies with the vision statement of, “Transforming society by optimizing movement to improve the human experience;” We, as physical therapists, conduct ourselves accordingly to enact this vision. Physical activity and exercise in the daily life play a huge role in movement. Everyone knows that exercise promotes a healthy lifestyle, but exactly how beneficial is it and how does one incorporate exercise into his or her busy life?

A recent study published in JAMA Network Open found that cardiorespiratory fitness is a long-term indicator for mortality1. Most people would agree with this finding without performing a formal research study, but there is more to it; the study also found that living a sedentary lifestyle is more threatening to your health than smoking, diabetes, or heart disease1. We always knew exercise was important, but more and more research is showing how it is one of the biggest indicators for mortality.

Living a sedentary lifestyle puts an individual at risk for many chronic conditions such as hypertension, diabetes, heart disease, and etc. Our country is currently facing a chronic disease epidemic with 86% of our health care costs going towards chronic and mental health conditions2. The CDC estimates that the lack of physical activity costs our country $117 billion dollars each year2. So how can we combat this issue?

A common complaint for why people do not exercise is the lack of time (physical therapists know this struggle all to well trying to get patients to comply with their home exercise program). How is a mother of two who works an 8-4 job or a full-time student supposed to fit exercise into their daily routine? Here’s a quick tip, it does not take much time to reach physical activity requirements. The ACSM and AHA claim that an individual needs at least 30 minutes of moderate intensity exercise 5 days a week or at least 20 minutes of vigorous exercise three times a week3. Taking those numbers into account, can you spare between 60-150 minutes a week to meet these physical activity requirements? If not, here are a few tips to help you out.

 

  1. Incorporate physical activity into your daily commute or work/school day
  • Walk or bike to work/school when/if possible
  • Incorporate physical activity into your lunch break
    • Here at Pitt PT, we love to play some volleyball or take walks by the river during our lunch break
  • Get up and move. If you work at a desk, make it a priority to get up every hour and walk, whether it is keeping a printer in a different room or simply doing a lap around the office
  1. Decrease the time in your workout by increasing the intensity
  • Super-sets are a great way to cut time out of your workout and to increase intensity
    • Example: Instead of just doing bicep curls with breaks in-between, alternate between biceps curls and shoulder press back to back in order to decrease time and increase intensity
  • Incorporate interval training into your cardio
    • Going for a run or walking on the treadmill can get boring or take a long time
    • Interval training can decrease the time needed to do cardio while increasing intensity while getting the same or greater cardiac effect
    • Example: One minute of walking on a treadmill at 0 incline followed by walking on an incline of 4.0 for 30 seconds and then repeating
    • Example (Higher level): One minute of walking on a treadmill at 4.0 incline followed by a sprint on 4.0 incline for 30 seconds and then repeating

Additional Tips

  1. Find an exercise buddy
  • Whether it’s a co-worker, friend, or family member, having an exercise partner will keep you interested and motivated
  1. Don’t forget about healthy eating! (Remember, fruit salad, yummy yummy!)

 

In conclusion, physical activity will not only help your health physically, but also mentally, so get out and get moving! As always, Hail to Pitt!

-Aaron McCullough, SPT

 

References

  1. Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Network Open. 2018;1(6):e183605. doi:10.1001/jamanetworkopen.2018.3605
  2. Health and Economic Costs of Chronic Disease. https://www.cdc.gov/chronicdisease/about/costs/index.htm
  3. Haskell, W. L., Lee, I-M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., … Bauman, A. (2007). Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1081-1093.\
November 19, 2018 |

Monday Memo 11/12/2018

The Monday Memo

November 12th, 2018                                                                           PITT DPT STUDENTS

 

Asian Immigrants: View on Physical Therapy

Being a first generation Chinese American, my parents didn’t really have an opportunity to attend college. They hail from a small, rural town in China where education was not stressed. When they came to America, they made it a goal for my brother and I to attend college no matter the cost. Due to their lack of education, they were required to work long hours at a family owned business to provide for us.

22 years later, and unsurprisingly they suffer from chronic lower extremity joint pain. As a student of physical therapy, I feel it is my moral obligation to urge them to try it. But they prefer their traditional oriental medicine, while remaining stoic and suffering through the pain. If the traditional oriental medicines worked, I would have no problem with it, but usually these treatments only aim to treat symptoms and not the underlying pathological problem. Much like my parents, many Asian immigrants also suffer from some sort of chronic pain Approximately 70% to 80% of people have chronic pain in the Asian geriatric population, compared to 50% to 55% in Western countries. Most studies report that this population in particular are Asians with low education.

Most Asian immigrants view healing as a spiritual process. That, along with a language barrier and decreased access to health insurance, is the reason why physical therapy services are underutilized among the Asian American community. Most families are reluctant to pay out of pocket for health services unless it is deemed completely necessary to live. Sadly, Asian immigrants are one of the largest populations that suffer from chronic pain.

Asian culture relies heavily on the belief of prestige. They view clinicians as an individual of high social status. This can serve as a barrier because, due to their culture, they will often try their hardest not to bother their clinician with their problems if they are not urgent. This means that if a PT were to treat an Asian American, the patient would downplay their symptoms, or would report exaggerated improvements in order to satisfy the physical therapist. This, in turn, causes decreased value of PT services because there is no actual improvement within the patient population.

One of the reasons I decided to pursue a career in physical therapy was to advocate for the benefits that physical therapy provides, especially for most Asian immigrants who, like my parents, suffer from chronic pain due to their strenuous occupations. Every time I learn a new treatment in class, I always think to myself: “Can this be used to help my parents deal with their pain?”. I believe as more Asian immigrants migrate to America, we need to advocate for them to utilize physical therapy services for pain management and to increase their overall quality of life.

 

-Sam Yip, SPT

 

References:

Tung, W.-C., & Li, Z. (2015). Pain Beliefs and Behaviors Among Chinese. Home Health Care

Management & Practice, 27(2), 95–97. https://doi.org/10.1177/1084822314547962

Zaki, L. R., & Hairi, N. N. (2015). A Systematic Review of the Prevalence and Measurement of

Chronic Pain in Asian Adults. Pain Management Nursing, 16(3), 440-452.

doi:10.1016/j.pmn.2014.08.012

November 12, 2018 |