Monday Memo 9/17/18

The Monday Memo

September 17, 2018                                                                           PITT DPT STUDENTS

 

In the course of my first two years in PT school there was one constant message that transcended our entire curriculum: the importance of patient education.  Whether my classmates and I were practicing transfer skills, reviewing examination components, role-playing exercise instruction, planning hypothetical discharges, or simulating gait training, our professors never ceased to mention how imperative it is for us to properly teach and inform our patients through their duration of care.

 

The consistency to which patient education was harped on in school mirrors how frequently I attempt weave it into my own patients’ plans of care. Every patient requires a certain level of exercise instruction and correction, but as I reflect on my clinical experience thus far I am conscious of how often the education I was providing had nothing to do with the right way to squat or perform a clamshell. Instead, I recall moments discussing affordable gym memberships, community resources, pathology and pain, and even fighting for the value of PT when patients verbalized a lack of motivation.  Every conversation had value; however, one patient I treated exemplifies how essential this aspect of PT can be.

 

My patient had recently received the diagnosis of Multiple System Atrophy (MSA) and expressed to me a lack of understanding of the disease and what it meant for his future function. We spent time at the conclusion of the session that day discussing what the disease was, which symptoms he currently had, and I pointed him towards online resources and organizations that are dedicated to supporting the community of people impacted by MSA. While the conversation was not easy due to the prognosis, it was clear that the exchange had an overall positive impact on the patient. He expressed his gratitude and how he could see that the therapists involved in his care genuinely cared about his current and future health.

 

This patient epitomizes why education plays a vital role in the rehabilitative process and why it should be used to compliment the physical interventions we provide on a daily basis.

 

-Caroline Talda, SPT

September 17, 2018 |

Monday Memo 9/10/18

The Monday Memo

September 10, 2018                                                                           PITT DPT STUDENTS

Deadbug Anti-Extension Progression:

Moment Arms & Torque Production

Core stability is a hot topic in the world of physical therapy for good reason. Today’s video memo provides you with an example anti-extension progression, beginning with a basic, day 1 pelvic control drill (1⃣), & progressing towards weighted, higher level versions (4⃣/5⃣). Check out the video below and then tune in for a follow-up message below!

 

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EPISODE 212 | Trunk Anti-Extension Progression: Deadbug Variations . ▪️I really enjoy posting content similar to today’s video. . Why? . Because it’s JAM-PACKED with conceptual information. . This video provides you with a fairly complete anti-extension progression, beginning with a basic, day 1 pelvic control drill (1️⃣), & progresses you towards weighted, higher level versions (4️⃣/5️⃣) that I’ve used to challenge professional athletes. . I’ll post a follow up detailing each exercise, but let’s use today to touch on an important concept: TORQUE PRODUCTION & MOMENT ARMS! . . . 🤓TORQUE PRODUCTION & MOMENT ARMS! . Revisiting physics, we know that you can create more torque by using a wrench w/ a longer handle. . In essence, a longer wrench has a longer moment arm, which means a relative amount of torque can be produced w/ less force. . We can apply this to single-leg lowers & deadbugs by understanding that our leg is the moment arm upon which gravity exerts a force to produce torque at the hip & up the chain. . In response, we need to produce an equal amount of force w/ our abdominals to maintain spinal positioning. . . 💡When we straighten our knee or lower our leg further, we’re effectively increasing the moment arm, & since gravity pulls w/ the same amount of force, our abdominals must contract harder & produce more force to maintain the same position. . We can take it further by including our arms or lowering both legs at the same time. . . 💡Our arms add another element that gravity uses to create more extension force & focuses more on controlling rib cage, rather than pelvic, positioning. . Lowering both legs at once inc the mass & eliminates the rotational component created by the unilateral Deadbug. . . . 🔥This is an incredibly important concept to understand & can be applied to ALL therapeutic exercise. . It’s this kind of knowledge that allows you to adjust for the trainee in front of you & work w/ a wider range of patients/clients. . . ▪️Questions, comments, concerns? Drop a line in the section below! . Was this information helpful? Tag a friend & help spread the word! . #StoutTraining #DPTstudent #Physics . @stoutpgh @clinicalathlete @perform_better

A post shared by Charles Badawy SPT, CSCS, USAW (@coach.charlieb.spt) on

 

It’s important to understand the underlying concept that allows this progression to be so effective: TORQUE PRODUCTION & MOMENT ARMS!

Revisiting physics, we know that TORQUE is a product of the FORCE APPLIED and the distance from the point of force application and the axis of rotation, or the MOMENT ARM. Think of a wrench! A wrench with a longer handle allows you to create more torque with the same amount of force!

We can apply this to single-leg lowers & deadbugs by understanding that our leg is the moment arm upon which gravity acts. This produces torque applied at the hip which is transmitted up the chain. In response, our musculature must produce an equal amount of force in order to maintain lumbopelvic position.

➢ When we straighten our knee or lower our leg further, we’re effectively increasing the moment arm, and our trunk musculature must contract harder & produce more force to maintain the same position.

We can take this further by including our arms or lowering both legs at the same time!. .

➢ Our arms add another point at which gravity act to create more extension force. The arms are a part of our upper quarter shifting the focus more towards controlling rib cage, rather than pelvic, positioning.

.
Lowering both legs at once increase the mass and eliminates the rotational component created when performing the unilateral Deadbug!

This is an important concept to understand and some critical thinking can help you apply it to ALL therapeutic exercise. It’s this kind of knowledge that allows you to adjust for the trainee in front of you, find success with a wider range of individuals, and enhance your abilities as a provider!

September 10, 2018 |

Monday Memo 9/3/18

The Monday Memo

September 3, 2018                                                                           PITT DPT STUDENTS

Handcycle 101

 

Recently, some Pitt DPT students have had the opportunity to work with athletes that participate in the sport of handcycling. These athletes have tremendous endurance and conquer unbelievable physical feats such as completing marathons in sub 2 hour times. Below is some background on the sport for anyone interested in learning more about handcycling.

 

Types of Handcycles

 

  1. An upright handcycle is an entry-level bike for those who are new to the sport, who just want exercise or recreation, or who don’t want to ride very long distances or go very fast. Because of their higher center of gravity, upright handcycles aren’t suitable for speeds higher than 15 mph. 
  2. recumbent handcycle, borrowed from the cycling industry, usually come in a choice of three or seven speeds, which naturally limits the speed to less than 15 mph. They are easy to transfer in and out of from a wheelchair, and have a natural, fork-type steering system.

Recumbent handcycles come in a few different variations. There are two steering options: fork-steer and lean-to-steer, and two seating options: one where the rider reclines and the other, a “trunk-power” version, where the rider leans forward. They usually come with 27-gear drivetrains, although they can be purchased with three- or seven-gear drivetrains.

  1. The trunk-power handcycle doesn’t have much of a seatback. The cranks are low to the ground and far away from the rider. With this arrangement, riders are able to put the weight of their trunks behind each stroke, allowing them to go faster for longer. The limitation to this type of handcycle, Lawless said, is that the athlete must have control of most or all of his abdominal muscles.

With the other seating option, the rider sits in a seat with a reclined back. The cranks are higher and closer, allowing the rider to use the seatback for leverage to rotate the cranks.

Hand Cycling Classifications

  1. H-1
    1. The most severe of this class grouping, H1 is reserved for the most severe quadriplegics and those who have impairments with equivalent limitations. These athletes compete in a recumbent (reclined) position.
    2. Lesion/impairment: C6
    3. Cycle used: AP2, AP3
  2. H-2
    1. H2 is for quadriplegic (and equivalent) athletes with more arm power than those in H1. These athletes compete in a recumbent (reclined) position.
    2. Lesion/impairment: C7-T3
    3. Cycle used: AP2, AP3
  3. H-3
    1. H3 is for athletes with varying impairments, including paraplegia, triplegia and hemiplegia. These athletes compete in a recumbent (reclined) position.
    2. Lesion/impairment: T4-T10
    3. Cycle used: AP2, AP3, ATP2
  4. H-4
    1. H4 athletes may have impairments, such as paraplegia, similar to but more moderate than athletes in H3. These athletes have full or almost full trunk control, and they compete in a recumbent (reclined) position. These athletes might also compete with a trunk propelled hand cycle.
    2. Lesion/impairment: T11 down, and amputees unable to knee
    3. Cycle used: AP2, AP3, ATP2
  5. H-5
    1. H5 is for athletes who can compete kneeling. These athletes usually have severe impairments of the legs, such as paraplegia or amputations, but have almost full control over their arms and trunk. These athletes compete in recumbent or trunk propelled hand cycle. Athletes with milder full-body disorders such as athetosis, but limited use of their legs, may also compete in H5.
    2. Lesion/impairment: T11 down(ability to kneel), and amputees with the ability to kneel
    3. Cycle used: kneeling
Type Specification
AP2 Reclined to 30 degrees
AP3 Reclined at 10 degrees
ATP 2 Long sit position
Kneeling
  • Bobby Jesmer, SPT
  • Jim Tersak, SPT, CSCS

References:

https://www.teamusa.org/US-Paralympics/athlete-classifications/cycling/

https://en.wikipedia.org/wiki/Para-cycling_classification#Handbike_or_Hand_Cycling

https://www.teamusa.org/US-Paralympics/athlete-classifications/cycling/

https://en.wikipedia.org/wiki/Para-cycling_classification#Handbike_or_Hand_Cycling

September 3, 2018 |

Monday Memo 8/27/18

The Monday Memo

August 27, 2018                                                                           PITT DPT STUDENTS

 

People First!

 

This past summer, I completed a clinical rotation in the hospital setting. Throughout my time there, I was exposed to countless learning opportunities including professionalism, communication, and time management as an inpatient student therapist. One experience I especially valued was the interprofessional communication opportunities throughout the various disciplines in the hospital. On a daily basis, I communicated with doctors, nurses, occupational therapists, and other general disciplines. With patient care being discussed so frequently, I began noticing something that was used by all disciplines:

 

People first language is described as acknowledging the person before his or her disability or diagnosis. This acknowledges that a person is not defined by their diagnosis. Healthcare professionals using this helps the patient feel valued and can lead to a healthier relationship between the patient and the nurse, doctor, therapist, etc.

 

As someone who is still very new to working in a healthcare environment, I must confess that it is difficult for me to always use people first language. Sometimes it is easy to address a person as “that total knee replacement man” or “the diabetic woman” in order to ensure patient confidentiality. However, we must try to avoid this kind of language that makes it seem we are defining a patient as their diagnosis.

 

Using people first language is a relatively simple and easy way to treat patients with respect and ensure professionalism. With practice, it may even become second nature! In the future, I aspire to use people first language as avidly as the faculty in my recent clinical rotation. Below are some additional resources in using proper patient first communication.

 

-Layne Gable. SPT

 

References:

https://www.cdc.gov/ncbddd/disabilityandhealth/pdf/disabilityposter_photos.pdf

https://www.inclusionproject.org/nip_userfiles/file/People%20First%20Chart.pdf

August 27, 2018 |

Monday Memo 8/20/18

The Monday Memo

August 20, 2018                                                                           PITT DPT STUDENTS

 

What do I do after PT school?

 
As a 2nd-year Physical Therapy student, you can not help but wonder, “what am I going to do after I graduate?” This thought crosses my mind more than it should, probably at least once per day, and my decision changes just as frequently. While it may make the final decision more difficult, Physical Therapists are fortunate to work in a field that offers such a variety of settings and opportunities. There are many variables that contribute to this decision including but not limited to, the level of compensation, the geographical area, the frequency of opportunities for promotion, the work environment, and arguably most important, finding the setting that interests you most. Below, I am going to discuss a few options that I have looked into, as well as, offer some resources to further inspect them yourself. Please keep in mind that this is not an exhaustive list of options, but some that I have come across during my search.
The first option and probably most well known is getting hired into a permanent job in an outpatient clinic or inpatient setting. Most people can quickly decide between inpatient or outpatient, but once this choice is made there are a variety of options within each. Below are some of the options available:
  • Outpatient Clinic – Offers services to more independent and medically stable patients, including orthopedic, neurological, and cardiovascular interventions
  • Inpatient – Hospital (neurological, cardiac, cardiothoracic, intensive care unit), skilled nursing facility, inpatient rehabilitation, long-term acute care
Also, something common in all settings of physical therapy is the difference in compensation per state. Each state has a different range of salary based on a multitude of factors. Here is a graphic from 2015 from https://www.google.com/amp/s/updocmedia.com/2015-pt-job-market-outlook-v2/amp/?source=images breaking down the pay for each state.
Second, an option that I have heavily considered, is going into travel physical therapy. Travel PT is essentially working contract to contract, typically lasting around 13 weeks, for different clinics on an as-needed basis. Luckily, there are established companies that you as a clinician can work through that find openings in clinics that you are willing to work in. Some of the benefits of travel PT include pay that may be significantly higher than a permanent position, per firm payment, exposure to multiple clinics, and ability to work in different demographics. Here https://www.hosthealthcare.com/how-to-choose-a-travel-therapy-company/ Host Healthcare breaks down some points to focus on when considering travel PT.
Finally, another option that I have considered is completing a Physical Therapy Residency. My interests lie in Sports Medicine and orthopedic physical therapy, but there are residency programs offered in many settings. Completing a residency is beneficial for improving your skills as a clinician and can be a quicker way to become specialized in an area. Typically, a residency program is between 18-24 months and has a set curriculum that you will complete during your time there. Most programs include carrying a caseload throughout the week, completing a set amount of credits during your time in the program, involvement as a teaching assistant at a university or within a Doctor of Physical Therapy Program, and attending rounds on a weekly or monthly basis. Some programs also require participation in research, but that varies depending on the program. Below is a link to a directory for all accredited residency programs. You can follow the link to each program to get more info about the specific requirements.
Always remember, whatever setting you choose is not set in stone. It is possible to be fluid throughout multiple settings during your career. Find the area that currently interests you the most, and work to the best of your abilities to help patients in need.
– Jim Tersak, SPT CSCS
References:
https://accreditation.abptrfe.org/#/directory
https://www.hosthealthcare.com/how-to-choose-a-travel-therapy-company/
https://www.google.com/amp/s/updocmedia.com/2015-pt-job-market-outlook-v2/amp/?source=images
August 20, 2018 |