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 |

Monday Memo 8/13/18

The Monday Memo

August 13, 2018                                                                           PITT DPT STUDENTS

 

Dynamic Neuromuscular Stabilization: A Brief Overview

 

What is DNS?

 

Dynamic Neuromuscular Stabilization (DNS) is an approach to facilitating appropriate core coordination that enables our patients to appropriately activate their core for optimal function. DNS is based upon principles of early childhood development that follow pre-determined, predictable patterns. These CNS movement patterns progress naturally as an infant learns to control its posture against gravity, roll, creep, and eventually stand and walk. The concept of an efficient kinetic chain – requiring adequate trunk coordination – is imperative for sport-specific tasks as well as activities of daily living. The DNS approach seeks to address inefficient motor synergies and re-train the CNS to promote optimal function.  Per Panjabi’s model of spinal stability, there is an interaction between neural, active, and passive elements to promote spinal stability and allow for optimal function. Treating core strength or passive elements alone is not enough to address these stability deficits. The DNS approach can be useful in addressing the neural element for patients suffering from chronic, recurrent low-back pain (LBP), those we often think of as a “stability” patient.

 

How can we Apply DNS?

 

There are several positions in which we can encourage stability. It is important to account for weight-bearing and non-weight-bearing positions. There are a few principles to keep in mind when guiding patient treatment:

  1. Restore respiratory pattern and abdominal stiffness (See Brooks Kenderine’s article on abdominal stiffness vs. hollowing)
  2. Establish quality support to allow movement of the extremities
  3. Ensure joint centration throughout the movement

 

Our interventions should be scaled with these in mind, and the patient’s ability to perform well in low-level developmental positions will indicate the addition of external resistance or advancement to the next position. Let’s look at some simple progressions:

Supine Dead Bug:

  • Unilateral or Bilateral 90/90 Isometric Hold
    • Cue patient to activate core to resist increased anterior pelvic tilt/lumbar lordosis as they bring one or both legs to 90/90 position of hip and knee flexion.
    • This is a great way to get the patient comfortable with diaphragmatic breathing and maintaining abdominal stiffness.
  • Unilateral UE/LE March with Straight Leg Raise
    • The patient will maintain 90/90 position with one leg, while alternating UE/LE extension and flexion.
    • Regression: Keep the leg in hook-lying position and perform UE/LE taps with SLR.
  • Alternating UE/LE March:
    • Emphasize slow and controlled tempo, and maintaining good diaphragmatic breathing.
  • Isometric Physioball Hold
    • The patient will squeeze physio ball between opposite UE/LE and hold, then switch.

Bear Position:

  • Isometric Hold
    • Ensure patient maintains chin retraction, good scapular positioning, and neutral spine.
  • Alternating LE Raise and Hold
    • The patient will raise and hold one foot, while maintaining chin retraction and neutral spine.
  • Alternating Bear Steps
    • The patient will step forward with opposite UE/LE, and then backward, alternating side to side.

video 1

video 2

video 3

-Joe Dietrich, SPT, ATC

 

Disclaimer: These are merely some of the movements described within the DNS system. The principles of appropriate spinal alignment and breathing techniques should be utilized across the board when prescribing therapeutic exercises to our patients.

References:

Frank, C., Kobesova, A., & Kolar, P. (2013). DYNAMIC NEUROMUSCULAR STABILIZATION & SPORTS REHABILITATION. International Journal of Sports Physical Therapy8(1), 62–73.

http://pittphysicaltherapy.com/2018/01

August 13, 2018 |

Monday Memo 08/06/18

The Monday Memo

August 6, 2018                                                                           PITT DPT STUDENTS

Do you know how to Yo-yo?

 

Oddly enough, the “Yo-yo test,” will be able to help gauge how an athlete can perform in endurance sports. Now, I am not talking about the toy that is tethered to a string around your finger, but a grueling endurance test that is commonly used in high-level athletics. The Yo-yo intermittent recovery test, or also known as the Beep Test, is commonly used for high endurance sports such as basketball and soccer. In short, the test is described in the literature as:

 

 …consisted of 20 m shuttle runs performed at increasing velocities with 10 s of active recovery between runs until exhaustion…”

 

However, we recently used this test for the Pittsburgh Steelwheeler athletes who we have been working with for the past few weeks. The test has been modified for wheelchair basketball and is described as follows:

 

“Due to the differences between running and propelling the wheelchair, the distance covered in the shuttle run was reduced to 10 m. Pushing speeds were dictated in the form of audio cues broadcast by a pre-programmed computer. The test was considered to have ended when the participant failed twice to reach the front line in time (objective evaluation) or felt unable to cover another shuttle at the dictated speed (subjective evaluation).”

 

This test has been showed to be important for recording athlete endurance and can be an effective measurement for improvement. The test was administered by a fellow 2nd year, Christie Chiesa, and can be viewed on our Instagram page: @pittsteelwheelers. We had four athletes participate, and they all had an amazing first performance. We hope to be able to use the results as motivation and performance benchmarks for the athletes.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314607/

https://www.instagram.com/pittsteelwheelers/

-Jim Tersak, SPT, CSCS

August 6, 2018 |