Monday Memo 1/28/19

The Monday Memo

January 28, 2019                                                                          PITT DPT STUDENTS

 Think BIG


What is it?


Parkinson’s disease (PD) is a neurodegenerative disease that progressively reduces the number of dopamine-releasing neurons in the substantia nigra. Dopamine is an important component of the motor pathways within the basal ganglia. It functions to excite the pathway that facilitates movement and inhibit the pathway that slows or reduces movement. This loss of dopamine results in the commonly seen signs of PD, including the resting tremor, rigidity, bradykinesia, and postural instability. A true PD diagnosis requires at least two of these signs, in combination with a positive response to a trial of Levodopa.


Common Signs and Symptoms of PD


Along with the four primary signs previously mentioned, people presenting with PD may report decreased writing size or micrographia, voice changes, and difficulty initiating movements. Additionally, they may exhibit gait deviations including decreased or lack of arm swing, decreased foot clearance, decreased step length, as well as a festinating gait pattern.




People with PD can benefit from a variety of modes of intervention, including cardiovascular endurance training, strength training, balance training, and task-specific functional training. Intensity is key. Studies have shown that high intensity training is superior to low intensity training for people with PD. There are a variety of high intensity exercise programs available to people with PD, including LSVT Big, PWR!, Rock Steady boxing, and Dance for PD.




LSVT BIG is a protocol driven, high intensity intervention specifically developed for people with PD. People with PD perceive their reduced movements to be of normal amplitude. This program focuses on encouraging what is perceived as high amplitude movement to facilitate normal amplitude movement. The program includes four parts, including a series of seven specific exercises incorporating large, purposeful movements, functional component tasks that are patient driven, gait training, and hierarchical task training based on patient needs and lifestyle. This program requires clinicians to be certified to provide it as an intervention to patients, however the concepts of large amplitude, high intensity movement can be applied to any task. Remember to Think BIG!


A special thank you to Dr. Dave Wert, PT,PhD and Jodi Krause, PT, DPT, NCS for their lectures on Parkinson’s Disease and the LSVT BIG protocol.


  • Katie Schuetz, SPT


For more info:

Welcome to the official Dance for PD® site




Landers, M. R., Navalta, J. W., Murtishaw, A. S., Kinney, J. W., & Richardson, S. P. (2019). A High-Intensity Exercise Boot Camp for Persons With Parkinson Disease. Journal of Neurologic Physical Therapy, 43(1), 12-25. doi:10.1097/npt.0000000000000249

January 28, 2019 |

Monday Memo 1/22/19

The Monday Memo

January 14, 2019                                                                           PITT DPT STUDENTS

Studying For The CSCS


Exercise is the best medicine. That may seem biased, for as physical therapists, exercise is our profession. However, there is no profession that better understands the importance of tissue loading to increase resilience. The overarching vision of our profession is to optimize human movement, and to do so requires advanced knowledge of training principles. The NSCA Certified Strength and Conditioning Specialist (CSCS) is an excellent certification to pursue in order to enhance this knowledge. Studying for the exam is challenging, so below are some tips to help you along the way.

Old School (Textbook) – The official textbook used to prepare for the CSCS exam is “Essentials of Strength Training and Conditioning.” This text is a vital tool to study for the exam and I would consider this a required resource for maximizing your chances of passing. The book covers everything from exercise physiology to nutrition to facility set up, and of course strength training. Covering a chapter per day, you could complete the entire text in about a month, but if you are someone who likes to be more thorough or make a second pass, give yourself a little more time.

Studying App – “NSCA CSCS Pocket Prep,” proved to be the most useful app during my studying. The app itself includes a bank of around 600 exam questions covering each of the main areas found in the exam, practice tests, and daily questions. One useful function of the app is that once any question is answered, an explanation of the correct answer is given along with the reference and corresponding page for that specific information in the “Essentials of Strength Training and Conditioning.” Together, these two resources pack a powerful punch when preparing for the exam. The app was $17.99 when I purchased it, and I believe it was worth the investment.

Your Friends/Colleagues – If you are in Physical Therapy school, or are a practicing Physical Therapist interested in becoming a strength and conditioning specialist there is a good chance that a classmate or colleague has already taken the exam and can be a useful resource. Study guides, useful tips, and prior experience from others may make a large impact on your preparation.

(Extra tip) Become an NSCA member when signing up for the exam! The exam can be rather expensive as a non-member and becoming a member before signing up for the exam is a cheaper option. Furthermore, becoming a member allows you access to journals with the most up-to-date strength training information and shows investment in pursuing further development as a strength and conditioning professional.


-Jim Tersak, SPT, CSCS

-Joe Dietrich, SPT, ATC

January 22, 2019 |

Monday Memo 1/14/19

The Monday Memo

January 14, 2019                                                                          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


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


– Layne Gable, SPT

January 7, 2019 |