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 |

Monday Memo 11/05/2018

The Monday Memo

November 5th, 2018                                                                           PITT DPT STUDENTS

Dancing to the Beat of Healing

Physical Therapy is a holistic approach to healing and physical wellbeing, but there are other practices that simultaneously target the body and mind when addressing the needs of each patient.  Dance Movement Therapy, like physical therapy, uses movement as an assessment tool, as well as a primary mode of intervention.  Dance Movement Therapy is defined by the American Dance Therapy Association as, “the psychotherapeutic use of movement to promote emotional, social, cognitive, and physical integration of the individual, for the purpose of improving health and well-being.”  The target of Dance Movement Therapy sessions is to use verbal and nonverbal communication to stage interventions to address the social, emotional, physical, and cognitive integration of an individual.  Dance Movement Therapists see patients with a variety mental health conditions, as well as those with medical conditions such as neurological disorders, traumatic brain injuries, Parkinson’s, Multiple Sclerosis, spinal cord injuries, cancer, fibromyalgia, and chronic pain.  Sessions often take place in moderately sized groups to facilitate the opportunity for touch, socialization, and group creativity. Simply moving together can connect patients without the use of verbal language.

Dance Movement Therapy is commonly practiced in mental health and psychiatric facilities, prisons, schools, nursing homes, eating disorder clinics, crisis centers, military facilities, private practices, hospices, forensic settings, and Alzheimer’s and dementia care facilities.  Dance movement therapy is also practiced in wellness centers, hospitals, physical rehabilitation centers, preschools, and adolescent day treatment centers.

Dance movement therapy has the ability to empower patients through embodiment.  The goal is that this confidence will ooze into their everyday lives and make a positive impact on both their physical and mental wellbeing.  Sessions are centered around each client’s individual needs at that exact moment.  For that reason, in recent studies, Dance Movement Therapy was seen to increase patient quality of life in both the short, and long term.  Additionally, dance movement therapy was seen to effectively decrease depression and anxiety, while simultaneously increasing subjective well-being, positive mood, affect, and body image.

Even in physical therapy, it is clear to see the power music has on each patient.  Whether the patient is using music as a form of motivation and distraction from physical pain, or to sway to the music while they perform an exercise, music can have a big impact on the patient’s experience and progression in therapy.  Collaborating with Dance Movement Therapists in clinical settings could assist in making treatment fun, functional, and patient centered!  The practice of Dance Movement Therapy is on the rise, so get excited to work with DMTs in the future!

 

-Mariah Callas, SPT

 

References:

  1. www.adta.org
  2. Check out this article: Dance Therapy Helps Alzheimer’s Patients Connect with Loved Ones

https://chicago.cbslocal.com/2018/06/25/dance-therapy-for-alzheimers-patients/

  1. Research regarding the effectiveness of dance movement therapy:

https://adta.org/2016/03/19/research-efficacy-dancemovement-therapy-growing/

November 5, 2018 |

Monday Memo 10/29/18

The Monday Memo

October 29, 2018                                                                           PITT DPT STUDENTS

 

Stress Less!

 

As graduate students, we are no strangers to the feeling of stress. We all know the anxiety that can arise when you get handed an exam form or the moment you walk in for a practical. Everyone experiences and everyone handles it in their own unique way. For some, it is a fluttering feeling in the pit of their stomach and for others, it is a lingering headache. The general consensus seems to to be that stress is an unwelcome feeling. In this brief memo, we will discuss various ways to cope with unwanted stress.

 

First off, it is important to know that everyone is affected by stress. It is a natural reaction to something that we, as humans, perceive as threatening. The physical effects include elevated blood pressure, faster respiratory rate, increased heart rate, and a slowed digestive system. This is what we commonly label as “fight or flight”. There are various types of stress, and not all are negative. Sometimes, it is just the body’s way of preparing itself to perform at it’s best, even if it may not feel that way at the time.

 

Now that we have established that stress is something we all live with, let’s discuss some ways to cope with it. Below are some tools to handle stress:

 

  1. Exercise! Numerous studies have shown that self-selected exercise is effective in reducing stress. Whether it be jogging, dancing, or yoga, putting aside time in your day to move your body is invaluable.
  2. Breathing and meditation. Techniques such as these can help ease some of the physiological factors that accompany stress. Taking long, slow breaths and centering the mind can help reset and refocus the mind.
  3. Communicate. Having a good support system while in high-stress situations can be extremely effective. Finding a family member or friend that you feel comfortable talking to can help ease stress.

 

Various other stress coping techniques can be found here.

 

As a final note, if you or someone you know is concerned about how stress is impacting their daily life, it is important to seek out professional help. The University of Pittsburgh Counseling Center is an excellent resource for any Pitt student experiencing increased levels of stress or anxiety. They can be contacted here: https://www.studentaffairs.pitt.edu/cc/

 

-Layne Gable, SPT

 

References:

  1. https://www.nimh.nih.gov/health/publications/stress/index.shtml
  2. https://www.medicalnewstoday.com/articles/145855.php
October 29, 2018 |