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 |

Monday Memo 10/22/18

The Monday Memo

October 22, 2018                                                                           PITT DPT STUDENTS

 

What Is In That Hip?

 

Total hip arthroplasties (THA) are among one of the most common elective surgeries performed in the United States. Approximately 2.5 million people in the have had a total hip arthroplasty performed. There are many different options for the material used for a THA. Some of the most commonly used combinations are metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, or metal-on-metal. Use of the metal-on-metal implants has greatly declined because of the side effects due to the metal-on-metal wearing.

Metal-on-metal implants were popular at one time because they had a very low wear rate, however, when the components wear, a large number of small particles are released that can reach potentially toxic levels in the body. The implants are most often made of cobalt, which is the cause of the toxicity. Symptoms of cobalt toxicity can be seen anywhere from 3 months post-op up to 6 years after. The most common symptoms identified were either neurological or cardiovascular in nature.

 

Neurological Symptoms
·      Hearing impairment

·      Cognition, memory, concentration impairment

·      Paresthesia (polyneuropathy)

·      Visual Impairment

·      Headache

Cardiovascular Symptoms
·      Dyspnea

·      Atrial Fibrillation

Miscellaneous
·      Rash/dermatitis

·      Fatigue

·      Weight loss

 

Many of these above symptoms could easily be associated with other disorders, especially in an older population. If these symptoms happen to occur in an otherwise healthy individual who recently underwent a THA, it would be worth looking into the type of replacement that they received. Although these incidents are rare and the rate of metal-on-metal implants have declined, it is something to keep in mind in case you have a patient in front of you who recently had a hip replacement and is reporting unusual symptoms. As always with red flags, contact the surgeon or another appropriate medical provider.

 

–Robert Jesmer, SPT

 

References:

  1. Devlin, J. J., Pomerleau, A. C., Brent, J., Morgan, B. W., Deitchman, S., & Schwartz, M. (2013). Clinical Features, Testing, and Management of Patients with Suspected Prosthetic Hip-Associated Cobalt Toxicity: A Systematic Review of Cases. Journal of Medical Toxicology, 9(4), 405-415.
  2. López-López, J. A., Humphriss, R. L., Beswick, A. D., Thom, H. H., Hunt, L. P., Burston, A.,Marques, E. M. (2017). Choice of implant combinations in total hip replacement: Systematic review and network meta-analysis. Bmj. doi:10.1136/bmj.j4651
October 22, 2018 |

Monday Memo 10/15/18

The Monday Memo

October 15, 2018                                                                           PITT DPT STUDENTS

 

Progressing Core Stabilization Exercises: The Pallof Press

 

The Pallof Press is an excellent way to challenge our patients’ core stability with a variety of positions and modes of resistance. Let’s look at a few ways to prescribe this exercise.

 

Seated Pallof Press on Physioball

This is a great initial progression, and the physioball presents a dynamic base of support to challenge your patient. You can easily regress this for other patients by beginning in a chair.

https://www.youtube.com/watch?v=D7OkCaor62E

 

Half Kneeling Pallof Press

This progression incorporates increased load on the contralateral hip abductor and external rotator musculature, which is useful in addressing any asymmetry.

https://www.youtube.com/watch?v=CGsN4yhGHmw

 

Tall Kneeling Pallof Press

Decreases the base of support from half kneeling, thereby increasing the demand on the lateral chain and core musculature.

https://www.youtube.com/watch?v=bF96USLxBDk

 

Split Squat Pallof Press

This progression allows for increased demand on hip and knee musculature, as well as increased demand on postural stabilizers to balance against the resistance in a heightened position. You can alter this progression by changing the depth of the split squat.

https://www.youtube.com/watch?v=DzDyw9EbRO0

 

All of these positions can be progressed by changing the degree of shoulder elevation, increasing the time the patient must hold, or altering the resistance. This list is by no means exhaustive. Please experiment, find what works well for you and your patients, and get pressing!

 

-Joe Dietrich, SPT, ATC

October 15, 2018 |