Physical Therapist Rover

Applied Kinesiology While Purchasing a New Mattress

2008-12-15T19:48:00.000-08:00

Oh boy did I have an experience that has enlightened me to write about it since I've taken about an eight month hiatus (sorry to my small # of subscribers).

My last living grandparent is a sweet old lady; Granny Ruth has given my fairly new fiance and I a new bed as a wedding present. We've been sleeping on my mattress that I bought for $20 when I was 18. I am going the miss the dip in the middle of ol' beddy that miraculously survived college, but anywho; we went to Denver Mattress to see what was available. WOW, beds can be really comfortable but I couldn't help but be overwhelmed with the paradox of choice. I wanted to leave. We ended up talking to the mattress salesman that obviously failed as a used car salesman.

"For an extra $200 we'll give you pillows specifically matched for the mattress, plus a free chiropractic exam to help determine the most correct mattress." (rolls eyes)

I notice sell-out Dr. Brian Wieder on TV nearby blabbing about, uh, whatever.

We hum-hah and blah blah for a little while with the mattress guy while lieing down on the beds again.

"Here, I've got a test that we've taken the chiropractic profession."

This will be interesting.

"Hold your arm up and resist me pushing on your arm while you lie in this bed."
"Now resist me while you lie in this other bed."

Holy Cow! Can you believe that I was able to provide more resistance on the more expensive bed because my back was more supported. Bullshit.

Little did this used car...errr..mattress saleman know is that my fiance and I already knew about his little party trick. Try this at home. Have someone hold their arm into shoulder flexion.

Push down on their wrists with a closed grip.

Do a voodoo majic dance, give a vile drop of vitamin C, or put a poor sap on a more expensive bed and push on their wrist with an open palm.
Stronger?
It's a neat party trick, but this little trick is often used by quacks to sell their product, and I do dare say this is unethical. Read all about how these ducks took a pseudo-scientific treatment and gave it a scientific name.

Oh well, at least we're getting a new bed. Thanks Grandma!

Now revived...somewhat

2008-04-09T17:32:00.000-07:00

Man have I been sick the past couple weeks. I often proudly flaunt that I never get sick. I missed a few days of clinical, I turned in a deliverable for my final project late, and I've neglected my readers of this blog. I apologize and I am now back...well somewhat, still something annoying is hanging around and making me cough. Now that I'm not sleeping every opportunity I get, I'll soon be back for creative PT Rover Ramblings.

BTW, for those of you in the Denver area this weekend; support funding for PT research while getting some high-quality education from Dr. Christopher Powers regarding the 2nd most common diagnosis seen in PT clinics, knee pain. Chris Powers is graciously donating his time to benefit the student organized Pitt-Marquette Challenge lecture series at U. of CO Denver.

Wiihab is a joke

2008-03-12T22:24:00.000-07:00

I'll jump the wiihab bashing bandwagon. The utility of using the nintendo wii in the PT clinic has been blogged about many times by the folks at Evidence in Motion and NPA Think Tank. I'm not going to beat a dead horse, but I will point out a couple funny youtube related vids to exemplify the humor of wiihab.

Enjoy!

A Great Moment as a PT (in training)

2008-03-07T16:25:00.000-08:00

I had an experience today that has gotten me even more super jazzed to be a PT than I already have been. I have begun working with an individual with C6 incomplete tetraplegia (quadraplegia). He had a crazy freak accident whereby a wooden stair broke underneath him and he fell about 18 feet to the ground. He has been recovering well and his motivation level reminds of a level of intensity as an Olympian. He took his first steps today since his accident. He took about 8 steps in the parallel bars; afterwards the energy and emotion emanating from the patient was amazing. Now I feel that I've gotten a snippet of why physical therapist turnover at Craig Hospital is near nil. I feel great! Can't wait to continue to help others who need a physical therapist to help them achieve their goals!

PT School Memories

2008-03-06T21:39:00.001-08:00

PT school has been amazing. I've met some some of the best and most genuine people since I've been a PT student. Additionally I met some of the most witty and intelligent people as well, from fellow classmates to faculty. I often think of some of the best friends I've made during my time at U. CO Denver and how grateful I am to have been graced with their presence. I wonder who I will continue to keep in touch with throughout the next few years and who will fall to side. I look back and remember some very funny times. In particular I remember one very embarrassing, albeit funny, moment where I must have ate too many burritos (I love burritos BTW) and my stomach was not happy with me. I had to sit in the far back of the class to try to seclude myself due to the uncontrollable flatulence; my classmate Liz ended up walking out of the class because she was uncontrollably laughing so hard. Another very funny moment that had our entire class crying with laughter was during a student presentation of a project whereby he had to figure out how to create and market an innovative idea/tool related to physical therapy. We had multiple options for the project be it developing a niche practice, opening a clinic, etc. There was a lot of work into the projects and every classmate did a ton of research and presented their projects very well. Despite how impressed I was with all my classmates projects I couldn't help but have the glassed over eye-balls after a week of student presentations. The last student project was a HIT; he did a lot of work, presented it well, then topped it off with a hilarious promotional video. This is one moment of PT school I will never forget. Enjoy.

Who would like to have dinner with?

2008-03-05T21:10:00.000-08:00

I was asked this the other day. The typical answers were running through my head such as the the president of [name a country], Ghandi, my girlfriend Rhea. Then I just blurted out Seth Godin. I was truly introduced to the genius of Seth by a book recommendation of Dr. Childs while I was participating in a 16 week research/clinical internship in Texas. Seth's recent book, The Dip, is a great and easy read that I truly enjoyed. Graduation from PT school is coming up and job opportunities as a PT are unbounded; I re-read The Dip last week and have ultimately decided that my choice in a great evidence based PT school and pursuing a residency fall into Seth's esoteric "dip." I also really enjoy keeping up with Seth's blog and I particularly enjoyed a recent post which may relate to my choice in immediately pursuing a residency.

The forces of mediocrity

Maybe it should be, "the forces for mediocrity"...

There's a myth that all you need to do is outline your vision and prove it's right—then, quite suddenly, people will line up and support you.

In fact, the opposite is true. Remarkable visions and genuine insight are always met with resistance. And when you start to make progress, your efforts are met with even more resistance. Products, services, career paths... whatever it is, the forces for mediocrity will align to stop you, forgiving no errors and never backing down until it's over.

If it were any other way, it would be easy. And if it were any other way, everyone would do it and your work would ultimately be devalued. The yin and yang are clear: without people pushing against your quest to do something worth talking about, it's unlikely it would be worth the journey. Persist.

It reminds me of the monetary arguments against doing the extra work for a Doctor of Physical Therapy (DPT) or being a board certified specialist, because it's true that either doesn't necessarily equal bigger pay. Maybe it's just me, but money doesn't influence me to be mediocre. Being armed with superior clinical reasoning and knowledge for my patients does influence me, though.

Who would you like to have dinner with?

A wheelchair is not an ashtray

2008-03-04T21:57:00.000-08:00

Dropped cigarette ignites man in wheelchair. The ground is also not an ashtray, I remember a few major fires in Colorado ultimately being pinned to some butt-heads littering their butts on the ground. Cigarettes are a major nuisance.

PT Lawsuit Risk

2008-02-26T18:11:00.000-08:00

This article was delivered to my google reader as a free form of evidence pushing provided by pubmed. For those interested in how to have physical therapy evidence pushed to you for free check it out. It was interesting timing for this PT malpractice article as I got to watch a lawyer prance around the clinic today through my PT intern office window whilst I ate hospital food. Basically before I became an intern at my current clinic, a patient fell and is sueing; that is about all I know. I've come to the realization that it is likely that I will be sued at one point in my life; this day and age, it's almost inevitable unless you hide under a rock, but even that's not 100% safe. At least I know the odds are against me getting sued while practicing as a PT.
Abstract

As physical therapists increase autonomous practice, medical error becomes more important to public safety and public perceptions of the profession. The purpose of this study was to describe malpractice by physical therapists in the United States based on physical therapist malpractice reports in the National Practitioner Data Bank between January 1, 1991, and December 31, 2004. A frequency analysis of data related to physical therapist malpractice reports was performed. The relationship between size of malpractice payment and public policy related to access to physical therapist services and malpractice experience was explored. A total of 664 malpractice reports were found in the study period (mean, 47.73 events annually). California had 114 malpractice events, while Maine and Wyoming had none. The median payment amount for physical therapist malpractice was $10,000 to $15,000. "Treatment-related" events and events related to "improper technique" were the most common reasons for a malpractice report. Incidence of malpractice by physical therapists is low (estimated at 2.5 events/10,000 working therapists/year), and the average malpractice payment is small (<$15,000). Typical physical therapist malpractice involves a direct intervention by an early to mid-career therapist in an urban state. Cumulative physical therapist malpractice incidence in a state was unrelated to public policy related to direct patient access to physical therapy services.

It is highly unlikely I'll ever work in California, and I'm not surprised that state of California took the cake for most malpractice events. Maine and Wyoming tend to fit my lifestyle more, so that looks up for me. An interesting finding which relates to me is that malpractice suits typically were filed against early-mid career PT's. I've noticed that I tend to be more aggressive than "seasoned" PT's. I also try to use evidence as much as possible and the evidence typically points to aggressive strengthening to improve strength, as opposed to the all too often seen exercises with little to no weight. No wonder people are calling PT boring and tedious when compared to wiihabiliation. Additionally I utilize manual therapy and exercise because evidence shows the two combined almost always trumps either when used alone. The possibility of injuring someone with manual techniques is there and needs to be considered. Side note: my CI barked at me today from across the gym for using grade I-II hip mobilizations for pain modulation on a patient that had a THA over 8 months ago; her risk assessment outweighed the potential benefit. I wonder how much my risk assessment will change once I am licensed? Definetely something to consider, but for my patients I will continue to listen and spend time with them, place my therapeutic hands on them, and educate them accordingly.

Improper Terminology

2008-02-13T16:24:00.000-08:00

Holy Cow! An unfortunate use of the term physical therapy and unfortunate treatment for the residents of this drug/alcohol rehab facility.

Clinical Education Model: Revisited

2008-02-12T15:55:00.000-08:00

I must say that the few readers of this blog have impressed me with their incite regarding the state of the current clinical education model across the country as a whole. There's a lot of strong feelings about clinical education and this has been known, the bruise has just been irritated. As a current student, it is easy to state the imperfections. It is a whole other beast to come up with solutions. The solutions are difficult to implement because they must attempt to create a win-win situation for students, clinical sites, academic institutions, and most importantly the patients. I'll begin by stating that I don't believe any one component of clinical education is to blame, I believe that the current Doctor of Physical Therapy clinical education model is just a longer version of the Bachelor's of Physical Therapy model. Additionally I want to make a clear distinction between PT students and PT interns. PT interns are technically students, but are participating in their longer, final affiliations preparing to "enter the work-force." PT students are everything before being an intern, they are doing class and shorter affiliations.

The Orthopaedic updates course offered by U. of Colorado Denver is great start because Paul Mintken and Tim Noteboom are correct that we shouldn't "come down" on the CI's that are graciously giving up productivity time to interns. Torey Gilbertson brings up great points from a CI/CCCE perspective:

Speaking from the CI side of things, some of us are very interested in taking students, but there are many who are assigned students against their will and desire. This is the main problem as I see it. CI's need to want to be instructors...As my clinic's CCCE I have a hard time accepting commitments to take students that I can't be the primary CI for. I am surrounded by several absolutely fabulous clinicians and can learn a lot from simply watching them work. But none of them are interested in taking students for an extended time and I don't want a student's experience to suffer because of this. Part of this is because of the extra work it takes to have a student (and please don't ever think that it's not extra work to take a student, if you spend any time with that student). The other part is because they are clinicians and neither see themselves as clinical instructors, nor have a desire to teach people other than the clients and families they work with.

Interns should not be assigned to CI's that don't want to be CI's, period. This is neither productive nor desirable for all parties involved; essentially it is a lose-lose situation. The Clinical Instructor certification is a positive move on the APTA to potentially thwart the aforementioned lose-lose situation; The assumption being credentialed CI's want to be CI's. John Duffy from PTupdate (love your website BTW) is entitled to his opinion about potential lack of utility of CI credentialing because it is truly not an end-all be-all solution, but I'm sure a few non-credentialed one-in-a-million CI's such as yourself is OK. John Duffy also expressed his dis-content with taking interns that resemble the apathy exhibited by a large percentage our PT colleagues; I can make assumptions to where your 8 out of 10 interns have learned this apathetic behavior from.

The current model HAS produced some of our professions greatest minds. Why change it? This is also a valid point that Roderick Henderson makes and he has posted about it on his blog (check it out-great stuff). While I agree that the go-getter will benefit from the current model and seek the great opportunities, I myself sought out the best clinical education opportunity that I posted about while spending my last night in Texas. Although I do argue that the current model does lend itself to create more apathetic PT's which ultimately limits the profession. Additionally MOST of us think that the model is due for a change, including the APTA.

So...back to the creating a win-win situation for all. The following are just thoughts and are fully available for scrutinization. Instead of PT institutions having 200+ clinical sites, have just a few available for the longer internships. The school and clinical sites will work closely with each other. The clinics take on 4+ interns at a time; 1 good CI, 4+ interns. Understandably, this may sound impossible from financial and feasible standpoint on the clinic at first, but delve a little deeper and it could be very beneficial for the clinic. Interns work in pairs initially with the CI and the CI's productivity does and will "take a hit" initially. In no time really the CI is then supervising 4 interns each with their own caseload, and the CI is not consumed with seeing their own patients but rather mentoring and supervising. All the while the CI's productivity is climbing the ranks and soon potentially reaching 300%, maybe more. Yes, I know there are MediCare limitations and getting enough patients through the door could be difficult; Once again I'm just spit-balling thoughts that truly are in their infancy. Additionally the interns benefit from critically thinking through each other and their CI; also the interns aren't being taught how to model the apathetic PT. The potential for the clinic to benefit is possible. The academic institution benefits from knowing their didactic structure is being followed up with a structured clinical. The patients benefit because they are getting high quality PT that is supervised by a high quality PT (CI), rather than the patient getting seen by an aspiring PT intern while the apathetic CI is managing their own caseload. I know of one institution already implementing such a model.

That is the basic gist of a thought to create the win-win situation without completely remodeling the system. It's not perfect, but it's a start. Thoughts? Fire-away!

CSM-Great Success!

2008-02-11T17:19:00.000-08:00

CSM was a Blast! I would have posted on Sunday about how much fun CSM was, but I got home and I slept, then I slept some more, then after I slept some more I finally got off my posterior to attempt to be productive and washed the ol Subaru which had about a year's worth of grime that cleverly waits to attack me whenever I wear professional attire. Then I graciously rested my eyes.

The programming was amazing, although it is impossible in making every session. The networking was worth the cost of the trip alone. Additionally I was fortunate enough to engage discussion with multiple prominent PT's and students regarding the broke back PT clinical education model. Keep a lookout as I will compiling some thoughts of mine as well as the thoughts of those that I have spoken with and the blog-o-rific comments posted.

Physical Therapist Clinical Education

2008-01-28T15:40:00.000-08:00

All PT schools seem to have a similar structured didactic curriculum. Generally the first year consists of Anatomy, basic sciences, and some basic examination courses to frame the mind around the human body as well as get our hands used to touching the body of another person. Then the structured integration of first year knowledge into more clinical knowledge with orthopaedic and neuromuscular conditions. There's a rhyme and reason for the placement of each course within the curricula. Some schools are slightly different, but from as a whole their course placement is the same.

Now, we PT students are ready to be interns and take on true application of knowledge in a clinical setting. We all pay a god-awful amount of money for our schooling (well except for Army-Baylor), but why is that some of us will walk away from our clinical internships ready and equipped while some won't feel ready to enter the professional world? I would be pissed if I walked away from three years of training and $100,000-$250,000 deeper in debt (dependent on school) and I didn't feel I got enough training. A student's clinical education is most important part of professional education, whether it is medicine, nursing, PA, or PT. If the clinical education is the most important, then why are PT students given such intricate didactic structure then thrown to the "clinical wolves" to fend for themselves to literally get the most for their money? Some of us travel internationally, some across multiple states, and some just travel down the road to our respective clinical sites. Most of us have never met our Clinical Instructor (CI) before and have no idea what to expect from our CI.

The kicker is that our clinical education faculty has never met our CI either, so it is completely unknown what the learning experience is going to be; well it is known what type of setting, but that is about it. Clinical education faculty don't have time to visit every 200+ sites that many schools "boast" about.

The 1 on 1 model is a failing model. The model especially fails with the much longer clinical internships for Doctor of Physical Therapy students. It doesn't take much time until the student gets "their own" caseload while their CI also has their own caseload. The intern is now a source of revenue for the clinic and the CI is getting nearly double the billable units (this is a whole other bag of worms). How is the PT intern supposed to learn critical clinical reasoning when the intern and CI's mind is too preoccupied with paperwork and each seeing their own patients. Don't get me wrong, learning to juggle patients and paperwork is an important real world aspect of PT, but it doesn't take a year long internship to learn this aspect. Additionally the model fails because the standardization process is a joke; the clinical performance instrument (CPI) basically determines if the PT intern is safe and communicates with patients through a series of very repetitive questions. Also, many can agree that there are PT's that vary on the spectrum of greatness; Shockingly, there are CI's that vary on the spectrum of greatness. Where's the standardization in this?

The PT clinical education model across the nation is due for an overhaul. A doctor level degree deserves a doctor level of education from beginning to end. The wheel does not need to be reinvented, just give it some studs.

New geriatric residency

2008-01-18T16:06:00.000-08:00

The future of PT is expanding at an exponential rate. The need for physical therapists continues to grow as the baby boomer's are getting older and becoming more functionally limited. PT programs across the country are implementing the Doctor of Physical Therapy (DPT) rather quickly and the list of residency/fellowship training opportunities is growing. The University of Delaware has stepped up to the plate in offering another geriatric residency program. I foresee many other geriatric residencies popping up.

Laxative's sooth chronic pain?!

2008-01-18T14:54:00.000-08:00

Apparently rubbing a laxative on your skin will take away residual chronic pain from fractured femur. Dr. Gott represents the epitome of all that is stupid. Question your surgeon as if it's the surgeon fault that you fell and broke your frail 70 yr old femur and rub castor oil on yourself. Why don't you just ingest the whole bottle of castor oil and I bet you won't feel your leg pain while you diligently sit on the toilet. Not only that, later within the Dear Dr. Gott piece he offers a diagnosis of carpal tunnel syndrome. I love the definitive diagnosis he makes based off of extremely little information; the differential diagnostic pathway in his head is ridiculous. I'd recommend first off is to seek some advice from a real health care professional that doesn't prescribe woo.

All seriousness and criticism aside here is video from a classic movie.

Back in CO

2008-01-14T19:11:00.000-08:00

It feels good to be back in CO. I went skiing at Copper mountain the past two days and had a blast. The snow coverage is great, and I was able to find a few untouched powder spots. Rhea's ski boots gave her the infamous "black toenail." There are generally two reasons for getting a black toenail, both of which are related to the toe getting mashed in the toebox. The boots can be too small, which is why mine turn black from wearing my incredibly tight fitting race boots. The other reason is the boots being too big. This may seem counterintuitive at first, but what happens is that the feet inside the boot have some room to slip around and create a "pistoning" of the toe into the front of the toe box. After some apres ski drinks, Rhea agreed to allow an athletic trainer friend and I to use a sterilized drill bit to hand drill a hole through her toenail in order to relieve the pressure of the blood build up within the nail bed. The treatment worked for allowing her to put more weight through her big toe, but she is still experiencing more pain than desirable. Additionally her toenail is no longer black and has a little mini blood geyser when she puts weight through her toe.

Overall is a good weekend of skiing, hanging with friends, using construction tools on the human body, and rallying the Subaru in the parking lot. Looking forward to more snow-related hi-jinks this winter.

A Brief Me

2008-01-10T22:44:00.000-08:00

Welcome to my blog of random ramblings of Johnny May. I'm a 3rd year Doctor of Physical Therapy student attending U. of Colorado Denver and am currently interested physical therapy research, orthopaedics, and manual therapy. I've been meaning to host a blog for multiple reasons, but a whole list of priorities usually allowed me to talk myself out of it. A recent post from NPA Think Tank and a bout of insomnia due to my excitement of moving back to Colorado has motivated me to finally start typing for fun. I've been living in San Antonio for the past 4 months participating as research assistant in a ground-breaking study looking at preventing low back pain in the military as well as interning at Texas Physical Therapy Specialists. The past 4 months has been an amazing experience for participating in research and implementing evidence based practice. Additionally the experience allowed me the opportunity to work directly with as well as meet some my professions leading clinicians and researchers. My classmate, Liz, also joined in on the San Antonio internship extravaganza; her blog has highlighted many of the more interesting moments.

The car is packed and I'm ready to return home. Ready to view Texas through the windshield and rearview mirror.