Wednesday, September 17, 2008
Research shows physical therapy as effective as arthroscopic knee surgery ALEXANDRIA: A new study questioning the usefulness of arthroscopic surgery
According to Eurekalert, the news service of the American Association for the Advancement of Science, the study found that physical therapy, combined with comprehensive medical management, is just as effective at relieving the pain and stiffness of moderate to severe osteoarthritis of the knee as surgery.
"This study offers hope and encouragement to persons with osteoarthritis who would like to avoid the pain and emotional toll of surgery," said APTA President R. Scott Ward, PT, PhD. "Too often, the first line of defense is surgery when it need not always be. Physical therapy can be equally effective and should be considered by not only patients themselves, but also the primary care doctors and orthopedists who are treating them."
According to physical therapist Christopher M Powers, PhD, PT, director of the Biokinesiology program and co-director of the Musculoskeletal Biomechanics Research Lab at the University of Southern California Division of Biokinesiology & Physical Therapy, "Many times knee pain is associated with abnormal movement patterns that cause increased stress on the joint. Arthroscopic surgery does little to correct the dynamic factors that may be contributing to knee pain and pathology. These findings reinforce the need for a comprehensive treatment approach for such patients."
The NEJM study adds to a growing body of evidence supporting physical therapy for treatment of osteoarthritis of the knee, including:
A report published in the January 2008 issue of the journal Physical Therapy that reviewed research on osteoarthritis of the knee from 2000 to 2007 and found "high-quality evidence that exercise and weight reduction reduce pain and improve physical function."
A study published in the Feb 1, 2000 issue of the Annals of Internal Medicine that concluded "a combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention."
A physical therapist will perform a thorough examination and design a plan of care that may include:
A series of exercises designed to help improve motion. Activities in this phase might include water walking, swimming, and flexibility exercises.
An exercise sequence to restore strength including a functional progression, that is, a gradual return to normal activities using exercises that simulate the knee stresses of your normal activities.
A knee's tolerance for stressful activities often decreases with age and loss of conditioning. As a result, stresses that would not have caused pain or injury to the knee last year could today. A decrease in levels of activity over a period of time may also contribute to the vulnerability of knees.
But there are steps one can take to help prevent injury in order to continue enjoying sports and exercise. Pursuing an exercise program designed by a physical therapist can be one of the best protections from injury.
The first step in designing your exercise program is an evaluation by your physical therapist. He or she can identify your predisposing factors, those body traits that may make you more or less vulnerable to a knee injury. Based on this evaluation, your physical therapist can design a program that will help you gain your optimum levels of function, strength and conditioning.
Tuesday, August 19, 2008
WEST BRADFORD — The Olympic games have inspired some young riders with disabilities to strive for extra accomplishments last week during their therapy sessions at Quest Therapeutic Services.
Quest uses horseback riding as a tool for physical therapy and therapeutic riding for young people ages 2 to 21. This week, the center has adapted its hippotherapy program to include exercises that the children can compare to what they see at the Olympics.
The therapy sessions have adapted to include mounted and unmounted games kicking off with a torch relay, using a simulated torch with tissue paper flames. Gold medals are given out daily to riders for executing swimming strokes with their arms while mounted, playing equestrian games and doing gymnastics.
Other mounted games on the horses include relays, basketball toss and jumps. There are also children's games on the ground, including softball, soccer, tennis, and track-and-field activities.
The addition of the games is intended to encourage children with special needs to meet goals on their individual treatment plans and bring excitement to their therapy.
"We use the horse as a tool as part of the therapy program," said founder and President Sandra McCloskey.
The program anticipates 160 young people will participate in the special events over two weeks.
"It helps to motivate them to reach their goals," McCloskey said. "They're getting really into the spirit of this. This is their day to be in the Olympics."
Hippotherapy at Quest Therapeutic Services is designed to enhance the development of children with special needs. Licensed pediatric physical, occupational and speech therapists serve children with diagnoses such as cerebral palsy, spina bifida, autism and developmental delays. Many volunteers also work to make the program possible, because it takes three people on the ground to assist every student on horseback.
Parents were enthusiastic about the program and how Quest has helped their children. "After less than six months, he's doing much better. He's very happy," said Seema Nayak of Malvern, whose son, Aashay, is benefiting from his sessions at Quest.
Aashay is weaker on one side of his body. But since he started the hippotherapy, he has begun to use his weaker arm and leg more.
"It's a big change for him," said Seema Nayak.
Lee Law of West Chester is a pediatric physical therapist who brings her 10-year-old son, Ryan, to Quest. "It's made a tremendous difference in his head control and support in his trunk," she said. "He gets excited about this as opposed to other therapies."
Parents Lee and Steve Law, along with Ryan's sister and aunt, watched from the lounge area while Ryan turned in different directions in the saddle, road over rails on the ground that simulates jumps and tossed nerf balls and bean bags at targets from the back of the patient pony.
One of the big benefits of hippotherapy is that the motion of the horse helps work muscles that do not otherwise get any stimulation.
"I think you get a lot out of a session because it works him all over," Law said. "It's something different from conventional therapy that you can work on all the things at the same time."
Monday, August 11, 2008
The Edmond Sun
EDMOND — People looking to prevent weakness and pain later on in life don’t really have a way to educate themselves on how to do it. Until now.
Eric Browning, physical therapist at Keith Physical Therapy, 13301 N. Meridian, created the Musculoskeletal Exam to predict the likely places an individual might develop pain and identify muscles that already might be causing episodic pain.
“Nobody else has done anything like this as far as I know,” Browning said. “It’s just using the knowledge we already have in a systematic way.”
Browning does an assessment of strength and flexibility of the main muscles through 140 to 160 tests during the exam, which costs $120. He said he takes patients through at least six tests per every area of the body and so feels confident in his predictions. Tested muscle areas include wrist, biceps, triceps and feet. He then enters the data into an Excel program, which graphs the strength of each muscle, identifying low- to high-risk areas.
His exams are unique in that he uses a manual muscle tester to measure strength, Browning said. He then compares that to what studies have shown an individual’s strength should be based on their age and body weight. Most doctors and physical therapists measure strength on a one to five scale. Browning said typically when people go to the doctor strength analysis is determined by squeezing the doctor’s hand.
After the MSE exam, Browning gives the individual a report of their exam and educates them on exercises they can complete for muscles that have been determined to be at high risk for pain. He said he also can refer an individual to the appropriate doctor if any problems are found.
“It allows me to help them learn how to fix something before it’s broken,” Browning said. “Most of what we do is empower people to do therapy with minimal equipment.”
He said people can come in for an MSE, work on strengthening their weak muscles and then come back for another exam.
“It’s a tracking system,” Browning said.
Browning said the exam also is good to help people identify what muscle is causing the episodic pain.
For example, a baseball player kept coming in for therapy because of pain in the middle of his back. However, the pain actually was coming from a weakness in his hip and was being absorbed in his back.
People who are planning to train with a personal trainer or people with hypermobility or flexibility are good candidates for an MSE, Browning said.
“People that train at extremely high levels are likely to have pain at some point,” he said.
Browning created the exam about a year ago and began implementing it about five months ago.
“Everyone that has come has been extremely pleased with the information I’ve given them,” he said.
All patients have been motivated to reverse effects, Browning said.
“The response he got is excellent and his predictability is excellent,” said Thomas Keith, Browning’s partner. “I think it’s an outstanding idea.”
Browning earned a bachelor’s degree in biology at Oklahoma State University and a master’s degree in physical therapy at the University of Oklahoma Health Sciences Center.
FOR MORE information about MSE, visit www.keithpt.com.
Monday, July 28, 2008
Evaluating Physical Therapists' Perception of Empowerment Using Kanter's Theory of Structural Power in Organizations
Evaluating Physical Therapists' Perception of Empowerment Using Kanter's Theory of Structural Power in Organizations
PA Miller, PT, MHSc, is Assistant Clinical Professor, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. At the time of the study, she was Profession Leader, Physiotherapy, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada. Address all correspondence to Ms Miller at 5 Undercliffe Ave, Hamilton, Ontario, Canada L8P 3G9 (firstname.lastname@example.org)
P Goddard, MScN, RN, is Assistant Clinical Professor, School of Nursing, McMaster University. At the time of the study, she was Chief of Professional Practice and Chief Nursing Officer, Hamilton Health Sciences Corporation
HK Spence Laschinger, PhD, RN, is Associate Director, Research, and Professor, School of Nursing, University of Western Ontario, London, Ontario, Canada
Background and Purpose. Little is known about physical therapists' perceptions of empowerment. In this study, Kanter's theory of structural power in organizations was used to examine physical therapists' perceptions of empowerment in a large Canadian urban teaching hospital. Kanter's theory, which has been studied extensively in the nursing profession, proposes that power in organizations is derived from access to information, support, resources, opportunity, and proportions. Subjects and Methods. A convenience sample of physical therapists who had been working in the hospital longer than 3 months was used to determine the scores for the physical therapists' ratings of empowerment using the Conditions of Work Effectiveness Questionnaire. Results. Physical therapists' scores were similar to reported staff nurses' scores for access to support, information, resources, and opportunity (=2.89, 2.91, 2.62, 3.25, respectively). Physical therapists' scores were higher than the majority of reported staff nurses' and nurse managers' scores for access to sources of informal and formal power structures (=2.81 and 3.29, respectively). There was a relationship between the empowerment score and the physical therapists' global rating of empowerment. Unlike studies of nurses, there were no relationships when demographic attributes and empowerment scores were examined. Discussion and Conclusion. Evidence for the validity of Kanter's theory of empowerment was found. Kanter's theory can provide physical therapists and their managers with a useful framework for examining critical organizational factors (access to information, support, opportunity, and resources) that contribute to employees' perceptions of empowerment. A baseline measure for comparing future empowerment scores of this sample is available. Further work to examine the application of Kanter's theory to other samples of physical therapists appears to be warranted.
Key Words: Empowerment • Kanter's theory of structural power in organizations • Organizational restructuring • Program management
Wednesday, July 23, 2008
by Staten Island Advance Monday July 21, 2008, 4:14 PM
From Bravest to busted?
A firefighter from Staten Island is accused of falsely claiming to be at physical therapy sessions and collecting approximately $7,500 in pay.
John Dimino, 45, a Prince's Bay resident, allegedly signed the Fire Department's command log on multiple occasions between August 2007 and February 2008 indicating he was leaving work to attend physical therapy sessions. The Department of Investigation says it found Dimino did not attend physical therapy on those occasions.
For most of his 18-year career, Dimino has been assigned to Engine 157 in Port Richmond. The alleged fraud happened at the Concord firehouse that houses Rescue Co. 5. Fire officials said that was most likely where he was performing light duty stemming from his injury.
Officials couldn't immediately say exactly how Dimino was injured or when, but said it was an on-duty injury.
He was charged today with third-degree grand larceny, first-degree falsifying business records and second-degree falsifying business records. The top charge of grand larceny carries a maximum penalty of seven years in prison if Dimino is convicted at trial.
The accused firefighter earns an annual salary of $68,470, according to officials.His attorney, Rob Gallo, declined to discuss the case. Dimino fled from a photographer outside court today.
332nd Air Expeditionary Wing Public Affairs
7/23/2008 - JOINT BASE BALAD, Iraq -- An Iraqi man whose leg was shattered two months ago can walk again thanks in part to a team of physical and occupational therapists at Joint Base Balad's Air Force Theater Hospital.
Moqdad lay on a raised bed in the middle of the Occupational Therapy and Physical Therapy clinic July 22. Nearby, a pair of crutches leaned against a wall, waiting for the Iraqi Marketplace employee to use them for the first time since he left the hospital. He smiled and chatted with medical technicians as they wove bandages around the pins of a large metal brace -- known as an external fixator -- attached to his right ankle.
The physical therapists first saw Moqdad as an inpatient here, said Lt. Col. Lisa Smith, element chief of occupational and physical therapy for the 332nd Expeditionary Medical Operations Squadron here.
"We started therapy with him, trying to get him to walk again," said Colonel Smith, who is deployed from Wilford Hall Medical Center at Lackland Air Force Base, Texas. "That was the big challenge for us."
Moqdad was accidentally shot in the lower leg, splintering both his tibia and fibula, said Emad, an Iraqi translator and the eldest of Moqdad's six brothers. Air Force surgeons repaired what damage they could and attached the fixator to Moqdad's limb to help the bones heal properly. Then, they released him.
When the hospital discharges a patient, staff members determine what follow-up treatment the patient may need, Colonel Smith said. In Moqdad's case, the follow ups included regular visits to physical therapy.
The OT/PT clinic sees about 300 inpatients per month, nearly 90 percent of whom are Iraqi patients like Moqdad, Colonel Smith said. Physical therapists focus on treatment of spinal and extremity movement dysfunctions, while occupational therapists work primarily with patients' hands.
Colonel Smith's staff works closely with the Orthopedic Clinic, which installed Moqdad's fixator, so the orthopedic doctors can focus primarily on surgeries.
"Because this is a trauma hospital, we see a lot of patients who would ordinarily go straight to the Orthopedic Clinic," Colonel Smith said. The OT/PT clinic assumes many of the duties of an orthopedic clinic stateside, including screening patients and treating injuries that don't require surgery.
While patients at a hospital in the United States get continuing treatment and advice on how to modify their environment to accommodate their disabilities, patients here don't have that luxury, said Maj. James Ronyak, an occupational therapist deployed from the 88th Surgical Operations Squadron at Wright-Patterson AFB, Ohio.
"We don't see our patients on an extended basis like we would back in the United States," Major Ronyak said, "but as much as we can, we try to help them get back to full function."
The therapists do as much as they can while their patients are in the clinic. The physical therapy team pulled a set of horizontal bars next to the bed's edge for Moqdad and helped him stand on his uninjured left foot. As he hopped gingerly along the bars, Airmen eased him onto the waiting set of crutches.
Moqdad carefully navigated the room, with Colonel Smith following close behind to make sure he didn't fall backward. Finally, he made it back to his bed and lay down as Airmen took the crutches and examined his injured leg.
Once Moqdad leaves the clinic, however, his continued rehabilitation is up to him.
"Continuity of care is important," said Tech. Sgt. Dan Wilson, a physical medicine technician deployed here from the 75th Medical Operations Squadron at Hill AFB, Utah. "We can't go out to the community, so we have to make sure we're giving him the resources to take care of himself."
"We give them whatever they need when they leave the hospital, including illustrated exercises, translated into Arabic," Colonel Smith said. "We go over the exercises ad nauseam with the translators and patients and tell them how important it is to do it."
Most Iraqi patients are grateful for the treatment they receive from Air Force therapists, Colonel Smith said. Moqdad was no exception, as he frequently thanked the medical team in Arabic during his therapy.
Moqdad's family also appreciated the hospital's medical care, Emad said.
"They're the best," Emad said. "Moqdad's very lucky. This is the best hospital in Iraq."
THERAPY CAPS. Medicare patients can spend no more $1,810 a year on speech and physical therapy and $1,810 on occupational therapy each year while recovering from an illness. But there are exceptions to these so-called "therapy caps."
If you’ve had a stroke and you need more therapy, for instance, Medicare has had a process for side-stepping the caps and getting extra services. That was due to expire at the beginning of this month.
The new legislation reinstates the exceptions process for speech, physical, and occupational therapy for another 18 months, making it possible for patients with serious illnesses to get needed help regaining essential functions.
PROTECTING SENIORS FROM MARKETING ABUSES. I wrote earlier this year about new regulations proposed by federal officials for private plans that operate under Medicare. Here’s a link to that post.
The new Medicare legislation requires the Centers for Medicare and Medicaid Services to make good on its promise and come out with new regulations for so-called Medicare Advantage plans this fall.
Among the practices that will be prohibited, according to the legislation: cold calling, door-to-door sales in apartment buildings and senior living facilities, sales pitches in doctors’ offices or at educational events, and cross-selling of non-health care products, according to materials from the chairman’s office of the Senate Finance Committee.