Capitol Hill Day
Today, hundreds of physical therapists, members of the APTA’s Othopaedic section, and members of AAOMPT, are spending the day on Capitol Hill meeting with as many legislators as we can.
In today’s rapidly changing healthcare arena, the timing of this event couldn’t be better. Providing input from the physical therapist’s perspective is important as so many decisions are about to be made. The day has started out well, with some excellent breakfast at the Russell Senate Office Building. Present were the leadership of representative organizations. Left to right: Jay Irrgang (APTA-Orthopaedic section) Scott Ward (APTA) and Bob Rowe (AAOMPT).
WebMD doesn't read clinical guidelines
http://www.webmd.com/back-pain/slideshow-back-pain-myths
Posted via email from Eric’s posterous
Creativity at Bradley U
This was honestly sent to me before last week’s untimely death of everyone’s favorite pitchman.
The follow-up video response is strangely entertaining as well.
Also check out this video [via GrassRoots AAOMPT SSIG blog]
Why Physical Therapy is the Answer for Neck Pain
This is the video of the day! Chad Garvey spends some time talking with the media about interventions for neck pain. What do you think about the close to this news piece? Nice job, Chad!
Back Pain Hotline
I’m not sure this was designed to be just a back pain hotline, but Intermountain Healthcare ran a unique outreach program and put consumers in touch with Physical Therapists via hotline. Anyone with questions could call in and speak to an expert. Very nice, and deserving of this piece of good press.
Jake Magel was featured in the article which discussed the conservative management of back pain:
“If people get proper care up front, they tend to use less health care in the years following,” he said. “They visit physicians less, take fewer medications and miss less days at work.”
By the way, Jake Magel is the lead faculty for my virtual rounds course in the EIM Fellowship program in addition to his role as the director of the Intermountain Orthopedic and Spine Therapy Clinic at Intermountain Medical Center. Go, Jake!
Revolutionizing Prosthetics
Watch CBS Videos Online
(Btw, it’s too bad there’s a 30 sec ad at the front end of this video. Bad CBS!)
Last night’s 60 Minutes program aired a piece highlighting the amazing work being done in the U.S. Department of Defense to revolutionize prosthetics. The segment featured the DEKA Arm, developed by everyone’s favorite Segway inventor, Dean Kamen. He’s had some success making transportation so simple a chimp could use it! So, I was looking forward to seeing what his nimble mind could come up with.
The DEKA Arm
Dean’s DEKA Arm is being developed as part of the DoD’’s DARPA Program, which is a very cool website to go explore. There are seemingly programs for everything futuristic you could imagine! This specific program comes from the Defense Sciences Office, in the Revolutionizing Prosthestics Project. The DEKA Arm allows users to pick up such delicate items as a grape, yet still be strong enough to power a drill. Even the interface with the residual lmb has been re-designed and is presumably superior.
The key point to these new prosthetics is the interface between the highly powerful processors living inside lightweight, high-tech materials and the human’s neural system.The DEKA Arm looks like it could be a big breakthrough in technology that’s previously been out of reach. The wrist alone contains 3 PC’s worth of processing power! I’m proud of the DoD for their efforts on this project.
The most interesting quote from the 60 Minutes program was this:
“I’m not really learning [to use the prosthetic arm] as much as the computer is.”
Wow! I’ve been searching all morning for rehabilitation programs that combine biotechnology and physical therapy degrees. No luck so far.
The Biotechnology PT
I think the Biotechnology Physical Therapist is coming soon to a clinic near you. I’m curious to see how technologies such as this will alter the landscape of traditional rehabilitation. This is a bit more specialized than strapping on a prosthetic device that was designed in 1940, even if the fundamentals of movement are the same. Modern rehabilitative specialists will need to understand and be able to affect sophisticated neural interfaces and computerized devices. Imagine that instead of strengthening a hip muscle, I only need to alter the output on processor #3-C to invoke the gait pattern I desire for the patient!
And people wonder why I spend so much time investigating every new technology I discover. Neural interfaces, stem cells, genetic scaffolds are technologies that are here already. I’m excited to see what the future brings!
Healthcare is Coming Over
Better Straighten Up the House!
Last week, the WSJ Health Blog was abuzz about announcements by a group of high-powered companies entering the home care market. GE, Intel, Google, IBM, Microsoft have all recently entered the home-health monitoring arena. This is serious stuff for telehealth initiatives, and one can only assume that the introduction of corporate backing into an arena that’s been here-to-fore largely neglected will have some significant impact. Check out these links for more information on this subject.
Do you think these companies are serious about this initiative? Check out this quote from Intel President and CEO, Paul Otellini:
“Most of the healthcare discussions today focus on the integration of more technology into traditional healthcare settings. While those investments are necessary and will create a more efficient healthcare system, it is not sufficient to meet the growing needs that are about to impact a system that is already at a saturation point. The GE and Intel partnership will not only help seniors and the chronically ill, but will also take a giant step forward in changing how healthcare is delivered.”
The current health system is in trouble. It may be that a big part of the fix will be by companies who are outside of the traditional health system, who see entrepreneurial opportunities to offer reform. Let’s hope so, because the physician-controlled model that we’ve been operating under doesn’t seem too eager to change.
Telerehabilitation?
So how does this impact physical therapy? There’s been an increasing presence in the body of scientific literature from a rehabilitative perspective, some articles even coining the term, “telerehabilitation.” However, most of these initiatives don’t mention physical therapy, focusing more on medical management of patients. Some state practice acts even have barriers in place that might prohibit physical therapists from performing off-site healthcare delivery. The physical therapy profession needs to be open and ready for these changes, and eager and capable of embracing the technological advances that will be part of a new model of healthcare. We also need to be better connected to these corporate initiatives. We might even need an iPhone app, as Selena Horner pointed out on the EIM blog.
By the way, last week I attended a talk on technical writing at the Refresh Augusta meeting. Part of that talk focused on localization of language, or making your writing appeal to different groups of people. One strategy offered by the speaker was to always use the first definition of a word, and avoid common slang. Well, as part of my research for this post, I’ve discovered a very terrible example of what can happen when these rules are not followed. Check out this image!
Influences on Autonomy
American Physical Therapy Association (APTA) President, Scott Ward, posed an interesting question in his latest blog post. Dr. Ward wondered, based on feedback from a group of stakeholders, if the inclusion of the term “autonomous practice” in the APTA’s Vision 2020 was the right word. Is it non-collaborative? Does it reflect a patient-first approach or a provider-first approach?
Wanted: Wordsmith, No Experience Needed
Well, before we word-smith “autonomous” and label it as bad, it’s probably helpful to be clear about why the concept is part of the vision in the first place. To me, this centers around the “self-governing” aspect of the profession. Too long, have physical therapists been positioned under the direction of other professionals. This doesn’t make much sense to me.
Consumers would be surprised to know that even if I know a better, evidence-based intervention for their condition, I’m legally bound to follow the direction of the physician’s prescription. Is it correct for me to have to follow a prescription written by a doctor for treatment interventions that are ineffective, not evidence-based, and a product of the 3 hours of rehabilitative education that person received in medical school? What about working as an employee of a physician referral source, who profits from every referral he makes to his employee? Is that a good idea? What about having the inability to perform certain techniques based solely on the strengths of oppositional lobbies, regardless of scientific support in our favor? Is that fair?
Autonomous is Patient-First, (sort of…)
Are these situations of limited autonomy good for healthcare costs or patient outcomes? NO! Being autonomous, having the ability to self-govern, is about putting the decision making ability of physical therapists in the hands of physical therapists, not people who don’t know the particulars and science supporting our profession. Is “autonomous” patient-first? Of course not. This is about the internal management of the profession. Do patients benefit from physical therapist autonomy? Of course they do. When I can follow my own treatment protocol for your chronic foot pain, for example, instead of a podiatrist’s order for anti-inflammatory transdermal medication…the patient benefits. When self-referral is eliminated, costs go down. This helps everyone. When physical therapists are allowed to see patients with back pain first, needless imaging, tests and procedures can be avoided, and the risk of surgery may be reduced.
That said, I don’t like the word autonomous practice. It has bad connotations and the potential to provoke needless defensiveness by other parties. What we’re really talking about is the profession’s ability to self-govern. Gaining the rights and privileges associated with being a licensed professional with a doctorate-level education. No one is ever “autonomous” in healthcare…or in today’s flat world, for that matter! And, who can fault someone for wanting the ability to self-govern your own profession?
So Now What?
Revise the autonomous practice statement. Be clear about what we’re talking about. The current statement for autonomy is too broad. It needs only be one sentence:
Vision for Physical Therapist Practice
Physical Therapists will have the ability to self-govern the profession and practice of physical therapy in all clinical settings, including self determined professional judgment within one’s scope of practice, consistent with the profession’s Codes and Standards and in the patient’s/client’s best interest.
That leaves me with a better taste in my mouth, and leaves out a word I have to continually explain to folks.
In my humble opinion…
Augusta AD Rehab as a Model of Care
Augusta, Georgia is unique for a number of reasons. Perhaps you notice the heaping piles of azaleas, or that golf course, or the downtown with much character and few people. Perhaps you notice that the city is “well laid out with wide and spacious streets”, as George Washington once did. Perhaps you notice the paper factory, and it’s none-too-pleasing aroma that drifts with the wind. You might, if you’re in healthcare, notice that there are several major hospital systems in a relatively small town. If you’re in healthcare or the military, what you should notice, is the VA Active Duty Rehabilitation Center.
Augusta’s Uptown VA Medical Center is home to the nation’s only Active Duty Rehabilitation Unit located within a VA facility. It’s integrated. It’s also closely associated with Dwight D. Eisenhower Army Medical Center at Fort Gordon, the Army’s home for the Southeast Regional Medical Command. Many injured soldiers come to visit Augusta, and for good reason. The cooperation has garnered the interest of Congress as a model for care. Make sure to visit Laurie Ott and the CSRA Wounded Warrior Care Project, who are major advocates of this unit.
The national media also has taken note. This week the unit was featured on NBC’s Nightly News with Brian Williams. Also featured was MSgt. Thomas Morrissey, a wounded veteran, and former patient of mine. He is an amazing man who survived a harrowing ambush in Afghanistan, and I’m happy to share his story here. Tom was kind enough to acknowledge the benefit of the OT and PT components of his recovery. The unit is cool, Tom is cool, and I’m proud to see it highlighted on a national platform!
Visit msnbc.com for Breaking News, World News, and News about the Economy
Be An Advocate
Occasionally, we get requests for guest posts from various individuals. Some of them are good. None of them have yet been published…until now! Look for more guest contributor posts as we transition and grow from NPA Think Tank to PT Think Tank! Thanks, ERIC
Be an Advocate!
In conjunction with the Special Olympics campaign to eliminate the use of the “r-word”, it only seemed fitting that Physical Therapists re-evaluate how our professional and personal speech affects others. Non-offensive language is an issue that is drilled into our heads throughout PT school, and is a skill that must be learned through direct application. When dealing with patients of all cultural, religious, and ethnic backgrounds, I’m sure that everyone can recall an instance where they have “put their foot in their mouth”. As most of you have probably heard about, even one of the most prominent figures of our nation is not excluded from this category.
It is especially important for Physical Therapists to monitor our language both in our professional and personal lives. In our personal lives, if we are not sensitive to language that will offend our clients, then what kind of an example of health care professionals are we? As a student, I especially know how hard it is to eliminate phrases from that which seemed “cool” in high school or college and fully grasp their offensive nature. Also, what kind of advocate for those with disabilities am I if I find humor in others jokes at their expense? I know that my personal struggle is one that I will work on daily and will take time to master. I encourage all health care providers to be especially cognizant of the nature of their personal speech and those around them because if we are not willing to stand up for the dignity of our clients then who will? Be an advocate!
Contributor: Diving Bell
Diving Bell is a student physical therapist who was inspired by author Jean-Dominique Bauby (Diving Bell & the Butterfly) to make a creative outlet for her thoughts. Since she is in the process of formally being accepted in the profession she thought it was best to let her opinions be free like a butterfly while hiding her identity in a diving bell. Her interests include geriatrics and neurological disabilities. If she has the opportunity to get her nose out of her textbooks, then she enjoys cooking, tennis, and traveling as far away as student loans allow.
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