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Use twitter to network before your next conference

tweetbeach

 

Earlier this year I had a very positive experience attending my first physical therapy conference – CSM 2011, in New Orleans, LA.

Twitter was instrumental in the success of my experience. I thought I would take a moment to show you what I did leading up to the conference. Using twitter, I was able to break-the-ice with several attendees in advance so that when I got to the event I had several conversations waiting to happen.

Use this post as a checklist to prepare for your next PT conference. For me this will be the 2011 AAOMPT Annual Conference, Oct 26-31 in Anaheim, CA.

1. Create your twitter account

  • Choose your name carefully. You want to avoiding changing your name down the road as this will force your followers to find you again once the change is made
  • Choose a name that represents the content of your tweets – JSmithDPT for professional content; JoeSmith22 for personal; XFactorPT for clinic content, etc…
  • Really consider including PT or DPT in your twitter name, especially if you’ll be tweeting about #physicaltherapy
  • Enhance your profile. Add a picture, write a brief biosketch (you are limited to 160 characters), add your location, paste in your homepage URL (university profile, facebook page, a zapd page, etc…)

2. Follow other people on twitter by mining a twitter list

  • Twitter has a way you can group twitter profiles with a common interest called lists
  • If you find someone has created a list of conference attendees, you can view the list and find some interesting people you can start following and maybe even reach out to
  • Here’s the list I’m putting together for 2011 AAOMPT Annual Conference
  • This is a good way to find people on twitter because someone else has already done all the work for you
  • You might also want to check out my list of physical therapy related twitter accounts and ask me to add you if I haven’t already

3. Create your own twitter list

  • Once you have seen the usefulness of a twitter list, I suggest you start your own for the conference
  • Start looking for people you know or would like to get to know by using the “Who to follow” feature
  • Also search for an official conference account and add that to your list – AAOMPT actually has one
  • If you find the conference organizer has an account, your can also mine their followers, here are the >1,000 people that follow @AAOMPT, do any of them look familiar to you?

4. Search twitter

  • Twitter is a powerful way to find information instantaneously about topics you’re interested in, so start searching for content related to your conference, “AAOMPT” for example
  • For large conferences, attendees will include a hash-tag to specify that their tweet is related to the conference, such as #AAOMPT11 or #CSM2012
  • As you find people tweeting about the conference, add them to your list

5. Broadcast your plans

6. Even if you’re not going

  • Watch the hash-tag (#AAOMPT11) to see what people are sharing
  • Ask questions, say hello
  • Help promote the event by tweeting: “hearing lots of good chatter from #AAOMPT11 this week!”

7. Go mobile!

  • Everything mentioned above can be done in a browser on a laptop or desktop computer, however, I found that I was much more likely to interact with twitter from my smart phone
  • In fact, I barely looked at twitter for the first 6 months I had my account. It wasn’t until after I got setup on my iPhone 3GS that I really got immersed
  • The screenshots in the gallery below were all taken from the iPhone app Tweetbot ($2.99 in the app store), but I suggest trying the free Twitter for iPhone app first (those on other smart phone platforms can chime in with links to your favorite apps in the comments below)
  • Plancast also has a free mobile app
  • It is also easier to share photos from your smart phone, assuming most smart phones have a camera these days
  • One free photo sharing app that is on fire right now is instagram, which also connects to your twitter account

Gallery of screen shots from my iPhone shows some of the features mentioned above:

In closing…

I hope this was helpful and easy to digest. As usual, we want your feedback on this post in the comments – what did you like, what was explained poorly, what is your story with twitter at PT conferences, did I leave anything out, etc…

If you’d like to read more about social networking in physical therapy, I suggest reading this recent article on the Australian Physiotherapy Association website – “Why social media matters for physiotherapists”

Mike Pascoe – @mpascoe

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Slide Design in Physical Therapy: A Case Study

A recent survey shows that most of us view at least 25 slide presentations per year. This is most certainly true for physical therapists, whether it is an in-service at the clinic or sessions at annual conferences.

Of the dozens of presentations, how many are memorable? What makes a presentation memorable? Aside from a story that resonates with your audience, engaging slide design is they key to sharing your message.

In this post I will illustrate what I mean by “engaging slide design” using a recent experience in which I was entrusted with a slide deck from a colleague who asked me to “jazz it up a little”. You see, I let this colleague in on my little secret – I am a presentation snob! Let’s get started…

Title Slide

Before

I did not like all of the logos on this slide. The “four corners” look really takes your eye away from the purpose of having this slide: to convey the TITLE of your talk and your name. Also presents too many font types and gives an eclectic feel to the slide. If you have a good introduction, which is not always the case, your audience will know where you’re from and who you represent. Presumably they also know that they are sitting in a chair at AAOMPT. I would also argue that only Johnny needs to be listed on the slide and to remove “Presenter:”. Mintken and Struessel can be moved to an acknowledgement slide. A black slide background is not a good choice, especially if your audience is going to attempt printing them out later.

After

One logo, one presenter name, no background color. Credentials are impressive but can take up more characters than your name and so I prefer to leave them off. I also convinced Dr. Mintken to finally join Twitter. You can learn more about Twitter use in physical therapy from this recorded lecture. Basically, by providing his Twitter user name “@PMintkenDPT” he is giving his audience a way to share content from his talk with others not in the room and providing a venue for discussions about his work long after the talk is over. It is 2011 and didn’t you know Twitter is the new Facebook?

Background Slides

Before

Time to build up your story by explaining why things are the way they are today, a.k.a. the background slide. This slide is typical of all slides in the “Before” deck, a title with bullet points, not one single image, redundant logos in the top corners, and a stock theme from PowerPoint.

After

In the first 60 seconds of your talk your audience is sizing you up and determining if they want to pay attention, you better grab them early! I suggest a full bleed, high-quality photo of a joint manipulation. The audience knows what they’re in for and they also have a better emotional response to a photo then a bunch of text. I confess that I did use bullet points here, but this is one of the only slides I used them. I felt that it was appropriate here because I am listing several items in the same class, terms for spinal manipulation.

Before

After #1

I really wanted an image to demonstrate how much research on the effectiveness of joint manipulation is out there – a stack of papers.

After #2

I used a photo of a classroom for the question – Are students receiving the education?

Before

Every talk with a research component needs to discuss what has been published previously. Here we see what is typical, a bulleted summary of the results.

After #1

It is also very common to put a screenshot of the title and author on your slide. I’ve been playing with a different way of showing the reference to the audience by capturing a screenshot of the top and sides of the paper and putting it into the slide with a shadow dropped behind it. The effect is that there is a physical paper out in front of you. Then I took a page from Garr Reynolds and built in the “56 %” in huge characters on top of the image of the article.

After #2

I also transformed the bulleted list of reasons why joint manipulation was not taught into a table.

Before

Here is another example of a slide that is covering the results of a previous study.

After

What I did here was magnify the bottom line of the study – 54% of clinical instructors reported not teaching joint manipulation. Again in a huge font, with an image of a PT clinic that reflects the fact that this lack of instruction on joint manipulation is happening in the clinic (where everyone in the audience also works).

Before

The presenter wanted to draw attention to the fact that some time had passed between when these studies above were published and when this talk was given. And did so with a text box.

After

I wanted to again use imagery to get a gut reaction for the audience. What happened in 2005 that really shows a large amount of time has passed? A pop culture image would surely connect with the audience. This is were Napoleon Dynamite can in to save the day. The presenter wanted to demonstrate that 5/6 years is a long time and I would argue that it feels like ages since since classic lines such as, “I told you! I spent the summer with my uncle in Alaska hunting wolverines!”

Methods

Before

People want to know how you did the research your presenting – the Methods. Here I saw another opportunity to transform bullet points into graphics.

After

The large blue circle represents the Program Directors and the small ones are the students that received the survey distributed from the Directors.

Results

Before

The data could be conveyed more effectively by using graphics over bullet points. But how?

After #1


Because the data were based on geography, a map immediately came to mind. You tell your audience that 38 states participated in your survey and they are probably wondering “was my state one of them?” I downloaded a vector graphic of the USA from wikipedia and filled in the relavanet states in Adobe Illustrator.

After #2

What about percentages? A pie chart works well to quickly show proportions. Put yourself in your audience’s place: while you are talking do you really want your audience to need to read all of your bullets? The words coming out of your mouth are in direct competition with the text on your slide. Make it easier for your audience to digest!

Before

For the first bullet point, a sub bullet point is used to convey MUCH IMPROVEMENT.

After

Made the 95% larger, in green to suggest this is a good thing, and put a thumbs up graphic in place of CAPITALIZED TEXT

Before

Here was an opportunity to tell the audience WHY students were not performing the joint manipulations they were trained to do.

After


Great opportunity to add some video into the talk. It is one thing for Dr. Mintken to stand up front and read quotes from students. It is a much better thing for him to show video testimonials from the actual students themselves.

To conclude…

So, all of these changes were made to this slide deck. How did it go? The presenter (Dr. Mintken) was pleased with his delivery of the talk, which is a good thing. For the remainder of the four day conference, every time someone approached Dr. Mintken the first words our of their mouth were “that was a really great talk!”

Here are some great books that have influenced my approach to slide design – Presentation Zen by Garr Reynolds – slideology by Nancy Duarte

I would love to hear your thoughts on how the slides changed in the comments section below.

– Mike

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Manage the Evidence Like a Pro

The problem. You are trying to stay current with the literature because that’s a great way to ensure quality treatment of your patients OR your a student in a physical therapy school that has a strong evidence based practice curriculum AND you end up having a hard drive littered with PDFs, like this:

Image by mekentosj.com

The solution. Papers2 by software developer mekentosj. This app makes it dead simple to organize your PDFs. Think of it as iTunes for PDFs, where instead of double clicking a track to listen, you double click to open the PDF in your favorite PDF viewer. You can search for articles quickly, email them to a colleague, even takes notes, all within the app. There are so many neat features I just had to put together a brief screencast demo, which you can view below:

Managing Physical Therapy Articles Like a Pro from Mike Pascoe on Vimeo.

In this 5 minute screencast, I show off some of the key features of Papers2. This video is directed toward those with a physical therapy background.

Papers2 can be downloaded here:
http://www.mekentosj.com

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From Bench to Bedside: Spinal Cord Physiology -> Clinical Interventions

Having just defended a dissertation in the field of neuroscience, this session was my guilty pleasure. I felt right at home hearing about the modulation of intrinsic motor neuron properties. But, the question I’ve had since graduate school was the focus of this session – how does the lab work in cat/rat/monkey motor neurons translate to human patients?

This session was presented by four brilliant researchers interested in brainstem modulation of the motor system. The patient population discussed was spinal cord injury, a condition in which the connection between the brainstem and the motor neurons are disrupted. Each researcher discussed the implications for force generation, spasticity, and locomotion. I’ll summarize their reports below.

Allison Hyngstrom, PT, PhD

First up, Dr. Hyngstrom highlighted a few key researchers that have influenced treatment of patients:

  • Sherrington – contributed the concept of the spinal motor neuron as the final common pathway – contributed to the understanding of locomotion by examining “air stepping” elicited by stretching hip muscles of spinalized
  • Eccles – introduced the idea that inhibition could sculpt the output of motor neurons, particularly the reciprocal inhibition pathway
  • Brown/Grillner/Lundberg – descending input, as well as specific neurotransmitters, could activate spinal networks without sensory inputs

The Dr. Hyngstrom progressed to ‘Motor Neurons 101’, including these key points:

  • MNs possess huge denritic trees to receive inputs from several sources (higher brain, local interneurons, afferent)
  • Two categories of receptors are expressed on the MN membrane – ionotropic and metabotropic
  • The activation of metabotropic receptors by monoamines create persistent inward currents (PICs)
  • PICs can amplify the output of the MN
  • In acute spinal cord injury there is a loss of seratonin in the spinal cord that decreases the excitability of spinal MNs

Moving to the spinal cord injured cat, researchers have found that by adding monoamines to the spinal cord the cat could walk again [link to article in PubMed]

Next Dr. Hyngstrom described some of her own work on MNs. In her dissertation she was interested in the factors that regulate PICs. One way she did this was by altering the amount of reciprocal inhibition.

In summary

  • Monoamines (like seratonin) increase the gain of the MN > which implies PTs could reduce effort for a given movement
  • Monoamines facilitate automatic movements
  • Dysregulation of monoamines likely contributes to alterations in cellular excitability in chronic spinal cord injury
  • Altered cellular excitability not necessarily a bad thing > consider other ideas
  • Targeted medications could be used to harness spinal network excitability

Chris Thompson, PT, DPT

Next up Dr. Thompson presented his talk, titled – “Activation of spinal networks in patients with spinal cord injury to improve volitional movements”.

He began with a bold statement – “indiviuals with motor incomplete SCI do not fatigue”. How could this be? It seems that in a repeated stimulation protocol, patients with acute SCI  do not exhibit a reduction in force generating capacity, whereas patients with chronic SCI and healthy controls do exhibit a reduction in the same protocol.

I also seems that people with incomplete SCI have a reserve of volitional force generation – 115% of maximal force can be achieved across the first 4-5 maximal contractions.

In acute spinal cord injury there is a period of spinal shock and spinal reflex responses are suppressed. But after time (chronic) the responses become super sensitive to seratonin.

Dr. Thompson want to know why and he looks to the motor neuron persistent inward current as a mechanism for the following three reasons:

  1. There is an increased EMG amplitude across contractions, through increased recruitment and rate modulation of motor units
  2. Prolonged torque in response to electricla stimulation using top hat stim protocol, which was abolished when a nerve block was in place
  3. There are alterations in motor unit activity due to pharmacological agents (SSRI), which block the reuptake of seratonin

Dr. Thompson concluded by review attempts at translation of the findings in animal models to humans patients. The idea best examined by his lab group basically involves applying a ‘top-hat’ stimulation protocol made popular in cat experiments to human patients. Something very interesting happens when comparing humans and cats. The amount of force and the strength of the persistent inward current are larger when muscles are at shorter lengths IN HUMANS. However, the amount of force and the strength of the PIC are larger when muscles are at longer lengths IN CATS. Explaining this difference is the next task on Dr. Thompson’s plate.

Arun Jayaraman, PT, PhD

Alright, that was a lot of motor neuron physiology and I appreciate you hanging in there so far. So, how can the above information be put into clinical practice? This is what Arun enthusiastically addressed – developing the rehabilitation protocol.

His main question was how can we harness the reserve in force generating capacity seen in patients with incomplete spinal cord injury?

This was tested in 10 patients with chronic motor incomplete SCI in a cross-over design with a two month washout period between the testing conditions. The phenomenon examined was that the harder you work, the more force enhancement you observe in the SCI population. As the time between maximal contractions gets longer, the enhancement in force production becomes lower (15 s is best). This phenomenon is present both concentric and isokinetic contraction modes.

Subjects trained with 65-80% of their one repetition maximum until they plateaued in function. Arun found that just isometric trained alone enhanced berg balance scores and walking distances in the 6-min and timed up and go tasks. Noxious stimulation at an intensity of 50 mA on the stomach skin was not so effective.

A follow up direction Arun is investigating is the use of intermittent hypoxia. It has been shown in rats that electromyography and force measurement improved in a ladder climbing task following a hypoxic state. How will patients with chronic SCI respond to hypoxic conditions during locomotor training? Arun is hopeful that benefits are realized in his patients.

In summary

  • Volitional drive can be enhance by working very hard
  • Does improve walking and balance
  • Can be done at home
  • What are long term effects?
  • Can this be complimented with intermittent hypoxia?

George Hornby, PT, PhD

The topic addressed by Dr. Hornby at the end of the session was the combination of physical therapy and pharmacological interventions.

It seems that providing glutamate can generate locomotion patterns and we also know that monoamines can excite central pattern generators (CPGs).

There is an increased Babinski Sign in SCI due to effects of monamines.

Seratonin (5HT) is effective in initiating locomotion in rats with SCI.

It seems that humans respond better to 5HT than norepinephrine (NE) when administered.

Lastly, Dr. Hornby has seen that strength, not spasticity, is related to locomotion function.

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CSM 2011 – The Pauline Cerasoli Lecture

Photo taken from APTA website

This lecture honors one of physical therapy’s best and brightest – Pauline ‘Polly’ Cerasoli (Feb 25, 1939 – Sept 11, 2010).

The Cerasoli lecture began with a tribute to Polly by a long-time friend and colleague Bette Ann Harris in which we learned more about the places she spent time:
  • Northeastern University (1967-1981)
  • Massachusettes General Hospital (1981-1987), doctorate in education
  • University of Colorado Denver (1988-1996), director of physical therapy program
We also learned of the major contributions made by Polly to the physical therapy profession:
  • Started the Boston Education Consortium in the 1970s
  • Published a landmark paper titled ‘Research experience in an undergraduate physical therapy program’ – [pubmed link]
  • First appointed clinical specialist at Massachusetts General Hospital in 1981
  • Mentored a blind physical therapist in 1992
Next, APTA President Scott Ward asked for a moment of silence, as it was the first Cerasoli lecture since she passed away in Sept of 2010. Dr. Ward announced that the 2012 Cerasoli Lecture will be given by Christine Baker from UT Galveston.
Dr. Ward then introduced us to the 14th Cerasoli Lecturer – Dr. James Gordon. Dr. Gordon is associate dean and chair in the division of biokinesiology and physical therapy at USC.
Dr. Gordon’s talk was titled ‘Excellence in Academic Physical Therapy – What Is It and How Do We Get There?’ I’ll try my best to summarize the talk below.
We (physical therapists) must accept the challenge that lays before us – pursue excellence.
On January 15, 1921, that 30 PT aides formed the APTA at the Keene’s Chop House in NYC. Now, a century later, Vision 2020 is lies ahead. It is the challenge.
What is needed to meet this goal is a strong academic foundation. It is in the academic setting that the physical therapy profession does its thinking.
Dr. Gordon defined a strong academic foundation as having three pillars – Education, Research, and Clinical Practice. All three pillars need to be in place. A classic three legged stool analogy, the foundation will topple with the absence of just one of the three pillars.
Dr. Gordon stated that excellence today is the norm for tomorrow. Excellence is the engine of the train, accredidation is the caboose (crowd chuckles).
So what is the agenda to achieve excellence? It is fulfilling all three pillars of the academic foundation.

1. Education

The most urgent task is to standardize curricular competencies. There is “unwarranted variation in physical therapy practice”. For example, there is large variation in the prerequisites, and program length. An emphasis on preparing generalists is the problem. Accreditation offers a list but no priority. Curricular competency needs to be standardized. Students need to have the ability to treat a patient with a defined condition under a defined set of characteristics (settings, acuity, age).

2. Research

Not much to say here. All programs should be involved and the big should help the small.

3. Clinical Practice

All programs across the country need to be involved. Currently, only 22% of programs have any form of program sponsored practice. Practice is important because it enhances teaching and provides a venue for research.
Lastly, Dr. Gordon addressed the infrastructure requirements to achieve program growth. Of the 213 accredited physical therapy programs in 200 institutions, 206 offer a DPT degree. Currently, 75% of faculty are PhD-level prepared. Many of these programs are very small. 50% are in Universities with research institutions and 35% of physical therapy programs are in medical centers. The average class size is 42.5, and 20% of programs have class sizes less than 20.
Why emphasize program growth? Dr. Gordon argued that this will bring a greater breadth of knowledge, support more research, and meet the need for more physical therapy students.
Dr. Gordon then wrapped up with his two take-home points:
  • A strong academic foundation is essential for achieving excellence in physical therapy
  • A strong academic foundation is dependent on three pillars (Education, Research, Clinical Practice), and you need them all
Photo taken from APTA website
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Getting Started in Educational Research

Educational research is critical to ensure physical therapy students are receiving the best training as possible. However, educational research needs to live up to high standards. Fortunately, this session provided several good tips on how develop and implement good educational research questions.

This presentation took on a panel format, with speakers from left to right:

As much educational research is present annually at CSM, the panel addressed many common problems of those that submit abstracts for presentation at the conference. The biggest problems include:

  • Not knowing the literature
  • Not performing appropriate statistics
  • Not using appropriate measures
  • Overall insufficient planning and thought (e.g. sufficient controls for the test groups)

In terms of developing a good education research question, the presenters offered the following pointers:

  • Where to begin? What are some good sources to inspire me to develop a good question?
  • Who are the primary drivers of PT educational research?
    • Clinical scholars
    • Academic clinical faculty
    • Traditional academics
  • What questions have been asked in the last 25 years?
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State-of-the-Art in Postural Control: Pelvic Floor

Dr. Paul Hodges undertook the difficult task of explaining the intricate connection between the respiratory / pelvic floor / and abdominal muscles. Through this article, you will also get an understanding of the symptoms and treatment of pelvic congestion syndrome. I have the difficult task of summarizing what he presented! Dr. Hodges has a presentation style I really enjoyed – pose a question first and then proceed to address that question.

Question 1 – Do the muscles of respiration and continence contribute to postural control of the trunk?

Yes. Many of the muscles of the trunk (diaphragm, scalenes, erector spinae, intercostals, pelvic floor muscles) and pelvic floor (anal, periurethral, vaginal) are active during breathing and they are modulated in concert with breathing. Dr. Hodges provided evidence of this by presenting recordings from many systematic studies which measured the all of the above muscles in tasks such as respiration, modifying posture, and when a mass was unexpectedly dropped into a box held by the participate.

Question 2 – Can postural control, respiration, and continence be coordinated?

It seems that concurrent modulation of all these muscles is normal and that tonic and phasic activity can be modulated concurrently by the nervous system. In chronic respiratory disease, posture is compromised with greater disturbances in the ability to balance in the medial/lateral direction (trunk and hip stability). One obvious example of coordination is when someone is sprinting or lifting something heavy –  you don’t breath for a short time (Dr. Hodges had us stand on our toes, reach up as high as we could, and notice how we held our breath).

In low back pain, postural function is disturbed for sure. But why? It seems that there is reduced activity of the transversus abdominis muscles, which leads to delayed activation, less tonic activity, muscle atrophy, and cortical reorganization.

Question 3. What are the conseqeunces of poor coordination of postural muscles?

The immediate implication is that breathing disorders, back pain, incontinence are linked together. Sure enough, Dr. Hodges presented results from an epidemiological study showing that those who had a breathing disorders were more likely to develop low back pain!

Question 4. What are the implications for rehabilitation?

For low back pain:

  • Considerations from continence – activation of pelvic floor muscle to facililatet abdominal mucsle activity
  • Considerations from breathing – ppl with back pain with breath in a more vertical manner (upper chest shallow breathing)
  • access breathing patterns thru palpation, observation, US imaging – train breathing patterns
  • goals – reduce activity, changin breathing apptern, train TVA, bretah mmore efficiently

For pelvic floor disorders:

  • Consideration from lumbopelvic control – tva activiaiton may assist with PFM – supericial muscles maybe over active, change posture
  • Considerations from breathing – overactive supericial abs incre IAP and can strain PFMs

For breathing disorders:

  • Consideration from lumbopelvic – breathing pattern may be affected by lbp
  • Consideration from incontinence – pelvic floor muscle function may be changed, consider PFM training

Although Dr. Hodges used the specific example of low back pain rehabilitation, the principles apply to other areas

  • Training the transversus abdomonis successfully changed its recruitment by as evidenced by a shift in the timing of activation closer to normal controls with specific training
  • Can these changes in timing be maintained? – yes
  • What do you do? -Situps without conscience attention to TVA activation
  • The brain of someone with LBP is different than normal control – brain mapping with TMS shows a shift in the locus of TVA cortical region – reorganization
  • Specific training can make the brain look like a control
  • Does motor training make a difference? – yes but the treatment needs to be targeted and indiviualized – the more severe the impairments in TVA activation the better the change with training
Conclusions

Patients will present with a range of issues, but it is impossible to separate the systems. You must look at your patients as a whole and develop a strategy that addresses all of their problems.

Bottom line – YOU MUST BE A MULTISYSTEM THERAPIST

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Multiple Sclerosis: Improving Physical Therapy Outcomes by Minimizing Neurogenic Fatigue and Maximizing Neuroplasticity

My first educational session at my first physical therapy conference was on what seems like a very challenging condition to manage in the clinic – Multiple Sclerosis.

Hebert Karpatkin began his talk by stating his main goal – to “change the way you treat MS”.

Why are these patients difficult to treat? Here are Karpatkin’s thoughts:

  • Unique neurologic diagnosis – can have effects at multiple regions of the CNS, therefore many neuro symptoms possible
  • Unique presentation – no two patients look alike
  • Therapeutic Nihilism – why even bother, what can I do? (extreme pessimism)
  • Disease of unknowns – progression, severity, and recovery are all so variable!

Dr. Karpatkin then went on to suggest four main areas to consider for successful management of your patients with MS.

1. Fatigue

As stated by the injury charges law firm serving in Canada, this is the most commonly reported symptom of patients with MS (74-89% of patients). The origin of fatigue is separated into two categories:

  • Primary fatigue – due to disease itself – either as motor fatigue specific OR lassitude genreal
  • Secondary fatigue – body’s response to the disease – arises from disuse, sedentary lifestyle, pain, movement compensation, infection, depression, sleep disorder

PT can help by intervening with four of the  secondary fatigue sources – disuse, sedentary lifestyle, pain, movement compensation = GET THEM MOVING!!! For the best stress-relief centers, outpatient rehab Huntsville AL can be checked out!

2. Thermoregulation

Another commonly reported symptom is thermosensitivity. Simply meaning that symptoms become more severe with higher temperatures. This is a fundamental problem as it limits the amount of exercise patients can perform.

How can therapists can intervene?

  • Cooling garments applied before therapy
  • Simply turning on the A/C in your clinic.

3. Intermittent Training

A patient with MS once said:

“Trying to get better makes me worse”

This quote really hit home because it highlights the main problem: the exercise itself is making me fatigued, how do I get better!?!?!

You need your patients to reach a critical dosage of exercise to improve, but how? Intermittent training:

  • Develop a “feel” for when to take breaks
  • Provide rest at first signs of movement difficulty
  • Vital signs (blood pressure / heart rate) are not very telling

Dr. Karpatkin the provided preliminary data that demonstrated that in four patients their 6 minute walk time performance was better with an intermittent protocol (1158) as opposed to a continual exercise protocol (966). To get a better reading of one’s status when it comes to health goals, an app like the tdee calculator comes to mind.

It was also suggested that PTs could apply this protocol to gait, strength, balance, functional activities as well.

4. Secondary Deficits

Posture and stretching

Posture can be poor in patients with MS. One of Dr. K’s patients was given PT 1-2 x/week +home exercise program and this significantly improved his posture and gait. Why was this not addressed with previous therapists? It was suggested that maybe those other PTs neglected posture because of a bias towards his condition.

Foot drop is a common presentation in gait with MS. Dr. K suggested plantarflexor stretching. This ca

n be done during sleep using a night splint.

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Best of Tech 2010…PT Edition

Hello.

If you read as many blogs as I do (see Google Reader later in this post) you probably noticed many of them put together an end of the year review of what tools made a big impact throughout the year. I thought it would be a good exercise for physical therapists to see what devices/services exist out there and to consider the benefits of integrating them into your workflow. Maybe they can help you in 2011?

Let’s get started.

1. iPad

iPad was unveiled by Steve Jobs on January 27, 2010. Since then, it has become the most popular tablet device on the market and hundreds of applications are developed every month for use on the device, many that can be useful in a physical therapy clinic. In place of discussing iPad in the PT clinic in this post, I refer you to a post on this very blog, from Dec 20, 2010.

It will be interesting to see what happens with the iPad with the much anticipated release of the 2nd generation, rumored to occur Feb/Mar of 2011. Perhaps we’ll even see some sweet demos a “technopalooza” at the Combined Sections Meeting this month week.

2. The “Cloud”

I’m not talking about cumulonimbus here. I’m referring to the storage of information on a remote server, thereby making it accessible across many devices and to many users. It seems that the days of storing data on hard drives within your device are numbered – AWESOME COMMON CRAFT VIDEO HERE. Some cloud-based services that really gained traction in 2010 include Dropbox, Springpad, Google Docs, and Google Reader. Mike Reinold has an excellent post over on his blog about the applicability of these services in a professional setting.

Dropbox came in handy this past month at Colorado Manipalooza (Jan 22), when the instructor Paul Mintken shared with us all of the videos demonstrating the manipultion techniques that were covered. Although I cannot perform these techniques myself, I can imagine a clinician pulling out their smart phone (they all have one right?) launching the dropbox app, and reviewing a technique prior to meeting with a patient.

An area ripe for the enhancements of cloud-based service is the management of Electronic Medical Records (EMR). Bronwyn and Tejal have covered this in detail in a post on My Physcial Therapy Space.

So, you think you are already “in the cloud”? Take the nifty quiz put together by who else, Google.

3. Google

I say it all the time, everything Google touches turns to gold. My professional and personal endeavors have been made much easier by leveraging all the tools Google has to offer. Here’s a short list of reasons why you need to get a Google account, right now:

  • Gmail – have a pesky email quota on your work/school account? Forward your email to Gmail, archive all your messages and never worry about that quota 95% warning again
  • Google Docs – working on an in-service presentation with co-workers? Collaborate on a shared document to combine your efforts.
  • Google Reader – staying current with PT research. I get so many questions about Google Reader that I actually put together a screencast to show off how effective this tool can be. I consistently find out about the best research either weeks ahead of my peers do or I get notified on articles published on topics in Journals they might not have on their radar screen. Have a look at the screencast here:

  • Gcal – a really handy way to edit your schedule on a variety of computers and from your smart phone.

4. Video

If a picture is worth a thousand words, than a video is worth…..more. It’s getting easier to produce good quality videos with portable HD camcorders apps like iMovie and it’s gotten way easier to share those videos on the web with platforms like YouTube and vimeo. There have been so many good examples of the use of video in physical therapy in 2010.

For the 3rd year, Evidence in Motion put on their Elevator Pitch Contest. This contest required entrants to convey the selected message in a 30 second video. Maybe if you’re on the faculty of a PT Program you could encourage your students to participate in 2011. After all, the more competition, the better the videos will become. You can view the Second, and Third Place videos here. First place video here:

Although not a new technology, we’ve seen the embedding of lecture video become more common place in PT. This makes the presenters message reach more ears than just those in the lecture hall. Like this popular lecture from Dr. Timothy Flynn.

Lastly, to lighten to mood, we saw a series of videos from the students at Pacific University taking popular songs and giving them a PT twist:

5. Social Media

I’m not that compelled to review all the hundreds of social networks out there, those posts are a dime a dozen. And a lot of the biggest networks have been around prior to 2010. What I would like to emphasize is how these tools can be used to network, using the upcoming Combined Sections Meeting as an example:

  • Twitter – this tool is all about what is happening here and now. Check out the hashtag #CSM2011 to see what people are saying about the meeting. I was able to “participate” in conversations happening at #CSM2010 even though I could not be there in person. Also keep track of people attending #CSM2011 by following this curated list of twitter accounts attending the meeting (let me know if you want to be added to the list).
  • Plancast – another way to share your plans to attend certain events, like the meeting as a whole, or even any specific events at the meeting.
  • LinkedIn – meet someone neat at #CSM2011? Connect with them after the meeting using LinkedIn.

I you were expecting something to be on this list and it wasn’t there, please let me know in the comments below (that’s a big part of social media).