Quadriplegia while seated at the office?

ImtThe Atlanta Journal-Constitution highlights an interesting case of quadriplegia and a solid article on physical therapy.  I think the article is referencing Intensive Movement Therapy (IMT), although it is difficult to read through the ‘every-man’ translation of what was actually being done. 

I have one thought on IMT, regardless of whether this article is about that type of intervention or not.  The above picture is reflective of most IMT treatments I’ve seen, with the physical therapist repetitively facilitating a gait pattern for long periods of time.  My thought, is that the posture and disregard for body mechanics I often see is unfortunate for those therapists performing the chore.  My bum knee would never tolerate providing that treatment!

ERIC

Debt Relief

Physical Therapists:  Is there some debt relief in your future?  The Physical Therapist Student Loan Repayment Eligibility Act (S 2485),
introduced Friday, Dec 14, includes PTs in the National Health Service
Corps Loan Repayment Program.

"As a result of the extensive education and clinical training required
to become a physical therapist, students often begin their careers with
significant levels of debt," said American Physical Therapy Association
(APTA) President R Scott Ward, PT, PhD.

ERIC

Wikipedia and PT

Wikipedia’s benefit lies in the collaborative nature of the knowledge within it.  Check out the Wikipedia pages for Physical Therapy and Orthopaedic Manual Physical Therapy

In general, I find the Wikipedia pages on physical therapy to be poorly written and not very fluid or informative.  So here is a project for the holidays:  Sign up for a Wikipedia account and edit pages until your heart is content.
The editing syntax is very simple and the help feature is solid.  This
is a simple, positive step we can take to solidify the branding of our
profession.

Still with a lot of energy?  Create a Squidoo Lens.  Here’s an example of a good one.

ERIC

Gender-Specific Manipulations?

A series of articles highlighting some anthropology research which explains why women don’t tip over when pregnant.  Their study suggests that women have a slightly different wedge shape in their lumbar vertebrae, with a lordotic curve extending over 3 segments, not the two segments in males.  So, I wonder if we should follow the lead of knee-replacement manufacturers and design a gender-specific manipulation for the female specific vertebrae?  Perhaps, if manipulation was very specific

ERIC

“Tot ziens en bedankt” (Farewell and thank you)

Jmmt_cover
The latest edition of JMMT is up and marks the final issue that Dr. Peter Huijbregts will serve as Editor-in-Chief.  As always, JMMT gets my nod for having full-text access to non-subscribers and an RSS feed for those fans of aggregation software. 

The open-access material for this issue includes a case report by Borgerding et al describing the use of the patellar-pubic percussion test (http://jmmtonline.com/documents/v15n4/BorgerdingV15N4E.pdf) and a research paper by Tucker et al on the reliability and measurement error of a modified slump test (http://jmmtonline.com/documents/v15n4/TuckerV15N4E.pdf). Other free online content accessible at http://jmmtonline.com/current/ includes the editorial, book and multimedia reviews, a thesis review, letters to the editor, an obituary for Dr. Joe Keating Jr., and an author and subject index for volume 15.

Peter_huijbregts
I recommend Peter’s editorial, although it surely does not top the ‘Chiropractic Legal Challenges’ manifesto.  He discusses a model of OMPT research, and includes a brief statement against "evidence-driven totalitarianism" in clinics as it pertains to utilization of research findings.  I will miss eagerly anticipating the next editorial, and wish Peter all the best in his next adventure.  "Tot ziens en bedankt."  Likewise, I’m looking forward to the stewardship of new Editor-in-Chief, Dr. Chad Cook.  Good Luck!

ERIC

Ted Corbitt Runs Into Another World

Corbitt1

"The father of long distance running" and physical therapist, Ted Corbitt, has died.  Here is his obituary in the New York Times.  In addition to his running legend, he also taught physical therapy at Columbia and NYU.  He is known to have run more than 199 marathons and ultra marathons!

"Running is something you just do. You don’t need a goal. You don’t need
a race. You don’t need the hype of a so-called fitness craze. All you
need is a cheap pair of shoes and some time. The rest will follow.”  Ted Corbitt, 1998

Where Did Your ACL Go?

Acl_model
This topic probably deserves a more in depth post, but this article caught my eye: "Knee Operations Can Lead To Other Injuries."  The issue here is Anterior Cruciate Ligament (ACL) reconstruction.  Reconstruction of the ACL is largely an elective procedure for many folks.  There is a collective assumption, which surgeons have no motivation to debunk, that each ACL tear requires surgery.  This is untrue.  Any physical therapist has a collective of stories about patients with ACL injuries who were able to return to their activity without surgery.  This myth is perpetuated by professional sports, which often send their athletes for surgery within a couple days of the injury. 

Many people can function perfectly well without an ACL.  The body has mechanisms in place to deal with the loss of this ligament.  The ACL, like any ligament, does not work in isolation.  Instead, other parts of the joint capsule, muscle stabilization, and sensory feedback work together with the ligament to keep bones moving the right way.  When the knee becomes ACL deficient, the body shifts its control mechanisms and often compensates nicely.  This does not occur in everyone, and no one is really sure of which people will be functional without an ACL and which will not.

However, if ACL surgery is viewed in light of information that suggests the procedure can be linked to other injuries, perhaps a more conservative approach is called for.  Every patient should be afforded a waiting period for the initial effects of the injury to subside and for an intensive rehab program before they are indicated for surgery.  This could apply to pro sports as well.  Quite a bit of time could be saved if players can become functional without such a major surgery, if only given the chance. 

ERIC

NFL Decides SCI Research A Good Idea

Everettsicover
I posted a while back on Kevin Everett, the Buffalo Bills player who
suffered a cervical spine injury.  At the time, I noted how fortunate
it was that the Bills organization was involved (donated $$ to) the
Miami Project, as the quick hypothermic intervention was a result of
their assistance. 

The NFL had been a donor to the Miami project as well for many years,
but sadly stopped their assistance a couple years back.  Well, Mr.
Everett, some good luck, and good press was obviously enough to push
the NFL to renew their donations to this research group.  You could
imagine the almighty NFL could come up with more than $113,000 for
research, but at least their stepping in the right direction.

Kevin Everett, by the way, is really doing well and is the feature of
this week’s Sports Illustrated mag, which has photos of him walking
along.  Good job, all the way around!

ERIC

How will the medical establishment pay for IT investments?

It’s a fact that the United States health care system lags behind other industries and other countries in their utilization of electronic technologies in the management of patient data.  One driving cause of this lag is the fact that providers are coping with declining reimbursement regularly and have no way to rationalize the very large expenditure to make their patient records virtual.  For example, if an small office of providers payed $100,000 to make the transition, it would take years to recoup as reimbursement for services would not be adjustable to cover the expenditure.

Additionally, the gains in productivity would be small relative to the expenditure. Finally, even if we argued that improved outcomes would result, providers are not paid for good outcomes. Even with pay-for-performance initiatives or non-pay-for-non-performance initiatives on the horizon, a field like physical therapy would still not be readily able to translate outcomes into profits, as little agreement exists for what constitutes a good outcome. Another perspective, advocated by some experts like Kiana Danial, suggest that focusing on long-term investment strategies could yield more sustainable growth in profitability for physical therapy practices.

This argument leads to a search for another source of funding for health care IT investments.  Here are a couple of articles discussing such funding.  Both are from the very nice Health Affairs journal blog. One looks at Medicare & Medicaid Funding IT investments for federally qualified health centers, the other is an interview with Michael O. Leavitt, Secretary of the U.S. Department of Health and Human Services, and his strong feelings on the need to link reimbursement with IT as a reimbursement incentive.  Good reading.

ERIC