#CSM2011 Acute Care Lecture: Our Foundation and Our Future?

#CSM2013 has arrived! Pre-conference courses are in full swing and the regular section programming begins tomorrow morning. Acute care practice received press online and discussion here on PT Think Tank. Now, I am going to review an inspirational lecture from 2 years ago at #CSM2011 that I truly enjoyed.

Jim Dunleavy PT, MS gave the inaugural Acute Care Section Lecture at #CSM2011 entitled “Acute Care: Our Foundation and Our Future.” Jim has been instrumental in the Acute Care section as well as served as president of the New York Physical Therapy Association.

Here are some quick facts you may not know about the Acute Care Section:

  • Formed in 1992
  • First section with platform presentations
  • First to share special interest groups across sections
  • Goal of establishing an acute care physical therapy speciality certification
  • APTA’s 2011 Most Outstanding Section award
  • Twitter @AcuteCarePT (ond of the most active sections)
  • Fantastic website with excellent resources


Jim discussed the history of our profession in the United States. The physical therapy profession grew out of serving societal need, providing necessary service not otherwise available. Jim urged us to not loose site of what society and patients need, not merely what we desire to accomplish professionally. A focus on need, service, and commitment.

Now, I must say Jim has VISION. Throughout his lecture he kept emphasizing the “courage and will to change.” He even poised the question how could direct access physical therapy be practiced within the hospital? Interational therapists, notably some in Australia, practice in a direct access environment even within intensive care units.

Jim stressed pursuing measurable financial, personal, and patient outcome effects of acute care provided by physical therapists. He presented the necessity for openness to new business relationships with the facilities at which physical therapists are currently employed. Changes in healthcare, payment and hospital care delivery require physical therapist practice to evolve. Can an acute care physical therapist structure their practice like a hospital physician?

As I discussed in so, you think you can walk? Jim maintains that a function only approach may cost a facility more money. It is imperative physical therapists research and present their impact on costs to the patient, hospital, and health care system in addition to patient outcomes (pain, function, morbidity). Across settings, a function only approach results in far too narrow and limiting scope of analysis for our practice. A great example of the profound effect we can have on medical outcomes and complications, regardless of function, was illustrated in a recent PTJ manuscript investigating an early mobility program in a trauma and burn intensive care unit.

No adverse events were reported related to the EMP [early mobility program]. After adjusting for age and injury severity, there was a decrease in airway, pulmonary, and vascular complications (including pneumonia and DVT) post-EMP. Ventilator days, TBICU and hospital lengths of stay were not significantly decreased.

So, regardless of the functional implications of early mobility and a lack of effect on ventilator days and hospital length of stay, there a strong argument for the presence of a physical therapist and early mobility in a TBICU exists. If this investigation focused soley on function, a vital, important outcome of movement would have been overlooked.

But, the Acute Care section needs help and recognition from the other sections. Further, it needs young, motivated individuals to sustain and execute it’s vision and goals. Despite impressive and innovative acute care practice expansion over the years including more complex, acute patient populations and environments ranging from emergency departments to intensive care units, the Acute Care section has struggled for meaningful recognition and collaboration from professional colleagues…

So, what’s next?

Research illustrates the importance, effectiveness, and outcomes when a physical therapist is involved in patient care. Future investigations should focus on specifics of interventions including frequency, duration, intensity, and content which is most efficacious and effective for specific populations. But, global inquiry on the impact of physical therapists on patient, hospital, and healthcare outcomes should not be abandoned. Some of the more profound research is not just what physical therapists can do to improve function and quality of life, but on reducing the risk of adverse medical outcomes and morbidity. ALL students should have some type of acute care rotation or experience prior to graduation. If we truly want to assume our role as direct access providers of choice all students must obtain didactic knowledge and clinical exposure to acute medical conditions.

Dan Malone, PT, PhD, CCS and recently elected president of the cardiopulmonary section states in his editorial The New Demands of Acute Care: Are We Ready?

The articles cited here should inspire us—acute care practitioners, therapy managers, and educators—to examine and evaluate how to provide services as well as how to facilitate the integration of the specialized knowledge, skills, and behaviors that will bring success in acute care. We face many challenges ahead—an aging population; changes in work processes and care delivery; recruitment and retention of high-quality staff; and the imperative to define the value of physical therapy to our many stakeholders, including patients, referral sources, and third-party payers. Are we ready?

Physical therapists in acute care (and beyond) need to step up to the challenge. We need to focus on changing the process and concept of our practice. We need to improve our understanding of pain and musculoskeletal conditions. We need to treat patients within the hospital who have pain complaints. We need to assist in pain management, pain education, and pain understanding for out patients, our colleagues, and other professionals. We need to continue to educate our outpatient colleagues on the physical therapists role in managing medical conditions. We also need to learn from and collaborate with them.

This years Acute Care Lecture is on Wednesday from 6:30PM to 7:30PM in the Hilton Bayfront Indigo GH rooms. Sharon Gorman PT, DPTSc, GCS will discus Leveraging Technology to Advance Acute Care Practice. Even if you do not practice in acute care, please stop by. Interested in attending some Acute Care Section Programming? Here is the #CSM2013 schedule.

#DPTstudent Chat Topic for January 16th: APTA’s CSM Conference- What’s in it for the SPT?

Image courtesy { pranav } via Flickr
Image courtesy { pranav } via Flickr

Yeah, this is were CSM is!

Next week, many DPT students are jet setting across the country to sunny to San Diego for the APTA Combined Sections Meeting. What made you decide to go? What do you hope to get out of it? We will discuss the benefits of being there as well as chat about your thoughts about what being an APTA member means to you. Talk to you all on Wednesday evening at 9pm EST on the next #DPTStudent tweetchat!



Click here for analytics and transcript.

CSM 2012 | The Pauline Cerasoli Lecture

from APTA

Being an educator of PTs, I always look forward to the Pauline Cerasoli Lecture. I had planned to relay the action through live blogging, but lack of free WiFi or 3G coverage left me in the digital dark. I did manage to take several notes during the lecture, summarized below.

This year marked the 15th installation of the Cerasoli Lecture, which is now in memory of Pauline “Polly” Cerasoli (1939-2010). Polly Cerasoli was the director of my physical therapy program, a fact I and many of my colleagues are proud of. The lecture was given by Christine Baker, PT, EdD, a faculty member at the Univ of Texas Medical Branch.

Christine had two primary objectives of her lecture. She proudly listed them to begin her talk “as any good instructor would”:

  1. Recognize benefits and challenges presented by technology
  2. Appreciate current technology in the way it changes things

Having been in the game for many years, it was a treat to listen to Christine reflect back on the old workflows students, clinicians, and faculty members used to take care of daily tasks. Students went to class in a building, went to the library to do research, used card catalogues to locate papers, and typed out the bibliography citation by citation. Clinicians hand wrote charts and documentation. Faculty posted exam grades on a cork-board in the hallway, arranged by social security number to preserve anonymity. The ways we complete these tasks today have completely changed due to the introduction of new technologies. Although you could still read a summary of the lecture in Chicago on a printed page.

flickr | McCain Library

Christine then presented a wordle word cloud taken from what I believe was a document on educational technology (please keep in mind that you need to explain the source if you are going to use the ubiquitous wordle cloud). Key phrases that stood out included laptops, podcasts, and blogs; all new tools in this digital age. Those comfortable using these emerging digital tools fall into the category of digital “immigrant” or digital “native”. The digital immigrant speaks an outdated language and can be identified by their accent (e.g., I dialed a phone, I wrote an email). To connect effectively with the digital native, the immigrant must make an effort to adapt to the changing technological landscape and also know about the eligibility to file adjustment of status (AOS).

I’d never though of this before, but Federal policies have actually facilitated digital literacy. Looking at the policy “A Nation at Risk” (1983), we find proficiency in computer science as a goal to be achieved by the completion of high school. You might be more familiar with George W. Bush’s “No Child Left Behind” (2001), which stated that all 8th grade students have the ability to use computers to communicate with others. Digital literacy is becoming acquired at younger and younger ages. Christine actually knows of several kindergarten students presenting slide presentations to their classmates! Show-and-tell as we now it has changed.

flickr.com | arfblat

What are the outcomes of this digital literacy? It seems that difference in student achievement between in-class lectures and online distance learning are shrinking. Students learn equally well in both formats. A review of the literature of technology use in the education of health care professionals shows that many tools are being utilized to facilitate learning, including:

  • Video modules for independent study of specific materials (Sanford et al 1996)
  • Hybrid/distance courses (English, 1998; Maring et al 2008; Bayliss & Wardon, 2011)
  • Web-based interactive tutorials (Perlman et al 2005)
  • Blogs (Goldman et al 2008)
  • Audience response systems (Wait et al 2009)
  • Computerized testing (Caudle et al 2011)
  • Podcasts and lecture recording (Allen & Katz 2011)

Christine did establish a mantra during her lecture “do not just use these toys, you need to know how to use them right.” Your students will not magically benefit from the fact you are using podcasts, you need to consider why you should use them and provide outcome measures to show how the students are benefitting from them. There are also intangible qualities of the education process that are hard to measure. It seems that students need to be part of a community to develop professional skills and would would argue that this can only comes from being in a classroom and socializing.

Christine offered some tips to faculty who choose to teach online:

  • Think about how to present material online
  • Do more than simply post PPT slides on the LMS (learning management system)
  • Consider how the materials will be consumed by the learners
  • Prepare the instructional environment, you are now the guy on the side instead of the guru in the front of the class
  • Monitor discussion boards, make yourself a presence in the course by providing feedback
  • Utilize departmental technology support
  • Consider establishing a distance education coordinator
  • Allow time to become familiar with technology before launching into content
  • Provide an orientation to the course and expectations

Christine also offered some tips from a student perspective in order to be successful learners online:

  • Be organized, carve out time, do not procrastinate
  • Participate, you will get out what they put into it
  • Be comfortable with technology, complete a technology readiness survey
  • Technology needs to be reliable, let faculty know when it isn’t
  • Utilize student support services

Christine also reviewed the types of interactions learners can expect to have in online courses:

  • Learner to content, occurs when the students reads and article or watches a podcast
  • Learner to learner, occurs during discussion forums, chats, study sessions over Skype
  • Learner to instructor, occurs when instructor provides feedback on assignments
  • Learning to interface, refers to the delivery of content, this often stressful to digital immigrants

Christine offered several benefits to computer-assisted instruction:

  • Students have more responsibility in participating and contributing information
  • Attracts student attention
  • Increases access to a variety of courses, scheduling ease
  • It is cost effective for the institution
  • Allows for the provision of immediate feedback

What about the PT clinic? Would you believe I have actually heard clinicians argue that they became PTs in order to avoid using technology? Guess what, technology is findings its way into the clinic. Computerized documentations through the use of EMR is the prime example. Several PT clinics also offer customized video clips of prescribed exercises for patients to take home and refer to. She mentioned the example of medical students using PDAs in the clinic to look up reference information. Christine encouraged those in the audience using technology to educate in the clinic to submit their studies to the Journal of PT Education.

flickr | ismnet

Technology also has a role in EBP (evidence-based practice). New content delivery platforms are providing a myriad options for continuing education courses. No more travel to a distance facility (manual techniques are another story). Speaking of continuing education, technology can help clinicians stay on top of relevant literature by leveraging RSS feeds.

Christine then moved onto a summary of the ways technology has penetrated into physical therapy. Today’s PT student is expected to attend class, but can review video recordings of the class later. They also order their textbooks online (and in some cases download them) and pay their tuition online. Today’s physical therapist does not wear a white jacket with an APTA patch on the sleeve, use EMR for treatment documentation, attend continuing education online at their own pace and use RSS feeds to be alerted of new research. Today’s PT faculty use clickers to poll students and group sessions to facilitate problem solving, post grades online to LMS, use DVDs and YouTube to demonstrate techniques, email handouts, use smart boards for diagrams and save hundreds of article PDFs to flash drive.

Christine offered her visions of a future that will include electronic textbooks with rich media and embedded videos, social media use, and advents in tele-health for the delivery of health care especially for those in rural serving communities.

Christine energetically concluded her lecture by stating “I cannot wait to see what is ahead!”

#CSM2012 Day 1 Programming

#CSM2012 is off and running! Over 10,000 physical therapists from across the nation are moving around the Chicago area. Conference programming officially started today. @MPascoe, @EricRobertson, and myself @Dr_Ridge_DPT have attended various sessions. Mike is utilizing Cover it Live to live blog during sessions. Check out his sessions HERE . You can ask questions or comment. Or, feel free to engage the content after the talk is over. This morning he was living blogging from Engaging Students in 140 Characters or Less.

I attended educational sessions on Physical Therapists in the Emergency Department, the Mechanisms of Manual Therapy, Glenohumeral Internal Rotation Deficit, ACL Rehabilitation, and The 2nd Annual Acute Care Lecture. Great variety today. In my downtime, I was able to read quite a few posters and interact with the authors. I even utilized my iPhone to send them e-mails with my virtual business card that contains my contact information, social media links, practice areas, and interests. Who needs paper? So if you got inspired by this, you can easily avail those virtual business cards online. Not only are they extremely convenient, but they’re also affordable. You won’t believe how much sense of professionalism they convey and how effective they truly are.

Well, I am off to the @AAOMPT Social located at The Scout Waterhouse on 13th and Wabash (1301 S. Wabash). If you are reading this then come on down!!!

Stay tuned tomorrow for more live blogging as well as blog posts about various talks and events. Keep moving and learning!

CSM 2012, Chicago Edition is Here!


My hat and gloves are packed, my boots are ready, although my ice walking skills may have gotten rusty having moved away from the northeast now 8 years ago. Regardless, I think I’m ready to dive in and embrace the winter wonder land that is Chicago, that is this year’s APTA Combined Sections Meeting.

PT Think Tank is going to be covering CSM in full force for those of you who can’t attend. Mike Pascoe, Kyle Ridgeway and myself will all be there and ready to tell you about the goings on either here, on Twitter, or however else we might discover. Dr. Pascoe is also planning some exciting live-blogging events from some sessions, so keep your eyes peeled and tune in REAL TIME from Chicago!

I’ll be representing the Orthopaedic Section as the Public Relations committee chair and performing tasks and attending events related to that role, and I’m excited to be presenting a research platform on Saturday afternoon.

Jason Tonley, PT, DPT, OCS, and Marcie Harris-Hayes, PT, DPT, MSCI, OCS, will be delivering a session entitled, “Don’t Forget to Be Hip: Looking at the Role of the Hip in Lumbar Spine Disorders” at 3:30pm Saturday. Part of that session will include several research platforms related to the topic. I’ll present the hip-spine case series I’ve been working on with Cheryl Sparks from Bradley U. and Derek Clewley from Benchmark in Atlanta. Check us out!

Here is our Twitter info: (Check out #CSM2012)





And check out, @AAOMPT, as it seems like they’re planning some fun, social gigs.

Also, don’t forget the APTA CSM Mobile App. Get it here. It’s way more convenient than trudging to those programming boards! I’m keeping my fingers crossed to see a little white stuff, but I do have some post-trauma from a failed attempt to get to Boston the last time CSM was held in a draft climate, so if it does snow, perhaps Friday night might be a good time. Can we schedule that?

See you there!