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).

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

deka-armDean’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.


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

autonomousAmerican 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

Uptown VAAugusta, 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!

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!

Obama on LenoIn 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

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.

DIY Healthcare?


Yesterday, a NYT article about the comraderie of Physical Therapy. Today, an article about the group of young uninsured who are resorting to do-it-yourself healthcare. We’re so close! Just put those two concepts together and physical therapists emerge as a viable option for those with limited insurance coverage.
I love this quote:

It’s not an intimacy we would choose. But, shoved out of our private, busy lives, whether reluctantly or gratefully, we fall into their strong, skilled, waiting hands.”

I don’t love this quote:

“I could have gone to a major university for a year. Instead, I went to the hospital for two days.”

Young adults are the largest group of uninsured Americans. It’s a serious problem. Thankfully, physical therapy sessions don’t cost the equivalent of a year of education. And, for the record, Caitlin Kelly: physical therapy really isn’t that painful…at least it shouldn’t be!

We get rid of pain, not cause it.

image courtesy of mkgillman via flickr

World Cancer Day: My Two Perspectives

Today, February 4, 2009 is World Cancer Day. Head over to the website for the Internation Union Againt Cancer to view a striking video and to find out more about their campaign to help promote a healthy, active lifestyle. It seems I've never stopped to take note of World Cancer Day before, but this year it seems more than appropriate.  

My Perspective
Cancer has touched my life before on several occasions, and was the cause of demise for more than one of my grandparents. I've followed Lance Armstrong's illness and subsequent world cycling domination and campaign from the start. I always purchased the breast cancer stamp, as if my 8 cents would offer some benefit. Still, I never really felt that I was effected by cancer, and I knew somehow I was lucky for that.

This past summer, my mother was diagnosed with breast cancer. She's been undergoing treatment and is doing well with a good prognosis, but through this process I've gotten a stark view of how truly tough cancer is, even for someone with a good prognosis. From the uncertainty during the diagnostic process to the painful, agonizing chemotherapy and the endless small battles one must endure, cancer is hard. My mother even lost her job due to her illness. Cancer rocks your world in a bad way, and its claws reach beyond the cancer patient into their family and friends. When one person suffers with cancer, many more suffer alongside. I think that's how it should be.

I've had other friends, and family members of friends, who are experiencing first hand interactions with cancer this year. For some reason it seems breast cancer is all around me this year. My friend and blog developer uber-geek, Jessica, has made a web page to keep friends and family apprised of her mother's progress that is ongoing. She comes home from the hospital today!

To all my friends, family and aquaintances who are dealing with, or have dealt with cancer on some level, my thoughts are with you.

My Physical Therapist Perspective
One thing I've noted throughout my mother's treatment is the lack of partnership between the oncologists, surgeons, and physical therapists. As I sat at a chemo treatment with my mother I observed the suffering, weakened bodies all around me and I felt they needed formal guidance. Physical therapists can help maintain strength, mobility, descrease pain through motion, and even improve respiratory health and function through a variety of methods. We need to be right along side cancer patients and their physicians. We can do great benefit for these people. This is not happening yet on the scale that it should be. There needs to be a seamless partnership that serves as a non-obtrusive resource for patients suffering the effects of cancer.1215_breast_cancer

Integration of oncologic physical therapy is improving and physical therapist education includes more of this every year, but still no clinical specialization exists for the oncologic phsyical therapist. Very few among us are considered experts in this area, though the ones that are considered such are very good.

I will be more aware of this opportunity to help those suffering with cancer. I will begin a process to make myself more educated in this field, and I might even join the Oncology section of the APTA. For now, my efforts are best realized by offering this post and a couple links:

What are you doing to help? I think if you just stop and notice, it is a start.

Good luck with your continued recovery, Mom! 

High Costs, Bad Outcomes

In an Epidemic of Overtreatment, John Halamka and Rick Parker check in on the Health Care Blog with a great list of contributing factors to the the high cost, and low value of the U.S. health care system.

The list can be summarized in the following manner:  Unhealthy lifestyles and overtreatment combine with a culture that promotes defensive medicine and a cycle is born.  The authors note, that while the causes of this crisis are easy to identify, the remedy for them is not.

Back pain gets a mention as an illustrative example of the problem.

"Some patients are not willing to accept risk or shared decision making with their doctors. They want to begin the evaluation of back pain with an MRI instead of trying a course of gentle exercise and pain medications."

While this blog post is opinion-based, the high costs and poor outcomes in the case of low back pain are well documented by research findings.

Solid reading.

Safe Falling?

I’m sure that, if this device had been invented during my childhood, I would have been required to wear it. 

A Japanese firm, Prop, is developing an airbag to be used to protect those who fall.  The product is designed for a specific type of fall (elderly with epilepsy) and in proposed to detect an acceleration to the ground which releases an airbag to protect the head and the pelvis.

This type of product is also being used by some motorcycle racers.  I can imagine some embarrassing moments when someone reaches down to pick up their keys a little too quickly!

This link to a news story has a video of the product in action…seems they still have some development to take care of…that last fall must have hurt!!