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It’s a Strange, New World!

View of San Francisco Bay

Well it’s been a bit. And what a bit it’s been!

I’m presently completing day one of “shelter at home” courtesy of COVID-19. As I am a regular worker from home, some parts of my day has not changed. Others, have changed greatly, and, really, who knows what is to come. I translate all this to: it’s a fine time to start writing again. Thus, new theme, new look, new images, and new thoughts for everyone!

Things on my mind:

Stay tuned. I need to go fixed m “Y” button on m three week old MacBookPro which makes me ver angr .

#dumbcoronavirus #DCV

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What’s the Cost of Quality? New ABPTRFE standards mean an uncertain future for Fellowships.

Back in February at the Combined Sections Meeting, the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) announced their new quality standards for post-graduate education. The release of the new standards marked ABPTRFE’s first step towards its initiative of revamping old policies and procedures. According to Tamara (Tammy) Burlis, Chair of ABPTRFE, the intent is to“ultimately enhance patient care and support overall goals of the physical therapy profession”. An external consultant company specializing in accreditation and compliance solutions for higher education helped with the development of the new standards. After a 6-month call for comments, the standards were finalized and are now slated to take effect on January 1, 2018. Residency and fellowship programs have until January 1, 2019 to comply. Physical therapy news outlet Talus Media News featured this story in their August 14th episode.

Behind the buzz of the shiny new standards, however, is the discontent expressed by some fellowship directors. The biggest concern regards the change in admission criteria into fellowship programs. Historically, there were three ways to be considered for admission into fellowship: (1) complete an accredited residency, (2) earn board certification in a related field, or (3) have adequate prior experience as judged by the program directors. The new standards have removed the third option, leaving residency training or board certification a mandatory requirement prior to applying for fellowship.

Pieter Kroon, program director and co-owner of The Manual Therapy Institute (MTI), a fellowship program started in 1994 for advanced manual therapy training, spoke up in an interview on Talus Media, “I understand where [ABPTRFE] wants to go with it but…there are some nasty consequences that come with that which threaten the viability of the physical therapy manual therapy fellowship programs…We have given input, but we always have the feeling it doesn’t get listened to a whole lot at the ABPTRFE level.” According to Pieter, fellowship directors don’t seem to have much of a voice in the decision-making process at ABPTRFE. The way in which program directors currently share their concerns is akin to a bad game of telephone. The manual therapy fellowship program directors share their thoughts in their Special Interest Group (SIG) meetings. SIG representatives then report to the Board of Directors at the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). After that, it is AAOMPT’s responsibility to talk to ABPTRFE and pass the messages along. It’s not hard to imagine why Pieter describes the communication between program directors and ABPTRFE “tenuous at best”. Of note, AAOMPT declined to comment on the potential impact of the new standards.

The consequences Pieter referred to are a few in number, but of primary concern to fellowship programs is sustainability. Or, as Pieter more bluntly puts it: “we would be out of business”. To illustrate his point, 95% of the fellows that graduated from MTI in the past five years were admitted via review of prior experience, the route now deemed obsolete. Without such a large section of the cohort, his program would not have had enough overhead to be self-sustaining. Pieter shared off record that he runs his program because he loves teaching and helping clinicians become their best; the revenue the program generates is marginal. The new standards pose a big bottleneck to fellowship admissions, limits student accessibility, and places programs like his on a pathway to an uncertain future.

But what makes fellowship programs think they won’t get enough applicants?

Though there has been a paradigm shift in recent years where clinicians are looking towards residency training soon after entering the work force, there has yet to be an identifiable fiscal incentive for clinicians to become experts in the field given their low ceiling of professional compensation. Furthermore, time is of the essence. The American Board of Physical Therapy Specialties currently only offers certification exams once a year. So, not only are the additional certification exams expensive, it also requires foresight and planning to fit it into one’s professional and personal timelines. There is additionally a current lack of evidence that suggests being a resident-trained therapist and/or having board certification contributes to being a more prepared fellow. Though that’s not to say there won’t be evidence of this in the future, it does call into question how this new admission standard was arrived at. Did it consider any of the current evidence in post-graduate education? Or, was it developed with more philosophical underpinnings? To that end, it remains to be seen…

PT Think Tank community: the point of this piece isn’t to say that the new admission standards are “bad”. Rather, I hope it makes us consider how its proposal potentially overlooks the current reality of the residency/fellowship climate. What parameters are in place, if at all, to help address the worries of Pieter and other program directors? What will be in place to aid them during this period of transition?

I’ll end it here, but do think on this last part of ABPTRFE’s position on the new admissions criteria: “Our goal is to support residency and fellowship programs, while addressing and planning for the future…As a part of our own continuous improvement process, we will continue to monitor the data that occurs as a result of this revised change. We will go back to this concept if we find that it has been detrimental to fellowship programs.”

Pieter and Tammy’s full interviews are available on Talus Media Talks.

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Physical Therapy: Technology Update

This is my presentation given at Evidence In Motion's Manipalooza 2013 Symposium held in Aurora, CO.

http://manipalooza.com

I was traveling at the time but the organizers graciously allowed me to submit my talk as a recorded video. Therefore, you will be experiencing the talk just as the symposium participants did!

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Critical Thinking Vs Clinical Reasoning

During #DPTstudent chats, there has been many great conversations and debates. However, it seems that some of the debates end with phrases along the lines of, “that’s where clinical reasoning comes in,” or “that’s where we use critical thinking.”  What are these vague terms and what is a #DPTstudent supposed to do when that’s the final, definitive statement of an interactive discussion?!

Often, it seemed the terms clinical reasoning and critical thinking were being used interchangeably. So, I began to wonder what these terms meant, how they are different, and how they are the same. Is this some sort of common denominator for all PT-speak? Or, are people just applying these terms willy-nilly? I decided to investigate.

According to: The Foundation for Critical Thinking, critical thinking is:

1) A set of information, belief generating and processing skills

2) The habit, based on intellectual commitment, of using those skills to guide behavior.

And more importantly, is Not:

1) The mere acquisition and retention of information alone, because it involves a particular way in which information is sought and treated;

2) The mere possession of a set of skills, because it involves the continual use of them

3) The mere use of those skills (“as an exercise”) without acceptance of their results.

In other words, critical thinking is the process of constant evaluation and application of available information, including analyzing your results. To me, it sounds a lot like another oft-employed term: evidence-based practice.

In the article: Thinking and Reasoning in Medicine, (Vimla L. Patel, Jose F. Arocha, and Jiajie Zhang) describes three components of clinical decision making:

(a) Choice options and courses of actions

(b) The belief about objective states, processes, events, outcomes and means to achieve them

(c) Ideas of the consequences associated with the outcomes of each action-event combination.

The overlap, and thus breakdown, between clinical reasoning and clinical decision-making occurs with confirmation bias, or searching for evidence to confirm a preconceived hypothesis. Critical thinking is constantly required to recognize these biases we all possess, and continue to analyze and challenge them by considering other potential courses of action.

A classic example I have observed in my short time in the clinic is the SI joint confirmation bias conundrum. In school, we learned how poorly reliable, and questionably valid many SI joint tests are. We also learned how many manual therapy effects are not specific in terms of spinal level, or even side. However, when assessing SI joints, many therapists hold tenaciously to their belief that they can detect, and then treat specific biomechanical malpositions of this very firmly structured joint.  “Do you feel that? Yep, that’s an upslip on the right,” I would hear so many times. Follow-up questions would be posed in a format of confirmation rather than pure inquiry. Confirmation bias. Clinical reasoning fail.

In his famous book about diagnostic clinical reasoning, “How Doctors Think,” author Jerome Groopman cautions that a primary rule for becoming a great diagnostician is to not get boxed into one frame of thought. That sounds reasonable enough to me. Perhaps this is much more difficult in practice, especially considering the nuances to becoming a good clinical thinker.

Critical thinking and clinical decision making are difficult. It certainly isn’t for the faint of heart, when so often we’re forced to face honest assessments of how little we actually know.  So, next time your ideas and opinions are questioned and you feel cornered, don’t resort to the catch-phrases of critical thinking and clinical reasoning as a defense. They’re not a “get out of jail free” card. Recognize the opportunity to expand you understanding of other methods and models of thought that you’re perhaps less familiar with.

Don’t be afraid.

I’ll leave you with one of my favorite quotes:

“But, if thought is to become the possession of many, not the privilege of the few, we must have done with fear. It is fear that holds men back — fear lest their cherished beliefs should prove delusions, fear lest the institutions by which they live should prove harmful, fear lest they themselves should prove less worthy of respect than they have supposed themselves to be.”

~ Bertrand Russell (Principles of Social Reconstruction)

 

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#PhysicalTherapy Hashtag Project 2.0

With #CSM2013 only days away, #physicaltherapist twitter chat relating to the conference will continue to increase. Quotes, links, pictures, and thoughts relating to #CMS2013 will spawn far ranging discussion. Individuals will participate remotely from all over the world. I anticipate the traffic on the #CSM2013 stream to be massive given the increase in physical therapists, students, and other disciplines engaging twitter professionally.

In #PhysicalTherapy Hashtag Project, I discussed hashtags in physical therapy specifically and healthcare in general. I also outlined some proposed hashtags for  the PT tweetsphere. These were meant to categorize links, discussion, and comments regarding specific practice areas and topics including sports, pain, acute care, business, advocacy, and research science. A nice discussion evolved both in the comments section, and on twitter inspiring me to create a follow up post based on the conversation.

The Healthcare Hashtag Project on Symplur continues to curate information relevant to various aspects of healthcare and various professionals within healthcare. Of course, much of the information is also important for public health and patients. Interestingly, the #DPTstudent and #solvePT tweetchats rank 5th and 7th respectively in trending tweetchats. #Rehab generally is 15th on the list of trending hashtags. Impressive! The four main categories of organization are hashtags, tweet chats, conferences, and diseases. I envision this project growing in both scope and specificity to connect various professions (and patients!) while simultaneously allowing for more focused categorization within professions. As introduced in the Physical Therapy Hashtag post, specificity of hashtags for the physical therapist profession adds value to the twitter community. A great feature is a schedule of healthcare related tweet chats.

A while back, PT Think Tank’s Eric Robertson introduced the idea of a new PT hashtag #LivePT to capture statements and sentiments that were more appropriately branded outside the #solvePT tag and chat. Below is the revised list of hash tags. Please review and comment….

Practice Areas

  • #AcutePT
  • #CardioPulmPT
  • #GeriatricPT
  • #ManualPT
  • #NeuroPT
  • #OMPT
  • #OrthoPT
  • #PainPT
  • #PediPT
  • #PelvicMafia
  • #SportsPT
  • #WellnessPT

Other Topics

  • #bizPT
  • #brandPT
  • #cashPT
  • #PTadvoc
  • #PTscience
  • #PTtech
  • #therapycap

Students and Education

  • #PTedu
  • #DPTstudent

Global #physicaltherapy Hashtags

  • #LivePT
  • #PTfirst
  • #PThero
  • #SolvePT

Other Hashtags

  • #HCSM
  • #meded
  • #mHealth
  • #SocialOrtho
  • #SportsSafey

Tweet Chats

 

Is the list too long? Too short? What hashtags do you utilize and follow? Any tweet chats you participate in or follow? Remember to utilize both the #CSM2013 hashtag and topic specific hashtags for your Combined Section Meetings tweets! See you in San Diego. Tweet with you if not!

 

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#PhysicalTherapy Hashtag Project

#Hashtags are a robust means of tracking or tagging information on Twitter. They help you manage the fire hose-like nature of the constant stream of information on Twitter. Conferences, tweet-chats, and general topics of discussion all benefit from the use of hashtags. Combined Sections Meeting (CSM) of the American Physical Therapy Association, the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT), and the Private Practice Section of the APTA all have hashtags surrounding their conferences. The conference acronym is usually followed by the year. For example, #CSM2013, #AAOMPT13 (No AAOMPT conference this year because of IFOMPT Conference), and #PPS2012. Functionally, hashtags  group tweets by keywords. For those not familiar check out Twitter’s help page what are hashtags? or the wikipedia page hashtag.

Personally, I have leveraged hashtags to follow and contribute to discussion surrounding conferences (CSM and AAOMPT for example). I  unfortunately was not able to attend #AAOMPT11 or #IFOMPT12. But I did learn, discuss, and contribute via the conference hashtags. The # creates potential for discussion and collaboration on a topic, course, conference, or issue. Unable to attend a conference or event? Participate virtually! Busy during the time of a tweet chat? No problem, you can search the hashtag later to read, respond, and continue the conversation. Wondering what individuals are saying on a particular topic? Search that hashtag. Storify even lets you create and save conversations or stories based on certain parameters.

Outside the PT Sphere

@HealtSocMed claims #HCSM (Healthcare Communications and Social Media) forumlated in January of 2009 was the first global healthcare tweet chat. Other non physical therapy specific hashtags or tweet chats include #SocialOrtho, #SportsSafety, #mHealth, and #MedEd.

Physical Therapy Hashtags

Established physical therapy hashtags include #physicaltherapy, #physicaltherapist, and #physioPT. Kendra Gagnon PT, PhD (@KendraPedPT) who has guest blogged here on PTTT, utilizes hashtags in entry level DPT education. Her students tweeted #WhyIchosePT to communicate their reasons for pursuing the profession of physical therapy. Her class used #PTprof throughout the semester. On her blog, Kendra discusses social media communication as a part of the curriculum in a Professional Interactions course.

In some cases hashtags are utilized both as a tweetchat and to track discussion on a particular topic. #SolvePT is an example with weekly tweet chats on Tuesdays from 9-10PM Eastern Standard Time as well as ongoing discussion related to issues pertinent to the physical therapy profession. @SnippetPhysTher (Selena Horner, PT, GCS) discusses the emergence of the hashtag and the tweet chat. The #SolvePT hashtag continues to be an interesting conversation regarding physical therapy.

Call to Action

I propose a #physicaltherapy hashtag project. As a physical therapy community lets discuss specific hashtags for practice areas, topics, and ideas. I recently began using #AcutePT to tag some tweets containing evidence and rationale for the physical therapist’s vital role in the acute care environment. The Healthcare Hashtag Project has curated content and hashtags relating to health care topics, specific tweet-chats, conferences, and even diseases!

Below are my proposed hashtags for the physical therapy profession in addition to what we currently utilize. What did I miss? Should we change the wording? Let’s get started…

Practice Areas: #AcutePT #CardioPulmPT #GeriatricPT #ManualTherapy #NeuroPT #OrthoPT #PainPT #PedsPT #SportsPT #WomensPT

#PTscience for research, evidence based practice, and critical thinking relating to physical therapy.

#PTAdvoc for physical therapy advocacy and legislative issues.

#bizPT for business and private practice topics.

#PTtech for information relating to technology and the physical therapist.

#DPTEd for topics relating to physical therapy education and educators, including clinical education.

Hashtags for education and student topics could include #PTedu or #PTschool. Rumor has it that #DPTstudent will emerge as a hash tag topic and potential chat spear headed some of the student leaders in social media. You know @MattDeBole is at the center of that! Also check out @LaurenSPT as well.

And last, but certainly not least, #PTHero for inspiration and greatness within our vital profession.

@Dr_Ridge_DPT

 

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#IFOMPT12 – Day 1 Summary

Bonjour!

Just sitting lying here in the hotel room reflecting on an excellent day of programming. I was able to attend and live blog from these seven sessions, take home messages summarized here:

“Management of cervical spine disorders: Where to now?” by Gwen Jull

  • Creating classification schemes for treating patients with neck pain is a slippery slope
  • Using one patient example we can easily construct over a million subgroups
  • Teaching entry-level DPTs may require black and white concepts, but clinical reasoning resides in the gray

“Knowledge Transfer in the Age of Information Technology” by Stuart Gowland

  • Telemedicine is revolutionizing renal surgeries in remote locations in the south pacific
  • Operating rooms can be mobilized in buses that can reach remote areas of NZ
  • The quality of video is very important when it comes to broadcasting

“Motor Control of the Knee”

  • Manual therapy did not modulate spinal excitability in patients with knee pain
  • Resting knee pain was reduced in patients with knee OA following manipulation
  • To maintain the gains in knee ROM following 6 weeks of stretching, the patient must continue stretching 3 X per week

“Understanding Cervical Muscle”

  • Patients with whiplash assoc disorder (WAD) have impairments in lengthening and shortening of deep neck flexor muscles as quantified using ultrasonography
  • Detailed dissection of cadaver neck flexors revealed strong adherence of the muscles to the bones, not like drawings in Gray’s Anatomy

“Physiotherapists/ Physical therapists’ role in exercise prescription & “Exercise is medicine”” by Karim Khan

  • More people die in the USA as a result of low exercise than smoking, diabetes, and obesity – COMBINED
  • You must appeal first to the emotions of your patient, then use simple statements to effect changes in their behavior

“Tendinopathy task force – guideline development” by Alex Scott

  • It takes 17 years to get 14% of research findings adopted into clinical practice
  • CPG are viewed as too restrictive by clinicians

“Biological mechanisms of dizziness” by J Treleaven, E MajMalmstrom, R Landel

  • The neck is very unique, not just a muscular joint but a major sensory organ
  • Multimodal therapy is a great approach for treating these patients
  • Postural stability is impaired in patients with neck pain
  • Put frickin’ lasers on the heads of your patients! (Dr. Evil Voice)
  • Treat the neck like you would a sprained ankle

Off to bed, catch you all at 8AM with live blogging of Joy MacMacDermid!

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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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The Next Step

NPA Think Tank's Former Look

Well, here we are, shiny new digs and everything! When I think back to this blog’s humble beginnings on Blogger with a standard template, to our current professionally designed site…well I just can’t imagine how I got from, “I wonder how you blog…” to this!

Where We’ve Been

Before I go any further, I would be remiss if I did not reflect back fondly on the old blog platform, and offer a great big pile of gratitude to Larry and everyone at Evidence in Motion for their generosity and help in getting this blog to where it is today. You see, NPA Think Tank has lived comfortably and safely under the wing of EIM on their blog server and platform for quite some time.  The folks at Evidence in Motion are consummate professionals!

Where We’re Going

First Step on the MoonOur new WordPress platform will enable some improved flexibility and visual appeal as we attempt to make good content available to our loyal readers. I hope you like it. Go ahead and explore the main navigation images on the top of the page. Stop first at the Blog page to learn all about our new authors, then check out the Physical Therapy Page, and the Resources content. Also, be sure to click on the Physiospot logo in the sidebar to see Rachael Lowe’s research summaries imported for your convenience.

I’m happy to announce the addition of two PT bloggers into our fold. Rod Henderson, author of the Orthopaedic Physical Therapy blog and, Mark Schwall, author of the Physical Therapy Etcetera blog, are coming over to write at NPA Think Tank. I also plan to have some additional authors come on board very soon, so keep your eyes peeled. The more voices, the stronger the discussion!

A New Name: PT Think Tank Coming Soon!

Here’s the deal on NPA. It is an acronym from an old business of mine, which no longer functions, but has a dear place in my heart. The “N” stands for Nostrebor, my last name backwards, and occasional nickname. Obviously, this is all just nonsense to everyone else but me. When I hear people reference this blog in conversation, no one seems to remember those 3 letters. “Do you read the Think Tank?”, I hear. Well, I hear you.

While it’s quite the risk and undertaking to switch a domain name for an already existing site, I think it makes sense. So, very shortly, NPA Think Tank will become PT Think Tank. It just makes sense, especially as others join me in the fun. We are Physical Therapists, hear us think!!

Stay tuned for more on this change, as we plan out how to make sure everyone stays with us. This should occur within the next two weeks or so. Until then, keep reading, enjoy some new voices, and the new site and…well…keep holding onto those hats!

Our Developer

Jessica King Web DevelopmentBy the way, do you love the design? Do you wonder how to get a blog from one platform and server to another with a new design, without breaking links, losing comments, and ending up in a FAIL? Do you wonder how to do this all in one evening? Yeah, I did too, until I met Jessica King. She is a developer. She is smart. She does amazing work. I would be lost without her friendship, skills and contributions.