Almost finished with ultrasound...

Well, I guess that's a relative thing to say. No one's ever really done practicing their ultrasound skills, after all.

But I AM almost done on the short-term front. Practical on Thursday sometime. I'll go in, do my two patient scenarios, and serve as a patient for two of my classmates, and then I'm DONE for the day.

Back from Busy Week!

I know, I know. In my last entry I said I was back, and I mean it this time. Having two practicals in one week means you don't really want to spend any free time doing anything BUT study and practice. And because of the way my personal life was set up at the time, I had zero time for anything outside of studying.

That'll probably happen again. And again, and again. Just the nature of the beast, I suppose.

We started doing ultrasound, and our teacher is understandably nervous about our being able to perform with little supervision -- hence the necessity of practice, practice, practice. I've probably put this much effort and practice into little else in my life, and had better results (since early youth I've spent many hours in front of a television playing video games, for example, and had much better results with those!).

Outside of that, school's going well. Making roughly mid-B's for everything, which is about what I expected.

Day Fifteen: So it's been a day...

...or two since I last updated. Sorry. Been busy! You understand, right?

Two practicals are coming up next week. I took a test today and did a presentation on my book I mentioned in a previous update ("The Horse Boy" by Rupert Isaacson). Think I nailed both of 'em. But THEN we had an "open lab" session with the teacher we're having practicals with next week and it made me pretty nervous to think of all the practice I still need. Worse still was the message I received through our online school forum with all the rules regarding practical day: our lab is one full day in the week, so on practical day we have to randomly select a time from a hat and prepare ourselves for it. Everyone will eventually go, but some will have more time to prepare for practicals that morning/early afternoon than others, so it's important to come to class prepared to go right away.

My lab day (and therefore my practical day) is Wednesday -- for that class, anyway (Clinical Kinesiology). I have another practical the following day (Therapeutic Procedures), with the same type of standards.

Basically I saw that message and it hit me that this is definitely happening.

I hope I don't come off sounding whiny or griping about the wonderful experiences I'm getting. But man. These practicals are 5-6 days away and I'm ALREADY feeling nervous.

I'll try to think of it like Russell Brand once said: "I feel nervous! It feels good to feel something."

Yeah. Maybe!

Day Twelve: More tests + practicals!

WHOA was I wrong when I wrote that I had no more tests yesterday. We're having one Friday (not to mention a five-minute presentation) plus two practicals and another test next week. It's been pretty much a solid string of tests since last week, really.

Sometimes you get so busy you forget you're taking seven classes with seven unique exams to take each time!

Gotten some of my test grades back. So far so good. Making pretty solid B's mostly. When I got in, I told myself to try to reach for the lofty goal of all A's each semester...

...we'll see!

Day Eleven: No More Tests + Ultrasound!

Took the last of my handful of tests today. I feel really good about this one. It was in Therapeutic Procedures I and consisted of everything we'd covered in both class and lab from the beginning up until our current stopping point (bed mobility and transfers). I actually feel better about this one than the last two. I had a moment though where I went into the student lounge and the 12-13 other students were all standing around chatting about correct/incorrect answers (something you'll find in pretty much every school, I suppose). Usually I go in and nervously check my answers against theirs, but in this instance, I felt more confident that I was right about the majority of the questions.

I think my studying is getting a lot better. I'm always nervous about my habits at the beginning of a new class -- you just don't know since you have no data.

After that it was just a matter of starting our newest section on heat and cold, plus our newest lab (for Thursday): Ultrasound! Apparently my teacher gets notoriously nervous about teaching new students how to perform ultrasound procedures (she supposedly even screams at people while they're trying to learn), so while this seems like a pretty cool section, we'll see how we fare.

Happy Labor Day!

Hope everyone had a good, long, fun-filled weekend!

Weekend Article: Tripping seniors to keep them from falling?

Researchers at the University of Illinois in Chicago have devised an experiment to help prevent falls in senior citizens, according to a report by Lindsey Tanner of the Associated Press. While conventional research methods have included exercises to boost stability and balance, a research team from the university - led by physical therapist professor Clive Pai, PT, PhD - has devised an experimental moving walkway that acts like a treadmill - except in that it includes shifting jolts in different directions to keep the user from getting too used to walking in that direction. The user will also be outfitted with a special harness to keep them from actually falling while "tripping" on the walkway.

Preliminary research found that 24 similar "trips" in just one walkway session taught older adults to learn to catch themselves and reduced their chances of falling outside the lab, during everyday living, by 50 percent up to a year later (Tanner 2014).

Pai is optimistic about the preliminary findings, which have proven more effective than standard conventional fall prevention techniques. "His research is focusing on building subconscious learning," the report said, "and evidence so far shows it can happen surprisingly fast. 'This is all implicit learning. We don’t give any instruction. They don’t have to be motivated — they’re naturally motivated because they don’t want to be on the floor,' [Pai] said" (Tanner 2014).

Pai's team received a $1 million, five-year grant from the National Institute on Aging to study and develop the treadmill system, and plans to enroll 300 participants within the next five years (Tanner 2014).

Tanner, Lindsey. (2014). Tripping seniors on purpose to stop future falls. The Associated Press. Retrieved from http://bigstory.ap.org/article/tripping-seniors-purpose-stop-future-falls

Day Ten: Week two, concluded

Did terrific on practical #1, aced the med term test (well I don't know truly how well yet, but I'm sure I did well), and all assignments were turned in on schedule.

Now time for a Friday/Saturday where I do absolutely nothing school-related. It's time I took some time off.

Then back to the books. This Labor Day weekend doesn't get to be fun just because I want it to be. I have two more tests this week plus a five-minute presentation to give. Oh, and ANOTHER practical coming up on bed mobility and transfers.

It sounds like a lot, and it is. But I think I'm finally getting the hang of this schedule.

Day Nine: Now that THAT'S over...

Practical #1 completed. Don't know yet how I did (I find out tomorrow). And I'm not going to violate my honor code by talking about what was on it, I'll just say I was pleasantly surprised.

Big med terminology test tomorrow. Gotta study hard. This week just doesn't stop!

Day Eight: Goniometry!

Goniometry is harder than it looks! That's probably what they expect from us, though. I always knew the therapists I'd observed were masters of measuring a patient's exact body landmarks. Hardest part had to be keeping the proximal arm steady during an active motion. After that it's just a matter of reading the right markings.

Well, the teachers have been saying that we're the "over-achiever" class. Apparently we're far ahead of the previous class. And instead of trying to get us to conform to their idea of where we should be, they simply keep raising the bar. Pretty great quality to have in a teacher.

Day Seven: Almost falling asleep

Definitely had one o' "those" days today. Getting out of school and working out was a really nice reprieve from the doldrums of sitting in a desk for seven and a half hours. All day.

Not to complain. Wednesday will get better. I have Kinesiology lab all day Wednesdays, and that's always a fun course.

We're doing goniometry, too (measuring range of motion in joints) so that'll be real fun.

Day Six: Work, work, work!

SO busy with studying these days I hardly had time to research/write on this blog. Sorry for the late entries. It's been hectic. I had a fun, relaxing weekend full of two whole days of NO school only to follow it all up with a super busy week including my first practical. So, yeah! Go school!

Anyone else get that feeling? I'm sure I'll look back on all this one day and go "Wow, I can't believe I made it this far."

Weekend Article: New Delaware law will include Telehealth outreach, dry needling

Delaware Gov. Jack Markell gushed about a new state law that opened doors for the practice of dry needling (a practice that dates back to the ancient days of Chinese acupuncture) and updated the definition of physical therapy practice in the state -- an update which now includes telehealth plus the ability to allow non-native visiting physical therapists to treat patients when they are "affiliated with athletic teams and organizations or performing arts companies who are temporarily practicing, competing, or performing in Delaware" (Brady 2014).

The move was seen as a major coup for the state Physical Therapy Association, as evidenced by George Edelman, PT, OCS, MTC, president of the Delaware Chapter. "The legislative process was very arduous," Edelman said. "I am grateful for all of our chapter members who attended hearings, met with legislators, and sent emails or made phone calls in support of HB 359" (APTA 2014).

The APTA chapter president could not have been more proud of the trajectory seen for his state. "We are thrilled that Delaware now has a physical therapy statute that reflects 21st century practice" (APTA 2014).

American Physical Therapy Association (APTA). (2014). New Delaware PT law includes Telehealth, dry needling [Press release]. Retrieved from http://www.apta.org/PTinMotion/News/2014/8/22/DelawarePracticeAct

Brady, Gerald L. (2014). House bill 359: An act to amend title 24 of the Delaware code relating to physical therapy and athletic training. Retrieved from: http://www.legis.delaware.gov/LIS/LIS147.NSF/vwLegislation/HB+359?Opendocument

Day Five: Emotional rollercoaster

That's what this week has been, largely. Just a series of ups and downs the size of which left me tired and weak by the end of each day.

Can't say I didn't enjoy it, though!

Future PTA students - those of you who read this blog, anyway - please do take notice. I don't know your program or your instructors. Everything is coming from my personal experience and my own instructors at my own campus. But what IS uniform with your program, most likely, is the pacing of the courses. And it is fast. I have a four-year degree in English from a local university and I've never had to learn so much in so little time. They cram 15 weeks of school into 11 to make room for administrative stuff plus clinicals. And I can guarantee that will be what your program wants from you.

No, if I'd had a better idea of the pace of this program (and had more than just people's words to go on), I'd have had all my homework done well ahead of time. Needless to say, I'm not exactly behind, but getting homework done is a critical process that slows study time down. It's nice to have weekends for a short reprieve, but once Monday hits it's going to hit hard.

I'm just saying: get ahead of the game before it gets ahead of you. That's the lesson I learned the hard way this week.

Day Four: Hellooo practical number one!

First day of Therapeutic Procedures Lab and I'm already signing up for my first practical next week. Luckily it's all about taking vital signs, and aside from a few hiccups, I'm about 90% on those.

We went from being complete amateurs (no vital sign taking experience) to having to master the skill over the weekend; then we did bed dressing and draping & positioning -- e.g. if someone has neck pain you need to position and drape them in the treatment room according to how you treat that pain (fyi - we learned that it's important to have them in a position where you can adequately get to their neck - or whatever part of their body aches).

Bed mobility was our final stop. I'd actually seen some PTAs and nursing assistants from a local home health clinic use a lot of bed mobility techniques on my grandmother a few years back, so there wasn't a whole lot of new ground there. We even got to perform these moves on one another using actual hospital beds so we could see things from the patient's perspective.

I'm learning a ton in a little time, and it's making me anxious - so anxious that one of my classmates read my heart rate at 105 (it was a time error, but it could've happened)! This is probably the most I've had to learn in such a short time. I'm still excited, though. My teacher today said that all the second semester students get to have more fun.

Hope she's right!

Day Three: Well THAT was interesting!

Had my first Kinesiology & Therapeutic Exercise lab today. Was pretty fun! Even for a class that lasted all day!

We were in a class of nine students. We discussed simple biomechanics, learned a few moves (ab/adduction, in/eversion, rotation, etc) and even did some hands-on with one another trying to find bony landmarks and learning how to palpate. Then we practiced our biomechanics moves until lunch break, then came back to do some fun experiments about finding center of gravity in wheelchair patients -- by climbing into wheelchairs and going up and down ramps. It was a pretty full day, too, considering. I started typing this around 4 in the afternoon and had to take a quick nap in between posting it; the day wore me out.

Super late day two post!

I know this is really late, and I have to be brief because it's late and I need to get to bed.

Documentation was the course I had today. Super interesting, fun, and very vital to the profession in every way. We have a fun teacher who is making us teach a skill (any skill we know well enough) to the class and recording it so we can watch it back and grade ourselves. It'll be fun and interesting. I might ask her permission to have the video of myself so I can share it here.

That's really all for now. My schedule was super light today but the work in other classes has me beat.

(First day of) actual class!

WOW. Man, I mean ... Wow. That was a ton of information. I've heard some horribly ill-informed people call PTAs "glorified secretaries," mocking the idea that because they have the word "assistant" in their title, they must not possess any technical medical knowledge. What planet were they from?

Today was an 8am-3:30pm day, roughly. With less than a handful of breaks in between. Man. Just a complete storm of information. I'll definitely have to go back and look it all up again in the teacher's notes because there were times I simply could not keep up.

All that aside, I definitely think this is it. This is where I need to be. With all this suffering and griping about falling behind in my note-taking, and I continue to know in my heart of hearts that coming to this program was not a mistake.

This is how it's gonna be for the next 8-9 months. Better get used to it!

Weekend Article: Neurons from stem cells in rats

I love the field of neurology. It fascinates me that these nerve cells throughout our body act as the medium by which all sensations are felt, all information is synthesized, and all activity in our body is directly impacted. It's very fascinating and it's always something I look for when I scour the web for science news.

In this particular article, it appears that, again, human stem cells are responsible for yet another marvel of modern neuroscience. Scientists at the University of San Diego School of Medicine used human induced pluripotent stem cells (iPSCs) to produce thousands of axons in lab rats with spinal cord injuries (News-Medical.net, 2014).

According to the early online edition of the scientific journal Neuron, Paul Lu, PhD, reported that the human iPSC-derived axons "extended through the white matter of the injury sites, frequently penetrating adjacent gray matter to form synapses with rat neurons" (News-Medical.net, 2014).

The stem cells were derived from a healthy 86-year-old male patient.

What's further fascinating about this study are the larger implications it could have on the very notion that spinal cord injuries will necessarily mean permanent damage to the body. If, for example, we can prove that the mechanisms involved with the growth and extension of these axons can overcome any amount of damage to the spinal cord and further synapse with the host body, even with stem cells derived from fairly aged patients.

To caution the reader, however, senior author Mark Tuszynski, MD, PhD, states that we might have to wait to learn how to control the growth of axons before jumping to human trials.

The enormous outgrowth of axons to many regions of the spinal cord and even deeply into the brain raises questions of possible harmful side effects if axons are mistargeted. We also need to learn if the new connections formed by axons are stable over time, and if implanted human neural stem cells are maturing on a human time frame - months to years - or more rapidly. If maturity is reached on a human time frame, it could take months to years to observe functional benefits or problems in human clinical trials (News-medical.net, 2014).

Tuszynski believes the findings to be extraordinary, however, the research is much too limited yet to properly restore functional use of limbs to the body. "Ninety-five percent of human clinical trials fail. We are trying to do as much as we possibly can to identify the best way of translating neural stem cell therapies for spinal cord injury to patients. It's easy to forge ahead with incomplete information, but the risk of doing so is greater likelihood of another failed clinical trial" (News-Medical.net, 2014).

I will however be updating this blog in the future to see how this plays out. I would love for this to become an opportunity in my lifetime.

But we'll see!


News-Medical.net. (2014). Neurons derived from human iPSC and grafted into rats after spinal cord injury produce cells. News-Medical staff. Retrieved from http://www.news-medical.net/news/20140808/Neurons-derived-from-human-iPSC-and-grafted-into-rats-after-spinal-cord-injury-produce-cells.aspx.

Review: Day Sixteen

Gonna start picking it up with the school work soon. Been studying more muscles than reading lately.

Once our online access is granted, I'm so gonna tear into those assignments and get them done early so they won't be hanging over my head the whole weekend. This has to be a fun weekend for me; there won't be many (or any) after that!

Any other budding PTAs out there know what I'm saying?

Review: Day Fifteen

Gotta make this one shorter than the others. My life outside PTA school is about to become a speck of what it once was. I'll have time to keep up the blog but probably not much. Weekend articles may get smaller, but hopefully nonetheless interesting for you folks to read. Usually they take about an hour to research (including APA citation; I'll get better at that as I go) and roughly 30-45 minutes to type. Might be cutting my overall content by about a third, so it all takes an hour. We'll see! If I have time, my best use of it will be putting my face between the pages.

Got most of my books today, save one. I have to order that one online. It's a lab book though, so I probably won't need it during the first week anyway.

So long for now. Got some muscles to work out before hitting the books again.

Actual homework?

I'm working on my first actual assignment. Yes, they had orientation yesterday, and aside from getting supplies and being super pumped about class starting, I actually have homework!

And it's a book report! Whaaaat.

We all have different nonfiction books that we're supposed to give a presentation on sometime during the third week of class. They're all about people who live with life-changing mental disorders or survive serious injuries. Mine is The Horse Boy by Rupert Isaacson. It's about a father who discovers that his kid is autistic but who also seems to change his attitude around horses. I'm about a third of the way through it now. It's really well written and reads like a great novel.

You can learn a little more about it here: http://en.wikipedia.org/wiki/The_Horse_Boy

Speaking of which, I've gotta get back to it. Wanna finish this thing soon!

Orientation Re-cap

I realize this is a pretty late post, but I've been busy! It was orientation day today.

I won't go into too much detail as to the specifics of who was there and where people were from. This blog won't be doing that. I want to keep my identity (as well as that of my classmates') as incognito as the Internet will allow.

Essentially what happened today was similar to the first day you start a new job: you meet new people, you shake hands and introduce yourself, you make small talk about where you're from and/or why you're there. Eventually you meet the boss(es) who tell you they're excited to work with you and that you'll fit right in (maybe not exactly, but I'll get to that). Then you fill out all the proper paperwork that tells everyone you're you and you're here to fulfill your duties, and you go home. Seven and a half hours after it started.

Today was basically that. I met my new classmates -- who were roughly all around my age, mid/late 20s, mostly from my area; though some were from farther away. We had a little ice breaker activity where we had to learn about the person sitting next to us and present our deskmate to the class. Then the teachers who run the program followed suit, and we started filling out first-day paperwork (health assessment forms, immunizations we had to get, emergency contact info, etc).

A teacher from another department gave us a lecture (with PowerPoint slides) on proper study habits and how to look and act professionally. He was from a research background so the information was presented in a very straightforward albeit lackluster way: and it was only 11am by this point.

Luckily we had a lunch break where we, as a class, got to talk to some students who were in the throes of their final semester of the program. Basically they spent an hour telling us we need to study hard and keep on top of things, because when you slack off in this program, the consequences can be dire (though, to be honest, when is slacking off ever a positive thing?). It was a nice warning, and it felt much more heartfelt coming from another group of young people who have been through it all than it would have if our teachers had kept telling us (like they had been telling us, for weeks now). Very big help, too, was the emphasis on studying muscle diagrams and origins/insertions/actions/innervations. I need to get back on that before next week!

We took a tour of the facilities after lunch, and we got to see where we'd be having labs and lectures. This was less interesting for me because I'd been taking pre-requisite classes on our campus for roughly a year. The building we were in was part of a central campus that houses classrooms for different programs, including the anatomy & physiology classes; I was no stranger to the building layout. It still seemed strange to me that there were people now going to school with me who had never even stepped foot inside my campus before.

After that we returned to our lecture classroom and talked about the PTA student manual for the rest of the time there (a monotonous three and a half hours that was). We got our schedules (which were basically made for us by our teachers; we had no real choice in what to take or when) and after a short Q&A with the director about how to read our schedules (since they were incomprehensible to most) we were dismissed. A lot of students still had to pay for their classes and get equipment and books from the bookstore; I paid for my classes online so I simply left.

So that was orientation. I'd say it was exactly what you'd expect: lot of ice-breaking and paperwork, and then your superiors spend several hours telling you to act and dress appropriately.

Tomorrow I have to get my student ID and parking tag made so security won't think I'm some weirdo hanging out with PTA students. Then I need to work on getting updated textbooks. I'm already a member of my chapter of APTA, who I believe follows this blog (how cool would it be if they read it?).

Just a few more days! Gotta keep it up!

ETA: 16 hours

Roughly 16 hours until I start my orientation. I'm super pumped for it, but I hope I get some actual sleep tonight.

I don't really know what to expect. And whenever I start thinking there'll be a test or quiz of some kind, I start reviewing old A&P notes.

So... tune in tomorrow to find out what actually happens!

Weekend Article: Oh no they didn't!

[Special Note]

This weekend article is a bit different.

As opposed to writing about an event or cutting-edge discovery or change in policies, the article will be about scientific findings and how and why we make certain decisions based on criteria. Most importantly, it will hopefully serve as a reminder that (a) correlation between two events does not equate causation between said events, and (b) just because something was published by a scientific community does not mean it is beyond reproach. These things should be taken into consideration for the following article.

Things might get ugly.

------

On August 7, 2014, the American Heart Association (AHA) and the American Stroke Association (ASA) published a scientific statement about cervical arterial dissections (CDs) and reviews their statistical association with cervical manipulation therapy (CMT). Being that CDs are a statistically high cause for stroke in young and middle-aged adults, the statement sought to review the current state of how CDs are diagnosed and place a particular microscope on how CMT correlates with CDs.

Just to eliminate any confusion, cervical manipulation therapy is a broad term referring to "cervical spine manipulation by any healthcare professional and includes cervical adjustments by chiropractors" (Biller 3). To better define the "healthcare professionals" referred to in the article, AHA elaborates by saying "the majority of spinal manipulations performed in North America are done by chiropractors; however, they are also done by members of the allopathic, osteopathic, and physical therapy/physio-therapy professions" (Biller 3). And because so many people in the United States (and few other territories) use chiropractors and other alternative medical professionals to treat cervical and spinal ailments, they saw fit to review the ways in which these treatments were performed in order to better understand CMT and any possible connection it might have with the rather high incidences of CDs in young adults -- which, by the way, account for 8-25% of strokes in patients under 45 years of age (Biller 1).

So far so good, right? We have so far: a scary high incidence rate of CD in young adults and a sparse connection with CMT -- which, for the most part, is performed by chiropractors and other alternative medical professionals.


Well, it turns out, CDs are a minority when it comes to ischemic strokes (2% in fact), and because of the small incidence rate, only a handful of studies were available that show any sort of connection with CMT at all (Biller 3). Only case-control studies were available to give any sort of usable data, and of those, only 4 exist that provide information on the connection at all -- give them a read. The data from pages 3-4 on Biller's statement provides all the pertinent results and conclusions.

So, not much help there. It actually looks more like the danger of stroke in all of those patients came from the fact that they visited a chiropractor to help them with neck pain rather than any other sort of physician. The AHA says that the patients, while not necessarily having CDs after CMT, should be given a proper warning about the risk of CD in conjunction with CMT when visiting a chiropractor or other healthcare provider (Biller 5).

Basically, the findings of the AHA were for the most part inconclusive and vague at best. Don't take my word for it: the following paragraph was in the conclusion to their statement.

Clinical reports suggest that mechanical forces play a role in a considerable number of CDs, and population controlled studies have found an association of unclear etiology between CMT and VAD stroke in young patients. Although the incidence of CD in CMT patients is probably low, and causality difficult to prove, practitioners should both strongly consider the possibility of CD and inform patients of the statistical association between CD and CMT, prior to performing manipulation of the cervical spine (Biller 14).

In stepped the American Physical Therapy Association (APTA), who wrote a challenge to the article stating that it vastly de-emphasizes the role of the PT in clinical decision making and that judgments made by PTs may reduce the risk associated with CDs in CMT.

Timothy Flynn, PT, PhD, OCS and immediate past president of the American Academy of Orthopaedic Manual Physical Therapists, said that the risk has been studied for over two decades and measures have been put in place to mitigate the risk associated with CMT (APTA 4). He continues to warn readers, however, that the AHA article must be placed in context. "Anti-inflammatory drugs, injections, and surgery for the treatment of neck pain or headaches have much larger risks than manipulation," said Flynn (APTA 6).

Indeed, the AHA has studied the effects of chemical treatments on patients with chronic pains:

...A 2007 AHA scientific statement¹⁰ indicated that for patients with a prior history of or at high risk for heart disease, certain pain relievers known as COX-2 inhibitors could increase risk for heart attack, stroke, and high blood pressure. Also, a 2013 study in Spine¹¹ found that patients who had cervical spine surgery were at significant risk of cardiac and breathing problems as well as gastrointestinal, neurological, blood cell, and urinary tract complications. In addition, there was a greater risk of death after cervical spine surgery among patients older than 65 who had a history of heart problems (APTA 7).

APTA concluded their response by saying that the incidence of CDs after spinal manipulation are rare, and for research purposes there has been no link between the incidence of CD and CMT. "In a 2002 review¹² of 64 cases of cerebrovascular ischemia, or lack of blood flow to the brain, associated with cervical spine manipulation, researchers concluded that strokes after manipulation appear to be unpredictable and should be considered a rare complication of this treatment approach" (APTA 8).

Flynn concluded by saying that APTA provides physical therapists with the tools to properly understand the biomechanics of cervical spine manipulation, including the risks associated with the treatment. "Physical therapists understand the small risk of stroke associated with cervical manipulation, and they base decisions regarding the select use of this procedure on a detailed and ongoing evaluation and a treatment plan that is consistent with patient preferences" (APTA 9).


American Physical Therapy Association (APTA). (2014). APTA responds to American Heart Association cervical manipulation paper [Press release]. Retrieved from http://www.apta.org/Media/Releases/Consumer/2014/8/7/

Biller, Jose, et al. (2014). Cervical arterial dissection and association with cervical manipulation therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke: Journal of the American Heart Association, 1-20. Retrieved from http://stroke.ahajournals.org/content/early/2014/08/07/STR.0000000000000016.full.pdf+html

Review: Day Fourteen

More review of the muscles and nerves. Been studying mostly at work. I'm eight days from quitting my part-time job to devote all my free time to school.

It's been a long struggle but I think I'm finally getting it all together. Mostly now I just have to work on being able to "demonstrate" each action at each major muscle and be able to point out where each origin/insertion is, which can't be as difficult as memorizing each in the first place.

Looking forward to finally getting back into the classroom, though. Those A&P courses are wonderful but they don't adequately prepare you for the rigor of the program (or so I hear); when I did my observation hours a few months ago, I spoke with a PTA who was also a state APTA board member who told me he had (keyword: HAD) to study for four hours a night.

While all the extra study time doesn't bother me much, the class-wide presentations plus the clinicals plus the extra study time might.

We'll just have to see.

TB FREE

I had a bunch of little matters to attend to today (just my car not working, needing new spark plugs and replacing a busted engine coil -- you know, the usual) so this update is  less about A&P review and more about the fact that yaaaayyy I don't have the consumption. My immunization test came back negative, which is a pretty great thing for a budding healthcare professional.

I'll go back to review posts again (since I'll go back to reviewing my notes again) soon but I just wanted to toss that one out there.

Also: if anyone has a suggestion on a PT/physiology related topic to do a long weekend article, I'm all ears!

Review: Day Thirteen

Another day, another re-acquaintance with muscles and bones. I'm getting awesome at determining where each major landmark is, and telling which muscle is which type. Jury's still out on whether I could do it on a test (when it really counts), but I know I won't completely fail either, so that's a slight relief.

A huge milestone for me today was that I bought a new laptop (Acer Aspire E series). It was basically the same price as my old one that busted after four years of extensive use but has twice the memory and RAM -- which is still nothing to write home about really, but it gets my writing and research stuff done no problem, so it's good for school.

I'm sorry these updates have been coming in kind of late recently. It's been hectic getting things done while keeping a regular update schedule. I mean, I hadn't had a laptop for a while. But my updates will be on a regular schedule soon after, and hopefully won't deviate too much from here on.

Review: Day Twelve

Today I got more of the muscle/nerve/bone stuff done while running around getting immunizations and buying equipment. Turns out that my campus bookstore is open during super inconvenient times while the bookstore of a neighboring university (and my alma mater) has the stuff I need at super inconvenient prices. Goniometers? Gait belts? Sphygmomanometers? All terribly priced. BUT at least I'll get them in time, rather than taking time off work to buy ones at slightly reduced prices... right?


Right?


Getting immunizations has been a terrible pain too, but at least it's finally done. I got three injections plus I need to go back for a couple more (two-step/three-step injections). So... here's hoping I don't have TB! Or Hep B! Or Tetanus!


Seriously. Tetanus is nothing to mess with. I have seen photos, and there are a few famous paintings (you can see them online) of people with tetanus. Looks like one of the worst ways to go. Like medieval torture-bad.

Review: Day Eleven

What little time I've spent not doing clerical chores, I've spent either studying or eating meals. It's been pretty much non-stop paperwork chores all day today. Had to get a bunch of pre-orientation materials printed out and turned in to the proper offices, then shop around for equipment (goniometers, gait belt, etc.) for the first lab which I believe we're doing on orientation day. Either way it's better to get the purchase out of the way now rather than later.

I was sent a bunch of review materials through email Friday, and I've been going over them since. It's probably going to take precedence over the muscle origin/insertion/action/nervation stuff though I know those are necessary too. I just can't ever feel 110% confident on any of it, and that frustrates me to a great extent.

In more positive news, however, with all of these chores out of the way, I'm several steps closer to being properly prepared (physically, anyway) for orientation and the start of class proper. I really can't even begin to express how excited I am to finally have classes that seem more than tangentially relevant to my career.

How about you guys? What are your career goals/ambitions? If you're in a health profession already, how do you feel about it and what is your ultimate goal (e.g. academia, research, public office, etc.)?

Weekend Article: Medicare Telehealth Parity Act of 2014

APTA's Web site included a news article about the Medicare Telehealth Parity Act of 2014, a new bill aimed at removing certain limits placed on "population areas that qualify for Medicare's telehealth reimbursements, allow for much-expanded remote patient monitoring, and include rural health clinics as approved telehealth care sites" (APTA 2014). It will also provide that outpatient physical therapy services "delivered via telehealth technologies would be reimbursable under Medicare" (APTA 2014).


Rep. Mike Thompson's (D-CA) law defines remote patient management services as:

the remote monitoring, evaluation, and management of an individual with a covered chronic health condition (as defined in paragraph (2)), insofar as such monitoring, evaluation, and management is with respect to such condition, through the utilization of a system of technology that allows a remote interface to collect and transmit clinical data between the individual and the responsible physician (as defined in subsection (r)) or supplier (as defined in subsection (d)) for the purposes of clinical review or response by the physician or supplier. Such services shall include in-home technology based professional consultations, patient monitoring, patient training services, clinical observation, assessment, treatment, and any other services that utilize technologies specified by the Secretary (pp. 5-6)

Which is a really wordy way of saying you can get consultations and treatment via video services versus coming to an outpatient clinic, or so it would seem. Which makes perfect sense for someone living with a chronic health condition in rural areas.


The current model of Medicare does not provide reimbursement for areas within a certain distance of clinical sites, and there are no provisions for remote patient monitoring. APTA has watched this bill with great interest, and supports its greater purpose.


I think the greater implications here point to the idea that soon physical therapists will be able to provide remote rehab for patients in certain areas, remote follow-up on patients, it would cut down on travel time between sites ... I don't see a whole lot of negatives. The debate in the comment section on the article was fascinating however. You'd think we just replaced physical therapy with robots.




American Physical Therapy Association (APTA). (2014). New Telehealth Bill Includes PTs, Could Mean Big Changes for Medicare. PT in Motion News. Retrieved from http://www.apta.org/PTinMotion/News/2014/8/1/TelehealthBill/.

Thompson, Mike. (2014). Medicare Telehealth Parity Act of 2014. Retrieved from https://s3.amazonaws.com/s3.documentcloud.org/documents/1225617/thomca-062-xml.pdf

Review: Day Ten(?)

It's been a short while since I last updated, and I haven't gotten a chance to do much reviewing, so instead of lying about it I thought I'd just inform you all that this weekend will be a bit of a different pace from the others. That is, I'll probably not get to the weekend article until Sunday evening sometime. I'm in the middle of getting a new computer this weekend for the tax-free weekend, and the lack of an accessible computer/internet connection 24/7 has put a slight temporary damper on my update schedule. Not a problem though, really.


Sorry for the lack of content. Everything will be back to normal Sunday.


In the meantime, anyone have any sports physiology/physical therapy ideas they might want some information on? I can cover a pretty large range of topics. If there are any ideas that might require assistance from someone with more expertise than myself, I can perhaps interview some.

Review: Day Nine

Reviewed more muscle diagrams at work today. Had a good time of it, though I was distracted by my impending resignation from the library, which I sent in to the main administrative offices. One door closing, a much brighter, nicer one opening. Can't complain about that!

Review: Day Eight

More muscle diagrams. Been going over the physical therapy textbooks though. They have some interesting ways of putting it all together that make this seem like more than just a bunch of memorization. It's definitely been worth it to take a look.

I'm hoping when time comes to apply all this knowledge, at least SOME of it will stick. So far it's been eye-opening how much review there is to do in so little time, plus how easily you tend to forget the things you studied when you were in "test mode." I remember going over the nerves and their functions by myself at a local coffee shop and literally just telling myself to "run through them again" if I wasn't 100%. I'm hoping a similar approach will be helpful here (I did well in the nervous system sections of A&P I, after all).

Anyone out there ever had something you just had to get 100% on, regardless of how much of a struggle it seemed? I'd love to know in the comments.

I've been at this pre-physical therapy stuff for so long now it's starting to feel old hat. And I've only been at it a week and a half!

C'mon, school!

Review: Day Seven

Still more muscle diagrams. The muscles of the extremities are the worst. The head, face, and trunk muscles are fine, I have them all down for the most part (only in name and position, not O/I/A/N), but the arm/leg muscles have a lot of little stabilizer muscles that all have a very specific function with very specific origin/insertion/action/innervation.

So, it's been less than fun, you could say!

Anyway. I'll have more about the arm/leg muscles throughout the week, probably.

Review: Day Six

More review. Basic neurology this time. Gotta get those cranial nerves down. Usually I love talking about neurology because it's by far one of the most fascinating and complicated systems in the body.

Reviewing material to get re-acclimated, however, less so.

A friend lent me his textbooks from when he attended the program a few years ago, so I'm trying to integrate some of the information in those books with my old anatomy text. It's actually going far better than I expected.

Anyone out there ever had a similar experience? Trying to study a bunch of things at once and just trying out different ways of integrating said material? I don't believe in the old "sleep with your book under your pillow" tripe a lot of old teachers used to joke about doing but I'm willing to try almost anything.

Weekend Article: Posture shirts

So I recently mined the American Physical Therapy Association’s (APTA) Web site for a topic I could write about in my first weekend big-issue article when I came across a blurb about a Wall Street Journal article on “posture shirts.”

I read the article (which was a little more of a review than a proper article) and while it had its share of upsides and downsides to the product, it had a much more important underlying message, one which has been with physicians and therapists alike: this is a great product, but by no means is it a panacea for all your aches. In order to more fully improve one’s posture, effort is still required on the part of the patient.

It should be noted that, with this being a general article on the health and well-being of their readers, the Wall Street Journal is not by any means a scholarly research organization that devises experiments and performs research based on furthering the community built by scientists and physicians alike. While I’m sure their reporters are well-meaning and have no ill will toward their readers, it’s also not entirely certain that they have all the proper data with which to give a completely unbiased opinion of any products endorsed or otherwise mentioned on their pages.

All that being said, it does seem that these shirts have positive results with a large portion of their clientele, which includes athletes and trainers.

According to the report, the shirts use “elastic bands to press gently on upper back and shoulder muscles, giving them a ‘mini-massage’ and helping to activate the muscles” (Johannes 2014) which is expected to help you improve your posture while sitting or standing. AlignMed Inc., the company responsible for creating the shirts and partially funding the studies, has lightweight and heavyweight models for $95 and $195, respectively.

The preliminary findings of studies performed on major and minor athletes have been somewhat positive, but scientists say that more research is required to give a more conclusive resolution (Johannes 2014). It should be noted too that while the shirts have shown improvements in posture, all patients given the shirts were under the guidance of the Department of Orthopedic Surgery at the University of Southern California’s (USC) Keck School of Medicine. This means that the patients, while athletes (mainly professional baseball and golf players), were under the care of not only the president and founder of AlignMed Inc., but also a team of researchers dedicated to studying the effects of the shirts on posture. They were patients who typically use their arms frequently in their sport, such as pitchers. It’s also interesting to point that, among the baseball pitchers studied, “difference in pitching speeds wasn't statistically significant over the entire three-inning test but there was a significant improvement in blood flow to the pitching arm” (Johannes 2014), according to Dr. C. Thomas Vangsness, a professor of Orthopedic Medicine at USC.

Most importantly, and I believe more to the point, these posture shirts have shown some improvements in patients over time, but “it's also important to correct the underlying issues that may be causing posture problems, such as an imbalance between strong pectoral muscles and weaker back muscles, says Timothy Sell, a physical therapist and associate professor in the department of sports medicine and nutrition at the University of Pittsburgh” (Johannes 2014).  This quote I believe sums up any and all products shown to improve balance and/or posture issues. While the symptoms of one issue may be gone, the underlying problem causing said symptoms is the real enemy. Knowing the difference can save you hundreds if not thousands of dollars on unnecessary treatments.

I’d like to end this article by simply stating that, with all of the wonderful technology we have available, it’s important to realize that the elements of human effort and care are needed when discussing matters of health and well-being. We need to remember that fancy tech products are not the only things responsible for caring for us; we have to take responsibility for our own well-being, first and foremost.

Johannes, Laura. (2014). Can a shirt help improve your posture? The Wall Street Journal Online: Aches and Claims. Retrieved from http://online.wsj.com/articles/can-a-shirt-help-improve-your-posture-1405980827.

Review: Day Five

Today I had to go back to work at my library job (which I've been intermittently doing this week) so I couldn't get a whole lot of study/review time in, but I did break out the muscle O/I/A/N sheets and start to glance at them a bit. It's hard to study on 15 minutes of break time, however, so I think I'll have to give it another go later on tonight perhaps.

I'll be finishing up my review work this week and you won't see a post from me on Saturday (Saturdays will be my off days/research for big article days). I'll pop back on Sunday though and give the "long article" thing a go for the first of it. I have a few ideas in the pipeline, but I have yet to fully form them in my head and research them. Again, this is something that requires more time and preparation than I'm clearly giving it at the moment...

I'd be interested in hearing topics from any of you out there who might be learning about the human body or anything physical therapy/medical related. I can even make it about something fitness oriented (sport physiology totally overlaps with the purpose of this blog) as long as we concern ourselves with covering the topic in some level of technical detail. Maybe to give an example: the physiology of gait training/how it relates to balance and performance in sports? As opposed to just a general article about walking upright.

You get the idea.

I'll be thinking about it. I'll get back to you on Sunday.

Review: Day Four

Decided to kind of take it easy with the memorization today and mostly reflect on what I've learned the last few days. Taking in manageable chunks of information at a time. Find (or make) some questions to test my knowledge, answer (or look up answer), rinse and repeat.

So you could say it's been a bit hard translating 3-3 1/2 chapters into one long study session, but my hope is that if I simply keep at it long enough it'll stick.

This is how I spent most of my time in A&P, basically, just going over the fundamentals. Luckily my textbook has exercises that put my knowledge to better use than simply "knowing the answer;" we had a whole section of clinical thinking exercises that place our terms in realistic situations we may or may not encounter, and had us thinking through the problems until we came to proper conclusions (it's almost like you have a bit of lee-way in terms of said conclusions; more than one way to peel a potato, so the expression goes).

So that's been a fun reprieve. Any of you out there enjoy studying A&P so much you can't wait to get to those sections? They do help put things in perspective. I also enjoyed creating case studies surrounding health dilemmas and having to think them through with my classmates. I've never felt so happy putting "hypoglycemia" on a piece of paper when we came to the diagnosis.

Review: Day Three

I'm pretty much spending all my time on histology and cells today. It's been a long time since I had to even look at a cell through a microscope, much less talk about mitochondria and epithelial cells. I've always hated discussing those chapters, they were never my strong suit. I'm more of a bones/nerves/muscles kinda guy myself.

Speaking of which, bones/nerves/muscles are, from what I understand, the majority of the review I absolutely need to have memorized and able to quickly recall when thinking about the human body. I guess I really do need a lot more than that, but I've been hearing a lot about daily tests in which you need to know proper origins/insertions/nervations for each muscle in every major muscle group.

So that's fun. I might need to work on that, especially.

What were some of your strengths/weaknesses when it came to studying/working with the concepts of A&P? What did some of you out there enjoy or hate about your favorite/hated section? I really wanna know!

Review: Day Two

Things are coming along a little better. I started off with the utmost basic of topics yesterday (organization of the body, cells and organelles, etc.) and am now onto the chemistry review -- which typically serves to remind you of the things you may have forgotten in Chem 101. It’s all fairly simple, and a diligent student like myself (I can hear my family and friends laughing at that one) should be able to recognize most of the major concepts on a test or review of some sort, given one.

I know full well my study time is not going to move as quickly as this. Pretty soon I’ll be spending an entire afternoon on trying to remember all the bones and their markings (which was NOT some of my favorite material to remember, regardless of how useful it is).

If any of you out there are or were in PT school (or med school, or nursing school, etc.) and had to take A&P as a course, what were some of your favorite/least favorite things about your courses? What made you want to come to class every day, and/or what made you completely hate it? Let me know in the comments!

Also, if any of you have any improvements and/or comments/criticisms about the blog, let me know too! I’d like to hear your opinions. The amount of planning that goes into the content of this blog is very stream-of-consciousness, so if there are things I can implement that would maybe streamline things a little bit (I’ve thought of opening a Twitter and sending out tweets about new posts, maybe I’ll do that for weekend posts? I dunno), I’d like to hear your opinions on the matter. Help me help you!

Review: Day One

My big orientation day is August 12. Until then, I’m studying like a first-time A&P student taking his first large exam: trying to cram as much information in on one day as I can remember.

I did fairly well in A&P 1 and 2 when I took them over a year ago, but everyone who’s been in school as long as I have knows full well the rule “if you don’t use it, you lose it.” NEVER is this truer than when studying something as complex as the human body. NEVER. So here I am, filling out sections on a review guide on the human body when I realize that half the material looks almost brand-new. Not a great way to start. A friend of mine once told me that he and his classmates got into the habit of telling their teacher “I promise I’m smarter than this” when he did the program a few years ago. I’m hoping to minimize those moments as much as possible by jumping on this review now and hopefully getting a majority of it down so I can recall the information when needed.

Hello, World!

Hello everyone! Welcome to my blog, PTA101.

In this blog, I plan on giving you daily updates on some of the cool things I'm learning in my physical therapy assistant classes. On weekends I'll be posting much longer articles with more in-depth discussions into the material -- articles on topics ranging from kinesiology, interventions, medical terminology, etc.

You can also think of this blog as a glance into the life of a typical PTA student. I’ll update each day with a new fact or topic that pertains both to the things we’re learning and to my own personal opinions on such topic(s). I’d like to keep this blog as informative as it is fun.

Each daily update should be about the length of this current post, with longer weekend posts running maybe 2-3 times longer (and involving a lot more text!).

Thanks for stopping by! I'm excited to start this journey, and hopefully you'll enjoy reading about it as much as I enjoy experiencing it!