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.