Making Waves With Aquatic Therapy
Transcription
Making Waves With Aquatic Therapy
|Oct 2012 Making Waves With Aquatic Therapy Emerging Leaders 2012 Resources: Claims Database ACA Medicaid Expansion Ads 1012.indd c2 8/30/12 1:52 PM Ads 1012.indd 1 9/6/12 9:01 AM O c t o b e r 2 012 , Vo l 4 N o 9 16 Water: A Tool for Healing 28 24 The Candidates “Face-off” on Health Care 16 Making Waves With Aquatic Therapy 24 Romney vs Obama on Health Care 28 Emerging Leaders A growing number of PTs are incorporating aquatics into physical therapy interventions, helping a wider range of patients and clients. Leaders Emerge Cover Image: iStock Where do the presidential candidates stand on health care issues? Twenty-one physical therapists were named this year’s APTA “Emerging Leaders.” Here is an in-depth look at what inspired them, their goals, and what they’ve learned. © 2012 by the American Physical Therapy Association (APTA). PT in Motion (ISSN 1949-3711) is published monthly 11 times a year, with a combined December/January issue, by APTA, 1111 N Fairfax St, Alexandria, VA. SUBSCRIPTIONS: Annual subscription, included in dues, is $15. Single copies $20 US/$25 outside the US. Individual nonmember subscription $85 US/$100 outside the US ($150 airmail); institutional subscription $105 US/$130 outside the US ($180 airmail). No replacements after 3 months. Periodicals postage paid at Alexandria, VA, and additional mailing offices. POSTMASTER: Please send changes of address to PT in Motion, APTA Member Services, 1111 N Fairfax St, Alexandria, VA 22314-1488; 703/684-2782. Available online in HTML and a pdf format capable of being enlarged for the visually impaired. To request reprint permission or for general inquires contact: [email protected]. APTA is committed to being a good steward of the environment. 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Summit of Achievement A physical therapist hits the heights. PT Resource Health Care Headlines 8 Practice Partner 8 Business Sense 10 Research Roundup 12 The Funny Bone 12 Data Points 14 Career Opportunities and Continuing Education 4● October 2012 PTinMotionmag.org 57 Marketplace 64 Index to Advertisers 66 Ads 1012.indd 5 8/30/12 1:58 PM American Physical Therapy Association 1111 N Fairfax Street Alexandria, VA 22314-1488 703/684-2782 • 800/999-2782 [email protected] Association Staff Publisher Magazine Staff Advertising Sales Office Editor Ad Marketing Group Donald E. Tepper [email protected] 2200 Wilson Boulevard, Suite 102-333 Arlington, VA 22201-3324 Associate Editor Product Display Advertising Eric Ries [email protected] Jane Dees Richardson, President 703/243-9046, ext 102 [email protected] Lois Douthitt Production Manager—Print and Digital Media Vice President for Communications Suzanne B. Kitts [email protected] Felicity Feather Clancy Director, Art Department Barbara Cross Recruitment and Course Advertising Meredith Turner 703/243-9046, ext 107 [email protected] Art Director, PT in Motion Alden Escobar [email protected] Chief Executive Officer John D. Barnes Advertising Manager Julie Hilgenberg [email protected] APTA Board of Directors Editorial Advisory Group Officers Directors President Jennifer Green-Wilson, PT, EdD, MBA Jeanine M. Gunn, PT, DPT Roger A. Herr, PT, MPA, COS-C Dianne V. Jewell, PT, DPT, PhD, CCS Stephen M. Levine, PT, DPT, MSHA Kathleen K. Mairella, PT, DPT, MA David A. Pariser, PT, PhD Mary C. Sinnott, PT, DPT, MEd Nicole L. Stout, PT, MPT, CLT-LANA Paul A. Rockar Jr, PT, DPT, MS Vice President Sharon L. Dunn, PT, PhD, OCS Secretary Laurita M. Hack, PT, DPT, MBA, PhD, FAPTA Treasurer Elmer R. Platz, PT Speaker of the House Shawne E. Soper, PT, DPT, MBA Charles D. Ciccone, PT, PhD Gordon Eiland, PT, MA, SCS, ATC Chris Hughes, PT, PhD, OCS Elizabeth Ikeda, PT, MS, OCS Benjamin Kivlan, PT, MPT, SCS, OCS Peter Kovacek, PT, DPT, MSA Robert Latz, PT, DPT, GCFP Alan Chong W. Lee, PT, DPT, PhD, CWS, GCS Daniel McGovern, PT, DPT, SCS, ATC, CSCS Tannus Quatre, PT, MBA Keiba Lynn Shaw, PT, MPT, EdD Jerry A. Smith, PT, MBA, ATC/L Mike Studer, PT, MHS, NCS Sumesh Thomas, PT, DPT Mary Ann Wharton, PT, MS Vice Speaker of the House William F. McGehee, PT, MHS DISCLAIMER: The ideas and opinions expressed in PT in Motion are those of the authors, and do not necessarily reflect any position of the editors, editorial advisors, or the American Physical Therapy Association (APTA). APTA prohibits preferential or adverse discrimination on the basis of race, creed, color, gender, age, national or ethnic origin, sexual orientation, disability, or health status in all areas including, but not limited to, its qualifications for membership, rights of members, policies, programs, activities, and employment practices. APTA is committed to promoting cultural diversity throughout the profession. ADVERTISING: Advertisements are accepted when they conform to the ethical standards of APTA. PT in Motion does not verify the accuracy of claims made in advertisements, and publication of an ad does not imply endorsement by the magazine or APTA. Acceptance of ads for professional development courses addressing advanced-level competencies in clinical specialty areas does not imply review or endorsement by the American Board of Physical Therapy Specialties. APTA shall have the right to approve or deny all advertising prior to publication. 6● October 2012 PTinMotionmag.org THE APTA MARKETPLACE IS YOUR ONE-STOP-SHOP FOR NATIONAL PT MONTH The Marketplace is your online destination for Move Forward™ logo apparel and specialty items for National PT Month. Take a tour at www.apta.org/Marketplace and check out the fresh assortment of products. Take advantage of bulk discounts and customization options on great gift and giveaway items for your patients and clients, classmates or students, friends and colleagues, staff and participants at community events, and a whole lot more. Visit www.apta.org/Marketplace today for all of your National PT Month essentials! Ads 1012.indd 7 8/30/12 1:59 PM PTResource HealthCareHeadlines Online Insurance Claims Database Opens to Researchers FAIR Health recently launched the Health Research Support Program, which allows licensing of data from its health insurance claims database by academic researchers in a variety of fields including health care policy and economics. FAIR Health is a national, independent, not-for-profit corporation created in 2009 to bring transparency to health care costs. In addition to researchers and policy makers, services are available to consumers, the health care community, employers, unions, and government agencies. The FAIR Health database includes over 14 billion charges for medical and dental procedures performed nationwide since 2002. Data are submitted by more than 70 private payers. FAIR Health details some of the ways researchers can use the data, including to: • Evaluate the impact of regulations and legislation on health care utilization, cost, preventive care, and treatment protocols; • Identify disparities in health care service utilization; • Compare prices of 2 or more health care procedures or products; and • Assess how prices for specific services or procedures vary by specific factors including geographic area, economic factors, and provider density. There is a charge to access the data through the Health Research Support Program, depending on the quantity of data, detail of the data, and the type of researcher. Charges range from $1,440 for students accessing 1 year of data to $99,000 for an institutional site license accessing 3 years of data. A sample data file is available at no cost. More info: http://research.fairhealth.org/ResearchProgram PracticePartner Use Typologies to Motivate Patients What’s the best way to motivate your patients? According to Verilogue—a company that specializes in providing linguisticbased market research by analyzing patient-health care provider interactions—patients can be divided into 6 typologies. Verilogue explains, “Understanding how patients in a particular disease state communicate is key to determining how to reach, influence, and motivate them. While more-engaged patients will actively search for information, assiduously keep track of their test results, and voice their opinions on treatment plans, less-engaged patients rely on their [health care providers] for information, seldom ask questions, and defer to their doctors for all treatment decisions.” The 6 patient types are: The Passive Patient, The Victim, The Student, The Detective, The Advocate, and The Physician Partner. Here’s a representative sampling of 3 of the 6 patient typologies across the spectrum, accompanied by Verilogue’s advice on how best to communicate with and motivate them: The Passive Patient: The Passive Patient responds to direct probes but rarely provides personal details or feelings. Advice: Because Passive Patients are unlikely to proactively search for information relating to their illness or treatment, it’s best to 8 ● October 2012 reach them either directly in the doctor’s office—for instance, with brochures in the waiting room or information materials [that can be handed out and reviewed] or in other locations (real or virtual) they frequent. The Student: The Student engages in disease and treatment discussions with many questions, although this is primarily a means of gathering information, rather than to influence the treatment decision. Students also look for confirmation of their suspected understanding of what’s happening in their bodies. Advice: Students are avid consumers of information . . . Try drawing them in with straightforward, compelling information that makes them feel more in control of their illness education and experience. The Partner: The Partner positions himself or herself as a full partner in the disease and treatment discussion. Partners bring a high level of knowledge and research to the [health care provider’s] office and speak fluently about their experience and needs. Advice: Appealing to their intelligence and desire to have control over their illness experience—and giving them tools to do so more easily—should pique their interest. More info: http://ww2.verilogue.com/The-Big-Book-of-Patient-Typologies.html. PTinMotionmag.org PTResource 3 Ways to Reduce No-shows Cancellations and no-shows are a continuing challenge for many physical therapy practices. Cancellation rates vary widely from one practice to another, but a cancellation rate of 2%-4% is inevitable for most practices. A higher cancellation rate (12%-14% or more) is a cause for concern that should be addressed. Many clinics don’t consider the financial impact of missed appointments. For example, if a clinic has a net profit margin of 15%, a cancellation rate of 12%-14% could eliminate virtually all the net profits. What are some effective techniques for minimizing this problem? The front desk personnel play a critical role in minimizing cancellations. They should be friendly yet firm and must know when to strike a balance. Here are 3 steps your front desk person should take: 1. Immediately have the patient schedule a full series of appointments. Use a script. Here’s an example: “We have these slots available in the therapist’s schedule over the next ____ weeks. Will Mondays and Thursdays at 4 pm work for you?” Patients should not “come in when they have time” or “call back to schedule.” The goal is to get them to commit in person, immediately after their initial evaluations. Also, try to persuade patients who have a flexible schedule to commit to an offpeak time slot. Again, use a script. Here’s an example: “By cancelling or rescheduling an appointment, another patient loses his slot and the physical therapist’s treatment time is lost. Therefore, we ask for your understanding in respecting the schedule of the therapist and the value of the treatment time for other patients. Thank you for your appreciating our commitment to a high quality of service. This helps you and all our patients.” Enforce your policy. Otherwise, your clinic will experience a loss of credibility. If you decide to have a cancellation policy, it must be implemented. Consult your insurance providers if you are unsure about a cancellation policy and how it affects your relationship with Medicare and other payers. 3. Send text and e-mail reminders. Follow up with patients using a text, e-mail, or phone call appointment reminders. Again, use a script. Your front desk staff should contact the patient on the second day after the initial evaluation to remind the patient about the appointment schedule. Then, the day before the appointment, provide a courtesy reminder. Many automated systems can help streamline this process. Nitin Chhoda PT, DPT, is the author of Physical Therapy Marketing for the New Economy. It can be downloaded at no charge at www.physicaltherapywebsite.com. 2. Reiterate the cancellation policy. You may consider charging a nominal penalty—such as $10—for patients who cancel with less than 24 hours’ notice. Combine a penalty amount and a cancellation deadline. Test to see which is most effective. Don’t let patient objections discourage you. Instituting a cancellation policy is, at worst, a short-term hiccup. But the results will prove to be a long-term benefit. ● 9 PTResource BusinessSense 6 Tips to Selecting the Right Documentation System for Your Practice Advances in technology are enabling practice owners to increase efficiencies and become more profitable. One example is the automation of clinical documentation. In addition to allowing physical therapists to capture and manage more complete and accurate clinical data, documentation systems can reduce scheduling challenges. Here are 6 steps to help you determine the needs you want addressed, and how to select a vendor to accomplish those goals. 1. Know your requirements. One size does not fit all. Systems designed specifically for a physician practice or hospital rarely will meet the case management process demands of a physical therapy practice. Look for a vendor that specializes in services for outpatient rehabilitation. The system should accommodate the daily operations and the requirements of a therapy practice. This is especially important when considering Medicare’s documentation requirements. Training should be viewed as an investment and leveraged to ensure optimum results from the system. 5. Make sure it is regulatory compliant. Compliance is essential in today’s audit-driven environment. Systems should have built-in rules and logic to assist in ensuring that all clinical documentation is compliant. Clinical documentation must be defensible and support all of the charges associated with each patient encounter. 6. Demand an ROI analysis. Vendors should be able to demonstrate and have references for a proven return on investment (ROI). Make sure the ROI analysis was developed for physical therapy practices. An ROI analysis addressing the documentation system for a hospital or physician practice will not provide an accurate analysis for outpatient rehabilitation practices. —David McMullan, PT, is vice president of product management for SourceMedical. 2. Consider vendor viability. Look for a proven track record and adequate company resources. Typical benchmarks include how long the company has been in business, its financial stability, its reputation, its client list, and the number of systems installed. 3. Understand the total cost of ownership. Rather than focusing solely on what a system costs per month or the license fees, consider the total cost of ownership. Include training, implementation, ongoing support, and maintenance costs. Ask about other potential costs such as hardware or technology upgrades, Internet access, and bandwidth requirements. 4. Ask about training. Understand the vendor’s training. Does it offer a variety of methods? What about ongoing training? Because employee turnover occurs, the vendor should offer ongoing staff training as needed. 10 ● October 2012 PTinMotionmag.org Ads 1012.indd 11 8/30/12 2:01 PM PTResource ResearchRoundup Physical Activity Fails to Counteract Sedentary Lifestyle in Children Children who spend more than three-quarters of their time engaging in sedentary behavior (SB), such as watching TV and sitting at computers, have up to 9 times poorer motor coordination (MC) than their more active peers, according to a recent study. However, the study also found that physical activity (PA) alone was not enough to overcome the negative effect of sedentary behavior on basic motor coordination skills such as walking, throwing, or catching. The researchers studied 110 girls and 103 boys aged 9 and 10 for 5 days with accelerometers attached to the children’s waists. Motor coordination was evaluated with the KTK test (Körperkoodination Test für Kinder). Girls who were sedentary 77.3% or more of the time were 4-5 times less likely to have normal motor coordination than more active girls. However, boys who were sedentary for more than 76% of their time were 5-9 times less likely to have good or normal motor coordination than their active peers. The study observed, “Mounting evidence has suggested recently that time spent in SB is associated with adverse health outcomes, an association that may be independent of the protective contributions of PA . . . Our study suggested that high time spent in SB was a predictor of low MC, regardless of PA levels and other cofounders . . . Our findings suggest that PA levels per se may not overcome the deleterious influence of high levels of SB on MC. Therefore, actions aiming to address the current inactivity crisis should attempt to both increase PA levels and decrease SB.” Lopes L, Pereira B, Santos R, Lopes V. Associations between sedentary behavior and motor coordination in children. American Journal of Human Biology. July 2012. DOI 10.1002/ ajhb.22310. TheFunnyBone My sister-in-law Jean Andrianoff works in the front office of our small physical therapy clinic. She heard incorrect use of the verb “to lie” one too many times, and so she decided to write a poem to help us PTs with our grammar. Please Don’t Lay on the Table! As an ex-English teacher, I have a pet peeve When I hear spoken words that I’d like to retrieve, Such as, “Lay on the table, please.” What do you think? That the man will lie down and lay eggs in a wink? If a patient must take a prone position To receive the treatment prescribed by physician, Invite him to LIE on the mat, if you please, And you’ll find he observes your request with great ease. If her purse or his book is the object in question The patient can easily take your suggestion To LAY the said object wherever you ask. He will put it down gladly, prepared for his task. But the poor chap can’t lay, try as he might. He’s come for PT and it just isn’t right To ask him to try like a cackling hen To lay on the table and count up to ten. Art by Mike Ferrin Do you have a funny story that you’d like to share? If so, e-mail [email protected]. 12 ● October 2012 So if you want eggs, please go to the store. But when talking to patients, I beseech and implore That each person politely be asked to LIE down After LAYING down things they have carried around. —Jeanne Dirksen, PT PTinMotionmag.org Ads 0912.indd 13 8/30/12 4:45 PM PTResource %DataPoints Health Care Employment Rose in July The Monster Employment Index U.S. grew 2% in July, the 29th consecutive month of positive year-on-year growth. However, it reflects a slowdown from the 5% rate in June. Transportation and warehousing recruitment continued to place among the top sectors with 11% recruitment growth, at a moderating pace compared with 22% in June. Health care and social assistance was up 9% over the previous 12 months. Growth was particularly strong in some of the non-practitioner subcategories, including information and records workers, as well as technicians and personal care workers. Among major metropolitan markets, Houston was the growth leader. Los Angeles continues to gain momentum, while metros such as Pittsburgh and Minneapolis are down in the rankings Meanwhile, online advertised vacancies fell 153,600 in July to 4,793,500, according to The Conference Board Help Wanted OnLine® (HWOL) Data Series. The supply/demand rate stands at 2.6 unemployed for every vacancy. In June the number of unemployed was 7.8 million above the number of advertised vacancies compared with 10 million above in the fall of 2011. Economy at a Glance July 2012 Unemployment Rate1 8.2 8.3 Change in Payroll Employment2 64P 163P Consumer Price Index3 0.0 0.0 Producer Price Index4 0.1P 0.3P Employment Cost Index5 * P 1 2 3 0.5 All data seasonally adjusted Preliminary Percentage In thousands All items, 1-month percent change Source: Bureau of Labor Statistics, Department of Labor. Available at www.bls.gov/eag/eag.us.htm Offices of Specialty Therapists, NAICS Code 62134 30 20 23.38 15 24.57 3,500 24.93 25.27 25.41 -2.8% change 3,400 Source: Bureau of Labor Statistics, Department of Labor. Available at www.bls.gov Operating Metrics Of Selected Health Care Companies HLS THC USPH KND Income/Employee 5,218 676 8,607 -774 Revenue/Employee 93,610 154,320 96,290 75,960 Asset Turnover 0.89x 1.06x 1.52x 1.42x 1.94x ReceivablesTurnover 9.17x 6.62x 7.99x 5.85x 15.38x Current Ratio 1.34 1.33 3.20 1.46 4 Finished goods, 1-month percent change 5 Civilian workers, 3-month percent change Average Hourly Earnings of Production Workers 25 PT Employment Trends 2010-2020: Government 2020 June 2012 More info: www.monster.com and www.conference-board.com. 2010 1st Qtr In July 4 of the 22 major occupational groups in the Standard Occupational Classifications (SOC) posted gains while 18 declined. Health care practitioners and technical fell 25,200 to 590,600. However, that classification still has a very strong supply/demand ratio of 0.41. Largely responsible for the drop were decreased advertised vacancies for physical therapists, occupational therapists, pharmacy technicians, registered nurses, and speech pathologists. The Bureau of Labor Statistics reported that job openings for June in the category of health care and social assistance were 644,000. That represents an increase of 2.4% over the May levels and a strong 20.4% over the levels a year earlier. The 644,000 openings is the greatest since July 2008. Job openings have increased monthly since February 2011, and only 3 times since then (in February, April, and October of 2011) has the monthly growth in openings been less than 13%. Hiring in the category of health care and social assistance was 419,000 in June. That represents a 10.1% drop from the May level, but only a 1.9% drop over the levels of a year earlier. IND. AVG. 40,744 1,521,370 1.39 All data areTTM (trailing twelve months). 10 5 0 2008 2009 2010 2011 June 2012 HLS: HealthSouth THC: Tenet Healthcare USPH: US Physical Therapy Inc KND: Kindred Healthcare Source: Bureau of Labor Statistics, Department of Labor. Available at www.bls.gov 14 ● October 2012 PTinMotionmag.org * Last 4 quarters + Rounded to nearest dollar Information updated: 8/10/12 Source: Fidelity Investments: Available at www.Fidelity.com Ads 1012.indd 15 8/30/12 2:03 PM Making Waves With Aquatic Therapy By Lisa Iannucci A growing number of PTs are incorporating aquatics into physical therapy interventions, nterventions, helping a wider range of patients and clients. lients. S arah Killian, PT, MSPT, ATRIC, recalls a recent patient. He was a male in his 60s diagnosed withh a massive rotator cuff tear. He was experiencing a high an level of pain and was unable to lift his arm. His physician gery. anticipated that the patient would have to undergo surgery. apy Aquatic therapy was incorporated into his physical therapy hat plan of care, allowing the patient to perform exercises that would have been impossible on land. Ultimately, the patient was able to avoid rotator cuff surgery. on That, Killian says, helps demonstrate the added dimension ntions. that aquatic therapy can add to physical therapy interventions. cial Killian is a physical therapist (PT) with Hospital for Special Surgery Sports Rehab and Performance Center in New York. sical A growing number of PTs are turning to aquatic physical therapy to treat patients with myriad health conditions. Water therapy has been shown to help joint pain and stiffness, muscle brospasms, back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia, lymphedema, systemic lupus erythematosus andd much arch more, the PTs interviewed for this article say. [See “Research Supports Aquatic Interventions”] 16 ● October 2012 evidenc ncce ha hhas as “Over the last 20 years, a substantial body of evidence chhililddrreenn accumulated to support the use of aquatic therapy for children and adults with musculoskeletal, neuromuscular, and cardiopulmonary disorders,” says Yasser Salem PT, PhD, associate professor in the Department of Physical Therapy at University of North Texas Health Science Center. “Also, adults who have had strokes, multiple sclerosis, and Parkinson disease can benefit from aquatic therapy to improve balance, strength, walking, functional abilities, and their ability to perform activities of daily living.” The Benefits of Water What makes water such a we well well-tolerated ll-tolerated form of eexercise xerc xe rcis isee to land-based land la ndd-b -bas assedd physical phy hysi sica ica call therapy? ther th erap apy? ap y? “It It and an effective adjunct to non-weighhtt-bearing or limited weight-bearing wei eigh ghtt-be gh beari bear arin ar ing ex ing exer ererer allows for non-weight-bearing exerrelaxati tion,, decreases decrea de ease ea sees muscle musc mu scclee spasms, scle spa pasm ms, s iincreases n re nc reas ases as es cises, promotes relaxation, impproves circulation, ciirc rcul ulat ul atio at ioon, increases inc ncre reas asees as es tthe he eefficiency ffic ff iciienc ic ncyy range of motion, improves sys yste tem and annd cardiac carddia i c output, ouutpput ut, an ut, nd de ddecreases ecr crea rea ease ease ss of the respiratory system and laccta tate,” says say ayss Karen ay Kare Ka renn Good, Good Go odd, PT, PT T, OCS, OCS, OC S, edema and muscle lactate,” physic ical al therapist at at the thhe Kennedy K nned Ke edy dy Krieger Krie Kri Kr iege ieg ger ger ATRIC, senior physical Baltimore re, Maryland. Institute in Baltimore, PTinMotionmag.org ● 17 17 Good Hardy Studer Water also reduces the risk of injury and provides security to the patient. “The patients can lose their balance and know they aren’t going to fall immediately [and injure themselves],” says Mike Studer, PT, NCS, CEEAA. Studer is president and co-owner of the Northwest Rehabilitation Associates in Salem, Oregon, and vice president of APTA’s Neurology Section. “We have an 80-year-old male patient with neuropathy who had a long history of falls,” explains Studer. “He has painful arthritic joints, limiting his ability to engage in therapy, but he walks in the water. It doesn’t hurt because of the buoyancy. And he knows that if he loses balance, he’ll just make a splash and not fall on the ground, so he can regain his balance in a non-threatening environment.” Studer explains that in some situations, especially postsurgical, aquatic therapy is only temporary, designed to improve early mobilization. “We then progress them on to land-based exercises before discharge,” he says. “As the science of geriatric rehabilitation has improved, we’re less fearful about increasing the dosage of exercise. We know that patients who are older can improve strength and endurance. It’s a gradual process, but research shows that we can expect improvements.” When Leonard Hardy, PTA, BS, ATRIC, began in aquatic therapy in 2007, he didn’t see many geriatric patients in the water. “Many skilled nursing facilities don’t have pools because they are expensive,” he says. “Many outpatient facilities typically contract out to the local YMCA, community pools, or university pools to provide aquatic therapy services. In the majority of these pools, the temperatures are too cold for geriatric clients. Community pools often maintain temperatures of 86 to Storm Warnings Hoy 18 ● October 2012 Although aquatic therapy offers many benefits to patients with a variety of ailments and conditions, there are also some cases in which it shouldn’t be used. They include: • Patients with infectious or water borne diseases. • Patients with open wounds. “Wounds can become infected,” says Hardy. “If the patient has a wound from surgery, we request approval from the surgeon or physician before aquatic therapy. Additionally, even after medical clearance I put a special dressing over the wound to protect from infection.” • Patients with severe seizures. • Patients with fixed contractures. “This is a joint that can’t move fully through a range of motion or is stuck in that position,” says Karen Good, PT, OCS, ATRIC, senior physical therapist at the Kennedy Krieger Institute. PTinMotionmag.org 88. We maintain our pool at a temperature of 91-93 degrees.” Hardy is with Tender Touch Rehab Services in Lakewood Township, New Jersey. Hardy describes the benefit of water therapy for 1 particular patient who had a total knee replacement. “The patient had active range of motion (AROM) of -10 to 75 degrees 3 days postop and needed a roller walker for ambulation,” says Hardy. “The patient was unable to ascend and descend stairs. Balance was poor.” Not a good situation for a patient who had to climb 5 stair steps to get into his home and 15 stair steps once inside. The patient first received land-based physical therapy. Then aquatic therapy was added. “After 1 week the patient’s AROM increased to -3 to 90 degrees,” Hardy says. “After 2 weeks, the AROM increased to 0 to 97 degrees, and the patient was able to ambulate without an • Those with a fear of water. • Patients who are incontinent. • Patients who are on oxygen or monitored by cardiac rehab. “The patient’s heart rate increases because of hydrostatic pressure of the water,” says Hardy. “So, we can’t monitor their heart rate in the water.” • Some obese patients. “We have had an influx of obese patients in our facility,” says Hardy. “Patients who are obese need lower water temperatures so their heart rate and blood pressure will remain normal. Temperatures higher than 90 degrees are not appropriate for patients who are obese. When I have such patients, I have to drop the water temperature to accommodate them. Unfortunately, in my pool it takes 2 hours to drop the temperature 1 degree. So it really requires planning for treatments with patients who are obese and those with high blood pressure.” assistive device and ascend and descend stairs safely. His balance improved. I believe that if aquatic and land-based physical therapy had been used earlier, the patient would have gone home much sooner.” help an aging NBA star or a community-based athlete who wants to compete in 1 more marathon or triathlon,” says Studer. “Before aquatic therapy, they would practice by pounding on land. We haven’t conducted research to know how many years it adds, but potentially it might be 10-15 or more years.” Killian has worked with a range of high-level athletes, including marathon runners, skiers, basketball players, climbers, soccer players, and—yes—even swimmers. Athletes pose their own sets of challenges. Killian explains, “Athletes already are at a very high level of fitness. The aquatic environment lets athletes Wounded Warriors The Walter Reed National Military Medical Center in Bethesda, Maryland, uses aquatic therapy to treat many of its military patients with injuries ranging from lower back or knee pain to post-operative total joints. “And we treat a special population of polytrauma patients (combat injuries in Afghanistan and Iraq) with amputations, limb salvage, and/or traumatic brain injury,” says Allison Hoy, PT, a physical therapist at Walter Reed. Hoy used aquatic therapy to help treat a 28–year-old Marine injured from an IED blast in Afghanistan. The Marine had suffered multiple injuries to his right hand and lungs. Both of his legs had been amputated. “Rehabilitation in the water allows him to work on his balance, core stability, strengthening, and cardiovascular endurance without the difficulties of being full weight bearing,” says Hoy. “He’s also experienced an increase in flexibility because he can use the buoyancy properties of the water to stretch.” The prosthetists at Walter Reed even constructed a prosthetic leg for the patient to use in the pool. “The leg allows him to progress through his standing balance exercises and gait training with less pain and ease of movement than if he were on land,” she says. “It assists him in learning to swim again with greater propulsion.” Aquatics for Athletes In addition to helping patients with health conditions, Studer says, he also credits aquatic therapy with helping extend the careers of athletes. “It can ● 19 Ennis maintain a high level of cardiovascular fitness and core stability that they may not have been able to maintain on land.” The mindset of the athlete often differs from that of other patients. “You need to make sure the athlete understands that the healing process takes time, and that following a proper rehab progression takes time. It’s getting them to buy into the fact that if they let the healing happen when it’s supposed to, they’ll recover better. So patient education is very important during the rehab process,” Killian says. Another difference when working with athletes can involve immediate versus long-term goals. Killian explains, “Our approach depends on where in the competitive season the athlete is and the level of the athlete. For example, if a swimmer is in the midst of championship competition, you’re not going to pull him or her out [unless it’s absolutely necessary]. But you do your best at the time. And then, during the off-season, you may devote more time to rehabilitation.” That, in turn, highlights the importance of communication. “Communication with others can make the rehab process run as smoothly as possible. Touching bases with coaches regarding limitations and activity modification is very important. For instance, if you’re working with a swimmer, perhaps altering the workout or reducing the amount of yardage is appropriate. And being in touch with the athletic trainer, to make sure that the training is complementing the PT’s program, is crucial,” she says. Guppies and Minnows Aquatic therapy is beneficial for children as well. “Children with such conditions as cerebral palsy, autism, and Down syndrome benefit from aquatic therapy to enhance motor, sensory, cognitive, and social development skills,” says Salem. When Beth Ennis, PT, EdD, PCS, ATP, of All About Families Think you can’t afford APTA membership? Think again. FREE CONTINUING EDUCATION: Free CEUs through the APTA Learning Center—a value of more than $800. FREE ADVERTISING: APTA’s Find a PT consumer search engine connects you with potential clients and patients. FREE SUBSCRIPTIONS: Members receive complimentary subscriptions to PT In Motion, Physical Therapy, and the Guide to PT Practice. BIG DISCOUNTS: Members receive up to a 40% discount on conference registrations, exam fees, retail products, publications, and more. INVALUABLE ACCESS: APTA staff experts are readily available to provide guidance to ensure members receive appropriate and timely payment. The Dollars & Sense of APTA Membership Not a Member Yet? Visit www.apta.org/join or call 800/999-2782, ext 3395 to join. 20 ● October 2012 PTinMotionmag.org Research Supports Aquatic Interventions Presented below is a sampling of the research on the benefits of aquatics. Autism Spectrum Disorder Fragala-Pinkham MA, Haley SM, O’Neil ME. Group swimming and aquatic exercise programme for children with autism spectrum disorders: a pilot study. Dev Neurorehabil. 2011;14(4):230-41. doi: 10.3109/17518423.2011.575438. Pan CY. Effects of water exercise swimming program on aquatic skills and social behaviors in children with autism spectrum disorders. Autism. 2010 Jan;14(1):9-28. Vonder Hulls DS, Walker LK, Powell JM. Clinicians’ perceptions of the benefits of aquatic therapy for young children with autism: a preliminary study. Phys Occup Ther Pediatr. 2006;26(1-2):13-22. Fibromyalgia Assis MR, Silva LE, Alves AM, Pessanha AP, Valim V, Feldman D, Neto TL, Natour J. A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia. Arthritis Rheum. 2006 Feb 15;55(1):57-65. Evcik D, Yigit I, Pusak H, Kavuncu V. Effectiveness of aquatic therapy in the treatment of fibromyalgia syndrome: a randomized controlled open study. Rheumatol Int. 2008 Jul;28(9):885-90. Epub 2008 Feb 16. Gusi N, Tomas-Carus P. Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial. Arthritis Res Ther. 2008;10(1):R24. Epub 2008 Feb 22. Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008 Dec;89(12):2250-7. Munguía-Izquierdo D, Legaz-Arrese A. Exercise in warm water decreases pain and improves cognitive function in middleaged women with fibromyalgia. Clin Exp Rheumatol. 2007 Nov-Dec;25(6):823-30. Tomas-Carus P, Häkkinen A, Gusi N, Leal A, Häkkinen K, Ortega-Alonso A. Aquatic training and detraining on fitness and quality of life in fibromyalgia. Med Sci Sports Exerc. 2007 Jul;39(7):1044-50. Elite Athletes Kim E, Kim T, Kang H, Lee J, Childers MK. Aquatic versus land-based exercises as early functional rehabilitation for elite athletes with acute lower extremity ligament injury: a pilot study. PM R. 2010 Aug;2(8):703-12. Epub 2010 Jul 3. Hale LA, Waters D, Herbison P. A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis. Arch Phys Med Rehabil. 2012 Jan;93(1):2734. Epub 2011 Oct 7. Hinman RS, Heywood SE, Day AR. Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial. Phys Ther. 2007 Jan;87(1):32-43. Epub 2006 Dec 1. Wang TJ, Belza B, Elaine Thompson F, Whitney JD, Bennett K. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. J Adv Nurs. 2007 Jan;57(2):141-52. Martel GF, Harmer ML, Logan JM, Parker CB. Aquatic plyometric training increases vertical jump in female volleyball players. Med Sci Sports Exerc. 2005 Oct;37(10):1814-9. Other Becker BE. Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R. 2009 Sep;1(9):859-72. Thein JM, Brody LT. Aquatic-based rehabilitation and training for the elite athlete. J Orthop Sports Phys Ther. 1998 Jan;27(1):32-41. Driver S, Rees K, O’Connor J, Lox C. Aquatics, health-promoting self-care behaviours and adults with brain injuries. Brain Inj. 2006 Feb;20(2):133-41. Osteoarthritis Arnold CM, Faulkner RA. The effect of aquatic exercise and education on lowering fall risk in older adults with hip osteoarthritis. J Aging Phys Act. 2010 Jul;18(3):245-60. Ferrell KM. Aquatics for people with arthritis. Lippincotts Prim Care Pract. 1998 JanFeb;2(1):102-4. Bartels EM, Lund H, Hagen KB, Dagfinrud H, Christensen R, Danneskiold-Sams0e B. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005523. Review. Cadmus L, Patrick MB, Maciejewski ML, Topolski T, Belza B, Patrick DL. Communitybased aquatic exercise and quality of life in persons with osteoarthritis. Med Sci Sports Exerc. 2010 Jan;42(1):8-15. Fragala-Pinkham MA, Dumas HM, Barlow CA, Pasternak A. An aquatic physical therapy program at a pediatric rehabilitation hospital: a case series. Pediatr Phys Ther. 2009 Spring;21(1):68-78. Getz M, Hutzler Y, Vermeer A. Effects of aquatic interventions in children with neuromotor impairments: a systematic review of the literature. Clin Rehabil. 2006 Nov;20(11):927-36. Review. Lim JY, Tchai E, Jang SN. Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial. PM R. 2010 Aug;2(8):723-31; quiz 793. ● 21 PLLC in Louisville, Kentucky, started as a physical therapist more than 2 decades ago in Arizona, her facility’s 2 pools only handled patients with musculoskeletal issues as joint replacement, arthritis, and ACL repairs. Today, pools are used for many patients, including children with special needs. Ennis notes that children with autism spectrum disorders (ASD) tend to have low muscle tone, poor coordination, and difficulty with social skills. She recently conducted small trials to see if children with ASD would benefit from water therapy. The effects surprised her. The benefits seemed to go beyond gross motor skill improvement. “When we got the kids into the water to strengthen their motor skills, we saw improvements in communications, social skills, and interactions that we hadn’t planned on,” says Ennis. Her program is designed to allow children and families to participate in a community-based, therapeutically beneficial activity. She uses simple equipment, such as kickboards, squirt guns, and float mats that families can purchase on their own and use in a home or community pool with their child. For More Information The goal of APTA’s Aquatic Physical Therapy Section’s is to meet the needs of physical therapists interested in using the water for various aspects of their careers and provide a means by which association members with an interest in aquatic therapy can meet, exchange, develop, and promote aquatic therapy as an important component to the physical therapy profession. It has 973 members. Aquatic Physical Therapy Section 703/706-8512 [email protected] www.aquaticpt.org 22 ● October 2012 “Kickboards are for balance and coordination,” she explains. “The squirt guns teach eye/hand coordination. Monkey walking exercises help with bilateral coordination. There’s a lot we can do, but the equipment is minimized so they can continue with aquatic activities afterward.” Some children with autism may pose behavioral challenges while in the water, Ennis says. “This is a different environment for them and they have challenges with sensation. Some children don’t like having water on their head in a bathtub, so being in a pool can be overwhelming. Some dislike touch,” she says. “We have to remind ourselves to be slow and patient and not expect the moon. But once you get them in the water, often it is a challenge to get them out, because they enjoy it so much.” Ennis and her team typically work with a child for 1 hour a week for 8-10 weeks. “We once had a second 10-week session. Although we still saw improvements, it wasn’t nearly as dramatic as the first 10-week session. So now we work on getting them acclimated to the water. Then we send them off with a home program,” she says. “Later, we survey the family to see how it is going. Aquatics is fun and can be a normalizing activity to get families reengaged in the community while still providing therapeutic benefits.” Evolving Technologies and Techniques The recent popularity of aquatic therapy has fueled advancements in its equipment and techniques. “Ten years ago, PTs primarily were using foam barbells and noodles to perform pool exercises. Although those still are being used today, new types of paddles, fins, and adaptive equipment are being invented every year,” says Hoy. Good adds, “Other advances are being introduced into aquatics as well, PTinMotionmag.org such as Ai Chi and more advanced lumbar stabilization and core exercises.” Good is a certified trainer in Ai Chi, an aquatics exercise that uses slow Tai Chi movements. Good says, “Ai Chi may be an ideal approach to use with patients who are in pain, or who need more awareness of their own movements through space. My role is to use the basic properties of water together with advanced technology such as video, treadmill, and aquatic tools to enhance movement, build strength, and restore function. I see myself as innovative not just in what I use, but how I use it. I believe that, if it’s not fun, it doesn’t matter how ‘cool’ it is.” On the equipment front, some of Studer’s patients walk on an underwater treadmill, an increasingly popular piece of aquatic equipment. Studer’s treadmill is in a 2,700 gallon pool “The entire floor of our pool is a treadmill,” he says. “We have windows in the pool. We use a video camera to analyze patient movement. This shows us the patient’s leg movement. We can use what we see to better help our patients.” Good, who has a similar setup, says, “We can make sure [the patient’s] walk is symmetrical. We can see the length of the stride and how much the knee flexes.” Underwater cameras project the image of the patient’s therapy onto monitors, which allows both the patient and PT to watch and adjust the walking or running motion. The technology allows PTs to challenge a full range of individuals of all ages and all physical conditions—from the sedentary and the elderly to highlevel athletes—because of the treadmill’s speed. “And hydropressure allows the PT to direct a flume of water while the patient is attempting to walk or run forward,” says Good, who adds that even patients who can’t move themselves on dry land—often bariatric patients or those with cerebral palsy— often are able to walk on underwater treadmills with assistance. For aquatic therapy to succeed, Hardy says it’s vital that therapists actually get in the water. “Getting in the pool helps the PT monitor body mechanics and safety. And if the patient loses balance and goes under the water, the therapist is close by to help.” Looking Ahead Going forward, Studer says that he’d like to see underwater treadmill use become even more widespread in physical therapy interventions. “It’s a well-kept secret. Some people feel that they can imitate the treadmill by walking on the bottom of the pool, but there’s no comparison for the level of intensity that the treadmill can provide,” he says. Killian sees several trends. One is a greater incorporation of aquatic therapy in the rehabilitation plans of patients. But, she said, additional research is needed in the area of aquatics. Another trend is a growth in the use of pools especially designed for therapeutic uses, allowing for adjustment of water flow and quick changes in temperature. But if that’s not available, “There’s plenty that you can do in a regular pool,” Killian says. As with most technologies and evidence-based interventions, there are constant advances in aquatic therapy. “Aquatic therapy has more applications, reaching a broader range of patients than most therapists had envisioned,” says Studer. “The benefits of new technology with the classic principles of aquatic therapy enable us to be even more intense and specific. This gives us an excellent option of an environment to help some patients improve faster and more completely.” Lisa Iannucci is a freelance writer.. References 1. American Physical Therapy Association. Demographic Profile of Physical Therapist Members. www.apta.org/ WorkforceData/ Accessed June 14, 2012. 2. American Physical Therapy Association. Demographic Profile of Physical Therapist Assistant Members. www. apta.org/WorkforceData/ Accessed June 14, 2012. 3. DePasquale L, Toscano L. The spring scale test: a reliable and valid tool for explaining fall history. J Geriatr Phys Ther. 2009;32(4):159-167. ● 23 The Presidential Candidates on Health Care Presented below are the positions of presidential candidates Mitt Romney and Barack Obama on health care issues. Their statements are excerpted directly from their websites. Mitt Romney The transformation in American health care set in motion by Obamacare will take us in precisely the wrong direction. The bill, itself more than 2,400 pages long, relies on a dense web of regulations, fees, subsidies, excise taxes, exchanges, and rule-setting boards to give the federal government extraordinary control over every corner of the health care system. The costs are commensurate: Obamacare added a trillion dollars in new health care spending. To pay for it, the law raised taxes by $500 billion on everyone from middle-class families to innovative medical device makers, and then slashed $500 billion from Medicare. Obamacare was unpopular when passed, and remains unpopular today, because the American people recognize that a government takeover is the wrong approach. While Obamacare may create a new health insurance enti24 ● October 2012 tlement, it will only worsen the system’s existing problems. Obamacare will violate that crucial first principle of medicine: “do no harm.” It will make America a less attractive place to practice medicine, discourage innovators from investing in life-saving technology, and restrict consumer choice. In short, President Obama’s trillion dollar federal takeover of the U.S. health care system is a disaster for the federal budget, a disaster for the constitutional principles of federalism, and a disaster for the American people. that paves the way for the federal government to issue Obamacare waivers to all 50 states. He then will work with Congress to repeal the full legislation as quickly as possible. In place of Obamacare, Romney will pursue policies that give each state the power to craft a health care reform plan that is best for its own citizens. The federal government’s role will be to help markets work by creating a level playing field for competition. Restore State Leadership And Flexibility Romney’s Plan On his first day in office, Mitt Romney will issue an executive order The positions of the candidates have been excerpted and adapted from their respective websites. The views expressed are theirs and do not reflect those of PT in Motion or APTA. PTinMotionmag.org Romney will begin by returning states to their proper place in charge of regulating local insurance markets and caring for the poor, uninsured, and chronically ill. States will have both the incentive and the flexibility to experiment, learn from one another, and craft the approaches best suited to their own citizens. • Block grant Medicaid and other payments to states • Limit federal standards and require- ments on both private insurance and Medicaid coverage • Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies • Ensure flexibility to help the chronically ill, including high-risk pools, reinsurance, and risk adjustment • Offer innovation grants to explore non-litigation alternatives to dispute resolution Promote Free Markets and Fair Competition Competition drives improvements in efficiency and effectiveness, offering consumers higher quality goods and services at lower cost. It can have the same effect in the health care system, if given the chance to work. Romney proposes to: • Cap non-economic damages in medical malpractice lawsuits • Empower individuals and small businesses to form purchasing pools • Prevent discrimination against individuals with preexisting conditions who maintain continuous coverage • Facilitate IT interoperability Empower Consumer Choice For markets to work, consumers must have the information and the power to make decisions about their own care. Placing the patient at the center of the process will drive quality up and cost down while ensuring that services are designed to provide what Americans actually want. Romney would: • End tax discrimination against the individual purchase of insurance • Allow consumers to purchase insurance across state lines • Unshackle HSAs by allowing funds to be used for insurance premiums • Promote “co-insurance” products • Promote alternatives to “fee for service” • Encourage Consumer Reports-type ratings of alternative insurance plans Medicare Romney’s proposals would not affect today’s seniors or those nearing retirement, and they would not raise taxes. But he proposes that tomorrow’s Medicare should give beneficiaries a generous defined contribution, or “premium support,” and allow them to choose between private plans and traditional Medicare. Romney’s plan honors commitments to current seniors while giving the next generation an improved program that offers the freedom to choose what their coverage under Medicare should look like. Instead of paying providers directly for medical services, the government’s role will be to help future seniors pay for an insurance option that provides coverage at least as good as today’s Medicare, and to offer traditional Medicare as one of the insurance options that seniors can choose. With insurers competing against each other to provide the best value to customers, efficiency and quality will improve and costs will decline. Seniors will be allowed to keep the savings from less expensive options or choose to pay more for costlier plans. Key Elements of Romney’s Plan • Nothing changes for current seniors or those nearing retirement. • Medicare is reformed as a premium support system, meaning that existing spending is repackaged as a fixedamount benefit to each senior that he or she can use to purchase an insurance plan. • All insurance plans must offer coverage at least comparable to what Medicare provides today. • If seniors choose more expensive plans, they will have to pay the difference between the support amount and the premium price; if they choose less expensive plans, they can use any leftover support to pay other medical expenses such as co-pays and deductibles. • “Traditional” fee-for-service Medicare will be offered by the government as an insurance plan, meaning that seniors can purchase that form of coverage if they prefer it; however, if it costs the government more to provide that service than it costs private plans to offer their versions, then the premiums charged by the government will have to be higher and seniors will have to pay the difference to enroll in the traditional Medicare option. • Lower income seniors will receive more generous support to ensure that they can afford coverage; wealthier seniors will receive less support. • Competition among plans to provide high-quality service while charging low premiums will hold costs down while also improving the quality of coverage enjoyed by seniors. Traditional Medicare will compete against private plans. It will be operated by the government and funded by premiums, coinsurance, and deductibles that are set at the level necessary to cover its costs. The attractiveness of this option to future seniors will depend on how its efficiency and quality compares with that offered by other providers in the marketplace. Future seniors will benefit from the innovation and competition among options. Sources http://www.mittromney.com/issues/ health-care http://www.mittromney.com/issues/ medicare ● 25 Barack Obama President Obama promoted the Affordable Care Act to restore health care as a basic cornerstone of middle-class security in America. The Affordable Care Act will make health care more affordable for families and small businesses and brings muchneeded transparency to the insurance industry. When fully implemented, the Affordable Care Act will keep insurance companies from taking advantage of consumers—including denying coverage to people with pre-existing conditions and cancelling coverage when someone gets sick. Because of the new law, 34 million more Americans will gain coverage—many who will be able to afford insurance for the first time. Once the law is fully implemented, about 95% of Americans under age 65 will have insurance. Providing Security to Working Families Working families are protected from losing their health care or being forced into bankruptcy when a family member gets sick or is in an accident. Families have the security of knowing their health insurance will be there when they need it most. Insurance companies are now required to justify rate hikes, and consumers have the ability to appeal to an independent third party when insurance companies refuse to cover services or care. Starting in 2014, all Americans will have access to affordable health insurance no matter their circumstances— whether they change jobs, lose their job, decide to start a business, or retire early. Purchasing private insurance in the new state-based health insurance 26 ● October 2012 exchanges could save middle-class families who can’t get employer-provided insurance thousands of dollars. Once fully implemented, the law will slow health care premium growth rates, adding another $2,000 to family savings by 2019. The law is expected to reduce the deficit by $127 billion from 2012 to 2021. Keeping Health Care Costs Low Before health reform, insurance premiums were skyrocketing, and the shared cost of caring for the uninsured added $1,000 to the typical family’s policy. The Affordable Care Act promotes better value through preventive and coordinated care, and eliminates waste and abuses. The Affordable Care Act also helps keep insurance premiums down. Insurance companies must publicly justify excessive rate hikes and provide rebates if they don’t spend at least 80% of premiums on care instead of overhead, marketing, and profits. As many as 9 million consumers are expected to get up to $1.4 billion in rebates under the Affordable Care Act. Ending Discrimination for Preexisting Conditions The Pre-Existing Condition Insurance Plan (PCIP) provides insurance to people with health conditions who have been uninsured for 6 months, helping those with cancer or other serious conditions to get the treatment they need. Young People and Health Reform Young adults are now eligible to stay on their parents’ health insurance plans as they enter the workforce, until they turn 26. Since the health care law passed, 3.1 million young adults—traditionally the group least likely to be PTinMotionmag.org insured—gained insurance because of the Affordable Care Act. Ending Lifetime Limits Before the Affordable Care Act, more than half of all private insurance plans included a lifetime limit on coverage— and nearly 20,000 people hit a lifetime cap each year. The Affordable Care Act banned these caps, and those who had already hit a lifetime limit will be eligible for unlimited coverage. Strengthening Medicare More than 47 million Medicare beneficiaries now have access to free health services—including an annual wellness visit, mammograms, and other health screenings—to help detect and treat medical conditions early. As a result of the Affordable Care Act, nearly 3.6 million seniors who fell into the Medicare “doughnut hole” last year saved an average of $604 on prescription drugs. As of August 2012, nearly 5.4 million seniors with Medicare have saved over $4.1 billion on prescription drugs. That’s an average of more than $700 per person. And this year alone, 18 million seniors with Medicare have taken advantage of preventive care benefits like mammograms or other cancer screenings that now come at no extra cost. This news is also a reminder of what’s really at stake when we talk about the future of Medicare. It’s not about overheated rhetoric at election time. It’s about a promise this country made to our seniors that says if you put in a lifetime of hard work, you shouldn’t lose your home or your life savings just because you get sick. Over the last 47 years, millions of Americans have worked for that promise. They’ve earned it. And for many seniors, the care they’ve gotten through Medicare has made all the difference in the world. As president, my goal has been to strengthen these programs now and preserve them for future generations. Because today’s seniors deserve that same peace of mind. And the millions of Americans who are working hard right now deserve to know that the care they need will be available when they need it. That’s why, as part of the Affordable Care Act, we gave seniors deeper discounts on prescription drugs, and made sure preventive care like mammograms are free without a co-pay. We’ve extended the life of Medicare by almost a decade. And I’ve proposed reforms that will save Medicare money by getting rid of wasteful spending in the health care system and reining in insurance companies – reforms that won’t touch your guaranteed Medicare benefits. Not by a single dime. Children and Health Reform Before the Affordable Care Act, insurance companies could deny coverage to children with medical conditions. Thanks to the Affordable Care Act, as many as 17 million children with preexisting conditions can no longer be denied health insurance. Preventive Care All new insurance plans are required to cover certain preventive services without charging a copay or deductible. Small Business and Health Reform Millions of small businesses are now eligible for a tax credit to help pay for their health care premiums. The credit will increase to cover 50% of premium costs in 2014. Under the Affordable Care Act, help for small businesses—including the new insurance exchanges—will reduce small business health care spending by nearly 9%, according to independent estimates. Sources http://www.barackobama.com/record/ health-care?source=issues-nav http://www.whitehouse.gov/ the-press-office/2012/08/25/ weekly-address-preserving-andstrengthening-medicare ● 27 APTA’s Emerging Leaders 2012 Twenty one physical therapists were named this year’s APTA “Emerging Leaders.” Here is an in-depth look at what inspired them, what their goals are, and what they’ve learned. By Lisa Iannucci It’s not that tomorrow’s physical therapy leaders are accident-prone, although a casual observer could stumble to that conclusion. Rather, the real lesson is that yesterday’s physical therapists (PTs) made such a positive impression on their patients that those patients—in turn—became interested in physical therapy and ultimately decided to enter the profession. For example, Marcy Crouch, PT, DPT, CLT, WCS, underwent knee surgery in high school. Sonya Irons, PT, DPT, CCS, sprained her ankle also while in high school. Ronald Lawrence, PT CSCS, experienced multiple shoulder dislocations and 2 shoulder surgeries in high school while ski racing. He underwent 6 months of rehabilitation so he could continue racing, but dislocated his shoulder again. “My physical therapist gave me hope,” he says. “This was an occupation that gave me goals and helped me take pride in being able to reach those goals.” Hope Engel, PT, DPT, GCS, was working for a natural foods company when she felt a calling to pursue a new career. Looking back to the time when she had fractured a bone in her arm, she recalled how much the physical therapists seemed to derive satisfaction from restoring patients to health. She knew then what direction she wanted her life to take. Of course, injuries aren’t the only experiences that motivate people in general—and APTA’s emerging leaders in particular—to become PTs. Sometimes it’s a family connection. For example, John Tawfik PT, DPT, GCS, who grew up in Egypt, always knew he wanted a job where he could use his hands and people skills. But it was his little brother’s health scare that pulled him into the profession. “He had an episode of facial palsy,” says Tawfik. “I admired the physical therapists and the work they did. It’s been a passion of mine ever since.” 28 ● October 2012 Erin Wentzell, PT, DPT, PCS, wanted to follow in her mother’s footsteps. “I saw that she loved being a PT and how it made a difference every day. I wanted that in my career,” says Wentzell. These PTs and more—21 in all—are this year’s recipients of APTA’s Emerging Leaders award. Each APTA chapter and section annually is invited to identify and honor 1 physical therapist or physical therapist assistant (PTA) as an “emerging leader” who has demonstrated extraordinary service early in his or her physical therapy career. Earning the Degree Marcy Crouch started college as an anthropology major. She became fascinated with her introduction to bones, evolution, and how the skeletal system works in humans and primates. Crouch changed her major to kinesiology with an emphasis on rehabilitation science and physical therapy. “I instantly loved the field,” she says. “I love working with people, helping them reach their goals, and having an active part in their lives.” Crouch is with the Pelvic Health & Rehabilitation Center in Oakland, California. Engel worked full time while attending evening PT prerequisite classes. She finally took the plunge, quitting her job to focus on her studies. “I funded my education with student loans, savings, and family financial support,” she says. “In school I started a PT club, was involved with the APTA chapter and its government affairs committee, and was president of a student special interest group,” she says. Irons, a first generation college student, applied for numerous scholarships, winning a significant one from the Golden Key International Honour Society, an organiza- PTinMotionmag.org ● 29 tion committed to a high standard of scholastic achievement. “I knew that I needed to work as hard as possible to achieve excellent grades to be eligible for multiple scholarships,” says Irons, who is employed by Madonna Rehabilitation Hospital in Lincoln, Nebraska. She focuses on cardiovascular/pulmonary physical therapy, working with patients after heart surgery through her clinical practice. Irons is one of many of the emerging leaders who described the advantages of earning a DPT or a t-DPT. “I’ve benefited from getting my transitional DPT because I took classes that weren’t available when I completed my master’s in 2003,” says Irons. “It filled in gaps addressing research and differential diagnosis. It also advanced my clinical practice by making me critically think about evidence-based medicine.” After Graduation The emerging leaders have taken diverse paths after leaving school. Since graduating, Engel—with Summit Rehab at Life Care Center in Longmont Colorado—has worked with colleagues to develop a multi-disciplinary approach to treating people with Parkinson disease, by incorporating physical therapy, occupational therapy, and speech therapy to help meet their goals. In March 2012, she fulfilled the qualifications to become a geriatric certified specialist and plans to returning to the classroom to get her PhD in rehabilitation sciences. Only a few years after graduating, Wentzell already has purchased her own pediatric practice, Brown Bear Therapists. Within the first 2 years, business has doubled. She works with children who have a variety of neurological and orthopedic conditions, as well as those in cardiac and neonatal intensive care units. She partnered with an elementary school in the District of Columbia to develop 30 ● October 2012 an after-school fitness program. She creates wellness programs for children with disabilities, is newsletter editor for the International Organization of Physiotherapist in Pediatrics, and is an active member of APTA’s Pediatric Section and the District of Columbia chapter. In addition to working with patients, several emerging leaders conduct research or teach. Wentzell’s practice ownership provides her with welcome flexibility. “I go to the pool with my patients in the evening,” says Wentzell. “I also have the opportunity to work as an adjunct faculty member and a teaching assistant in the George Washington University physical therapy program.” “I was attracted to the integrative knowledge base from anatomy and physiology to biomechanics,” says Keith Avin, PT, DPT, PhD, who received a BS and MS in kinesiology from the University of Illinois at Urbana-Champaign, and his DPT from Indiana University. For 2 years, he worked in both outpatient and acute care settings. He left to earn his PhD in physical rehabilitation science from the University of Iowa, which he completed in May. Currently, he is a postdoctoral scholar at the University of Pittsburgh with a research focus on regenerative capacity in aging muscle. “I have been contributing to an expanding knowledge base through publications and serve as a reviewer for 2 section journals,” says Avin. He is a member of a group in the Section on Geriatrics that is developing clinical practice guidelines. “Through research, I hope to contribute to the body of knowledge in our field so that students are learning evidence-based medicine,” he says. Working to Improve the Quality of Life Despite their various directions, the emerging leaders all seem to be workPTinMotionmag.org ing to improve the quality of life for their patients. Irons, who teaches at Creighton University and the University of South Dakota, also works in research at the Movement and Neurosciences Center, located within the Institute for Rehabilitation Science and Engineering at Madonna Rehabilitation. There, she is studying ICARE (Intelligently Controlled Assistive Rehabilitation Elliptical training system) to promote walking and fitness in persons with physical limitations and chronic conditions. “We’re studying how ICARE can improve the delivery of cardiovascular exercise in patients who have chronic conditions such as stroke, multiple sclerosis, and Parkinson,” says Irons. She’s part of the research team led by Judith M. Burnfield, PT, PhD. “In research we are working for an even bigger purpose—doing something that can help multiple patients. Whether I am researching or providing patient care, it comes down to placing the needs of the patient first.” Determined to provide students with the best possible education, Crouch says that most are not exposed to pelvic floor dysfunction during their education, but promises “by the time I retire that will change.” Crouch completed her physical therapy studies at the University of Southern California. She focused on women’s and men’s health, breast cancer rehab, female athlete, pelvic floor dysfunction, and obstetric physical therapy, receiving her DPT in 2010. “This is an underserved population with a great need for skilled and competent clinicians. If we can educate students and young professionals at the start of their career, more people can be helped,” says Crouch. Hope Engel—the emerging leader nominated by the Colorado Chapter— offers another example of efforts to improve the quality of life for patients. In nominating Engel, Amy Stone Hammerich, PT, DPT, explained, “Hope uses evidence-based medicine to determine best practices for patient care in [the geriatric] population. She has assisted with the development of a successful multidisciplinary approach to treating people with Parkinson disease, including skilled physical therapy, occupational therapy, and speech therapy one-on-one services as well as a hybrid ‘graduate’ program for those who have successfully completed the program . . . . In addition, Hope serves as a volunteer for Boulder County Aging Services for a program called ‘A Matter of Balance: Managing Concerns About Falls,’ which is designed to reduce the fear of falling and increase activity levels among older adults.” When they aren’t with patients or conducting research, many of these leaders are working to influence legislation that will benefit their patients and the profession. For example, Lawrence was involved in promoting the Wisconsin Sidelined for Safety Act. That law aims to reduce the problem of concussions. It requires Wisconsin school districts to take student athletes off the field and out of practices if they suspect students have a concussion. Young athletes are not allowed to start playing again until they are cleared by a health care professional, and activity organizers must receive training to identify symptoms of a concussion and injuries that can lead to one. Wisconsin governor Scott Walker signed the bill (AB 269) into law in April. Lawrence is a certified strength and conditioning specialist at Advanced Physical Therapy & Sports Medicine in Shawano, WI. Tawfik, who completed his certification of exercise expert of aging adults from the APTA Geriatric Section, has dedicated himself to promoting legislation to allow patients access to physical therapy. “I was involved early on as a student petitioning legislators in support of Medicare direct access,” he says. Amber Devers, PT, DPT, has served with the Virginia Physical Therapy Association as its Central District legislative chair, State Lobby Day chair, and state legislative chair. She explains what led to her involvement: “I knew coming out of school I didn’t have much money to contribute to our PAC, but I knew I ● 31 could at least volunteer my time. I knew that having someone who was willing to learn in the position was better than having nobody at all.” She’s subsequently found that her involvement has resulted in multiple benefits. “My profession has really evolved in a different way by working on legislative affairs. I am not just learning more clinical knowledge and skills; the depth and breadth of understanding physical therapy is so much more. I can talk to my colleagues about why they should be involved in their association and what the association does for them. I can talk to patients about what therapists do to protect their health care needs, not just how we work with them when they are sick,” Devers says. Demonstrating the Value Of Physical Therapy The emerging leaders also seek to demonstrate the value of physical therapy not only to patients and clients but to others as well. Tawfik explains, “My area of expertise is in geriatrics, and we need to demonstrate superior outcomes to those seeking our services. Success Tips From the Emerging Leaders Here’s advice from the emerging leaders on how to make the most of the first years after graduation. Find a mentor. “Learn as much as you can during school, rotations, and residency. Never ever stop trying to be a better clinician,” says Marcy Crouch. “A professor at USC told me once that when we have been out in the clinic for 10 years, we want to be sure that we are clinicians with 10 years of experience, not new grads on their 10th anniversary.” Learn from your patients. “From a professional standpoint, I’m challenged by every patient I see,” says Hope Engel. “There’s always something unique about them. It alters the way I work with them to help them meet their goals.” Look for opportunities to become involved. “Get involved. Attend chapter meetings. It’s really important,” says Ronald Lawrence. “When I was hired, early on I was ‘dragged’ to a lot of board meetings and chapter meetings. If I hadn’t had anyone introducing me at those meetings, I don’t think I would have gone. Take those opportunities and see what’s being done. Open your eyes.” “If you have an interest in research, you can contribute to the body of knowledge in many ways, from the clinic to the lab,” says Keith Avin. Have confidence. “Be confident in the knowledge you bring to patient care, especially when you are part of a multidisciplinary health care team,” says Avin. Listen. “Listen to what is important to your patients and their families. Work as hard as you can to find a way for them to be successful,” says Erin Wentzell. “Your creativity and passion will be the catalyst for them to achieve their goals.” Create the future you want in the profession. “Students who are graduating today are certainly the leaders of that profession with their active involvement and enthusiasm,” says John Tawfik. “It’s the only way to make the profession grow and make it a major component of a healthy health care environment.” Give back. “My most meaningful experience as a physical therapist came when I volunteered to go to the Dominican Republic with Creighton University as a clinical instructor,” says Irons. “I became a better clinician by being pushed outside of my comfort zone. The experience also renewed my passion for the profession, and made me better appreciate the global impact of education.” 32 ● October 2012 PTinMotionmag.org I constantly strive to show that what we do is based on evidence and translates to results that are measurable and tangible, but also demonstrates to legislatures who are looking for ways to provide for reimbursement for medical care that’s effective and not unnecessary. In my role as a clinical specialist with Accelerated Care Plus, I am able to put this concept into action by delivering clinical education that is outcomes-oriented in post acute care settings.” “There are so many unanswered questions in our field that can have a significant impact upon our patients’ lives,” says Avin. “I feel blessed to be in a position to help discover some of those answers. I also truly enjoy the process of research, from identifying a relevant question to research design and writing.” The Value of APTA Membership The emerging leaders said their membership in APTA has been crucial to their success and will be crucial to the success and leadership of future PTs. Tawfik came to the United States in 1996 and joined APTA as a student. “I had great mentors, and I wanted to contribute and get a strong footing in the leadership of a fairly young profession,” says Tawfik. Engel—who is on her chapter’s board of directors and serves as treasurer for the chapter’s political action committee— says, “I like paving the way and figuring out where we’re going as an association, as an advocate for our patients, and pushing the profession forward to help our members.” Irons was Nebraska’s eastern district co-chair for 3 years, was on the NPTA executive committee and the APTA Hooked on Evidence Task Force, and is a member of the Cardiopulmonary, Education, and Acute Care Sections. She’s had multiple peer reviewed publications, is a manuscript reviewer for The President’s Sustaining Fund ATION FOR PH YS UND O I F USTAINING FUND ’S S NT PY X PRE SID HERA T L E A C The President’s Sustaining Fund provides vital unrestricted funding to the Foundation’s operations, helping to facilitate more physical therapy research. Visit our website, foundation4pt.org, to learn about the special benefits of our President’s Society club! Make a gift today! R E S E A R C H • R E S U LT S • R E C O G N I T I O N 1111 N. Fairfax Street Ads 1012.indd 33 Alexandria, VA 22314 800/875-1378 foundation4pt.org 8/30/12 2:03 PM the Cardiopulmonary Physical Therapy Journal, and was an item writer for the CCS exam. “I’m involved both on the Nebraska level and national level because that’s part of our duty as professionals,” says Irons. “These organizations assist physical therapy in growing as a profession.” Wentzell is the representative for the pediatric section of APTA’s District of Columbia Chapter. “We disseminate information and encourage participation in events such as Team Super Kids, a team of kids with special needs and their siblings to participate in the Marine Corps Marathon Healthy Kids Fun Run,” says Wentzell. “It’s a passion for me to work with kids with disabilities.” Lawrence’s big push was to improve communication with his local chapter members. “We created a mobile website for the chapter, created a Facebook page for chapter members, and are creating a blog or forum to encourage more member participation. Our goal was to increase member participation and discussions by using those technologies,” says Lawrence. Leading by Example When it comes to discussing the role of leadership, all the PTs said it’s important to lead by example. “Setting an example of becoming involved in your professional organization as a young clinician is important,” says Crouch. “I also am involved with the Section on Women’s Health as a member of its residency committee, and have been nominated for a board position. I would hope that my patients would say that I am caring, am truly dedicated to their wellbeing and health, attentive, and skilled in my practice. Crouch says that her new patients express a concern about a lack of validation. She strives to address that issue. “It’s important to me to validate their concerns, educate them on why these issues are happening, what we are going to do about it, and then help them see that they can lead more functional lives and that they will become independent,” she says. “If I can’t help or they are not appropriate for therapy, I will get them to the right person and seek other opinions. I am open and honest with my patients, and we work together as a team to devise a successful and efficient treatment plan.” Lisa Iannucci is a freelance writer. Any amount. Every month. Leads to excePTional results. The Foundation for Physical Therapy is the first and only national organization whose sole purpose is to support research within physical therapy. Your investment in the best and brightest scientists will make a difference. Support our work by joining our monthly giving program! Help fund physical therapy research by making a $10, $20, or $50 monthly or quarterly gift today. Visit Foundation4PT.org or call 800/875-1378. 34 ● October 2012 R E S E A R C H • R E S U LT S • R E C O G N I T I O N PTinMotionmag.org Emerging Leader Criteria The purpose of the Emerging Leader Award is to identify and honor 1 physical therapist or physical therapist assistant “emerging leader” from each APTA chapter or section who has demonstrated extraordinary service early in his or her physical therapy career. The individual should have made exceptional overall accomplishments and contributions to the American Physical Therapy Association (APTA), the component, and the physical therapy profession to advance APTA’s vision. The nominee must be a current member of APTA for at least 5 years and no more than 10 years from formal graduation. The nominee must have current or prior service on 1 or more appointed or elected groups at the component or national level. For more information, contact APTA’s Component Services Department at 703/706-3232. 2012 Emerging Leaders Steven Ambler, PT, DPT, OCS Nominated by: Florida Chapter Employment: Assistant clinical professor at the University of South Florida, School of Physical Therapy and Rehabilitation Science. Education: DPT, Washington University in St. Louis Service: First vice president of the Arizona Physical Therapy Association; chair of the West Central District of the Florida Physical Therapy Association; reviewer for the Guide to Physical Therapist Practice. Brittany Anderson, PT, DPT Nominated by: North Dakota Chapter Employment: Lead pediatric physical therapist for outpatient/home-based therapy services with Beyond Boundaries Therapy in Fargo, ND. Education: DPT, University of North Dakota Service: NDPTA membership retention and recruitment committee chair, 2011-present; board member for HOPE INC, a nonprofit organization for mobility-challenged children, 2009-present; member of APTA’s Pediatrics Section. Keith Avin, PT, DPT, PhD Nominated by: Section on Geriatrics Employment: Research assistant, graduate program in physical therapy and rehabilitation science, The University of Iowa. Education: DPT, Indiana University. PhD, The University of Iowa Service: Practice Committee member, APTA Section on Geriatrics; graduate student senate representative, The University of Iowa, 2008-2010; graduate student organization representative, Indiana University, 2003-2005. Marcy Crouch, PT, DPT, CLT Nominated by: Section on Women’s Health Employment: Clinic director and physical therapist with Pelvic Health and Rehabilitation Center in Oakland, CA. Education: DPT, University of Southern California Service: Served on the executive committee of the Section’s Student Special Interest Group and serves on the section’s residency committee, southwest region. She also is a member of the International Pelvis Pain Society. Amber Devers, PT, DPT Nominated by: Virginia Chapter Employment: Staff physical therapist with Sheltering Arms Physical Rehabilitation enters in Mechanicsville, VA Education: DPT, Old Dominion University Service: VPTA Central District legislative chair; Lobby Day chair; state legislative chair Hope Engel, PT, DPT, GCS Nominated by: Colorado Chapter Employment: Physical therapist with Life Care Center of Longmont, Summit Rehabilitation, in Longmont, CO. Education: BA in anthropology, State University of New York at Oswego. DPT, University of Colorado Service: Treasurer PT PAC Colorado, 2009-present; key contact for Congressional District 4; chapter director at large, 2010-2012; chapter government affairs committee and Colorado representative to PT Day on Capitol Hill, 2011. ● 35 Bart Hawkinson, PT, DPT, OCS Nominated by: Washington Chapter Employment: Staff physical therapist with North Lake Physical Therapy Education: DPT, University of Puget Sound Service: APTA Federal key contact; founded the Skagit/Snohomish District in 2006 and was the chair until 2008; member of the PTWA Spinal Manipulation Task Force; delegate for the Washington state delegation to APTA’s House of Delegates, 2008-2010. Kristin Holbrook, PT, DPT, SCS, CSCS Nominated by: Ohio Chapter Employment: Physical therapist and athletic reconditioning specialist with The Ohio State University Athletics—football and Olympic sports in Columbus, OH. Education: DPT, The Ohio State University Service: Board member, Ohio Physical Therapy Association. Volunteer for the Ohio Wheelchair Rugby Tournament, Ohio Wheelchair Games, Ohio Special Olympics, and the Columbus Sports Classic. Assisted in the campaign efforts for former OPTA executive director Nancy Garland when she ran for the Ohio House of Representatives. Sonya Irons, PT, DPT, CCS Nominated by: Nebraska Chapter Employment: Inpatient physical therapist/ research physical therapist with Madonna Rehabilitation Hospital in Lincoln, NE Education: DPT, Temple University; MPT, Mayo School of Health Sciences Service: NPTA eastern district co-chair for 3 years; NPTA executive committee; APTA Hooked on Evidence Task Force; manuscript reviewer for the Cardiopulmonary Physical Therapy Journal; and item writer for the CCS exam. Shawn Israel, PT, DPT Nominated by: Oncology Section Employment: Pediatric physical therapist with Experimental Education Unit in Seattle, WA Education: DPT, University of Washington Service: Collaborated to create the Pediatric Oncology Special Interest Group within the Oncology Section; volunteer with the Special Olympics in Fort Lewis, WA; Special Olympics Youth Games in Portland, OR; Sharing the Dream in Guatemala; and Cabral Hospital in the Dominican Republic. 36 ● October 2012 Meg Jacobs, PT, DPT Nominated by: Georgia Chapter Employment: Staff physical therapist with Grady Health System in Atlanta, GA Education: DPT, Emory University Service: Georgia delegate at APTA House of Delegates; Secretary and board of directors for the Georgia Physical Therapy Education and Research Foundation; board of directors for the National Study Assembly; Friends of Disabled Adults and Children service learning project in Atlanta; South Georgia Farmworker Health Project in Valdosta, Georgia. Debi Jones, PT, DPT, SCS, CSCS Nominated by: Sports Physical Therapy Section Employment: Staff physical therapist with Shands Rehab at the Orthopaedics & Sports Medicine Institute in Gainesville, FL Education: DPT, University of Florida Service: Shands prehab representative, Women’s Golf, University of Florida Athletic Association; physical therapy consultant, all sports, Buchholz High School, Gainesville, FL; APTA National Student Conclave Orthopaedic Section representative. Ronald Lawrence, PT, MS, CSCS Nominated by: Wisconsin Chapter Employment: Physical therapist with Advanced Physical Therapy and Sports Medicine in Shawano, WI Education: MS, University of Wisconsin Service: Chair of the WPTA’s Public Relations Committee; leader of WPTA’s Technology Task Force; chair of the WPTA 2010 spring conference. Tasha MacIlveen, PT, DPT, CSCS Nominated by: Oregon Chapter Employment: Staff physical therapist with Providence Portland Medical Center in Portland, OR Education: DPT, Pacific University Service: APTA Vision Statement Task Force; OPTA delegate to APTA’s House of Delegates; OPTA Research Committee; field technician for the National Geological Service Biological Resources Division; volunteer, Institute for Bird Populations. PTinMotionmag.org Benefi ts of Belonging ng ng Move Beyond the Classroom With APTA on Your Side. Awards & Scholarships Gain recognition for your accomplishments and stand out among your peers. Leadership Opportunities Don’t wait until you’ve graduated to get involved. Get started now by running for Student Assembly Office or volunteering with your chapter or section. Stay Up-to-Date Each month you’ll receive the Student Assembly Pulse with news and information written by students, for students. Open New Doors Explore your interests through section memberships, advocacy involvement, and more. APTA will help you advance your education—and your career. For more information, visit www.apta.org/students. Not a Member Yet? Visit www.apta.org/join or call 800/999-2782, ext 3395 to join. National Physical Therapy Month 2012 – Celebrate Movement! Physical therapists understand how the body moves! This October, celebrate everything you do to help restore and improve motion in people’s lives. Go to www.apta.org/NPTM to find all you’ll need to make your celebration a success: • Event Planning Guide with sample press release, gubernatorial proclamation, community event planning information and more! • NPTM products and the new fitness collection available at www.apta.org/Marketplace. • New public relations campaign, “Fit After 50.” AL L N A TIO S I C P Y A N HY RA T H P HE N T O M A Ads 1012.indd 37 HY NP ICA R ME P RA HE LT A SIC N TIO CIA SO S YA 8/30/12 2:44 PM Nathaniel Mosher, PT, DPT Nominated by: New York Chapter Employment: Supervisor and physical therapist with Thomas Nicolla, PT, in Latham, NY Education: DPT, Sage Graduate School Service: ATA Task Force on Chapters Volunteer; Chairman, Eastern District of the New York Physical Therapy Association; delegate to NYPTA Delegate Assembly; NYPTA Public Relations Committee member. Wendy Romney, PT, DPT, NCS Nominated by: Connecticut Chapter Employment: Clinical assistant professor with Sacred Heart University in Fairfield, CT. Also, per diem physical therapist with Mary Wade Home in New Haven, CT, and with Gaylord Specialty Healthcare in Wallingford, CT Education: DPT, Ithaca College Service: Connecticut Physical Therapy Association Northwest District vice-chair; CPTA program committee member; assisted in developing a New Professional SIG. Jeffrey Ryg, PT, DPT, OCS, ATC, CSCS Nominated by: Indiana Chapter Employment: Staff physical therapist with Indiana University Health in Indianapolis, IN Education: DPT, Emory University Service: Chapter publications chair; Central District vice chair; legislative committee; political action committee. Stephanie Vandover, PT, DPT Nominated by: Minnesota Chapter Employment: Gentiva Home Health Education: DPT, Washington UniversitySt. Louis Service: APTA Federal key contact; organized 3 state Legislative Days; chapter Continuing Education Committee member. Beth Ward, PT, DPT Nominated by: Louisiana Chapter Employment: Clinical physical therapist for STAT Home Health in Shreveport, LA Education: DPT, LSUHSC Service: LPTA president (2011-present); LPTA membership chair; Louisiana advocate to APTA’s Section on Geriatrics. Erin Wentzell, PT, DPT Nominated by: Section on Pediatrics Employment: Physical therapist, president, and owner of Brown Bear Therapies, Inc., in Washington, DC Education: DPT, Oakland University Service: Section on Pediatrics state representative; communications chair and newsletter for the International Organization for Physical Therapists in Pediatrics; Michigan Physical Therapy Student Conclave co-chairperson. John Tawfik, PT, DPT, GCS Nominated by: Pennsylvania Chapter Employment: Regional manager of training and compliance with Accelerated Care Plus (North East Division) in Reno, NV. Education: DPT, University of Medicine and Dentistry of New Jersey Service: Federal key contact (District 13), chair of APTA Advisory Panel on Member Recruitment and Retention; APTA Elections Committee; APTA Student Assembly treasurer and vice president. 38 ● October 2012 PTinMotionmag.org Ride the wave of excitement to San Diego for CSM 2013! As an attendee at the leading conference in physical therapy, you will: • Benefit from a specialized assortment of session programming of real-world solutions and best practices. • Engage in deep-dive discussions, professional dialogue, and critical analysis with your peers and industry experts. • Sample the latest products, services, and technology in our dynamic Exhibit Hall. • Connect with the movers and shakers of the profession during special events and networking opportunities. • Identify strategies to grow professionally and advance your practice. Registration opens in late September. Be sure to take note of the change in programming days. The conference will run Monday–Thursday, January 21-24. Visit www.apta.org/CSM for complete programming and registration details. SIGNATURE SESSIONS The Linda Crane Lecture Tuesday, January 22, 2013 From Silos to Bridges: Preparing Effective Teams for a Better Delivery System The Pauline Cerasoli Lecture Wednesday, January 23, 2013 Life Lessons: Teaching for Learning that Lasts 29th Annual Eugene Michel Researchers’ Forum Thursday, January 24, 2013 Lost in Translation: Implementation of Research Findings in Today’s World of Clinical Reality EXHIBIT HALL The Exhibit Hall provides an opportunity for attendees to meet with representatives from the premiere companies and vendors providing products, services, and technology solutions in the physical therapy community. Make TechnoPalo TechnoPalooza your first stop in the Exhibit Hall. Come and exchange ideas about how interactive techno technology is shaping the profession and how it can help you help your patients. TechnoPalooza w will offer opportunities to share ideas, discuss your findings, and provide your creative persp perspective on all kinds of interactive technology used in physical therapy research, education, aand clinical care. TechnoPalooza will feature three pavilions of technological inspiration and exploration. Be sure to take advantage of this unprecedented opportunity to see and par participate in the future of physical therapy. ONSITE NAVIGATION TOOLS We’ve Got an App for That Make the most of CSM with the new mobile app for your phone. View the CSM schedule, look up speakers, explore San Diego, get instant alerts, and so much more. This convenient application enables you to create a personalized schedule to maximize your time, discover helpful convention facts and content, quickly verify locations or start times of any session, and find appealing places to eat and visit. CCONFERENCE PREVIEW T There’s not enough space to list all of the conference sessions. Here is a sampling of the exciting section programming planned ffor CSM 2013. For complete program descriptions and speaker biographies, please visit www.apta.org/CSM. TUESDAY ACUTE CARE FEDERAL PHYSICAL THERAPY • Research to Reality: Evidence-Based Outcomes • Prosthetic Advances: Evidence and Experience in to Change Critical Care Culture the Care of Injured Service Members AQUATIC PHYSICAL THERAPY GERIATRICS • Aquatic Therapeutic Exercise for Patients With • Identifying the “Fallers”: Comprehensive Fall Multiple Complex Conditions CARDIOVASCULAR & PULMONARY • Physical Therapy and Cystic Fibrosis: A Success- ful Team From Birth to Healthy Aging! • Best Practices Update for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis • Death to PowerPoint! High-Tech to Low-Tech Teaching Strategies for Cardiovascular/ Pulmonary Education Risk Assessment for Community-Dwelling Older Adults HAND REHABILITATION • Assessment of Upper Extremity Impairment, Function, and Activity Following Stroke: Foundations for Clinical Decision Making HEALTH POLICY & ADMINISTRATION • The Case for Preventing Fraud and Abuse in Physical Therapy CLINICAL ELECTROPHYSIOLOGY & WOUND MANAGEMENT • Starting From Scratch: Making Your PT Vision • Rehabilitating the Patient With Wounds: HOME HEALTH Approaches for the Non-Wound Care PT EDUCATION • Global Opportunities in Physical Therapy Education Through Fulbright Scholar and Fulbright Specialist Programs a Reality • Hospice and the Role of Rehab • Strengthening Your Vital Sign Assessment Skills (2-Part Series) • Ethics in the Home Health Industry NEUROLOGY • The Anne Shumway-Cook Lectureship: The Brain • Genomics, Part 1: Linking Molecules and Genes to Clinical Practice: A Closer Look at the Spine • Genomics, Part 2: Linking Molecules and Genes to Clinical Practice: Recovery After Stroke • Outcome Measures Recommendations From the Neurology Section Spinal Cord Injury EDGE Taskforce ONCOLOGY • A Prospective Surveillance Model for Rehabilitation for Women With Breast Cancer ORTHOPAEDIC • Evidence-Based Update on Management of Patients With Rotator Cuff Disease: Nonoperative and Postoperative Rehabilitation • Rotator Cuff Disease Management, Consensus, and Controversies (3-Part Series) • Consensus and Controversies in Rehabilitation of Rotator Cuff Disease PRIVATE PRACTICE • Developing a Sports Medicine Physical Therapy Practice: The TEAM Approach • Forget Customer Service-: Do you Deliver an Experience That People Will Pay For? • Improving Evidence-Based Practice and Professionalism Across the Health Care Spectrum RESEARCH • Gait Retraining: Taking the Next Step Across Populations From Osteoarthritis and Neurological Impairments to Running-Related Injuries SPORTS PHYSICAL THERAPY • Navigating the Complicated Athletic Shoulder • Rehabilitation of the Injured Athlete: Muscle and Tendon Injuries WOMEN’S HEALTH • Highlights in Obstetrics Series PEDIATRICS • Yoga, Pilates, and Zumba: Alternative Techniques to Improve Core Stability, Breathing, and Posture for the Pediatric Population • Congenital Muscular Torticollis: Conservative Management Is Plastic: A Pathway for Guiding the Future of Physical Therapy WEDNESDAY ACUTE CARE FEDERAL PHYSICAL THERAPY HEALTH POLICY & ADMINISTRATION PEDIATRICS • The Third Acute Care Lecture Award: Leveraging • The Development and Implementation of a • Global Health SIG: Going Beyond Borders, • Core Stability in the Child With Motor Challenges Collaborating Internationally—Challenges and Opportunities • Physical Therapy Management of the Child With Technology to Advance Acute Care Practice AQUATIC PHYSICAL THERAPY • Aquatic Physical Therapy to Improve Balance Dysfunction in Older Adults CLINICAL ELECTROPHYSIOLOGY & WOUND MANAGEMENT • Dissecting the Chronic Wound: What’s Really Going on in There? EDUCATION Clinical Practice Recommendation for Service Dogs in the Veterans Administration System of Care GERIATRICS • Let’s Get More Hip HAND REHABILITATION • Hand Therapy: Unraveling the Confusion in Practice, Coding, Documentation, and Reimbursement • Creating Successful Clinical Mentoring Programs Developmental Coordination Disorder: Improving Participation and Fitness ONCOLOGY RESEARCH • Physical Therapy Across the Continuum of Care • Clinical and Basic Science of Muscle in Pediatric Oncology Fatty Infiltration ORTHOPAEDIC SPORTS PHYSICAL THERAPY • Incorporating Evidence-Based Practice Into the • Structural and Functional Considerations in Continuum of Care After Total Joint Replacement • There’s an App for That! Exploring Technology- Rehabilitation of Young Active Adults With Intra-Articular Hip Disorders, Parts 1 and 2 Enhanced Clinical Practice and Learning in the Era of the iPad THURSDAY ACUTE CARE EDUCATION HEALTH POLICY & ADMINISTRATION PEDIATRICS • PTJ Symposium: Rehabilitation of Patients • Walking the Talk: Threading a Fitness • Technology SIG: Are You Ready for Telehealth? • Prediction of Cerebral Palsy in the Young Infant With Critical Illness AQUATIC PHYSICAL THERAPY • Maximizing Your Plan of Care: Aquatic Therapy After Total Joint Replacement CLINICAL ELECTROPHYSIOLOGY & WOUND MANAGEMENT • Surface Spinal Cord Stimulation and Recording Multisegmental • Motor Responses in Upper and Lower Limbs: A Potential Procedure for Testing for SCI and Diseases Component Throughout a Physical Therapist Assistant Program FEDERAL PHYSICAL THERAPY • How Is It The Same and How Is It Different? Unique Challenges of Managing Low Back Pain in the Military Health Care System GERIATRICS • Are You Pushing Aging Adults Hard Enough? Evidence-Based Exercise Prescription HAND REHABILITATION • Painful Upper Quadrant Entrapment Lesions Resulting in Peripheral and Central Nervous System Dysfunction YOU ARE HERE Best Lessons of Innovation and Integration • May I See a Receipt? Ensuring Documentation Supports Services Billed ONCOLOGY • Red Flags of Lymphedema ORTHOPAEDIC • Running Injuries: Pathomechanics, Injury by Observation of General Movements: Current Concepts and Research • Showcasing Yourself: How to Market Your Professional Journey Through an e Portfolio SPORTS PHYSICAL THERAPY • The Adolescent Female Athlete • Update on Medial and Lateral Knee Pathology Patterns, Evaluation Considerations, and Intervention Strategies for the Lumbo-Pelvic, Hip, Knee, Foot, and Ankle Regions • Rehabilitation and Prevention Concepts for the Runner (3-Part Series) Navigate the Exhibit Hall You Are Here, an interactive map and trade show directory, is a multiplatform web tool that allows you to download and plan your conference experience before and during CSM via the conference website or at one of the on-site stations that will be positioned in the Exhibit Hall. This tool will allow you to access presenter information, search for exhibitors alphabetically or by category, view maps, and more! PRECONFERENCE COURSES All preconference courses will run from 8:00 am to 5:30 pm on Sunday, January 20, through Monday, January 21. Please go to www.apta.org/CSM for complete course descriptions and pricing details. ACUTE CARE HAND REHABILITATION Do It Right From the Start: Task-Specific Training for Relearning Gait After Stroke MONDAY | Pricing: 1B Survey Course in Hand Therapy: The Basics and Beyond MONDAY | PRICING: 1A AQUATIC PHYSICAL THERAPY HEALTH POLICY AND ADMINISTRATION Introduction to AquaStretch™: A New Aquatic Manual Therapy Technique SUNDAY | PRICING: 1B Lead Wherever You Are: Becoming a Personal Leader SUNDAY & MONDAY | PRICING: 2A Manual Therapy Interventions for the Spine: A Laboratory Intensive Course SUNDAY & MONDAY | PRICING: 2B Limit to 50 Participants | PTs Only Out-Think Being Out-Sized: Manual Therapy Approaches for the Not-So-Large Clinician MONDAY | PRICING: 1B PTs Only Manual Therapy for Mechanical Dysfunctions of the Canine Lumbar Spine: Human and Canine Comparisons MONDAY | PRICING: 1B Doing It Right! How to Develop an Aquatic Physical Therapy Program MONDAY | PRICING: 1A Leading Others: Adaptive & Transformational Leadership in Physical Therapy SUNDAY & MONDAY | PRICING: 2A The Burdenko Method: Therapeutic Applications MONDAY | PRICING: 1B HOME HEALTH PEDIATRICS california chapter Therapy Leadership in the Home Health: Building Your Executive Portfolio SUNDAY & MONDAY | PRICING: 2A Fit & Active PT for Persons With CP: Intensity & Outcome Measures MONDAY | PRICING: 1A Strengthening Your Exercise Intervention: Effectively Using Theraband MONDAY | PRICING: 1A Looking Forward: Functional Electrical Stimulation in Pediatrics MONDAY | PRICING: 1A NEUROLOGY Linking Structure to Function: Muscle, Bone, and Brain MONDAY | PRICING: 1a Functional Biomechanics of the Lower Quarter: Implications for the Evaluation and Treatment of Musculoskeletal Disorders DATE: sunday + monday | Pricing: 2b CARDIOVASCULAR AND PULMONARY Assessment and Treatment of the Obese Patient Across the Lifespan: The Role of Physical Therapy DATE: monday | PRICING: 1b Clinical Reasoning for the Patient With Complex Cardiovascular and Pulmonary Dysfunction DATE: monday | PRICING: 1b CLINICAL ELECTROPHYSIOLOGY AND WOUND MANAGEMENT A User-Friendly Framework for Evidence-Based Decision Making in Electrotherapy MONDAY | PRICING: 1A Multiple Sclerosis From Diagnosis to Intervention: Translating Science Into Clinical Practice SUNDAY & MONDAY | PRICING: 2B Correlating Neuroanatomy With Patient Presentation and the Neurologic Exam MONDAY | PRICING: 1A Differential Diagnosis and Treatment of Typical and Atypical Benign Paroxysmal Positional Vertigo MONDAY | PRICING: 1A Wound Debridement Skills MONDAY | PRICING: 1B Considering the Seated Client in Pressure Ulcer Management, Part 1: Getting the Assessment Completed MONDAY | PRICING: 1A Exercise Training Guidelines for Cancer Survivors: Endurance and Strength MONDAY | PRICING: 1a EDUCATION ORTHOPAEDICS Systematic Program Assessment: A Dialogue and Workshop for PTA Educators SUNDAY & MONDAY | PRICING: 2A Manual Therapy Interventions for the Lower Extremity: A Laboratory Intensive Course SUNDAY & MONDAY | PRICING: 2B GERIATRICS Cleveland Clinic Osteoporosis & Bone Health Education Program monday | PRICING: 1A Limit to 50 Participants | PTs Only Treating Scoliosis of All Ages: The 3-Dimensional Schroth-Based Method to Arrest and Prevent the Progression of Scoliosis SUNDAY & MONDAY | PRICING: 2B Limit to 40 Participants Tai Chi Fundamentals® Professional Training Program: Level 1 monday | PRICING: 1B Focus Geriatrics: The Aging Adult MONDAY | PRICING: 1A Section Member Pricing Day 2 Day 1 Residency and Fellowship Mentoring MONDAY | PRICING: 1A PRIVATE PRACTICE How to Start a Private Practice SUNDAY & MONDAY | PRICING: 2A Taking Your Practice to the Next Level SUNDAY & MONDAY | PRICING: 2A SPORTS PHYSICAL THERAPY Comprehensive Management of the Triathlete MONDAY | PRICING: 1A ONCOLOGY Developing an Oncology Rehabilitation Program Through Integration of Physical Therapy Intervention Throughout the Continuum of Care MONDAY | PRICING: 1a iTeach, iLearn, iPad MONDAY | PRICING: 1B Limit to 20 Participants | PTs Only The Female Runner Throughout the Lifespan MONDAY | PRICING: 1A Titleist Performance Institute: Level 1 Golf Fitness Certification MONDAY | PRICING: Titleist Course Price Info: To register for either Titleist course, visit www.mytpi.com/seminars/schedule.asp Titleist Performance Institute: Level 2 Medical Professional Certification MONDAY | PRICING: WOMEN’S HEALTH The Practical Application of Mental Imagery in the Therapeutic Setting Monday | PRICING: 2B Non-Section Member Pricing Standard Standard Plus Standard Standard Plus $255 1A $305 1B $355 1A $405 1B $330 2A $400 2B $430 2B $500 2B REGISTRATION J. Spargo and Associates will handle registration for CSM 2013. Registration opens September 28, 2012. For complete registration and payment deadlines, please visit www.apta.org/CSM/Registration. Online: www.apta.org/CSM/Registration Phone: 877/585-6003 (same phone number as Housing Bureau) Fax: 703/818-6425 Email: [email protected] CSM 2013 REGISTRATION FEES Early Bird registration full registration DEADLINE 11/16/12 DEADLINE 12/21/12 On-Site registration PT Non-Member 680.00 750.00 940.00 PT Non-Section Member 480.00 530.00 660.00 PT Section Member 430.00 480.00 600.00 PTA Non-Member 430.00 475.00 590.00 PTA Non-Section Member 300.00 330.00 410.00 PTA Section Member 270.00 300.00 380.00 Life Member 100.00 110.00 140.00 Student Non-Member 310.00 340.00 430.00 Student Member 180.00 200.00 250.00 Post-Prof Grad Student Member 260.00 290.00 360.00 Corporate Member 390.00 430.00 540.00 Guest 90.00 100.00 130.00 HOUSING APTA’s exclusive and official housing bureau for the Combined Sections Meeting is J. Spargo and Associates. APTA does not endorse booking hotel reservations via sources other than J. Spargo and Associates. Book your reservation by January 3, 2013, to take advantage of the special rates offered to all attendees. Hotel rates, location, and availability may be viewed online or by contacting the J. Spargo representatives by phone. CSM 2013 Attendees can secure reservations in one of the following ways: Online: www.apta.org/CSM By Phone: Call in your reservations to the APTA Housing Center at 877/585-6003. If outside the USA/Canada: 703/449-6418 The APTA Housing Center is open Monday through Friday, 8:30 am–5:00 pm, ET. Suite Requests: To request hospitality suite, contact Angela Taylor, APTA Housing Account Manager, at [email protected]. Note: All suite requests must receive APTA approval before the reservation is confirmed. TRAVEL Air Travel Discounted rates are available for CSM 2013 participants. Please reference the codes below when making your reservations: American Airlines By Phone: 800/433-1790 — use Authorization Number: A8513BI Online: www.aa.com/group — use Promotion Code: 8513BI (No ticketing charge) Valid Dates: January 16, 2013,–January 27, 2013, for travel through San Diego Delta Airlines By Phone: 800/328-1111 — use File Number: NME25 Online: www.delta.com and select the Meeting Event Code field. (No ticketing charge) Valid Dates: January 16, 2013,–January 27, 2013, for travel through San Diego Rail Travel The Santa Fe Depot is the located in the heart of downtown San Diego and within walking distance of the Convention Center. Amtrak offers a 10% discount off the best available rail fare to San Diego from January 18 through January 27, 2013. To book your reservation, call Amtrak at 800/872-7245 or contact your local travel agent. Conventions cannot be booked via Internet. Please be sure to refer to Convention Fare Code X62K-950 when making your reservation. This offer is not valid on the Auto Train and Acela Service, and is subject to other restrictions. Ground Transportation Airport Shuttle SuperShuttle: To make reservations, go to www.supershuttle.com (use discount code 2F9RP) San Diego Trolley: For more information, visit the San Diego Trolley website at www.sdmts.com/trolley/trolley Ride the wave to San Diego for CSM 2013. In addition to the premier programming, special events, and networking opportunities, set aside some time to enjoy all that San Diego has to offer! Explore the dining and the urban excitement of the Gaslamp Quarter. Stroll along the waterfront. Enjoy eclectic shopping. It’s all within steps of the Convention Center. To uncover all of San Diego’s infinite options, please visit www.sandiego.org. by Roshunda Drummond-Dye, JD ComplianceMatters Medicaid Expansion and Physical Therapy The Supreme Court has spoken. What’s next? On June 28, the American health care community took a collective deep breath as it awaited the US Supreme Court’s ruling on the constitutionality of the Patient Protection and Affordable Care Act of 2010 (ACA). In this landmark case—National Federation of Independent Business v Sebelius—the high court specifically considered the constitutionality of 2 provisions of the ACA: the individual mandate requiring citizens to purchase health insurance through a variety of private and public means, and the mandatory expansion of Medicaid to nearly all individuals with incomes of up to 133% of the federal poverty level (FPL). Both provisions were slated to take effect in 2014. In the immediate aftermath of the Supreme Court’s actions on June 28, most headlines focused on the upholding of the constitutionality of the individual mandate. Considerably less noted was the court’s ruling that significantly altered the mandate to expand state Medicaid programs in order to provide health care coverage to millions of uninsured Americans. The Supreme Court ruled that mandatory Medicaid expansion under the ACA was unconstitutional because it would withhold existing Medicaid funds to states that did not comply with expansion. The court said this provision posed an unfair financial burden on states. The high court struck down the provision that would have taken away federal matching dollars to states and ruled that state governments can choose to decline Medicaid expansion while maintaining federal funding for their existing Medicaid population. Medicaid has evolved from a welfare benefit program to a complex system of care that plays 3 main roles—providing health insurance to more that 52 million individuals (including 25 million children) who otherwise would be uninsured, covering long-term care services to Medicare recipients and lower- to middle-income families, and providing subsidies to safety net providers. More than 8 million people with disabilities are enrolled in Medicaid, accounting for 44% of the program’s total expenditures. Of Medicaid funds spent on behalf of individuals with disabilities, 37% go to long-term care services. Rehabilitation treatment is a key health service for Medicaid beneficiaries. Therapy services under Medicaid are provided in a variety of settings, including but not limited to home care, intermediate care facilities for people with mental retardation (ICF/MR), and schools. Therapy helps beneficiaries achieve optimal function, and physical therapy services are vital to the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health. Currently under Medicaid, physical therapy falls under the category of “optional benefits” and is covered in disparate settings and amounts across 39 states. When it is covered, it serves the most vulnerable Medicaid populations—children with or without disabilities and adults with disabilities. Under Medicaid expansion in the ACA, however, physical therapy services are a mandated, covered benefit— part of an “essential health benefits” (EHB) package targeted toward an estimated 17 million uninsured, lowincome Americans. ● 45 ComplianceMatters EHB encompasses 10 categories that provide a baseline of services to Medicaid beneficiaries and enrollees. Designated groups of newly eligible Medicaid beneficiaries must receive these benefits by 2014. These services include: • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care Most important for physical therapists (PTs) is coverage of rehabilitation and habilitation services. The National Association of Insurance Commissioners (NAIC) defines rehabilitation services as “health care services that help a person keep, get back, or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled.” These services may include physical and occupational therapy, speech-language pathology, Resources APTA Health Care Reform Page (www.apta/org/HealthCareReform/) Association summaries of the Patient Protection and Affordable Care Act (ACA) and its key provisions, news and updates related to the law and its implementation, analysis of its impact on health care issues and practice settings, APTA’s position on health care reform, and key links. APTA Medicaid Page (www.apta.org/Payment/Medicaid/) General resources, APTA summaries of proposed and final rules, APTA comments on a variety of program-related issues, and copies of the Centers for Medicare and Medicaid Services’ guidance letters to state Medicaid directors. Medicaid.gov Affordable Care Act Provisions Page (www.medicaid.gov/AffordableCareAct/Provisions/Provider-Payments.html) Information on increased payments for primary care services, reduced payments to disproportionate-share hospitals, and improvements to the Medicaid and Children’s Health Insurance Program (CHIP) payment advisory commission. Henry J. Kaiser Family Foundation Medicaid/CHIP Page (www.kff.org/Medicaid/index.cfm) A guide to the Supreme Court’s ACA decision, an updated fact sheet on Medicaid and long-term care services and supports, an issue brief on accountable care organizations, a summary of key CHIP provisions in the new health care law, and more. 46 ● October 2012 PTinMotionmag.org and psychiatric rehabilitation services in a variety of inpatient and outpatient settings. NAIC defines habilitation services, meanwhile, as “health care services that help a person keep, learn, or improve skills and functioning for daily living.” Examples of this include therapy for a child who isn’t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient and outpatient settings. Medicaid expansion under ACA covers nearly all people under the age of 65 with incomes of $14,856 per year for individuals and $30,657 per year for a family of 4 based on FPL for 2012. A few states already have waivers from the US Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) to cover populations whose incomes are well above these levels. The reality, however, is that most states do not offer such coverage, as they are struggling financially to cover the minimum populations mandated by federal law. To ease the financial burden on states, the ACA provides that the federal government will cover 100% of Medicaid expansion costs in 2014 through 2016. This amount gradually will decrease to 90% in subsequent years. Tools for PTs In the coming months, as state legislatures fully digest the ramifications of the Supreme Court decision and its potential effects on the state budget, the design, scope, and coverage of the rehabilitation and habilitation benefit will be front and center. While opportunities exist for more patients to gain access to physical therapy services through public entitlement programs, it remains to be seen what additional flexibilities and nuances CMS will advance through guidance and regulations. PTs are well advised to tap into resources provided by APTA both nationally (see “Resources” box within this article) and via their state chapters to better distinguish between the rules that govern physical therapy services provided to the existing, traditional Medicaid population and rules that govern service provision to this newly expanded population as prescribed under the ACA, because these policies may differ significantly. For example, while in 2014 the state Medicaid program may provide physical therapy coverage at a certain rate and/or number of visits for a low-income adult in an outpatient rehabilitation facility, those same services may not be covered at all for a child being treated in that same setting,—or, if covered, they may be subject to a different fee schedule and/or visit limitations. PTs also should be aware that there is far more to the ACA than what the Supreme Court decision addressed and modified regarding Medicaid expansion. Other provisions of the ACA will have major effects on state Medicaid programs—such as gradual reductions in payments to hospitals designated by states as serving a disproportionate share of low-income and uninsured patients, and expansion of home- and community-based services—will be implemented in the next 2 to 3 years. (See “Resources” box.) The bottom line is that physical therapy coverage will remain a regulatory challenge under state health programs, and the rules governing those services will become more complex. This necessitates constant internal checks and balances, such as compliance plans and self-audits, by physical therapy practices to best ensure compliance. Roshunda DrummondDye, JD, is director of regulatory affairs in the Public Policy, Practice, and Professional Affairs Unit at APTA. She can be reached at [email protected].. ● 47 EthicsinPractice by Nancy R Kirsch, PT, DPT, PhD Trailer-Made Conundrum Cycling through the arguments for and against. Physical therapists (PTs) often face the difficulty of differentiating between a patient’s medical needs and the psychological and quality-of-life needs of the patient and/or the family. When the treatment venue does not conform to the medical model, decision-making can be that much more difficult. Is Location Everything? Jim has been treating Bobby at home since he turned 3 and entered the rolls of the school system that employs Jim as a school-based physical therapist (PT). Bobby recently turned 6. Jim continues to treat him at home because he is medically fragile, but he fully expects Bobby to have the sitting tolerance and medical stability by next fall to be able to attend school at least part time. Bobby’s parents, Les and Carol, are pleased with their son’s progress and feel reassured that Jim will continue to work with him in the school setting. One thing that saddens them, however, is that they cannot share with Bobby their love of riding bikes on an extensive network of local trails. They enjoy engaging in this activity with Bobby’s older brother Devon, who’s 8, but at those times 1 parent always must stay behind with Bobby. Carol happens to mention this regret during one of Jim’s visits. “Have you looked into bike trailers for children with special needs?” he asks. To Jim’s surprise, it turns out that Carol and Les are unfamiliar with the products, which attach to bicycles and are an enhanced version of typical trailers for small children, offering additional support and safety features. Jim says he’ll send Carol and Les an e-mail with links to some vendors of these trailers, and will make his own recommendations based on the experiences of other families with whom he’s worked. Carol is thrilled. “We’d give anything,” she says, “to share with Bobby our love of the outdoors and the feeling of freedom Resources Code of Ethics for the Physical Therapist • “Ethical Decision Making: Terminology and Context” (PT Magazine, February 2006) • For the Code of Ethics, go to www.apta.org/ethics. PT in Motion/ PT Magazine columns and articles are available to APTA members by clicking on “News & Publications” at www.apta.org. 48 ● October 2012 PTinMotionmag.org you get when you’re on a bike. It would be incredible, I think, to finally have our entire family riding together.” When Jim next arrives at the house, however, a visibly crestfallen Carol says with a rueful laugh, “You know how I said we’d give anything to put Bobby in a bike trailer? That was before I realized the cost of the model we like best is $750, and that even the least-expensive trailer that would meet Bobby’s needs costs nearly as much. I’ve told you how tight our budget is, even with both of us working full time and my putting in overtime. We really can’t afford a bike trailer right now.” Jim feels bad for having brought up the subject—especially when Bobby says during that day’s session that he feels sad because, if it weren’t for him, his mom and dad and Devon all could ride bikes together. But then, just as Jim is preparing to leave, Carol poses a question that gets him to thinking about a possible solution. “Could you maybe order a trailer for Bobby as part of his therapy?” she asks. “It seems to me that it could help him with his balance, and that all the sightseeing he’d be doing as we biked through the woods might help strengthen his neck, too.” Carol might be onto something! Jim knew he could justify the trailer therapeutically. Riding in it most certainly would help with Bobby’s sitting balance and stimulate his cervical EthicsinPractice range of motion and head control. There could be no doubt that therapy goals of socialization and enhanced quality of life would be met, as well. Although he is careful to give Carol a measured response—“Let me look into that and get back to you”—he leaves feeling optimistic, and bemusedly wonders, “Now, why didn’t I think of that?” That evening, however, Jim comes to realize why his subconscious mind might have shut down the “therapeutic” scenario. Jim is seeing Bobby through a school-based program, which means that Jim’s therapeutic goals for Bobby need to be school-based ones. Granted, sitting balance is a school-based goal, but can Jim reasonably justify strapping Bobby into a bike trailer as a way of building Bobby’s sitting-posture endurance for the classroom? Can those socialization goals be considered valid in this case, given that Bobby already is sufficiently aware of his surroundings and socially engaged to be able to function in a school setting? One thing that is clear to Jim, though, is the main reason he’d recommended a bike trailer in the first place—it would have a positive effect on Bobby’s quality of life. Isn’t that therapeutic goal justification enough for the equipment, even with the program being school-based? Jim is a longtime employee of the school system and is well-liked and highly respected. The superintendent always has deferred to his judgment, saying such things as, “You’re the expert” and “We count on you to steer us straight and do what is best for our children.” Jim knows he can present a rationale for purchasing the bike trailer that the school district will accept. He’d very much like to accommodate parents who work so hard to do what’s best for their child. And in the grand scheme of costs for physical therapy care, is $750 really such a great expense? But Jim knows he is trying to justify in his own mind a decision with which he isn’t entirely comfortable. Were he to submit the request-for-equipment form, could he feel satisfied that his judgment was sound, that he was not being unduly influenced by his deep respect and affection for Bobby and his parents, and that he was not compromising his reputation among his local special education colleagues ● 49 EthicsinPractice as something of a “guru” of the field? Was he considering all the factors he needed to be taking into account in order to reach a fair and professionally grounded decision? Considerations While Jim considers Carol’s request sufficiently reasonable to merit serious consideration, he understands that his decision must properly weigh such factors as the practice setting, the context of his interventions and their educational relevance, and whether his long involvement with the patient and his family is coloring his judgment. How can he step back to determine if his decision-making is objective and fully aligned with professional standards? Who said you can’t take PTJ with you? PTJ now offers a mobile website that is a more streamlined version of PTJ Online and is compatible with most smartphones and tablet devices. The mobile site includes all the essential features you have come to expect from PTJ Online, such as: • Access to full-text and PDF articles from January 1999 to the present • Access to PTJ’s archive from January 1980 through December 1998 in PDF • Accepted manuscripts published ahead of print at Online First • Figure/Table-only views • Keyword, title, and author search capabilities • Fully linked reference lists • PTJ’s podcasts • Ability to manage your alert settings to receive the monthly e-Table of Contents, citation alerts, and notifications when Online First articles are posted PTJ Mobile @ m.ptjournal.apta.org 50 ● October 2012 Ethical Decision-Making Realm. Individual, in that this matter is between Jim and his patient and his patient’s family. Societal, as well, because any additional resources expended on Bobby might serve to decrease resources available to other children served by the school system. Individual process. Moral sensitivity, clearly, as Jim is uncomfortable about the situation. Moral judgment constitutes a challenge, as right and wrong are not clearly defined here, in Jim’s mind. Situation. A temptation, given the potential for taking the wrong action based on what Jim might justify as being the right reasons. Ethical principles. The following principles of the Code of Ethics for the Physical Therapist provide guidance: • Principle 3A. Physical therapists shall demonstrate independent and objective professional judgment in the patient’s/client’s best interest in all practice settings. • Principle 8C. Physical therapists shall be responsible stewards of health care resources and shall avoid overutilization or underutilization of physical therapy services. For Reflection Jim is faced with a difficult decision because of a very important factor: quality of life considerations. Quality of life is an intangible that can be difficult to quantify. But quality of life issues are more pronounced and salient in this case because they relate to a child whose access to what might be considered everyday life is limited, and to parents who are deeply vested in the extent of that access. Another important issue is that Jim, as a perceived expert in his field, seems certain to get the bike trailer for Bobby should he request it. It’s important to note, however, the schools superintenPTinMotionmag.org dent’s certainty that Jim will do “what is best for our children.” Note the plural— a reminder that Jim is responsible not only for best meeting Bobby’s needs, but also for best meeting the needs of all the children he serves. I encourage you to share your thoughts about the issues raised in case with me and each other in the “comments” section of this article at www. apta.org/PTinMotion/, or, should confidentiality be a concern, to e-mail me directly at [email protected]. Also, check out the ethics decisionmaking tools at www.apta.org/Ethics/ Tools/. There, you’ll find links to past columns, Ethics and Judicial Committee opinions, real-life guidance to avoid ethical conflicts, and the realm-individual process-situation (RIPS) model of ethical decision-making. Nancy R. Kirsch, PT, DPT, PhD, a former member of APTA’s Ethics and Judicial Committee, is the program director and professor of physical therapy in the University of Medicine and Dentistry’s School of Health Related Professions in Newark, New Jersey, and practices in northern New Jersey. Ads 1012.indd 51 8/30/12 2:08 PM PTAsToday by Jeremy Foster, PTA Mapping the Mother Lode A momentary miner finds fulfillment above ground. For me, being a physical therapist assistant (PTA) is all about mining the array of opportunities our dynamic profession offers us to serve patients— in partnership with physical therapists (PTs) and as important members of the health care team. I work 2 full-time jobs that differ in significant ways but are equally rewarding. (More on that later.) I’m also always mining opportunities for professional growth and for sharing with colleagues the things I’ve learned. I’ve earned Recognition of Advanced Proficiency for the Physical Therapist Assistant in 3 different practice areas— integumentary, geriatric, and acute care physical therapy—and I’m a APTAcertified clinical instructor (CI) who absolutely loves to teach. I started my working career doing a different kind of mining, though. Literal mining. Where I grew up in Utah, coal mining was a way of life. It was pretty much what you did when you reached a certain age. So, I applied for a job and reported for work. It’s an honorable job, and I have great respect for those who can descend day after day down into the cold, wet ground and extract the raw material that powers our homes and businesses. But I lasted in the mines exactly 1 day. It wasn’t for me. My health care career began more or less by default. There weren’t a lot of other employment opportunities in the area, but I found work as an orderly and 52 ● October 2012 certified nursing assistant at a care center for older adults. I hadn’t been in that job long when, in January 1991, I was called up to serve in the Utah Army National Guard during Operation Desert Storm. I never got any closer to Kuwait than Germany, but while I was there I reflected on what I really wanted to do with my life. I would serve others by applying myself and becoming a nurse, I decided. Back stateside, I was offered a position as a rehab tech by a contract company that placed me under the instruction and mentorship of a PT named John Kendall. It was a fateful pairing for me in a number of ways. I was fascinated and challenged by John, who shared with me his 30 years of physical therapy knowledge and constantly quizzed me about various aspects of patient care. He inspired me to continue my education. Crucially, he exposed me to literature in which I learned of a position called “physical therapist assistant” that offered a fast-track path to joining the profession that John loved so much. I’d seen through his work how physical therapy helps individuals reach their highest level of independence, and I felt that was the ideal role for me. I was thrilled when, shortly before graduation from the PTA education program at Salt Lake City Community College, I was hired by the same contract company for which I’d worked previously to again be paired with John, this PTinMotionmag.org time as a PTA. Sadly, however, my friend and mentor died shortly after that, and the company’s inability to find a replacement for him lost them the contract at that facility. Just as meeting John in the first place had been a life-changing event for me, so, too, was losing him, because it led to my doing something I’d never really thought I’d do: relocating to another part of the country. Double Duty I was working for a different contract company, Professional Placement Resources, when implementation of Medicare’s prospective payment system resulted in upheaval and layoffs in the physical therapy profession in the late 1990s. I’ll always be grateful to the owner of that company, Dwight Cooper, for advising me to take a full-time position in January 1998 at Grenada Lake Medical Center (GLMC) in Grenada, Mississippi, where I had been doing contract work. It meant leaving behind my family and friends back in Utah, and exchanging my home state’s beautiful snow-capped mountains and great trout fishing for steamy temperatures and flat terrain, but GLMC’s family atmosphere, small-town feel, and, most important, enthusiastic embrace of me as a valued member of the acute care team and transitional care unit have kept me here for the past 14 years. PTAsToday My supervising PT the entire time I’ve been at GLMC has been Marionette Yarbrough, with whom I have a great relationship based on honesty, mutual respect, and love of evidence-based practice and learning. We function as a strong PT/PTA team, discussing patients’ issues and sharing thoughts about corrective actions. But there’s something else I greatly appreciate about my role at GLMC: the degree to which my opinions are valued by all members of the patient care team. Because I am in daily contact with patients and have helped individuals overcome a wide variety of injuries and medical conditions in my career, my input is welcome when it comes to assessing patient progress, discussing the plan of care, and offering discharge recommendations. Physicians ask my opinion daily—whether I think this patient is ready to safely return home or needs more physical therapy in our transitional care unit, or if it’s my belief that another patient will need an assistive device when he or she gets home. With changing Medicare policies, advances in care delivery, and decreased reimbursements, hospital lengths of stay have decreased dramatically from what they once were. More than ever, physician gatekeepers are looking to the PT/ PTA team for expertise and supporting documentation to achieve the desired result. I’m well-equipped and proud to contribute that counsel. In fact, physicians have consulted me on some of their more difficult wound cases, asking me to view the wound and share my physical therapy care recommendations, or to apply a wound VAC (make a vacuum-assisted closure) after the patient has been evaluated by a PT. It’s clear that my opinion as a provider of physical therapy services is desired and weighed. But I mentioned earlier that I work not 1, but 2 full-time jobs. It’s true. I work a total of 70 hours a week. Am I crazy? Maybe. Do I need the money? Definitely. I have a 3-year-old daughter for whom I’m setting up a college fund. But also, I honestly enjoy what I’m doing and the role I play at both workplaces. At North Sunflower Medical Center in the rural community of Ruleville, Mississippi, I spend most of my time under the direct supervision of my supervising PT, Crissy Lamastus. It’s a different model than the one at GLMC, but it’s equally rewarding. While at GLMC I enjoy a certain amount of independence, what I like about working with Crissy is the constant brainstorming we do—about everything from the most appropriate assistive device for the patient, to the optimal amount of exercise, to our discharge recommenda- tions. Although Crissy is the ultimate decision maker, my views always inform those decisions. And she wouldn’t have it any other way. Seizing Opportunities I don’t like seeing PTAs get “stuck behind the title.” What I mean by that is, I think many of my peers get hung up on the word “assistant” and feel limited by it, and don’t explore the many avenues available to us to increase our own knowledge and educate others, to fill a variety of clinical roles, and to advocate for the profession and ourselves. I noted earlier that I’ve taken advantage of the opportunity to earn Recognition of Advanced Proficiency for the Physical Therapist Assistant VINYL GAIT BELT WITH APTA IMPRINT Many facilities prefer vinyl over cloth for its sanitary and quick “wipe clean” ability. This premium quality 60”, made-in-the-USA belt is comfortable yet sturdy, features closed, rounded edges, and is imprinted with APTA’s logo. Black with teal imprint. Order No. APTA-91 Regular price: $30 APTA Member price: $24.95 Order online at www.apta.org. Or call 800/999-APTA (2782), ext 3395, M–F, 8:30 am–6:00 pm, Eastern time. ● 53 PTAsToday in 3 different categories thus far in my career. I’m not done! I strongly believe that learning never should stop—especially with health care being an ever-evolving field and with there being such a constantly growing need for PTAs’ contributions to quality and evidence-based care. I’ve served as a CI to PTA students for the past 15 years, and I became credentialed by APTA in 2010. It’s a great feeling and a valuable service to be able to share with others my accumulated knowledge. And having completed the credentialing course has made me at better CI and PTA. The role-playing exercises and other aspects provided great insights into my own strengths and weaknesses, as well as those of my students, and spurred me to step up my game. I always tell PTs and PTAs who aren’t credentialed CIs that it’s well worth considering. I’m proud to be a PTA. We do so much to contribute to the overall health and wellness of patients. I’m also committed to APTA membership, because the association is our profession’s the national voice. Do I agree with every APTA position? Frankly, no. But I respect the association’s tireless advocacy for our profession and for the patients we serve, and I believe in being a part of the process of review and potential change. I guess what I’m saying is that I’d like every PTA to get out there and mine his or her opportunities in physi- cal therapy, as I’ve always tried to do. With the caveat that you don’t have to first work in an actual mine—for even 1 day. Jeremy Foster, PTA, is on staff at Grenada Lake Medical Center in Grenada, Mississippi, and at North Sunflower Medical Center in Ruleville, Mississippi. Take a Look at APTA’s Easyy Payy Plan Take a Look at APTA’s Easy Pay Plan Make your dues payments more manageable with APTA’s Easy Pay Plan, which lets you pay your membership dues in four payments over six months. How does it work? When you join APTA or renew your membership, you can use your credit or debit card to have four equal payments automatically deducted from your account every other month for a period of six months. Simply complete the Easy Pay Plan portion of your application or renewal notice. For more details, visit www.apta.org/easypay or contact an APTA Member Services representative at 800/999-2782, ext 3395, or [email protected] 54 ● October 2012 PTinMotionmag.org Ads 1012.indd 55 8/30/12 2:09 PM Nobody ever thanks paperwork for making them feel better. Physical Therapy is about as personal as it gets. Yet therapists often spend more time documenting patient care than providing it. APTA Connect, developed by Cedaron and the American Physical Therapy Association, lets you focus on what matters most... improving the lives of your patients. Patient and staff scheduling, accurate and defensible documentation, ICF language and codes, charge capturing and even outcomes reporting. APTA Connect PZL]LY`[OPUN`V\ULLKPUVULÅL_PISL easy-to-use software solution. Ads 1012.indd 56 8/30/12 2:10 PM CareerOpportunities & ContinuingEducation ● !Classified+AdIndex-1012.indd 57 57 8/30/12 4:55 PM CareerOpportunities & ContinuingEducation 58 ● October 2012 !Classified+AdIndex-1012.indd 58 PTinMotionmag.org 8/30/12 4:55 PM CareerOpportunities & ContinuingEducation ● !Classified+AdIndex-1012.indd 59 59 8/30/12 4:56 PM CareerOpportunities & ContinuingEducation www.moveforwardpt.com ADVERTISE HERE It’s Your Brand – We Help You Deliver! Contact Meredith Turner, Ad Marketing Group Go to www.apta.org/BrandBeat 703/243-9046, ext 107 60 ● October 2012 !Classified+AdIndex-1012.indd 60 PTinMotionmag.org 9/6/12 8:54 AM CareerOpportunities & ContinuingEducation ● !Classified+AdIndex-1012.indd 61 61 9/6/12 8:54 AM CareerOpportunities & ContinuingEducation 62 ● October 2012 !Classified+AdIndex-1012.indd 62 PTinMotionmag.org 8/30/12 4:56 PM When it comes to professional education, not all CEUs are created equal. If you’re performance-driven, hands-on, and not afraid to take on challenging course content, APTA’s Advanced Clinical Practice courses are perfect for you. Blended learning delivers the ultimate experience: • face-to-face contact with nationally known PT experts • access to evidence-based content that zeroes in on best practices in patient/client management • added emphasis on examination and selected interventions Build your knowledge and your skills. Advanced Clinical Practice courses arm you with practical information you’ll use right away. Plus, you can save 20% if you register by the early bird date. Learn more at learningcenter.apta.org/acp learningcenter.apta.org Ads 1012.indd 63 8/30/12 2:11 PM Marketplace IndustryNews Baseline Concussion Testing Added to Sports Screening Event ReDoc Partners With FOTO Featured Marketplace Products Presbyterian Sports Medicine recently hosted its fourth Competitive Edge Sports Screening Day, a free sports screening available to all student athletes in Union County Public Schools, in the southern Piedmont region of North Carolina. More than 200 clinicians and non-clinicians volunteered for the event, which screened more than 1,200 student athletes from 10 area public high schools. The screening included an overview of general health and family history, blood pressure and heart rate checks, lung and abdomen checks, strength and flexibility tests, vision testing, and height and weight measurements. New this year was baseline concussion testing, using equipment provided by Biodex Medical Systems. The screening used the Biodex BioSway as the primary vestibular assessment tool. The Rehab Documentation Company (TRDC) has formed a partnership with Focus on Therapeutic Outcomes (FOTO). FOTO has provided a national benchmark database and reporting service for outpatient rehabilitation providers since 1992. The line of TRDC’s ReDoc products is designed to address the clinical documentation and business needs of physical therapists and others throughout the continuum of care. As part of the partnership, FOTO has adapted its system to be interoperable with ReDoc’s product line. ReDoc, with FOTO’s assistance, is incorporating up-to-date research with technology to transform the way ReDoc users incorporate patient satisfaction, best practices, and outcomes that meet and exceed various government and industry mandates. For product information from these advertisers, visit www.apta.org/freeproductinfo. 64 ● October 2012 PTinMotionmag.org Featured Marketplace Products For product information from these advertisers, visit www.apta.org/freeproductinfo. ● Marketplace-1012-FINAL.indd 65 65 9/4/12 11:14 AM APTA’s Job Bank— The Red HOTTEST PT Career Site! Check out all of the specialized features that allow job seekers to customize search criteria, develop cover letters and résumés, receive job alerts, track applications, and more! Bookmark www.apta.org/jobs— the tools you need for a meaningful job search are only a mouse click away! Featured Marketplace Products What’s Hotter Than Hot? www.apta.org PT in Motion Advertisers Active Innovations ..............................5 Alter-G ...................................... 19, 64 Balanced Body ................................. 65 Bioex .................................................65 CMS-ICD-10 .....................................1 Source Medical ................................ 11 Membership (Easy Pay) ....................54 Toyota ......................................Cover 3 Membership (Move Beyond the Classroom) .................................. 37 Tri W-G ..................................... 13, 66 USPH ......................................Cover 2 Web PT ............................................64 National PT Month ........................ 37 PTJ Mobile .......................................50 Red Hot Jobs ....................................66 APTA Spanish for Physical Therapists .........67 Products & Services Gebauer ............................................23 Continuing Ed & Career HPSO .......................................... 3, 65 APTA Learning Center .....................63 KLM Labs ................................. 27, 64 APTA Marketplace .............................7 Marsh Affinity Services .....................15 Cedaron/APTA CONNECT ...........56 MPN Software..................................51 CSM 2013.................................. 39-44 MW Therapy ....................................65 Foundation (Planned Giving) .......... 34 OPTP ...............................................31 Parker Laboratories ............65, Cover 4 Foundation (Presidential Sustaining Fund) ...........................................33 Pearson .............................................47 Gait Belt ...........................................53 Physio 123 ........................................65 Ingenix ..............................................55 Sanctuary Health ....................... 49, 66 Membership (Affordable Membership Dollar)................... 20 Opportunities Career Opportunities and Continuing Education ................ 57 For product information from these advertisers, visit www.apta.org/freeproductinfo. 66 ● October 2012 !Classified+AdIndex-1012.indd 66 PTinMotionmag.org 9/10/12 2:04 PM Communicate With Your Spanish-Speaking Patients. Instantly! Spanish for Physical Therapists: Tools for Effective Patient Communication, APTA’s concise 8-chapter course in Spanish conversation, will provide you with the listening and speaking skills you need to communicate effectively with your Spanish-speaking patients and clients and their families. The manual was designed to achieve the most communication with the least technical information—to enable you to perform assessments of your patients, determine a treatment’s effectiveness, and provide patient education and instruction in exercise and ADL. And an accompanying exam allows you to earn CEUs. When you complete the course, you’ll be able to: • Use simple questions, commands, and phrases to • Conduct a basic patient/client interview, communicate in Spanish. including symptoms description, mechanism • Recognize Spanish words and phrases associated of injury, identification of primary complaint, with physical therapy evaluation and treatment. and patient status. • Instruct patients/clients in Spanish. Take note: Latest printing (2011) incorporates reader feedback on word use, spelling, and punctuation. Order No. SPAN-1 Regular price: $178 APTA Member price: $105.95 Student Member price: $74.95* To order, call APTA’s Member Services Department at 800/999-APTA (2782), ext 3395, Mon-Fri, 8:30 am-6:00 pm, Eastern time, or order online at www.apta.org. *Phone orders only— please call 800/999-2782, ext 3395. Ads 1012.indd 67 8/30/12 2:49 PM ThisIsWhy by Peter Spagnoli, PT, MS, SCS Summit of Achievement A physical therapist hits the heights. I started climbing big mountains about 10 years ago. My first experience was hiking in the winter in the White Mountains of New Hampshire. My first glaciated climb was Mt Rainier in Washington state, a starting point for many mountaineering hopefuls. I’ve since climbed many other major mountains, among them Mt Kilimanjaro, the highest peak in Africa. Last June, on my second attempt, I reached the 20,320-foot summit of North America’s highest peak—Mt McKinley, or Denali (“the high one”) in the Koyukon Athabaskan tongue. It’s about the size of a living-room rug. There’s a marker and a prayer flag up there among the clouds. I was freezing and exhausted, but euphoric. In a very real sense, I can’t help but think, my 30-year career as a physical therapist (PT) brought me to that rarified space. The author atop 14,061-foot Mt Bierstadt in Colorado this January. 68 ● October 2012 I chose the profession of physical therapy because I always was interested in sports and physical activity, and because I wanted to be able to make a difference in people’s lives. But I couldn’t have known at the time just how much of an impact my being a PT would have on my future avocation in both of those regards—on facilitating my own progress and on my being at the right place at the right time to help others. Knowledge of physical therapy has provided me with the tools I’ve needed to train for climbs and to rehabilitate myself when injuries have occurred. On many occasions, too, my physical therapy skills have afforded opportunities to counsel and treat fellow climbers. I’ve been able to use my training to assist injured individuals, to treat a variety of ailments that tend to occur on the mountains, and to educate climbers on how best to prepare, condition, and position their bodies. One of my most memorable climbing experiences related to my profession occurred a few years ago during my ascent of Aconcagua in Argentina—the highest mountain in the Americas, at 22,841 feet. I was one of 6 men from all over the world climbing that peak with a guide service. People kept exclaiming, “Wow, you’re a physio!” They’d all had good experiences with physical therapy. As it turned out, I’d literally be in position to deepen their respect and admiration for our profession. After several days of trekking, we reached base camp, at 15,000 feet. This would be our home for a week PTinMotionmag.org or so. Base camps are like small cities, where teams acclimatize to the high elevation, sort their gear, interact with one another, eat, and sleep. People from different countries and all walks of life are represented. Everyone has a job to do: fixing or bartering for gear, maintaining camp by clearing snow, boiling water for drinking, and cooking. On Aconcagua, my job was to be the expert who could answer everyone’s questions about training and injuries. It was my particular privilege and joy to be able to reassure climbers in my group that injuries they’d sustained along the way were not serious and would not prevent them from reaching their cherished goal of attaining this magnificent mountain’s summit. Having maintained a successful private practice for the past 28 years has given me the financial freedom to pursue these adventures. So, it’s clear to me that there are many parallels between my career as a PT and my ability to have reached high summits on several continents. What it’s all been about is setting lofty goals, working hard to attain them, and being rewarded with a depth of fulfillment I couldn’t even have imagined when I was starting out. Peter Spagnoli, PT, MS, SCS, is a principle owner of Spagnoli Physical Therapy & Manual and Sports Physical Therapy, with 6 locations in eastern Long Island, New York. With mobility options like wheelchair and scooter lifts, hand controls, wheelchair-accessible vehicles and the industry-first, factory-installed Auto Access Seat and other adaptive equipment, Toyota offers quality solutions to accommodate both caregivers and the people they care for. www.toyotamobility.com Options shown. ©2010 Toyota Motor Sales, U.S.A., Inc. Ads 1012.indd c3 8/30/12 2:12 PM Ads 1012.indd c4 8/30/12 2:13 PM