The gait belt

While I was in Physical Therapy (PT) school I was taught that patients who did not wear gait belts during gait or balance exercises, any slips, trips and falls resulting in personal injury could be a medical malpractice/negligence claim and is an issue of ethics. And, if the personal injury does result in a lawsuit, you — the PT — lose.

Please note that when using a gait belt there needs to be contact (or very close) supervision. (If there’s no supervision, then why the gait belt?) The level of supervision needs to be documented in the chart, as well as the use of the gait belt. In this BLOG, whenever the term “gait belt” is used, please assume the level of supervision was either contact or close.

Recently I’ve visited various outpatient clinics and rehabilitation facilities. I made it a point to ask the PTs whether they used gait belts when treating patients with balance/gait deficits that could result in slips, trips and falls. And I noted the type of business of employment.

This led to some very interesting discussions, so I decided to include YOU in the discussion. The following is a four-question quiz for those of you working with patients, and after that is a one-question quiz for those working in academia. I am quite interested in hearing from you — both in the quiz and in the comments. I will let you know the results of the quiz in a subsequent BLOG.

Questions for clinicians

Question for academics

 

In a medical malpractice/medical negligence case, it will be important to know whether a gait belt owned by the owner of the rehabilitation business was on the premises at the time of the bodily injury. Also, it will be important to know whether the use of gait belts is appropriately in the Policy and Procedure manual. If the rehabilitation business does not have a gait belt on the premises, the rehabilitation facility may be liable for not providing a safe environment.

The bottom line is that every physical therapy place of business should have functional gait belt(s) on the premises, and the use of the gait belt needs to be in the Policy/Procedure manual.

The above two paragraphs are only about legal ramifications around the gait belt. Let’s now look at the ramifications around ethics.

The American Physical Therapy Association has identified eight principles around the core values of ethics: Accountability, Compassion, Professional Duty, Social Responsibility, Altruism, Compassion/Caring, Excellence, and Integrity. It is the professional duty of a PT to cause no harm (i.e., no personal injury) to the patient. Also, if the patient falls, the question of “excellence of care” arises.

So, if the PT does not use a gait belt and personal injury ensues, the PT or the employer must ask the questions of ethics:

1. Did the PT have a professional duty to the patient?
2. Did the PT act in manner providing excellence of care?

So, let’s use that gait belt.

Now it is your turn! Please share your thoughts about gait belts below — and if you haven’t taken them yet, take a look at our courses related to balance and falls.

• Functional Assessment and Exercise for the Aging Adult
• Fall Prevention: What’s All the Fuss Over Falls?
• Interprofessional Fall Risk Management: We > Me

How do you face change?

INTRODUCTION: We received a number of great PT stories and we will announce the random winner of our $200 Amazon card next week. Meanwhile, as PT Month wraps up, I’d like to focus on the future and invite you to consider and answer this important question: How do you face the one certain thing we have in front of us: change. I look forwards to your comments!

— Marilyn Pink, PT, Ph.D.

Eyes on the Future

There is a letter from Martin Van Buren to president Andrew Jackson that I keep in my wallet to remind me that things change: always have and always will (see below).  Our profession is changing.  Reimbursement is a stickler, more paperwork is necessary and less hands-on treatment is given.   There are three ways to face the changes that comes you way:

1. You can resent that which happens to you
2. You can consent to that which happens to you, or
3. You can invent that which happens to you

As you consider the motivations that brought you into PT –the “why”– and as you consider the work you have done so far, we’d like you to tell us how you can leverage your experience for the next phase of your career: what is your response to the inevitable change?

Tell us your physical therapy story!

INTRODUCTION: We were not surprised, but still very gratified, to see the results from last week’s poll. We love that PTs and PTAs are so prompt and ready to help. And we loved comments like Larry’s, who loves what he does!

We look forward to hearing what you have to say and the stories you’d like to share. In fact, if you tell us one of your PT stories (it can be touching, funny, a learning experience — whatever you feel like telling us), we’ll be keeping an eye out to randomly select one story for a $200 Amazon gift certificate.

So, you started down this path with a specific purpose. Is that still your motivation today? Or has it changed, adapting to the twists and turns of life as it happens?

I remember serving on a panel about career direction to a group of PT students. One person on the panel was a pediatric PT, one was well known for her work in governance, another worked twice a year (for a month at a time) in a country/region of need, the fourth person worked in home health, and I was a researcher. Since I was the last seat on the panel, I had the luxury of hearing everybody else’s story first. I commented on how interesting it was to look at the pattern of the five of us: While our careers were so different, we were each PASSIONATE about what we did, we all had the same background/studies/degrees, yet we were able to contribute to our profession so differently.

Now, it’s YOUR turn. I look forward to hearing from you! — Marilyn Pink, PT, Ph.D.

Tell us your story!

Have you ever run into a situation, either as a PT student or in your work life, that you thought, “This one is for the books!” Tell us! If you found something to be funny, or something that inspired you, or something that has a lesson — we’d love to hear it.

We look forward to hearing from you! Click on “leave a comment” and tell us your story below.

 

What led YOU to become a PT or PTA?

It is PT Month and let’s focus on YOU as we open a 3-part series focus around the career of physical therapy.

As a PT myself, this month is the time I use for professional reflection: where I have been, where I am, where do I want to go, and how am I going to get there. Am I leveraging my past to be the best PT that I can be today? What have I given, what am I giving, what do I still want to give to our profession?

Given this is a ‘professional reflection’ month, let’s start by remembering your interview for school. Please take this short poll (below), and let’s engage into a conversation about this wonderful path we have taken. I look forward to what you have to say! 

Marilyn Pink, PT, Ph.D

PLEASE TELL US…

 

There are no right or wrong answers — you’ve chosen a noble career and we salute you as we look forward to what you have to say.

And keep your eyes peeled for stories, reflections and tools that we will be publishing, which we hope will be useful in your professional life.

Comment at will!

How good is your differential diagnosis?

INTRODUCTION, by Marilyn Pink, PT, Ph.D.: Differential diagnosis is critical for our professional development — and a topic that will be updated throughout our careers, particularly for PTs who practice with direct access to patients. We thought it would be fun to do a quick check on our understanding and see how we measure up. So treat yourself to this quick, 3-question quiz, below. 

Test yourself!

Here is a simple, 3-question quiz on differential diagnosis. To see how others answered, click on the “view results” link on each question. To see the correct answers, click here.

How well did you do? Feel you could use a brush-up and earn CE credits in the process? We have a great audiovisual course by Dr. Chad Cook in our course catalog. There are also many papers in our research library that cover the topic as well. Enjoy!

Here is how you voted:

Well, that was interesting! Here is how you voted on the 3-question quiz about differential diagnosis:

The question was: What’s the best test for ruling out impingement of the shoulder? You voted:

And the correct answer? The 297 people (62% of total) who chose Hawkins-Kennedy Test were correct!

The next question was: What is the best test to determine the presence of clinical osteoarthritis? Votes were close between “Pain in the morning” and “3 or more planes of ROM loss”. Correct answer?

3 or more planes of ROM loss! 35% of respondents had it right.

And, finally, we asked: “Which is the most useful test for ruling out the presence of any sacroiliac lesion?” You answered as follows:

Who hit it on the nail? Well, the 65 (only 14% of total respondents!) who said “Long dorsal ligament palpation”!

Seems like this is an area where a bit of skill sharpening could be useful! Our Differential Diagnosis course is taught by Dr. Chad Cook, a recognized expert in this field. He has taught over 2,000 physical therapists a year on the topic, and his books have sold over 5,000 copies. His writing and teaching is evidence-based and well received, as demonstrated through his over 70 peer-reviewed publications and his multiple awards in teaching and writing, including the 2009 Dorothy E. Baethke — Eleanor J. Carlin Award recipient for Excellence in Academic Teaching, from the APTA.

Differential Diagnosis is a 7.5-CE-hour course, so not only are you learning important information from the best in the field, but also getting con ed credits for your certification renewal.

Hope you found the above test fun and useful, and we welcome your comments and suggestions. Feel free, as always, to peruse our FREE research library where you can find many great papers on this subject.

Warmly,

Marilyn Pink, PT, Ph.D.

 

Top 5 Things a PT Should Know About Treating the Shoulder

Treating patients with shoulder issues? Then this article is for YOU!

 

If you want to activate the Rhomboids in an exercise program, it is best to be done isometrically at the end range (and usually toward the end of the exercise program).

 

The supraspinatus, while one of the rotator cuff muscle, functions mostly to pull the deltoid head into the glenoid.If the supra shows any signs of weakness, it should be strengthened early in the exercise program, and at the lower (first 30 degrees) of elevation.

 

Every sport is unique, and requires unique motor control. As Physical Therapist, we all know which muscles function at each phase of the gait cycle.  Similarly, as therapists, we need to understand the muscle activity during each phase of the sporting activity, and know the substitution patterns so that we can most accurately treat the athlete.

 

Specific stretches can be good for a patient, or they can be bad. When they are our patients, we can see that rationale and appropriate select the correct stretch.  What do you do, however, if you are advising a team on warm up stretches?  What do you take into consideration in selecting Team Warm-Ups and Cool Downs?

 

The serratus anterior functions as an ‘endurance’ muscle during the freestyle swim stroke.  Thus, it needs special attention for team exercises and, if the swimmer is your patient, definitely check for any signs of weakness in the serratus. Typically, the serratus in one of the first muscles to fail: therefore it is commonly one the basis for early subtle signs.

To hone your knowlege and skills on the shoulder, check out two of our courses, taught by Marilyn Pink, PT, Ph.D., a sports rehab expert who worked closely with such luminaries as Dr. Frank Jobe and Dr. Jaqueline Perry to develop innovative orthopedic techniques that are widely used today.

These courses examine the anatomy, mechanics and pathomechanics of the shoulder complex in amazing depth and detail. You will learn how these factors apply to specific sports, such as golfing, swimming, and playing baseball and tennis.

PURCHASE THEM TOGETHER AND RECEIVE A 15% DISCOUNT! If you are interested in this offer, send an e-mail to info@educata.com to receive your coupon code.