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.

 

How do the 2014 California regulations impact YOU?

A number of very significant laws that regulate our profession came into effect in January of this year. Some of them are changing the practice of physical therapy in California. Do you know what these are and how they impact you?

An example of changes include the area of DIRECT ACCESS: physical therapists are now legally allowed to see patients directly for musculoskeletal care. This, of course, grants a much larger degree of autonomy and independence to PTs. But, did you know:

• What are the limitations of this law?
• What are the parameters under which you can or cannot see patients without a referral?

Another significant and major change is in the PROFESSIONAL CORPORATION ACT, which now allows physical therapists to be employed by medical and podiatric corporations.

And yet another regulatory change is in the area of Supervision of PTAs. In this case, regulations have loosened up quite a bit and it’s important to fully understand the legal definition of “PT or record” and how it applies to PTA treatment.

To operate within the framework of these new regulatory conditions –or, better yet—to use the new environment to build a thriving career or practice–, the California PT needs to be thoroughly educated on these historic changes. The EDUCATA course, A Practical Approach to California PT Law — 2014 is fully updated with the new regulations and devoid of non-applicable, older laws.

This unique course presents vignettes of actual case examples to better illustrate, with examples, how the law is implemented.

DURING THE PERIOD OF TIME BETWEEN NOW AND APRIL 15^TH, 2014, EDUCATA is making this course available at a special pricing:

• For those who have already taken the course previously: purchase it now at half rate ($29.95). Send us an e-mail to info@educata.com so we can send you your personal coupon code.
• If you have never taken the course before, purchase it at 25% discount of regular price, or $44.92, using coupon code CALAW2014.

This course is taught by Dr. James Dagostino, a well known PT and educator who specializes in all issues related to the legislation of physical therapy in California.  Dr. Dagostino was instrumental during the law change process in Sacramento and presents these issues from a unique perspective.

* * *

Now, going back to DIRECT ACCESS, the new law specifies, for example, that a physical therapist may see a direct access patient for 12 visits, or 45 days –whatever comes first. What is required for treatment past those parameters?

How will the new law changes affect YOU?

Chime in on your reactions to these law changes and the future of PT IN California!

Farewell and Thank You, Dr. Jobe!

by Marilyn Pink, PT, Ph.D., MBA

A patient sitting in his/her pre-op exam with Dr. Frank Jobe would hear about the surgery, and then they’d hear “—and that is only the first half of the job, the second half is your physical therapy”. On March 6, 2014, physical therapy lost a great friend and a firm believer in the profession with the passing of Dr. Jobe.

Given the great therapists he worked with, it is easy to see how he came to appreciate the benefits of PT. So, before going on with remembrances of Dr. Jobe, I, as a PT, would like to thank all of you PTs who affirmed Dr. Jobe’s belief in us: Haideh, Judy, Clive, Kevin, Pat, Brian, Matt, Stewart and many, many more. For those PTs who have not had the privilege to work with Dr. Jobe: we are making his EDUCATA course The Process of Progress (a collaboration between myself and Dr. Jobe) available for free this month of March 2014 in his honor. Click here and enter coupon code JOBE2014 at checkout if you’d like to hear and learn directly from this great clinician, surgeon, educator.

Like Hippocrates, Galen and Pare, Dr. Jobe went to war to learn about surgery. He joined the Army out of high school during World War II and served in the 101st Airborne Division during the Battle of the Bulge. One day, out of the blue, he told me a story about how his group was about to move to a new location the next day. As the medical supply sergeant, he stayed up all night packing supplies. The next day, once they’d arrived at their new destination and he had unpacked, he decided to take a nap.  So, he went into the forest and fell asleep – until he heard yelling, screaming and gunfire. He looked out from the dense forest, and saw the Germans had overtaken his camp. As a young man not knowing what exactly to do, he went deeper into the forest and became quite lost. Multiple days in the cold without food went by. Then he heard trucks. He decided it didn’t matter if those trucks were American or German, he was going to flag them down.

Lucky for him, and us, they were American trucks. Dr. Jobe became a medic and the Army doctors whom he saw performing surgery, keeping calm and focused with gunfire overhead, became his inspiration.

Indeed focus and keeping calm became landmarks of his personality.

The first lecture I did for Dr. Jobe was at a Baseball conference. After speaking and on stage, Dr. Jobe came up to shake my hand and leaned in, for what the audience probably assumed was a gentlemanly kiss on the check.  But, here’s the truth – he was whispering in my ear that I’d forgotten to distinguish between the upper and lower subscapularis!! So, Dr. Jobe: in the lecture on shoulder biomechanics that is currently in production at EDUCATA, I make a big deal out of the difference of those two RADICALLY DIFFERENT parts of the muscle.

Baseball Fantasy Camp for MD’s and PTs. Dr. Jobe flanks one end and Marilyn Pink the other

Much has been said this past week about his breakthrough surgical procedures and the famous people he treated – mostly athletes. But I’d like to put in my two cents for his generosity to humanity. Here was a busy man who loved his work and the people around him. He helped us define our strengths and then gave us an opportunity to push a bit more. He knew what and when something was taking our minds off of work, he’d gently inquire about it and turn the focus to what we did well. He helped us believe in ourselves.

I’m at a lack of words for the greatness of this human being, but I’d like to close with this remembrance: frequently, at the end of a lecture, Dr. Jobe would turn to the audience and say “We aren’t done.  It isn’t over yet.  It is for you, the next generation, to take this knowledge to the next level.  I want YOU to do the research to make my words outdated.”

I take that to heart.  This past year we saw Dr. Perry pass away, as did Dr. McKenzie and now Dr. Jobe.  Who among us are the next leaders in clinical advancement?  What questions are we asking?  What do we look for and how can we consistently optimize treatment with our patients?  Equally pertinent is how do we deftly communicate our findings and promote learning in all of us?

So, thank you Dr. Jobe, Dr. Perry, Dr. McKenzie and many other leaders who have shown us not just the facts of medicine, but also the process of thinking through problems, deriving solutions and communicating results. Thank you too, for making it clear that we each have a responsibility to enjoy our work as we push it forward.   Thank you for being our inspiration.

Marilyn

“A great surgeon but a better person” – Tommy John, retired Dodger’s pitcher.

Would you exercise this patient?

If you were asked to create and execute a PT program for a patient and his ECG graph looked like this:

Would you?

Tell us your choice and comment as to why you think you should or should not. We’ll let you know the results (and the correct answer) shortly.