PT Pintcast - Physical Therapy

Jenna Tosto Mancuso is a physical therapist at the Abilities Research Center at Mount Sinai Hospital in New York City.

Chronic COVID presentation is known as long haulers which means these patients are in the long haul of symptoms. These long haulers do not present with classic COVID symptoms and do not have a diagnosis in place. Other diagnoses like post viral syndrome and dysautonomia present similar to the chronic phase of COVID.

Her presentation “Precision Recovery: Chronic COVID Rehabilitation” discusses the post COVID patient, symptoms, and physical therapy treatment.

QUOTES

“This is our time in rehab… We can step into the forefront, educate ourselves, get that professional development and understand what is going on.” – JENNA

“Don’t be afraid to advocate for the profession. Don’t be afraid to advocate for your patient.” – JENNA

PARTING SHOT

“This is your time to shine.” – JENNA

This is the Private Practice Panel!

We have Ashley Johnson, Rachel Gelman, Lex Lancaster, and Kyle Brunelle who are physical therapists and recent private practice owners. Some of them even started during COVID!

Check out each here:

* Doc Jay Physical Therapy* Pelvic Wellness & Physical Therapy  * Renegade Movement & Performance

Biggest Challenges:

* Constructing a new clinic* Rushing to sign lease papers* Length of time to open and continue to accommodate patients* Marketing* Overspending

80% of changes come from 20% effort. Here are their 20% effort areas:

* Marketing* Relationship building* Logistics* Building a brand* Targeting a patient population with a financial burden for therapy 

The Most Fun Opening a Business:

* Building the brand* Documentation* No uniform* Increased autonomy* Creating a website

PARTING SHOT

“Find your lane. Do not give up. Be personal. Be cool when people come to you.” – ASHLEY

“Believe in yourself.” – RACHEL

“Send it.” – KYLE

“If you’re a new grad watching this, you can do this.” – LEX

Ryan Hendrickson is a service member in the Navy, Air Force, and Army, author of Tip of the Spear, and current Green Beret. Ryan was chatting with us while on his deployment in Afghanistan.

His book details his life serving through three branches of the military and eventually becoming a Green Beret.

One specific deployment in Afghanistan searching for improvised explosive devices (IED), Ryan tells us how he was injured stepping on one which ended up becoming life changing.

Through multiple surgeries, skin grafts, and extensive physical therapy with his PT Johnny Owens, Ryan was able to walk and return to Afghanistan.

Check out his book of his journey back to battle Tip of the Spear.

QUOTES

“You don’t control life and you don’t control death. Everything in between are blank pages.” – RYAN

“You don’t really fail… unless you adopt a victimization mentality that you’re a failure.” – RYAN

“As people would quit, I would feed off that weakness because I’m still here.” – RYAN       

“You’re not just working on a patient or a client… you’re changing lives.” – RYAN

“You’re getting guys and girls back into the fight regardless of what fight it is.” – RYAN

PARTING SHOT

“Refuse to become a victim of circumstance because life is full of them.” – RYAN

We have Cindy Miles (Academy of Pediatrics President), Sharon Gorman (Academy of Acute Care President), Angela Campbell (Academy of Cardiovascular and Pulmonary President) and Dee Kornetti (Home Health Section President) talking about APTA’s COVID-19 Aerosol Generating Procedure (AGP) statement.

As aerosol is one of the chief modes for COVID-19, APTA created an aerosol generating procedure guide because exercise and mobility could generate those aerosols.

For more information on this AGP statement, check out these resources created by the APTA:

* Taking Precautions for Mobility and Exercise as Potential Aerosol-Generating Procedures* COVID-19 Core Outcome Measures* Infectious Disease Control

Check out APTA’s Post-Acute COVID-19 Exercise and Rehabilitation (PACER) Project on APTA’s Learning Center to learn more about the physical therapy management and education required for this population.

PARTING SHOT

“It’s chaos. Be kind.” - SHARON

“Through adversity comes opportunity.” - ANGELA

“’...the credit belongs to the man who is actually in the arena...’ – Theodore Roosevelt, The Man in the Arena” – DEE

“Peds rocks. APTA and everyone in the academies and all the chapters rock. We all rock better together.”  – CINDY

Let’s talk about sex!

On this episode, we bring on Tammy Roehling, Pam Kays, Ariana Jones, and Anya Vierra who all treat and educate in pelvic health physical therapy.

Tammy starts with common pelvic dysfunctions seen in clinic that may affect patients during sex – pelvic pain, incontinence, and erectile dysfunction. The women discuss how these are seen in most if not all patient populations as well as portraying society's view about sex.

Treatment techniques mentioned include while keeping in mind patient comfort and consent:

* Education & communication* Internal & external massage* Therawand* Biofeedback* Vaginal dilators* Diaphragmatic breathing* Desensitization* 3 phase progression for mind-body connection 

Fun Facts:

* Water based lube or coconut oil is best for lubrication* On average, it takes over 10 years from onset to diagnosis of pelvic pain conditions* Since onset of COVID, there was an increase in dyspareunia present in clinic which the group agreed was due to stress* Audio record sessions if it involves treatment performed internally

As a physical therapist, it is important to understand how the patient defines sex and what their goals are because it may be different from our own beliefs about sex. Even when pain-free sex is achieved, it is essential to continue thinking of function with sex – orgasm with pleasure.

Ariana is holding a webinar about returning to sexual activity after delivering a baby on Tuesday August 27th, 2020. Register here.

PARTING SHOT

“Always have a curiosity. Always have compassion. Ask all the questions” – ANYA

“Get comfortable with the uncomfortable.” – PAM

“A lot of people have dysfunctional pelvic floors especially after having a baby… Women need to get in and get their pelvic floor healthy." – TAMMY

“All the women out there, look at your vulvas so you can pick it out of a line up.” – ARIANA

Sammy Stryke is a physical therapist assistant in a skilled nursing setting who is aggressively passionate for helping her patients, students, and fellow clinicians.

Sammy believes everyone can use a mentor no matter what stage of your career you are in. There are benefits of being a mentor – fulfillment, relearning material, different perspective, etc. As a mentee, you can gain confidence and new skills.

She is passionate about PT advocacy and becoming a leader to have a voice at the table to make change at national levels.

Check out the PTA Caucas for more information on PTA leadership in physical therapy.

Becky Bliss breaks down the BJSM Article - Concussed Athletes Walk Slower than Non-Concussed Athletes During Cognitive-Motor-Dual Task Assessments but not During Single-Task Assessments 2 months after Sports Concussion: A systematic review and Meta-Analysis using Individual Participant Data

Released in January 2020 from Butter, F., Howell, D., et al.

Article Link: http://pubmed.ncbi.nlm.nih.gov/31331944/

The What

Current concussion assessment tools may not be difficult enough to identify residual neuromotor control deficits in athletes that have sustained a concussion.  Recent evidence has shown that concussed athletes have a 2-3x greater risk of subsequent lower extremity musculoskeletal injury.  This poses to question current return to sport decision making tools and injury mitigation strategies for concussed athletes.  In this systematic review, meta-analysis, slower walking speeds and greater frontal plane CoM displacement was found during dual task activities to include cognitive motor challenges as compared to single task activities up to 2 months following injury.  Gait impairments persist beyond reported clinical recovery timelines and current assessment methods may not be sensitive enough to identify residual deficits prior to return to play.   Dual task assessments (with motion capture) may be a useful clinical assessment method to evaluate higher level motor control following concussion injury.

The Who

Studies that included individuals with sports concussion And non-injured controls

The How

Systematic review looking at inclusion criteria that included concussed and control participants with steady-state walking or static balance task as the primary motor task, and dual-task performance was assessed with the addition of a second cognitive task.

So What?

Dual task motor-cognitive assessment showed residual neuromotor deficits in concussed athletes as compared to matched controls, as single task was not a discriminating condition.  This indicates that current assessment tools may not be sensitive enough to identify residual neuromotor control impairments.

What does it mean?

This confirms that higher level neuromotor control, specifically dual motor-cognitive tasks, may help identify residual deficits following concussion up to 2 months post injury.  This is a potential postulated theory of why these individuals are at risk for subsequent LE MSK injury.

Now What?

Clinicians should be employing dual task, higher level cognitive motor assessments in athletes following concussion and prior to return to play.

What Went Wrong?

Continued investigation of what is the “best” assessment tool is unknown.

Conclusion

Athletes need to be able to cognitively make decisions, react and perform during game play.  Assessment tools that can mirror skills needed for sport may help identify higher level neuromotor control deficits that are currently undetected with static, single task measures and mitigate the risk of subsequent LE MSK injury risk.

NYC COVID-19 Follow Up with David Putrino

Ellie Somers is a team physical therapist for the USAFL women’s national team, run coach and owner of Sisu Performance and Physical Therapy in Seattle, WA.

Biases are always involved even in leaders. Ellie hopes people learn about their own implicit biases and how those biases can influence continued racism in our profession as well as the little steps and actions taken to make change.

Ellie is active on social media and recognizes the difficult conversation discussed on these platforms favoring loud voices. Her advice is when in doubt, lead with a question and understand the voices to amplify and why.

Her goals for DEI in PT - follow racially different PT’s and take actionable steps in the community and clinic.

QUOTES

“We follow our bias because it is the easy path.” – ELLIE

“I have a responsibility to try and ensure that the content I’m consuming on social media works against my ingrained white privilege.” – ELLIE

“We have to amplify the voices of black and brown colleagues. Consistently.” – ELLIE

“I think we need to shift the vision a little bit and say how do we elevate the entire profession? How do we ensure we are being equal, equitable, and inclusive? The realm of physical therapy has a long way to go.” – ELLIE

“Crisis doesn’t create character, it reveals it.” – JIMMY

PARTING SHOT

“Do the best you can to support diversity, equity, and inclusion every day.” – ELLIE

Michael Lewis is a state affairs specialist for the APTA. He has worked in state and federal healthcare and disability policy for 10 years, a cause dear to him as he has cerebral palsy.

He tells his story about his life with cerebral palsy and his personal connection to physical therapy.

He was young when the ADA was enacted but it benefited him immensely to improve his mobility in the community and complete college and graduate school.  

Read his article The ADA Turns 30 This Year on the APTA website.

At APTA Legislative Affairs, Michael helps to move forward the advocacy efforts therapists strive for to improve health care – direct access, increase scope of practice, providing telehealth, and increasing access to the PT compact. Michael mentions recent APTA accomplishments including dry needling in Florida, co-pay law in Georgia, and the Choose PT campaign.

QUOTES

“The world was an obstacle for people with mobility issues.” – MICHAEL

“People don’t ask questions because they do not know how to ask questions.” – MICHAEL

“ADA is a great piece of legislation to progress, but hopefully we’re not done yet.” – JIMMY

PARTING SHOT

“Never underestimate someone with a disability because they will always outsmart you.” – MICHAEL