Making Waves With Aquatic Therapy

|Oct 2012
Making Waves With
Aquatic Therapy
Emerging Leaders 2012
Resources: Claims Database
ACA Medicaid Expansion
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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
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2● October 2012
PTinMotionmag.org
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columns and departments
O c t o b e r 2 012 , Vo l 4 N o 9
10 45
Deciding on Documentation
45
48
The Effects of a Supreme Court Decision
Medicaid Expansion and Physical Therapy
The Supreme Court has spoken. What’s next?
Trailer-Made Conundrum
Cycling through the arguments for and against.
columns
Compliance Matters
45
Ethics in Practice
48
PTAs Today
52
This Is Why
68
departments
52
68
Mapping the Mother Lode
A momentary miner finds fulfillment above ground.
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
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American Physical
Therapy Association
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Production Manager—Print and
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Chief Executive Officer
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Advertising Manager
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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
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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
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Take advantage of bulk discounts and customization options on great gift and giveaway
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and participants at community events, and a whole lot more.
Visit www.apta.org/Marketplace today for all of your National PT Month essentials!
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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
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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.
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October 2012
PTinMotionmag.org
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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
donaldtepper@apta.org.
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
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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
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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
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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
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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.
ƒ FREE CONTINUING EDUCATION: Free CEUs through the
APTA Learning Center—a value of more than $800.
ƒ FREE ADVERTISING: APTA’s Find a PT consumer search
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on conference registrations, exam fees, retail products,
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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
aquaticspt@apta.org
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
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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
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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
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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
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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
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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!
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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.
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Help fund physical therapy research
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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
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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: aptaregisstration@jspargo.com
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 Angela.Taylor@jspargo.com.
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
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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 roshundadrummonddye@apta.org..
●
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?
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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 kirschna@umdnj.edu.
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.
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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
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●
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.
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54
●
October 2012
PTinMotionmag.org
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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
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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