Re: Mandated recredentialing of PTs

[Guest guest]

I think that a geriatric ortho course sounds great, especially because of your (I believe) predominantly home health practice. I work in an outpatient orthopedic clinic, dealing with work and sports injuries (active duty Army) during the regular work week, and moonlight 2 weekends per month at a county hospital with rehab, acute and LTC units. This week, I took some vacation time to work at the county hospital in all of thier settings, and I was amazed at the lack of orthopedic knowledge. Many patients (especially in rehab units) aren't progressed with exercises nearly as quickly as they could be. Small mistakes when working with hip ORIF and THA/TKA patients can make a huge difference in outcome. I find that many rehab facilities that mostly handle neurological and geriatric patients are not equipped to handle orthopedic problems. I think that this happens because of an extreme amount of experience in one area, with lack of experience in others. Unfortunately, the " norm " for hip ORIF outcomes, especially in those that have suffered prior CVA, is far less than what these patients are typically capable of if placed in the right hands.

That leads me to an observation/question: I have always enjoyed rotating between settings and using the knowledge to benefit all patients in all settings. How many other clinics on this list have a policy where all or most of the staff PTs rotate between several settings? FOr instance, my best ideas (best improvement) in treating adhesive capsulitis, came from a series of lectures dealing with scar tissue development and healing in patients with severe burns. I got the idea to be much more aggressive much earlier with these patients. My cohorts though I was insane, but it's worked very well since. Later that year, two other articles were published advocating the same type of approach, with a similar rationale to the one that I used to justify my treatment. That is info that I would never have gained at an orthopedic course. This " shift in gears " jumpstarted my thinking about a problem, and pushed my thinking " out of the box. "

Along those lines, I also saw a patient this week that had an incomplete SCI (now about C8) one year ago, and is now s/p intrathecal baclofen pump implantation. They had been standing and walking with him in the parallel bars, but as he has been adjusting his baclofen dose, he's been complaining (and did sometimes before) that his right knee would " give out " while he was trying to stand, and that he couldn't stand to have it placed in full extension since his SCI. I was told by the PTA who usually treats him to " watch out " while stretching his hamstrings, because his knee would " go out, " and swell later in the day. He had a prior knee injury playing football some years ago. They had secured a post-op derotational braced (found by trial and error) that helped him stand.

As I was stretching his hamstrings, I felt his tibia sublux anteriorly at about 30 degrees of flexion. I was unable (due to tone) to fully assess Lachman's, but this sublux during his stretch was an obvious pivot shift. More assessment revealed a positive McMurray (lateral joint line). This is the first case that I have ever heard in which an ACL deficiency caused a functional loss in a quadriplegic. Anyone else heard of anything like this?

Sorry about the length (I do this every so often)

Guy Terry, MPT

Betsey: Will throw my .02 into the ring -- I have taken the GeriatricOrthopedics course with Carole and I HIGHLY recommend it. She isabsolutely the best lecturer I have had the pleasure of attending. Youwould not be sorry to attend that one. Having said that -- the OASIScourse, which I believe is put on by Swaldo and Krulish shouldalso be a good one. I have attended several courses by them as well. Theyare well organized and are officers in the Community Home Health Section,so definately know what they are talking about. I will say that if you arethinking about attending the Combined Sections meeting in February, theywill probably offer something similar there. The Combined Sections Meetingis also money well spent and an incredible source of information. Thiscoming Feb it will be in Seattle. Hope that helps Pike, PT, GCS

[Guest guest]

Guy Terry,

Thanks for that info, I'll have to start broadening my scope.

I have always been interested in accumulating broad knowledge, thus I have

signed on as an on call therapist in the various local hospitals, while

putting most of my time in the Geriatric settings; I do appreciate the info

you are sharing with us, and will definitely research on that.

Thanks again.

Winnie RPT

______________________________________________________________________

[Guest guest]

In a message dated 98-10-06 16:57:07 EDT, you write:

>

> Meanwhile......lets encourage our states to take the bold, but perhaps

> unpopular move to require accountability from each of us and at a minimum

> require CEUS. There are many ways of regulating this....from an honor

> system to a reporting system and most professions are doing it. We could

> also consider other evidence of professional learning such as teaching,

> publishing, researching, home study, etc. We have no real excuses,

> especially from our patient's perspective.

>

> Dale Avers

>

Literature notes no consistent change in behavior, or practice with continuing

education, as it is traditionally practiced. If we wish to measure something

we must first define " what " , then determine " how " .

______________________________________________________________________

[Guest guest]

Winnie,

APTA has suggested that physical therapists use PT not RPT or LPT. PT suggestes

that you are both a graduate of an accredited program and licensed (or

registered in Minnesota) to practice. Think about it...MD is not LMD etc. If

you retire and are no longer licensed, if would not seem appropriate to use PT

after your name. Geri

At 06:33 PM 10/9/98 EST, you wrote:

>Guy Terry,

>

>Thanks for that info, I'll have to start broadening my scope.

>I have always been interested in accumulating broad knowledge, thus I have

>signed on as an on call therapist in the various local hospitals, while

>putting most of my time in the Geriatric settings; I do appreciate the info

>you are sharing with us, and will definitely research on that.

>

>Thanks again.

>Winnie RPT

>______________________________________________________________________

>

>

[Guest guest]

The CEU issue has been revisited over the years by the Michigan Chapter with the

stumbling block being who will monitor ie pay to monitor. The licensing board

says they cannot afford to. The Chapter feels it cannot afford to and the issue

lies dead in the water. Perhaps with the computerized world it is not the same

expense it was 10 years ago when MI began the debate. I agree it is indicated.

Geri Connor

At 01:37 AM 10/10/98 EST, you wrote:

>In a message dated 98-10-06 16:57:07 EDT, you write:

>

>>

>> Meanwhile......lets encourage our states to take the bold, but perhaps

>> unpopular move to require accountability from each of us and at a minimum

>> require CEUS. There are many ways of regulating this....from an honor

>> system to a reporting system and most professions are doing it. We could

>> also consider other evidence of professional learning such as teaching,

>> publishing, researching, home study, etc. We have no real excuses,

>> especially from our patient's perspective.

>>

>> Dale Avers

>>

>

>Literature notes no consistent change in behavior, or practice with continuing

>education, as it is traditionally practiced. If we wish to measure something

>we must first define " what " , then determine " how " .

>

>

>

>______________________________________________________________________

>

>