Posts

March 2018: Graded Imagery & Advanced Technology in the Treatment of a Patient Post-Stroke

Graded Imagery and Advanced Technology in the Treatment of a Patient Post-Stroke

Lisa Peterkin, SPT
 

With the advancement of technology comes the advancement of treatment tools that can be used in all areas of physical therapy.  Newer techniques used to treat patients after a cerebrovascular accident (CVA) have become more popular both in and out of the clinic setting to improve function.   

Traditionally, patients who have been affected by a stroke have been treated with Neurodevelopmental Treatment (NDT) techniques that include proper patient positioning and tactile cueing to progress the patient and improve their function.  Once the patient has improved strength, special awareness and normalized tone, they can begin to work with a physical therapist on more functional activities such as transfers and improved ambulation.

More frequently, now, physical therapists are including more advanced techniques such as Graded Motor Imagery (GMI) in their treatment of patients who have had a stroke.  GMI is thought to promote cortical brain activation and promote motor recovery after a stroke, specifically in the upper extremity. Within the category of Graded Motor Imagery are subgroups that include Explicit Motor Imagery (EMI), Implicit Motor Imagery (IMI) and Mirror Therapy (MT).  EMI uses the Kinesthetic and Visual Imagery Questionnaire (KVIQ), which includes 5 movements (shoulder flexion, finger tapping, trunk flexion, hip abduction, and ankle dorsiflexion) that are described to or demonstrated for the patient, then the patient is to imagine themselves performing the movement that was just described or demonstrated.  This Questionnaire is graded on a 5-point scale, from 0, where the patient was unable to imagine demonstrating that movement, to 5, where the patient could imagine it clearly. The next area of IMI incorporates Left/Right Hand Judgement, where the patient is shown 60 images of a hand in various positions, and the patient has to determine whether the picture is of a left or a right hand.  The last intervention is MT, where the patient is angled with their upper extremity next to a mirror so they have a clear view of the mirror with the reflection of their limb. The unaffected arm moves in various ways instructed by a physical therapist, and the illusion is perceived by the patient that their involved arm is moving.

The benefit of using these techniques is that they are simple to teach from one physical therapist to another, and easy for the patient to understand and be able to perform.  However, because patients who have suffered a stroke may have cognitive deficits, their lack of imaginary skills due to the CVA may influence the effectiveness of these techniques.

There have been many studies that assess the effectiveness of using more advanced technology with post-stroke patients.  The H2 robotic exoskeleton is used to improve gait in a post-stroke patient with hemiparesis who was able to walk only short distances at lower speeds.  The robot has 6 joints and focuses on improving an asymmetric, deviant hemiparetic leg during the stance phase of the gait cycle. It allows the patient to walk farther distances and have more stability in the affected leg while ambulating.  

Robot-Assisted Game Training has also been studied on its effectiveness with post-stroke patients.  Patients are given conventional therapy along with a secondary treatment that includes game training.  This includes a robotic arm that allows the patient to adduct and abduct the shoulder, and flex and extend the elbow of the involved arm.  By maneuvering the robotic arm, the patient can navigate through a gaming system on a computer and improve motor planning skills and cognition.  

While these techniques are still new and have minimal research, they open up a new world of treatment possibilities, especially in rural areas that are underserved with healthcare.  With these techniques and newer technology, patients may be able to return home sooner and have effective treatment sessions without going into a clinic, while continuing to show improvement in gross motor skills and cognitive function.

 

Bortole, M., Venkatakrishnan, A., Zhu, F., Moreno, J. C., Francisco, G. E., Pons, J. L., & Contreras-Vidal, J. L. (2015). The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study. Journal of neuroengineering and rehabilitation, 12(1), 54.

Lee KW, Kim SB, Lee JH, Lee SJ, Kim JW.   Effect of Robot-Assisted Game Training on Upper Extremity Function in Stroke Patients.   Ann Rehabil Med. 2017 Aug;41(4):539-546.   https://doi.org/10.5535/arm.2017.41.4.539

Polli, A., Moseley, G. L., Gioia, E., Beames, T., Baba, A., Agostini, M., … Turolla, A. (2017). Graded motor imagery for patients with stroke: a non-randomized controlled trial of a new approach. European Journal of Physical and Rehabilitation Medicine, 53(1), 14–23. https://doi.org/10.23736/S1973-9087.16.04215-5

 

Welcome

New Members to the bestPT Network!

 

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT Billing’s newest members!

 
Ehrum Khan   
PT Max, Philadelphia, PA 
Alicia Molloy
Jesslyn Scholl
Morgan Helser
Joshua Castro
PT Max, Philadelphia, PA
Katelyn Smitherman


Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year!

 

Feb 2018: Avoiding PT Burn Out While In School

Mini-Clinics Help Prevent Student Burnout

Lisa Peterkin, SPT

We hear about burnout after a physical therapist begins practicing for a few years.  We also learn ways to prevent this from happening so that we remain interested and invested in our practices and in our patients  However, we never talk about burnout while in school.  After sitting in class, week after week, for 35+ hours, it can be mentally and physically taxing. It can be hard to still have that passion that we had when we first entered the program.  

In the Physical Therapy program at the University of New Mexico, we participate in weekly mini-clinics.  We go to various clinics, rehabilitation facilities, and hospitals throughout the city and surrounding areas for 4 hours each Wednesday morning.  We are partnered up with another student in our class and are assigned to a clinical instructor at the clinic we’re attending.  This is extremely beneficial because it allows us to practice newly learned skills while brainstorming together as we’re presented with newer conditions or techniques.

It’s also beneficial to be able to work with different physical therapists of different backgrounds, work experiences, ages, educations, and so much more.  It exposes us to a variety of styles and techniques, and we gain little tips and tricks on how to transfer larger patients, hand placements to improve reliability of special tests and ease when performing them, or how to have proper body mechanics for different body types.  These first-hand experiences also give us insight on what to prioritize when the physical therapist is running out of time with a patient during an evaluation or a follow- up treatment.  Many of the physical therapists I’ve worked under have a different flow while doing an evaluation, it’s helpful to see what works and to think about what I would do differently to come up with my own flow.

After every mini-clinic, we have a little reflection assignment due in our classes. We have a checklist of different things that we ideally would have seen in a morning at a clinic or hospital.  This includes things such as testing sensation, proprioception, range of motion, balance, etc.  It gives us an opportunity, once we’ve left the clinic, to reflect on everything we did, and why that was necessary for that patient. Occasionally, depending on the setting, we have the opportunity to work with, or alongside, other health care professionals, such as occupational therapists, speech and language pathologists, MDs, and nurses. We get to see how the physical therapist we are working under interacts with other health care professionals and see what role each of those people play in the patient’s overall health care.

While all these tips and tricks and times to practice are valuable and helpful, I personally believe the most valuable part is actually being able to work with real patients in a real clinical setting.  It breaks up the monotony of sitting in a classroom listening to lectures for 7-8 hours every day, and it gives us a chance to reignite the spark that made us all want to become physical therapists in the first place.  It gives us half a day of problem solving with complex patients, talking with patients about their goals with physical therapy, and allows us to see even minor improvements with patients within one treatment session.  Mini-clinics keep us interested and passionate about the profession when we start to feel burnout from being a student.  


Welcome

New Members to the bestPT Network!

 

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT Billing’s newest members!

 
Sandre Allegre   
Sue McKeown
Asbury University, Wilmore, KY
Sara Beckley & Chris Poveromo
Thompson Physical Therapy.  Fresno, CA
Craig Brunson
Axiom PT & OT Plus,  Tuckahoe, NY
Betsy Harnden & Gervante Millender
Anne Moore & Deborah Doster
Integrated Mechanical Care, Sandy Springs, SC


Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year!

 

Jan 2018: Importance of Developing Mentor-Mentee Relationships During PT School

The Importance of Developing Mentor-Mentee Relationships During PT School
Lisa Peterkin, SPT

At the University of New Mexico, Department of Physical Therapy, faculty, staff, and students all understand the rigor of the program and how much of an adjustment it can be to start a doctorate graduate program.  It doesn’t matter if the student came directly from undergrad, from a different graduate program, or took time off between prior schooling and PT school; there is always an adjustment period and a learning curve for any change.

We’ve developed a mentor-mentee program for all incoming students who are offered the opportunity to request having a mentor from the class above.  Both mentors (soon to be second year students) and mentees (incoming first year students) fill out a questionnaire about interests, hobbies, and schooling background, and based on the responses, we pair people who have similar interests and we feel will be able to connect outside of PT school.

Throughout the program, mentors are there to provide advice and support to their mentee, and to be another familiar face outside of their own classmates. In my personal experience, having a mentor made me less nervous about starting the program, and it gave me someone in the class above to look up to if I ever felt overly stressed or anxious about upcoming exams.  It was also somebody who I could ask about tips for classes, certain professors, or even exams and quizzes.

Mentors go beyond our student program.  Our professors are all mentors to us every day, both inside and outside the classroom.  They are always available to offer advice or answer questions via email, or if we’re lucky, we can catch them in their office when they’re not teaching or in clinic.  We have a strong and close bond with every professor in our program that make it easy to look up to them as role models and mentors, which, in turn, makes it easy to reach out whenever we need assistance in classes or advice on a patient we see in clinic.

In our student-led clinic, REACH, a handful of our professors participate as the licensed Physical Therapist when we see and treat patients.  They guide us when we’ve hit a roadblock or jump at an opportunity to teach us new techniques during an examination.  Based on their years of experience, they also offer new and creative exercises to use with our patients, or how to simplify an explanation for a patient.

We also form mentorships with our clinical instructors who guide us in a more practical and hands on way with patients in the clinic.  During my first rotation, my clinical instructor helped me to grow and improve my skills in physical therapy, but more importantly, she taught me how to think outside the box and to get creative with treatment ideas.  I always looked up to her and she was always there to offer advice or to encourage me to struggle on my own so that I could learn from my mistakes or work through a problem, which I always thought was even more valuable.

We are surrounded by mentors every day, even if we don’t necessarily realize it.  It helps us to grow as students, future physical therapists, and life-long learners.  We learn how to learn from other physical therapists’ and appreciate their styles and experience, and some of these mentors will continue to mentor us beyond our school years.


Welcome

New Members to the bestPT Network!

 

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT Billing’s newest members!

 
Becky Staudt   
Jaidy Matos
Tammy Duncan & Savanna Booker
Kid’s Creek Therapy,  Suwanee, GA
Amanda Newman
Brooke McAdam
Jason Piken & Kristina Borza  


Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year!

 

Oct 2017 Newsletter: How the Cloud Protects Your Practice in a Disaster

October, 2017 Newsletter

Protected by the Cloud

The Cloud Protects Practices From Mother Nature

by Terry Douglas

As Irma devastated Florida’s Atlantic and Gulf coasts, I was reminded of how valuable it is to have your entire practice’s data securely stored in the cloud-far away from the rain, devastating winds, and storm surge.
With the destruction left in the wake of hurricanes Irma and Harvey, it is wonderful to know that cloud technology is helping people worry less and avoid further damage.
Here are four disasters modern medical practices across the southern U.S. will sidestep in the storm aftermath…

 


 
Let’s welcome bestPT Billing’s newest members!
Tiffany Enache
University Of New Mexico,  Albuquerque, NM
 
Vanessa Ruiz
 
Angelina Ferrel
Melwood Rehabilitation Center, Upper Marlboro, MD
 
Chelsea Parson
Asbury University, Wilmore, KY
 
Margot Connole
Health Rehab Solutions,  Kalispell, MT
 
Jamal Alian and Robin Walker
Basis Whole Body Wellness, Palm Beach Gardens, FL
 

Each new member benefits from and contributes to our network strength.


 Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year!