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[MoRE ARTIClES]
oN THE WEB www.advanceweb.com/pt UPDATED DAIlY!
6 ADVANCE for Physical Therapy & Rehab Medicine
Check Your History Before
Ringing in the New
To the Editor:
I was anxious to read the cover story of
August 8, 2011 issue and quickly opened my
copy to read about early mobilization in ICUs.
Certainly it would take me back to my days
as a new PT, working in acute trauma centers
and general acute care hospitals. Thirty years
later, that kind of work is outside the scope of
my bodys abilities, but those early days as
a new PT remain among the most stimulat-
ing of my career. Indeed, the photograph of
Lisa West, DPT, kneeling behind the patient
working on postural control could have been
me back in 1982.
Imagine how disheartened I was to read
the frst paragraph: Traditional practitioners
in an acute intensive setting, including physi-
cal therapists, nurses and physicians have
historically expected patients to remain on
bed rest. Really? And later, traditionally,
patients with low blood pressure, abnormal
lab values or impaired cardiac function (such
as arrhythmia) are on bed rest for fear of
worsening an already unstable condition.
One of the positive and exciting changes
that has happened with the advance of physi-
cal therapy education is the ability to research
and validate what many of us were doing
back in the day.
There have been many discussions on these
pages on the ramifcations of the DPT entry-
level program on the relationships between
old therapists and new therapists. The
above-mentioned quotes point out an atti-
tude among some new therapists that vet-
eran therapists are able to overlook, but that
create tensions in the workplace that could
be avoided.
I can assure you I was rarely fearful in an
ICU setting. My medical education taught me
to know what to do, how far to go, when to
push the envelope and when to pull back.
My colleaguesnurses, respiratory thera-
pists, occupational therapists, doctorsall
communicated daily on scheduling patients
to achieve optimum beneft from therapy
treatments.
We coordinated medication schedules and
ventilator weaning schedules. We went home
exhausted each day after wrestling with the
tangle of tubes and monitors that were as
much a part of the patients in the ICU as their
arms and legs. We worked on bed mobil-
ity and transferred patients to the edges of
beds and into gurney chairs, onto tilt tables,
and watched carefully as many times the
blood pressure measurements would actu-
ally increase to a more normal range. I am
surprised that Ms. West writes about this as
if this is a news fash.
It is wonderful that there is now support
from facilities and schools, as well as from
therapists who are now in a position in life
to donate money to the cause of research, so
that the new generation of therapists can
confrm that our interventions are valid and
appropriate.
However, much evidence-based medicine
is ultimately based on a history of interven-
tions that, lacking the necessary resources,
we learned through trial and error.
I am delighted to know that what we did
years ago in the ICU can now be put into an
algorithm, and commend Ms. West for doing
so, but to suggest that we traditionally did
not do it at all until now is disheartening.
At worst, it is disrespectful of the many
dedicated therapists, nurses and doctors who
did not need an algorithm to do what they
knew was best for patients.
I would encourage the schools to continue
to impress upon DPT students the impor-
tance of understanding that experience mat-
ters, and would encourage young researchers
to delve a little more deeply into the his-
tory of patient careif the research doesnt
exist, at least interview therapists who were
therewhen writing articles introducing a
new approach. n
Mary Horton Sondag, BSPT
Lafayette, CA
University of Health Sciences/
Chicago Medical School, 1982
[lETTER To THE EDIToR]
PlEAsE gIvE Us
YoUR TWo CENTs
if you have a topic you would like to discuss
in a letter to the editor, send your letter
and contact information to Letters to the
Editor, c/o lisa lombardo, AdvAnce for
Physical Therapy & Rehab Medicine, 3100
Horizon dr., King of Prussia, PA 19406-0956;
Fax 610-275-8562; or email llombardo@
advanceweb.com
HoW To CoNTACT uS
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is published by Merion Matters
Publishers of leading healthcare magazines since 1985
PUBlIsHER
Ann Wiest Kielinski
gENERAl MANAgER
W.M. Woody Kielinski
AssoCIATE PUBlIsHER
Meg Lynam
EDIToRIAl
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Managing Editors-Brian W. Ferrie, Jonathan Bassett
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[uP FRoNT]
Dear Reader,
If you are taking time to read these words, then I
hope you will take a little time to do something for
me after you read this message. We at ADVANCE
are proud of the outstanding level of information
and guidance we are able to provide to you in each
print and digital issue. We work hard to research
the hottest topics, fnd expert contributors and list the latest jobs and
continuing education opportunities. And we provide all of this to
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Have you learned something that helps you do your job better
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staff through an ad in ADVANCE? Have you ever attended one of our
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8 ADVANCE for Physical Therapy & Rehab Medicine
[HEADER]
8
Although physical
therapists who treat older
adults with amputation
can rely on little scientifc
evidence
1
, a few investi-
gators have scrutinized
some aspects of clinical
practice. Dillingham and Pezzin followed
2,468 elderly patients for a year, and found
that inpatient rehabilitation immediately after
amputation is associated with signifcantly
less mortality, fewer subsequent amputations
and greater medical stability as compared with
treatment in SNFs or at home.
2
The place of a PTs employment impacts
the rehabilitation outcome. Ideally, rehabilita-
tion should start prior to amputation surgery.
Evaluating the patients joint excursion enables
the PT to institute measures to prevent con-
tractures. Appraising the individuals general
physical and emotional condition permits the
PT to recommend candidates for immediate
postoperative prostheses. Postoperatively,
the semirigid dressing stabilizes amputation
limb volume and fosters prosthetic use more
effectively than elastic bandage, especially for
patients with transfemoral (above-knee) ampu-
tation.
3
Prior to being ftted with a defnitive
prosthesis, patients who wore pneumatic tem-
porary prostheses responded positively.
4
Prostheses Classifcations
Medicare regulations specify reimbursement
guidelines for prostheses for individuals with
unilateral transtibial (below-knee) and trans-
femoral amputation. Excluded from reimburse-
ment for prostheses are people deemed unlikely
to beneft from a prosthesis, K0. Household
ambulators, K1, will wear a prosthesis primar-
ily at home. K2 designates people who will be
limited community ambulators. Those who are
predicted to walk in the community and be able
to vary gait speed are listed as K3, while K4 clas-
sifes individuals who will attain high levels of
activity.
5
Older people with dysvascular ampu-
tation usually are classifed as K1 or K2.
Consequently, their prostheses are relatively
simple without energy storing feet or electronic
knee units. Regardless of prosthetic compo-
nents, rehabilitation should include instruction
in donning the prosthesis and transferring from
sitting to standing. Patients with transtibial
amputation should strengthen the knee exten-
sors in order to control the prosthesis and pre-
vent inadvertent knee collapse.
Both individuals with transtibial and trans-
femoral amputation beneft from hip extensor
strengthening, which contributes to prosthetic
control when the wearer walks. Basic gait train-
ing focuses on erect standing posture, sym-
metrical weight shifting, and walking with
uniform step lengths.
6
Auditory cueing with
a metronome shown to improve the gait of
patients with Parkinsons disease is an effec-
tive strategy to foster gait symmetry among
those wearing prostheses.
7
Nadollek and colleagues demonstrated
that 23 elderly adults with unilateral tran-
stibial amputation achieved less asymmetry
when standing and walking after performing
exercises emphasizing hip abductor strength.
8
Twenty-fve adults with unilateral transfemoral
amputation had 10 half-hour sessions of prop-
rioceptive neuromuscular facilitation resistive
gait training; they exhibited better gait and bal-
ance than the control group, which received
traditional training.
9
Prospective study of 37
elderly prosthesis wearers indicated they use
many ambulation aids, including various types
of walkers, crutches and one or two canes.
10
Evaluating Outcomes
Rehabilitation outcome is infuenced by several
factors. On the basis of evaluating 309 adults
with transtibial amputation, Taylor and asso-
ciates identifed coronary artery disease, cere-
brovascular disease, and impaired ambulatory
ability before amputation as critical,
11
while
Asano and coworkers reported depression and
nonparticipation in daily living as predictors of
poor quality of life among 415 older subjects.
12
Interviews with and questionnaires submitted
by 199 geriatric patients with dysvascular ampu-
tation revealed that only a third were ftted with
a prosthesis; negative factors included death,
reamputation, cerebrovascular disease, cogni-
tive defcits, advanced age, and transfemoral
amputation.
13
A recent survey of 177 patients
amputated because of vascular disease shows
that those who lived at home and wore prosthe-
ses had higher quality of life scores.
14
Among
the implications for PTs from the research are:
1) The patients physical and emotional sta-
tus is important in determining the outcome
of rehabilitation. PTs should establish rapport
with the patient and encourage their participa-
tion in exercises aimed at increasing strength,
maximizing cardiopulmonary function and
improving standing and walking balance.
2) The site of rehabilitation affects the out-
come; PTs who work in rehabilitation centers
are more likely to achieve good results.
3) Rehabilitation prognosis is tempered by
immutable factors, including patients age,
comorbidities, and walking ability prior to
amputation.
It can be reasoned, based on published evi-
dence, that important components in the suc-
cessful rehabilitation of each individual with
lower-limb amputation involves a comprehen-
sive approach. Foremost on the PTs agenda are
thorough physical and emotional evaluation,
perceptive patient education, individualized
fexibility and strengthening exercises, active
participation in Medicare classifcation and,
when suitable, selection of appropriate pros-
thetic components. Nevertheless, as PTs we
need to aware that some people of advanced
age can continue the active lifestyles they
enjoyed prior to amputation. They deserve a
prosthesis and training that enables them to
reach their highest goals. All PTs entrusted
with the care of older adults with amputa-
tion: Walk the talk so that our patients with
amputations can walk the walk. n
References available at www.advanceweb.
com/PT or by request.
Joan E. Edelstein was senior research scientist in
the department of prosthetics and orthotics at New
York University, and later director of the program
in physical therapy at Columbia University. Her
latest book is Lower-Limb Prosthetics and
Orthotics: Clinical Concepts, co-authored with
Alex Moroz, MD, and published by Slack Inc.
By Joan E. Edelstein, MA, PT, FIsPo, CPed
walk the Talk for People with Amputations
[GERiATRiC FuNCTiON]
We need to be aware that
some people of advanced
age can continue the active
lifestyles they enjoyed
prior to amputation.
9 ADVANCE for Physical Therapy & Rehab Medicine
S
C
o
T
T
D
E
R
B
y
o
kay, youve made the decision to
move from paper-based to digital
clinical documentation.
Many a health care practice
owner has suffered paralysis by analy-
sis when pondering all the intimidating
details of implementing an electronic medi-
cal records system. How can you organize
your thoughts and move forward without
becoming lost in excessive analysis?
First of all, dont invest in a digital system
expecting to increase margins; at least, not
directly. Much federal and state reporting
can now only be done with specifed IT, so
its more of I need to do this, said Walter
Reid, vice president of product strategy and
marketing for McKesson Provider Technolo-
gies, a health care IT company. Your ROI
needs to place value on how quickly you can
get into position to meet these new needs.
And expect glitches. EMR systems are
wonderful but their implementation is nor-
mally painfulas with any kind of software,
health care economic consultant Gary Isakov,
CPA, CA (S.A.), told ADVANCE. No transi-
tion is 100 percent pain-free. But in the long
run will it result in more effciency? Yes.
Choosing a Vendor
When choosing a vendor, ask: How quickly
can this vendor get me to implementation?
If you take two years to implement, youve
waited two years with nothing to show for
it, Reid said. If you consider the pace of
regulatory and statutory changes, you need
to implement sooner.
Transparency is another determining fac-
tor. You are making a long-term decision,
he said. What level of comfort do you have
that you are getting the information you
need? Can you ask hard questions? Is this
the right go-forward answer or is the vendor
just saying something to win your business?
Their willingness to talk about positives and
downsides indicates how well they will per-
form for you.
When starting off, practice owners need
to settle on a technology stack and make
decisions based on that, Reid added. A
consistent technology stack will deliver lower
overall costs.
And dont underestimate what President
George H.W. Bush once famously called the
vision thing.
Many administrators want a vendor
selection reduced to a checklist of features
and functions or a scorecard that compares
product A with product B, Reid said. Thats
an okay way to proceed, but it marginalizes
vision. You need to look at both.
Product A meets your needs, but does that
vendor also have knowledge and a passion
about moving forward? Dont go overboard
evaluating functionality. Give equal weight
to vision and the ability to deliver forward-
looking products, Reid said.
Equipping your staff with a practice soft-
ware system that merely incorporates dicta-
tion is missing the boat, Dr. Garcia added.
One thing a [provider] must do is document
[MANAGEMENT FOCuS]
Going Paperless
When implementing a software solution
at your facility, avoid paralysis by analysis
By Michael gibbons
If you take two years to
implement, youve waited
two years with nothing to
show for it.
Walter Reid, McKesson Provider Technologies
10 ADVANCE for Physical Therapy & Rehab Medicine
[MANAGEMENT FOCuS]
QUEsTIoN: i work in an acute care hospital. The question is: Should or
can we do and bill for re-evaluation for PT and/or OT services when there
is signifcant change in the status of the patient and the goals have to
be adjusted accordingly, with the last original evaluation having been
done three weeks ago?
ANsWER: In the acute care setting, Medicare does not have any writ-
ten guidelines for billing therapy services as they are bundled into
the dRG reimbursement. The purpose of therapy billing is to get
an accounting of time spent relevant to services and used in the cost
reporting process. As such, the CPT coding system has been utilized
as the standard accounting process even though you dont actually
get paid that amount.
Based on Medicares guidelines for when a re-evaluation is appro-
priate, they do state in the Part B guidelines that Re-evaluation is
separately payable and is periodically indicated during an episode
of care when the assessment of the clinician indicates a signifcant
improvement, decline or change in the patients functional status that
was not anticipated in the plan of care. Based on that statement i
would say that your situation meets those guidelines.
DIsClAIMER: The answers provided are based on Medicare guidelines
for what is payable under the Medicare Part A and Part B Beneft.
As always, the provider should be aware of other regulations that
might supersede the Medicare payment guidelines, such as the state
Practice Act and the state Administrative Code. In any scenario, the
practitioner must go with the most stringent requirement in order
to be compliant. The information provided is current as of the time
of publication.
Pauline M. Franko is owner of encompass consulting & education
LLc, a consulting and education company specializing in Medicare
consulting, compliance training and Medicare seminars based in
Tamarac, FL. visit www.encompassmedicare.com for a list of services
they provide. The companys direction on demand service special-
izes in providing the rehabilitation professional with a clear, easy
way to understand how to provide Medicare compliant services to
their patients in the skilled nursing facility (SnF) and outpatient
rehabilitation settings. Readers may contact the author through
the encompass consulting & education website or by phone at 954-
720-4087.
MEDICARE ADvIsoR
Billing for Re-Evals After Change of status
By Pauline J. Franko, PT
11 ADVANCE for Physical Therapy & Rehab Medicine
the patients progress from day to day, he said.
A [provider] must document abnormal fndings, diagnoses, treat-
ments, how the patient is progressing, and summarize it all into a
discharge summary for billing. It doesnt just end with the initial his-
tory and physical.
Diverse Information Needs
When launching a software system at a large practice network or hos-
pital, input from those that will be using the system day-to-day will
help ensure a smooth transition and staff buy-in. Provider input was
a priority when Wayne Memorial Hospital, of Jesup, GA, transitioned
from paper to digital beginning early in 2008.
We held special meetings with physicians, and they gave us direc-
tion, explained Deborah Six, director of information services/CIO.
Some physicians helped us understand what their needs are, and
how to meet those needs. For example, certain physicians needed to
see patient information in specifc ways and others needed to see it
in other ways, based on their specialties.
Her other tips: Have a group from the top of your administration
buy in to it. Put together a good team willing to work endless hours
getting everything prepared. Make sure the super-users have had all
the time they need to prepare everyone to go live.
And make sure your budget refects some overrun. You always
have things come up with training and support staff that will eat up
more of your money, Six said. Dont get down to the end and say,
well, we cant do this because its not in the budget.
Just Getting Started
Finally, be advised: Once you go digital, not only is there no turning
backtheres no slowing down. Buying IT only begets more requests
to buy IT.
A CEO might say, Okay, this will take a lot of time and money but
then well be done, Reid said. But no, the more EMR you implement,
I am confdent, you will only get more requests for more ITfrom doc-
tors, from pharmacy, from nursing, etc. Thats a hard sell for boards of
directors not intimate with clinical processes. They think, We bought
this so we should be good for awhile. In reality, health care is really
just getting started on IT-driven innovation.
Its an industry undergoing an ever-accelerating pace of change.
To keep up, review your IT purchases and update your software fre-
quently, Reid suggests.
In the early 1980s, DRGs came out, he said. Then, in the 1990s,
came Y2K. Then came HIPAA, then meaningful use legislation. Major
changes once occurred every 10 to 12 years; now its about every three
yearsthink ICD-10 deployment, value-based payments and increased
quality reporting. All those changes have IT implications. If a cus-
tomers system is not on the right platform, vendors will not be able
to respond and get the needed software to that customer. A lot of IT
products are not bad, just old. And it becomes increasingly costly to
maintain older products. n
Michael Gibbons is a contributing editor to ADVANCE.
[MANAGEMENT FOCuS]
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12 ADVANCE for Physical Therapy & Rehab Medicine
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OCTOBER 25
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M&T Bank Stadium
Baltimore, MD
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13 ADVANCE for Physical Therapy & Rehab Medicine
PASADENA, CA SEPTEMBER 7
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14 ADVANCE for Physical Therapy & Rehab Medicine
H
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W
ith obesity levels and inci-
dences of childhood diabe-
tes skyrocketing across the
United States, many health
care facilities have begun to focus efforts on
improving health at the community level.
Hendricks Regional Health of Danville, IN,
and the YMCA of Greater Indianapolis have
developed a comprehensive plan to improve
the health status of their own community.
The two entities opened a joint facility, the
Hendricks Regional Health YMCA, on June
26 in Avon, IN. The facility is central Indianas
frst fully-integrated YMCA and hospital col-
laboration and will allow both organizations
to provide comprehensive health and well-
ness care under one roof.
This facility is a destination where people
can learn, play and take action to improve their
health and enrich their leisure time, shared
Mary Beth Carmichael, community executive
director, Hendricks Regional Health YMCA.
Carmichael was among the group of YMCA
staff members involved in the fundraising,
planning, design and implementation with
the Hendricks Regional Health partnership.
At our YMCA, community members will
experience easy and convenient access to
everything they need for prevention, treat-
ment and maintenance of a healthy life,
she observed.
Hendricks Regional Health was interested
in partnering with the YMCA to increase its
focus on wellness and to reach out to the
community more directly.
Our relationship with the YMCA moving
forward is to make sure its a wellness des-
tination, explained Shane R. Sommers, PT,
MS, OCS, CSCS, director of physical therapy,
occupational therapy and sports medicine,
Hendricks Regional Health. We want the
members and our patients to spend time
here, having lunch, working out and receiv-
ing medical services all in one place.
YMCA-Based Health Care Services
The 118,000 square-feet healthy lifestyle center
features physical and occupational therapy
services, cardiac rehabilitation, lab and X-ray
services, medical practices, sports medicine,
nutrition counseling and diabetes education,
an indoor aquatics center, state-of-the-art well-
ness center, dance/aerobics studio, gymna-
sium, teen center, child watch, indoor climbing
wall, outdoor sports felds, walking trails and
an outdoor education center.
The entry to the facility houses an open area
with Internet access and comfortable seating
for the patients and YMCA members to use
and enjoy. Additionally, the area has a Sub-
way which was selected for its reputation as
a healthy fast food restaurant.
The hospital employs wellness nurses and
dieticians to address diabetes management
issues and to run wellness programs for com-
munity members and plans to have orthope-
dic surgeons on site a few days a week.
Hendricks Regional Health originally
hashed a plan to build a health and well-
ness facility but elected not to move forward
with the project. Then, an opportunity to
partner with the YMCA presented itself and
together, the two organizations were able to
create a health and wellness center that is far
superior to anything either party could have
achieved individually.
This YMCA is designed to break down
barriers to a healthy lifestyle by framing a
complete circle of care, combining traditional
health care offerings with ftness and wellness
activities within the same building, according
to Carmichael.
When medical treatment or therapies are
complete, members will fnd encouragement
and support in pursing ongoing health through
the YMCA programs, Carmichael shared.
[FACIlITy FoCuS]
Wellness Begins with a
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mobility continued on page 39
24 ADVANCE for Physical Therapy & Rehab Medicine
K
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ibromyalgia syndrome (FMS), a condition
that is typically of insidious, adult onset
affecting females more than males,
1,2
is
characterized by pain, fatigue and stiff-
ness of muscles and soft tissues.
1-6
Condition Defned
This condition is defned by the American Col-
lege of Rheumatology as widespread pain
for at least three months, pain involving the
upper and lower body on both right and left
sides including axial pain, and with the pres-
ence of at least 11 of 18 specifc tender points
on both sides of the body, above and below
the waist.
1,2,4
The presence of muscle spasm, nodules, skin
discoloration and a non-restorative sleep pat-
tern is also characteristic.
6
There are a number of associated conditions
including disruption in Stage IV sleep, head-
aches, temporomandibular dysfunction, mental
and physical fatigue, Raynauds phenomena,
respiratory dysfunction, depression and hyper-
sensitivity to noise, odors, heat or cold.
1,4,6
Simple daily tasks including dressing,
grooming and meal preparation may be chal-
lenging.
7
Goals in the treatment of FMS include
pain management, restoration of sleep patterns
and increasing functional activity levels.
4,6
Krsnich describes exercise as one of the most
effective interventions for long-term manage-
ment of FMS.
6
An exercise program should
include low-load stretching and a low-impact
aerobic component.
Due to the unique properties associated with
immersion, aquatic therapy has been recom-
mended for the treatment of fibromyalgia
syndrome.
2,4,6,8
One beneft of aquatic physical therapy is
the buoyant support of water that dramatically
decreases compression stress on joints, allow-
ing for improved fexibility with greater ease
of movement, especially in concert with the
increased hydrostatic pressure and reduced
gravitational pull.
9-11
Active, passive and assistive stretching
through a greater range of motion are all pos-
sible in the supportive aquatic environment.
Evidence-Backed
There is evidence supporting the use of aquatic
physical therapy as an intervention technique
for patients with fbromyalgia.
Cedrashi et al was able to demonstrate
signifcant improvements in quality of life
and function following a six-week self-man-
agement program that included pool exercise
and education.
12
Pool exercise was a minor component in
the self-management program; however, the
design of the intervention was more refective
of clinical practice.
Altan et al also demonstrated improved
quality of life and decreased pain with a
12-week pool-based exercise program, the
effects of which lasted for up to 24 weeks.
13
Components of the pool program included
warm-up, activity, relaxation and a few out-
of-pool exercises.
Jentoft et al demonstrated improved car-
diovascular capacity, walking time and well-
being, and decreased daytime fatigue, pain,
anxiety and depression following a 20-week
pool program.
14
The pool group showed more signifi-
cant improvements in more variables than
did the land-based exercise group, further
strengthening the argument for the use of
aquatic therapy.
In their frst study, Mannerkorpi et al found
that six months of pool exercise combined
with education sessions improved quality of
life, physical function, pain severity and psy-
chological distress.
15
The exercises in this study
included endurance, fexibility, coordination
and relaxation.
The combination of exercise and education is
again a realistic clinical intervention. A follow-
up study by Mannerkorpi et al found that these
improvements in symptom severity, physical
function and social function lasted for up to
24 months following the completion of a six-
month program.
16
When looking at all of these research studies,
aquatic therapy balanced with education and
land-based exercise appears to be benefcial in
modifying the symptoms and disability associ-
ated with FMS. In addition, all of the programs
appeared to have fexibility and relaxation
components. The land-based program should
emphasize sleep hygiene (e.g., sleep habits,
environment, preparation for bed), physical
activity, relaxation, normal movement and core
strengthening, primarily in the form of a home
exercise program.
Session Focus
The aquatic sessions should also focus on physi-
cal activity, relaxation, normal movement pat-
terns and core strengthening. Initially, the focus
should be on pool-based activity (60 percent of
the time) with supportive land-based activity
(40 percent), progressing to a primarily land-
based program (70 percent) with supportive
pool-based activity (30 percent).
A number of specifc techniques can be used
in the water to assist with symptom reduction
and restoration of function for individuals with
fbromyalgia. Ai Chi, simple water exercise and
[AQuATiC THERAPY]
A Good Match
Aquatic therapy can support
patients with chronic pain
and fbromyalgia
By Janet gangaway, PT, DPT,
oCs, ATC, ATRIC, Ai Chi Trainer
25 ADVANCE for Physical Therapy & Rehab Medicine
relaxation, utilizes deep breathing and slow, broad movements of the
limbs and torso. This technique may help lessen anxiety, while improv-
ing breathing and endurance.
17
Watsu has been described as an excellent alternative intervention
for patients with fbromyalgia
2
and is a passive technique involving
rhythmical, gentle rocking motions with repeated trunk elongation and
rotation.
11
BackHab is a program designed for the treatment of individu-
als with low-back pain, but the principles can also be applied to those
with fbromyalgia.
5
Program Goals
The goals of this program are to provide exercise, slowly increase cardio-
vascular conditioning, and tone and condition muscles in a low-impact
medium, an ideal solution for individuals with FMS. The program could
begin with an active warm-up using Ai Chi techniques, followed by
Watsu
11
for additional relaxation and stretching.
17
To improve fexibility, slow sustained stretches of the major muscle
groups could follow the warm-up, with specifc attention paid to areas
that are symptomatic during that session. This would allow for continual
adjustment of the program based on the patients symptoms.
Using BackHab principles for core strengthening and exercise, the
general conditioning and strengthening portion of the aquatic program
could include a progressive walking program.
The water session would end with additional Watsu and Ai Chi
activities to promote additional relaxation prior to returning to the full
gravity of land-based living.
A well structured program of aquatic-based relaxation, fexibility and
general exercise activities combined with land-based education, relaxation
and general exercise will optimize functional recovery and outcomes.
Emphasis on relaxation, posture and the importance of activity will
help restore normal function. A combination approach of education,
aquatic physical therapy and traditional land-based physical therapy
appears to be the most effective way to assist these patients in reaching
their goals. n
References
1. Hulme, J. (2000). Fibromyalgia: A Handbook for Self Care and Treatment, 3rd Ed.
Phoenix Publishing.
2. Vargas, L. (2004). Aquatic Therapy Interventions and Applications. Idyll Arbor, Inc.
3. Stedmans Medical Dictionary for the Health Professions and Nursing, 5th Ed. Lip-
pincott, Williams & Wilkins, 2005.
4. Chaitow, L. (2003). Fibromyalgia Syndrome: A Practitioners Guide to Treatment.
2nd Ed. Churchill Livingstone.
5. Sova, R. (1996). BackHab: The Water Way to Mobility and Pain Free Living. DSL, Ltd.
6. Krsnich-Shriwise, S. (1997). Fibromyalgia Syndrome: An Overview. Physical
Therapy, 77(1). www.ptjournal.org/Jan97/krsnich.cfm.
7. Bates, A., & Hanson, N. (1996). Aquatic Exercise Therapy. W.B. Saunders Co.
8. Mannerkorpi, K., & Iversen, M. (2003). Physical exercise in fbromyalgia and related
syndromes. Best Practices in Research and Clinical Rheumatics, 17(4), 629-647.
9. Essert, M. (2001). Water works: Aquatic therapy can help treat a variety of
painful conditions. ADVANCE for Directors of Rehabilitation, 10(1), 43-46.
10. Sova, E. (2000). Aquatics: The Complete Reference Guide for Aquatic Fitness Profes-
sionals. DSL, Ltd.
11. Cole, A., & Becker, B. (2004). Comprehensive Aquatic Therapy. Elsevier, Inc.
12. Cedrashi, C., Desmeules, J., et al. (2004). Fibromyalgia: A randomised, con-
trolled trial of a treatment programme based on self management. Annals of
Rheumatic Disorders, 63, 290-296.
13. Altan, L., Bingl, U., et al. (2004). Investigation of the effects of pool-based
exercise on fbromyalgia syndrome. Rheumatology International, 24, 272-277.
14. Jentoft, E., Kvalvik, A., & Mengshoel, A. (2001). Effects of pool-based and
land-based aerobic exercise on women with fbromyalgia/chronic widespread
muscle pain. Arthritis Care Research, 45, 42-47.
15. Mannerkorpi, K., Nyberg, B., Ahlmn, B., & Ekdahl, C. (2000). Pool exercise
combined with an education program for patients with fbromyalgia syndrome.
A prospective, randomized study. Journal of Rheumatology, 27, 2473-2481.
16. Mannerkorpi, K., Ahlmn, B., & Ekdahl, C. (2002). Six-and 24-month follow-
up of pool exercise therapy and education for patients with fbromyalgia.
Scandinavian Journal of Rheumatology, 31, 306-310.
17. Sova, R., & Kunno, J. (1999). Ai Chi: Balance, Harmony, & Healing. DSL, Ltd.
Janet Gangaway works at the University of Hartford as an assistant professor
of PT and academic coordinator of clinical education. She practices aquatic and
orthopedic physical therapy at University Physical Therapy LLC, also at the
University of Hartford. She has 17 years of experience as a physical therapist
and is board-certifed in orthopedic physical therapy. She is also a certifed and
licensed athletic trainer.
[AQuATiC THERAPY]
For more information on aquatics, visit www.advanceweb.com/
PTAquaticTherapy
26 ADVANCE for Physical Therapy & Rehab Medicine
revolutionary
new swimsuit
easy to put on, even easier to take off.
Ideal for plus sizes, physically challenged, aquatic
physiotherapy, pregnancy, arthritis, Fibromyalgia,
Parkinsons and all disabling diseases. Are you tired
of putting on and taking off your swimsuit? Then this
is the suit for you.
Flattering design
Chlorine Resistant
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The patented SlipOn Swimsuit is made of the highest quality material
with a four way stretch for a very forgiving ft. Unmovable wide straps
for comfort, double cross over the stomach helping to give you a
slenderizing look creating an extremely fgure fattering style.
Water exercise will ease your pain even if you just walk in the water to
start. Medical advice DVDs will be available, your guide for safety in the
water for your disability. SlipOn Swimsuits will be available May 2011.
Dianne Rothhammer Sheetz, SlipOn NZ Limited, P.O. Box 448, Orewa 0946
Hibiscus Coast, Auckland. Phone 09-427 6595, Email dianne.slipon@xtra.co.nz
www.sliponswimsuits.com
The SlipOn Swimsuit
is a completely
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designed for the
elderly and the
physically challenged.
Get into the water
with independence
and comfort!
Putting on the swimsuit:
Undo Velcro to open to
panty area. Pull panty on
to the waist. Adjust straps
over your shoulders. Bring
left Velcro over to right side
of Velcro on the suit. Pinch
bottoms together and guide
Velcro upward with the
other hand to close. Cross
over to match up the left
side to close the Velcro
securely.
The revolutionary swimsuit that
simply slips on
and off!
27 ADVANCE for Physical Therapy & Rehab Medicine
A
leading cause of serious, long-term
adult disability, stroke can happen
to anyone at any time.
1
Stroke
attacks the brain, discontinuing
necessary blood fow and oxygen. It increases
the risk of lasting brain damage and disability
by killing 2 million brain cells every minute.
Thats why recovering from stroke can take
a lifetime. Formal rehabilitation to gain inde-
pendence is the frst step to recovery for many
people. It is common for rehabilitation to begin
in the hospital, and in stable patients, within
two days following the stroke. The quicker
patients start rehabilitation, the more likely
they are to recover lost abilities.
Effects of Stroke
Different abilities will be affected by stroke,
depending on the degree of brain damage
and where the stroke occurred, as every area
in the brain is responsible for a specifc func-
tion. A person can experience any one of the
following strokes:
Right-Hemisphere Stroke. Because the right
hemisphere controls the left side of the body,
a stroke in this area of the brain will typically
cause paralysis in the left side of the body. As
the right hemisphere also controls analytical
and perceptual tasks, a stroke in the right hemi-
sphere may also lead to spatial and perceptual
abilities and judgment diffculties.
Left-Hemisphere Stroke. This side of the
brain controls speech and language abilities,
as well as movement on the right side of the
body. A left-hemisphere stroke would likely
cause speech and language problems, as well
as paralysis in the right side of the body.
Cerebellar Stroke. Refexes, balance and
coordination are controlled by the cerebellum.
A stroke in this area of the brain would lead to
coordination and balance problems, such as
foot drop, as well as abnormal refexes.
Brain Stem Stroke. The brain stem controls
all involuntary functions, such as breathing rate,
heartbeat and blood pressure, along with eye
movements, hearing, swallowing and speech.
A stroke in the brain stem can be devastating
and life threatening.
2
Stroke Rehabilitation
Treatment goals help patients relearn basic
skills to regain independence, prevent strokes
in the future and prevent complications. Stroke
rehabilitation can include therapy to regain
speaking and comprehension; motor skill
strengthening; mobility training; psychological
evaluation; range of motion therapy; electrical
stimulation to stimulate weakened muscles;
constraint-induced therapy to improve function
of the affected limb and more.
3
Rehabilitation specialists can help stroke
survivors learn how to keep muscles strong,
use assistive devices to stay mobile, perform
appropriate stretching exercises, bathe, shower,
dress, eat and other necessary functions and
return to work. Feeding, moving and perform-
ing normal tasks may not be as easy as they
once were before the stroke.
Sometimes, muscles can be weaker or not
work at all on one side of the body. Patients
may experience muscle spasticity (tight mus-
cles) and joint contractures (hard-to-move
joints) on the weak side of their body. It is
not uncommon for muscles that havent been
affected to become weak as well.
4
Muscle spasms or spasticity, joint contractures,
subluxation or dislocation of a joint (commonly
the shoulder) and refex sympathetic dystrophy
(complex regional pain syndrome) are typical
ways patients may experience pain after stroke.
While pain medications can be taken, a health
care provider needs to approve anything bought
without a prescription. To combat muscle spasms
and/or spasticity, a combination of physical
therapy, braces and medication can help.
Returning Home
Returning home depends on stroke severity,
whether or not the patient can take care of him-
self, what type of help will be available and
if the house is deemed safe. Rehabilitation
options, aside from home therapy, can include
a rehabilitation unit in the hospital, a subacute
care unit, a rehabilitation hospital, outpatient
therapy, and/or therapy and skilled nursing
care at a long-term care facility.
For patients capable of returning home after
rehabilitation, changes may need to take place
in order for the patient to stay safe. Consider
the proximity from bed to bathroom, and
move items that can pose a falling hazard. The
National Institutes of Health notes that patients
often see improvement in moving, thinking
and talking in weeks to months following a
stroke. In many people, improvements will
continue to be seen years after a stroke. n
Resources are available online at www.advance
web.com/pt.
Beth Puliti is a frequent contributor to
ADVANCE.
Life After Stroke: Regaining independence
DISClAIMER: Your doctor or therapist has given you this patient handout to further explain or remind you
about an issue related to your health. This handout is a general guide only. if you have specifc questions, dis-
cuss them with your doctor or therapist.
ADVANCE
for Physical Therapy & Rehab Medicine
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[PATIENT HANDouT]
For more patient handouts visit us at www.
advanceweb.com/PTHandouts
28 ADVANCE for Physical Therapy & Rehab Medicine
29 ADVANCE for Physical Therapy & Rehab Medicine
Coming in August: Focus on the new england Region. dont Miss it!
A
fter Olivia Chang Yanagi, PT,
received her bachelors degree
in physical therapy from the
University of North Dakota and
completed her clinicals in different states, she
could no longer resist the allure of her native
state of Hawaii and returned home to be with
family and friends.
Many people who were raised in Hawaii
leave the islands for college and may choose
to live there. Because of new experiences,
higher paying job opportunities, and the cost
of living is less, people usually feel it is hard to
move back home to Hawaii, Yanagi said.
However, when it is time to raise a fam-
ily, most people try to move back eventually
to be with families for support or to be in a
more family-oriented environment. Some-
times quality of life outweighs the rest.
Yanagi, a staff physical therapist at Rehab
Therapy Partners in Honolulu, takes full
advantage of the quality-of-life factors
that Hawaii affords its residents, making
frequent early-morning or late-afternoon
trips to the beach.
I either walk or run around Diamond
Head and Kapiolani Park, then go to the
beach to cool off, she said. My family has a
picnic dinner during sunset at the beach, and
then continues playing in the sand and water
throughout the evening.
Children who grow up in Hawaii can play
outside most of the time throughout the year
and are also exposed to a diversity of people,
foods and cultural customs, Yanagi said.
Indeed, Hawaii is an excellent place to
raise a family, said Kristin Hawkinson, PT,
who works in an outpatient, PT-owned phys-
ical therapy clinic in Honolulu. The cost of
living is high, but the number of activities
that people participate in out here is endless,
she said.
Hawkinson trains for fve rough-water
swims and one marathon a year. When
shes not training, Hawkinson enjoys going
to the beach, swimming, running, hiking
and basically enjoying all the things sunny
tropical weather has to offer. Hawaii is the
perfect playground for the active individ-
ual, she said.
Professionally, Hawaiis community atmo-
sphere allows PTs to participate at the county
and state levels with a feeling that their voice
was heard without becoming overwhelmed,
O
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F
T
O
u
R
i
S
M
This suspended tram
offers a majestic view
of the Oregon land-
scape below.
Pacifc Region
[ADVANCE ExTRA!]
Its a more elevated way of life for therapists
in the Pacifc Region By sarah long
Coastal Allure
Hawkinson said.
As a member of the Hawaii Physical Ther-
apy Association (HAPTA), Yanagi also fnds
many opportunities to work with colleagues
for community events, on professional or
legislative issues or social events.
Private practices or hospital managers
often form special interest groups to help
each other work through insurance, quality
assurance or JCAHO issues.
Hawaii is also a small community, and
many people know each other through
growing up together, prior work expe-
riences, living near each other or see-
ing each other at continuing education
courses, she said.
HAPTA offers continuing education
courses at least twice a year, and many
lecturers who come to Hawaii provide
courses throughout the year. Although
the University of Hawaii-Hilo is begin-
ning work on a DPT program, aspiring
PTs in Hawaii currently have to travel to
other states to attend PT school, and PTs
interested in earning their DPT must do
so online, Yanagi said.
Professionally, Ive had the opportunity
to work in different environments and to
attend several continuing education courses
from many experts in the feld ranging in
orthopedic, neurological and geriatric top-
ics, she said.
Hawaiians seeking a PT program in
the continental United States might con-
sider Washington, which offers three
DPT programs and six physical therapist
assistant programs, according to Elaine
Armantrout, PT, DSc, ECS, a private prac-
titioner at Cypress Labs in Seattle, WA. In
the Seattle area, there are opportunities
for acquisition of masters and doctoral
degrees along with certifcation programs
in various specialty areas.
The Physical Therapy Association of
Washington (PTWA) supports a Legisla-
tive Impact Day during every legislative
session providing a prime opportunity for
networking, particularly in meeting stu-
dents, Armantrout said.
Armantrout moved to Washington from
the Midwest in the early 1980s because she
30 ADVANCE for Physical Therapy & Rehab Medicine
could ride her bike and snow ski on the same
day, she said. We can sail and hike all year
round. When we get tired of the weather, we
can cross the Cascades and get into a com-
pletely different climate.
Armantrout lists the absence of a state
income tax, the fact that women occupy high-
profle roles in government and geographic
expansiveness as some of the states endear-
ing attributes, but the best thing about living
in Seattle is that we dont have screens on the
windowsno bugs!
Paul Purdue, BS, PTA, a physical therapist
assistant at Physical Therapy Associates, a
private outpatient practice in Tacoma, WA,
said he cant imagine living anywhere other
than Washington even though he has trav-
eled extensively across the country.
Our climate is conducive to outdoor
activities year round: hiking, biking, boating,
fshing, hunting, snow and waterskiing, golf-
ing, SCUBA diving and whitewater rafting to
name just a few examples, he said.
Washington is divided by the Cascade
Mountain Range, which creates two vastly
different climates between the Eastern and
Western parts of the state, Purdue said. The
East is dry, arid and seasonal with more
extreme temperatures while the West is gen-
erally mild and gets the rain but is beautiful
year-round.
The best thing about raising a family here
is you have the beneft of city life, country liv-
ing and everything in between, he said. We
have professional sports, incredible music for
all tastes, technology and aerospace indus-
tries, and great people.
PTWA is very responsive to people inter-
ested in being involved in leadership roles
and offers great mentoring programs, Pur-
due said.
I was the PTA Caucus rep for six years
representing all PTAs in the Washington
Chapter for the APTA PTA caucus at the
House of Delegates. I mentored an indi-
vidual for three years to replace me as I am
now a national delegate for the PTA Cau-
cus, he said.
I am also on the PTWA BOD, PR Com-
mittee and served as the Chair of the Advi-
sory Panel for the PTA for the APTA. These
opportunities would not have been available
if Washington was not such a strong sup-
porter of leadership.
PTs also can fnd networking events in
many cities across Oregon, but the main con-
centration of a variety of groups are in the
Portland area, said Johnny Galver, PT, BPM,
staff PT and owner of Physical Therapy Cen-
ter Inc., a small, family-operated PT practice
serving the Salem community.
Oregon provides diverse work settings in
both rural and urban areas, with the greatest
opportunities to learn and work concentrated
in smaller communities that look to the PT
as important elements of the medical com-
munity, Galver said.
With that being said, truly PTs come to
Oregon because of the recreational oppor-
tunities, Galver said, citing hiking, cycling,
boating, fshing, hunting, rock climbing,
wind surfing, snow and water skiing,
Pacifc Region
[ADVANCE ExTRA!]
APTA Chapters, salary Information in the Pacifc Region
Alaska California Hawaii Oregon Washington
President
Jeffrey August
lePage, PT
James M. Syms, PT,
DSc, ATC, SCS
Ann Frost, PT
John Christopher
Murphy, PT
Susan Chalcraft,
PT
vice President Joy M. Backstrum, PT Carla Griffth, dPT
Candice Turner, PT
(board liaison)
Derek Nathan Fen-
wick, PT, MBA, GCS
Elaine Ann
Armantrout, PT,
DSc, EC
Employed PTs 430 14,860 670 2,370 4,110
Employed PTAs 30 4,460 230 530 1,170
Employed PT Aides 50 6,080 90 680 1,130
CE units required per year (PTs) 24 hours 30 hours 0 24 hours 40 hours
CE units required per year (PTAs) 24 hours 30 hours 0 12 hours 0
state Approval for CE courses? No No No No No
PT Average salary $92,720 $84,600 $71,940 $75,150 $75,180
PTA Average salary $40,960 $57,760 $41,450 $50,200 $48,200
PTA Aide salary $33,210 $27,350 $30,550 $25,510 $26,970
Chapter website www.akapta.org www.ccapta.org www.hapta.org www.opta.org www.ptwa.org
Chapter phone number 907-566-3749 916-929-2782 No offce 503-262-9247
800-554-5569
Ext. 10
Chapter contact
Laura Kaczorowski
adminakpta@gmail.
com
Stacy DeFoe
sdefoe@ccapta.org
webmaster@hapta.
org
Sandra Fisher,
info@opta.org
Jackie Barry,
jackiebarry@
ptwa.org
Salary information provided by the U.S. department of Labor, www.bls.gov. State licensing agencies can be found at www.fsbpt.org/licensing/index.asp
At A glance
31 ADVANCE for Physical Therapy & Rehab Medicine
Pacifc Region
[advance extra!]
mountain biking and off-road motor-
cycle/quad riding as some of the more
popular activities.
We have a coastline, mountains, high
desert plateaus and dense forest areas which
cater to a variety of individuals, Galver
said. Yet most of the population lives in the
Willamette Valley where it rains a lot and
allergies due to grasses, trees, hay, molds
and many others are plentiful.
Galver enjoys year-round barbecuing,
fishing and occasionally attempting to
shoot a goose or duck, just one reason to
make noiseI hardly ever hit anything,
he said.
I have raised my family here for the past
14 years and am blessed to have them work-
ing with me. The education system here is
good, Galver said. Like any other state we
have our issues, but for the most part there
tends to be more a feeling of community
regardless of what city you live in.
Derek Fenwick, PT, MBA, GCS, an Area
Rehab Director for Infnity Rehab based in
Wilsonville, OR, and specializing in post-
acute care rehab and geriatric outpatient
rehab, loves Oregons culture of inclusion
and environmental awareness.
Most Oregonians have a genuine appre-
ciation for the individuality of every person,
he said. Oregon is also a national leader in
the transition toward clean energy. It is easy
to live an environmentally responsible life in
Oregon, and weve got lots of people work-
ing together to keep it that way.
The genuine culture, the natural wonders
and the daily opportunities to experience
lifes diversity make Oregon an ideal place
to raise a family, Fenwick said.
People who were born here tend to want
to come back, and people who fnd Oregon
later in life tend to not want to leave. n
Sarah Long is a freelance writer.
Advance your career in the Pacific region with these facilities. Look to these employers for a great
new job in the Pacific region!
Our special Pacific region section, starting on page 30, details what it is like to live and work in the
Pacific regionand these highlighted employers want you to know about their exciting job openings.
If you're looking for a job in the Pacific region, think of these facilites first. And, remember, when you
respond to an ad in ADVANCE, you are helping to keep ADVANCE coming FREE to Physical Thera-
pists and PT Assistants all over the nation. Our magazine is FREE because of the support of these
and other advertisers. Happy job hunting!
Advertiser/State URL Page #
Advertiser Index
AlAskA
All for Kids 53
Health Quest Therapy www.healthquesttherapy.com 52
Ketchikan General Hospital www.peacehealth.org 53
KPO Rehab 52
Norton Sound Health Corporation www.nortonsoundhealth.org 52
CAliforniA
Hallmark Rehabilitation 53
Interface Rehab Inc www.osfhomecare.org/employment 53
HAwAii
Rehabilitation Hospital of the Pacifc www.rehabhospital.org/jobs 52
nATionAl
Aureus Medical Group aureusmedical.com 53
Creative Health Solutions 53
EBS Healthcare www.ebshealthcare.com 54
Supplemental Health Care www.supplementalhealthcare.com 54
Tara Therapy 54
PACifiC
SunDance Rehabilitation www.SunDanceRehab.com 53
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MP2.2_3.5_4C011807_1.indd 1 1/18/07 10:12:17 AM
IMMIGRATION for PTs:
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Houston, Texas www.rnlawgroup.com
713-953-7787 emily@rnlawgroup.com
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MP2.2_1_4C011807_1.indd 1 1/18/07 10:11:57 AM
32 ADVANCE for Physical Therapy & Rehab Medicine
VIDEO SEMINARSVVVVVVVVVVVVVVVVVVVVV
#1 Home Study Course in
Stroke Rehab: 15 Hours!
Jan Davis fills her courses with real patients, great treatment
ideas and practice labs. Easy to use, no expiration date, quick
turnaround time. Very affordable: $195 for 15 hours, $295
for 30 hours, train more staff for just $95 per person. Three
courses offered, each with clear, concise step-by-step han-
dling methods: Functional Treatment Ideas and Strategies,
Teaching Independence: A Therapeutic Approach or
Treatment Strategies in Acute Care. Meets PT license board
requirements. Pre-approved in 28 states. Contact: 888-665-
6556 (toll-free); or www.ICELearningCenter.com
DISTANCE EDUCATION
Great Online Courses Made Easy
Not Boring
Learn and earn 5 hours of continuing education credit
from each of our many exciting, interactive and extremely
clinical online courses: Gait and Balance, Knee Osteoarthritis,
Seating and Mobility, Lumbar Spinal Stenosis, Wiihabilitation,
Aging Foot, Vestibular, and Research to Practice. Well-
known instructors such as Dr. Carole Lewis and Dr. Richard
Bohannon bring these courses to life with real patients,
case studies and a focus on practical application. Fast and
easy to complete. Hyperlinks to PubMed for all references.
Bring evidence into your clinic. Visit our website to watch
2 minute relevant research videos on the most current
studies impacting your practice - for free. Contact: www.
Greatseminarsonline.com
DISTANCE EDUCATION
Online and Home
Study Courses
Earn 6 hours of continuing education credit from any one of
our four home study or online courses; 1) Assessment and
Treatment of Age Related Balance Impairment, 2) Introduction
to Therapeutic Ultrasound, 3) Dressed for Success! (An
Introduction to Wound Dressings), and 4) Taking charge of
Chronic Wounds: An Introduction to Electrical Stimulation
and Wound Healing. Offered by the original author, Jamie
Birmingham, PT, CWS, these courses have been recently
updated to provide you with the most current information
available and are only offered by JVB Enterprises, Inc., Cost:
Only $125 per course or $100 each for 2 or more. Contact:
JVB Enterprises, Inc., 888-328-6755 (toll-free); www.teachtx.com
DISTANCE EDUCATION
Start Your Own
In-Home Therapy Practice
Learn how to take control of your physical therapy career and
work for yourself, instead of someone else. This seminar will
teach you the ins and outs on how to successfully start and
operate an in-home therapy practice under Medicare Part B.
Therapists will learn about the start-up process, business
structures, Medicare Part B requirements and regulations,
proper documentation and billing, and marketing and prac-
tice expansion. Participants can access the seminar through
our website. Contact: In-Home Therapy Services, LLC,
800-931-5769; www.inhometherapyservices.com for more
information and to register online.
ONGOING INTERNET/ON-SITE
Become an Accessibility &
Home Modifications Consultant
2 for 1 REGISTRATION PRICE SALE + FREE CE hours!!
Instructor: Shoshana Shamberg, OTR/L, MS, Abilities OT
Services, Inc., with over 22 years of private practice expe-
rience specializing in design/build services, specialized
products, home safety, environmental modifications, assis-
tive technology, and ADA consulting. Start a private practice
or add to existing services. Extensive manual + 2-Day
on-site training options nationwide (currently in Baltimore,
MD and Phoenix, AZ.) AOTA Approved Provider of CE +
NBCOT CE Registry. Group and COMBO discounts. SEMINAR
SPONSORSHIPS AVAILABLE. Contact: Abilities OT Services,
410-358-7269; info@aotss.com or www.AOTSS.com for
registration, brochures, + calendar for current dates and
locations.
AUG. 4-5, 2011 BATON ROUGE, LA
Wound Management Strategies for
Patients with Lymphedema
The Academy of Lymphatic Studies has pioneered lym-
phedema management in the U.S. since 1994. The Academy
offers a variety of advanced and refresher programs spe-
cifically tailored to the continuing education of Health
Care Professionals. Wound Management Strategies: this
intensive 2-day course is designed to further the knowledge
of therapists in the management of chronic wounds. Upon
completion of this course, therapists will be able to properly
identify wound characteristics consistent with venous insuf-
ficiencies in combination with lymphedema, and understand
how to effectively apply the different components of MLD/
CDT for patients with integumentary dysfunction associated
with lymphedema. Discounts are available for APTA & AOTA
members. Contact: 800-863-5935 for a free brochure;
academy@acols.com or www.acols.com
AUG. 5-6, 2011 LAS VEGAS, NV
OCT. 21-22, 2011 NEW YORK, NY
Secrets & Steps to
Private Practice Success
Step-by-step instruction course on how to increase referrals,
revenue, & reimbursement quickly and affordably! Perfect
for Experienced Owners & Beginners. SECRETS INCLUDE: 1)
Why an MD will stop referring, 2) Your front desk will make or
break you, 3) Coding & Modifier Secrets to double your reim-
bursements, 4) Employee Leadership is Key, 5) Advertising
Secrets & Templates, 6) Secret Promotions for Instant
Business, 7) Best Equipment & Software. TESTIMONIALS:
You will kick yourself if you dont go. Its so worth the
money and time to come here, It would be a MISTAKE not
to take this course! 100% Money-Back Guarantee. Contact:
800-801-4511; www.IndeFree.com for more locations.
AUG. 6-7, 2011 FT. LAUDERDALE, FL
Edema-Differential
Diagnosis & Treatment
This intensive two day course is designed to teach clini-
cians to differentiate between various edema etiologies
and design effective treatment programs based on those
findings. Topics include the evaluation of the arterial, venous,
and lymphatic systems. Numerous treatment techniques
will be covered, such as compression bandaging as well as
hands-on introduction to manual lymphatic drainage. Over
80% of attendants rated this course Excellent, all others
rated it Good. Cost: $350 for 16 hours. CEUs vary from state
to state. Contact: JVB Enterprises, Inc., 888-328-6755; or
www.teachtx.com for other courses offered in your area or
for more information.
AUG. 8, 2011 LAS VEGAS, NV
Advanced Billing, Coding,
Collections and Audit-Proofing
There are more requests for refund, denials, audits, and
reimbursement issues than ever before in the history of our
profession. Also, are your therapists billing only 3 units while
spending over an hour with patients? Is your documentation
making you vulnerable? This course will help solve many
of the problems confronted by most PT/OT practices today.
Get the secrets to quicker payment, better reimbursement,
appealing denials, audit-proofing, and more. TESTIMONIALS:
This is the best course Ive ever attended on billing, and
Ive attended over 100. Take it! 100% No-Risk Guarantee.
Contact: (800) 801-4511; www.IndeFree.com
AUG. 12-13, 2011 SACRAMENTO, CA
SEPT. 16-17, 2011 SPOKANE, WA
NOV. 4-5, 2011 TRUMBULL, CT
Torticollis: Effective
Assessment and Treatment
Has the clinical presentation of torticillis changed? Novice
and experienced clinicians will explore the effects of torticol-
lis, sleep posture and increased use of positional devices
on infant postural development. Functional, clinically ori-
ented evaluation and evidence based treatment strategies for
infants through 2 years of age will be provided. Clinical path-
ways of management of infant head shape, diagnostic pro-
cedures and surgical intervention will be appraised. Learning
opportunities will transpire through lectures, group problem
solving and video review. Instructor: Cindy Miles. Contact:
Education Resources, Inc., 508-359-6533; 800-487-6530
(outside MA); www.educationresourcesinc.com
AUG. 19-20, 2011 HARTFORD, CT
SEPT. 16-17, 2011 RENTON, WA
OCT. 28-29, 2011 CHICAGO, IL
Brachial Plexus Injuries
Treatment: Infant thru Teen
Do you assess and treat pediatric patients with Obstetrical
Brachial Plexus Injuries? This workshop will provide you
with the comprehensive knowledge you need to be able
to confidently perform comprehensive examinations,
develop attainable goals and choose the most effective
therapeutic strategies and make surgical referrals for each
stage of recovery throughout infancy, childhood, and teen
years. Instructors: Cindy Servello & Pia Stampe. Contact:
Education Resources, Inc., 800-487-6530; 508-359-6533;
www.educationresourcesinc.com
AUG. 19-20, 2011 NEW BRUNSWICK, NJ
OCT. 1-2, 2011 LEXINGTON, KY
DEC. 2-3, 2011 OREGON, OH
Yoga Therapy for the Child
With Developmental Challenges
This workshop teaches a balanced therapeutic yoga approach
w/ modifications for various populations. Through experien-
tial labs you will learn the physical, physiological, regulatory,
emotional & sensory-motor benefits of Yoga for the Child w/
Developmental Challenges. Use of Rhythm & Breath control
will be emphasized to facilitate regulation & organization.
A sequence of postures will be analyzed to highlight the
therapeutic aspects. Case studies will highlight the therapeu-
EDUCATION OPPORTUNITIES
VIDEO SEMINARS
DISTANCE EDUCATION
ON-SITE SEMINARS
(Continued on next page)
FREE E-NEWSLETTER WWW.ADVANCEWEB.COM
PTCal_07_25_2.indd 1 7/20/11 4:44:18 PM
33 ADVANCE for Physical Therapy & Rehab Medicine
E
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I
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T
U
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I
E
S
tic benefits. Instructor: Anne Buckley-Reen. Contact: Education
Resources, Inc., 508-359-6533; 800-487-6530 (outside MA);
www.educationresourcesinc.com
AUG. 20-21, 2011 EDISON, NJ
Assessment & Treatment
Age-Related Balance Impairment
This intensive two-day course is designed to provide evi-
dence-based fall prevention strategies for reducing the number
of falls in the elderly population and discuss balance treatments
for inpatients as well as community-based falls prevention pro-
grams. Through interesting lecture and hands-on labs, this course
will provide skills that can be used in the clinic setting the very
next day. Over 80% of attendants rated this course Excellent, all
others rated it Good. Cost: Only $350 for 16 hours. CEUs vary from
state to state. Contact: JVB Enterprises, Inc., 888-328-6755; or
www.teachtx.com for other courses offered in your area or for
more information.
AUG. 20-21, 2011 SEATTLE, WA
SEPT. 17-18, 2011 MINNEAPOLIS, MN
OCT. 15-16, 2011 BOSTON, MA
Starting and Running a
Pediatric Therapy Practice
This seminar presented by entrepreneur Vincent Mullins, MOT,
OTR, will provide clear steps to open and run a pediatric OT/
PT/ST private practice. All aspects of start-up and growth of
the practice will be presented through personal experience and
years of research and development. Both therapy and business
portions will be discussed. 11 CE hours. Live video available
for those unable to attend. Contact: 940-300-2299; or www.
THERAPYSEMINARSLLC.com to register online.
AUG. 26-27, 2011 PORTSMOUTH, NH
SEPT. 23-24, 2011 FORT WAYNE, IN
OCT. 21-22, 2011 ROCKFORD, IL
Yoga and Pilates Therapy for
The Child with Special Needs
Learn how to integrate pilates and yoga exercise techniques
in to your therapeutic intervention. These techniques will be
applied to the child with special needs from birth to school
age with diagnosis of sensory impairments, tone issues,
autism, ADHD and spina bifida. Instruction will be completed
on how to include these techniques into your everyday prac-
tice in pediatric rehabilitation. You will be able to design
family friendly home programs for your clients and participate
in labs so that you can better appreciate the use of these
techniques. Instructor: Angelique Micallef-Courts. Contact:
Education Resources, Inc., 508-359-6533; 800-487-6530
(outside MA); www.educationresourcesinc.com
AUG. 27-30, 2011 CHATTANOOGA, TN
SEPT. 17-20, 2011 BATON ROUGE, LA
OCT. 1-4, 2011 PALM BEACH GARDENS, FL
Lymphedema
Management Seminar
The Academy of Lymphatic Studies has pioneered lym-
phedema management in the U.S. since 1994. This course
serves as an introduction to the management of upper and
lower extremity lymphedema (primary and secondary) and
is focused on increasing the understanding of proper lym-
phedema management and the application of the techniques
known as Manual Lymph Drainage (Vodder/Foeldi technique)
and Complete Decongestive Therapy for lymphedema and
other conditions. The 31 hour program is taught in only 1 1/2
working days; the course length is 3 1/2 days in total. The
program covers the anatomy, physiology and pathophysiol-
ogy of the lymphatic system and the introduction in the
current treatment techniques for upper and lower extrem-
ity lymphedema. The textbook Lymphedema Management
authored by the Academys director was published in 2004
by Thieme Medical and Scientific Publishers, NY, and is
included in the tuition. Discounts are available for APTA &
AOTA members. Contact: 800-863-5935; academy@acols.
com or www.acols.com
SEPT. 8-11, 2011 PITTSBURGH, PA
SEPT. 15-18, 2011 ATLANTA, GA
SEPT. 30-OCT. 3, 2011 DETROIT, MI
Intro to NDT Part I
Improving Gait Faster Part II
Achieve functional outcomes for adults with hemiplegia.
Content includes the principles of NDT, facilitation of sit-
to-stand, use of the LE in functional activities, transfers,
UE weight bearing, remediation of pain and subluxation of
the hemiplegic shoulder. Bed mobility will be demonstrated.
Treatment ideas and a framework to document goals based
on functional outcomes using NDT will be provided. Get to
results faster when improving gait. Increased clinical rea-
soning will enable you to know what to expect and what to
predict. You will be able to assess the cause of the problem
and have more immediate influence. You will have a better
understanding of the normal components of gait and then
understand why your patient with hemiplegia has tendencies
in gait. You will practice with hands-on how to increase
ROM of the hip and foot. Concepts for use of a self-exercise
program and use of orthotics will be discussed. Additional
treatment ideas related to gait and more examples of docu-
mentation will be provided. Both parts include videotapes,
hands-on experience and live patient demonstrations.
Cathy Runyan, OTR, & Peggy Miller, PT, NDTA Inc. Certified
Instructors. Audience: PTs, PTAs, OTs, COTAs. Contact hours:
30. Contact: Recovering Function, 408-268-3691; or www.
RecoveringFunction.com for a complete brochure of intro-
ductory, advanced, and certification courses as well as infor-
mation about additional course dates/locations, group rates,
& free registrations when hosting courses at your facility.
MCMT: Mastery Cercaon
in Manual Therapy with
Dr. Dimitrios Kostopoulos &
Dr. Konstanne Rizopoulos
CAMT: Cercaon in
Advanced Manipulave
Therapy with
Dr. Ines Nakashima
Manipulaon of
Upper & Lower
Extremies
9/10-11/2011
Woodbridge, VA
9/17-18/2011
Astoria, NY
FELLOWSHIP WITH
DR. INES NAKASHIMA
9/12-16/2011
Astoria, NY
PT-01: Myofascial Trigger Point and
Propricepve Therapy
August 6-7, 2011 Ft. Lauderdale, FL
September 17-18, 2011 Lakeland, FL
October 1-2, 2011 Dallas, TX
December 3-4, 2011 Astoria, NY
January 28-29, 2012 Astoria, NY
PT-02: Comprehensive Manual Therapy
Approach for Cervical Spine
August 13-14, 2011 Astoria, NY
September 24-25, 2011 Warwick, RI
October 22-23, 2011 Astoria, NY
February 25-26, 2012 Astoria, NY
April 14-15, 2012 San Antonio, TX
PT-03: Comprehensive Manual Therapy
Approach for Lumbar Spine
September 10-11, 2011 Dallas, TX
September 17-18, 2011 Astoria, NY
September 24-25, 2011 Los Angeles, CA
November 5-6, 2011 Warwick, RI
November 19-20, 2011 Astoria, NY
PT-04: Comprehensive Manual Therapy
Approach for Shoulder, Elbow, Hand
July 30-31, 2011 Astoria, NY
August 20-21, 2011 San Antonio, TX
August 27-28, 2011 Lakeland, FL
September 10-11, 2011 Ft. Lauderdale, FL
September 10-11, 2011 Chicago, IL
September 24-25, 2011 Wilmington, NC
PT-05: Comprehensive Manual Therapy
Approach for Hip, Knee, Foot
August 20-21, 2011 Chicago, IL
October 22-23,2011 San Antonio, TX
October 29-30, 2011 Lakeland, FL
November 4-6, 2011 Astoria, NY
November 19-20, 2011 Dallas, TX
November 19-20, 2011 Ft. Lauderdale, FL
PT-MCMT: Mastery Cercaon in
Manual Therapy
August 20-21, 2011 Astoria, NY
October 1-2, 2011 Wilmington, NC
October 22-23, 2011 Chicago, IL
December 10-11, 2011 Dallas, TX
Your Clinical Success is your Choice... and our Passion!
FOR MORE DATES AND LOCATIONS, VISIT US AT
www.HandsOnSeminars.com or Call 1-888-767-5003
Presents a Continuing
Education event featuring:
Jan Davis, MS, OTR/L
Facilitating Movement
and Improving Function
in Adult Hemiplegia
15 Contact Hours
August 19-20, 2011
Austin, TX
November 5-6, 2011
Sacramento, CA
January 21-22, 2012
Orange County/LA, CA
For more information
contact Janel Peck
at (800) 961-7553
jpeck@hrehab.com
www.hallmarkrehab.com
Registration Fee is $395.00
(Continued from previous page)
WWW.ADVANCEWEB.COM/JOBFAIRS
PTCal_07_25_2.indd 2 7/20/11 5:29:36 PM
34 ADVANCE for Physical Therapy & Rehab Medicine
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SEPT. 9-10, 2011 ENGLEWOOD, NJ
OCT. 15-16, 2011 NEW BERN, NC
NOV. 4-5, 2011 MINNEAPOLIS, MN
Geriatric Neurology:
Falls Prevention and Balance
Are the interventions you are using to improve balance in
geriatric and neurologic patients the most effective, up-to-
date and relevant for your individual patient? This course
will teach you to select and use the most appropriate tools
to assess the risk for falls, evaluate function and assess bal-
ance. Therapists will learn to differentiate normal aging from
pathology and develop effective evidence based treatment
strategies to improve functional balance outcomes to opti-
mize the environment. (Medically complex patient-Stroke-
Dementia-Balance Elderly-Frail Elderly). Instructor: Carole
Burnett. Contact: Education Resources, Inc., 508-359-6533;
800-487-6530 (outside MA); www.educationresourcesinc.com
SEPT. 9-10, 2011 WHITE PLAINS, NY
DEC. 9-10, 2011 NEW BERN, NC
Comprehensive Assessment and
Treatment of the Shoulder
This lab seminar is an evidence based approach to examina-
tion and treatment of the conditions affecting the shoulder
complex. This will address shoulder pain and overall func-
tion for adults with Impingement conditions, rotator cuff
tendonitis, bicipital tendonitis, subacromial bursitis, adhesive
capsulitis, frozen shoulder Pain, arthritis, overuse syndromes,
scapular syndromes, shoulder instability, thoracic outlet syn-
drome, radiculitis/peripheral nerve entrapment. This seminar
will cover differential diagnosis of this region and address
cervico-thoracic contribution to the shoulder condition. The
treatment approach will integrate the best evidence in a clini-
cally relevant manner. Instructor: Megan Donaldson. Contact:
Education Resources, Inc., 508-359-6533; 800-487-6530
(outside MA); www.educationresourcesinc.com
SEPT. 10-11, 2011 DENVER, CO
OCT. 1-2, 2011 POWELL, TN
OCT. 28-29, 2011 SPRINGFIELD, MO
Geriatric Neurology in
The Medically Complex Client
Learn evaluation tools and treatment protocols for medi-
cally complex older persons with neurological dysfunction.
Evidence-based information on assessment and treatment
of clients with Parkinsons Disease, Stroke, Alzheimers bal-
ance and gait disorders, neurosensory pathologies and pain
will be provided. The changes associated with aging as well
as pathological manifestations that affect the neurosensory
system and result in problems with coordination, mobility,
proprioception and kinesthesia, balance and falls, weakness
and pain will be presented. Instructor: Jennifer Bottomley.
Contact: Education Resources, Inc., 508-359-6533;
800-487-6530 (outside MA); www.educationresourcesinc.com
SEPT. 10-11, 2011 SEWICKLEY, PA
OCT. 14-15, 2011 SPOKANE, WA
DEC. 2-3, 2011 KEENE, NH
Small Patients, Big Challenges:
Complex Pediatric Patient
Therapists are often challenged by complex pediatric patients
whose care is constantly interrupted by medical issues,
hospital stays and surgeries. This comprehensive course
will guide clinicians through the process of managing
complex pediatric patients and medically fragile patients
within the context of their families, in all settings. Instructor:
Jonathan Greenwood, PT, MS, NDT, PCS. Contact: Education
Resources, Inc., 508-359-6533; 800-487-6530 (outside MA);
www.educationresourcesinc.com
Attention Therapists: Interested in Lymphedema Management Certication?
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PTCal_07_25_2.indd 3 7/20/11 4:44:19 PM
35 ADVANCE for Physical Therapy & Rehab Medicine
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PT1129_C02-C03.indd 2 6/27/11 8:43:14 AM
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PT1129_C02-C03.indd 2 6/27/11 8:43:14 AM
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PT1129_C02-C03.indd 3 6/27/11 8:44:26 AM
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100% high-grade cotton fabric with 100%
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cut for use, latex-free and hypoallergenic,
one-piece construction, water-resistant,
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#16470 Low Back
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