by Debra Gorman-Badar, APTA Montana, Chair of Ethics Committee

The Golden Rule is commonly invoked in ethics discussions and seems to be thrown out on the table like a trump card. While some have touted it for its simplicity because it is easy to remember, easy to understand, and easy to apply; it is a much more complex concept that lends itself to confusion and, thus, to critique.

First, let’s define what we are talking about. The Golden Rule can be stated in a positive and directive form as, “Do unto others as you would have them do unto you,” or “Treat others as you would like others to treat you.” It can also be stated in a negative or prohibitive form as, “Do not do to others what you would not want them to do to you,” or “Do not treat others in ways that you would not like to be treated.” It is thought to reflect empathy and reciprocity in human interactions.

Both forms are generally accepted to come from almost every religious tradition including humanist/atheist traditions. Some traditions use the positive form as an expression of the concept of beneficence: do good. Other traditions use the negative form expressing the concept of non-maleficence: do no harm. People living within specific traditions or communities have deep explicit and implicit assumptions that particularize their conceptions of doing good and doing no harm. They share many of the same beliefs, values, and customs that undergird their “Golden Rule.”

In our pluralistic society, where there are many traditions and communities with differing beliefs, values, and customs, applying the Golden Rule becomes problematic. My interpretation of the Golden Rule may not be yours. Critiques of the Golden Rule point out that it does not take into consideration differences in preferences, situations, contexts, or relationships. Let’s look at the following case:

A 63-year-old man who is s/p a CVA is your patient. Because he has plateaued in his physical therapy progress, his insurance company decides they will no longer pay for your services. To continue his recovery, he wants to keep coming for therapy, but does not have the financial resources to pay for your services. What do you do?

Either the directive or prohibitive forms of the Golden Rule would require you to continue treating this patient without being paid because you would want to recover as much as possible from a stroke even if you didn’t have the financial resources. The Golden Rule is too abstract to be of use and becomes a cliché. Using the Golden Rule to think about your actions in this case may highlight which features are morally relevant to your decision; however, now an easy rule to remember is not so easy to understand and apply.

Ethics involves the study of and reflection on the collective and individual values, beliefs, traditions, and customs that we live by. At the Montana APTA’s Spring Conference 2020, we will spend time examining, deliberating about, and discussing Current Topics and Issues in PT Ethics. I hope to see you there.

Debra Gorman-Badar, PT, MA, PhD(c)

Chair, Montana APTA Ethics Committee

By Justin Elliott, APTA vice president of government affairs

With the start of 2020 we begin the second and final year of the 116th U.S. Congress. Last year was filled with challenges and opportunities on Capitol Hill and with federal agencies, and they're sure to continue into this year. APTA's taking the advocacy lead on a number of bills impacting the physical therapy profession and the patients we serve that may be addressed in the 116th Congress, including:

• Physical Therapist Workforce and Patient Access Act (H.R. 2802/S. 970): Adds PTs as eligible providers to the National Health Services Corps Loan Repayment Program, which can provide up to $50,000 in student loan forgiveness in return to for a two-year commitment to work at an approved site located in a rural or underserved area.
• Prevent Interruptions in Physical Therapy Act (H.R. 5453): Expands locum tenens — the ability for a physical therapist to bring in another licensed PT to treat Medicare patients and bill Medicare through the practice provider number during temporary absences — under Medicare for outpatient PTs in all geographical areas (currently, PTs may use locus tenens only in designated areas that typically lack adequate health services).
• Primary Health Services Enhancement Act (H.R. 5693): Designates PTs as primary health providers in federal community health centers.
• Allied Health Workforce Diversity Act (H.R. 3637/S. 2747): Creates a scholarship program for individuals from underrepresented populations for the fields of physical therapy, occupational therapy, audiology, and speech-language pathology. The U.S. House of Representatives has already passed its version of the bill, so our focus now turns toward the Senate.

While those issues continue to be discussed, we also worked on legislation that was resolved last year. Among our wins: the finalization of the fiscal year 2020 appropriations bill for the U.S. Department of Health and Human Services, which included a $3 million increase in funding for the National Institute on Disability, Independent Living, and Rehabilitation Research. APTA was part of a coalition that advocated for this increase in rehabilitation research funding. Congress also passed, and the president signed, the Protecting Access to Wheelchairs Act, another piece of legislation that we backed.

Our successes in 2019 were fueled by tremendous work by our member advocates, who sent over 67,000 emails to members of Congress and hosted 60 in-district practice visits with members. In addition, PT-PAC, our political action committee, raised $812,963 in 2019, a 9% increase over 2018. It's hard to overestimate the role PT-PAC plays raising our profile on Capitol Hill, just as it's hard to overestimate the value of donations to the PAC. Federal law prohibits APTA from using member dues for political contributions, so your support of PT-PAC is much appreciated.

So what's in store in 2020? My colleague Laura Keivel, APTA's grassroots and political affairs specialist, and I recently recorded a webinar that covers many of the issues and bills that are on APTA's advocacy radar. It's free to download and provides lots of detail. In the meantime, here's a quick summary of some of our biggest issues.

Clearly, the biggest issue facing the profession in the near-term is fighting CMS-proposed changes to the 2021 Medicare physician feel schedule that would result in an estimated 8% payment reduction for PTS. This year, we're ramping up efforts to fight that ill- conceived plan. APTA is grateful to Reps. Buddy Carter (R-GA) and Lisa Blunt Rochester (D-DE), who are leading a House letter of inquiry about the proposed cuts that will be sent to CMS. We're also working with the other impacted health care provider groups to aggressively advocate to CMS on this issue, as well as to pursue legislative options to prevent the CMS proposal from being implemented in its current form. If you haven't seen it yet, check out APTA's #FightTheCut resource page and consider adding your voice using some of the advocacy vehicles provided.

But that's not all, by a long shot. We're also working with legislators and their staff on multiple bills related to home health and postacute care; advancing physical activity, prevention, and health promotion; providing better access to care for children, the elderly, our veterans, and persons with disabilities; and advancing rehabilitation research. Like I said, it's going to be a busy year. Some other bills we are working on include:

• Improving Seniors' Timely Access to Care Act (H.R. 3107): Seeks to reduce prior authorization burdens in Medicare Advantage plans. This bill continues to gain momentum and currently has 161 House cosponsors.
• The Individuals with Disabilities Education Act (IDEA) Full Funding Act (H.R. 1878/S. 866): Increases spending over the next decade to bring the federal share of funding for special education up to 40%, the amount committed when the law was first enacted in 1975.
• CONNECT for Health Act (H.R. 4932/S. 2741): Expands the use of telehealth under Medicare.
• Medicare Patient Empowerment Act of 2019 (S. 2812): Allows PTs to privately contract under Medicare (also known as an "opt out").
• Protecting Student Athletes from Concussions Act (H.R. 5611/S. 2600): Establishes specified minimum requirements for the prevention and treatment of concussions in school sport.
• Lymphedema Treatment Act (H.R. 1948/S. 518): Expands Medicare coverage for compression garments for beneficiaries with lymphedema. The legislation has passed the House, and the APTA-supported bill will now be considered by the Senate, where it already has 70 cosponsors.

With 2020 being an election year, our work to let our voice be heard is now more important than ever. While the elections will undoubtedly strain partisan divisions and increase political noise, we will continue our bipartisan focus on advocating for the physical therapy profession and getting results for the patients we serve. And there's still time for you to engage: Join us at the 2020 APTA Federal Advocacy Forum this March 29-31 in the District of Columbia, where we will bring our message to Capitol Hill.

As APTA member Theresa Marko, PT, DPT, MS, wrote in a recent APTA blog post, "Advocacy for our profession isn't a spectator sport." We need you on the team now more than ever. Check out our federal advocacy page for more information.

Want to know more about APTA's efforts on Capitol Hill? Check out this webinar that provides an in-depth update on APTA's Public Policy Priorities as they relate to the 116th Congress. The webinar covers many of the issues and bills that APTA is leading or supporting up on Capitol Hill. It's free to download and provides lots of detail. Note: The webinar was recorded via AdobeConnect.

The US Centers for Medicare and Medicaid Services (CMS) unveiled an unwelcome New Year's Day surprise for outpatient therapy providers, including private practitioners and facility-based settings, when it announced it will no longer allow two frequently used therapy billing codes to be used in combination with evaluation codes. It's a decision that flies in the face of standard PT practice and effective patient care—and CMS and the National Correct Coding Initiative (NCCI) contractor need to hear that perspective loud and clear, from as many stakeholders as possible as soon as possible.

At issue are current procedural terminology (CPT) codes 97530 (therapeutic activities) and 97150 (therapeutic procedures, group, 2 or more individuals) which, until January 1, were allowed to be billed on the same day as physical therapy or occupational therapy evaluation. Under new CMS NCCI edits, however, that's no longer allowed. And in a further complication, the latest NCCI edits also require use of the 59 modifier—the modifier that's used to indicate that a code represents a service that is separate and distinct from another service to which it is paired—whenever code 97140 (manual therapy) is billed with an evaluation.

[Editors' note: to view the full list of edits that went into effect January 1, visit the CMS PTP coding edits webpage, and scroll down to the "related links" area, where you can select your setting to find out what's changed.]

The problem, according to APTA Director of Regulatory Affairs Kara Gainer, is that the changes ignore accepted PT practice, which often includes the startup of care on the same day as evaluation, as well as continuation of care on the same day as revaluation.

"The whole NCCI process is supposed to put a check on payment for codes that represent overlapping services," Gainer said. "These edits not only miss that mark, they actually have the effect of restricting patient access to the most effective, efficient care, and risking a patient's ability to achieve the best possible outcomes."

APTA usually receives notice of intended NCCI edits well in advance. That didn't happen in this case, making it imperative that the association, its members, and other stakeholders take action quickly to convince NCCI to reverse its decision. APTA is in communication with Capitol Bridge, LLC, CMS' NCCI contractor, as well as with the American Medical Association, to press for a resolution to the problem.

What you can do: APTA has developed a comment letter template that you can fill in with your personal information and email to Capitol Bridge, LLC, at NCCIPTPMUE@cms.hhs.gov. Make your voice heard.

http://www.apta.org/PTinMotion/News/2020/01/02/NCCIEdit/

The Fall meeting for APTA of Montana (MAPTA), saw changes to our delegation with appointment of myself to the the Chief Delegate position, relieving Mary Beth Wilson. So, here I am heading the HOD's portion of the newsletter. Firstly, I would like to thank Mary Beth for her service to MAPTA and her support of the delegates. We will miss you. I am excited to welcome back Joseph Parker who was elected to the Four Year Delegate Position. I think Joe will be a key figure in our association moving forward. Welcome to Holly Ferguson, our new One Year Delegate. Holly has 25 year of PT experience. She is eager to serve, looking for ways to stay involved in the Association beyond her one year position. Finally, Lori Graybill remains our representative for the PTA caucus. Her contributions at the state level with the PTA vote have been invaluable. For all of us, I anticipate a great year ahead. 

Fall and winter are the quieter seasons for the House of Delegates. There is one motion, however, coming down the house pipeline which I believe is of interest to us all and the profession. To be part of the House of Delegates is an honor. There is an energy to the house which infuses us all. It is a patriotic experience which fills one with pride to be part of the Physical Therapy Profession. The most inspiring aspect to me, is president Sharon Dunn's keynote speech. She asks us to be more, do more and aspire to lead our profession to greater heights. This year, President Dunn challenged us to address the financial burden of Student education and debt. See link below: 

(http://www.apta.org/Blogs/PTTransforms/2019/6/11/Dunn/) 

In July, the Arizona delegation started a conversation with robust dialogue ensuing. As one would guess this is a complex, multifaceted issue which is not unique to our profession. However, let’s go back to get a little perspective. At the 2106 HOD, RC-11-16 passed. The motion was written as follows: 

“That the APTA evaluate existing and emerging data available from internal and external sources, such as ACAPT and CAPTE, to identify potential effects of student loan debt upon the physical therapy profession, and to develop a plan with feasible options to address the identified issues, with implementation initiated no later than June 2018.” 

As a result of this motion, the APTA developed the Financial Solutions Center. In 2016, the Education Leadership Partnership (ELP) was formed in response to the Excellence in Education Task Force. It is a collaboration of APTA, the Academy of Physical Therapy Education (APTE), and the American Council of Academic Physical Therapy (ACAPT). ELP created a task force to further investigate, “the issues influencing student debt,” A final report is due at the 2020 CSM. 

Addressing student debt is aligned with the APTA's strategic plan for Stewardship, which aims to, “foster Long-Term Sustainability of the Physical Therapy Profession- champion students and early-career issues including debt burden and career-earning potential.” 

Arizona is now proposing a motion which reads as follows: “Charge- Financial Transparency of Education Programs for Physical Therapists and Physical Therapist Assistants.”

Full disclosure would entail annual publication of data to assist students and all stakeholders to make informed decisions. Arizona proposes collecting the following information: 

• Cohort size of the first-year class at the time the report is submitted to CAPTE 

• Total cost of tuition for the entire program (not by unit, semester, or term because these vary by institution) 

• Total additional fees charged for the entire program 

• Average annual living expenses for the geographical area of the program 

• Total program operational costs including total faculty and staff payroll costs (including full-time, part-time, adjunct, etc.) 

• The amount of subsidy required by the university, state or other sources to meet total program operational costs, or the amount of surplus above total program operational costs that accrued to the university in the previous fiscal year 

• A link to each program’s curriculum, listed by each academic session each year 

• Ultimate National Physical Therapy Examination (NPTE) pass rates for each program (not the first time, but ultimate pass rates) 

• Graduate employment rate at 6 months after graduation 

This is a comprehensive list. There is a definite need for more information to understand the problem of student debt. But here are some other areas to consider: 

• Student financial literacy. There are resources available through APTA and educational institutions however what is the literacy level of applicants/students? 

• Student perception of debt. Is it now the cultural norm to expect that at graduation one will be saddled with a large debt? 

• Public Education funding through legislature vs Private with endowments. Is it enough? Does society value Higher education? 

• Costs of overseas clinical education. 

• Has the transition to a doctoral program been a contributing factor to debt? 

• Program length. Is a different model a solution? Decreasing undergraduate requirements. 

For further discussion look also to the HUB where more facets of this problem are found in detail. 

So, in conclusion, I invite you to join me and my fellow delegates on this conversational journey with the goal of making a difference and taking a different path than we've taken. President Dunn's path of change! As she says,

“It's the path we take when we embrace the idea that every day deserves our heartfelt best effort-not just to live that day to the fullest but to shape the future more than it shapes us. Because we want to pay it forward. Because we demand that we leave something better than we had for ourselves.” 

I look forward to hearing back from you. 

One of my friends called me recently to ask about her rehabilitation that she is doing for her injured shoulder.  She called to tell me that she noticed that she has more pain free range in her shoulder when she engages her pelvic floor first when doing her shoulder exercises.  She asked me if she is cheating by doing this. I said, “Heck no!” As a pelvic floor therapist, I was then able to easily explain to her why the pelvic floor should be engaged (ideally automatically) with any shoulder movements. 

My friend is not a PT, she is a dancer.  So, she has not read any of the research published by Paul Hodges which shows that the inner core muscles, including the pelvic floor muscles, engage in anticipation of movement, including movement of the arms or movement of the legs or prior to impact such as during gait.  She did not read the 2007 study by Hodges, Sapsford & Pengal, which showed that the pelvic floor muscles were active prior to arm movements performed by the participants in the study.

While it makes sense that my friend, being a dancer, has a good understanding of how inner core control ideally precedes movement, I couldn’t help being impressed with how much she understood about her motor recruitment patterns when doing her shoulder rehabilitation.   Her experience as a dancer taught her what we PTs know after years of school and ongoing learning of evidence about core control. Thanks to the extensive research of Paul Hodges and other great researchers for over 20 years, PTs now understand and can teach their patients about the inner core, and how to improve movement patterns with less pain.  

As evidence evolves, so do we as PTs.   With this evidence, we now know that we need the inner core muscles, including the diaphragm, transverse abdominis, deep multifidi and the pelvic floor muscles to “anticipate” movement.  Ideally, our inner core activates prior to movement in order to provide a stable base or anchor, from which the outer core muscles and limbs can move off of.  

As my career led to my becoming a pelvic health therapist, I have had the opportunity to become very well acquainted with the evidence that supports enhancing inner core control for improved function.  Since I now do both internal and external palpation of the muscles “down there,” the pelvic floor muscles, I am seeing how much I can help a patient improve their function with better pelvic floor control.  Yes, I am often working more with complaints of bowel and bladder dysfunction and pelvic pain, but a lot of these patients have other complaints and impaired function (back pain, hip pain and balance issues to name a few) and these do often improve when my patients gain more functional mobility and strength of the pelvic floor. 

It is very encouraging to see that there are so many PTs, not just the ones with a pelvic health specialty, who want to keep learning more about the pelvic floor muscles.  Obviously I have a bias towards wanting everyone to see how much the muscles of the pelvic floor have such a BIG impact on our activities of daily living. I want to give these little muscles all of the attention that, I feel, they clearly deserve. 

I want to continue to provide more education to all PTs, not just pelvic health PTs, about the impact that we can have on any dysfunction when we at least consider the pelvic floor muscles in treatment.   This is why I was so excited to have Michelle Nesin, PT, OCS, FCFMT, FAAOMPT agree to teach a Pelvic Health course in Montana. The goal of Michelle and her co-founders of the Pelvic Education Alliance, has been what I was imagining for a Pelvic Health course: the goal of bridging the physical therapy orthopedic and pelvic health worlds.  

I have taken a course from Michelle many years ago, a course that was not geared to the pelvic health therapist at all.  I took her Functional Gait course with the IPA, with a PNF course being a pre-requisite. Michelle’s experience as an orthopedic therapist and teacher of all things orthopedic is extensive.  She earned an Orthopedic Manual Therapy Fellowship, studying with Gregg Johnson of all people! With her experience with teaching orthopedic and gait concepts, in addition to her experience teaching pelvic health courses and her experience as a Pelvic Health therapist, Michelle’s course is expected to provide new skills and treatment ideas, for Montana PTs treating a variety of populations.  

Lucky for Montanans, Michelle is interested in developing her course, “Treating Pelvic Girdle and LE Dysfunction using Pelvic Health and Orthopedic Concepts,” such that it appeals to therapists, serving a variety of populations.  In her course, therapists will learn how to evaluate the pelvic floor muscles, and enhance pelvic floor function, with external techniques only. At the end of this course, Michelle will be able to give a demonstration of how a pelvic health trained PT does an internal pelvic assessment to any interested participants.  However, internal pelvic floor assessment will not be part of this course’s objectives. Instead, the objective of the course is to provide tools for all Montana PTs, not just pelvic health therapists, to help them treat patients, by maximizing the function of their inner core muscles, including the pelvic floor muscles.   

By Kimberlee Raynovich, PT, PCS

Programming Director, APTA Montana

To register or to find out more information about Michelle Nesin’s course, Treating Pelvic Girdle and LE Dysfunction using Pelvic Health and Orthopedic Concepts, a 2 day course hosted by APTA Montana in Bozeman February 1-2, 2020 go to:  http://www.mapta.com/mapta_events

PLEASE GO TO THE ABOVE WEBSITE FOR ALL UPCOMING APTA MONTANA EVENTS

Fellow Physical Therapists, we are looking for some help in June, 2020.  A fun volunteer activity putting your therapy skills to work! 

Missoula will be hosting the Montana Senior Games June 11-13, 2020 and we are looking for help to be able to offer the SAFE - Senior Athlete Fitness Exam.

We are anticipating that we will have 2 hour shifts at two locations on Thursday the 11^th and Friday the 12th of June.  The screen takes about 20 minutes and the Academy of Geriatric Physical Therapy has quality pre-made handouts that we can provide for education. 

We would like to have a planning meeting to share the SAFE and to start prepping so we are well prepared come June 2020. 

Missoula Parks and Rec will be sending out their brochures soon and we would like to insert our SAFE into their schedule of events.

Thanks,

Lisa Hamiliton and Mary Thane

To volunteer at this event please contact mmthane@gmail.com

Montana PTA Caucus Representative Montana’s Physical Therapist Assistants celebrated the 50th Anniversary of the profession Friday, September 27th. PTAs, student PTAs, and PTs enjoyed an evening of good food and enriched conversation. Past president, Jay Shaver, and current president, Christian Appel, gave heartfelt speeches on the importance of the PTA on the PT/PTA team, as well as the importance of PTA membership in the APTA.

History was made in Montana when PTAs were granted the full vote at the chapter business meeting the following afternoon. Joining Montana in this historic vote for inclusion is the Colorado Chapter of the APTA. At press time, the outcome of the Wyoming vote is unknown. Idaho has moved their vote to the spring 2020 meeting according to Chandra Price, PTA, Idaho PTA Caucus Representative. Laurie Roberts, PTA and Lori Graybill, PTA were named Co-PTAs of the Year by the Montana Chapter of the APTA.

Current issues being discussed by the PTA Caucus delegates are ideas for an updated welcome process/welcome kit for new reps and mentors, ongoing discussions of upcoming motions that affect PTAs, as well as the PT profession as a whole, as well as Core Values and PTA Pledge. Further discussion has been had on the effects of social media, especially with the recent CMS ruling and the negativity expressed after. PTA Caucus Representatives are encouraged to respond with positive and accurate information, as well as not being too quick with a response.

A PTA Caucus Town hall meeting is expected at CSM 2020 in Denver.

If you’re like me, the years spent in PT school went by much slower than the practicing years have been.  The working years seem to fly by.  My impressions of what physical therapy has to offer a community has certainly changed over the years.  I thought it would be a valuable exercise to spend some time reflecting back upon my physical therapy journey.  I’ve been spending time trying to recall what drew me to the field in the first place and if those same things still draw me today.  Has my understanding and view of health changed over the years?  How and why have my practice patterns changed over time?  Theresa Kelly-Mitchell is a third year PT student getting ready to graduate from the UM.  Theresa has spent a great deal of time helping MAPTA and has been a leader and advocate for the profession long before actually becoming a PT herself.  I have much respect for Theresa and wanted to have a refresher on what it was like to be in PT school and just be starting out in the profession.  Theresa was kind enough to share her thoughts with me and respond to a few questions I had.  It was a valuable exercise for me and hope it will be for you also. 

1.)  What initially attracted you the physical therapy profession?  Had you considered other medical professions?  If so which ones and why did you choose PT in the end? I have a background in yoga, martial arts, and theater, and what the human body is capable of has always amazed me. My whole life, anytime someone asked me what I wanted to be when I grew up, I would say scientist. I went the arts route, but never lost my love of science. I think PT blends these worlds so beautifully. I wanted to be able to prescribe movement to people because the body is meant to move, not stay still. I wanted to tie my backgrounds together and expand my ability to help others. Getting a DPT gives a legitimacy to my passion for creative movement in the medical field. I think I have always wanted to go into some type of therapy field of study, and honestly, yoga was what pushed me into the physical therapy world. I have a similar story to many others who chose PT- I got injured in high school and PT helped me. However, the PT I worked with recommended yoga to me to increase my ROM and maintain the gains I had made. Fast forward 10 years and I was teaching yoga as my main job and I found myself advising and modifying movement and poses for people who had injuries. The only thing I couldn't do was offer MORE movement, because I didn't have the education (and insurance) to prescribe exercises. I didn't want to tell people not to move, that seemed counter to what I stood for, so I began to look into going back to school- and here I am!

2.)  Reflecting back upon physical therapists you have been taught by or mentored from; does any particular therapist stick out to you as having been particularly influential and if so, why?

I have worked with a few PT's that were right out of school, and while there were really new to the scene, their dedication to their patients and an evidence-based practice astounded me. Also, I think back to them often, because they always seemed confident, even if it was uncharted territory. I think about them when I am nervous in the clinic and am not sure of my next step. They give me courage because I watched them take time to think through the problem, always focus on the patient, and adapt to each changing circumstance. Also, I think- if they made it through school and found a job, so can I! New grads are very inspiring (I hope I can offer that to a student when I get out of school). 

3.)  What has been the most challenging aspect of your physical therapy training thus far? The most challenging is that in order to become a general practitioner, you have to learn the general information in every PT specialty, and that makes it hard to stay fresh and comfortable in different skills. For example, we spend the first year and a half learning orthopedic tests and techniques, but I spent my second clinical in an acute care setting where I didn't get to use those skills very often. So, I have to constantly go back to the things I learned over a year ago and try to find time to practice and refresh my memory. It's hard when you are not confident in your skills yet to even know if you are reviewing and practicing correctly. 

4.)  What is one thing you wish you knew before starting PT school? The didactic learning is to lay foundations and sometimes it doesn't feel applicable to real life. It's scary and frustrating to feel like you have to know everything all at once. But, luckily, the more practice in clinic settings and the more you use your resources, the more things will come naturally to you. It's a process, like everything else- and it's ok to look things up if you don't know it off the top of your head! 

5.)  If you could change one thing about the physical therapy profession right now, what would it be and why? I would love to have more interdisciplinary collaboration integrated into our DPT training and school work. I think if we built relationships with students of other professions, we can set ourselves up for better collaboration within care teams across our profession. I know there are a lot of amazing PTs out there who really work for outreach and community partnerships, but I would like to see us more involved in the public health realm. Looking for ways to partner with public health initiatives more frequently could push the PT's who want to focus more on prevention and wellness into a more integral role in our community. (For ex: Eat Right Missoula does BMI screens at elementary schools- could PT help change that to more functional testing of health? Could PT's hep with increasing support for breastfeeding initiatives by providing education and therapy to new mothers?) This would help us expand our community's knowledge of what physical therapy is and how we are advocating for the entire realm of health. I think the collaborative approach will also help with accessibility to our services. I wish more people could take advantage of what we have to offer.

6.)  Reflecting back on what your expectations were prior to physical therapy school.  What has changed since starting PT school? I think being a non-traditional student, I mostly had expectations that I just had to work hard, study, and practice and it would come to me with time. I also had a sense that if I didn't study every night I was going to get left behind. I also thought that I had enough foundational knowledge to feel like I was at the same level as the Ex Phys majors...I was wrong! However, I quickly found my routine and I found out that as long as I know my study habits and work within my limitations, it's just like any other thing you want to be good at. And, there were some classes that I had to do extra work on my own to learn more about the language and background of the class just to stay on top of things. Those were hard, but other things came easier for me. So it's all about balance.  

I can't really explain my specific expectations, I just had a sense that this was the right thing for me to do in my life and I just needed to do what had to be done. I think that still lines up today.

7.)   What are you most excited about becoming a physical therapist?  Firstly, I am excited to actually have a career set out in something that I love. I’ve worked for a long time to find the right path for myself and it's finally here. The more I learn about PT, the more I know I can help others in ways I never knew were possible 3 years ago. I am really, really excited to see how I can tie my DPT degree in with my MPH degree. I can't wait to move into chronic disease management and prevention and wellness. I want to expand our profession into more collaborative settings and promote PT as a sustainable option for people to live healthier lives. I am excited to use my creativity and clinical reasoning every day, and get paid for it! (What?!? Imagine that!)

In the news recently: 

https://nbcmontana.com/news/local/butte-physical-therapists-outline-opioid-alternatives

BUTTE, Mont. — A five-year report from the Montana Department of Public Health and Human Services and the Montana Board of Pharmacy shows a decline in opioid prescription rates. However, physicians in Butte say physical therapy should still be considered an option when treating chronic pain.

“We talk about that a lot as far as what is the research showing that’s effective for breaking those chronic pain cycles as opposed to the acute pain that opioids were designed to treat,” said Holly Ferguson, director of therapy services at St. James Healthcare in Butte.

She says the first step is breaking the perception of pain.

“We’ve sort have been trained that ‘I want a pill to fix this,’” Ferguson said.

She says a pill can only do so much, since opioids are effective for two to four weeks.

Ferguson says physical therapy can play a role in treating long-term chronic pain.

“There’s also desensitization therapy that we do, where we touch the limb that’s hypersensitive to touch or motion with different things -- sometimes sharp, sometimes dull -- in different places, and then we ask you, the patient, to tell me what you feel,” Ferguson said.

Ferguson’s says the exercises are designed to build up your body’s tolerance to pain.

No matter which option you’re considering -- opioids or physical therapy -- officials say it’s important to talk to your doctor first. That’s because there are a lot of different options for dealing with chronic pain.

“If you have had chronic pain -- and chronic pain is something defined as you’ve had it for three months, and it’s not gotten better, and you’ve been to doctors, and you’ve had tests, and they’re not finding something to fix -- then I think you need to start thinking about what are my other options besides this pill, because we know that pills don’t fix it long-term,” Ferguson said.

Hello APTA Montana. I will take over as president at the fall membership meeting in Missoula. I would like to take this opportunity to introduce myself. Before I do so, I must recognize the contribution of others.

Thank you, Jay Shaver, for serving as the president of APTA Montana for the past 8 years. Your leadership and commitment to the profession is unmatched. Thank you! On a personal note; thank you for your mentorship during the past year. I only hope that I can perform the duties of this position as well as you.

I would like to thank the membership for APTA Montana for electing such a fantastic board with whom I get to serve. The current board comprises individuals representing the many different fields of our profession and from many different geographical areas in the Last Best State. I expect each board member will bring varied view points and perspectives to our discussions. I encourage good professional dialog and debate amongst our board and membership. APTA Montana will be stronger and more successful when we have good professional dialog and debate.

My first challenge is setting the agenda for our membership meetings. We meet 3x/ year for 2 hours. During which time we eat, hear reports, old business, new business, motions and professional discussions. Two hours passes quickly! The board members and I want to encourage and engage in discussions with and amongst our members. We must follow Roberts Rules of Order; which will allow meetings to proceed in an organized manner and allow organized professional discussion. Moving forward we will be looking at ways to leverage technology to continue good discussion following our meetings.

At our November board retreat we will be reviewing our strategic plan, committees and governance and outlining how we will successfully meet the needs of APTA Montana during the following year. We look forward to working for you and with you. Yes, WITH you! We will be looking to bring members on to committees and to help serve in other roles as well. In this way, when we transition off the board, there will be other members who are ready and excited to step into our positions.

A little about me; I am an old has been that never was.  My wife and I are both graduates of the University of Montana PT program class of 1991. I have previously served on the MT board as vice president, served 2 terms on the MT board of physical therapy examiners, have served on other boards unrelated to our profession and have been appointed to collaborative groups to help resolve issues at local, state and national levels. I currently am co-owner of an outpatient orthopedic, sports and women’s / pelvic health clinic in Bozeman, MT. I will do my best to keep the APTA Montana ship sailing on course under the power and momentum created by our members.

Thank you APTA Montana!

Christian Appel