We walked into his house-or rather, we walked under his roof as there were no walls surrounding the structure. Inside, a harsh man who had suffered from a stroke, the painful process of losing his wife, addiction, and a lifetime of poverty, sat in his wheelchair in the heat of day. There was hardly room to maneuver for him as every cubic meter of space was filled with items appearing untouched for years. Finding ourselves so far outside of our element in this foreign environment, we used the tools at our disposal: our clinical instructor and translator, Dr. Pakaratee, some fine-tuned (certainly not awkward) body language, and our wits to provide this man physical therapy. As we carried on, the shock wore off, and the treatment session remarkably gained a sense of normalcy. We practiced gait, like in the States, to ambulate to the toilet next to the chicken coop inside the attached house. We educated him in his home exercise program, as we would, sticking a detailed stick figure illustration drawn on wrapping paper onto his wall. When we left, he bowed and said something later translated to us as “Thank you, my children.”
This summer, I traveled to Thailand with three fellow students and a professor to spend three weeks exploring physical therapy there. The most persistent question asked from my colleagues upon return was, “How was PT different?” All I could answer was how similar it was. Of course, I could create a lengthy list describing the discrepancies between their practice and ours, but the base of it is so recognizable and obvious it makes me question why I expected much else.
We experienced treatments with a myriad of clients with a wide variety of issues within a large spectrum of settings ranging from individual houses to Siriraj Hospital which, with its multiple skyscrapers, took on the appearance of a city. Everywhere we went throughout our stay, we saw the type of patient care defining our profession. We witnessed so many therapists who possessed immense passion and knowledge of the field. Therapists whose work embodied the spirit of the phrase “Exercise is Medicine.” They applied that passion and knowledge with a care and kindness we are known for in America.
It was so clearly apparent not only to us, but also to the patients and their practitioners. With the kind of people drawn to our profession, why would it matter, the country we are in?
There will be a new face running the membership meeting this fall. Christian Appel, will start his term that day as the incoming president. He is a good friend and and someone I respect as a leader, clinician, and professional. MAPTA is in good hands.
There are many aspects of the organization that will make the transition easy. We are an active organization with a steady increase in membership each year. Montana has traditionally had one of the highest rates of membership in APTA, and we strive to get more PT’s involved.
We continue to be financially stable, due in part to the growth of our membership, but also due to our continuing excellent continuing education classes. Over the last eight years, programming chairs Adena Carter, Carissa Benjamin and Kimberly Raynovich have brought in local and national leaders in our profession.
He will have ample opportunity to communicate with members and others important to our organization. The newsletter will continue, although paper free as MAPTA works to decrease waste. Spearheaded by Beth Nordstrom, MAPTA has begun telecommunication with the eastern side of our state, improving our ability to get input to those who live too far away to attend all of the business meetings. Christian will continue the tradition of 7 AM meetings when important topics arise that don’t fit into the business meeting time frame. Business meetings will continue to follow state statutes that call for a 10 day notice of agenda items to ensure that everyone has a chance to understand the agenda prior to the meetings. He will have input from the licensing board through our liaison Brianna Irion and will benefit from open communication lines with other areas of interest including BCBS, MMA, MTSBA and the Montana Chiropractic Association.
Legislation issues will be an easy transition. Christian has headed the legislation committee in the past, and Ashley McDonald is currently doing an excellent job. Our lobbyists, Strategies 360, have been outstanding. Together, with helpful input to legislators from our grassroots organization, we have seen numerous bills related to PT pass over the last eight years, while none of the bills we have sponsored have been defeated.
Public relations? We are in great hands with Mike Tran working with his task force to educate health care professional and the public about PT’s role in chronic pain and how PT’s can be players in helping control the opiod epidemic.
Christian will have the support of our house of delegates. Montana was represented by Marybeth Wilson our chief delegate Adena Carter and Joseph carter in Chicago represented and Adena be working through the year to make sure that rural areas are represented fairly in all of APTA’s issues, particularly those related to self-referral. Although Lori Graybil was unable to attend, she continues to be a leader for PTA’s thought the state.
Many challenges will face Christian during his term. We are part of a changing health care system, and as with any any change there will be pitfalls but also opportunity. PT’s will always have to fight to have a better seat at the table in the medical arena. I will always believe that no one can get better results at a lower cost with excellent patient satisfaction, but we need to make our voices heard. That means being active in legislative issues, both state and federal.
We need to have the hard data that supports our place in medicine. That means the use of registries by all PT’s, and using that data to advocate for the fair reimbursement benefits that we deserve.
Christian is the right person to help guide the chapter through the next few years, and I know he will have the full support of MAPTA. I would like to thank all members who have spoken out on issues, volunteered for committees, and especially those who have given up their time to sit on the BOD, and of course, the glue that keeps us all together, Gail. It will be a nice change to sit on the sidelines, knowing that MAPTA will continue to lead our profession with members that are not afraid to speak out setting the bar high for all rural states.
Whether it’s for competition, staying in shape or just getting outside, it’s a well-known fact that running is very popular amongst Americans. According to Running USA, nearly 18.3 million Americans registered for road races in 2017. I enjoy running myself and am included in the road race statistics. After recently finishing my second road marathon and having participated in many half marathons, I’m now transitioning into the world of trail running. Like road running, trail running has become increasingly popular in the last 5 years. The popularity and diversity of both running options brings me to the question I’ve been pondering lately. Which one is better?
To begin, I thought I would contrast both options based on my personal experience and discussions with other runners. First of all, road running typically produces more force through your joints whereas trail running allows for more force absorption and less joint compression. Trail running is likely more removed from people while road often allows for running surrounded by more people. Road running promotes maintaining one pace the entirety of the run where trail running requires change of pace based on the terrain.
The contrasts could continue as they are abundant and you will often find runners who identify themselves as one or the other. But maybe one is not better than the other. Maybe the combination of the two allows for a dynamic, well-trained runner. Training on roads to allow for pace increase and training on trails to improve strength of smaller, stabilizing muscles. Training on roads to experience the blissful daydreaming and mind wandering that running allows. Training on trails to sharpen the mind as you constantly look out for rocks and sticks that are there to make you stumble.
I won’t argue one or the other. I will sit happily in the middle of the spectrum, between trail running and road running and promote the benefits of each. More than anything, I will advocate for the benefits of getting outside, getting moving and doing what you love. I for one am excited to begin exploring the beauty of trail running while continuing my running journey on roads.
The Montana delegation to the APTA House of Delegates (HOD) enjoyed a busy and productive 2019 session this June in Chicago, Illinois. We were fortunate to enjoy good weather and plentiful deep dish pizza. Collectively the HOD heard 40 motions and completed elections for national office. Here is a summary of this year’s session:
Kip Schick was elected secretary.
Kyle Covington was elected vice speaker of the House of Delegates.
Deirdre “Dee” Daley, Heather Jennings, and Carmen Cooper-Oguz were elected directors.
Carole “Carrie” Cunningham, and V. Kai Kennedy were elected to the Nominating Committee.
Summary of motions heard before the HOD:
RC 9-19 Amend: Opposition to Physician Ownership of Physical Therapy Services: passed. This amendment updated an existing APTA position statement that speaks to the Association’s opposition to physician owned physical therapy services. The amendment cited the latest evidence that demonstrates the negative consequences of physician owned physical therapist practices.
RC’s 21-27 all passed. Collectively, these motions strengthened the Association’s commitments to diversity, equity, and inclusion within the profession and across society
RC 29-19 Amend: Guiding Principles to Achieve the Vision: passed. This amendment provides a formal definition to the movement system. That definition is as follows, “The movement system is the integration of body systems that generate and maintain movement at all levels of bodily function. Human movement is a complex behavior within a specific context, and is influenced by social, environmental, and personal factors.”
RC 32-19 Amend: Core Values for the Physical Therapist: passed. Previous to this motion, there were separate core values defined for the PT and the PTA. This motion combined those core values and ensured they were appropriately aligned. The core values are: accountability, altruism, collaboration, compassion and caring, duty, excellence, integrity, and social responsibility.
RC 56-19: Adopt: Position on Public health Crisis of Firearms-Related Injuries and Deaths in the United States: passed. A position statement that the APTA supports public health policies and studies that advance a public health approach to reduce and prevent firearms-related injuries and deaths.
RC 58-19: Charge: To Optimize Accessibility of Consumer-Based Communications Provided by the APTA: passed. This charge asks, “that the APTA develop and implement a plan to ensue consumer focused communications disseminated by the APTA are congruent with current health literacy standards.”
RC 62-19: Adopt: Naloxone Availability Where Physical Therapist Services are Provided: passed. A position statement that states the APTA supports Naloxone availability and its use by therapists to reverse the effects of an opioid overdose.
RC 65-19: Charge: Eligibility to Participate in Medicare’s “Annual Wellness Visits” and “Initial Preventative Physical Examination”: passed. This motion asks the APTA to report back to the 2020 HOD regarding the possible impact and implications of seeking eligibility for PT’s to participate in Medicare’s Annual Wellness Visits and Initial Preventative Physical Examination.
RC 69-19 Adopt: Wound Management Physical Therapy as an Area of Specialization: passed. Adds Wound Management as a clinical specialization area similar to those that already exist for orthopedics, women’s health, pediatrics, etc.
Representing Montana during the 2019 HOD would not have been possible without my co-delegates, Adena Carter and Joseph Parker, and Lori Graybill our PTA caucus representative. This fall sees the end of my term as chief delegate and it has been my pleasure to serve the MAPTA membership. As always, please contact us with any questions you may have.
Marybeth Wilson firstname.lastname@example.org
Adena Carter email@example.com
Joseph Parker firstname.lastname@example.org
Lori Graybill email@example.com
The #ChoosePT campaign has been in full swing in Montana. Thank you, Adena Carter, for reaching out to MAPTA to help promote the profession of physical therapy and the #ChoosePT camp within the Deer Lodge community. MAPTA was present at the annual Deer Lodge Medical Center Health Fair along with Adena Carter, Daylen King, Beau Larson and myself to educate the fair goers about what the profession of physical therapy has to offer. We asked community members what they knew about physical therapy, what their impressions of physical therapy are and then discussed the profession’s role in reducing or preventing the use of addictive pain medications amongst a plethora of other issues that PT’s are trained to help people with. We shared our role in chronic disease prevention, vertigo, and fall reduction in the aging population amongst many other common societal health issues. We handed out educational fliers, discussed research related to the field of PT, and handed out stickers and buttons with the #ChoosePT brand. Adena and Daylen are both experienced and passionate PTs at Deer Lodge Medical Center. Beau Larsen is a pre-PT student completing his final internship before applying to PT school and will be an asset to the profession in the years to come. The following is from the APTA’s #ChoosePT online toolkit:
“No one wants to live in pain. But no one should put their health at risk in an effort to be pain free.
Doctor-prescribed opioids are appropriate in some cases, but they just mask the pain—and opioid risks include depression, overdose, and addiction, plus withdrawal symptoms when stopping use.
That's why the CDC recommends safer alternatives like physical therapy to manage pain.
Physical therapists treat pain through movement, hands-on care, and patient education—and by increasing physical activity you can also reduce your risk of other chronic diseases.
Pain is personal, but treating pain takes teamwork.
When it comes to your health, you have a choice. Choose more movement and better health. Choose physical therapy!”
For more information or if your clinic would like to take advantage of the prepackaged marketing #ChoosePT toolkit visit: www.moveforwardpt.com/choose-physical-therapy-over-opioids-for-pain-management-choosept. Also, if you have an upcoming community health fair or other event that you think you be a good opportunity for MAPTA to attend please contact me at firstname.lastname@example.org.
Since Ancient Greece, people have been considering the philosophical question: How do we live a good life together? Often this question is reduced to: What is right and wrong behavior in a particular situation in order to not cause unjustified harms?
To attempt to answer these questions, a common starting point is morality. Morality can be defined as societal or group codes of conduct about right/wrong (or good/bad) behavior that individuals who live in those societies and groups agree to in order that all can live a flourishing life. These codes of conduct are either legal, ethical, or customary to specific groups. How does this affect physical therapy practice?
First, we have a plethora of laws to follow. From local laws to our state practice acts to CMS’s national billing and utilization laws with many other laws in between. As practicing physical therapists, we are required to follow these laws. If we don’t, whether by ignorance or choice, then we can be punished for breaking these laws. Everyone seems to know this and yet, some still break laws and suffer the societal consequences.
Legal behavior is our minimal standard of behavior. Societal rules become laws through legislation and are enforced by a society with punishment to those members who break the laws. Ethical behavior is a higher standard that is based on the theories, principles, and rules set out by ethics as a branch of the academic discipline of philosophy. Ethics is “a systematic study of and reflection on morality” (Doherty & Purtilo, 2106). Within ethics, there are judgments delineating which behaviors are prohibited, permitted, required, and ideal.
Second, ethical standards of physical therapy practice are particularly laid out in the APTA’s “Code of Ethics” and its accompanying “Guide to Professional Conduct” (APTA website). Our professional code, like most professional codes, is based on a philosophical concept called principlism which simply sets forth principles that govern right and wrong behaviors. The ATPA Code of Ethics lists eight principles with each principle containing a set of sub-principles. Professional Codes of Ethics are written by professionals within an organization to protect the profession and to guide the professionals. While our state practice acts are the legalized agreement that our profession has with the society we serve, our Code of Ethics is our social agreement with the society we serve. Both are the way we, as a profession, foster trust with the public.
Last, all of us have specific groups that we belong to such as a church community, a political party, or an activist group that has their own codes of conduct aligned with an ideology or perspective toward community life. It is our preference and choice to join or leave these groups according to our agreement with their codes of conduct.
These different types of codes of conduct rarely align and more often create tensions within individuals. One may personally agree or disagree with any of them in varying degrees. However, in our society, a physical therapist as a citizen must follow the laws. As a professional, they should follow the Code of Ethics, and as a member, they may follow their chosen group’s rules. However, all three types of codes of conduct change in historically and culturally significant ways. Practicing physical therapy today is very different than in the 1970’s because many of the legal changes reflect the professional development of physical therapy practice. Also, our current APTA Code of Ethics which was updated and passed in 2009 is very different from the original American Physiotherapy Association’s Code of Ethics and Discipline passed in 1935.
An ethical person is self-aware, self-critical, and self-reflective. Feel free to send comments to email@example.com. Debra Gorman-Badar, PT, MA, PhD student, Chair, MAPTA Ethics Committee
The Comprehensive Addiction and Recovery Act (CARA) is now a federal law whose purpose is to advance treatment and prevention measures to reduce opioid use. APTA has jumped on board with the very successful #Choose PT campaign to educate the public, healthcare professionals and state legislators on how PT’s are at the forefront of this effort. Currently, 22 states have used TV Public Service Announcements, with over $1.8 million of donated time and an estimated 146 million potential viewers. Printed public service announcements have appeared in over 950 papers with an estimated viewing by 149+ million Americans. We are starting up our program in Montana and hope to have the same level of success that other states have enjoyed.
But are we ready for the potential influx of new referrals from the publicity? There were many therapists I visited with in San Antonio at the Combined Sections Meeting a few weeks ago, that were worried about the limited number of physical therapists that have advanced training in pain. Consider the following:
In rehabilitation, there is a growing body of research that suggests our models of explaining pain are outdated (Mosely 2003; Mosesly 2007; Louw and Butler 2011; Nijs, Rousell et el. 2012). The biological model of explaining pain in relationship to tissue and tissue injury that is the cornerstone of traditional pain education has been shown to have limited efficacy and can increase fear in patients ( Green, Appel et al.2005: Morr,Shanti et al.2010. Using a word such as wear and tear, disc space loss, and deterioration has been associated with a poor prognosis (Sloan and Walsh 2010).
As discussed in the last newsletter, there is good evidence that PT’s can help with pain through exercise, manual therapy, and education. Are we offering quality education to our patients with pain? We get plenty of opportunities to improve our hands on skills, but do we seek out programs that focus on pain? Considering that almost all of our patients in the outpatient setting are dealing with some level of pain, it would appear to be a good idea.
Thanks to Caressa Benjamin, our programs chairperson, you have an opportunity to get the most current education this spring in Whitefish at the Explain Pain education course. The NOI group is recognized worldwide as a leader in pain research and treatment. This is a great opportunity to improve your knowledge of pain education and treatment.
Let's continue to work to decrease the use of opiates with treatments that are based on good research. The gift is ours. Let's make sure we use it wisely.
As treating physical therapists we are well aware of the positive effects we can have on facilitating symptom management and improving overall function in a collaborative effort with our clients. Working with clients, who are in chronic pain, we are also aware that the drugs prescribed are often not solely effective in managing pain and do little to normalize movement, restore function and/or address fear of re-injury. The Center for Disease Control and Prevention (CDC) has urged health care providers to reduce the use of opioids in favor of safer, and often more effective, treatments such as physical therapy. The APTA has taken an active role in educating the public and health care providers in the benefits of physical therapy in the treatment of pain and dysfunction. It has done this most recently in its #Choose PT campaign. “Opioids come with numerous serious side effects and only mask the sensation of pain,” stated #ChoosePT campaign spokesperson Joseph Brence, PT, DPT. “Research shows that physical therapist treatment can reduce or eliminate the need for opioids by improving physical function, increasing range of motion, and decreasing pain."
However, treating persons in chronic pain can come with many challenges. Living with chronic pain is miserable. If you are living with chronic pain it makes sense that you are often also depressed, sleep deprived and anxious. As a relatively healthy person, I am grateful for an acute/painful injury sustained during a recreational activity or the isolated headache to have the physical reminder of how brutal pain can be. I am also grateful that the pain I experience is usually temporary and that I have an above average understanding of pain physiology. During my final clinical rotation as a physical therapy student, I had the opportunity to work with a Clinical Instructor who was part of an interdisciplinary team for the treatment of clients with chronic pain. We had weekly meetings with the treating physicians, the anesthesiologists, cognitive-behavioral psychologists and nurse practitioners/case managers. Utilizing a team approach is essential when working with this population and I learned a lot. In addition to these team meetings, my CI had me read just about everything in the literature published by Lorimer Moseley and David Butler particularly, the research relating to complex regional pain syndrome. As a student project, I painstakingly posed for, photographed and printed a series of photographs of my left and right hands in various postures that were then laminated and cut into “flash cards” to be used by client's for laterality recognition tasks and imaginary (mass) practice for the primary purpose of cortical de-sensitization, symptom management and improved function.
If any of this sounds familiar you have likely read Explain Pain or other published works relating to graded motor imagery, neurodynamics or pain neuroscience education (PNE). Things have come a long way since homemade flash cards. There is now an online laterality recognition program called Recognize to assist in the treatment of chronic pain conditions like CRPS. In addition to the books like Explain Pain and Painful Yarns, resources abound for the treatment of chronic pain conditions. The Neuro-Orthopedic Institute (NOI) group website offers online resources, programs as well as live lectures on topics ranging from the Sensitive Nervous System, Graded Motor Imagery and the Mobilization of the Neuro-Immune System. However, it all started with the book Explain Pain and the lecture series that accompanies it. It also remains as one of the most sought after lectures and will be coming to Whitefish, MT for the Spring MAPTA conference on April 22-23. You can learn more about the course from either the MAPTA (http://www.mapta.com/event-2388660) or NOI (http://www.noigroup.com/en/Courses) website. In addition, you can check out this Explain Pain “trailer”: https://www.youtube.com/watch?v=zCGvNwJDtvU, or this Ted Talk by Moseley called Why Things Hurt?: https://www.youtube.com/watch?v=gwd-wLdIHjs.
Looking forward to seeing you in Whitefish!
Since January, 2016, Montana Chapter members and friends have graciously contributed funding to provide three customizable wheelchairs and approximately 300 additional hours of local Physical Therapist services for children with unmet needs in Ecuador. That is incredible and worth noting! Thank-you from the children of Ecuador and Families With Heart based in Helena and Puerto Quito, Ecuador.
Social events have been sponsored by your Montana Chapter of APTA at each of the quarterly meetings held around the state. Activities have included silent auction fundraisers, short stories told by colleagues called “Snap Shots,” Oxford Debates and even a biker gang meeting. More recently the Chapter sponsored Global Health Receptions. These have provided a way to learn about local and international public health initiatives presented by your colleagues. I wish to acknowledge everyone that has participated in these events, given time and money to projects that often go unnoticed as we engage in our busy clinical lives.
Your MAPTA program committee is eager for your suggestions. Saturday evenings during our quarterly meetings will only get better as the goal is to entertain, inspire and think something new. As we plan for upcoming meetings, you are invited to submit your ideas for events. Contact Carissa Benjamin, MAPTA Board of Directors, Education Services at firstname.lastname@example.org.
During a conversation with a physical therapy student, who is completing his clinical rotation with me as his clinical instructor, I admitted that I had recently caught myself being guilty of already “knowing everything” about anterior cruiciate ligament injury, reconstruction and rehabiliataion. That I, in fact had become, that therapist who was resting on her laurels regarding this particular matter. After all, I have treated countless clients “successfully” over the last ten years. Overall, most do great, most of the time. Then there are those who don't do quite as great as you would like. It's easy to chalk it up to relative non compliance on the client's part or perhaps their slow progress or lingering knee pain is the result of their genetic make up, pre injury condition or current activity level. But again, all in all, come the anniversary of their injury or surgery, they are doing pretty darn well. So, I never really was drawn to pursuing the matter further from a treatment persepctive.
Then, this past winter, my husband injures his ACL. The words from the orthopedic physician, if I remember correctly, was that his ACL was “gone-zito.” Now, all of sudden, I am no longer entirely confident just how to proceed. I mean, this is not only my ski buddy, he is the father to our two young budding skiers. He is also the one that I am counting on to keep up with them when they leave their Momma in the (powder) dust. Could he “cope” without his ACL. Did he “need” surgery? If he did have surgery, how would he fair. How do we set him up for success!
The timing of it all was quite serrendipitous as I was already in discussions with Dr. Ryan Mizner to offer a continuing education course, regarding that very topic, at one of our MAPTA conferences. Unfortunately, for me and my husband, the course would have to be postponed until the Fall – months after his surgery and rehabiliataion. Regardless, Dr. Mizner was very gracious in offering his advice based on his clinical expertise, research and vast knowledge base on the subject. And I realized, that perhaps, I didn't know everything about the subject. Things change over time, research reveals new ideas and we have the opportunity to improve our skills and clinical decision making to provide more efficient and effective care for our clients. The kind of care you want to provide for your closest loved ones. Thankfully, through the combined efforts of his physical therapist (not me) and his own dedication to his rehabilitation, my husband is doing great and has confidently returned to all pre-injury activities – even the ones that make me cringe a little bit. Even so, you can bet that I will be in attendance in Dr. Mizner's course this fall, Contemporary Topics in Physical Therapy Practice for Athletes with ACL Injury. There is a downside though. Attending this course means that I am not available to also attend Therapeutic Neuroscience Education and Pain Approach to Headaches, presented by the International Spine and Pain Institute, as it is happening that same weekend at the MAPTA Fall Conference. These are, undoubtedly, first world physical therapist problems and I welcome them with open arms.
We hope to see you in either of these fantastic courses this Fall. If, however, you are unable to travel to Missoula or have a scheduling conflict that weekend, you may still have time to take advantage of the online course, Primal Reflex Release Technique (PRRT), which is being offered at a significantly discounted price with a MAPTA coupon code which can be found on our website. Those who complete the online course will be eligiable to take a live PRRT course which we hope to bring to Montana. So check it out! You can learn more about PRRT at their website http://www.theprrt.com.
Keep learning and we will see you in October!