Obtaining Physician Orders for PT services in School Systems?

Distinguished ERI Faculty Member, Debra Dickson asks a question of school therapists:

DEAR ERI COMMUNITY: We have a question regarding physician orders for PT services for children in school systems. Here in CT we are able to do 8 visits and then are required to obtain a script. We have 2 questions:
1. Is the same required when seeing a child in a school setting? Are school guidelines different? We have been unsuccessful in getting an answer from the State Board.
2. We have always gotten them, however, lately we have been servicing a school where parents do not show up for meetings and we have been unable to obtain a script or even a release of information so we can obtain a script ourselves. Has anyone else had this difficulty and do you stop seeing a child when the school team has recommended services? It seems we are in a legal dilemma as the IEP document is a legal document that must be fulfilled yet legally we are required to have the paperwork from the physician to fulfill those services. How have others handled this?

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Looking for an Assessment Tool for Balance

Louis Posts:

DEAR ERI COMMUNITY: A discriminant, reliable and valid perturbation-based fall assessment tool, (Spring Scale Test) has been reported by DePasquale and Toscano in 2000 JGPT. Predicated on repeated incremental predictable perturbations, (RIPPS), the Spring Scale Test (SST) seeks to quantify limits of non-stepping and stepping postural responses expressed as percent of total body weight ( % TBW). Validated on an active independent-living older adult sample, the SST 10 % TBW performance measure was the most discriminant to fall history compared to TUGT, gait speed, single limb and tandem stance time timed performance measures. Pardassanay, Pai and others have recently concluded that more challenging, sensitive and responsive tests are needed for active older adult fall risk and intervention assessment. Mansfield recently concluded that physical therapists do not routinely assess reactive balance. Altered stepping and adaptation to perturbations is associated with fall risk. The SST is a feasible, safe and evidence-based tool, providing therapists with a clinical tool capable of quantifying threshold and stepping limits based upon body weight. 

Please share the assessment tools you use for balance.

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Blog Competition Winner – Free CEU course

We are pleased to announce Samantha as the winner of our blog competition. She can attend one of our two day courses for free.
Samantha asked for advice for a challenging case she was involved with and received tremendous constructive advice and suggestions from fellow therapists.

Please visit the thread here:
http://www.educationresourcesinc.com/case-challenges-and-solutions-for-pt-ot-and-slp/clinical-challenges-and-solutions-pediatrics/therapy-autism-jra-tha

Samantha would like to thank everyone for their advice:

Thank you for the numerous responses regarding this specific patient. I read over all of the ideas that were presented while treating the patient which were all very helpful! As far as treatment was concerned, the parents were heavily incorporated into the session, which they appreciated greatly. I was informed, from the parents, that the use of the Ipad was a large motivator for participation from the child. The use of the Ipad gave the patient interest in ambulation. The use of the visual/audio stimulus was also helpful with education regarding hip precautions. As far was weight bearing status was concerned, I spoke with the primary orthopedic team and the surgeon who performed the surgery regarding the difficulties that were encountered during therapy session, he decided that NWB would be more appropriate at this time secondary to difficulty maintaining TDWB. We were able to facilitate NWB status through the use of a pediatric walker and with the help from parents when ambulating. The patient was to follow up in OP PT with a pediatric orthopedic PT with long-standing experience in the realm of complex patients. As far as maintaining NWB per the time frame of the surgeon, the plan is for OP PT to facilitate the use of the device that is more appropriate for the patient. Thanks again for all your help! It was pleasure to read through responses from such experienced therapists and begin to integrate these ideas into my own repertoire of treatment techniques.

Congratulations Samantha!

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Acute Care Physical Therapy Is Not A Location

The Boston Marathon Bombing on April 15, 2013 brought together various disciplines from the healthcare spectrum to handle and triage wounded people at the actual bombing site downtown, and subsequently in the various admitting hospitals in the area. Physical Therapists were some of the key people who covered both the medical tents at the site, the hospital ERs, and the trauma floors including the ICU while entire hospitals went into triage mode.

Acute Care trained physical therapists also covered for nurses by stepping in to monitor vital signs and other physiological responses such as heart rate and rhythm, respiratory rate and oxygen saturation in trauma ICUs and other floors such as critical care where patients are unstable. 

Jim Smith, PT, DPT, president of the APTA’s Acute Care Section brought the point of acute care being a physiological state rather than a physical location where the patient is being treated. “Things that were ‘acute’ when I was a new PT and had to be handled in the hospital, we’re now routinely managing in home care, in rehab centers and even in outpatient clinics” he noted. (1) 

The Boston Marathon Bombing called attention to the role of this specialty in both the lay press and in several of our physical therapy magazines. Based on the latest research, The Acute Care specialty stresses early mobilization for complex medical patients now under circumstances of physiological instability, where years ago they would be left in bed or at best, in a chair. It became clear that the benefits of mobilization outweighed the risks so long as the physiological responses were monitored for safety, and to push the patients little by little to achieve optimal outcomes. In the case of the Boston Marathon Bombing victims, many of them were receiving physical therapy within a day or two to get them up, and for the amputees to start to teach them desensitization techniques to handle their pain.

(1). www.apta.org/PT inMotion/2013/9/Feature/LessonsfromBoston/ 

Since many of us are seeing acutely ill patients in many different practice settings (SNF, home care, rehab, OPD), let us know how you have adapted to early hospital discharges and if you have issues that are unresolved about this process. How do you facilitate communication across the continuum between settings and facilities with these quick transitions of care? 

 

 

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Why Patients Don’t Exercise – What’s a Therapist to do?

Suzanne Clark[/caption]

Post from Education Resources Faculty Member: Suzanne Clark

You do a great job putting together an exercise program for your patients with chronic disease. You teach them how to do the exercises and they return the demonstration. You give them a written program to do at home. When you see them again you say “let’s see how you’re doing with those exercises” and they either tell you they did not do them or when you ask them to demonstrate the exercises it’s obvious they have not been following through with their programs. This gets in the way of their progress and your ability to meet your goals. So you lecture that they need to do their exercises if they want to progress. You ask them if they have any questions and they say no but the non-compliance continues. What’s a therapist to do??

Fitting exercise into a daily routine is a lifestyle behavior change. Behavior change does not come easy for many people. Think about yourself – are you having trouble sticking to a diet or exercising the recommended 150 min per week?   It can be especially hard for people who are also trying to manage a chronic disease such as arthritis, diabetes, Parkinson’s Disease, CAD, or COPD. One of the ways to promote behavior change is to ask your patients what is getting in the way – what are their barriers. Perhaps your patients do not see how exercise is relevant to their goals. Have you asked what the patient’s goals are? Maybe they have fear that the exercise will increase their arthritis pain, induce their asthma or cause a heart attack. Cognitive issues could be impairing their ability to initiate or sustain an activity. You do not know what the barriers are until you engage your patients and ask. There are many other motivational techniques you can use to promote behavior change including adult learning principles, health literacy, goal-setting, and building confidence in their ability to change.  Exercise can help prevent chronic disease or slow its progress but it doesn’t work unless it’s used consistently.

In Education Resources new course; Evidenced-Based Therapy for Chronic Disease:  Intervention, Documentation and Reimbursement you will learn to implement evidenced based treatment for chronic disease and how to motivate your patients to improve adherence to their exercise programs that will allow them to progress towards their functional goals.

Please share your successful tips on how to motivate patients 

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