Académique Documents
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Professional PT
Clinical Corner
Issue 10
October 2015
1
Who do I contact if I need assistance with Clinical Education?
Customer Service
Dynamic Balance
A.R.T.
Finding a Mentor
CPR/AED Cheat
Case Study
Gems
Announcements:
November 6-8
Maitland study group:
October 8th, Merrick
office, 8:30 PM
Tim Stump
rpanariello@professionalpt.com
Clinical Affiliation Program; Any questions related to students, CIs & school
relations; Student to Staff Recruitment.
Compliance Corner
McKenzie course:
Donis Gill
Rob Shapiro
516-321-2496
tstump@professionalpt.com
516-321-2436
dgill@professionalpt.com
516-321-2450
rshapiro@professionalpt.com
516-321-2441
For internal use only. Not intended for external sharing or distribution.
Page 2
A favorable first impression gets our patient experience started on the right foot and in the right
direction.
Editors Note:
Hello all and happy fall! There
is a lot going on at Professional
Physical Therapy. We are looking forward to Dr. Tim Hewett's
lecture this month and are especially proud of our affiliation
with him.
Rob
For internal use only. Not intended for external sharing or distribution.
YPage 3
For internal use only. Not intended for external sharing or distribution.
YPage 4
For internal use only. Not intended for external sharing or distribution.
cols. There are different certifications- lower extremity, upper extremity, spine, whole body. Depending on the course, there are
anywhere between 90-100+ protocols that you will learn/practice over
the 3 days. Once you pass the
class, you are put on the ART website as a certified provider. To
maintain your status, you have to
recertify each year. Recertification
consists of taking the class again
and having the instructors sign off
on your skills from 10 protocols.
Depending on your preference either
UE or LE is a good place to start.
Taking the spine course might entail
treating UE or LE and knowledge of
the protocols may be helpful prior to
taking the spine certification. The
courses are expensive and in order
to be listed as a provider on their
website you are required to take a
recertification class each year.
Page 5
Finding a Mentor :
Murphy and Hurwitz suggest the use of three diagnostic questions for a clinical decision making in the management of mechanical and nonmechanical musculoskeletal pain.
The first question, Are the patients symptoms reflective of a visceral disorder or a serious or potentially life-threatening illness, in other
words are there any red flags or reason to suggest that this is not a patient I should be treating.
The second question, From where is the patients pain arising , find THE PAIN not A PAIN ,as Maitland would say, find the comparable sign.
The third question: What has gone wrong with this person as a whole that would cause the pain experience to develop and persist? Depression, anxiety, fear avoidance, or are they doing something during the day that causes them to put too much load through the dysfunctional
tissue which in turn causes them to reach their adaptive potential and therefore experience pain.
Murphy D, Hurwitz E. A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain.
BMC Musculoskelet Disord 2007;8:7586.
For internal use only. Not intended for external sharing or distribution.
Page 6
CPR
6. Breaths go in, check pulse no
longer than 10 seconds
7. No pulse, start chest compressions
8. 30 chest compressions at a rate
of 100 compressions per minute
9. Followed by two rescue breaths
10. Continue for two minutes (5 cycles of compressions/breaths)
Unconscious Choking
11. Recheck for breathing/pulse for
no longer than 10 seconds. If victim
continues to have no pulse/
breathing give another 5 cycles of
Initial Steps
CPR before rechecking
1. Check scene for safely look for
12. Use AED as soon as available
any usual sounds, sights, odors. Call *Compression depth 1 1/2 in. for
local police/firemen/911 if unsure of infant; 2 in. for child; at least 2 in.
safety
for adult
2. Check victim for conscious if the
*Hand Placement for child/adultscene was determined safe
trace rib cage up, place hands two
3. If unconscious call or have some- fingers above where rib cage meets.
one else call 911
Interlock fingers, keep elbows
Recovery position for any victim
4. Perform head tilt/chin lift and
locked out, and shoulders over
who has a pulse and is breathing
look, listen, feel for breathing for no hands.
6. Breaths do not go in
longer than 10 seconds
7. Re-tilt head and re-attempt two
5. If not breathing give 2 rescue
rescue breaths
breaths. Each breath should last one
8. Breaths still do not go in, start
full second, exhaling slowly into vicunconscious choking
tims mouth while pinching the nose
9. 30 chest compressions
closed
10. Look for object, finger sweep
(pinky sweep for infant only if you
see object)
11. Give two rescue breaths
12. Continue cycle until breaths go
in
Infant- using three fingers trace
across nipple line to center of chest, 13. Once breaths go in, stop and
lift up top finger and use two fingers check for breathing/pulse. Care determined based on what you find
for compressions in center of chest
Rescue Breathing
6. Breaths go in, check pulse no
longer than 10 seconds (carotid for
adult and child, brachial for infant)
7. If they have a pulse start rescue
Christina Kavanagh is a BOC certibreathing, 1 breath every 5 seconds
fied and NYS licensed Athletic Trainfor adult; 1 breathe every 3 seconds
er. Christina graduated from Florida
for infant/child
State University with her BS in in
8. Re-check breathing/pulse every
Sports Medicine and Athletic Traintwo minutes (about 20 breaths) for
ing, and went on to earn her MS in
no longer than 10 seconds
Exercise Physiology from the University of West Florida
For internal use only. Not intended for external sharing or distribution.
YPage 7
Compliance Corner:
I was tempted to review the popular ICD-10 rules and guidelines again, but Melissa Tobis and Lauren Bailey have
already done an excellent job preparing every one of the new concepts starting with the official implementation on
10/1/2015. Two charts listed below are Internal Audit statistics from the first analysis for physical therapist, front
desk/billing and the overall clinic. Please take a few moments to see if youre in the majority or part of the exceptional!
For internal use only. Not intended for external sharing or distribution.
Page 8
Issue 10
7.
Maintain the position at least 10 seconds and repeat this technique six to ten times
MedBridge Facts:
Professional Physical Therapy clinicians earned C.E.U's 1836 and completed 895 courses this year
through MedBridge.
Top 5 clinics in completed courses are :
1. Queens (91)
2. West Side (57)
3. Garden City (46)
4. Mamaroneck (43)
5. Rosyln (37)
For internal use only. Not intended for external sharing or distribution.
Page 9
Issue 9
glide was sustained and the paPassive Accessory Testing Findtient used a dynamometer to
ings:
grip just to the point of onset of
Humeroulnar, humeroradial, and
Comparable Sign: heavy lifting
pain, repeated 30 times
more than 10 lbs causes THE pain. radioulnar accessory joint play revealed mild stiffness w/o reproducPain is reproduced by active end
tion of pain.
range right elbow extension/
abduction.
Likely Diagnosis: Common ExtenNature of the Condition: condition
sor Tendinopathy.
mildly limits pts daily activities such
as cleaning, cooking, and teaching
Treatment Options:
but severely limits gardening and
Basset et al performed two randommoderately heavy lifting.
ized clinical trials which showed that
Mobilization with Movement (MWM)
Behavior of Symptoms: pain be home work was given, (see
comes worse during activities espe- combined with a graduated/
above picture) along with an
cially with lifting of heavy objects or progressive exercise program administered by a qualified physical
eccentric training program conwhen the elbow is placed at end
sisting of progressive resistance
range of extension. Pain is alleviat- therapist sped up resolution of signs
and symptoms similar to a cortisone
training.
ed by rest.
shot. MWM combined with exercise Hing, Wayne, Toby Hall, Darren A. Rivett, Bill VicenziPlanning the exam:
no, and Brian R. Mulligan. The Mulligan Concept of
improves the recover rate by twoManual Therapy: Textbook of Techniques.
The patients condition was not irrita- fold compared to adopting a wait
Bisset,
L., E. Beller, G.Physical
Jull, P. Brooks,
R. Darnell,2015
and
For
internal
use
only.
Not
intended
for
external
sharing
or
distribution.
Professional
Therapy
and see policy.(2).
ble but did limit her function. We
Outcome Measure: DASH score:
29
B. Vicenzino. "Mobilisation with Movement and Exercise, Corticosteroid Injection, or Wait and See for
Page 10
The subtalar axis of rotation allows the triplanar motions of pronation and supination.
Scapulohumeral reflex is evaluated from upper neuron signs coming from C1-4. To elicit the reflex strike the superior tip of the
patients lateral acromion process. The positive sign is involuntary shrugs and/or abduction
of the shoulder.
Quiz answers:
1. Pain with Joint stress
2 Acetabulum, iliofemoral, pubofemoral and ischiofemoral ligaments.
3. superior and inferior gemellus muscles and obturator internus
4. Pronator teres
5. Transverse, vertical axis
For internal use only. Not intended for external sharing or distribution.