Physical Therapy and the Camaraderie of Healing by Caitlin Kelly

Throughout RehabVisions, we have professionals working in a variety of settings presenting a variety of strengths and interests.

No matter what setting, involvement, both internally and externally, is a key to success.

Internally, it is important to be involved and to be visible within your facility. Know your administration and their expectations. Attend regular meetings. Volunteer for committees. Always be willing to tell the story of your department and its successes. Good communication is fundamental.

Externally, it is important to be involved within the community you serve. Give presentations or in-services to local civic, school or senior groups. Present or volunteer at local health fairs. Speak to local schools or colleges regarding the therapy profession. Assist with health or athletic screenings. Volunteer or assist with causes and organizations that you believe in.

The more visible you are, the more attention you may attract to your facility. These types of contacts help to present your department in a positive light and help to give it credibility within your community.

But it’s not all about what this involvement can do for your facility. Think about the personal and professional growth that can be gained from such experiences. Consider this your challenge for 2012. Go out and get involved!

Brandon is an 11-year employee of RehabVisions. He coaches various recreational sports for his kids including soccer,
basketball, baseball and football. He has served as the athletic trainer for the local high school teams for the last 5 years and is part of the Optimist Club.

The AlterG is a revolutionary Anti-Gravity Treadmill. The concept of unweighing to facilitate a faster, more effective, recovery of rehab patients has been around for many years. Many of us have been fortunate enough to work in facilities that offer aquatic rehab or advanced harness unweighing capabilities.

The AlterG provides therapists with an opportunity to leverage technology in order to enhance patient outcomes. Modifying research initially generated by NASA, the AlterG allows you to work with a patient in a range from 20 to 100 percent of their body weight. This incredible technology has far-reaching implications for a wide variety of patients with varying orthopedic or neurological problems.

Patient set-up time is typically three minutes to get “zipped in,” and therapists can change the percent of weight bearing in one percent increments. The degree of unweighing can be set to the level in which the patient can perform the specific activity pain-free or in a more normal coordinated sequence.

Forward and backward walking/running, hopping, jumping and a limitless number of proprioceptive exercises can be completed by the patient. This also provides the therapist with an additional documentation advantage to precisely describe improvement in weight bearing status as patients progress toward their ultimate goals.

You can learn much more about the AlterG here. We’re excited to incorporate this cutting-edge technology into our current hands-on practice.

Steve Finn, PT, DPT, OCS

It has been a mighty long time
Since this old buckaroo
Has seen fit to put his foot
On the inside of a shoe.

Now he has a therapist
Who is pushing mighty hard
To change his mode of footwear
But I don’t think so pard.

He thinks it will help my balance
And give me Happy Feet
And if I wear Nikes or some such shoe
It will give my feet a treat.

I have a pair of Justins
And a pair of Hyers too
I have two pair of Luccheses
And Tonys to name a few.

I bought a pair of Elk skin
Now there’s a boot to love
Soft and pliable
Fits just like a glove

There are some alligator
Boots that Mary bought
You’d think they would be waterproof
But they certainly are not.

Mary bought me a pair of Lizard
I thought some one would warn her
Boots with toes like that
Are for stomping bugs in a corner

I had some rough outs
Some made from cow hide
Then some French calf
And I wear them all with pride

I’ve got some ropers and some doggers
Some have walking heals, some underslung
Most for riding, none for joggers
But they aren’t made for walking
And don’t ever try to run.

But I can’t part with them old boots
Cause they represent too much
And to throw away those memories
I wouldn’t dream of such

Because my therapist thinks he’s winning
And I let him believe
But I go out and pull my boots on
The moment that I leave.

Jack is a patient at a RehabVisions facility in Central Nebraska. Alan Daup, OT is his therapist and the inspiration for this poem.

Below are just a few ideas our office came up with to handle these stressors:

1. Get a massage.

2. Exercise over your lunch hour.

3. Breathing techniques. (As therapists, we teach them, we may as well use them!)

4. Eat some baked goodies (in moderation of course).

5. Stretch.

6. Laugh with your patients.

7. Remember no one is perfect.

8. Walk when you can.

9. Drink some hot chocolate.

10. Take a nap.

Relaxation techniques really work. Read about them here and take the time to practice some stress reduction this holiday season.

By Jacque Sedlacek, PTA

Jacque is a PTA in a RehabVisions facility in Central Nebraska.

I list the nuts and bolts but most importantly I tried to give them food for thought in considering their first position as a professional. The process I outline below is geared toward ours as a contract therapy services provider but is applicable across most settings.

THE JOB SEARCH

WHAT SUITS YOU? Define what fits you in terms of setting and population.

- Geriatric
- Pediatric
- Schools
- Long-term care
- Clinic/hospital
- Short-term travel

LOCATION? Define what’s important to you.

- Near family
- Open to a long-distance move
- Big city
- Small town

PREPARE FOR THE PROCESS

- Develop a resume.
- Contact three professional references for permission to use their names.
- Research opportunities.
o Internet searches
o Word of mouth/networking
- Prepare a concise/well-written letter/email to go along with resume.

INTERVIEW Answer honestly and be a good listener

Call with recruiter
- Understand who the recruiter represents (actual hiring company, head hunter, travel company).
- Where did you learn about the company openings that interest you (website, referral, etc)?
- Ask questions about the specific job, location and community.
- Request information about company benefits.

Phone interview
- Don’t drive or multi-task.
- Take call in private.
- Take notes.
- Have list of questions prepared
- Be yourself and sell yourself.

On-site interview
- Dress professionally.
- Observe team dynamics.
- Have list of questions prepared.
o Specifics about the job
o Team dynamics
o Supervisor support
o Facility dynamics
o Community
o Timeline for decision-making
o Additional information needed? References?
- Talk to potential co-workers about their daily routines.
- Be yourself and sell yourself.
o Don’t ask what the company can do for you. Tell them what you can do for them.

FOLLOW-UP

- Email follow-up message is appropriate, particularly if that’s how you’re already communicating with them.
- Most importantly the message should be sincere and well written (not canned).

OTHER CONSIDERATIONS

- Consider your social media status/pages (do they convey a professional, respectable image?)
- Make sure your voicemail message is clear and professional (no cutesy music or silly messages)
- Don’t use a silly email address (ie: huskersrock@gmail.com)
- Return phone calls/emails promptly, even if you’re not interested
- Remember to never burn a bridge.

IS THIS THE JOB FOR YOU?

Once you’ve interviewed and have the information, think about these things.
- Can you see yourself in the environment on a daily basis?
- Are you comfortable with the level of supervision?
- Is the company culture a fit with your values?
- Are you comfortable with the productivity expectations/caseload?
- Are the training and development (mentoring) opportunities what you’re looking for?
- Are you comfortable with the direction of the therapy department and philosophy of treatment decisions?

Go with your gut! Don’t try to make something work that isn’t right.

As a Certified Lymphedema Therapist, I have spent years teaching patients and other therapists about the many different facets of lymphedema therapy. The current gold standard for treatment of lymphedema is considered to be Complex Decongestive Therapy (CDT). It is “complex” due to the comprehensive nature of the treatment including manual lymphatic drainage, bandaging, proper skin care and diet, compression garments, remedial exercises, self-manual lymphatic drainage and bandages and a long-term maintenance program. It has been my experience that all of these components of the CDT are valuable but not all are possible or even beneficial for each type of patient.

In my opinion, several other factors need to be addressed before implementing the CDT program. Some areas to consider include:

1. Emotional status Is this patient a cancer survivor? Are they still going through radiation? Is the diagnosis of lymphedema a worse fate in the patient’s eyes than anything they have previously experienced? Are they overwhelmed?

2. Support system Do they have someone that can help them manage their condition long term? Will they need someone to learn how to assist with bandaging or garment donning/doffing?

3. Resources available Will they be able to pay for the garments and bandages that are necessary for the treatment, but not covered by insurance? Are there other resources available through grants, private foundations, churches, agencies, friends?

4. Severity of condition How long have they had swelling? How long is it going to take to reduce it? What complications are there? Wounds, history of infection, trunk edema, genital edema?

5. Education What is the patient’s current understanding of the condition? What have they been told or researched on their own? Is their understanding accurate?

6. Lifestyle changes Are they willing and ready to make lifestyle changes to manage their swelling on a daily basis?

7. Compliance Are they able and willing to follow through with recommendations made? Can they commit to the lifelong maintenance program? What modifications may need to be made to the program to make it do-able for this individual?

The outcome and overall success for the patient’s treatment and long-term management will be more beneficial if the above are addressed in addition to the basics of the CDT program.

As this article infers, there are ways to stand out in any business or profession–even cab driving. If a cabbie can figure out ways to create a memorable experience for a customer, we too should be able to come up with some new, thought-provoking, customer service-oriented approaches to take. Read the article and when finished, challenge yourselves to think of two or three ideas that could be implemented in your rehab clinics that would make it harder for any patient or patient’s family member to forget us. In a day and age when competition truly is present everywhere, it only makes sense.

The article, Lost & Found: What Brain Injury Survivors Want You to Know, was written by Barbara J. Webster, Lash & Associates and came from Brainline.org (preventing, treating and living with traumatic brain injury).

Clinics: (1) Quality measures beginning to factor into reimbursement and evidence-based medicine becoming a standard versus suggested protocol; (2) Development of ACO organizations and how outpatient clinics factor into what is a Hospital/Physician-driven model; (3) BC/BS Kansas trend of reimbursement differentials between Therapist and Assistant provided treatment.

Hospitals: (1) Direct Supervision requirement for provider-based outpatient therapy departments (particularly off-campus facilities); (2) Increasing level of self-pay customers (and higher deductible/co-insurance plans for insured patients) – consumer vs. institutional (insurance company) payment; (3) Reimbursement pressure – MPPR, contingent quality-based payments, readmission penalties, payer visit limits, therapy caps, daily per diem limits from insurers.

SNFs: (1) SNF PPS 2012 – continued dis-incentive for clinical student training, reduction in overall market basket and narrowing of assessment windows (3-day no therapy discharge and 7-day COT assessment); (2) Focused congressional and legislative attention – will we see a replay of 1997 where reimbursement was eviscerated?; (3) High volume urban “abuses” impacting lower volume rural viability (throwing the baby out with the bath water).

HHAs: (1) Congressional scrutiny of therapy’s ability to subjectively modify treatment intensity; (2) High profile abuses of HHA reimbursement model (Florida); (3) Increasing sophistication and consolidation of HHA’s and resulting benchmarking of therapy visit ranges against CMS data.

Travel Staffing: (1) Proliferation of Vendor Management Companies (many of whom are also competitors in recruiting); (2) Changes in SNF reimbursement creating 7-day/week therapist demand (modified travel schedules); (3) economic uncertainty continuing to create a permanent staffing bias.

In the 28 years we’ve been in business, scenarios such as these have come and gone and we’ve weathered the storms, as I know we will in this case. I welcome your comments and thoughts on where you believe each of these are moving.