1. Floating on into Summer!

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    What a rush the past few weeks have been! We have successfully tied up all the loose ends in our classes and completed our last… Final…. EVER!!!! (oh except that comprehensive exam in two months that covers two years’ worth of curriculum). We are all very ecstatic about the completion of our last final and are looking forward to this short summer quarter before our internships.

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    In the past few weeks we finished up our musculoskeletal class with Dr. Kawaguchi lecturing on the hot topic of concussions. As a PT and ATC, Dr. Kawaguchi has seen more than his fair share of concussions. When he was lecturing one of the messages that came across loud and clear is that there are discrepancies in what exactly defines a concussion and how do we properly assess for concussions. Ultimately it is not just one sign or symptom that determines if someone has experienced a concussion, but rather it is a constellation of signs and symptoms that are observed and felt. More importantly there have been way too many inconsistencies in the manner in which we detect concussions that have led to poor outcomes and even death. As PTs we have to be cognizant of some of the signs and symptoms and be able to know when it would be recommended that someone would benefit from further analysis/treatment. Aside from our concussion lecture our last two appearances in class were for aour two finals. Our practical was a case study that contained two diagnoses that we had to figure out from the history and physical exam that was provided. After filling out the entire plan of care we had to explain our diagnoses to our partner and then perform a manual technique or two exercises targeting the area of interest. IT sounds straight forward but there are always difficult questions that are asked by our professors during the practical scenario that challenge us to critically think on our feet.

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    In neuro we completed the quarter with practical study scenarios and our two finals. For the most part the scenarios were with hypothetical patients with brain injury, CVA, and SCI, which are some of the more common diagnose that we will encounter in our acute and rehab settings. Our two finals were difficult in sections mostly because of subtleties that differentiate the treatment and care of these injuries. The incredibly fascinating aspect of neuro injuries is that no matter how much you know about the pathology, the presentation is unique for every patient. Whether it is cognitive, sensory, or motor, each patient will present with an entirely different distribution of strengths and deficits and will require an innovative physical therapist to accommodate their therapeutic interventions.

    In our multiple systems course we finished with the project presentations we had been working on all quarter. Topics that were presented on were chronic illness, cancer, and women’s health. Each of the presentations included a mock case study of a patient with the particular diagnosis. The beauty of these projects is that we have to work through each of the systems that are impacted by the pathology and thus influenced by our interventions. Our final consisted of our two projects completed this year as well as our section on women’s health. Like always there were a few stumpers but everyone passed and we finished strong into summer.

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    On some lighter notes we have been getting out in this lovely weather lately having BBQs and happy hours and birthday celebrations. The other weekend a group of the both the first and second years got together and did a multi-boat raft trip down the Spokane river. Although it was a water battle between the boats most of the way down, we all had a blast without any injuries.  The following weekend was exciting as my classmate Brandi and I share the same birthday. As it landed on the last day of class on a Friday we took to the town and did a tour de Spokane visiting a variety of bars and even Elk fest, one of the sweetest music festivals that takes place once a year in the heart of Brown’s Addition. Another pearl of Spokane that was unexpected at first glance. As you may know the 2014 World Cup has been going on and as an active class we have been getting together for each of the US games through thick and thin and on to the next round!!!

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  2. Professors Love TMJ Week… Cant Ask Questions With A Hand In Your Mouth

    In just the last two weeks in our musculoskeletal class we have covered the craniovertebral junction along with the temporomanibular joint.  These two sections of the body are intimately related and come with plenty of red flags and precautions that have to address prior to treatment, or even a full examination as a matter of fact. Due to the location of the brainstem and the referral patterns of these structures we have learned that it is very important to tread lightly in this area of the body so as to not flare symptoms or misdiagnose a patient that in reality has a potentially deadly pathology or compromised tissue. In the craniovertebral area it seems that less is more. Because of the high rate of dysfunction and the correlation with headaches, neck and facial pain, small grade oscillatory mobilizations and very mild MET treatments tend to be more effective and resolving the tissue of issue while at the same time limiting the reason the patient has come to see you; pain. For our TMJ section Dr. Mary Ellen Anton, our professor’s wife who is equally entertaining and witty came in to help instruct this section. For the lab portion we all gloved up and performed intraoral examination and evaluation of the TMJ and surrounding soft tissues, something that most PT students probably never imagined that we may do as therapists. The caveat that I have to take away from this section is that the TMJ is not only a referral site for a variety of other neighboring soft tissues and structures, but it also may refer to those same areas. This means that as therapists we must be diligent and vigilant when it comes to ruling out TMJ and other local tissue dysfunction in our examinations and evaluations.

    In neuromuscular systems we have been focusing on practical skills and patient interventions. We have been practicing a variety of different transfer techniques for patients with neuro diagnoses like SCI and CVA requiring integration of the patient’s functional presentation and level of dependency. Along with those diagnoses we have also been practicing different intervention techniques that involve new devices like the Rifton and standing frames that allow upright and standing mobility to those that have LE weakness due to neurologic compromise. Our professors decided to take these practical exercises one step further by having us add in vision deficits simulated by modified glasses to mimic disorders like left neglect, retinopathy, glaucoma, and a few others. This exercise helped us recognize some of the speed bumps that may arise with multiple system involvement.

    In our multiple systems course we finished off our section with the pelvic floor muscle examination with diagnostic ultrasound in lab. Dr. Nelson has been doing extensive research on the pelvic floor muscles and has acquired two very expensive ultrasound machines that we were able to use in lab to see real live views of the pelvic floor and transverse abdominis muscle activation to a variety of different cueing strategies. For the pelvic floor the most popular cueing was, “lift urethra up and forward towards pubic bone”. For the transverse abdominis it was split between, “pull your hip bones together” and, “lift up urethra (females) testes (male)”. Regardless it will be important to use a variety of different techniques for your individual patients. More recently we have begun our group presentations on our hypothetical patient cases in which we explore potential exam findings, signs and symptoms, prognoses, and interventions for patients with a specific diagnosis that involve all of the four cardinal systems. This past week the groups presented on cancer and HIV/AIDS, two different diagnoses with surprisingly similar presentation and intervention considerations due to immunocompromised states.

    In our PT administration class we had a guest speaker, Bob Paul, one of the founders of Apex physical therapy, come and speak with us about the plethora of nuances in starting a clinic. The core of a company lies in its PLLC, a document that designates the do’s and don’ts, the manner in which to resolve conflicts/issues, and all of the inner workings of a company. This document must be incredibly thorough and drafted appropriately by a business attorney that really knows his/her stuff. By creating this document, owners and staff will all know their position and roles in the company as well as the distribution of the payment and profits the company makes. The PLLC will allow the company to function much more smoothly without causing unrest with decision making because it will be laid out already and signed by all stakeholders in the company.

    In other news four of us went on a trip to Leavenworth with EPIC, the outdoors program that is associated with the EWU undergraduate campus. There we went rock climbing and whitewater rafting and had some good ole fun camping in such a pristine area of the great northwest.

     
  3. Zach whippin’, and whippin’ it good!!!

     
     

  4. Fun, Sun, and Bloomsday Run

    Over the past two weeks our class has been incredibly busy with activities outside of the classroom. Last weekend was Bloomsday, one of the largest races in the northwest with this years attendance over 48,000 runners, a handful of which were our classmates. This 12 K run is no easy feat, with the last portion being named the ominous “Doomsday Hill”, this race is only for the dedicated. But this races would have been possible without the 5000 plus volunteers, again of which a handful of our classmates assisted with, including the wheelchair time trials the week before. One of the many perks to being part of such an awesome group/family/collective/team of people. Last week a good portion of the class came out to the 424 house for the first official BBQ of the season. Activities included a slackline, beanhole games, yard pong, and good ole relaxation accompanied by hot dogs, burgers, and a delectable assortment of appetizers and beers. Overall it was a success with great ideas for the next one.

    As for class we have been slowly working through more material. In musculoskeletal we have finished up our spinal manipulation section with Steve Allen. It all culminated with our practical exam last week in which we had to perform two the spinal manipulation setups and techniques. Little to say that having such a great guru as a professor we all passed flying colors. The written exam was another story. This exam covered our spinal manipulation, SI joint, and foot and ankle complex sections which made an already difficult exam to study for even more so. Dr Anton makes the majority of the questions very complex reasoning questions that have distractors and require proper analysis before deciding on an answer. Arguably one of the harder exams we have had all year but we were all still breathing the next day so onward we go.

    In neuro we took a visit to the Northern Idaho Advanced Care Hospital (NIACH) to observe Dana work with a patient that had a CVA. The best part of this learning opportunity was getting to see a diversity in the treatments that Dana decided to use to challenge the different systems, including playing catch with a balloon on a foam incline board, obstacle courses, and even Jenga. Her creativity and ingenuity is inspiring and intimidating all at the same time, but we all know that this ability to modify and adapt a treatment to your specific patient is the art of practice and will grow through years of experience. The rest of our neuro classes were spent in the lab practicing wheelchair mobility/recovery and performing the ASIA scale on one another. The ASIA is the standard assessment to determine the neurological level of spinal cord injury that a patient has. This is an important assessment to organize the plan of care of the patient because it will be able to accurate track a patient progress in recovery and help determine the amount of function that is likely to return. Through these practical situations we gain just the slightest insight as to how difficult it is for the recovery of function after a spinal cord injury and the steps in which we must take to track and facilitate their return of function.

    In multiple systems we have moved on to gender health. It was coined as women’s health but as we progress forward as a profession nomenclature is very important and men can also have problems with pelvic floor activation, incontinence and a variety of others similar to those of women. Granted that women occupy the majority of gender health patients, Dr Nelson made it very clear that anybody can have dysfunction, especially in an area as complex and dynamic as the pelvic floor muscle synergy.

    In our geriatrics course we took a field trip to the Riverview Care facility along the centennial trail. This particular facility is a type of Continuing Care Retirement Community that provides a spectrum of care for the aging population. At the facility we had members of the facility come in to be assessed by us to give them an overall idea of their health status. Some of the assessment that we completed were the mini cog, SLUMS, Berg Balance Scale, Tinnetti, 4-square step test, TUG, and some basic information like gross motor function and vitals. This was a lovely experience to be able to be all on our own to engage with patients as the sole providers of care with the ability to choose whichever assessments we deemed necessary, a little preview of what our internships may hold.

     

  5. "Speech apraxia in the elderly: Not applicable to profanity. Those select words are clear as day. =)"
    — Frustrations with communication and speech among patients with degenerative neuro diagnoses are often the most clear and well verbalized.  Some words just never fade…
     

  6. "A patient history is like turning over rocks at the beach; 80% of what’s worth knowing about is found there."
    — Arguably the most important aspect of patient care.
     

  7. "When I do my job well, I get fired."
    — The reality of physical therapists and many of the healthcare team.
     

  8. Running Into The Future of Healthcare

    The past two weeks have just cruised by, and with a shorter amount of time being spent in the classroom and the days getting longer and weather warmer, I don’t believe any of us can complain. When the sun shines we spend most of our breaks and lunch periods outside in the sun, playing hacky sack, stroop ball, and just lounging around getting ready for summer to show its face.

    In musculoskeletal we have continued on with Steve Allen’s case based lectures and insightful spinal manipulation labs. When you watch him practice you can see in his eyes and body language that he knows the body so well and can feel it move into the perfect position to manipulate the spine; something that takes years of practice to master.  Last Tuesday we had the luxury of having Mike Lauffer, a PT at B & B Physical therapy here in Spokane who specializes in treating runners. We had an informal lecture/lab where we got to look at different running gait styles, focusing on the main components and the range in which they differ among runners. We then had Mike instruct on finding sub talar joint neutral for one another and the corresponding amounts of forefoot and rearfoot varus/valgus and inversion/eversion respectively. This lab went over much smoother than our ankle introduction in the first year which is nice knowing that our hands are slowly but surely becoming fine-tuned palpation devices. We finished off the lab looking at a variety of different types of running shoes in regards to the amount of support and wear patterns for selected pathology.

    In neuro we had the opportunity to talk with a few wheelchair/adaptive equipment vendors after our lecture on mobility devices and home modifications. The rep from TiLite, one of the leading ultralite wheelchair manafacturers in the world, came and talked about his own experience of being in a wheelchair and all the different components and modifications to their wheelchairs one can make. The other two reps talked about different types of electronic and hydraulic wheelchairs, standing frames, lifts and tilt n space chairs. One of the most eye-opening thing I learned was that these devices run anywhere from $2,000 - $10,000. Along those lines third party payers will generally only pay for one chair so for particular degenerative neurologic diseases it its important to advocate for your patients when trying to obtain a wheelchair that they will require in the future so that they will not have the financial burden of buying a new one as their disease worsens.  Since our visit with the vendors we have moved on to the examination section of low functioning patients. With Dana as our fearless and well informed leader there is just about no question that is off limits. She has worked with so many patients that range from Rancho Level 1 – Level 9, giving her an incredible breadth of practice and experience which is gladly welcomed in a class full of intrigued, confused, and eager students.

    In our multiple systems course we had Marty Blazekovic, an experienced PT at Eastern State Hospital come in a talk about working with patients with psychiatric illness. His lecture focused on our role in being active listeners to our patients so that we can provide compassionate therapy. He emphasized an awareness of the therapy environment, body language, tone of voice, cueing, and patient friendly language. With these patients it will be very important to have patience and allow them time to respond to your questions and requests. Last week Dr. Gersh lectured on a case study of a patient with colorectal cancer of someone very close to her. Although there were many case specific details that cannot be generalized to other patients, we did learn the important aspects to care for a patient with cancer specifically in regards to patient centered care and patient advocacy. Ultimately I believe that too often health care professionals overlook the little things when it comes to treating patients. IT is important to remember that you are helping another human being that needs it more than ever. Compassion and caring is a prerequisite to caring for any patient.

    In other news we had an incredible speaker and healthcare reformist, Chad Priest come to campus and speak on health care reform. He has worked as a military nurse, a healthcare lawyer, a university faculty member and most recently as the CEO of a non-profit crisis management organization. Ultimately his mission is to change the way we think about healthcare and who provides it.  In essence, to create health, we must mix it up: crossing professions and cross-pollinating solutions that lead to breakthrough thinking. A handful of us participated in an interdisciplinary workshop including PT, OT, Speech Pathology, Nursing, Law, Exercise phys/nutrition, and a few others where we discussed our definitions of health, healthcare, and what we feel is working/not working in regards to our education. One of the most important pieces I gained from the workshop was that all of our professions had similar ideas of health and identical qualms in terms of our education. Chad’s goal for the workshop was to get our collective brain flowing and move us in the direction of redesigning the health care of the future so that one day we will be at the pinnacle of world healthcare.

     

  9. "If you are frustrated, the odds are that so is your patient, even more so."
    — Learn to practice with patience and tolerance. Everyone learns and heals at a different pace.
     

  10. New Faces, New Perspectives

    It’s only been two weeks and we are finally picking up the pace in class. This spring quarter was intentionally organized to be significantly easier that winter quarter to create a better segue into summer and our comprehensive exam coming up in august. We have added a couple new courses to the program during this quarter to tag along with the cyclical coursework in neuromuscular, musculoskeletal, and clinical education: Multiple systems, PT Administration, and Geriatrics. Although it may seem like an over the top kind of schedule, there a less hours this quarter spent in the classroom and more time outside of class to work on group projects, quizzes, and homework assignments. On top of it all the weather has been making a turn for the best with the daytime temps extending into the 60’s which has got our class and seemingly everyone on campus very excited to know the cold is now behind us.

    In musculoskeletal we have moved on from the knee and hip and have started covering the SI joint, and just this past week progressed to spinal manipulation with one of the most decorated and knowledgeable orthopedic PT specialists around; Dr. Steve Allen. Due to the recent change of events, physical therapists have finally recaptured the ability to practice spinal manipulation in Washington again. Years ago Washington PTs gave up that privilege while negotiating for the option of obtaining direct access. But in the end we have prevailed in getting that right back with a few stipulations regarding the amount of spinal imaging and manipulation practice. For these reasons we have brought in Steve Allen in to assist in teaching this section of our coursework. It is so nice to be taught by a man with so much knowledge and passion for what he does, yet the humility and modesty of the average man. We will be sure to glean as much as we can in the weeks to come.

    Our Geriatrics class that is held once a week is instructed by one of our adjunct faculty members, Chris Henderson who is an experienced clinician and rehab director over in Olympia at Aegis Therapies. Chris is a bit of a comedian who makes his lectures on dementia and aging engaging and substantial. In his course we are learning the in’s and out’s of geriatric care from the first evaluation all the way to home assessments and modifications for discharge. The past two weeks we have discussed the differences between normal and pathological aging. Because as we age there are some expected consequences to our health but it need to be known where to draw the line between expected detriment and disease related changes in function. This past week we have moved on to one of the larger, more umbrella topics of dementia and cognitive decline. One of my favorite quotes was when he said, “ Its not that the patient was non-compliant with the therapy program, but the therapist was non-compliant with the dementia program”. Wise words and very insightful as to what it is like viewing therapy in the patients perspective.

    Appropriately, this quarter our professor Dr. Russell, who is also the associate dean of the health sciences, is teaching our PT administration course. In this course we have been talking about some of the legalities of PT practice, boundary violations, communication within and between companies/occupations, and marketing a business, because ultimately that is what we will become a part of. Later this quarter we will be dividing up into groups and constructing a business plan for a proposed clinic that includes all the nuances of running a business.

    As a culmination class, our multiple systems course focuses on patients that will come to us with a plethora of pathology that does not fit a single diagnosis code. This course is taught by Dr. Gersh and Dr. Nelson, as well a few guest lecturers that specialize in specific pathology. So far we have lectured on patients with hemophilia and patients with psychological disorders, each presenting with their own clinical difficulties and considerations. This past week we had a comedic guest lecture by Dr. Ron Klein, a clinical psychologist who detailed the in’s and out’s of how to work with patients with a variety of common disorders. He also talked about the difficult topics of sexual inappropriateness and how to redirect and diffusing awkward situations that undoubtedly will happen to all of us at some point in our careers.

    This quarter in our neuromuscular class we have had the luxury of having Dana McPhee come back to help with our Neuro ICU section. So far we have covered ischemic pathology along with spinal cord injury. Specifically we have discussed the different pathologies, varying presentations, diagnostic tests, and medical support equipment. One of the benefits to having Dana is that she is so knowledgeable, current, and experienced in the field that she has the capacity to condense her understanding into a palatable dose that we can make sense of. A true blessing at this point in the curriculum when we are running out of space upstairs.