CroppingTemplate From Jeanne.indd 1 4/2/15 9:03 AM VOL. 27 | NO. 14 | DECEMBER 2016 www.advanceweb.com/pt

ON THE WEB CONTENTSADVANCE FOR PHYSICAL THERAPY & REHAB MEDICINE ➔ 2017 SALARY SURVEY COVER STORY ENTER YOUR INFO NOW! Help us compile the industry’s most comprehensive examination Our 2016 of PT salaries. Results will 10 Practice of be revealed in March.

The Year ➔ NAMES & FACES Meet the therapists at Professional Physical PTs IN THE NEWS Therapy, who are setting the standard for In this new online feature, superior customer satisfaction and evidence- meet your PT colleagues based care. (Photo by Jeffrey Leeser) who made news this month.

➔ STUDENT & NEW GRAD CENTER FEATURED ARTICLES DEPARTMENTS & COLUMNS THE BENEFITS 4 Ad Index OF STANDERS 14 Gentle Motion Pediatric experts discuss Do children exposed to drugs in-utero need 5 Editorial the advantages of getting children upright. physical therapy? 6 Sports Medicine Focus: The Industrial Athlete Mindfulness and Meditation 17 ➔ BLOGS Integrating mindfulness, guided meditation and 8 Management Focus: visualization into your next therapy session. Front Desk Procedures ADVANCE PERSPECTIVE 9 Geriatric Journal: Physical therapy and O&P have mutual goals and 19 The Balancing Act What I’m Thankful For Achieve more with less while fine-tuning your interests. fall prevention approach. 25 Education Opportunities

28 Classified Employment ➔ PATIENT HANDOUT 21 Hands-On Approach to PT Opportunities Grounded in evidence, manual therapy improves WINTER WEATHER FOR AMPUTEES patient outcomes. SILVER-LEVEL PARTNER IN RESEARCH Common winter hazards for people with mobility challenges — and how to 23 Welcome Home overcome them. Driver rehab programs improve quality of life for veterans injured in service. PLUS: Daily News Watch, multimedia offerings, webinars and much more!

Coming Next Issue! Find us on Stay tuned in January for Rehab Insider, a newly rebranded publication targeting the rehabilitation profession. Our inaugural cover story will highlight the coming trends to watch in the field for 2017.

Postmaster: send address changes to ADVANCE for Physical Therapy & Advertising Policy: All advertisements sent to Merion Matters for Rehab Medicine®, Merion Matters, Circulation, 2900 Horizon Drive, King of publication must comply with all applicable laws and regulations. ­Prussia, PA 19406-2651. Contents are not to be reproduced or reprinted Recruitment ads that discriminate against applicants based on sex, without permission of publisher. ©2015 Merion Matters. age, race, religion, marital status or any other protected class will ADVANCE for Physical Therapy & Rehab Medicine® is published 15 times not be accepted for publication. The appearance of advertisements a year by Merion Matters, 2900 Horizon Drive, King of Prussia, PA 19406- Our company publishes magazines and websites for audiologists, laboratory in ADVANCE Newsmagazines is not an endorsement of the advertiser 2651. ADVANCE was established March 1990 as a national newsmagazine. administrators, health executives, health information professionals, medical or its products or services. Merion Matters does not investigate the Its purpose is to provide in-depth coverage of news and employment laboratory professionals, respiratory care and sleep medicine profession- claims made by advertisers and is not responsible for their claims. opportunities to therapists in the nation. Subscriptions are free to all PTs, als, nurses, occupational therapy practitioners, nurse practitioners and ADVANCE is a member of the National Association for Health PTAs and senior students as well as to national PT schools & health care physician assistants, physical therapy and rehabilitation professionals, and Care Recruitment facilities employing PTs. speech-language pathologists.

www.advanceweb.com/pt December 2016 ADVANCE for Physical Therapy & Rehab Medicine 3 ADVERTISER INDEX Log on to www.advanceweb.com/pt Our searchable online Resource Directory allows you to receive detailed information about the companies and products listed below, as well as submit requests for free info.

SUPPORT THE COMPANIES THAT SUPPORT YOUR PROFESSION The companies listed below support the physical therapy profession by placing advertisements in ADVANCE for Physical Therapy & Rehab Medicine. Their support keeps our publication coming to you free of charge. Please contact these advertisers or visit their Web sites to learn more about their products or services.

ADVERTISER WEB PG. # ADVERTISER WEB PG. #

Academy of Lymphatic Studies www.acols.com 26 Great Seminars and Books Inc. www.greatseminarsandbooks.com 27

ADVANCE Healthcare Shop advancehealthcareshop.com BIC LiteCure LLC lightforcelasers.com 15

ADVANCE Job Board advancehealthcarejobs.com 22 MCBE www.mcbexpress.net 20

ADVANCE Subscriptions j.mp/advancevipt 18 OPTP optp.com 13

CM&F Group Inc. www.cmfgroup.com BC TOYOTA Motor Sales toyotamobility.com FIC

Ekso Bionics eksobionics.com/stroke 7 West Coast University westcoastuniversity.edu 25

GW Heel Lift www.gwheellift.com 16 ZetrOZ Systems LLC www.samsport.com 4

4 ADVANCE for Physical Therapy & Rehab Medicine December 2016 www.advanceweb.com/pt By JONATHAN BASSETT, EDITOR, ADVANCE Is produced by Merion Matters, celebrating 30 years of excellence in healthcare publishing

PRESIDENT Ann Wiest Kielinski

GENERAL MANAGER W.M. “Woody” Kielinski Editorial In With the New VICE PRESIDENT Maria Senior ehabilitation professionals: Here’s to you. EDITORIAL As you read this, patients in your community and across Editor Jonathan Bassett [email protected] the nation are walking taller, standing stronger and enjoy- Editorial Assistant Dillon Stickle ing renewed quality of life because of your expertise and dedication. [email protected], Children with disabilities are eating lunch with their friends in Katherine Bortz [email protected] Web Director Jennifer Montone school cafeterias, injured workers are back to meaningful employ- [email protected] ment, and senior citizens are entertaining family and friends in the homes you’ve enabled them to return to. DESIGN Design Director Walt Saylor While expressions of gratitude don’t always arrive as often as Production Manager Cheryl A. Drotar they should, take solace in the knowledge that you’re transforming Mac Tech Manager & Production lives every day. At ADVANCE, we’re honored to present your stories Michael Galban Associate Art Director Matthew Taraborrelli demonstrating the power of physical and cognitive rehabilitation. And beginning in 2017 we’re excited to share them through a brand-new MARKETING print publication and website. Marketing Director Maria Senior Marketing Manager Jessaley Stercula Starting with our January issue, our rehabilitation audiences will begin receiving Rehab Insider, a rebranded publication tailored ADMINISTRATION strictly to the rehabilitation clinician. Our lineup of expert-writ- Human Resources Manager Ellen Spiegel Director of Sales Administration ten departments and features will remain as relevant and engaging Mike Connor as ever, with an expanded editorial focus. This monthly publication marks the return to print for our speech-language pathology and MEDIA & MARKETING OPPORTUNITIES audiology audiences, in answer to our subscribers’ many requests. Coinciding with this launch will be a redesigned and community- DISPLAY ADVERTISING National Corporations Sales Manager specific website with more intuitive content organization, enhanced Rachel Laird [email protected] visual elements and a user-friendly interface designed to embrace the Associate Publisher latest in visitor styles and preferences. Stay tuned for more information Meg Celmayster coming your way in January. Happy holidays to all our readers. n HEALTHCARE FACILITY ADVERTISING Group Sales Managers EDITORIAL ADVISORY BOARD Amy Sherlock [email protected], Kevin Reagan [email protected] ACUTE CARE AND INPATIENT REHAB NEUROLOGY Barbara Garrett, PT, NCS Mike Studer, PT, MHS, NCS, CEEAA, CWT EDUCATION ADVERTISING Clinical Specialist President, Northwest Rehabilitation Associates Senior Account Executive Christine Hudak Kessler Institute for Rehabilitation Salem, OR West Orange, NJ CUSTOM PROMOTIONS ORTHOPEDICS Sales Manager Mike Kerr BUSINESS AND PRIVATE PRACTICE Jared Vagy, PT, DPT, OCS, CSCS Michael Nula, DPT Adjunct Instructor of Clinical Physical Therapy Owner and Founder University of Southern California HOW TO CONTACT US Elite Physical Therapy Los Angeles, CA Merion Matters Warwick, RI ADVANCE for Physical Therapy & PHYSIATRY AND PM&R Rehab Medicine EDUCATION AND PTA ISSUES David Cifu, MD Claudia Medeiros, PT, MS, Lic Ac., GCS Chairman and Herman J. Flax, MD Professor 2900 Horizon Drive Academic Coordinator of Clinical Education Department of PM&R King of Prussia, PA 19406 2651 Physical Therapist Assistant Program Virginia Commonwealth University (610) 278 1400 Keiser University Richmond, VA www.advanceweb.com Miami, FL For a FREE subscription: (800) 355 1088 SPORTS MEDICINE & To order Article Reprints: LEGAL AND REGULATORY AFFAIRS ATHLETIC TRAINING Marje Albohm, MS, ATC (800) 355 5627, ext. 1484 Franklin Rooks Jr., MBA, PT, Esq. Director, Ossur Academy, Ossur Americas To place an education, Co-founder, PRO Physical Therapy Principal, Jacobson & Rooks LLC Past President, NATA display or recruitment ad, Philadelphia, PA Mt. Pleasant, SC or to contact the editorial department: (800) 355 5627

www.advanceweb.com/pt December 2016 ADVANCE for Physical Therapy & Rehab Medicine 5 SPORTS MEDICINE FOCUS

By MARTY MATNEY, MBA, LAT, ATC

Reducing Occupational Injuries Incorporating a sports medicine approach to industry

ike the athletes who practice and perform at high address movement dysfunction, or when working with levels on a regular basis, the “industrial athlete” coaches and healthcare professionals, athletic trainers has similar characteristics. direct care and are uniquely skilled at getting the right Both are highly skilled. They work at their craft and person, be it athlete or worker, to the right resource. become experts at the duties they perform. They expose Often, safety programs address injuries after they their bodies to stresses that are unique to the task at have happened, and then attempt to incorporate pre- hand. And they both accomplish goals that without vention strategies to keep further injuries from occur- This article was pro- preparation would be difficult if not impossible for ring. Introducing an athletic trainer, who is focused on duced in cooperation someone unaccustomed to the task. injury prevention, helps move these programs upstream, with the National Athletic Trainers’ Most often, the biggest difference between these two addressing injury drivers early and developing strategies Association (NATA), groups is the “traditional” athlete does a lot more run- that are effective in reducing injuries. the professional mem- ning than the “industrial” athlete. But “traditional” ath- bership association letes perform their activity for 3-4 hours per day, while for athletic trainers Sports Medicine Model in Industry and those who sup- the “industrial” athletes do theirs for 8, 9, 10 or more Physicians, athletic trainers and other healthcare profes- port the athletic train- hours per day, at least five days per week if not more. sionals bring a sports medicine approach to the work- ing profession. Visit Cumulative stresses on the body of the industrial place. They understand the body and how it moves, the www.nata.org athlete are very similar to those experienced by the tra- stresses placed on it and how it can wear out and break. ditional athlete. Industrial athletes include manufac- Much like working with a football or basketball team, turing and construction workers, firefighters and those athletic trainers are on the front lines and focused on in public safety, warehouse and delivery workers, and prevention. They specialize in keeping players on the those who work in physically demanding occupations. field and court. In manufacturing, industrial and occu- We commonly see sprain, strain and inflammation pational settings, they can do the same thing. injuries from awkward positions, repetitive use, maxi- For example, workers who may perform repetitive mal exertion and cases in which job processes or differ- lifting or bending and twisting expose themselves to ent duties can cause injuries because the body is simply low-back injuries. Analyzing how they perform their not physically ready to perform the task. job, educating them on proper movement techniques

Marty Matney is pro- and working closely with them to prepare their bodies to gram manager at Enter the Athletic Trainer perform this work can effectively halt low-back injuries. Work-Fit and chair of The prevention of musculoskeletal disorders (MSDs) Those with significant injuries often continue work the National Athletic is one of the many skill-sets of the athletic trainer. until they can go no further. By getting the individual to Trainers’ Association Committee on Practice Whether through preventive taping and strapping, a resource that can help, athletic trainers can save money Advancement. biomechanical assessment and corrective programs to associated with time loss and medical costs.

INJURIES IN INDUSTRY & MANUFACTURING According to The Travelers Companies 2014 The causes of these injuries are: Strains and sprains resulted in an average of Injury Impact Report, the following are the • M aterial handling (32% of total claims) 57 missed work days per case. Inflammation most common injuries occurring in American • S lips, trips and falls (16%) caused the most time away from work at manufacturing involving 1.5 million workers’ • B eing struck by or colliding 91 days. Strains, sprains and ­inflammation compensation claims between 2010 and 2014: with an object (10%) account for 35% of injuries and when • St rains and sprains (30%) • A ccidents involving tools (7%) addressed properly, are largely preventable. • C uts or punctures (19%) • T raumas occurring over time — •  Contusions (12%) for example, when a part of the body View the full report at https://www.travel • Inflammation (5%) is injured by overuse or strain (4%) ers.com/iw-documents/resources/work • Fractures (5%) place-safety/workplace-injuries-report.pdf

6 ADVANCE for Physical Therapy & Rehab Medicine December 2016 www.advanceweb.com/pt The Cost to Employers Return on Investment The Travelers Companies 2014 Injury Impact Report shows that The American Society of Safety Engineers states that for every dollar strains and sprains averaged $17,000 per claim. Inflammation aver- spent on ergonomic-related safety programs, employers realize up aged a cost of $24,500 for each claim. to $3 to $5 in savings. The Executive Summary: Certified Athletic According to the U.S. Bureau of Labor Statistics, work-related Trainers Deliver ROI in Occupational Work Settings states a return musculoskeletal disorders (WMSDs) accounted for 388,060 cases on investment of up to $10 saved for every dollar spent where the in 2012 alone, making up 34% of all workplace illness and injuries. athletic trainer is the principal staff member focused on injury pre- The U.S. Centers for Disease Control and Prevention states that vention. These are significant savings and can be applied to practi- WMSDs have higher costs than other workplace injuries resulting cally any industry and occupation. in problems that include lost productivity and absenteeism, which According to OSHA, an injury prevention program is a proactive add to the cost of the injury alone. process to help employers find and fix workplace hazards before Direct costs that include workers’ compensation payments and workers are hurt. Not only do these employers experience dramatic medical expenses associated with WMSDs nationwide are between decreases in workplace injuries, but they often report a transformed $45 and $54 billion. Indirect costs are often significantly greater workplace culture that can lead to higher productivity and quality, than direct costs. According to the Occupational Safety and Health reduced turnover, reduced costs and greater employee satisfaction. Administration (OSHA), the ratio of direct-to-indirect costs varies Based on the positive experience of employers with existing from 1:1 to as high as 20:1 and depends on many factors. programs, OSHA believes that injury and illness prevention pro- Indirect costs include lost productivity, employee training, dam- grams provide the foundation for breakthrough changes in the way aged product, re-work and repair, low employee morale leading employers identify and control hazards. to absenteeism and presenteeism, and negative company public An injury and illness prevention program will result in work- relations. Every sector of American commerce is exposed to the ers suffering fewer injuries, illnesses and fatalities. Employers will risk of WMSDs with some of the highest numbers of claims in improve compliance with existing regulations, and will experience the construction, manufacturing and assembly, transportation and the financial benefits of a safer and healthier workplace, including healthcare industries. significant reductions in workers’ compensation premiums. n

www.advanceweb.com/pt December 2016 ADVANCE for Physical Therapy & Rehab Medicine 7 MANAGEMENT FOCUS

By DEBBIE LINDABERY, PT

Better Front Desk Procedures Do you really know the level of customer service your patients are receiving?

s a former multi-clinic private practice owner, ensuring that current patients are seen as often as rec- outpatient physical therapist for over 28 years ommended, whether that’s once, twice or three times and business consultant, it’s become increas- per week? ingly obvious to me in this continuously changing Scheduling includes some decision-making, which is healthcare environment that a practice’s front desk often overlooked or not even considered when creating staff and procedures can impact a practice as much as scheduling procedures. Specifically, how does your front the treatment provided. desk staff handle patients whose authorized visits have First in an Private practitioners often undervalue the importance expired, or Medicare patients who have reached their occasional series. of front desk operations and are unaware of what goes therapy cap? What often happens is that unbeknownst on at their front desk. This article series will address to the practice owner, front desk staff dissuades or even the four main front desk procedures that can make or prevents patients from scheduling because they believe break your practice. it’s in the best interest of the practice, when in fact it’s Before focusing on any single procedure, the first silently crippling it. questions to ask yourself are these: Do you really A recommended strategy for all private practice own- understand your front desk operations? Would you ers is to designate someone a “secret shopper” to call be able to sit at the front desk and perform all the and/or walk into the clinic to observe first-hand what tasks you’re asking your front desk staff to do? Do greeting the patient receives and to determine whether you have the right people operating the front desk? your front desk staff is providing the utmost in cus- Usually, the honest answer to these questions is “no” tomer service. or “I don’t know.” It’s also helpful to conduct periodic surveys of your There is an old saying: “Don’t judge someone until existing patient population to determine whether your you’ve walked a mile in his shoes.” So take a half day front desk staff is accommodating their needs and going to sit at your front desk and shadow your front desk above and beyond to make scheduling appointments staff to truly understand what they do and how they easy and stress-free. The bottom line is that every prac- do it, as well as the obstacles that make their jobs dif- tice must have clear, effective written scheduling pro- ficult. It will be time well spent. Not only will it be cedures, as well as ways to ensure these procedures are an enlightening experience that will give you a deeper being followed. appreciation of your front desk staff, but it will allow Scheduling is multi-faceted. It includes not only you to better understand and evaluate your front desk scheduling patient appointments, but also reschedul- people and procedures. ing, cancelling and confirming appointments, as well The first procedure that will be addressed in this as managing patient compliance including frequencies series is scheduling. You’re probably thinking to your- per week and patient dropouts. self, “What’s so hard about scheduling?” Hopefully, your practice utilizes an EMR system that Believe it or not, a majority of practices lose a stag- can easily provide cancellation and no-show statistics, gering number of visits due to poor scheduling pro- patient frequencies per week and names of patients who cedures for both new and existing patients. Because drop out. If your current EMR system does not provide capitalizing on every new referral and patient visit is this information, you must either devise manual ways critical for PT-owned private practices, it’s imper- to monitor these metrics or consider acquiring a better ative that practices adhere to efficient scheduling EMR system. procedures, focusing on customer service and accom- Scheduling both new and existing patients is an art modation of patients’ scheduling needs. and a talent that’s often overlooked in private practice, Debbie Lindabery is Does your practice currently have written schedul- despite its tremendous impact on the patient census. It’s an outpatient physical ing procedures, or are you just winging it and hoping critical that you scrutinize both the people you employ therapist and owner of your front desk staff is doing the right thing? Are the at your front desk and your front desk procedures to Medkita LLC, a physical therapy consulting firm scheduling procedures in your practice conducive to ensure that they’re both providing what your practice in West Chester, Pa. converting potential patients to actual patients and needs to thrive, not just survive. n

8 ADVANCE for Physical Therapy & Rehab Medicine December 2016 www.advanceweb.com/pt GERIATRIC JOURNAL

By CAROLE LEWIS, PT, DPT, GCS, GTC, CCOEE, MPA, MSG, PHD, FAPTA

Time for Giving Thanks s this year draws to a close, I’d like to reflect informative PT Pintcast, which has over 8,000 listen- on physical therapy trends that make me ers. Jimmy McKay is a new graduate (August 2016) but grateful. This is my short list. There are also a seasoned DJ, having worked with Howard Stern. many more, and I encourage you to write in and share He is a creative genius and his 30-minute podcasts are your feelings of gratitude as well. Please write to edi- extremely entertaining. tor Jonathan Bassett at [email protected] and A second example was clearly demonstrated this we will share them online. year at PPS. The conference is delightful because it’s First on my list is the increase in technology to small and people are eager to meet each other. The enhance patient engagement. Several years ago I opening line is usually “Where are you from?” and started using my patients’ iPhones to record their per- “What kind of practice do you have?” I was star- formance of home exercises. I provided direction and tled to hear from so many young, new PTs owning feedback while the video recorded my audio and the not one, not two, but 3-9 offices! This shows the patients’ movements. confidence and entrepreneurial spirit of our newer My patients loved it and I found that it increased grads. You rock! compliance. Variations included using a smartphone to photograph patients engaged in treatment exercises My hope is that consumers and adding descriptive text. Patients found this to be very helpful as well. will be motivated to see their At the APTA’s Private Practice Section (PPS) meeting in Las Vegas in November, I saw that many compa- physical therapist for an nies have taken personalized feedback even further by annual visit to be sure they are including database information such as the patient’s tests and history. Use of these technologies is burgeon- on track for successful aging. ing and it gives me great hope for the future of exercise adherence and improved outcomes. Finally, this year clearly shows more outreach and Second on my 2016 gratitude list is the increase in collaboration among disciplines within the health- direct access. Currently, direct access is legal in every care community. Physical therapists are working hard state and many insurance companies do not require to serve on committees and panels for the future of physician prescriptions for PT. Even 10 years ago, healthcare delivery. every patient had to see a physician before going to a I am also seeing the benefit of taking our skills physical therapist. directly to the public. As I said in the McMillan lec- Interestingly, while on the flight to the PPS meeting, ture this year, “We need to show the world what we I sat next to an older woman who was a huge fan of can do to help people age successfully.” My hope is physical therapy. She popped right up and said, “Oh, I that consumers will be motivated to see their phys- never go to see my doctor so that I can see my therapist. ical therapist for an annual visit to be sure they are Carole Lewis is a pri- I go directly to her.” Gotta love it! on track for successful aging, and that therapists can vate practitioner in Third, it’s becoming more widely known that we are deliver a quick, head-to-toe assessment in the areas Washington D.C. and cost savers. Many speakers at the PPS meeting men- of physical function: strength, flexibility, endurance, consultant to Pivot Physical Therapy. She tioned this in their presentations. More research sup- posture and balance. lectures exclusively ports this conclusion, and the media are beginning to Great Seminars Online and Great Seminars and for Great Seminars disseminate these findings. Books will soon launch a new screening tool and and Books and Great Fourth on the list is the genuine eagerness I am seeing training package that will provide physical thera- Seminars Online. She is editor-in-chief of in many newer graduates. There seems to be a hunger pists the tools and training they need to excel in Topics in Geriatric for new knowledge and a commitment to ravenous life- this area. Rehabilitation and an long learning. How can that not be wonderful for the These are just five of the trends we see that are help- adjunct professor in future of our profession? ing our profession grow, and I am so grateful! I am George Washington University’s College This group of new therapists is also very creative and also grateful to our readership for your interest and of Medicine. entrepreneurial. One example is the very funny and support all these years. Thank you. n

www.advanceweb.com/pt December 2016 ADVANCE for Physical Therapy & Rehab Medicine 9 COVER STORY

Professional Physical Therapy, headquartered in Uniondale, N.Y., along with over 100 satellite locations in New York, New Jersey and Connecticut, serves a wide range of patient pop- ulations with a strong focus on sports and orthopedic injuries. With so many clin- ics, Professional takes pride in offering convenience to all their patients. JEEFREYLEESER

11 ADVANCE for Physical Therapy & Rehab Medicine December 2016 www.advanceweb.com/pt A DREAM HONORABLE MENTIONS These deserving practices received ‘Honorable Mention’ REALIZED designations in this MEET OUR 2016 PRACTICE OF THE YEAR: year’s Practice of the PROFESSIONAL PHYSICAL THERAPY Year contest. Read By Dillon Stickle more about them at www.advanceweb. : wning a physical therapy pri- Founded in 1999, Professional PT was the dream com/pt vate practice is hard work, and startup of three physical therapists who observed • Cioffredi & requires a level of dedication that a need for effective, high-quality and individual- Associates can seem intimidating to many. ized patient care. What started as a single clinic in Physical Therapy, Every year, ADVANCE selects a Bayside, N.Y. has grown exponentially into a mul- Lebanon, N.H. Oprivate practice that proves they have what it takes tistate organization with more than 100 locations to run a successful, quality business for our Practice and over 1,000 employees across New York, New • Foothills Sports of the Year Award. From Central Virginia to Texas Jersey and Connecticut. Medicine Physical to California, we’ve searched for the best of the best, “We wanted to start our own thing where we had Therapy, and we’ve made no exception for our 2016 winner: local people with local relationships,” said Adam Phoenix, Ariz. Professional Physical Therapy. Elberg, president and CEO of Professional PT. “We started in a tiny strip mall with the idea that we could • Synergy Physical continue those relationships we had and make sure Therapy & people had the care they deserved and wanted.” Sports Medicine, Jacksonville, N.C. The Gift of Convenience If there is one thing Professional PT takes pride in Now in its 15th over all else, it’s the convenience it offers to patients year, the ADVANCE who lead hectic, busy lives. With so many locations Practice of the Year in one regional area, Professional offers patients the Contest tallies anon- option to receive therapy whether close to their ymous entries from homes or their workplaces. “We are committed to getting across the country patients better as quickly as and scores them on we can in the most conve- a range of success nient fashion; we are truly metrics. The contest the only PT organization is free to enter and in the tri-state area that has never connected the geographic coverage to allow with advertising con- them to go one day near work and tracts or incentives. one day near home,” said Elberg. Look for details to “We can easily accommodate in terms of their electronic medical enter next year’s records being available wherever they go. contest on our web- Professional PT is unique because people site beginning in come multiple times a week and can choose June 2017. COVER STORY

any location that is close to them. Convenience Patients like Meisner are all looking for the members to become certified in clinical spe- is a big aspect of our organization.” same thing — therapists who truly care and cialties, and in 2012 they instituted their own Hillary Meisner, a patient who has received want to help. She found that at Professional seminars division, which offers topics relevant treatment at Professional PT, was pleasantly PT. “I only wanted someone who really knew to the current population through lectures, surprised when she found out she could easily how to help and, after the way they took care workshops, hands-on learning and roundta- work in therapy sessions for herself as well as of me, it’s now the only place I will go. I rec- ble discussions. her children. “My children needed physical ommend them to everyone for any condition.” Such opportunity for advancement around therapy, and I was able to send them to loca- every corner has supplied Professional PT with tions closer to home while I could either go to Ample Opportunities an impressive clinical staff turnover rate of 8%. that one or the one close to my work. It made Every employee in any profession wants the “The greatest aspect of working for them is things really easy for my family.” chance to apply their skills and advance in the growth opportunities that are provided to “We cover every aspect of the physical their careers, moving up the industry ladder. the employees,” said Quinn. “There has always therapy process and we take pride in hav- At Professional PT, that concept is brought to been an opportunity ahead of me. It’s some- ing a wide variety of professionals including fruition at every level. thing to strive for and it keeps our environ- PTs, PTAs and athletic trainers,” added Jaime ment a motivational one.” Quinn, DPT, regional clinical director and staff therapist at Professional PT’s Manhattan Benefits of Giving Back location. “We try to provide the best care and One aspect that sets Professional PT apart is are up-front with our patients about cost and its charitable contributions to local philan- outcome. We also know it takes time out of thropies, including Cycle for Survival and the patient’s day, so we try to make it a part of Miracle Jeans Day. their lifestyle and incorporate an individual- They hold an annual Charity Challenge for ized approach unique to each patient.” employees to split into teams, and each one selects local charities for which to fundraise. Patients are Family Professional donates all the money raised There is a mission statement prominently dis- and matches the winning team’s amount up played at every Professional PT location: “We to $25,000. will work to ensure that each and every patient “We also give everyone a philanthropic Professional PT is constantly working toward clinical has an exceptional experience with our facility, excellence. There are ample opportunities for day where they can volunteer at their place staff and care.” This patient-first culture has employees to advance in their career through CE of choice and we pay them for that day, even resulted in a reputation for being a leader in offerings, internal and external lectures, customer though they’re not at work,” added Elberg. service training and more – one of the many reasons quality and convenient care. they have excelled since their inception in 1999. In 2015, Elberg was selected as “We are probably one of the few organiza- Humanitarian of the Year by Northwell tions that are trying to marry the hospitality Health’s New Leaders Division and helped industry with the healthcare industry,” stated About 80% of the practice’s therapists raise over $500,000 for their Child Life Elberg. “People want to be treated in an envi- started out as students in their Clinical Program. “Giving back is good for our employ- ronment that mimics an experience that you Affiliation Program (CAP). Once hired, ther- ees and it’s good for the community,” he said. associate with fun places, like The Ritz Carlton apists are enrolled in the company’s “novice” or Disney, along with the outstanding quality program, which includes educational require- A Reason to Celebrate of care. People want to get better, but we think ments and opportunities such as knowledge This year, Professional is celebrating its 17th there’s an important piece besides being great tracks, training centers, shadowing programs, anniversary. They are proud of their growth therapists — and that is creating great experi- seminars and lectures, clinical libraries, and continue to impress with their ability to ences for our clients.” advanced clinical education tracks and more. offer high-quality patient care at every one “You don’t feel like a patient when you go “We’re growing quickly, so there’s tons of of their clinics. in for treatment, you feel like family,” said opportunity for advancement,” Elberg told “We’re proud of this honor. We work really Meisner. “Everyone worked together to take ADVANCE. “We try to create career tracks hard every day,” reflected Elberg. “The cus- care of me. They go the extra mile.” for every employee. If you’re a receptionist, tomer experience and charity is more import- One day, while at a clinic for her child’s there’s room for advancement into adminis- ant to us than making a profit. If you keep therapy session, Meisner noticed her neck was tration. If you’re a clinician, but maybe don’t employees happy, you keep patients happy. twitching strangely. Before she knew it, one of want to manage, we have mentorship posi- Then everyone is happy.” Professional PT’s staff therapists helped her on tions available.” It goes without saying that happiness is in the spot to get the kink worked out. “Most Professional PT is so dedicated to offering abundance at Professional Physical Therapy. n places would have told me to use a heat pack room for advancement that they give each cli- and sent me on my way — but not the staff at nician $1,500 annually for continuing edu- Dillon Stickle is on staff atADVANCE . Contact: Professional,” she said. cation credits. They create incentives for staff [email protected]

11 ADVANCE for Physical Therapy & Rehab Medicine December 2016 www.advanceweb.com/pt Understanding Pain Doesn’t Have to Hurt NEUROSCIENCE EDUCATION TOOLS FOR CLINICIANS AND PATIENTS BY ADRIAAN LOUW, PT, PHD

Why You Hurt Therapeutic Neuroscience Education System Teach your patients about their pain with this clinician system. The all-inclusive system delivers immediate clinical application of therapeutic neuroscience education in the form of illustrated flashcards, homework sessions, discussion topics and teaching cues. Features 14 in-depth sections including “Pain Knowledge,” “Sensitive Nerves,” “Calming Nerves,” “Immune System and Pain,” “Emotions and Pain,” and more.

NEW

Why Do I Hurt? Pain Neuroscience Posters Why Do I Hurt? Workbook A Patient Book About the This educational poster set includes This new neuroscience workbook Neuroscience of Pain four 17¾” x 24” posters designed allows patients to understand their This book is designed to teach patients for display in your clinic or practice. pain and how it works in the body. about the science of pain in approachable Featuring the content and recognizable Patients write in the workbook to language with metaphors, examples and illustrations of the patient books, the record their pain experiences and images. It explains how the brain and posters explain foundational principles learn how to treat their condition. nervous system collaborate to create pain. behind the neuroscience of pain so The workbook complements Patients will also learn strategies to lessen patients can understand the reasons the posters, patient book and their pain and treat their condition. why they hurt. clinician system.

Additional Patient Education Books These neuroscience education books use simple language to help patients understand and lessen their pain. Patient books and clinical resources from Adriaan Louw are available exclusively from OPTP.

800.367.7393 | OPTP.COM EARLY INTERVENTION

ventricular enlargement, suggestive of atypi- cal development. Gentle Motion Scans comparing drug-exposed to non-ex- Do children exposed to drugs in-utero need posed controls using volumetric analysis physical therapy? By Brian Scott Hoppestad, PT, MS, EdD demonstrate diminution of the amygdala, putamen, pallidum, brainstem, cerebellar white matter and inferior lateral ventricles. o children exposed to drugs Effects on Brain Development There is diminished cortical volume through- during fetal development sus- The placenta was once thought to be a barrier out, most notably in the right rostral anterior tain lasting damage affecting to drug exposure in the fetus, but it’s been cingulate region and part of the right lateral gross-motor function necessi- established that many drugs do enter the fetal orbitofrontal cortex. tating interventions by physical therapists? bloodstream. Opiates readily cross the pla- Research on opiate drugs in pre-school With the increased prevalence of illicit drug centa, as do most other illicit drugs, perme- and elementary school children demon- use in the general population, including among ating the blood-brain barrier and affecting strates that motor and cognitive impairments pregnant women, this has become a more neuronal development.1,3,5 in pre-natal opiate exposure is enduring salient question. As of 2013, 5.9% of pregnant Within 1-3 days of being born, most babies with nervous system changes in dendritic women aged 15-44 were using non-prescribed undergo symptoms of withdrawal.5 In-vitro length, synaptic plasticity, neuronal prolif- psychoactive drugs, and younger women out- studies of cell cultures and animal models, eration and cholinergic function. Ross et al. pace males of the same age.1 brain imaging analysis and autopsy examina- detailed physiological changes in the brain However, self-reporting of drug use by tions have detected changes in cellular struc- and detected problems in cortical neurogen- pregnant women may be erratic, and many tures of the brain with exposure to substances esis (abnormal growth of dendrites, cortical have polysubstance abuse and use alcohol and such as methamphetamine, cocaine, alcohol, projections and interneurons) and migration, tobacco.2 Other factors that may enhance the opiates and amphetamines. lower cortical density, and impaired dopa- negative effects of drugs on the developing Grewen et al. report that in-utero exposure minergic function. They posit from this data fetus include stress and poor diet.3 to drugs on fetal development differs from that cocaine appears to affect the brain’s A University of California, Berkeley study the effects encountered by adults. Children arousal levels, reflexes and motor coordina- found that while media and anecdotal evi- are subjected to these substances as the brain tion in animal models exposed to MDMA dence appear to point to the severe adverse forms, laying the foundation for future neu- (commonly known as ecstasy).1 effects of drug exposure on the developing ronal connections.6 fetus, research points to the fact that many Hans and Jeremy demonstrated that Gross-motor Consequences ill effects of prenatal exposure to illicit sub- pre-natal cocaine exposure causes decreased A few studies have been conducted to deter- stances are amenable to treatment and that gray matter volumes in the prefrontal and mine the gross-motor consequences of chil- 4 environmental factors are consequential. frontal cortical regions of the brain as well as dren exposed to drugs in utero. Arendt et al. THINKSTOCK/ISTOCK

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Untitled-5 1 1/15/16 12:55 PM EARLY INTERVENTION

reported the loss of fine-motor skills in children and delayed physical pre-natally. While the authors found that Online growth affecting motor skills in babies born to mothers with substance the opiates were not a significant predic- abuse problems, especially in babies exposed to cocaine. However, tor of mental and motor deficits, children the authors maintain that early intervention measures can improve of drug-addicted mothers did score more motor outcomes.4 poorly.5 Kartin et al. observed that binge Van Baar et al. compared children who were born drug-addicted alcohol and drug use combine to delay to a control group of normal children at 44 weeks on various mea- development regardless of the interven- sures including motor responses, finding a significant difference tion. Deficits were noted on the BSID II, during the first week of life and at 44 weeks corrected age for pre- which has a motor section.10 term infants. Children who were drug-exposed scored lower on the For more sensory Peabody Developmental Motor Scale (PDMS) at age 2 in both gross- Implications for Physical Therapy integration articles and fine-motor skills, though other variables such as age, pre-natal care, Do children exposed to drugs in utero and resources visit and environment may influence development. Again, the authors felt require physical therapy to treat gross-mo- www.advanceweb. 7 that it’s important to intervene early. tor deficits? It appears that there may be com/ptpediatrics Kronstadt examined various studies of substance abuse and early structural changes in the developing brain childhood development and found that it’s difficult to find a direct as a consequence of substance abuse in connection between polysubstance abuse and development and parse pregnant women, and drugs have an impact on the development of out the effects of the drugs vs. the environment.8 the CNS on a cellular level. Logan et al. found deficits in motor patterns in methadone-exposed Anomalies in structures and deviations in neural connectivity in infants on the Bayley Scale of Infant Development (BSID III), notably various parts of the brain have been detected on scans, though the in the milestones of crawling and sitting, recommending early inter- significance of these changes on motor development warrants further vention and monitoring.9 study. Studies have found a correlation between drug use and gross-mo- Hans and Jeremy conducted a longitudinal study of mental and tor difficulties. It’s noteworthy that environmental factors also have a motor development in children up to age 2 that were exposed to opiates fundamental impact on motor development. In my experience, I have seen evidence of deficits in the gross-motor capabilities of infants and toddlers exposed to drugs who have been referred for treatment. These children have delayed motor milestones Help Your Patients and impairments in balance, coordination, visual motor skills and strength. They often have co-existing deficits in fine-motor skills and sensory processing capabilities as well as delays in language and compre- hension requiring referrals to OT and/or speech therapy. These children are frequently followed by early intervention specialists and various physicians due to a variety of medical problems. Additionally, some are in environments in which parents or guard- ians are struggling (many are in foster care or adopted, often by other family members) or live in a less-than-optimal setting to foster normal development. I practice in a rural setting in an area of the country that has one of the highest per capita rates of drug addiction. This is a serious A Short Leg Caused By: problem, and if current levels of addiction continue, repercussions with Hip or Knee Replacement, regard to childhood development will be felt in communities across the Fracture of Lower Extremity, country for years to come. Or Other Lower Extremity Issues, Can Diminish Their Quality of Life. Studies revealing motor problems are nascent, and more research is Our Products Can Help Them: needed to definitively link drug abuse by pregnant women to abnormal Rehab Better, motor development and the type of deficits that may be encountered. Walk better, Physical therapy intervention should be instituted early in development And Feel Better. to ameliorate gross-motor problems that may manifest early and per- sist throughout childhood and should play an integral role in helping these children. n

References are available at www.advanceweb.com/ptreferences

www.gwheellift.com Brian Scott Hoppestad is an NDT-certified staff physical therapist at Grace Heel Lift, Inc. 1.800.235.4387 Rehabilitation, Lafollette, Tenn., which contracts with school systems and operates outpatient facilities. He also treats adults with developmental dis- abilities at Open Arms Care, Karns, Tenn.

11 ADVANCE for Physical Therapy & Rehab Medicine December 2016 www.advanceweb.com/pt HOLISTIC CARE

Mindfulness & Meditation Integrating proven holistic strategies into your next therapy session By Sara Daly, PT, CLT, MT

s. Carlson rushes into your the journey and feeling fully present is a have a chance to share a technique that will clinic, hops onto your treat- learned behavior that has tremendous ben- impact their client’s current situation and ment table and proceeds to efits to mind and body. Studies have shown carry on long after the patient has been give you the blow-by-blow that mindfulness training can ease pain in discharged. of her shoulder since she saw you last week. musculoskeletal conditions.1 In therapy, we can use the concepts of She describes her pain level, explains how the Imagine eating a $50 piece of the most mindfulness by incorporating specific tech- exercises have been done (or not done) and incredible dark chocolate. You would savor niques during treatment sessions. My team catches you up on her current events. Before you know it, your time with her is Nature is a powerful tool for healing, and studies over, she’s given a fresh set of exercises and you have documentation to complete. You have shown that being in nature promotes health. perform this routine 10 times per day, and life becomes a blur of joints, pain scales and the experience, paying attention to the tex- has developed a patent-pending therapeutic SOAP notes. Luckily, there is a way to reduce ture and the aroma, enjoying the sensation technique we’ve termed a’chromatherapy™. stress for you and your client: mindfulness of the chocolate on your tongue and how This simple and effective technique uses training. it sounds as you bite into it. We are mind- the multiple modalities of color therapy, ful when we take it all in, feel positive and aromatherapy, guided meditation and Concepts of Mindfulness process the moment. nature imagery to bring about a sense of My definition of mindfulness is “to distill Clients miss the information and educa- well-being. an experience so that it becomes a mem- tion we provide them for a variety of reasons, ory.” If you have a hard time remembering and being mindful is certainly at the top of Imagery and Meditation what happened, the experience hasn’t been the list. They are distracted, not enjoying the Nature is a powerful tool for healing, and

THINKSTOCK/ISTOCK mindful. Being in the moment, enjoying experience or in a negative state. Therapists studies have shown that being in nature

www.advanceweb.com/pt December 2016 ADVANCE for Physical Therapy & Rehab Medicine 11 HOLISTIC CARE

2 promotes health. Images of nature can reinforce this, and we use nature Motivation, emotion, learning and Online images as a first step in the program. memory all take place in the limbic sys- Clients are asked to choose one of seven nature images. We ask them tem. Aromas help cement the neurolog- where they’d want to go if they could be in one of these photos right ical pathways in the brain and recreate now. By imagining ourselves inside the nature scene, we take deep a positive experience when the aroma is breaths and clear the mind of possible negative images such as discom- smelled. fort. Studies have shown that visualization can reduce stress, elevate the immune system and impact white blood cell counts.3 Therapeutic Insights Listening to guided meditation is a helpful tool for anyone learning This treatment approach has proven very how to meditate and relax. Guided meditations take your client into effective during shoulder manipulations, the image of their choice. This allows them to connect more deeply during which any resisting or guarding For a series of patient handouts on holis- to nature, to clear their mind and to be in a positive and optimistic from the client restricts results. Using a tic care visit www. mindset. Studies have shown that meditation can speed healing and five-minute a’chromatherapy session with advanceweb.com/ 3 decrease pain. heat allows better accessibility into the pthandouts and select Color is used every day to create moods. Many prisons have pink joint from the therapist’s perspective. ‘Health and Wellness.’ walls to calm inmates. Eating off of a blue plate has been reported to I often speak with the client to get decrease hunger and companies choose colors in their logos to make them to visualize the shoulder joint us react. We have found that people relax when they choose the color opening, creating images with them that there is space in the shoul- that makes them feel good. der. It takes practice to learn how to guide a client through visual- Likewise, aromas in essential oils have been used for centuries izing a positive result. Professional athletes have been visualizing in healing. When studying them, we found that pairing a scent to outcomes for years, and this practice is very effective when translated a nature image and a guided meditation enhanced the feeling of into a therapeutic application. well-being. Later, we were able to use only scent to recreate the feel- Mindfulness and meditation training is used in a variety of clinical ing of stress reduction. settings with exceptional results. In senior living and dementia care environments, mindfulness and meditation training are employed to decrease anxiety. Group sessions are held as a part of clients’ daily schedules to keep anxiety at bay. Residents are using mindfulness training as part of their care plans and to reduce the use of psycho- tropic drugs. In hospitals, mindfulness training is used in labor and delivery units to reduce stress among mothers during early labor. Connecting to nature, guided meditation and aromatherapy reduce pain levels and allow laboring mothers to use alternative pain methods readily. Infusion centers are another area in which stress can be reduced Yo u’re via meditation. All This in a Half Hour Session? If you’re reading this The program we devised can be completed in less than five minutes. Studies show that perceived stress levels can be reduced up to an average issue, your name is of 75% in five minutes. It’s worth the time to realize these immediate already on the list. and powerful results. IN! If you’re having your client stretch, have them stretch while listen- Every physical therapy and rehab medicine professional ing to the meditation they chose. If they are being positioned on heat is welcome beyond the velvet rope when they come to or ice, allow them to listen to a guided meditation and visualize that our website. And because you’re a member of that elite they’re on a dock by the ocean. Encourage all team members to learn group, you have exclusive access to tons of premium this practice. It’s great for assistive personnel, nurses and other rehab content. All you need to do is finalize your free online professionals working as a team to reduce stress and improve healing. account and the doors will swing wide open. Your clients can practice mindfulness and meditation at home, and it can be part of their treatment plan. Not only will they effectively Go here to get the VIP treatment! 4 j.mp/advancevipt improve their brain’s gray matter, but they’ll be able to relax more quickly and effectively on your treatment table. n

References are available at www.advanceweb.com/ptreferences

Sara Daly is CEO of Waterfalls Day Spa, Middlebury, Vt.

11 ADVANCE for Physical Therapy & Rehab Medicine December 2016 www.advanceweb.com/pt

192881_PT_Subscription_Ad_1/4.indd 1 3/9/16 10:11 AM GERIATRICS

Therapists at Shuksan Healthcare Center in Bellingham, Wash., fine-tune their fall prevention approach for each patient. At left, holiday decorating is a meaningful activity that reinforces reaching and weight-bearing. At top, a former professional musician plays the piano while standing during rehabilitation from a fall sustained at home.

time restrictions placed on therapists. How can we satisfy the patient, doctors The Balancing Act and insurance companies? The current trend Achieve more with less while fine-tuning your fall is personalizing care to achieve outcomes more quickly by addressing patients’ deficits. prevention approach By Jennifer Bauer, MSPT The constraints we must work within include reimbursement and length-of-stay restrictions he “Silver Tsunami” is approach- number rises. Therapists in skilled nursing along with the pressing initiative to reduce ing, and therapists need to be facilities must fine-tune their approach to fall hospital readmissions. prepared. As the baby boomer prevention, thereby streamlining their bal- These require us to be as efficient as pos- generation enters retirement age ance and gait training techniques. sible with each treatment. We do this by and the medical system, therapists must ready At Shuksan Healthcare Center, a 52-bed triaging the content of our care plan, per- themselves for a unique set of standards. short-term rehabilitation and skilled nursing forming exercises that combine multiple Cookie-cutter protocols simply aren’t facility in Bellingham, Wash., we see this muscle groups and focusing on function acceptable any longer. Boomers want cus- trend. While our patients share the goals of and safety. tomized programs and more personalized improving function and returning home as care; this is the trend. soon as possible, our approach to each patient Back to Basics According to the National Council on is unique. Not only do patients appreciate Our team begins with a full musculoskele- Aging, 25% of the population over age 65 this personalized approach, it’s quickly tal evaluation. This provides objective infor-

COURTESYSHUKSAN HEALTHCARE CENTER, BELLINGHAM, WASH. falls each year. As the population ages, this becoming necessary due to the fiscal and mation of weak muscle groups and range of

www.advanceweb.com/pt December 2016 ADVANCE for Physical Therapy & Rehab Medicine 11 GERIATRICS

motion that is lacking. In general, the most important muscle Online groups to strengthen for functional balance ADVANCE maintains a specialty site focused on balance rehab. are the dorsiflexors, knee extensors, hip exten- Visit www.advanceweb.com/ptgaitandbalance sors and hip abductors. Conversely, the most common muscles that require stretching are the plantarflexors, knee flexors and hip flexors. patient by progressing to a narrower base of sup- Not Just Walking a Patient When these muscle groups are appropriately port, changing the stability of the surface on Effective balance training carries over to balanced, an individual’s ability to perform which a patient stands and decreasing feedback improving a patient’s gait. Instructing patients safe functional mobility is improved. from their environment. To add a challenge to to normalize their gait pattern can be initiated The cascade of problems caused by weak any of these stages, add upper-extremity activity in parallel bars utilizing demonstration, a full- or tight muscles is inevitable, and it is our to further challenge balance. length mirror and tactile cues and facilitation specialty as physical therapy professionals It’s not outside our scope to screen for visual from the therapist. to identify and correct these imbalances. deficits and to recommend a medication review It’s important however to get into the hall- Tight plantarflexors or weak dorsiflexors put when we feel it’s indicated. As the healthcare way as soon as possible to practice the rhythm a patient at risk for tripping over their toes professionals patients spend the most time of gait that can only come with repetition. while walking. with, we can draw attention to issues that may Therapists should prevent improper gait pat- The same muscle asymmetry also causes otherwise be overlooked, and these factors can terns from becoming ingrained but also refrain impaired balance in standing when hyperex- have a big effect on balance and safety. from becoming overwhelming with corrections. tension of the knee causes flexion at the hips What does this look like at a skilled nurs- Using the right verbal and tactile cues at the to maintain a person’s center of gravity over ing facility? Meet our former professional right moment can be the most important thing their base of support. Functionally, we see accordion player Ms. June. She came to us to recognize. Repetition is key. this in people having difficulty bringing their with a left humeral fracture after a fall at Meet our gracious resident Ms. Ardis. She feet underneath their chair when preparing to home. Her physicians expected us to rehabil- came to us with a periprosthetic femur fracture stand from a sitting position, which increases itate her left arm, but we knew it was equally after eight weeks of being non-weight bearing. their risk for falls during transfers. important to improve her balance and help By this time in her recovery, she’d been com- Don’t chase the symptoms; address the root prevent future falls. pensating for so long that she was now hesitant of the problem to make a difference in creating We incorporated traditional treatment strat- and fearful to weight-bear on her affected leg. more timely outcomes. Specific exercises for egies to improve function in her arm, but dis- We practiced weight-shifting and walking balance training should be very individualized covered that she was most receptive to therapy in parallel bars, but Ms. Ardis continued to and challenge a patient a bit beyond the current while playing the piano, dancing and singing. off-load onto her arms. We quickly realized comfort level. In general, you can challenge a While she played the piano in standing, we we’d need to be creative to defuse her anxi- stabilized her proximal humerus as she used ety. One of her favorite activities was helping both hands to charm us with her rendition of us decorate for the holidays. We would work “That’s My Baby.” on reaching, weight-shifting and building her MEDICAL CLAIMS & We asked her to vary her foot position confidence, all of which improved her balance BILLING EXPRESS to engage functional muscle groups as she and carried over to normalize her gait. naturally swayed to the music. Added ben- FULL MEDICAL BILLING SERVICE* efits included resolving the swelling in Ms. Individualized Care for Best Outcomes LONG List of Services, Including: June’s left hand and forearm along with The current challenge of care in skilled nursing • One Person Contact System; that’s just improved morale among nearby patients facilities is balancing outcomes, dealing with one person to contact ALWAYS with any questions Mon-Sat, 9 AM-10PM! and staff. insurance restrictions and preventing hospi- • 24 hr Online Access to View All Claims Let’s get back to the original question of tal readmissions. No matter their diagnosis, Sent, Status of Claims & More* how to make everyone happy. Insurance com- patients want to walk and not fall. • Credentialing/Contracting Services panies require standardized test scores for bal- We must go back to the basics and evalu- 2016 Promotions: ance to justify continued payment for therapy, ate each patient’s needs. It’s not a one-size- • FREE Trial Offer and we use these scores to justify the impact fits-all package any longer. Individualizing • Drop in our Already LOW RATES for First 3 Months we have on outcomes. They are also a good patient care and working with them toward • Waiver of Set-Up Fee tool to see where our patients begin to falter reaching their goals faster leads to better out- • No Contractual Obligations in their abilities, which can show us where to comes, along with happier, safer and more begin in balance training exercises. balanced patients. Why not have a little fun MCBExpress...YOUR PATH TO PRACTICING The score itself will not reveal the whole pic- while you’re at it? n WITH PEACEC OFO MIND* ture. You must know where to intervene based Jennifer Bauer is lead physical therapist at www.mcbexpress.net • (215) 900-3818 on what you see in your functional evaluation to achieve the best outcomes. Shuksan Healthcare Center, Bellingham, Wash.

22 ADVANCE for Physical Therapy & Rehab Medicine December 2016 www.advanceweb.com/pt MANUAL THERAPY

Hands-On Approach to PT Grounded in evidence, manual therapy improves patient outcomes By Katherine Bortz

here is nothing new about the concept of “hands-on” physi- cal therapy treatments. Various studies show that conditions such as low-back pain and musculoskeletal pain are effectively treated with a combina- tion of manual therapy and other treatments such as exercise and strengthening. Manual therapy, according to Craig O’Neil, PT, DMT, OCS, COMT, vice president of clinical excellence at Results Physiotherapy, a Tennessee-based network with over 100 locations, is much more than a set of tech- niques. “Current manual therapy is not only technique, but it is also skilled examination, clinical reasoning and a movement-analysis thought process that integrates the neuromus- culoskeletal system at all levels,” he said. Adam Lever, PT, DPT, ATC, staff physi- cal therapist and member of Drayer Physical Therapy’s orthopedic residency program in Mechanicsburg, Pa., believes that perform- ing manual therapy on his patients “allows for more of a connection with the patient and allows you to physically change some- Online thing, whether it’s muscle tone, flexibility or More manual therapy articles and resources are available at joint mobility.” According to Lever, he per- www.advanceweb.com/ptpainmanagement forms some form of manual therapy on every patient he sees at the clinic. one-size-fits-all treatment. Certain condi- Protocols and techniques for manual Conditions Treated tions should be considered before beginning therapy can be learned through school- Though the two physical therapists are at or continuing manual therapy. Aggressive ing, residency programs and continuing different points in their careers, both recog- joint mobilization may not be the best option education courses, but the patient should nize the broad range of conditions that can for someone with a healing fracture, rheu- be taken into consideration when choos- be treated with manual therapy. “The power matoid arthritis or osteoporosis. Ultimately, ing which technique to use. “What I’ve of touch can cause a number of benefits to if a particular manual therapy technique learned through my residency training are occur within the nervous system,” O’Neil does not benefit the patient or if the patient specific mobilization and manual therapy said. “There are mechanical, psychological, has already achieved their desired results, it techniques that are very effective,” Lever physiological and biochemical results, and should not be performed. said, “but a lot of times, you’ll see clinicians there are very few things that we treat that that have five different techniques they use can’t benefit from that level of influence.” Protocol and Techniques Used on anybody, and they don’t retest a specific The influence of hands-on therapy can While the previously mentioned protocols movement or function to see if it’s actually be achieved through joint mobilization and and techniques are applied in physical ther- making a change.” manipulation, soft-tissue manipulation, apy clinics and facilities across the country, O’Neil agrees that there tends to be a “dog- hands-on guidance or retraining movement, Lever claims that joint-specific techniques matic approach” to manual therapy. “Hands-on trigger-point dry needling and instrument-as- tend to work best for many patients. “When physical therapy works in many different ways, sisted manual therapy. you have a joint stiffness, [physical therapists] and I think it’s useful for our profession to When treating patients, it is important can easily get in there and quickly change understand what manual therapy has evolved

THINKSTOCK/ISTOCK to remember that manual therapy is not a that condition,” he said. into from what it was,” he said.

www.advanceweb.com/pt December 2016 ADVANCE for Physical Therapy & Rehab Medicine 22 MANUAL THERAPY

Test, Retest and Test Again understand why exactly they need to be [in the therapy. Historically, we’ve thought of man- Both O’Neil and Lever noted how using the clinic] for physical therapy,” Lever said. “They ual therapy as a very mechanical approach to right interventions at the right time creates will be able to see how it helps their symptoms movement, but understanding the effect that it positive results in almost all areas to some and change their functioning at home.” has on patients’ nervous systems, their expec- extent, from the cervical spine to the hand. By allowing a place for reassessment after tations and ultimately the outcomes…we need However, Lever firmly believes that without manual therapy during a physical therapy ses- to learn how to understand how to integrate evaluating and then re-evaluating the affected sion, the therapist and patient are able to take that into our treatments to further enhance area, there is no way to see progress. the time to see whether the patient feels better the effects of manual therapy.” “We go through specific mobilization and and if the affected area looks different. If the While some newer and increasingly popular manual therapy techniques, but more than attempt to change the area was ineffective, a techniques have received media attention, such anything, my standard protocol is to test and new technique can be applied. as trigger-point dry needling, this hands-on then retest to see if the techniques have made approach to change muscle tone is not avail- a difference,” Lever said. “If someone’s hav- The Future of Manual Therapy able in physical therapy clinics in every state. ing trouble going down steps and it’s caus- The positive effects that manual therapy can Currently, eight states (California, Florida, ing a lot of ankle pain, I’ll do some type of provide seem almost endless, but what will the Hawaii, Idaho, New York, Pennsylvania, South manual therapy on the ankle to change those future of physical therapy look like in regard Dakota and Washington) do not allow physical symptoms and retest right after I use those to manual therapy technique and protocol? therapists to perform this type of manual ther- manual techniques.” O’Neil thinks that therapists should look apy. Lever expects that in the future, patients In addition to the fact that reassessment further into the way our bodies process pain. should see more therapists using instrument-as- allows the physical therapist to determine “The integration and understanding of pain sisted manual therapy and techniques such as what steps must be taken in real time to help science and the way that manual therapy works dry needling. n the patient, retesting manual therapy results beyond the mechanical effects is the biggest also helps with patient buy-in. “If the patient change coming in our future,” he said. “It will Katherine Bortz is on staff at ADVANCE. can see the improvement, they’re going to definitely maximize the benefit of manual Contact: [email protected]

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22 ADVANCE for Physical Therapy & Rehab Medicine December 2016 www.advanceweb.com/pt INDEPENDENCE

Magrann, OTR/L, CDRS, of MossRehab’s Driving Program in Philadelphia. “This Welcome Home includes whether they need adapted devices How driver rehabilitation programs improve quality of for any physical dysfunction or not. life for veterans who have given life and limb in service “If they do need adaptive equipment, regardless of whether it’s addressing the loss By Tamer Abouras of a limb or a spinal cord injury, we move through the process of finding the proper s much as things may change, commodity of sorts, to the degree that hav- equipment that will best meet their need,” many others remain the same. ing it taken away can leave one feeling out continued Magrann. “From lower-tech And innovations to high-speed of step with one’s peers. equipment such as a left-foot pedal, mechan- rail, ride-sharing apps and other This can be of particular issue to those ical hand controls or a spinner knob, and up forms of public transportation notwithstand- whose loss of the capabilities to drive through the higher end of the spectrum with ing, the fact is that driving a car is a practical is sudden — such as those who suffer head things like joystick driving, electric hand necessity for many Americans. injuries, senior citizens whose cognitive controls and steering, or driving from your Whether as a means of commuting to functions begin to sharply decline, and wheelchair, there’s a wide range of options work or school, shopping for groceries and especially military veterans who return with regard to adaptive equipment.” household supplies, or simply for social pur- home with life-altering wounds requir­- Describing his involvement in the driver poses, driving is a great equalizer for millions ing amputation. rehabilitation process, Magrann noted that who do not live in metropolitan areas with although he is an occupational therapist, efficient public transportation systems. And Getting Back on the Road his certified driver rehab specialty is most even if the desire is not purely practical, the “When someone first presents to us, we’re utilized in the middle and latter stages of a

THINKSTOCK/ISTOCK freedom to get behind the wheel and go is a evaluating what their needs are,” said Dennis patient’s overall recovery.

www.advanceweb.com/pt December 2016 ADVANCE for Physical Therapy & Rehab Medicine 22 INDEPENDENCE

Since driving is such a well-established, practical necessity, it’s heartening to know that those who have sacrificed so much have access to a program that helps get them back behind the wheel.

“Generally speaking, those of us in driver available, while others might be deterred by the is my social responsibility to do as much as I rehab typically get involved toward the mid- costs of adaptive equipment. But the reality is can to give back to all who have served. We dle or end of the process. First, a doctor that many often just want the ability to drive donate to, sponsor and support veterans’ ini- needs to make sure a person is medically and see their family and friends.” tiatives as well as offer military discounts to stable with their condition. A lot of times, Magrann did mention, however, that the service members, retired military, veterans, we’ll wait for what physical and occupa- U.S. Department of Veterans Affairs (VA) spouses and their families for all our products tional therapy say about moving forward does sponsor driver rehab. and services.” with their rehab.” Magrann added that these Meanwhile, Magrann said, initiatives such evaluations can cause recovery and rehabili- Sponsoring Servicemen and Women as this that seek to secure funding continue tative timetables to vary depending on inju- As Magrann pointed out, the VA does invest to be a necessity for American veterans — ries and symptoms. in driver rehabilitation programs, which helps and especially those requiring driver rehabil- “If someone has a head injury one week, you address the needs of servicemen and women itation — despite the fact that the VA itself wouldn’t expect them to take a test the next,” who come home from conflict with signifi- sponsors a driver rehabilitation program and he explained. “The same goes for a stroke. cant injuries. Moreover, numerous nonprofit includes that course of care among veterans’ On the average, someone with a mild con- organizations work closely with the VA to help healthcare needs. According to Army veteran cussion or stroke might wait a few months to fund these medical services and provide better William Mitchell of Dallas, “The only reason test, while those with more significant injuries care for wounded soldiers. you won’t get something out of this program (including spinal cord injuries) might have a Just this past Veterans’ Day, Disabled is if you don’t want it.” wait that is several months or possibly a year, American Veterans (DAV) Charitable Service The organization states, “VA offers vehi- depending on the severity and some of the Trust partnered with an organization called cle modifications and subsidies for Veterans other variables involved, like getting a wheel- VINSmart in just such an initiative. Per a with limited mobility to install equipment chair for instance.” VINSmart press release, the company donated that allows them to manipulate every feature Magrann added that though the require- all proceeds from purchased vehicle history that any other driver would adjust. For some ments for a certified driver rehabilita- reports between Nov. 11 through midnight 100% service-connected Veterans, VA will tion specialist (CDRS) credential from Nov. 14, 2016 to benefit the DAV Charitable purchase and install the technology and offer the Association for Driver Rehabilitation Service Trust. up to $11,000 for a new vehicle. VA prefers Specialists (ADED) is a national certifica- According to VINSmart, the trust “sup- to install the equipment on new vehicles, but tion, the medical requirements for helping ports physical and psychological rehabili- will retrofit any vehicle less than three years patients through driver rehab and those who tation programs that give direct service to old and with less than 35,000 miles. The cost need vehicle adaptations vary from state to ill, injured, or wounded veterans. The DAV for the materials and labor can be as high as state. In either case, the ADED website is Charitable Service Trust supports driver’s $50,000.” the best resource for finding out information rehabilitation services for veterans with The VA website also lists locations in each specific to yours, he said. traumatic brain injuries, post-service men- state in which its medical centers offer driver Regarding insurance, however, Magrann tal health services, and more. The trust also rehabilitation services. And with regard to stated that several patients can have their helps to fund programs that supply food, shel- regained freedom and independence, Mitchell, treatment funded through vocational rehab. ter and other necessary items to homeless or who lost use of both legs in a 1999 motor vehi- “Many of those coming to our facility pay out at-risk veterans and their families.” cle accident, said, “I’ve become the errand-run- of pocket,” he said, as some insurances do not VINSmart is a product of NOBEL Systems, ner in my family — I do all the shopping, I go cover driver rehabilitation. whose founder weighed in on the partnership: to the cleaners, I can go out to eat. Everything “I’ve had people who have gone several “I’m very appreciative to all veterans and I used to do before, I can do now.” years without driving,” he added. “In some active-duty military who have done and con- Since driving is such a well-established, cases, they’re unaware that these services are tinue to do so much for our country. I feel it practical necessity, it’s heartening to know that those who have sacrificed so much have access to a program that helps get them back behind the wheel. n Online For a Patient Handout on navigating winter weather for amputees visit www.advanceweb.com/pthandouts Tamer Abouras is on staff at ADVANCE. Contact: [email protected].

22 ADVANCE for Physical Therapy & Rehab Medicine December 2016 www.advanceweb.com/pt EDUCATION OPPORTUNITIES

This course awards 15 EBP CEUs through the BOC! Mention ONLINE SEMINARS JAN. 20-22, 2017 HOUSTON, TX this ad to receive a 10% tuition discount. Contact: Postural ONLINE EDUCATION Kinesiotaping 3 & 4 Restoration Institute, Toll-free: 888-691-4583; www.postur- January 20, 2017 Kinesiotape 3: Clinical concept and Become Your Own Boss: Starting alrestoration.com advanced whole body application. January 21, 2017 An In-Home Therapy Practice Kinesiotape 4: Specialty Pediatric concepts. January 22, JAN. 21-22, 2017 PHOENIX, AZ Reap the personal and financial benefits of working for 2017 Kinesiotape 4: Specialty Sports concepts. These spe- FEB. 11-12, 2017 SAN FRANCISCO, CA yourself! This online seminar will teach you the ins and outs cialty Kinesiotaping courses provide lab times to practice FEB. 18-19, 2017 PALM BEACH, FL of how to successfully start and operate an in-home therapy skills on new concepts through a variety of clinical appli- Pelvis Restoration practice under Medicare Part B. Therapists will learn about cations. Specialty courses focus on applications correlated Advanced lecture and lab course designed to assist clini- the start-up process, business structures, Medicare Part B to specialty areas of pediatrics and sports. Location: Texas cians with complex patients struggling to improve. Gain an requirements and regulations, proper documentation and bill- Children’s Hospital Feigin Center. Contact: Mitzi Wiggin, appreciation for the influences of an asymmetrical pelvis ing and marketing and practice expansion. Participants can 832-826-6107; e-mail: courseregistrations@texaschildrens. and how this imbalance contributes to pelvis dysfunction. access the seminar through our web site. Contact: In-Home org for more information; or www.texaschildrens.org/pmr to We will explore in detail the function of the pelvic inlet and Therapy Services, LLC, 888-253-6077; www.inhomethera- register online. outlet as it relates to anatomy, respiration, and asymmetry in pyservices.com for more information and to register online. a multiple polyarticular chain system. Learn to restore pelvic JAN. 21-22, 2017 FREDERICK, MD and respiratory neutrality through a PRI treatment approach. ONLINE EDUCATION FEB. 11-12, 2017 ATLANTA, GA Treatment integration to assist with the following pelvic floor Three Great Options FEB. 25-26, 2017 SPOKANE, WA dysfunctions will be discussed: incontinence, hypertonicity, Clinician’s View® offers Unlimited CEUs for one low price. Postural Respiration prolapse and sacroiliac instability. This course awards 15 Three great options. 7 months for $177, 1 Full Year for $199 Clinicians will gain an appreciation for the postural influences EBP CEUs through the BOC! Mention this ad to receive a 10% and Super Saver 2 Full Years for $299. Over 640 contact of: rib torsion, asymmetrical oblique strength, inconsistent tuition discount. Contact: Postural Restoration Institute, Toll- hours approved for CEUs by BOC for Athletic Trainers, New breathing patterns, habitual use of accessory respiratory free: 888-691-4583; www.posturalrestoration.com York, California and Illinois state PT Boards, and accepted in musculature & a positionally restricted diaphragm. The focus of this course will be to assess and restore polyarticular JAN. 25-27, 2017 LARGO, FL numerous other states. Check our website for states accept- muscular chain function of the thorax. Treatment interven- FEB. 9-10, 2017 LARGO, FL ing Clinician’s View® courses. Take as many courses as you tions including manual & non-manual techniques to restore FEB. 22-24, 2017 LARGO, FL want for the duration of your unlimited coupon. Contact: reciprocal and alternating respiratory & rotational function Get AIB Certified in 575-526-0012; or www.clinicians-view.com for previews of of the thorax will be covered. Participants will be able to Vestibular Therapy all courses and details. Click on Unlimited CEU offer. immediately apply PRI clinical assessment and intervention The American Institute of Balance has trained thousands of therapists from around the world and is one of the few insti- ONLINE EDUCATION strategies when treating diagnoses such as shortness of breath, thoracic outlet syndrome & shoulder dysfunction. tutions that provide certification. Our 3 day program includes Tired of Boring Online Courses? Learn and earn 5 hours of continuing education credit from our exciting, interactive and clinically focused online DemandDDeemaandnd forforor physicalphyh siicaal therapiststhere appisststs courses: Hip Fracture, Multiple Sclerosis, Total Knee & Hip Arthroplasty, Functional Assessment & Treatment, Gait iss eexpectedxppecectet d to growgrow nationallynatiiono allyly byby 1 and Balance, Knee Osteoarthritis, Seating and Mobility, 34%344% bbetweenete weweeenn 20142010 4 andand 2024.2024 . Lumbar Stenosis, Wiihabilitation, Stroke, Medically Complex, G-codes, Vestibular, Documentation and Home Health. Well- WestWWeestt CoastCooaasts UniversityUniiveersiti y offersofferss known instructors such as Dr. Carole Lewis and Dr. Richard a focusedffocucusseed DoctorDDooctoorr ofof PhPPhysicalysysicala Bohannon bring these courses to life with real patients, TherapyTThherraappy deddegree.grg eee . case studies and a focus on practical application. Fast and easy to complete. 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Learn assessment and management Commission on Accreditation in Physical Therapy Education (1111 North Fairfax Street, Alexandria, VA, 22314; phone: 703-706-3245; email: accredita- skills when treating piriformis syndrome, right SI joint dysfunc- [email protected]). Candidate for Accreditation is a pre-accreditation status of affiliation with the Commission on Accreditation in Physical Therapy Education tion, and low back strain. This course awards 15 EBP CEUs that indicates that the program may matriculate students in professional courses and that the program is progressing toward accreditation. Candidate for Accreditation is not an accreditation status nor does it assure eventual accreditation. Graduation from a physical therapist education program accredited through the BOC! Mention this ad to receive a 10% tuition by the Commission on Accreditation in Physical Therapy Education (CAPTE), 1111 North Fairfax Street, Alexandria, VA 22314; phone; 703-706-3245; discount. Contact: Postural Restoration Institute, Toll-free: 888- [email protected] necessary for eligibility to sit for the licensure examination, which is required in all states. 691-4583; www.posturalrestoration.com For graduation rates, median debt of graduates completing these programs and other important information, visit westcoastuniversity.edu/disclosures

www.advanceweb.com/pt December 2016 ADVANCE for Physical Therapy & Rehab Medicine 22

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Geriatric Therapeutic Exercise Taking Balance to the Limits Using Effective Examination and Intervention Janene Barber, PT, GTC Strategies to Guide Exercise Prescriptions Mission Viejo, CA ...... February 25-26, ‘17 Mark Traffas, PT, GTC Jackson, MS ...... April 29-30, ‘17 Iowa City, IA...... April 29-30, ‘17 Billings, MT ...... July 22-23, ‘17 Seattle, WA ...... July 22-23, ‘17 Nashville, TN ...... September 16-17, ‘17 Bismarck, ND ...... August 12-13, ‘17 Clinical Geriatric Neurology Fort Lauderdale, FL ...... October 14-15, ‘17 Putting It All Together Effective Examination and Intervention Strategies Birmingham, AL ...... November 4-5, ‘17 Using Case Studies for Excellence in Evidence-based Dr. Carole Lewis, PT, DPT, GTC, GCS, Geriatric Treatment, One Patient at a Time MSG, MPA, PhD, FAPTA Cancer Rehabilitation Linda McAllister, PT, GCS, GTC, CEAGN San Luis Obispo, CA ...... March 25-26, ‘17 An Evidence Based Course for All Clinicians Chicago, IL...... April 29-30, ‘17 West Orange, NJ ...... August 12-13, ‘17 Nicole L. Stout, MPT, CLT-LANA Toledo, OH ...... December 2-3, ‘17 Columbus, OH ...... October 14-15, ‘17 Kansas City, KS ...... April 29-30, ‘17 Dallas, TX ...... November 4-5, ‘17 St. Paul, MN ...... May 20-21, ‘17 Rehab of Persons with Tacoma, WA ...... September 16-17, ‘17 Common Medical Pathologies Clinical Geriatric Orthopedics Toms River, NJ ...... December 2-3, ‘17 Dr. Steven Tepper, PhD, PT Safe and Effective Evaluation and Treatment Jacksonville, FL ...... March 25-26, ‘17 Dr. Carole Lewis, PT, DPT, GTC, GCS, Rehabilitation for Older Adults with Dementia Las Vegas, NV ...... April 29-30, ‘17 MSG, MPA, PhD, FAPTA Maximizing Our Impact Washington DC ...... July 22-23, ‘17 Baltimore, MD ...... March 4-5, ‘17 Greenville, SC ...... August 12-13, ‘17 Julie Ries, PT, PhD New York, NY ...... April 29-30, ‘17 Lafayette, LA ...... September 16-17, ‘17 Cherry Hill, NJ ...... April 7-8, ‘17 New Orleans, LA ...... TBA St. Louis, MO ...... October 14-15, ‘17 Kissimmee, FL ...... September 16-17, ‘17 Madison, WI ...... July 22-23, ‘17 New Rochelle, NY...... November 4-5, ‘17 Charleston, SC ...... December 2-3, ‘17 Safe Steps: Measuring Gait and Balance to Show Treatment Works Manual Therapy for the Geriatric Patient Rehabilitation for Osteoporosis Dr. James Wall, BSc, MSc, MEd, PhD Fit and Frail with a Pilates Emphasis Maitland, Mulligan, and McKenzie Hawthorne, NJ ...... March 25-26, ‘17 Sherri Betz, PT, GCS, CEEAA, PMA®-CPT Techniques for the Older Patient Phoenix, AZ ...... May 20-21, ‘17 Omaha, NE...... May 20-21, ‘17 James Gose, PT, DPT, OCS, Cert. MDT, COMT, CMP Oklahoma City, OK ...... August 12-13, ‘17 Allentown, PA ...... July 22-23, ‘17 Indianapolis, IN ...... April 29-30, ‘17 Savannah, GA ...... October 14-15, ‘17 Spokane, WA ...... May 20-21, ‘17 Lincoln, NE ...... July 22-23, ‘17 Put Some Muscle Into Ther Ex Total Joint Arthroplasty Dr. Wendy Anemaet, PT, PhD, GCS, CWS, GTC, COS-C Richmond, VA ...... September 16-17, ‘17 Alisa Curry, PT, DPT, GCS, GTC Cheyenne, WY ...... May 20-21, ‘17 York, PA ...... November 4-5, ‘17 Portland, OR ...... March 25-26, ‘17 Amarillo, TX ...... July 22-23, ‘17 Atlanta, GA ...... May 20-21, ‘17 Twin Falls, ID ...... September 16-17, ‘17 Clinical Implications of Pharmacology for Syracuse, NY ...... July 22-23, ‘17 Therapists Working with Older Adults Denver, CO ...... August 12-13, ‘17 Kenneth L. Miller, PT, DPT, GCS, CEEAA Home Health: A Specialty of Its Own Philadelphia, PA ...... September 16-17, ‘17 Bristol, TN - 1 Day, 10 Hours ...... February 25, ‘17 Deborra Rodgers, PT, GCS, GTC, CEEAA Salt Lake City, UT ...... March 25-26, ‘17 Middleburg Heights, OH ...... May 20-21, ‘17 Powerful Treatment for Fragile Patients Raleigh, NC ...... April 29-30, ‘17 Birmingham, AL ...... July 22-23, ‘17 Muscle Energy and Soft Tissue Releases San Jose, CA ...... August 5-6, ‘17 Sioux City, IA ...... TBA Des Moines, IA ...... October 7-8, ‘17 Wilmington, NC ...... TBA Carleen Lindsey, PT, MScAH, GCS, CEEAA Derby, CT ...... October 14-15, ‘17 Acute Care Rehabilitation Comprehensive Rehabilitation Mark Nelson, MPT Strategies for the Geriatric Patient Home Study Courses See website for details. Venice, FL ...... May 20-21, ‘17 Doug Dillon, PT, GTC, CSST San Antonio, TX ...... September 16-17, ‘17 South Bend, IN ...... August 12-13, ‘17 Improving Mobility in Older Persons with Functional Greensboro, NC ...... October 14-15, ‘17 Palm Springs, CA ...... September 16-17, ‘17 Assessment & Treatment San Mateo, CA ...... November 4-5, ‘17 Albuquerque, NM ...... October 14-15, ‘17 Health Promotion & Exercise for Older Adults Rehab Roadie: Ride and Learn! (5 hrs)

Toll Free 1-877-794-7328 All GREAT Courses are 20 Contact Hours. Qualify for your Geriatric Training CertiÚ cation once you Email: [email protected] have completed 8 courses. See website for details. Visit our website for clinical tips and reference Fax 330-865-6941 materials such as: The Functional Toolbox I & II, Geriatric Clinical Strategies, Prevention and Looking for GREAT Online courses? Wellness Toolbox. Interested in Hosting a GREAT Seminar? Give us a call. Visit greatseminarsonline.com

www.advanceweb.com/pt December 2016 ADVANCE for Physical Therapy & Rehab Medicine 22

PT_12192016_EDU.indd 3 12/16/16 4:12 PM CLASSIFIED EMPLOYMENT OPPORTUNITIES New York

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JOIN US 11am-4pm AT OUR CLINICAL OPEN HOUSES • Tuesday, 01/10/2017 – George Bruce Library, 518 West 125th Street, NYC NY 10027 • Thursday, 1/19/2017 – Francis Martin Library, 2150 University Ave., Bronx NY 10453 • Friday, 01/27/2017 – Baychester Library, Asch Loop North, Bx., 10475 • Wednesday, 02/22/2017 – Belmont Library, 610 186th Street, Bx., NY 10458

St. Mary’s Healthcare System for Children is one of the nation’s premier providers of intensive rehabilitation & specialized care for children with special needs and life-limiting conditions. The largest pediatric post-acute care provider of its kind in the region, St. Mary’s treats 2,000 children each day through our Hospital, Home Care 2 Middle Atlantic ...... p. 28 and Community Programs in the fi ve boroughs of New York City, Nassau, Suffolk, Westchester and beyond. 3 Upper South Atlantic...... p. 39 4 Lower South Atlantic ...... p. 29 PTs, OTs & SLPs – All Boroughs, Nassau & Suffolk 9 Southwest ...... p. 30 11 Pacific ...... p. 30 FULL TIME, PART TIME & FEE-FOR-SERVICE We seek NYS licensed Therapists to enhance the lives of others while working for an exceptional organization which recognizes ability and rewards excellence. Must have 1 year PEDIATRIC EXPERIENCE.

›› MIDDLE ATLANTIC Positions available at St. Mary’s Homecare, our hospital in Bayside & our Roslyn Offi ce. The opportunities are great...The rewards are excellent! • Excellent individual/family benefi ts • Tuition reimbursement• Life insurance • Flexible spending accounts • 403(b) retirement plan • And much more! Transcending Community Care Please apply online at: www.StMarysHealthcareSystemforChildren.appone.com or email your resume to: [email protected] Physical Therapist – Home Care, F/T & P/T WWW.STMARYSKIDS.ORG • An Equal Opportunity/Affirmative Action Employer South Nassau’s home health care ranks in top 25% of home health care agencies in the U.S. Physical KIDZ THERAPY SERVICES, PLLC Situated on the sunny south shore of western Therapists Long Island, minutes from Jones Beach and thirty minutes from NYC, is an exceptional Spec Ed Pre-school Program and PHYSICAL THERAPIST/OCCUPATIONAL THERAPIST Magnet®-designated hospital... South Early Intervention Programs Nassau Communities Hospital. Our Home Care Nassau/Suff olk Division is currently seeking a few dedicated Full-Time & Part-Time opportunities • New Full-time/Part-time Clinic and School District Positions PTs to join our quality Home Care Team. • EI, Preschool, School-based Independent Contractor Positions Dix Hills & Setauket • State-of-the-Art Sensory Gym and Equipment We require: Bachelor’s/Master’s Degree in center-based school. • Excellent benefi ts for full-time employees Physical Therapy with NYS Physical Therapy Lic. • Supervision and Professional Development Available Flexible on days/hours, work on school • New Grads Welcome calendar. Experience with pediatrics/school Apply online: southnassaujobs.org based setting preferred. Contact: [email protected] or Job# 16087 Phone: 516-747-9030 (Nassau) or 631-382-7311 (Suff olk) Contract Early Intervention Physical Therapists Fax: 516-877-0998 (Nassau) or 631-382-7399 (Suff olk) South Nassau is an equal opportunity employer. All qualified also needed for our Home-Based program. applicants will be afforded equal employment opportunities Equal Opportunity Employer without discrimination because of race, creed, color, national email: pamela.demeo@ origin, sex, age, disability or marital status. EOE M/F/D/V alternativesforchildren.org or fax: 631.331.6865 Physical Therapists The SMILE Center Hawthorne Country Day School A Center-based facility with a state-of-the-art www.hawthornecountryday.org sensory gym in Manhattan Midtown East, seeks EOE NYS Licensed, Salary exempt for Westchester & Manhattan Sites. F/T & P/T. 12-month calendar, Special Education, autism & motivated and passionate fully NYS Licensed 14 Research Way, E. Setauket, LI, NY multiple disabilities. Great Salary & Bene¿ ts. EOE Physical Therapists to serve children aged 0-7 with a range of developmental disabilities. **MUST have two 914-592-8526 x3039 or [email protected] current years of pediatric PT working experience**. Sensory Integration, NDT or/and DIR/Floor time a plus. YOUR ONE-STOP Full-time, part-time and fee-for-services positions are CALL 800-355-1088 available. We offer strong supervision and an excellent internal Continuing Ed program. For more information, CAREER CENTER TO SUBSCRIBE FOR visit us on the web at www.smilenewyork.org AdvanceHealthcareJobs.com FREE!

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PT_12192016_REC.indd 28 12/19/16 11:06 AM PT_12192016_REC.indd 29 ww.advanceweb.com/pt w www.advanceweb.com/pt pediatric clinicinPhiladelphia. state-of-the-art new, brand our in work to PTs seeking is Play at Kids ›› citizenship, disability or protected veteran status. veteran protected or disability citizenship, religion, sex, sexual orientation, gender identity, national origin, color, race, to regard without employment for consideration receive is employer. an University Rutgers AA/EEO All applicants will (973) 972-2645. edu), ([email protected]. Cronin Christine of attention the to resume your fax or email Please welcome. are inquiries All children with developmental disabilities. have to one or pediatric one affiliation year of with experience recommended are Applicants pediatrics. in experience of Reimbursement is commensurateCertificate. with the level Education of Department Jersey aNew possess and Jersey New in licensed be must Therapists time. part or full are available positions Contracted environment. acollegiate is Services Therapy Newark Rutgers EducationalProgram. Individual in the with student’s accordance integration community of goal ultimate the with environment educational in participation and function maximal attaining student each of intent the with student each for services therapeutic quality highest the providing for a reputation has assessments and treatment. Newark Therapy Services to school-based provide Therapists Physical Pediatric qualified seeking is Services Therapy Newark Rutgers Our Purpose is Purpose Our email • Experienced/multidisciplinaryteam • EarlyinterventioninFairfaxCounty • PRN/PT/FTwith UPPER SOUTHATLANTIC Participation. Visit Our Focus is Focus Our Call Lornaat703-978-8400 Exciting Opportunity Therapy 4Kids Please call [email protected] fax resumeto Pediatric Physical Pediatric NEED CAREER ADVICE [email protected] AdvanceHealthcareJobs.com Function. for PediatricPT Therapists OPPORTUNITY Great Environment

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