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What's hot in PT now?
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What's hot in PT now? - September 11, 2000 7:35:00 PM
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JSSSH
Posts: 45
Joined: September 10, 2000
From: Kingston, Ontario, Canada
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I am a first year PT student in Canada. One of the assignments we need to do for a course this year is to find out some topics that are the current "hot topices" in PT. I tried to do a search on web but I found that the advances in techniques or technology is just too difficult for me to understand at this point. I am wondering if there is some issues or trends that are happening in PT? Thanks for all your help!
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Re: What's hot in PT now? - September 12, 2000 5:23:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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JSSSH:
Unfortunately one of the hottest topics in PT right now is the job market [IMG]http://www.rehabedge.com/forums/frown.gif[/IMG]
Go to the APTA's web site (www.apta.org) and look at the Vector study for job projections.
Not the most pleasant topic but it is what most PTs are concerned with.
mcap
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Re: What's hot in PT now? - September 12, 2000 11:15:00 AM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
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Check out this month's posting in the journal review club section of RehabEdge. There is some very interesting Basic Science research going on with OEC cells (do you even know what they are?), and PWB-GT (do you still think that the "walking center" is in the cortex???).
Some amazing things are happening in basic science research folks. Between the PWB-GT research (See Hesse et al, 1995, and Schindal & Hesse 2000), and the article written by researchers at Yale and published this month in the Journal of Nature Technology (Nature Technology 2000; 18: 949-953, 925-927) I've come to two conclusions:
First, when Christopher Reeve says that he's going to walk someday . . . he may be right. Second, Chistopher Reeve seems to understand more about basic science than most PT's
I've already gone over the PWB-GT research, so if you missed that, please review the other thread in the Journal Review Club, look into the Neurology forum, or look up "Hesse" on MEDLINE (http://www.ncbi.nlm.nih.gov/PubMed/)
The researchers genetically re-engineered olfactory ensheathing cells (OEC's) harvested from pigs, greatly enhancing the regrowth of COMPLETELY SEVERED spinal cords WITHOUT GENERATING A REJECTION RESPONSE (in rats)!!! OEC's have previously been shown to enhance neurogenesis, but there are obvious problems with tissue rejection when cells are transplanted from different species. Noting this, the researchers created pigs whose OEC's and Schwann cells carried a blocker of human compliment (which is a key initiating agent of human rejection reactions).
Now here's the kicker . . . the nerve conduction velocities (NCV's) across the lesioned rats was even FASTER then those had never been injured (rats who were lesioned and received no graft were of course unable to transmit an impulse over the gap).
These are hot topics that may revolutionize PT . . . or destroy it. How many more PT's will loose their jobs if in 10 years, COMPLETE spinal cord injuries can be completely cured with OEC injection and 12 weeks of PWB-GT??? It's not here yet . . . but the basic science research is pushing the clinical research frontier (and eventually clinical treatments) in that area. Are you aware of that? Are you fellow students, spending thousands of dollars to get an education with the dream of working in a neurologic rehab setting aware of this? Will there be implications for other areas of PT practice such as spina bifida and CP??? These are hot topics, but are not being discussed. As usual, most PT's are taking a "reactionary" response to basic science developments (which is usually synonymous with professional illiteracy). The smart students and new graduates understand where this research may take us, and are already working to establish themselves in a niche.
The "hot topic" is not these basic science breakthroughs though, but rather that most "experienced" clinicians are blissfully and ignorantly unaware of them. Those that are, as Jules Rothstein points out in his latest editorial, are too quick to apply them to patient populations without regard to the rules of generalizablity, or scientific method.
Andrew M. Ball, MS, MBA, PT
Any thoughts?
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Re: What's hot in PT now? - September 12, 2000 4:15:00 PM
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DarinPT
Posts: 13
Joined: August 14, 2000
From: Galveston, TX, US
Status: offline
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Interesting question and what timing! I am a staff PT for the University of Texas Medical Branch at Galveston and would like to inform you and others of the "hot topic" at our facility. This technology is currently in the developemental phase and today we received the first prototype from the manufacturer. Some burn therapists may be familiar with the idea because I presented the information at the ABA Conference in Las Vegas. Disclosure- I am the patent owner and an exclusive license is in negotiations with the manufacturer.
Hopefully this will also stimulate some "out of the box" thinking as well.
I saw the problem a few years ago in the burn unit- After prolonged immobilization, patients were too weak to perform a sit-to-stand activity with 100% of their body weight. This closed-chain exercise is great, but it requires several therapists to "lift" the patient. Deconditioned patients usually can only perform this exercise a few times (with the therapist's assistance) before exhaustion or sometimes are unable to stand at all. If the patient can only perform a sit-to-stand with 20% of their body weight, the therapists must make up for the remaining 80%. Patients often have a fear of standing because they are dependent on the therapists to stand. It also takes a toll on the therapists working with patients weighing over 200 pounds--may require 3-4 therapists.
Well, the solution came to me when I had a burn victim on a tilt table. I thought--what if there were rails and a carriage with wheels on the table that allowed the patient to slide down, then push the carriage back up to a standing position? The patient could then perform unloaded, closed-chain, functional exercise with their lower extremities at a percentage of their body weight, depending on the tilt of the table. It could assist with strengthening, endurance, and most importantly for burn victims--lower extremity ROM.
I made a model and it worked perfect. Long story here but in short--patented the technology, found a manufacturer, got IRB approval and began case reports on several patients over the last year. The prototype arrived today and I can now say with confidence-what a machine!
So, this is the next generation of the tilt table that is indicated for any patient that requires moderate to maximal assistance to stand. If they cannot stand with 100% of their body weight, unload them to a percentage that they can lift. When the carriage is locked, it is similar to any traditional tilt table. When the carriage is unlocked however, the patient can perform a functional exercise that mimics the activity of sit-to-stand. It is a "hands-off" approach that eliminates the fear of falling. It also facilitates all of the benefits of standing and "true" weight-bearing for the deconditioned patient. (tilt tables do not allow reliable weight-bearing because the patient is strapped to the table-too much friction)
There's more--We developed a support pad that could support one extremity and allow the patient to perform the unloaded exercise exclusively with the other extremity. We use this pad for NWB extremities and residual limbs. Also, for neurological rehabilitation (such as hemiparesis), the support pad is utilized to support the non-affected extemity and exclusively strengthen the AFFECTED extremity. It is forced-use or constraint-induced therapy for the lower extremity. (I hope someone from Birminham is listening-Dr. Taub?)
As you can probably tell, there is a wide variety of diagnoses that could benefit from this unloaded exercise in the acute, rehab, or SNF setting. To list a few--burns, stroke/head injury (motor control or stimulation), orthopaedics (esp. bilateral total knee replacements), incomplete spinal cord injuries, debilitation from prolonged immobility (ICU patients), GBS, MS, amputees,...These are all diagnoses that we have used the table with successfully.
There are other features on the prototype that is truly amazing such as a patented lateral transfer system. The surface of the carriage actually slides onto the bed and the patient rolls onto it. Using a crank system, the surface slides the patient onto the table. This makes it easy for one therapist to transfer a patient onto the new tilt table. Those of you familiar with the traditional table know it takes at least 3 people to safely transfer a patient onto a tilt table. This feature makes it very efficient. It is also mobile so we can use it next to the patient's bed in the ICU- patient still hooked up to the monitors. Oh, the weight limit is 400 pounds currently.
There is much more, but I will end there for now.
We are presenting a poster presentation at the TPTA meeting next month in Austin. We start a randomized study with TKA patients next week. We will try to present a presentation at next year's ABA Conference in Boston. Research is the main focus for now and I would love for other facilities to get involved. I am interested to see if this early mobilization technique can show effectiveness compared to conventional methods.
It seems so logical. Many patients have asked-why didn't we do this several years ago? Can't answer that, but it is nice to know there is an answer now. Patients are active participants in the treatment. It also helps with self-confidence because the patient can now work at their own tolerance to increase strength, endurance, LE ROM, and in the end, possibly expedite mobility.
This technology is around the corner. We still need to do some finishing touches on the design and get FDA approval. I hope this sparks some interest and welcome any feedback. Thanks for your time!
Darin Trees, PT
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Re: What's hot in PT now? - September 12, 2000 6:08:00 PM
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JSSSH
Posts: 45
Joined: September 10, 2000
From: Kingston, Ontario, Canada
Status: offline
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Thanks for all of your replies. Since this is only my second day as a PT student, I am still taking some time to digest what Andrew and Darin said about the new research and new technology. It seems to me that mcap and Andrew hinted that the job market for PT is not as good as we want. But I think (and correct me if I am wrong) if our profession keeps up with the changes in technology, we will be able to find new areas that needs PT. Plus, PTs are people and you can never replaced that with any computer software or medicine.
And thanks Darin for sharing your story of how you invented the new equipment for burn patients. Your experience opens up my understanding of what a PT can do. And isn't this a perfect example of keeping the profession up-to-date with the world?
BTW, where can I find out more information about your new equipment? Is there any website / publication about the study using the protocol?
Thanks very much again. I certainly will need a lot of help for my study from you!
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Re: What's hot in PT now? - September 13, 2000 7:31:00 AM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
Status: offline
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JSSSH,
As Drew mentioned the partial wt. bearing gait training is a hot topic in PT. I recently had a 3rd year intern from the U of Montana who had worked with this treatment and had some impressive results. I look forward to applications in the orthopedic setting. (ortho patients are also neuro patients and vice versa)
The hot topic in the orthopedic setting (or at least should be the hot topic) is treatment of back pain.
This recent article stating the findings of the Paris Task Force should be mandatory for anyone who works on backs.
Abenhaim L, Rossignol M, Valat JP, et al.
The role of activity in the therapeutic management of back pain. Report
of the International Paris Task Force on Back Pain.
Spine (United States), Feb 15 2000, 25(4 Suppl) p1S-33S
The role of HMO's in health care will always evoke an emotional response if brought up in a room of PT's.
Professional membership and the role of the APTA/CPTA is always a hot topic this time of year (membership dues are due soon).
Encourage your classmates to join us on this forum.
Good luck
[This message has been edited by edilling (edited September 13, 2000).]
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Re: What's hot in PT now? - September 13, 2000 5:36:00 PM
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DarinPT
Posts: 13
Joined: August 14, 2000
From: Galveston, TX, US
Status: offline
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JSSSH,
Unfortunately there are no publications or websites at this time. However, we are working with RehabEdge to post our case report in a link to the site. It will show the functional outcome and have pictures of the prototype. This poster presentation will also be at the TPTA conference next month. The posting will hopefully be available in the next few weeks.
For those of you that may have a problem with visualizing the apparatus, it is like combining a squat machine with a tilt table- indicated for patients that have difficulty standing without assistance (esp. mod or max assist). Patients cannot learn to walk until they are able to stand. This technique enables a patient to make the transition from bed rest to ambulation in an efficient and safe manner.
In the past, therapists have only had 2 choices in the acute setting for this population of patients; in-bed exercises, (non weight-bearing exercises) and full body weight exercises which requires manual assistance by the therapist(s). This may be a missing link in the rehabilitation process between the 2 choices.
As for protocols, it is entirely up to the therapist AND the patient. Some patients like to perform the exercise in sets of 10-15 repetitions. Others may prefer performing the exercise for a certain amount of time with rest breaks. You can use Delorme, Oxford, or a daily adjustable progressive resistance(DAPRE) technique. I almost feel guilty sometimes because I am used to having my "hands on" the patient instead of just encouraging the patient to reach his or her goal for the session. I feel like a trainer and it's great. I know my back really appreciates it too.
Also, by having the patient perform a 1 or 2 rep max, we can objectively measure the patient's gain in LE strength from day to day. This is much better than saying min, mod, or max assistance. (or max assist x 2??) Patients can now see their progress by either doing more repetitions at a certain % of body weight or can perform the exercise with more of their body weight (higher slope of the table).
We discontinue the unloaded squats once the patient is performing the exercise with a substantial percentage of body weight. Then we can safely begin pre-GT exercises such as standing posture, balance, weight-shifting, and finally taking some steps in the parallel bars or with an assistive device. Partial weight-bearing gait training (PWB-GT)may also be indicated at this time.
Do you agree with this approach?
Darin Trees, PT
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