Keeping Pace with PT

Social Media Marketing Tips for Occupational Therapy

Posted by Diana Echert on Fri, Aug 18, 2017 @ 11:08 AM

pediatric_occupational_therapy.jpgYour door is open. Patients are coming to your clinic and leaving with good outcomes, but what is your bottom line? Could you see more patients?  How do patients find you? Is it the sign out front?  Is it the referrals from the medical clinic down the street?  Marketing is the key to your business success.  Smart marketing ideas can bring more patients to your OT practice.  First consider what’s working and build from there.

As ideas pop into your head, let’s write down a few details:

What can you offer patients?

  • Specialty skills you and your staff offer (pediatrics, wound care, hand therapy, vestibular treatment)
  • Special services (PCE physical capacity evaluations, lymphedema treatment, home health visits, wellness services, pool therapy)
  • Group classes (arthritis care, Parkinson’s care)

What can you offer the community?

  • Convenient location
  • Extended clinic hours (early morning, evening or weekend appointments)
  • Support for local projects or events
  • Sponsor booth at local Health Fair
  • Guest speaking at schools and senior centers

Who is your competition?

  • Other Occupational Therapy clinics in local area
  • Local hospital outpatient rehab services
  • Orthopedic medical practices with inhouse OT’s

How to make your marketing budget go further?

  • Use social media – Create a Facebook page, share informative ideas and links on Twitter, join Linkin to find other OT’s in your area
  • Write a blog you can share with patients
  • Offer to write an article for your paper
  • Create a website for your OT clinic

Now it’s time to develop a plan.  Feel free to be creative with your marketing plan.  Send a note introducing yourself to local physicians, chiropractors, massage therapists, yoga instructors, athletic trainers and others who may have an interest in sending patients your way. Arrange a one-on-one lunch with those who appear to have practice styles compatible with yours. Introduce yourself to school counselors to offer your services for talks to students on career choices. Contact the director of your local senior center for talks or exercise classes. To help your therapy practice stand out, write an article for your local paper sharing advise on fall prevention.

Marketing in social media improves your access to the community and other health care providers. Current marketing strategy should include Social Media. It’s very simple to create business accounts on Twitter, Linked In,Facebook , and Pinterest to connect with other professionals and people in your area. These sites allow you to offer info and links to current healthcare ideas. To maintain your credibility, keep your content professional and educational….not personal. Another benefit of using social media is the zero to minimal cost to your budget. Always good for your bottom line. 

Social media marketing should include a website for your occupational therapy practice. It can be as basic as a single web page introducing your abilities to the world.  Down the road, expand your website to multiple web pages explaining your services, staff and perhaps even a blog. A blog offers the opportunity to provide info on educational topics relevant to your patients and the community. If directing a blog to your patients, write in terms that have meaning and are easily understood. A well-written blog gives you credibility to your followers (patients and others). Check out websites and blogs of local therapists to learn more about your competition – what services do they offer?

Reaching out to the community is a great way to market yourself and your therapy practice. Offering your expertise to schools and coaches provides opportunity for you to share your knowledge. It benefits student safety with information on conditioning, shoe wear, and concussion awareness. Volunteering at community events as charity fun runs, career fairs, and sports events helps people get to know you and what you can offer them.  Offer community workshops on popular topics - living with arthritis, knee exercises, walk vs run options, life after joint replacement therapy. 

Understanding the lifestyle in your area will help you determine practice hours. Is there a need to offer early or late day appointments? Is there a need for weekend appointments? Is there a week day less requested for patient visits? Clever marketing will convey your practice availability times and emphasize that “you are there for them.”

Saving the best for last….Word of Mouth….does more to market your practice than you think. Social media can be included as “word of mouth” marketing. Digital “Word of Mouth” marketing can make or break your therapy practice. If your patients have a good experience, it will build your business. They’ll tell their friends, who in turn recommend you to more friends. Doctors and other medical staff will do the same. Patient confidence is key to your success.

Now that you have a marketing plan, how do you know it’s working? To evaluate your success, consider your goals and ask for feedback.  A few weeks after completing treatment, send a survey to your patient.  Great opportunity to let them know you care about their progress and gather info about their experience with your practice at the same time.

Is your plan working?  Set a timeline to re-assess the following at 3 months, 6 months, 9 months and 1 year:

  • New patients added
  • Number of patient visits
  • Compare marketing costs
  • Track sources of referrals
  • Types of treatment provided

Here is where a comprehensive EMR shows comes in handy. The best EMR software will allow you to track all the goals listed above and more as well as documenting patient treatment. Therapy EMR software should integrate patient records with appointment scheduling, insurance, PQRS and ICD-10 codes, exercise plans, referral sources, and treatment outcomes. A good EMR incorporates all the pieces of your practice into one place allowing you to quickly see if you are meeting your business goals. Tracking enables you to make adjustments to improve marketing efforts.

You are in charge. Decide what works for you. Create a marketing plan, but always be ready to make changes. Have fun with your marketing ideas. Quality patient care is always the primary goal, but creative marketing will have a positive impact on your practice and your bottom line.

Occupational Therapy    Why do I need an EMR?

 

Topics: occupational therapy in social media, social media marketing for occupational therapy, marketing for occupational therapy clinics

Healthcare Coding....What's the Fuss About?

Posted by Diana Echert on Thu, Jul 6, 2017 @ 06:07 AM

changes in healthcare coding    Healthcare is in the headlines almost every day.  It appears in the news as a political hot potato.  Advertising campaigns entice us to live healthy lives through their products.  Insurance companies want to provide access to healthcare……for a fee.  You may even get a Tweet now and then about the good, the bad and the ugly side of healthcare in the US.  You may think you’ve heard it all, but more is happening behind the scenes. Medical or healthcare coding changes are fast and furious.

For those enrolled in Medicare, brand new numbers are coming your way……meet the MBI (Medicare Beneficiary Identifier).  This idea has been in the planning stage for many years to combat identity theft and false claims.  Currently, your social security number automatically becomes your Medicare number.  In April 2018, the change begins.  New Medicare cards will be mailed to eligible people with their own personal MBI…….it will be unique to you.  The MBI will consist of 11 characters in a random combination of numbers and uppercase letters.  All new MBI cards should be mailed by April 2019.  No worries…..lots of time for the transition.  There will be a twenty-one month transition period after issue begins in which Medicare will continue to recognize either your old social security number or your new MBI.  Good news…..all Medicare benefits remain the same.

When insurance of any form determines your coverage, it is based on the information submitted by your doctor, physical therapist or other licensed provider.  Documentation in your medical record is now usually handled electronically in an EMR.  To make life easier, a joint effort by the AMA and insurance groups created a shortcut.  A system of numbers and decimal points to represent the reason for your visit (ICD diagnosis codes) and another coding system to describe your treatment (CPT codes).

2016 was the year of the big change in diagnosis coding.  ICD-10 took over the medical community.   The USA was a little late to the party, Canada and Europe had switched several years before.  ICD-10 is recognized world-wide.  Codes increased from 14,000 to over 67,000, providing doctor, physical therapist, and other providers many, many choices.  An ICD-10 code creates a very detailed description of your medical problem in a specific series of numbers,  letters, and decimal points.  Looking at the code, your provider can tell if your problem is on the right or left side, chronic or recent, degree of intensity, and if it is a disease or injury.  More good news.....no limit to the number of diagnosis codes you may be assigned.  Of course, the goal is to reduce the number of diagnosis codes as quickly as possible.  As you go through treatment, your codes may change to show your progress and match notes in your EMR.

Not to be left out, 2017 brought significant changes to physical and occupational therapy.  Again, the changes had to do with coding.  The time was right.  For many years, PT’s and OT’s have asked to have their expertise recognized in more specific ways.  In past years, every initial PT or OT evaluation was seen as the same…….with no distinction as to the complexity of the patient’s condition, other medical issues affecting treatment, and length of time needed to work with the patient.  A person walking in with an elbow sprain received the same evaluation (CPT) code as a person with a hip replacement with diabetes and deafness.  At last PTs and OTs can justify their time and work with specific codes for their first encounter with a patient.

Three new evaluation (CPT) codes are now available for Physical Therapists to use:

97161  One or two problems, no other medical issues, otherwise healthy, happy patient

(Example: Young adult male who sprained his knee playing soccer.  Eager to return to work and play as soon as possible)

Approximately 20 minute visit

97162  Two or three problems or body parts involved, may have some moderate health issues

(Example:  Young adult male with 2nd degree right knee and ankle sprain and history plantarfascitis on same leg, may also have borderline diabetes)

            30 minute visit

97163  Three or more problems or body parts involved, health issues, and/or condition is not stable

(Example:  Young adult male with 2nd degree right knee and ankle sprain with extensive bruising on left hip and sacrum, history of high blood pressure, borderline diabetes)

            45 minute visit

New Occupational Therapy evaluation codes follow the same guidelines from low to maximum complexity

97165  Identify 1-3 performance deficits which limit physical, cognitive, or psychosocial activity

(Example:  Young adult woman with carpal tunnel R wrist, normal behavior and rational thinking)

            20 minute visit

97166  Identify 3-5 performance deficits limiting activity as described in 97165

(Example:  Young adult woman with carpal tunnel R wrist and rheumatoid arthritis with history of high blood pressure)

            30 minute visit

97167  Identify 5 or more performance deficits limiting activity as described in 97165

(Example:  Young adult woman with carpal tunnel R wrist and rheumatoid arthritis hands and fingers with recent history of concussion and memory lapse)

            45 minute visit

From a distance, these changes look like a jumble of numbers and letters.  They are more….so much more.  They are the key to ensure you receive quality care and your medical records are accurate down to the last detail.  Correct coding also ensures your care is covered with less cost to you.  Healthcare is not a debate……it’s a real-life benefit everyone deserves.

Why do I need an EMR?

Topics: physical therapy evaluation codes, medicare switch to MBI, occupational therapy eval codes, healthcare coding changes

School Backpacks.......Is Bigger Better?

Posted by Diana Echert on Sat, Oct 22, 2016 @ 21:10 PM

school_girl_with_backpack.jpgOccupational therapy is about more than hand therapy and adult return to work programs.  OT’s are trained to work with kids.  Let’s start with the school backpack.

Watching a child walk to school, do you notice how big that backpack is?  It is not unusual to see an 8 year old heading off to school with 15 to 20 pounds in that pack.  It happens more often than parents and teachers realize.  Library books, lunch box, text books, PE clothes, “show and tell,” and more.  The weight adds ups quickly.  Of course, our first question is “do children need to carry all these stuff from home to school and back again?”  Some schools don’t provide cubbies or lockers or other student storage space.  Students are instructed to carry their books or risk losing them.  The time has come for parents, teachers, and school administrators to work together to remedy this situation…..sooner than later.  Can teachers be more specific on which supplies are needed for a specific day?  Are paperback books an alternative?

An occupational therapist can tell you this issue is not just about strength and size.  Heavy packs place an incredible load on young developing spines, shoulders, hips, and knees contributing to overuse injury or microtrauma.  When a tendon repeatedly tugs on the area of bone it is attached to, microtrauma occurs.  This repetitive action results in an inflammatory response which can damage surrounding tissues.  Given time and rest, these inflamed tissues can recover, tissues will heal without further damage.  Putting that heavy pack on again day after day, re-starts the process.  These repetitive stresses lead to chronic or long-term injury leading to muscle weakness, loss of flexibility, pain, and potential degenerative changes.  The tendon remains intact, but the repetitive stress at the boney site leads to physical problems later as the child develops.

A school backpack should never exceed 10 – 15% of a child’s body weight:

  • 50 lb child should carry no more than 7.5 lb pack
  • 80 lb child should carry no more than 12 lb pack
  • 100 lb child should carry no more than 15 lb pack

Now for the tough question, “How do you fit a pack to a child the right way?”  An occupational therapist will tell you the secret is adjusting the shoulder straps.  The entire pack should fit against the child’s back in the space between their shoulder blades and waist.  No higher, no lower.  Padded straps are always a good idea and help prevent excessive pressure on the young nerves in the shoulder area.  Packing heavier items in the bottom also makes the pack more manageable.  As your child grows…..simply lengthen the shoulder straps.  For most children, a backpack can be adjusted to last 2 – 3 years, depending on your child’s growth rate.

If a child develops neck, back, shoulder pain or even headaches or finger numbness, referral to an occupational or physical therapist is a good idea.  One of the first signs is a change in a child’s hand-writing or ability to hold a crayon.  Headaches and hand symptoms are often tell-tale signs of a poorly fitting pack.  Check the backpack, this could be a simple fix by lengthening the straps.  An occupational therapist can help.  After evaluating the fit of a child’s pack, an OT will likely recommend specific stretches, posture advice, and possible strength building activities.

As parents use a backpack, please set a good example.  Recreation, travel, or work….fit the backpack to your body and adjust the straps.  Kids love to copy what they see their parents do.

When it comes to school backpack safety, bigger is not better.

Occupational Therapy

Topics: school backpack safety, occupational therapy

7 Secrets to Becoming a Good Physical Therapist

Posted by Diana Echert on Tue, Aug 2, 2016 @ 16:08 PM

hand_therapyjpg.jpgIt all starts with the big question….WHY become a physical therapist?  Why would anyone want to follow a career where you can encounter pain, distress, irritation, conflict, and insurance issues?  Are you good with people?  Do you have personal experience with disability, pain, or serious injury?  Do you like the sound of the terms “physiology,” kinesiology,” and “bio-technology?”  Is one of your favorite phrases “pain-free” or “return to normal life?”   Do you want to become a physical therapistThe first secret is knowing yourself and what you are capable of.

Physical therapy is all about people.  It’s a career made of constant change, adapting to each new patient you see.  Every person with low back pain needs their own approach to achieve a successful outcome.  Every sprain and fracture needs its own treatment and plan of care.  Old, young, in-shape and out-of-shape, healthy and fragile….each needs special consideration and expertise.   This is the second secret of becoming a good physical therapist ….recognize each person you see as needing their own evaluation and unique treatment plan.  Cookbooks don’t work here.  The key is a good physical therapy EMR.

Where do you start?  “Look and listen” are the third secret.  Greet your patient in the waiting room.  Watch as they rise from their chair, walk with them down the hall.  Watch as they take off their jacket.  In these few minutes you have learned a great deal about their mobility.  As you begin taking notes, notice the words they choose to describe their symptoms.  Do their words describe intense or vague symptoms, as “stabbing, burning, hot” vs “ache, tender, sore.”  Do their words match the observations you noted in the first few minutes?  How does their problem affect their lifestyle?  Listen to their story…..this helps you understand the significance of their problem and potential motivation to improve.  It also helps establish appropriate goals and expected outcomes.

 When do you add exercise?  Manual therapy?  Modalities?  Postural and gait training?  ADL training?  Here’s where functional testing pays off.  Functional tests (or functional outcome surveys) include range of motion, strength assessments, Berg Balance, Oswestry Pain Index, RIPA and many other tests proven to reveal an accurate picture of their current status.  They also help reveal other factors which may or may not contribute to the problem as well as affect the length of treatment.  Two patients come to you with low back pain.  One has limited movement in their lumbar spine, but is walking fairly well.  The other patient has low back pain, but walking is wobbly and unstable.  A Berg Balance test is given, finding the second patient also has poor balance.  Both are treated for low back pain, but poor balance issues for the second patient need to be addressed.  Discuss this with your patient, report your findings to the patient’s physician, and adapt their program to include balance training.  This is the fourth secret of a becoming a good physical therapist.  Recognize when unexpected issues appear and include others who may assist in patient’s care.

achieving_goals.jpgThe fifth secret involves setting goals.  Consider your patient, their lifestyle, motivation, and rehab potential.  Physical therapy goals are about function….what does this person need to achieve to return to work, family, home?  What would they like to do in their future….play softball again?  Go camping?  Swim every day?  Drive to Montana?  Physical therapy goals are about your patient, not the therapist.

Every therapist wants and works for the best possible outcome for their patients.  Creating home exercise plans, suggesting changes in the ergonomics of their workplace and home, encouraging regular physical activity, and educating your patients in injury prevention……All are things we do to ensure a good outcome.  We want our patients to get better and stay better.  The sixth secret is sometimes the most difficult, the realization that you can only do so much.  The rest is up to them.

Secret 7 is to learn something new from every case you see.  Each time you do an evaluation, perform a functional test, or begin a treatment program……look and listen….and watch what happens.  It may be big or small, the smallest detail may make a big difference in the treatment outcome of the next patient coming through your door.

Click me

Physical Therapy       therapy exercise software

Topics: physical therapy EMR, physical therapy evaluation,, how to become a good physical therapist

Prevent Cognitive Decline.....Keep Your Brain Busy

Posted by Diana Echert on Tue, Jul 5, 2016 @ 09:07 AM

brain_cognition.jpg Cognitive decline – not a risk anyone wants to take. In this world where social media and news often dominate our information pathways, we depend on our brain to sort through all the bits and pieces to understand how the pieces fit – or don’t fit.  A function of our brain called cognition makes this possible.

In school we learn "2 + 2 = 4," this is fact.  Cognition comes into play when our teacher presents a story problem " Mom is holding a basket.  Jane puts 2 bananas in the basket, Jerry puts 2 oranges in the basket.  Mom asks what is in the basket?"  Counting, we know there are 4 things in the basket, but cognition tells us they are not the same......2 bananas and 2 oranges.  Does 2 + 2 always equal 4?  Cognition helps us determine what is being asked....or should we ask more questions?

Cognition is our brain’s ability to sort external information, our memories, our experiences, and input from our senses into thoughts we can understand. Cognition affects how we perceive a change - try a new flavor of ice cream – do we like it? Cognition gives us insight into what happens next – which button to push to close the elevator? Cognition helps us make decisions – which shoes go with this dress? Cognition helps us solve problems – what to do when you’ve locked your keys in the trunk of your car? Cognition helps us associate an old memory with a new one – how do you use an i-phone?  Stimulating cognitive function starts with keeping your brain busy.  New experiences, new foods, new people, new hobbies....all keep your brain busy reacting and adapting to the change.

Cognition is not about what is right or wrong, it is more about what is the best answer or action at the moment.

Heads_with_idea.jpgCognition is all about:

Flexibility – helping us adapt and determine the appropriate response or behavior for the situation

Anticipation – predicting events or another’s actions based on previous memories

Problem-solving – identify the basic problem, consider possible solutions, select a solution, regroup if solution doesn’t work, come up with another answer

Working memory – the ability to recall information when needed

Emotional self-regulation – the ability to manage your own emotions

Sequencing – the ability to separate actions and events, then prioritize them

Inhibition – the ability to handle distractions and internal urges, then respond appropriately

As with all things, cognition tends to decline with age. “STOP” you say. How can I avoid a decline in my cognition? The answer is simple – keep busy. Busy people walk, read, cook, garden, play golf and tennis, take classes, and above all they talk to people. Researchers have found a direct relationship between active, busy people and a higher level of cognitive and memory function. Exposing yourself to new ideas or talking about old ones – both help to maintain cognition. Learn to quilt or play poker….teach a class in photography or about logging in the 1950’s. Keep busy.

At times, what appears to be memory loss may have more to do with a decline in cognition than an actual loss of memory.   Not paying attention is often mistaken for memory problems. Often times we are distracted and unaware of our surroundings - where did I park my car? Often times we don’t listen - not knowing the name of the man you were just introduced to. Again, the solution is simple – work on your concentration. Take time to listen, look, and focus on the task in front of you.

As with all things, there are exercises you can do:

  • Work on your listening skills by talking to someone. Ask them questions. Did you learn something new?
  • Take a walk in your neighborhood. Are there changes in the landscape? What sounds do you hear?
  • Think about reversing the direction you walk tomorrow. Does this change what you notice?

If you find issues in problem-solving, making decisions, relating one event to another, or recognizing faces, you may want to consider having a cognition evaluation. Where to go? Find a speech therapist or SLP, they are well-trained in recognizing cognition issues. They have some basic tests which will help determine if you have cognitive decline….and is it significant? RIPA is a well-established cognition test, with adaptations for children, adults and seniors. This eval takes about an hour, but is very thorough.  Your therapist will share results with your doctor, you or your family.  If needed, your doctor will refer you back to the speech therapist to work on your cognitive skill development. SLPs are trained to work with these issues and can help you improve cognition.

Above all, keep busy……a busy brain helps you keep your edge.

SpeechTherapy

Topics: brain and cognitive function, speech therapy, cognition, SLP assessment

Digital Marketing for Your Physical Therapy Practice

Posted by Diana Echert on Tue, Sep 15, 2015 @ 09:09 AM

        Life is good. Patients are coming to your clinic and leaving with good outcomes, but how is your bottom line? Could you see more patients? Perhaps it’s time to take a step back to see how patients find you. Is it the big neon sign out front…or your ad in the local paper…or the medical clinic down the street? Marketing is the key to the success of each method and more. Have you thought about how improved marketing ideas can have a positive impact on your therapy practice?

Before jumping into a new marketing plan, a few things to consider:

What can you offer patients?

  • Specialty skills you and your staff can offer (pediatrics, sports medicine, wound care, orthopedics, vestibular treatment)
  • Special services offered (school sports evaluation, fitness assessment, PCE physical capacity eval, lymphedema treatment, home health visits, wellness services, open gym)

What can you offer the community?

    • Convenient location
    • Clinic hours (early morning, evening or weekend appointments)
    • Support for local projects or events
    • Services your community needs

Who is your competition?

What is your marketing budget?           

Now it’s time to become creative with your therapy marketing plan. Introduce yourself and your practice to the community by sending notes to local physicians, chiropractors, massage therapists, yoga instructors, athletic trainers and others who may have an interest in sending patients your way. Arrange a one-on-one lunch with those who appear to have practice styles compatible with yours. Introduce yourself to school coaches to offer your services for talks to students on stretching, physical preparation for a sport, and appropriate shoe wear. To help your therapy practice stand out, write an article for your local paper sharing advice on knee injury prevention or low back exercises.

Digital marketing improves your access to the community and other health care providers. Current marketing strategy should include Social Media. It’s very simple to create business accounts on Twitter, Linked In, Facebook, and Pinterest to connect with other professionals and people in your area. These sites allow you to offer info and links to current healthcare ideas. To maintain your credibility, keep your content professional and educational….not personal. Another benefit of using social media is the zero to minimal cost to your budget. Always good for your bottom line. 

Digital marketing should include a website for your physical therapy practice. It can be as basic as a single web page introducing your abilities to the world or several web pages explaining your services, staff and perhaps even a blog. A blog offers the opportunity to provide info on educational topics relevant to your patients and the community. If directing a blog to your patients, write in terms that have meaning and are easily understood. A well-written blog gives you credibility to your followers (patients and others). Check out websites and blogs of local therapists to learn more about your competition – what services do they offer?

Reaching out to the community is a great way to market yourself and your therapy practice. Offering your expertise to schools and coaches provides opportunity for you to share your knowledge. It benefits student safety with information on conditioning, shoe wear, and concussion awareness. Volunteering at community events as charity fun runs, career fairs, and sports events helps people get to know you and what your practice can offer them.  Offer community workshops on popular topics - living with arthritis, knee exercises, walk vs run options, life after joint replacement therapy. 

Understanding the lifestyle in your area will help you determine practice hours. Is there a need to offer early or late day appointments? Is there a need for weekend appointments? Is there a week day less requested for patient visits? Clever marketing will convey your practice availability times and emphasize that “you are there for them.”

Saving the best for last….Word of Mouth….does more to market your practice than you may think. Social media can be included as “word of mouth” marketing. Digital “Word of Mouth” marketing can make or break your therapy practice. If your patients have a good experience, it will build your business. They’ll tell their friends, who in turn recommend you to more friends. Doctors and other medical staff will do the same. Patient confidence is key to your success.

Now that you have a marketing plan, how do you know it’s working? To evaluate your success, consider your goals.

Set a timeline to re-assess the following at 3 months, 6 months, 9 months and 1 year:

  • New patients added
  • Number of patient visits
  • Compare marketing costs
  • Track sources of referrals
  • Types of treatment provided

Here is where a comprehensive EMR shows comes in handy. The best therapy EMR software will allow you to track all the goals listed above and more as well as documenting patient treatment. Therapy EMR software should integrate patient records with appointment scheduling, insurance, PQRS and ICD-10 codes, exercise plans, referral sources, and treatment outcomes. A good EMR incorporates all the pieces of your practice into one place allowing you to quickly see if you are meeting your business goals. Tracking enables you to make adjustments to improve marketing efforts. Why do I need an EMR?

Decide what works for you and create a long-term marketing plan, but always be ready to adapt to changes. Be creative and have fun with your marketing ideas. Quality patient care is always the primary goal, but improved marketing will have a positive impact on your practice.

 

Topics: physical therapy EMR, digital marketing for physical therapy

Feet First.....Finding the Right Sports Shoe

Posted by Diana Echert on Tue, Jul 7, 2015 @ 06:07 AM

find the right sports shoeYears ago finding the right sports shoe was no problem.  Little thought was given how a shoe could affect activity.  All casual shoes were called tennis shoes or better yet, sneakers.  These soft-soled, canvas top marvels were a sign of summer.  No arch support and a rainbow of colors to choose from.....with white, black and red being the most popular.  Designed to last only till the end of summer. In September our feet moved back into saddle shoes and loafers.  Choosing the right shoe for sports was not a problem.  Choices were Converse or Keds?   Gender did not matter, all sports shoe designs were based on men’s feet.  The difference between boys and girls shoes was all about color and size. Girl's shoes were really men's shoes in a smalller size and a pretty color. In the 1980’s the innovative Avia company came up with the novel idea of designing shoes with the female body and foot in mind.  Nike, Addidas, Reebok and other major shoe companies quickly followed suit.

Athletic shoes have come a long way since then.  Tennis shoes are now one of many specialty shoes found in the world of sports equipment.  Sport shoes are built to adapt to the movement and physical demands of a particular activity.  In the court shoe category, tennis is joined by basketball, racquetball, and volleyball.  Court shoes are built to accomodate the need for repetitive forward, backward, side-to-side and pivot stability.finding the right tennis shoe  In comparison, walking and running shoes have a rocker-like design for forward stability.  Running and walking shoes have added  heel stability and a flexible forefoot to prevent rolling your ankle while improving push-off with each step.a good running shoe

Traction is a big factor to consider in choosing the right sports shoe.  Cleats create more secure footing when playing turf sports like baseball, football, soccer and lacrosse.  For other sport shoes, it’s all about the tread.  Wood floors or tennis courts, shoes need to provide traction to grip the playing surface and yet allow the player to change direction quickly.  The right tread can make all the difference – wavy or circular patterns under the ball of the foot provide traction to stop and turn at the same time.  Crosswise tread lines allow a runner’s foot to grip a wet sidewalk surface.

Tennis shoe tractionTennis Basketball shoe treadBasketball  running shoe tractionRunning                    Soccer shoes with cleats  Soccer shoe tread gives good tractionSoccer

The downside to the specialization of sports shoes is the potential for wearing the wrong shoe for the sport or, more significantly, the wrong shoe for the individual player.  All major shoe brands have specific patent  designs built into their shoes.  Some of these designs are created with specific body types and postural  concerns in mind.  One brand does not fit all.  It may be as simple as the angle of the arch support to lift the foot from the bottom or the side.  It may be as dramatic as seating the center of the heel slightly off center to cause the foot to roll a bit to one side or the other.  All shoes are not created equal.  When finding a brand that works for you, its best to stay with that brand.

As a physical therapist, I’ve seen many (too numerous to count) injuries related to wearing the wrong shoe or wearing  worn-down shoes which no longer provide stability. Tenosynovitis, shin splints, knee pain and swelling, plantarfasciaitis, and hip bursitis are just a few unnecessary injuries caused by working out in the wrong shoe or wearing worn-out shoes.  Physical therapy treatment includes testing your shoes and observing your movements  when walking, standing, throwing, or simulated motions involved in your sport. Stooped posture, muscle weaknes, uneven leg length, tight muscles and ligaments, immobile joints and poor balance – one or a combination of these factors can cause changes in how you walk, run, throw, jump or kick.  Wearing the wrong shoe increases the effort needed, increases impact, and diminishes efficiency.  The end result is compensation – the body’s ability to adapt.  Repetitive compensation causes wear and tear – and injury. After evaluating your foot and movement dynamics, a physical therapist can help guide you in shoe selection.

No matter how much you pay, no shoe will take more than 300 – 500 miles of activity (i.e. running, tennis, walking, jumping).   Shoe wear can’t always be seen.  Wear patterns on the tread or inside of the shoe are indicators, but instability happens between the layers making up the internal structure of the shoe.  A good rule of thumb is to check your shoe's stability every six months with a simple bounce test:

  • Place a pair of shoes on a firm surface, laces tucked inside
  • Use thumb and index finger to lift heel of one shoe one inch off surface
  • Release shoe and watch.  Repeat on second shoe
  • Slight rocking once or twice is normal
  • Continuous rocking, wobbling, or shoe drifting to the side is sign the shoe is breaking down.  The greater the rock or drift, the sooner these shoes need to be replaced 

Another story can be told by noting excessive shoe wear on:

  1. Ball of the foot – indicates tight heel cord tendons.  Remedy by stretching calf and Achilles tendons
  2. Inner side of sole (forefoot and heel areas) - indicates excessive pronation or turning toes inward.  Remedy is adding arch support
  3. Bumps on top of shoe – indicates shoes are too small, toe box needs to be higher and longer (3/8” – ½” between longest toe and end of shoe)
  4. Outer side of sole – indicates supination or turning foot outward excessively.  Remedy is to strengthen front lower and upper leg muscles
  5. Bulge on side of big toe – shoes are too narrow or tendency for bunion to form.  Wider shoes or adding metatarsal support inside shoe under ball of foot lifts forefoot to provide more room for big toe
  6. Worn area on upper front of shoe – indicates toe drag or dropped foot.  Remedy is to strengthen anterior tibialis muscle on front of lower leg. 

Finding the right sports shoe means thinking of your feet first.

  • Go shoe shopping after a workout or later in the day.  Your feet will be the largest at these times.
  • Try on sport shoes with the socks you will be wearing with these shoes
  • Can you freely wiggle ALL your toes
  • Comfort from the start….No break-in time needed
  • Walk, turn, pivot on a hard surface, not carpet, to get the “feel” of the shoe when you are moving
  • Heel should not slip in shoe with slow or fast walk
  • Bounce Test – after selecting, place both shoes on firm surface (laces tucked inside) and do bounce test.  If one or both shoes wobble or bounce excessively, ask for another pair.

Physcal therapy is a great resource to get help to determine what type of sports shoe would be best for you. Choosing the right sports shoe takes time, but if the shoe fits…..get another just like it.

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Concussion.....More than a Bump on the Head

Posted by Diana Echert on Mon, Jun 15, 2015 @ 13:06 PM

concussion and physical therapyConcussion is a more than a bump on the head.  Every day in the news we hear about a concussion keeping a professional athlete out of an important game.  The bigger story is that a concussion can impact anyone at any age with the same life changing consequences as a professional athlete.  By definition, a concussion occurs when some form of violent jarring results in a disturbance in brain function.  This usually is caused by a blow to the head (as in a fall or head to head collision on a sports field) or sudden, rapid head movements (as in whiplash during an auto accident).  In most situations, concussions result in a temporary loss of brain function as memory loss, blurred vision, dizziness.....even headaches.  Second guessing the end result of a concussion cannot be safely made at the time of injury.  Every concussion should be taken seriously, allowing adequate time for the brain to recover.

A common myth is that you must lose consciousness to have a concussion….Not true.  It is true that the longer a person remains unconscious, the more likely there will be severe brain injury.  According to the CDC, over 1.6 million concussions occur every year in the USA from falls, on  playgrounds, on sports fields, and during auto accidents.  Of these, 90% do not lose consciousness.

When a head injury occurs, coaches, athletic trainers, teachers, parents and students are encouraged to be aware of a Concussion Checklist.

  • Vacant stare
  • Complaint of “pressure-feeling” in head
  • Blurred vision
  • Delayed verbal response
  • Inability to maintain attention
  • Disorientation and confusion
  • Balance problems
  • Slurred or incoherent speech
  • Emotional changes
  • Memory deficit
  • Any period of loss of consciousness
  • Nausea or vomiting
  • Headache
  • Dizziness

Any one or combination of these symptoms following a head injury is an indicator it’s time to seek medical attention.

When it comes to concussions, education is key.  Two concussion awareness groups are working to train and educate the public about this issue.  The REAP Project (Reduce, Educate, Accomodate, Pace) focus is to create a team approach in addressing concussion and its consequences.  The REAP concussion team is comprised of the student, their family, the coach, the school team and the medical personnel.  All are encouraged to understand what a concussion is, the level of activity allowed, the recovery plan, and the safe criteria allowing the student to return to play.  HEADS UP is an awareness program sponsored by the CDC which provides training tools for coaches, parents, and health professionals.  These tools emphasize prevention, recognition, and response to concussion injuries.  Both programs are available to schools and sports programs across the country.

All head injuries should be checked out by medical staff.  Subtle neurological tests help to determine if a concussion occurred.  X-rays and MRI’s alone may or may not indicate brain injury.  Their results should be used in combination with neurological testing to accurately make the call.   Screening for a concussion involves cervical spine exam, balance tests as Dynamic Gait Index, eye tests, light sensitivity, or patient reporting as in the Rivermead Post-Concussion Symptoms Questionnaire or the British Columbia Postconcussion Symptom Inventory.  Neuro tests note changes in reflexes, sensory, vision, muscle strength, walking, balance and fine coordination.

Research now shows there are specific risk factors associated with potential longer recovery times from a head injury:

  • Previous history of concussion
  • Females
  • Collegiate vs high school athlete
  • Post-traumatic migraine
  • History of psychiatric disorders
  • History of learning disorders
  • Early onset of dizziness immediately following injury
  • Cognitive deficits noted in the first 72 hours after injury

Sometimes months pass before the long-term effects of a concussion appear.  Late appearing symptoms can be difficulty concentrating, memory lapses, sudden mood change, depression, panic attacks, interrupted sleep patterns, light or noise sensitivity, frequent headaches, balance issues, vision problems, and neck pain.  Any or all of these are good reasons to return for a check-up.  Treatment is as varied as the symptoms, from medication to physical therapy.  Depending on the symptoms, physical therapy may involve modalities for soft tissue injury, strengthening program, manual mobilizations to improve joint movement, vision exercises, balance training, coordination skills, BPPV maneuvers, and gait training.

For years, the standard treatment plan was complete rest until all symptoms (headaches, dizziness, etc) were gone.  Treatment approach has changed.  Current research indicates that recovery is faster with fewer long-term problems if people resume light physical activity (non-contact) within a few days of the injury.  Activity level gradually increases as symptoms diminish in intensity.  Before returning to a sport or work full-time, a patient should be symptom-free and no longer taking symptom-reducing medications.  When treating concussions, less is more.

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Ways to Reduce Inflammation and Get Back into the Game

Posted by Diana Echert on Tue, May 19, 2015 @ 15:05 PM

InflammationIt's the weekend and you have big plans.  A morning of golf, lunch with friends, and a movie tonight.....but first you have to get out of bed....and that's where the problem begins.  Pain and stiffness in your knees, back, neck, or shoulders make you wonder how you are going to do it?  It's that old nemesis...Inflammation.  Even though inflammation is a normal response, we don't have to like it....and we don't have to live with it.  Good news...there are ways to reduce inflammation and get your life back.

To effectively reduce inlflammation, we need to find the cause.  Usually it is due to injury, overuse or general wear and tear on our body. It can begin simply with slight pain and swelling, but quickly progress to more intense symptoms if not halted in its tracks.  It all begins as a normal protective response in injured tissues resulting in pain, swelling, and reddened/tender areas.  Our immune system triggers these symptoms as a defense to get our attention.  Swelling is due to the pooling of fluids within the tissues.  Often the pooling is accompanied by the formation of fibrinogens which can lead to adhesions (scar tissue).  Repeat injury leads to chronic inflammation which can cause extensive tissue damage and lead to anemia, constant pain, coronary heart disease, diabetes, dementia, and a variety of arthritic conditions.

Reducing inflammation as quickly as possible speeds healing, prevents scar formation, and immobility issues.  Several effective factors to improve the situtation are:

  1. Good sleep - a lack of or interrupted sleep increases the inflammatory response
  2. Keep moving - rest is good...for short periods...then get up and move
  3. Avoid foods cooked at high heat - foods cooked at high temps tends to 'brown" causing the formation of glycotoxins (chemical reaction of sugars and fats with protein).  Glycotoxins stimuate the inflammatory process
  4. Keep insulin levels low -- eating foods low in sugar content reduce inflammatory responses
  5. Lose excess weight - less stress to joints, excessive fat cells worsen inflammatory conditions
  6. Eating foods which are known to have anti-inflammatory effects   mixed_fruit
  • Avocados - a good source of fat and a phytosteriod, especially effective for those involved in high impact activities (running, jumping, soccer)
  • Berries - powerful anti-oxidants which reduce inflammation and relieve oxidative stress
  • Citrus - lemons, oranges, grapefruit, and limes are good anti-oxidants.  High levels of Vitamin C can reduce swelling and inflammation in the lungs (asthma).  Lemons also cleanse and alkalize the tissue to balance hgih levels of acidity that occurs with physical activity
  • Dark leafy greens - spinach and kale contain high levels of Vitamin E which helps protect the body from some forms of inflammation
  • Ginger - effectively reduces inflammation in the intestines and overall soothes the digestive tract
  • Fatty fish - salmon, sardines, tuna are very oily fish, high in omega-3 fatty acids which is known to effectively reduce joint swelling
  • Garlic - has long been known to reduce inflammation and inhibit pain responses
  • Peppers - sweet bell and spicy peppers contain capsaicin, an effective topical for arthritic joints.  Red peppers contain salicylates (compound similar to aspirin)
  • Red tart cherries - Reduce muscle pain
  • Yougurt (and fermented foods) - resupply the gut with healthy bacteria and reduce inflammatory responses
  • Raw honey - known to boost performance and your immune system

With a little attention to your diet, sleep, and activity level, you can reduce inflammation and get back into the game.

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How to Write Notes for Today's EMR

Posted by Diana Echert on Tue, Sep 2, 2014 @ 08:09 AM

Writing notes in EMRWhat's new in health care?  As a dedicated physical therapist, I would like to say how far we've come in the treatment for concussions, spinal cord injury, stroke rehab, and pediatric care.  Much to my dismay, the focus of health care has shifted from treatment to "how" we record and report our patient visits - overtaking the obvious - the care of our patients.  At times I feel patient treament has had to take a backseat to new federal rules.  Documentation requirements are now highly detailed...and often repetitive.  Those responsible for creating new documentation guidelines often don't communcate with others also creating new policies. The net effect has been rampant repetition of the same data within a single visit record.  This sometimes results in chaos for physicans, therapists and other health care providers, sometimes making a patient visit to be more about the document than the treatment. The past five years have brought more and more government and insurance rules.  In an effort to simplify this chaos, our representative organizations - APTA, AOTA, and ASHA -  have created new, complex protocols for our professions.

While writing notes has become more complex, the evolution of today's  EMR has been our salvation.   Most everyone agrees....replacing pen and paper and creating legible notes has been a good thing.  An EMR can manage the repetitive data requests, enabling a provider to only enter datas once.  The EMR will automatically record data in all the appropriate fields.  In fact, the new EMR can actually ensure we  include tests, flow sheets, and social backgrounds that explain how therapy is progressing.  Other complications arise when new guidelines mandate our profession to categorize our patients into specific areas.  A real life evaluation should reflect more than checking items in boxes.  Explanations and side notes are needed to tell the "rest of the story."  A quality EMR should provide both.  To accomodate the new "meaningful use" guidelines, an EMR needs to be able to transition the patient data entered into categories which show both the current status and what you expect to be the final outcome of treatment.

For Medicare, federal guidelines require that a therapist select from a list called PQRS (physician quality reporting system).  PQRS has been around in the medical community for quite awhile.  Information gathered from PQRS data is intended to determine which forms of treatment are most effective for specific conditions.  On the practical side, many Medicare patients don't fall into a single category.  This fact has now been recognized....allowing doctors and therapists to now list up to 9 different PQRS measures for a single patient. This takes time - time taken away from your patient.  A quality EMR can now provide more efficient ways for doctors and therapists to record PQRS - giving us back more quality time with our patients.

Some therapists and physicans are uncomfortable writing notes during a patient visit.  The secret......interact with your patient while entering info.  It's really no different than writing notes in a paper chart or filling out a form  It all starts when you meet your patient - whether escorting them to the treatment area or walking into a room - always introduce yourself, smile and say "hello."  A smile goes a long way - for you and them.  Sit down facing your patient, with your computer, laptop, or tablet at a 45 degree angle.  Review the record with them to ensure it is accurate, including medications.  Making small talk puts everyone at ease, allowing you to make more accurate observations.  An EMR should follow a step-by-step method, including provocative tests, functional outcome measures....ending with functional goals related to your findings and a plan of care.  A bonus is to have your EMR include diagnosis and treatment codes, PQRS, treatment time, and other factual data at the end of the record.  It often helps to casually mention to your patient "why" you are asking certain questions such as those related to PQRS.  Communicate and educate.

Not to be naive, we are not done yet.  As a professional, your notes reflect your work.  Take time to re-read the record.  An EMR allows you to quickly make edits, add comments, and adjust goals.  It's not as hard as you think.  The new documentation guidelines are here to stay.....make the most of your EMR.

Topics: physical therapy EMR, physical therapy software, PQRS documentation, electronic medical documentation, EMR, writing goals for EMRs, goal writing for therapy documentation

Diana Echert

Jumping for PT DocTools

Diana is a licensed physical therapist whose experience spans inpatient and outpatient work in rehab, geriatrics, orthopedics and sports medicine. An avid hker and tennis player, she you must practice what you preach.  Stay active and informed any way you can

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