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With the advancement of technology coupled with the limitations that physical therapy health care providers are encountering via insurance limitations telemedicine allows patients immediate access, near and far, to get specific health care advice, prescriptions of movement and consultations which could prevent unnecessary diagnostic tests and measures.
As our health care world continues to change I am excited to be part of the telemedicine movement.
In the past month we had a patient encounter that we felt we important to share for a couple reasons:
- This case specifically highlights the difficulties that normal people go through when dealing with our current medical model and all the practitioners one may encounter.
- It also highlights how when patient cases are dealt with properly someone can get more effective treatment regardless of whether someone is local or thousands of miles away.
- With proper resources and communication people can receive physical therapy via telemedicine and it can be very effective
To protect the patient’s confidentiality names have been omitted, substituted with initials. DW has agreed for me to post this case and she hopes that it will provide some insight to our Telemedicine process and how it has helped her.
A few weeks ago I received a Facebook message from an old college friend asking if I knew anything about a “rare” diagnosis named “idiopathic lumbosacral radiculoplexus neuropathy”. Turns out his mother, who lives on the other side of the country, had been diagnosed with this over a year ago and was frustrated with her progressive worsening. I told him that I had seen thousands of patients with idiopathic back pain that also had some sort of radicular symptoms down the extremities. In layman terms idiopathic means unknown cause, lumbosacral defines the lower back and pelvic tailbone region, radiculoplexus neuropathy basically is an irritation or inflammation of the nerve bundles that exit from the spine. It is important to note my friend’s mother, until acquiring this diagnosis was a normal active nurse and after dealing with this diagnosis she had now lost the ability to walk independently or perform many of her prior activities of daily living. I received multiple emails from the son and daughter of the patient, which gave me some insight on the patient’s medical history and timeline of diagnostic tests. Now through these emails I had found out that over the past year DW had been to multiple doctors, multiple specialists, undergone 7 MRIs, 2 X-rays, formal physical therapy and various prescription medications to help her symptoms without any definitive plan or answers to why she had acquired this “idiopathic diagnosis” or more importantly what to do from today moving forward.
After reviewing the medical notes I set up our first Telemedicine appointment, which was just like any normal evaluation we perform here in our clinic. Per the patient’s request DW had her daughter present on the video conference as to be an assistant just in case DW would need help with any mobility testing and/or we had technologic difficulties. Normal subjective examination was performed, objective testing, and special tests in order to determine an action plan. In the hour appointment we spoke of DW’s diagnosis, and I came up with a physical therapy assessment of her orthopedic limitations and her functional impairments. In addition I gave her some mobility exercises to start on that day that she could perform independently and some exercises that her daughter would assist with.
It is important to note here that in just this first appointment DW and her daughter mentioned that they received more from me in the initial evaluation that they had in the past 6 months. How does this happen?! How can one person see that many doctors, specialists and participate in formal physical therapy without some sort of education, evaluation and proper action plan to address this patient’s needs and goals.
Our next appointment was 1 week later however I told DW and her daughter that we were always available via phone, email, or Facebook messenger if they needed to contact us prior to our next appointment.
The next appointment we learned and witnessed some pretty amazing things. She had gained more mobility in her leg than she had in previous months. She also mentioned feeling more sensation in her leg something that had been absent for quite some time. Her mobility was starting to return but her strength and endurance for maintaining these new positions was very poor. At this appointment she was given a progression from her day one exercises and we planned on meeting in another week. The next goal would be to stand and be able to shift her weight from one leg to the other.
Next appointment was two weeks later and once again more good news. DW was bearing more weight through her legs with less assistance with her arms on the assistive walker she had been using to stand. Even better news was that DW felt her muscles in her legs working, something she hadn’t felt in months. Her ability to transfer from chair to wheelchair, wheelchair to bed, bed to sitting and sitting to standing all improved. Her strength and endurance were slowly improving but more importantly DW had new hope. She was seeing progress herself.
Now DW and her daughter were given more exercises to perform daily and DW was instructed that returning to a local physical therapist was the next recommended intervention. Going to a local physical therapist that understood DW’s needs, goals and progression was crucial to her continued recovery. In order to assure DW’s transition our office called local physical therapists near to DW, explained to the therapists what we had accomplished in just a few visits & recommended our physical therapy assessment and plan of action and collaborated with DW what she would have to do moving forward from here on out.
I’m happy to say that DW had her first physical therapy appointment this week and I received some good feedback from her regarding her first visit. I plan to follow up with a video conference in the beginning of next year to see how far she has come with her functional mobility and if she is closer to her goal of being able to walk again…
As the weather is changing and the end of the year quickly approaches there are many of us that are experiencing the holiday work parties, the friendsgiving gatherings, and the eventual holiday hustle to travel, eat, drink and be merry.
With all these increases in tasks and relative decreases in time to complete the parties, shopping and last minute meetings stress is bound to increase. Statistically the last quarter of the year is when hospitals see a large increase in admissions. This has been attributed to heart attacks, strokes, and car accidents mostly stress related. Managing stress through proper planning can prevent these health issues and potential accidents.
Thankfully we only have a few weeks left of 2014 to get through this stressful quarter however here are some gems from the Center of Disease Control and Prevention to use while we close out this year.
Wash your hands to avoid getting a cold of flu
If you haven’t done so already, consider getting a flu shot
Balance your day with work, home, play and rest
Plan properly for those holiday travels
If you are more musically inclined here is The CDC Holiday song on the 12 ways to Health.
Another component to be mindful of is Vitamin D intake. Living in Oregon most physicians recommend taking Vitamin D supplement due to the lack of Sunshine that the population receives. In the past 10 years technologic advances have pushed people to spend more time indoors on computers, watching television or spending time on our tablets. During the winter as temperatures drop and holiday season demands increase people spend less time outside, therefore Vitamin D intake is sparse. This leads to increased reports of depression possibly due to seasonal affect disorder and/or people who may not have friends or family to celebrate the holidays. This article highlights some good information regarding Vitamin D, SAD and depression.
Lessons to be learned, plan ahead this holiday season, aim to properly balance work, home, play and rest, and get outside and enjoy being active!
Stay Tuned…Over the last few weeks of 2014 we will be giving gifts of knowledge in regards to health, wellness and pain free functional mobility, we hope that these gifts not only provide components of education but also inspire you to make positive changes towards a better 2015 version of you. Happy Holidays Everyone!
I work very hard, and I play very hard. I’m grateful for life.
And I live it – I believe life loves the liver of it.
I live it.Maya Angelou
As the holiday season approaches there are many things to be thankful for. I am thankful for my wife, my daughter, my family and my friends. I am thankful for my health and my ability to help people everyday. Regardless if you celebrate the Thanksgiving holiday, this time of year presents opportunities to spend time with friends, family, and loved ones. As a physical therapist and human mechanic my patients constantly remind me to be grateful everyday… my encounters with each person usually consists of painful histories, complex injuries, and devastating changes in lifestyles. I am blessed to have the ability to actively listen to people’s stories, to objectively change someone’s mobility, to assess and prescribe proper movements in order to return people to pain free function. I have a job where I am welcomed into people’s lives … and I am given the chance to positively affect their lifestyles.
I’ve had the opportunity to work with 4-week-old twin babies who were diagnosed with functional torticollis, and a 102-year-old patient who told me his only wish was to be able to attend his great grandchild’s wedding. I have worked with thousands of high school athletes who dream of being the next big superstar, and I have worked with many professional athletes whose drive is to get back to work so that they can keep inspiring the youth. I have worked with many sick patients with terminal illnesses but yet they still find inspiration within themselves to keep trying, to keep moving. I have helped many military and first responders to eliminate aches and pains from their daily routines or to recover from traumatic surgeries. I have worked with numerous weekend warriors who struggle with the battle to find a balance between work, family and recreation. I am thankful for all of my patients, past, present and future. They are part of who I am and who I want to be. I am thankful that I have a job I love and that I have a support system that believes in me. Happy Thanksgiving from Therapydia Portland and I hope you all have a safe and healthy end to 2014.
We as physical therapists are a natural fit for providing movement analysis for patients with biomechanical faults. With our educational background and clinical experience we are able to provide a complete assessment for the running athlete while also being effective in providing interventions to address the athlete’s inefficiencies. This past Tuesday (my birthday and election day for those who are paying attention) I had an opportunity to speak with two exceptional movement scientists on the topic of run analysis and how physical therapy played a role in performing these assessments. Now I have spoken to many physicians, running coaches, and thousands of patients regarding motion analysis and how physical therapists may use certain tools to properly create treatment plans to make people pain free and more efficient athletes but what was interesting about this talk on Tuesday is that we broadcast it “live” on the internet. This was somewhat intimidating but also exciting to know that we could answer questions from anyone around the world throughout this 60-minute slot.
Throughout the talk I not only shared my ideas and concepts of what movement analysis would comprise for a runner but I also learned a great deal from Nicole and Chris. Some of the gems from our Google + hangout were without a proper history and subjective exam we cannot provide an accurate or efficient assessment for interventions with our patients. What does that mean? Without a defined start point of how that athlete or patient presents to us how are we as health care providers able to determine positive change? Or any change for that matter. Chris mentioned collecting his athlete’s behaviors both past and present and making changes to “habits”. I love this and will from now on steal this in my practice to educate patients on changing their lifestyle habits rather than performing executed medical prescriptions in stretching or strengthening. (Thanks Chris) Nicole stated that as physical therapists our educational background includes studying the “whole body across many systems” & it is our (magical) ability to juggle all of these systems in our head while we have a patient sitting in front of us or moving in front of us. Then with a quick wave of our wand we make medical decisions on how to intervene with the patient or athletes apparent functional limitations.
Something that physical therapists utilize that you won’t get in a running store or from your local personal trainer is evidence-based medicine. What is evidence based medicine (EBM)? EBM is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients. These research studies are often performed over many years and with thousands of patients…. The choices that Physical therapists make based on EBM gives you the best care!
“Doesn’t matter what tools you have, it’s the clinician who makes the decisions with those tools & applies a differential diagnosis that is the most useful – Nicole”
One of the biggest messages from this talk was that no matter what fancy machines are used, or how amazing the high-speed video cameras are the patient or athlete will not get the most complete analysis and assessment without a good clinician. So what makes a good clinician you may be asking? Someone who has taken multiple courses on biomechanics, understands the body as a complete system, and someone who has worked with thousands of higher level patients who perform at a faster speed than your typical activity of daily living.
Another topic of discussion was patient testing coupled with the run analysis. All members of the discussion mentioned that physical therapists are able to properly test strength, range of motion, functional mobility and muscular symmetry more than many other health care providers and this allows for proper interventions to address biomechanical weaknesses. Plain and simple: If you have pain with movement the best person to see is a qualified physical therapist! It is our job as movement scientists to help people move pain free and more efficiently.
“Shoes can’t fix your running- Chris”
As Dr. Powers states “you have to be fit to run, you should not run to get fit”. Take home message from this whole talk is find a good therapist, get a through examination, and prepare yourself for success by building a foundation of knowledge, flexibility, strength and motor control. Internal limitations in joint mobility and strength cannot be fixed with fancy shoes or compression braces. “Running is not easy” as Chris enlightens us.
Now if you have the time to watch the video I have attached it to this blog and if you have further questions regarding the content or possibly are interested in having a run analysis performed you can contact me at the office via phone or via email at Jason@therapydiaportland.com.
We are excited to welcome Jason Villareal, DPT, ATC to the Therapydia Portland clinic. Jason comes to Therapydia after successfully running two outpatient orthopedic physical therapy clinics, one in Newport Beach, CA and the other in Coos Bay, OR. Jason is eager and excited to contribute his clinical reasoning skill set and exceptional customer service to the Portland community.
Clinically Jason has been involved in the sports medicine and physical therapy field for the past 14 years. He has had the opportunity to work at the high school, collegiate, and professional level with athletes, while also helping patients in the pediatric, geriatric, inpatient, outpatient, transitional care and home health settings. This vast amount of experience has given Jason a unique skill set to treat all levels of patients. Jason is excited to contribute his knowledge and experience to this community and he takes pride in making positive outcomes for each and every patient that he encounters. Jason has spoken at large physical therapy conferences regarding clinical efficiency and was most recently invited to speak at Grand Rounds for the physicians at Bay Area Hospital regarding running analysis and injury prevention. Jason has participated in many specialty continuing education courses and is actively looking for ways to advance his knowledge for movement sciences incorporating technology into the physical therapy field.
Outside of the clinic Jason stays active with his beautiful wife Abbie and little girl Edie.
Stop by Therapydia Portland on October 26th from 11am-3pm to celebrate our official launch! Enjoy some delicious food truck bites, mingle, and learn more about our innovative approach to treating musculoskeletal injuries, including hands-on manual therapy, mobility and movement assessment and patient specific exercise.