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Minnesota Chapter APTA	Phone: 651-635-0902 E-mail: info@mnapta.org
Soundwaves	July-August 2008 Volume XXVIII, Issue 4
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In This Issue of Soundwaves	MN APTA will be at the Minnesota State Fair! Read more below to learn how you can get involved at the Great Minnesota Get-Together!
-- APTA Core Values in Action at the Phillips Neighborhood Clinic by Erinn Bothwell, SPT
-- Noninvasive Brain Stimulation to Promote Plasticity and Recovery by Jim Carey, PT
-- Why Wii Fit at the Minnesota State Fair? by Ann Ryan, PT
-- Evidence in Action: Long-Term Effects of Prilosec and Nexium reviewed by Nathan Hellyer, PT, and MN APTA Research Committee Members
-- Get Involved in the PTA Special Interest Group! by Julie McDonald, PTA
-- Calling Pediatric Physical Therapists!
-- Call for Posters: 2008 MN APTA Fall Conference
-- Save the Date for 2008 MN APTA Fall Conference!
-- Correction: 2008 MN APTA Spring Elections
MN APTA Updates
-- From the President by Joan Purrington, PT
-- From the Executive Director: At MN APTA, Professionalism is the Buzz Word by Judy Hawley, PT
-- From the Quality Improvement Coordinator: A Closer Look at Physical Therapy Reexamination/Reevaluation by Deb Madanayake, PT
-- Pats on the Back
-- Physical Therapy in the News
-- Condolences
Classified & CE Ads
-- MN APTA Partners
-- Classified Ads
Contact Newsletter Editor Mary Weddle if you have comments about Soundwaves or would like to contribute content to upcoming issues of Soundwaves.
FIND A PT Find a PT is a web-based referral service located on the APTA (national) website. Be sure to sign up for this member-only benefit! Consumers use Find a PT to located physical therapists in their areas, and APTA promotes this service to the public in many of its materials. To enroll in Find a PT, visit www.apta.org/findapt. Find a PT enables consumers to search a national database of physical therapist members of the APTA for the purpose of finding a physical therapist that is right for them. Consumers are informed that physical therapists who are members of the American Physical Therapy Association are bound by the Association’s Code of Ethics and are especially committed to providing competent and compassionate care. Informed consumers are also made aware that physical therapists must be licensed by the state in which they practice.
APTA Core Values in Action at the Phillips Neighborhood Clinic
By Erinn Bothwell, SPT APTA Member since 2007
The Phillips Neighborhood Clinic (PNC) is a free clinic run by Academic Health Center students from the University of Minnesota and is located in the basement of the Oliver Presbyterian Church in Minneapolis. Students from the schools of medicine, public health, physical therapy, pharmacy, and nursing work together with licensed, volunteer healthcare providers from each field to reduce the burdens of poor medical access and raise the quality of life for residents in and around the culturally diverse Phillips neighborhood of south Minneapolis. Additionally, health professional students learn the skills they need to effectively and compassionately serve people who are underinsured and unstably housed. The licensed volunteers are given the title of preceptor and oversee care provided by students. For PT students and preceptors, participation addresses many of the core values designated by the APTA, including altruism, by incorporating pro bono service into practice; and professional duty, by providing access to PT services and promoting cultural competence. The patients are grateful for the services provided by the PNC, and the student volunteers are grateful for the learning experience that the patients and preceptors create. I am a physical therapy student and have been volunteering at the PNC for one year. The experience has been beyond rewarding. My primary reason for getting involved with the PNC was to help provide healthcare for people who may otherwise go without it. Volunteering is also personally beneficial for both the physical therapy student and preceptor. There is a great exchange of information between preceptors and students as they work hand in hand. The PNC provides a unique learning experience for both parties. The students and patients truly appreciate the instruction and time that the preceptors give because the PNC could not run without them. It is amazing what can be accomplished with an old church basement and a group of people who are mission-driven. The clinic is currently open on Monday nights from 6-9 p.m. and is located at 2647 Bloomington Avenue South. The clinic has been so successful that is has recently been approved to open a second night each week starting this fall. The Phillips neighborhood residents, AHC students and the current preceptors are very excited about this second night as it will allow clinicians to reach more people and see physical therapy patients who need ongoing treatment. We are currently in need of more physical therapy preceptors in order to staff this second night per week. The time commitment is minimal (one night every two months) and the experience is extremely rewarding! If you are interested in volunteering or would like more information on the Phillips Neighborhood Clinic, please feel free to contact me (both0043@umn.edu or 651-357-6285); I would be happy to share more information or set up a visit to the PNC for anyone who may want to get involved. < Back to Table of Contents
Noninvasive Brain Stimulation to Promote Plasticity and Recovery
By Jim Carey, PT APTA Member since 1978
University of Minnesota faculty are using a new form of treatment for the brain: Repetitive transcranial magnetic stimulation (rTMS). I would like to briefly describe it to you, with the hope that you help pass the word to your patients who might be interested in participating in one of our studies. Repetitive transcranial magnetic stimulation involves applying a magnetic stimulus to the brain through a coil electrode held by the therapist on the skull over the motor cortex (see picture at left). When a stimulus is delivered, a focal magnetic field is sent through the skull and creates a small electrical current in the brain that activates motor neurons. Depending on the exact location of the coil, muscle twitches may be evoked in the hand, forearm, or other area. Brain excitability can either be increased with high-frequency stimulation or decreased with low-frequency stimulation. Thus, in people with stroke, we are attempting to increase excitability of motor neurons that have survived the stroke to make them better available for voluntary recruitment. Conversely, in people with focal hand dystonia, where excitability is too high, we are trying to lower excitability and thereby reduce writer’s cramps and other dystonic postures. Treatments are painless and last approximately 20 minutes. Previous research has shown long-lasting effects with this treatment (Fregni et al., 2006) and we are exploring different treatment combinations to maximize the benefit even further. There are inclusion/exclusion criteria for our studies that would be best described in a conversation. If you would like further information to see if an existing or former patient of yours might be appropriate, please contact Jim Carey, PT (carey007@tc.umn.edu) or Teresa Kimberley, PT (tjk@umn.edu). Your patient could also contact us directly. These studies are approved by the University’s Internal Review Board and funded by external grants, so there is no charge to patients for treatment. This is an exciting topic because of the future possibility of physical therapists including brain stimulation in their treatment regimens to augment the effectiveness of conventional treatments. Fregni, F., et al. 2006. A sham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients. Stroke. 37, 2115-2122. < Back to Table of Contents
Why Wii Fit at the Minnesota State Fair?
By Ann Ryan, PT, MN APTA State Fair Workgroup Chair APTA Member since 1977
If you have been curious about why MN APTA is using the Wii Fit program at the Minnesota State Fair this year, the short answer is: The timing is perfect for us. Here are the specifics: The governor just signed our new bill allowing for direct access to physical therapy for wellness, prevention, education and exercise. The APTA just adopted a new branding of physical therapy: It’s all about movement! Because of our past good performance and high turnout of volunteers (HINT, HINT!), the folks at the KARE-11 Health Fair turned to us when they wanted to feature the association of movement (vs. inactivity) with computers. KARE-11 brought MN APTA together with Best Buy and Nintendo to come up with a good idea. Nintendo makes the Wii Fit and Best Buy knows the technical aspects of making the Wii work for consumers (cables, cords, TV, etc., which is expertise we do not have). Nintendo is loaning us industrial kiosks with integrated TV screens to use at the Fair. We provide our expertise by describing how we use various means to work on balance and movement in any PT setting, how we work to prevent injuries with any type of movement activity, and how we help people have fun while exercising. It is our same booth space with sponsorship from two new sources. Nintendo’s Wii Fit tag line is “How will it move you?” and the Wii Fit is used in clinical settings mainly as a tool for balance activities. We are not promoting Wii, but we do promote movement, balance, and fitness, using whatever form is fun for patients. Right now, Wii and Wii Fit games are very hot commodities and very fun to play! The Wii Fit games are the “hook” that will bring people to our booth. We will be promoting health and prevention of injuries, while addressing the usual side questions we frequently get about common injuries, how to find a PT, how we use various equipment in any number of PT settings, etc. One of the best things we could do as a profession is get good publicity including public awareness of who we are and how we can be of value to consumers. Promotions research indicates that at big events, any activity that draws a crowd, especially a crowd of kids, will attract all the local adults. This increases our exposure. The Wii Fit will draw kids and adults. The Wii Fit will play well on TV and other media, so we will increase our chances of getting spots on the TV and radio during the fair. This is the most inexpensive way to get excellent promotion for the field of physical therapy, reaching hundreds of thousands in the state at no expense to us. Exposure is one of the biggest dividends at an event of this size. North Memorial is giving away even more bike helmets this year, and with our two booth lines, we will fill the Health Fair Building—which means lots of exposure. Market research shows that the primary decision makers for health care needs are women between the ages of 25 and 55. This is our target market—these are the people we want to influence about choosing physical therapy. From our experience last year, this is the same demographic that came for bike helmets. This is the same demographic that Nintendo is targeting with the Wii Fit. This means we have a good chance of generating interest in our booth to our target market. We decide the message. It is still the MN APTA booth and we are hosting Nintendo. We do all the talking. We pick what we say. To repeat what might now be obvious, the timing is perfect for us. We are educating the public about our accessibility and expertise in any setting that deals with wellness, prevention, education, exercise and movement. You can help by volunteering for a shift at the fair (www.mnapta.org/statefair.htm). We need to fill 170 spots, and the sooner you sign up, the quicker we can place our shirt order and get training materials out to you. If we do not get enough volunteers to staff this year, we run the risk of KARE-11 turning to another of the health provider fields (chiropractors, athletic trainers, personal trainers, etc.) to keep a booth fully staffed. There are any number of associations who would love to have this exposure and connection to the KARE-11 Health Fair. Visit www.mnapta.org/statefair.htm for information and sign-up opportunities. Hope to see you at the Fair! < Back to Table of Contents
Evidence in Action: Prilosec and Nexium May Increase Risk of Hip Fracture
Reviewed by Nathan Hellyer, PT (APTA Member since 1998), and the MN APTA Research Committee
Clinical Question: A large number of patients take over-the-counter drugs such as Prilosec (omeprazole) and Nexium (esomeprazole) to manage gastric reflux and heartburn. These drugs are also commonly prescribed by physicians to manage ulcer risk associated with chronic aspirin and ibuprofen use. What are the long-term side effects of taking these medications? Evidence: A large nested case-control study by Yang et al. (2006) revealed that proton pump inhibitors, such as Nexium and Prilosec, increased the risk of hip fracture. Hip fracture risk was significantly increased when patients were prescribed these drugs for greater than one year (adjusted odds ratio, 1.44; 95% CI, 1.30-1.59; p<0.001) and at high doses (adjusted odds ratio, 2.65; 95% CI, 1.80-3.90; p<0.001). Although mechanisms were not explored in this study, the authors speculate that these medications may increase osteoporosis by causing calcium malabsorption in the gastrointestinal tract. Clinical Decision: Patients taking proton pump inhibitors such as Nexium and Prilosec should consider taking supplemental calcium and be educated on osteoporosis risk associated with these agents. Clinicians should incorporate osteoporosis precautions and preventative measures into their plan of care when managing patients taking chronic high doses of proton pump inhibitors. Reference: Yang, Y-X., Lewis, J.D., Epstein, S., Metz, D.C. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006;296(24):2947-2953. < Back to Table of Contents
Get Involved in the PTA Special Interest Group!
By Julie McDonald, PTA, PTA SIG Chair APTA Member since 1999
Happy summer to all of you! As PTAs, we have made some significant progress in our profession. This includes PTA licensure in Minnesota (which is now in effect), as well as APTA Advanced Proficiency Recognition for the Physical Therapist Assistant. Now is the time for PTAs to look toward the future, and chart a course for ourselves, our profession and for our Special Interest Group. We need your help in bringing forward ideas for the PTA SIG to help determine areas of growth for us as a profession, as well as to voice your opinion on issues facing PTAs on all levels. If you would like to attend a PTA SIG meeting, we meet the third Monday of every month at 6:30 p.m., at the chapter office. As members, you are always welcome to attend these meetings. We are in the process of rescheduling our PTA Leadership Seminar for this fall. This program will allow PTAs to hear about issues affecting the profession, discuss ways to grow professionally, discuss ways to get involved, and network with our colleagues. Enjoy the rest of your summer, and look for information via e-mail and mailings regarding upcoming PTA SIG meetings and the PTA Leadership Seminar. < Back to Table of Contents
Calling Pediatric Physical Therapists!
The Pediatric Outcome Study Group has developed an e-mail discussion group. Our hope is to provide a forum for therapists from Minnesota to discuss topics in pediatric physical therapy. Members of the discussion group can send an e-mail to a specific address and it will be automatically distributed to everyone. Topics of discussion can include treatment ideas, resources, and anything else! This group is limited to APTA members only. For more information or to join, please contact Katherine at iteskath@yahoo.com. < Back to Table of Contents
Call for Posters: 2008 MN APTA Fall Conference
The MN APTA Research Committee encourages clinicians, students, and faculty to submit a case report or completed research project for poster presentation at the MN APTA Fall Conference. Posters are to be presented on October 11, during the lunchtime exhibit hall. All submissions are welcome, including work that has been presented at other conferences, symposia, or inservices. Deadline for abstract submission is 4:00 p.m. Friday, September 5, 2008. For more information, please visit the MN APTA website (www.mnapta.org/conf.htm or www.mnapta.org/research.htm), contact the Chapter office, or e-mail John Schmitt at jsschmitt@stkate.edu. < Back to Table of Contents
Save the Date for 2008 MN APTA Fall Conference
JOIN YOUR COLLEAGUES AT THE 2008 FALL CONFERENCE Mayo Clinic Rochester, MN October 10-11, 2008 information available soon at www.mnapta.org/conf.htm CONFERENCE COURSES: Tips and techniques to lead and participate in a positive meeting, and reduce the effects of an unproductive meeting (1.75 contact hours) Jeffrey Larson-Keller I am a leader! Which way do I go? Developing a personal leadership plan (2.75 contact hours) Joan Bohmert, PT Seating, positioning, and mobility topics: Adult spinal cord injured clients (2.0 contact hours) Tamara Vos, OTR/L; Scott Miller, OTR/L; Aaron Rindflesch, PT, PhD, MS, NCS; Jeffrey Lamb, PT, MS, BSBA Review of gross anatomy and biomechanics of the shoulder complex using human cadavers in the anatomy laboratory (1.5 contact hours) Nathan Hellyer, PT, PhD; John Hollman, PT, PhD; David Krause, PT, MBA, DScPT, OCS; James Youdas, PT, MS The utilization of rehabilitative ultrasound imaging in spine stabilization therapeutic exercise programs (2.0 contact hours) Kathy Cieslak, PT, DScPT, OCS Exploring emerging research of neuroplasticity in spinal cord injury, and applying it to treatment planning for the adult patient with an incomplete spinal cord injury (1.5 contact hours) Mayo Spinal Cord Injury Team: Marie Goihl, PT, NCS; Melanie Brennan, PT, MS; Lisa Beck, RN, CNS; Megan Gill, PT; Pamela Heins, PT; Jayne Molde-Boeding, PT Imaging the patient with spine pain (1.5 contact hours) Timothy Maus, MD Review the Clinical Performance Instrument (Version 2006), and evaluate a student’s performance through a case study (1.5 contact hours) Members of the Northern Plains Clinical Education Consortium (NPCEC): Aaron Rindflesch, PT, PhD, MS, NCS; Heidi Dunfee, PT, DScPT; Jeanne Lojovich, PT, NCS Current concepts in the treatment of acute stroke (1.5 contact hours) Kevin Komenda, PT, NCS: Brian LeLoup, PT, NCS Explore evidence supporting utilization of manual therapy techniques, exercise, and ultrasound imaging in the evaluation and treatment of shoulder and scapular dysfunction (1.5 contact hours) Darren Calley, PT, OCS; Kathy Cieslak, PT, DScPT, OCS; Mark Jensen, PT, OCS Neuromuscular impairment and physical therapy interventions in children with acute lymphoblastic leukemia and other cancers (1.5 contact hours) Lynn Tanner, PT, MS; Casey Hooke, RN, PhD(c), CPON PLUS: Special Interest Group meetings Political updates Exhibit Hall And much, much more! Join your colleagues for classes, networking and fun! < Back to Table of Contents
Correction: 2008 MN APTA Spring Elections
In the May-June 2008 issue of Soundwaves, we failed to acknowledge that Julie McDonald, PTA, was elected chair of the MN APTA PTA Special Interest Group, and mislabeled the delegates below: Delegates Joan Bohmert, PT Laura Gilchrist, PT Susan Sisola, PT            Barb Wiegand, PT (first alternate delegate) Julie Tilley, PT (second alternate delegate) MN APTA regrets these errors. < Back to Table of Contents
From the President
Joan Purrington, PT, MN APTA President APTA Member Since 1975
Greetings! This is a very exciting time in our association. Instead of taking more of your valuable time to read another article, please go to the web sites listed below and take in a “breath of fresh air!” MN APTA WEBSITE (www.mnapta.org): Allison has done an exemplary job of creating and maintaining our web site. Please check it out and sign-up today to work at the State Fair 2008. Jackie Petersen-Morehead, pictured, displays the MN APTA booth goodies at the fair last year. Visit our MN APTA Partners. These companies help to make all of our work on behalf of our members possible. APTA (National) WEBSITE (www.apta.org): APTA has many changes on the web site. If you have not been there lately please take time to look at the branding initiative, view the work of the House of Delegates, become familiar with the Member Directory and review the latest research. MINNESOTA BOARD OF PHYSICAL THERAPY (www.physicaltherapy.state.mn.us/licensee.asp): Learn more about PTA Licensure on the MN BPT website. Best wishes to each of you as we celebrate our members and our profession! Joan Joan Purrington serves as MN APTA President through June of 2010. Joan is available by e-mail (president@mnapta.org). < Back to Table of Contents