Patrick Thompson

@noriamitchell I suppose that CFM utilizes some pain gate theory to help temporarily alleviate pain, but then again, you could just do some STM if that were the goal. Interesting question...

@PJThompson93 Patrick, you have a really great argument. What if your patient is experiencing a lot of pain during your treatment, would you consider using CFM as a way to address the pain and not necessarily to make tissue changes?

#PT582 #NM I believe an exercise designed to target the tendon is a better use of time than CFM b/c it utilizes therapeutic stresses, while also strengthening the muscle attached to the tendon. This is more functional because muscle strength will be required to return to activity

#PT582 #KR Phillips et al 2004, geriatric motivation can be broken down to an interaction of 4 factors, 1)perceived chance of success & 2)importance of goal vs 3)perceived cost & 4)inclination to remain sedentary. Creatively influence factors to motivate bit.ly/2uQjwo3

@n_skotak The precautions are the same...I guess the article is just emphasizing that it is even more important for patients w/ rTSA.

#PT582 #NS bit.ly/2zAR0MP Boudreau et al. -> Pt edu on joint protection due to increased risk of shoulder dislocation following rTSA (IR, Add, ext = shirt tuck in position). Also focus on maximizing deltoid function given RC impairment. For normal TSA, focus on RC rehab

@MichelleRumpel Perhaps there should be some kind of concussion CEU for PT's who haven't learned those tests, whether they are DPT's or not.

@PJThompson93 While I was at the APTA Next conference I attended a vestibular session where the VOR, head-shake, etc tests we take for granted from our education were completely foreign to a lot of practicing PTs. Should only those with a DPT education be allowed?

#PT582 #MR PT's are 100% capable to make return to sport decisions. Vestibulo-ocular, exertional, cognitive and cervical testing skills are learned in PT school. Paired w/ stepwise return to play protocol, we are more than capable. bit.ly/2zGcQyK

#PT582 #NM It appears that adjacent segment pathology (ASP) is common (depending on definition and study cited) as seen in radiographic changes, however, not always symptomatic. This study concluded that a portion of pt w/ ASP will require revision. bit.ly/2KxsT6M

#PT582 #KS PT should address nutrition during initial eval. Basic level info is important to provide, but anything beyond that should be referred to a nutrition expert. Diet can impact recovery and healing, so we need to determine it is sufficient. bit.ly/2NkuieU

@krs572 Definitely, however I think it would be important that all of the patients in the group are at a similar level of function or perhaps have a similar dx.

@PJThompson93 #PT582 #KS Same! I had never seen CV rehab in the pool either! Do you think it's possible to have group therapy for patients for ortho and cardiac rehab in the same group? Or would you change treatment parameters and have them exercise differently?

#PT582 #KS I don't recall pt using the pool specifically for CV rehab, but rather a pt w/ CV issue rehabilitating an orthopedic injury. Pt w/ serious CV considerations should be kept in shallow water to minimize hydrostatic pressure and should be monitored closely.

@nutmeg91 Depending on their impairments. I might discuss how the pool can specifically alleviate one or more of those impairments. Example: Assist with balance for a pt with fall risk where LE strengthening is primary goal.

@PJThompson93 #PT582 I agree listening to the patient's values and expectations and proper communication will help engage them in rehab. How would you try to "sell" doing aquatic therapy to them if they're slightly unsure?

#PT582 #ML Listening to patient values/expectations (pillar of EBP) should help guide treatment. Also, empathy, clear communication, & pt edu may also help increase engagement to promote partnership in their rehabilitation.

@APulverSPT The buoyancy can allow patient to perform dynamic movement such as jogging or shuffling with less fear of pain or falling. Transfer to land with confidence after completing the movement prior in pool.

@PJThompson93 Thanks Patrick! I think its interesting they mentioned patients could get into the pool 3 weeks post-op! Do you think regaining confidence in the pool will transfer well to land therapy?

#PT582 #AP ACL rehab in the pool is an excellent place for pt to regain confidence on their recovering limb. Added buoyancy decreases GRF, which can assist with increasing ROM and strength with minimal pain. Should inspect incision healing prior to using pool.

@Reannon26 I was thinking perhaps a psychologist would be best or a even a marriage and family counselor.

@PJThompson93 Great point, chronic pain is multi-dimensional. What specific providers do you have in mind to work with in order to better treat chronic pain?

Given the complex psycho-emotional nature associated with chronic pain, perhaps it is best for PT to focus on establishing pain free motion, while referring to counselors to better address psych component of care. #PT582 #RJ

@houseofstark22 Maybe you can start progressing the intensity by working in more shallow water and start to get more of the effect of plyometric exercise #PT582 #BW

@PJThompson93 I agree with you Patrick and as we learned the faster that phase is you get a better result from the plyometric training. Can you think of any ways that we could reduce this phase in the water? #PT582

The only problem I see with plyometrics in the pool is the buoyancy may increase amortization phase = decrease muscle spindle action and possibly limit the neural adaptions. Perhaps still beneficial for elderly to work on balance with the added support. #PT582 #BW