The Skinny on Sarcopenia

One definition of sarcopenia by Santilli et al1, states: Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength and it is strictly correlated with physical disability, poor quality of life and death. Risk factors for sarcopenia include age, gender and level of physical activity.

To diagnosis sarcopenia three of the following need to be present:

  • HR >84 bpm at rest
  • Orthostasis: a decrease in systolic 20 bpm or diastolic 10 bpm within three minutes of standing compared to sitting or supine
  • Muscle weakness: a general 3/5, no specific muscle group
  • Impaired mobility: need assistive device, need assist with bed mobility, difficulty with transfers
  • Heart rate increases 10-20 bpm with verbal exam
kele-murdin

Kele Murdin

As PTs we should be drooling at this. All of these are WELL within our scope to treat and VERY treatable! Treatment of deconditioning typically targets activity HR 20 beats greater than resting (light load). And remember to educate your patients to be patient as recondition takes two times longer than deconditioning.

Ikezoe2 found that older adults need knee extension force of 45 percent of their body weight and sit to stand of 5.6 times in 30 seconds to retain their ability to walk independently.

There is a wealth of research to support the benefits of low intensity strength programs that improve knee extension strength and functional mobility in frail older adults. Westoff3 demonstrated significant strength increases using these parameters: one to three sets of four to eight reps, with one minute rest, using TheraBand and using criteria that when they can perform three sets with good form to increase load.

Sarcopenia cost over 18 billion dollars in healthcare costs per year.  We as PTs have the power to impact that and significantly improve the quality of life of our older adults! What a great job we have!!

Kele Murdin, PT
Geriatric Certified Specialist
Geriatric Training Certification
Certified Exercise Expert for Aging Adults

References:
1) Santilli V, Bernetti A, Mangone M, and Paolone M. Clinical Definition of Sarcopenia. Clin Cases Miner Bone Metabv. 11(3); Sept-Dec 2015. Published online 2014 Dec 10.
2) Ikezoe, et. al, Muscle Strength and Muscle Endurance Required for Independent Walking in the Elderly. Journal of Physical Therapy Science. 9(1):19-22. January 1997. DOR 10.1589/jpts9.19
3) Westhoff M, Stemmerik L, Boshuizen H. Effects of a Low-Intensity Strength-Training Program on Knee-Extensor Strength and Functional Ability of Frail Older People. Journal of aging and physical activity. 8(4):325-342. October 200. DOI: 10.1123/japa.8.4.325

 

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We Are Moving

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Jim Rivard

Vision statements are typically born of small groups with big passion. Brainstorming, discussing, wrestling, and finally writing a statement of direction for the future – a vision. A vision statement is something not yet achieved, not a description of what is already. A vision may never be achieved, but defines the work and energy of the organization moving forward.

In 2013, the APTA adopted a new vision: Transforming society by optimizing movement to improve the human experience. The APTA as an organization, and physical therapy as a profession, has much work ahead to achieve this ambitious vision. I have had the pleasure and pain of spending time in different groups and task forces pounding out strategic plans and visions. Often the hard work of these small groups is lost in translation when attempting to have the larger body adopt the vision and move toward steps of implementation. The APTA is putting equal energy behind their new vision, with the most recent being The Movement System Summit held near the home office December 8-10, 2017.

 

The Movement System Summit involved 100 therapists stuffed in a room for three days in a collaborative discussion and debate as to the implementation of The Human Movement System as a primary tenet toward achieving the APTA’s vision statement. A safe and open environment of discussion, debate and dissention was established and maintained throughout the meeting, allowing all voices, thoughts and opinions to be heard. As president of the American Academy of Orthopaedic Manual Physical Therapists, I was invited to attend this summit. This is not to establish my credentials, but more to exemplify the inclusiveness of the group, having representation from within and outside of the APTA. Every corner of the profession was represented, including several students. The diversity in brain function—listening, critical thinking, communication—across the room was remarkable. Regardless of where you place yourself in the diverse landscape of physical therapy, you had fair representation. That said, having 100 physical therapists agree on anything related to the profession is unrealistic. Thankfully, lunch had been previously decided upon and was not open to debate.

So, what exactly is the Movement System? The definition is a moving target (pun intended). Currently it stands as follows: The movement system is the term used to represent the collection of systems (cardiovascular, pulmonary, endocrine, integumentary, nervous and musculoskeletal) that interacts to move the body or its component parts. The overall intention is to brand physical therapists as movement specialists that are the go-to profession for addressing the Movement System. We are the profession with a unique set of skills to define and own this area within the healthcare system. If we cannot define our advanced clinical skill set to the consumer and medical profession, we risk being replaced by a less expensive, lower-quality product to address movement and performance.

If you were mentally challenged by the naming of a “new system” that encompasses these other systems, then include yourself in minority group of participants (including myself) that pushed to remove the word system but continue with the concept. But semantics aside, bringing all branches of physical therapy together with a common language for defining, describing and evaluating movement is a worthy goal. For example, an imaginary line between orthopedic and neurologically trained PTs would be replaced with a common training and language to define basic movement. Those participating at the summit attempted to create a basic short list of movements, regardless of specialty, that all therapists could assess and describe. A branding shift toward movement specialists would place the focus on our ability to evaluate and restore these movements across a wide variety of clinical presentations. Movement could then be assessed by an annual visit to a physical therapist, much as with an annual dental exam, to identify movement impairments and potential interventions. The preventative approach could go a long way toward “Transforming society by optimizing movement to improve the human experience.”

The summit’s objectives:

  1. Describe the history and development of the term “movement system” as the identity
  2. principle with the APTA’s new vision. (You can read more on the APTA’s website at: Movement System).
  3. Develop a common understanding of the definition of the movement system and the role of physical therapy in the movement system.
  4. Identify the potential benefits of integrating the movement system in physical therapy education, research and practice.
  5. Discuss the movement system as it relates to both ICF language and the patient‐client management model in the Guide to Physical Therapist Practice.
  6. Begin to identify essential activities that should be included in the patient/client examination for assessment of movement performance and the criteria for how to measure these.
  7. Agree upon criteria for adopting or promoting movement system diagnostic labels.
  8. Describe the implications of using movement system diagnostic labels, including selection of treatment options, communication with other professionals, clinical documentation, reimbursement, education and research.
  9. Develop an action plan for the integration of the movement system into practice, education, research. This document will be a recommendation to the APTA Board of Directors.

Further discussions revolved around the need for movement system diagnoses. A collaborative lecture between physical therapists and an orthopedic surgeon colleague established a much easier consensus on removing terms such as shoulder impingement from the list of diagnoses we use, as they are inaccurate, often describe nothing and are often too vague to directly assist in establishing an intervention. The need to establish a movement diagnosis instead, that better describes the impairments leading to the symptoms of an impingement, did cause more spontaneous movements of heads nodding up and down. What replaced this nodding with cervical paralysis and reflexive oral expulsion was the intention of replacing all pathoanatomical descriptions for diagnosis with movement-based diagnosis. As the gloves came off, and the once cordial discourse was replaced by factions of dissention, the challenge of the broader strokes of this fundamental shift in the branding of our profession became more apparent. The diagnosis of shoulder impingement, having many causes, does little to establish a frame of thinking for intervention. Likewise, cerebral palsy as a diagnosis provides nothing in the clinical frame for which a clinician can make decisions for intervention. The insertion of classification schemes has attempted to address this clinical conundrum. One of the many arguments for maintaining the pathoanatomical description is that physical therapy has a long history of specific intervention to address specific tissue pathology. Influencing collagen repair, bone density and healing, as well as cartilage lubrication, has a long history in physical therapy. The arguments at the summit to maintain both the movement and pathoanatomical diagnoses then moved to which one would be first. As you re-read this paragraph, and your head begins to ache, it may occur to you how we create movement-based diagnoses and intervention when there is only pain, or normal walking for only short distance, or the patient presents with a wound. The last day of the summit did not ignore these issues but dug in, attempting to lay out a working plan to address them all.

The analogy for the Movement Summit was moving from sea level to summiting a mountain. It was obvious after three days that we had gained some altitude but there is much more to address to make it over the hill with this movement systems concept. We only scratched the surface on professional interaction between disciplines, organization and countries. Billing, coding and reimbursement would also need to see a significant overhaul.

If you have made it this far in reading you have demonstrated the grit required to be engaged in this process. The APTA has provided all the details and progress on this issue on their website, and is asking for comments, input and energy. The APTA is not some outside body, it is made up of all of us. We are the APTA. The leadership of the APTA is leading, and should be commended for thinking boldly. We have an opportunity here to better define who we are and what we do, finding better ways to message and deliver this to both colleagues and clients. Regardless of how you currently feel about this issue, acceptance is the key; this is happening. If all participants in the summit were honest, they would admit entering with a little bias on the issue. Maybe there was even a little confirmation bias in how some of us prepared for the summit. But all participants left with a broader understanding of the issues we face and how they affect all corners of the profession, not just within our own bubble.

You can elect to sit as we Move Forward, but we are stronger with all voices. Move with us.

Jim Rivard, PT

Doctor of Manual Therapy
Orthopedic Clinical Specialist
Fellow of the American Academy of Orthopaedic Manual Physical Therapy
AAOMPT President

New Year Starts with a Bang for Many Reasons

Happy New Year.

 

A lot happened in 2016 to say the least. My office started the new year with a new EMR and the utilization of the new evaluation codes. I am thankful to our American Physical Therapy Association for the resources they have been providing on these codes since September. We at PTWA have been updating you with links to these great resources.

January always starts with a bang as it coincides with our state’s legislative session. This year is a long session for our legislators. We will be hosting our annual Legislative Impact Day (LID) on January 26th at the Capitol in

Erik Moen_EditedOlympia. I would strongly encourage you to attend. The legislative session is the culmination of year-round work to assess need, create language and gain legislator support. Our most pressing issues this session include the areas of interstate licensure compact, public school system years-of-service credit and continued work with prior authorization. Our legislative efforts are not limited to these three issues. We have other items our Legislative Committee is working out with their year-around process, including work on the scope of assistive personnel. Our legislative work is crucial to the practice of physical therapy within the state of Washington. Legislative work is truly that…work. It takes time, relationships, working for consensus..and did I mention time? Your involvement with this process should be one of your personal prioritized professional duties. It can be as simple as getting to know who your district legislators are and being able to articulate how their work affects our/your profession.

Still feeling a little lost?  I would ask that you attend the PTWA LID. Not only will you gain a greater appreciation for Washington state’s legislative process, you will get to know your legislators with peers from your district and have the opportunity to gain some CEUs in the process. PTWA will host concurring complimentary CEU opportunities during this year’s LID. This will allow you the ability to further your professional obligation for licensure requirements.

I would like to thank the members of the Legislative Committee for their year-round work. This committee is always open for volunteers to join the ranks. Has your legislative fire been lit? An obvious opportunity awaits for you on the Legislative Committee and/or Legislative Impact Day on January 26th. I look forward to seeing you all on January 26th in Olympia!

Erik Moen

PTWA President