Get Inspired and Lead by Example during the Special Olympics 2018 USA Games in Seattle

@2018USAGames. #RiseWithUs #2018USAGames

The Special Olympics oath: (McCallum, 2008)
Let me win,
but if I cannot win
let me be brave
in the attempt

Last summer, I had the opportunity to join physical therapists, physical therapist assistants, students and a few other members of the community who volunteered for a FUNfitness screening program in Everett during last year’s Special Olympics of Washington (SOWA) Summer Games. FUNfitness is part of the Special Olympics Healthy Athletes initiative to assess flexibility, strength, balance and aerobic fitness of the athletes. Introduced in 1997, FUNfitness is a fitness screening event that is part of the Healthy Athletes program and that was developed in collaboration with the APTA.

Lagging healthcare for those with intellectual disabilities culminated in this program of health education and prevention. Despite a mistaken belief that people with intellectual disabilities receive the same or better healthcare than others, they typically receive sub-standard care or virtually no health care at all. (Special Olympics Organization Health). In 2008, the global adult obesity rate was 12 percent compared to 30.9 percent for adults with intellectual disabilities. (Sunders M, 2008). Healthy Athletes has the world’s largest database of health data for people with intellectual disabilities.

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During the Healthy Athletes screenings, Special Olympics athletes receive dental, vision, hearing, foot and general health screenings and receive recommendations for improvement after each screening. Physicians and healthcare professionals provide the screening services at tournaments at no cost to Special Olympics athletes. Special Olympics has set a goal of having 100 locations recognized as Healthy Communities by 2020. (Special Olympics Organization Health).

The Special Olympics movement was born out of the work of Eunice Kennedy Shriver, a constant champion for those with intellectual disabilities. Today, the mission of Special Olympics Washington (SOWA) is “Special Olympics Washington BUILDS Communities and LEADS in Wellness through Sports and Inclusion. (SOWA website, 2017).

As a veteran orthopedic manual physical therapist I was confident that I could help somewhere, but this new adventure brought a little nervous excitement. I had no idea what I was expected to do and I was not sure what the athletes would expect from me. Special Olympics was something I learned about when I was a child. This early education left me with the impression that I would be working solely with an athletic, pediatric population with intellectual disabilities. Wrong. Well partially wrong. The athletes with intellectual disabilities span from individuals age 8 and upward into adulthood.

Under the direction of Natasja Ysambart, PT, DPT, SOWA Clinical Director, and Vicki Tilley, PT, GCS, Special Olympics consultant and trainer, volunteers were oriented to the FUNfitness screening stations: flexibility, functional strength, balance and aerobic capacity. While we waited for the athletes to finish competitions the Summer Games volunteers talked and learned from one another, particularly from the current UW student. We had fun running through the tests and it was nice to speak to a group that works with pediatric patient populations and those who rehabilitate patients with varied neurologic conditions. We also had a brother and sister team of high school volunteers, incredibly helpful as our extra hands.

The athletes that night shined – in their medals, in their dress attire (many of them stopped for screenings on their way to a big dance) and in their smiles. Once the process got rolling, it really became busy. Having so many athletes come for screening and education is inspirational. Earlier we ate alongside the athletes in their cafeteria dining room. One realizes quickly how much more can be done to educate and empower this population. At-risk populations are enabled to thrive with instruction and improvement of their awareness.

While we scrambled through the testing, I noticed that the athletes who received dental tools from the Special Smiles dentists were especially careful about saving their packages and educational materials as they worked through our busy screening stations. Behavioral change can occur when you educate and provide tools to those who want to improve their quality of life. The athletes were learning a great deal from what we tested and discussed that night. And likewise, I was learning from them.

During our testing I met a woman who was a fabulous athlete as proved during her fitness screening. She was also proud but competitive with her fiancé. She introduced the FUNfitness team to her fiancé, showing off her physical fitness while supporting his work on balance for his long-term health. After all, he is part of her future life.

Another athlete moved me during an educational discussion about stretching and her home exercise program compliance. She was not particularly fond of flexibility exercises. She told me about becoming a leader for the Special Olympic athletes.  After some discussion we concluded that her role as a leader in the athletic community meant that she needed to be a strong example for others. This piece was inspiring and motivational to both of us; we all have to lead by example.

The athletes and volunteers that I met that day were truly motivating. Everyone was excited about their sports performance, the dance that was being held that night and their future.

The Special Olympics USA Games will take place in Seattle from July 1-6, 2018. Hundreds of volunteer providers will be needed to offer screenings for thousands of athletes who will come from around the country to compete. Visit our web page to find more information and for links to sign up to provide screenings or to sign up for other volunteer opportunities.

http://ptwa.org/misc/special-olympics-usa-games-2018

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Robin Schoenfeld
PTWA Vice President

 

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Update on #StopTheCap Efforts

A message from Dena Kilgore, CAE, from APTA:

I wanted to provide an update on the efforts to permanently repeal the hard therapy cap that went into effect January 1. As you know, the federal government had been shut-down since midnight on Friday, January 19 due an impasse on funding the federal government over the lack of a deal to protect young documented immigrants from deportation, known as the Deferred Action for Childhood Arrivals (DACA).

Yesterday, Monday, January 22, Congress passed yet another short-term spending bill that will re-open and provide funding for the government open until Thursday, February 8.  The Senate spending deal will also fully fund the Children’s Health Insurance Program for six years, ending a nearly four-month lapse in the program’s long-term federal funding.  In return, Democrats accepted a pledge from Republican Senate Majority Leader Mitch McConnell (R-KY) to bring a vote on DACA to the floor if an immigration deal is not reached by Feb. 8.  Despite an enormous turnout on social media, phone calls, grassroots, Hill meetings, etc. by APTA, AOTA, ASHA, and partners in the Repeal the Therapy Cap Coalition, the short-term spending deal does not include the permanent fix to repeal the hard therapy cap, nor does it include a whole host of must-pass critical Medicare issues, impacting everything from rural health funding to community health centers.

On Friday there appeared to be a glimmer of hope that the Therapy Cap fix might be added to the short-term spending deal; APTA and our partners had been working with Senate Minority Leader Chuck Schumer to have it added to a revised deal that was under discussion with President Trump. Those talks did not produce a deal addressing the broader range of critical issues, including repeal of the Therapy Cap. Two senators who we’d like recognize are Sen. Ben Cardin (MD) who took to the Senate floor Tuesday afternoon to implore his colleague to address the Therapy Cap and other Medicare extenders in the next spending deal that must be passed by February 8. In addition, Sen Stabenow (MI) offered an amendment over the weekend to include the Therapy Cap and other Medicare extenders to the short-term deal.

The message from Capitol Hill continues to be that there is broad agreement to repeal the cap; the bipartisan, bicameral proposal to permanently fix the hard cap appears to be one of the few issues Congress is in agreement on. However CHIP funding and DACA continue to overshadow the politics and process.  With the issue of CHIP funding now resolved, Congress can focus on the critical Medicare extenders and Therapy Cap repeal to include in the next spending deal. However until DACA is resolved, it will continue to play a major factor in the work of Congress, and could potentially result in another government shut-down in the near future.

APTA and our partners will continue to wage an aggressive lobbying, social media, paid media, and grassroots efforts between now and February 8. APTA will be sending out additional action alerts to our members this week, and we will continue our push on social media (#StopTheCap).

During this time of uncertainty under the hard cap, APTA is also pushing CMS to provide additional guidance and clarification on their handling of outpatient therapy claims.  Most recently CMS provided information that they have been holding all outpatient therapy claims since January 1 that go above the $2,010 cap. CMS is expected to begin processing those claims in the near future, but they have not yet provided a timeline, In addition, CMS has stated that providers should continue to submit claims with the KX modifier, even though the exceptions process is not in place, under the assumption that Congress will retroactively apply the permanently therapy cap fix. APTA issued a FAQ document earlier this month and we will be revising it this week based upon additional expected guidance from CMS.

Help Observe National Physical Therapy Month

The heat of summer made one last push as we moved into “school season.” Hard to think it will be fall very soon!

NPTMLogoColor 2017I would ask that you consider some sort of observation of National Physical Therapy Month (NPTM) in October. The American Physical Therapy Association (APTA) recently posted resources for your 2017 planning.  National Physical Therapy Month resources may be found at http://www.apta.org/NPTM/ . Plan to share your observations with us (PTWA) and our national association (APTA).

This form of professional advocacy is critical. We must tell the public who we are and what we do. Tell the public why you are the reason to #ChoosePT. Let them know of your education and scope of practice. You make differences in people’s lives…as long as they know who you are. Not everyone knows who you are and what you do as a professional. Take the opportunity to leverage your voice to the public during NPTM.

#ChoosePT

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Erik Moen PT
PTWA President

Rich Content and Networking at CSM

Combined Sections Meeting (CSM) 2017
San Antonio, TX

Washingtonians flocked to San Antonio to attend the most-attended CSM in APTA history. Can  you believe there was 14,000 PT, PTA, respective students and exhibitors there? That is a lot of PTs. Why do they go? Excellent programming that addresses their needs specific to their practice interest, a huge exhibit hall, alumni, section and industry receptions, excellent keynote/featured speakers and plenty of networking with friends and peers from around the country. Our great state of Washington was well represented in leadership, presentation, industry and social aspects.

Also featured are state and federal affairs updates. This is where we are updated on processes with the definition of dry needling in the states practice of physical therapy, license compact initiatives, concussion management and continued work to repeal the therapy cap.

Discussion took place regarding the incorporation of the new evaluation codes. Continued work and practice with their use in billing will be critical. The new evaluation codes have far more complexity then our previous 97001 and 97002. Physical therapists can do their part by reliably following the code criteria to clearly define their clients as low, moderate or high complexity. The resultant data will help to better understand physical therapy practice and our interventions. The APTA has numerous resources on its website.  http://www.apta.org/PaymentReform/NewEvalReevalCPTCodes/. APTA was recognized nationally for their efforts in association education regarding the new evaluation codes.  Our Arizona friend Helene Fearon accepted the award on behalf of the APTA.

Want to get involved? I strongly believe that return on your association membership comes through your active membership. APTA does have volunteer opportunities for committees and task forces. http://www.apta.org/VolunteerGroups/.  The March 1st deadline is quickly approaching.

As this is a blog, I will conclude my summary comments. It is safe to say that the entire coverage of a meeting like CSM cannot be fully covered in the length of a blog. CSM certainly is an exciting, material rich meeting. CSM is the meeting for you if you are thinking of attending a national meeting for the first time. See you in New Orleans next February!

Erik Moen_EditedErik Moen
PTWA President

We Are Moving

jim-rivard_2016-conf-cropped4web

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

Exhilarated by Passion and Brain Power as APTA House of Delegates Comes to Life

AmandaScharen-Cropped-and-for-Web

Earlier this month I had the opportunity to represent the state of Washington as a first time delegate for the APTA House of Delegates (HOD). Despite preparing for the week with monthly conference calls with my fellow delegates and reading through material posted on the APTA website beforehand, I initially felt overwhelmed but was quickly swept up in the excitement of the house.

For the months prior to HOD, I listened to the voices that were my fellow Washington delegates on monthly conference calls, during which we discussed the motions and candidates that we would be voting for at the HOD. Soon after arriving in Nashville, I was in a room putting faces to voices. It was exhilarating to be in a room with so much brain power, vision and passion for the profession of physical therapy.

As we later entered the HOD, the excitement was palpable. Again, I felt energized and in awe of the amount of passion and intellectual power of the delegates from across the country. Over the course of the next four days, it was fascinating to see the visions of the APTA Board of Directors and HOD come to life. The most exciting was to see the HOD and APTA enthusiastically support a recent Center for Disease Control report on opioids, which listed physical therapy as a safe and effective alternative for pain management. Before the HOD even commenced we had seen a billboard in Nashville on the way to the hotel from the airport with the APTA campaign. With a swift unanimous vote, the #ChoosePT campaign was promoted with a press release; the action of the HOD visible the next day on Twitter feeds everywhere and even a Washington Post article.

Over the course of the week, I felt I was taking ownership for the direction of my profession, playing my small part in steering our ship to safe and secure waters. The HOD voted on motions supporting PT’s role in diagnostic imaging, to the role PTs ought to play in promoting active lifestyle options in communities, to investigating the burden that student debt places on those of us who are new in the profession. In a rapidly changing healthcare environment, this involvement in the direction the APTA is going feels like an integral and necessary part of shaping a secure and prosperous future for the PT profession.

The HOD seemed to end as quickly as it started. I left Nashville feeling more connected than ever to the profession and to the APTA. I left knowing that there are avenues for change and advocacy out there and that there are brilliant PTs working so hard to represent our profession every day. Thank you PTWA for allowing me to serve you in the HOD!

Amanda First Name
Amanda Scharen
PTWA Delegate to APTA House of Delegates