Dementia, and reflections on Legislative Day and geriatric PT

Tomorrow is Legislative Day for Minnesota PT’s.  Last week I went to class with the 2nd-year PT students at the UMN.  The presenter talked about the history of PT legislation in Minnesota, the importance of being involved, and the possible items on the agenda for tomorrow.  Afterward I talked to her in the hallway and asked – given the importance of PT related legislation and relatively less involvement of acute care and SNF/TCU PT’s in the APTA and state chapters, how do you “sell” non-members on being involved in the APTA?  For full disclosure – I am an APTA and MNAPTA member, and belong to geriatric, neuro, and ortho sections. I believe in the importance of membership, and while I am a new professional and thus have limited exposure, wherever I have worked or interned in a rehab setting relatively few were APTA members, and I know long-time PT’s who work in rehab settings that aren’t APTA members.  My discussion and this post are from those views and interactions.

In politics it comes down to a numbers game.  Outpatient PT’s are often leading the charge (thanks all!), but it seems that relatively few of us working in other settings (as a percentage) are members or are involved.  Reasons I’ve heard include that it doesn’t seem that advantageous to spend hundreds of dollars to get journals that don’t make much of an impact on how we practice (more on that later), and it seems like all the legislative action needed affects outpatient (direct access, manipulation, ATC’s trying to be PT’s, etc).  Why invest time and money in a cause that doesn’t benefit me?  Involvement of the APTA at the Federal level is abstract (can we really make a difference?), and we in rehab settings are basically guaranteed patients (vs outpatient where you rely on referrals or marketing) so there is less of a sense of urgency to even participate at that level.  She and I hope to continue the discussion tomorrow.  I think the APTA should work on recruiting rehab PT’s (for those rehab PT’s reading who are involved, thanks for your involvement!), starting with surveying PT’s in acute and SNF/TCU settings to see why there is a difference in membership rates between outpatient and rehab – how do we view the APTA?  What is our view of the profession?  What is our view of where we are headed?  Is there a generational difference in this or in where we practice?

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When I was searching for resources for dementia and physical therapy for the end of my journal club presentation on dementia (future post), I came across this PT Advance article, which says in part:

Being a specialist in geriatrics has a down side at national meetings, at times. We see our peers in sports medicine and manual therapy projecting a veneer of being the “best“ in the profession. When we encounter them after many years and we are asked our specialty there is an uncomfortable somewhat condescending moment. We feel like our specialty is not as rigorous or deserving of praise. This is a bad feeling. When we reflect on the complexity of our patients, their multiple co-morbidities and medications as well as challenging functional levels we wonder why anyone would not think we are the brightest and hardest working of the profession ?

I love my specialty – it combines medical complexity (with meds issues) with patients who really need help to function better (and are largely a joy to work with).  But are we in SNF/TCU settings challenging ourselves (or students), let alone our patients?  And I mean really challenge.  Could that be a major reason why we feel that way?

I think we unfortunately have a reputation of not doing that.  The highest weight I’ve ever seen used in a SNF/TCU is 5# (the favorite weight is 3# for some reason).  We seem to love Theraband (blue, green, or red, and sometimes yellow) and seated and sometimes standing exercises, 3 x 10 of course.  We grade strength improvement based on a MMT, rely heavily on the Berg or Tinetti (using the cut-off scores to indicate fall risk or improvement for a goal).  We only take vitals if the patients are on O2 and if the oximeter is handy.  We are only now starting to time gait speed, and seem to only record (approximate) distance walked, not time that it took to go that far.  As a group we don’t seem to belong to the APTA, or utilize literature from at least PTJ.  It doesn’t mean that people don’t read it, but I’ve never seen an issue of PTJ or any other journal where I’ve worked or interned unless a student brought it.  We don’t have journal clubs or discussions unless a student does it (because it was required by the program).  We aren’t involved in using social media (blogs, twitter, FB, Google+, etc) for promoting/ enhancing our skills, knowledge, or professional interactions.

For non-geriatric PT’s, I’d love to hear your thoughts about PT’s that work in geriatrics – is the quote above accurate?  For those geriatric PT’s who are challenging yourselves and your students and patients, I’m glad that you are out there making a difference (this isn’t about you).  Please, let me know you are out there, and volunteer to be a guest blogger!  But as a whole, if we want to feel respected that our specialty is “rigorous or deserving of praise” or that we are “the brightest and hardest working” or even change a student’s mind about geriatrics, I think we (including myself) need to truly practice Evidence-Guided PT, be an example to those around us to step up their game, and be involved in the greater community of PT’s through the APTA and social media.

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