Category Archives: Neuro

Compendium for teaching professional level PT content (neuro focus)

From an email I received earlier this month.  If you are an instructor this is a great resource for neuro-related coursework ideas.


The Academy of Neurologic Physical Therapy is pleased to announce the
release of the updated *“Compendium for Teaching Professional Level
Physical Therapy Content, v. 2016”*. This compendium is an update of the
previous compendium published in 2000 and edited by Margaret Schenkman PhD,
PT and Kathleen Gill-Body, MS, PT, NCS.

The purpose of the Compendium is to provide examples of high quality
teaching and learning strategies that have been developed and refined by
the contributors. Some activities include detailed patient cases and/or
grading rubrics, which can be difficult and time-consuming to write. These
will be useful for novice faculty who are seeking innovative ways to
deliver content. In addition, experienced educators will find new ideas
and alternative teaching strategies.

The compendium is online, and open access Activities may be searched by
elements of the patient management model, by pathology, or by type of
teaching activity. *Activities can be downloaded individually, and
educators may freely adapt or adopt the learning activities while providing
recognition to the Academy and the original authors*.

The Compendium co-chairs would like to recognize the hard work of authors,
editors, and Academy leaders in developing this resource. We hope you find
it useful in planning your curriculum!

*Jody Cormack, PT, DPT, MS Ed, NCS*
* Sue Perry, PT, DPT, MS*
Compendium v.2016 Co-chairs


Articles of interest – initiating change in the clinic, BESTest in subacute stroke

I’m catching up on journals (part of a New Years resolution to reduce/ eliminate the collection I have) and came across two good articles, so I thought I would share briefly.

The first is “Use of the Theoretical Domains Framework to Develop and Intervention to Improve Physical Therapist Management of the Risk of Falls After Discharge” in the November 2014 issue of PTJ.  If you have input into programs at your facility, or you have initiated a program but then had limited change in therapist behaviors, you may want to read this.  I found it interesting as I’m currently reading through “Better” (see previous posts).

The second is “Reliability and Validity of the Balance Evaluation Systems Test (BESTest) in People with Subacute Stroke” in the same issue of PTJ.  If you see patients with subacute stroke (or Parkinsons) and you haven’t checked out this test, you can read more about it here.

Speaking of EDGE task forces (Neuro recommendations)

In the previous post I mentioned the GeriEDGE task force.  In the same October 2013 issue of PTJ, there is an article Outcome Measures for Individuals with Stroke: Process and Recommendations From the American Physical Therapy Association Neurology Section Task Force.  I like how they broke it down into the ICF model (body structure/ function, activity, participation) and then made recommendations for patient acuity, practice setting, and educational exposure.  I will be sure to consult these recommendations when I evaluate a patient with a CVA either in the SNF/TCU setting or in the OP clinic.

Of note, the Neuro section also has posted these and other recommendation summaries on their website:

Neuro, geriatric, and pulmonary learning opportunities online

I haven’t posted in a while, but wanted to post two archives of webinars and an interesting interview:


Brain injury awareness month

A100319_MAMC_TBI 1

Brain injury is regularly in the news, with the focus on concussions and Chronic Traumatic Encephalopathy (CTE) in sports, or for soldiers returning with traumatic brain injury (TBI) and more from roadside bombs, etc. What is overlooked and that people may not be aware of is that older adults can have a brain injury as well from a fall, in fact “adults aged 75 years and older have the highest rates of TBI-related hospitalization and death.” ( March is Brain Injury Awareness Month, so I wanted to write a brief post to help increase awareness.

One in three adults over the age of 65 fall each year. If you associate falls with fractures, you would be correct – fractures are the most common injury from a fall. But most TBI’s are caused by falls and these are a definite concern. The Centers for Disease Control and Prevention (CDC) has a pretty good handout about TBI’s.

Symptoms of mild TBI include:
• Low-grade headache that won’t go away
• Having more trouble than usual remembering things, paying attention or concentrating, organizing daily tasks, or making decisions and solving problems
• Slowness in thinking, speaking, acting, or reading
• Getting lost or easily confused
• Feeling tired all of the time, lack of energy or motivation
• Change in sleep pattern—sleeping much longer than before, having trouble sleeping
• Loss of balance, feeling light-headed or dizzy
• Increased sensitivity to sounds, lights, distractions
• Blurred vision or eyes that tire easily
• Loss of sense of taste or smell
• Ringing in the ears
• Change in sexual drive
• Mood changes like feeling sad, anxious, or listless, or becoming easily irritated or angry for little or no reason

Symptoms of a moderate to severe TBI include:
• A headache that gets worse or does not go away
• Repeated vomiting or nausea
• Convulsions or seizures
• Inability to wake up from sleep
• Dilation of one or both pupils
• Slurred speech
• Weakness or numbness in the arms or legs
• Loss of coordination
• Increased confusion, restlessness, or agitation

Photo credit: A100319_MAMC_TBI 1, originally uploaded by Joint Base Lewis McChord

Exercise for Parkinson Disease patients

The recent newsletter from the Neurology section included this article, that I thought I would pass along in its entirety as it describes how and why this program and website came about.  I also have a link to the program under the PT Resources page.

How to implement evidence based research into a community program for people with Parkinson Disease?
“Many people with Parkinson Disease (PD) enjoy group exercise programming, but believe they do not fit into the general exercise classes offered.  Many years ago, a small group of physical therapists (PTs)  developed exercise classes that directly targeted the needs of people with Parkinson disease. These classes consist of treadmill walking forward and backwards, along with a floor routine of exercises promoting back, hip, and shoulder extensor strength as well as activities focusing on stretching the hip flexors and trunk. Clients also use the strengthening equipment if available at the site.
In an effort to analyze the program’s effectiveness, a research study was completed:  “Community-Based Exercise and Wellness Program for People with Parkinson Disease: Experiences from a 10-Month Trial,” by Teresa Steffen, Cheryl Petersen and Leah Dvorak (Journal of Geriatric Physical Therapy in 2012). It demonstrates walking endurance had the largest improvement over time (11%). The second unpredictable outcome was that mentation, behavior and mood on the Unified Parkinson Disease Rating Scale improved by 38%.
Currently, there are 15 Wisconsin sites that offer these exercise classes.  They are operated by PTs in Fish Creek, Grafton, Greenfield, Hartford, Green Bay, Madison, Manitowoc, Oconomowoc, Racine, Shawano, Sheboygan, Sturgeon Bay, Waukesha, West Bend, and Whitefish Bay.
It is the belief of the developer of these programs, Dr. Teresa Steffen, that no one should “own” these programs, but rather, that these programs should be able to develop and grow wherever there is a need and a therapist with the energy and qualifications to run them.  In an effort to help grow and support these important programs, Dr. Steffen has developed a website:   The website has an important section on the assessment of the client with PD. It also has one on exercises that have shown the largest response in the Parkinson literature including treadmill training, resistive exercises and then a few fun exercises like dance and tai chi.  This website not only includes important information for clinicians, but can also be a useful source of information for those with Parkinson’s disease.”
From Neurology Section E-Newsletter 10.22.2012

How do you determine your dose?

#ds286 repetition

It has been a rather chaotic few months, but our condo in Seattle sold and we are now settled in an apartment in Minneapolis. The residency has started (practice paperwork is very different here).

Last Tuesday I met with Dr. Kimberley and discussed two papers. The first was an observation of the number of repetitions performed during stroke rehab, and the second was looking at stroke and TBI. They were both interesting reads and provoked good discussion (her expertise is in neuro). Why do new grads and the most experienced do the least number of repetitions, and no one approaches anywhere near the number of repetitions recommended for neuro rehab/ recovery? They definitely got me thinking, and examining my own practice pattern and approach.

We also talked about various aspects of skilled nursing and ortho, and are talking about doing a single-subject design looking at dose/ repetitions in their rehab. I just finished my draft of Aging in America (I may post it here), so my plan for tomorrow evening is searching the literature for hip fracture rehab, starting with the recent Cochrane review. Stay tuned!

Addendum: the two papers we discussed were:

  1. Lang CE, MacDonald JR, Reisman DS, Boyd L, Jacobson Kimberley T, Schindler-Ivens SM, HOrnby TG, Ross SA, Scheets PL.  Observation of amounts of movement practice provided during stroke rehabilitation.  Arch Phys Med Rehabil 2009;90:1692-8.
  2. Jacobson Kimberley T, Samargia S, Moore LG, Shakya JK, Lang CE.  Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke.  J Rehabil Res Dev. 2010;47:851-62.


Photo credit: #ds286 repetition, originally uploaded by rosipaw