A Bulgarian man whose spinal cord was completely severed has regained limited mobility and feeling in his lower extremities after a surgical procedure that used nerve-supporting cells taken from his nose. Once completely paralyzed in both legs, he can now walk with a walker and drive a car.
According to an article in the Guardian, Darek Fidyka is believed to be the first person to recover from a complete severing of the spinal cord, an injury he sustained in a knife attack in 2010.
Polish surgeons accomplished the recovery by transplanting olfactory ensheathing cells (OECs) from Fidyka's nose into the severed ends of his spinal cord. The cells connected and allowed nerve impulses to once again travel through the entire spinal cord. The technique was developed by the University College of London's Institute of Neurology.
Although Fidyka's recovery is not complete, 1 of the authors of a study on the procedure published in Cell Transplantationdescribed the technique as one that "opened the door to a treatment of spinal cord injury which will get patients out of wheelchairs," according to an article in the Washington Post.
In the wake of 2 Dallas nurses contracting Ebola from the first person to die of the disease in the US, the US Centers for Disease Control and Prevention (CDC) has issued "tightened" guidance for health care workers interacting with infected patients. The announcement was one of several Ebola-related developments occurring recently.
The new guidelines focus on better training, more extensive personal protective equipment (PPE), and more rigorous monitoring of donning and doffing. The enhanced recommendations are informed by practices at Emory University Hospital, Nebraska Medical Center, and the National Institutes of Health Clinical Center—facilities that have had success in handling patients with the disease. The CDC reports that the guidelines are similar to those developed by Doctors Without Borders.
A story in Modern Healthcare (free access with one-time registration) quotes CDC Director Thomas Frieden as describing Ebola care as "hard," saying that "the way care is given in this country is riskier than in Africa. There's more hands-on nursing care, and there are more high-risk procedures."
CDC is recommending all of the same PPE included in the August 1, 2014, guidance, with the addition of coveralls, disposable hoods, and full-face shields instead of goggles. Also recommended:
The CDC warns, however, that "focusing only on PPE gives a false sense of security of safe care and worker safety," and urges extensive training and practice, as well as a careful monitoring process as health care workers put on and take off PPE.
Other recent Ebola-related developments:
The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) is seeking members with diverse clinical expertise to serve on the Accreditation Services Committee, a group of trained experts who review applications and visit physical therapist education program sites undergoing accreditation.
Members interested in being considered to serve on the committee should complete the application on the ABPTRFE website by November 30, 2014. The Accreditation Services Council will make appointments in December 2014. Notification about appointments will be sent in January 2015.
Appointed members must be available for training at APTA headquarters in Alexandria, Virginia, on March 2, 2015. APTA will reimburse all travel expenses for this meeting.
Sure, if you're reading this you probably get to put "PT" or "PTA" after your name. And maybe you can even add "DPT" or "PhD." But—and be honest here—can you tack on the word "adventurer" after those designations?
Stanley Paris can. And he's getting ready to kick that particular part of his qualifications into high gear.
Stanley Paris, PT, PhD, adventurer, has announced that he will make another attempt to set the age and speed record for solo circumnavigation of the globe by sailboat as a way to raise awareness for the Foundation for Physical Therapy (Foundation) and physical therapy research in general. The adventure is set to begin in early November in St Augustine, Florida. Last year's attempt raised more than $250,000 for the Foundation.
Paris made his first attempt to break the age record of 56 years and the speed record of 150 days in early December 2013, but he suffered equipment failure that prevented him from completing the voyage. Since that time, both records have been broken, with the speed record now set at 137 days, and the age record now 70. If he's successful, Paris will beat the new age record by 7 years.
"I am looking forward to taking on this challenge once again and using this opportunity to raise awareness for the Foundation," said Paris in a Foundation news release (pdf). "We need more research that demonstrates the value of physical therapy, and the Foundation is doing just that."
Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, praised Paris's commitment and generosity and said that his efforts are "important in the Foundation's determination to support research that helps physical therapists improve the quality of life."
Paris will once again sail in his 63-foot yacht, the Kiwi Spirit, a craft that will run solely on wind and solar energy. If successful, Paris will also become the first person to circumnavigate in a completely "green" way—or at least the first person to do so in a really, really long time.
Paris will document his journey, post videos, and provide other information on his Facebook page, www.facebook.com/uofstaugsolo. Visit the Foundation's website to find out how to contribute to physical therapy research.
Healthy People 2020, a US Department of Health and Human Services initiative that establishes goals for improving the health of all Americans, is being updated and needs your input.
The program, which provides a set of 10-year national objectives, has issued proposed new objectives in the areas of arthritis, osteoporosis, and chronic back conditions; early and middle childhood; heart disease and stroke; maternal, infant, and child health; and tobacco use. The objectives include issues around hypertension, chronic pain, and attention deficit-hyperactivity disorder. Participants may review and comment on the proposed objectives.
APTA is a member of the Healthy People Consortium, and will gather comments from member experts to develop a formal response from the association.
Plan on submitting individual comments? Be sure to identify yourself as a PT sharing your own perspectives to avoid confusion with the official APTA response.
The US Office of Special Education and Rehabilitative Services (OSERS) has announced funding opportunities for nonprofits and institutes of higher learning that train individuals to work with children with disabilities, and physical therapy is among the training areas that could qualify for the awards. An estimated 26 awards averaging $237,500 will be made.
The funding is intended to help address state-identified needs for personnel preparation in special education, early intervention, related services, and regular education to work with children with disabilities. Special attention is being focused on ways to ensure that personnel have the necessary skills and knowledge using scientifically based research and experience.
Some of the "Personnel Development to Improve Services and Results for Children with Disabilities—Personnel Preparation in Special Education, Early Intervention, and Related Services" grants will be awarded to projects associated with preexisting education programs in special education, early intervention, or a related field; however, grants may also be awarded to projects associated with various assistant programs—among them physical therapist assistant programs. Primary focus areas include projects that prepare related services personnel, such as physical therapists (PTs), to serve children, infants, and toddlers with disabilities. OSERS intends to fund 8 awards under this focus area.
Other award areas include projects related to preparation for professions in "related" services that include physical therapy.
For details, requirements, and application instructions, refer to the program posting on the Federal Register (pdf).
"Transformative" changes mandated by the Affordable Care Act (ACA) and a slowly recovering economy have contributed to a Medicaid system in which most states are expanding eligibility, adopting delivery system reforms, and increasing community and home-based services, according to a new study from Kaiser Commission on Medicaid and the Uninsured.
The Kaiser report surveyed Medicaid directors in all 50 states and the District of Columbia to gather information on program changes implemented in the 2014 fiscal year or planned for the next year. Authors of the study write that these years "will stand out as a time of significant change and transformation." Among the findings:
While the Kaiser report shows more variation in how states are adjusting provider rates, authors note that generally "more states implemented provider rate increases across most major provider types … inpatient hospital rates being the exception."
"States are expanding their reliance on managed care but also implementing new innovative delivery systems and care coordination arrangements, some of which are new options made available by the ACA," according to the authors. In turn, this expansion could be putting some programs to the test, with most directors "report[ing] staffing and resource constraints in the face of the magnitude of the changes occurring in the program today."
Keep up with Medicaid as it continues to evolve: check out APTA's Medicaid webpage for resources, including a members-only guide titled "Making Sense of Health Care Reform: Medicaid Expansion."
The American Medical Association's (AMA) latest ratings of health insurance competitiveness across the United States finds that in 17 states, a single health insurer commands 50% or more of the market in each state, and that in 45 states 2 insurers have captured over half or more of each state’s share.
The AMA's Competition in Health Insurance: A Comprehensive Study of US Markets (summary available for free) uses commercial enrollment data from 2012 to create lists of the country's most and least competitive states for insurance companies, and to assess competitiveness in 388 metropolitan areas.
The 10 least-competitive states are, in order, Alabama, Hawaii, Michigan, Delaware, Louisiana, South Carolina, Alaska, Illinois, Nebraska, and North Dakota. States that have the most competitive markets are, in order, Oregon, Wisconsin, Pennsylvania, New York, Colorado, Missouri, Washington, Ohio, California, and Florida.
The AMA analysis of metropolitan areas found a "significant absence" of competition in 72% of the areas studied, and identified a single insurer as capturing 50% or more of the market share in 41% of the areas.
Overall, Wellpoint Inc was found to be the largest insurer in most markets, with a "commanding position" in more than 20% of metropolitan areas—more than double the number of the next 2 largest insurers, Health Care Services Corporation and UnitedHealth Group.
Carmen Elliott, senior director of payment and practice management at APTA, thinks the shrinking competitiveness contributes to a larger picture of insurers looking to reduce costs and control utilization.
"The lack of competition is a reality," she said. "At the same time, insurers are trying to keep costs down by doing things like narrowing the network of providers covered by the system, increasing copays and deductibles, and implementing utilization management programs. The insurers argue that some of these efforts, like the shift of a greater payment burden to patients, will make consumers more accountable around health care costs and lifestyle choices, but the real challenge is to reduce costs while ensuring high-quality care. That can be a difficult balance."
Keep up with the insurance industry as it continues to evolve. Check out the APTA Private Insurance webpage to find resources including toolkits, videos, podcasts and FAQs on topics ranging from payment methodologies to patient and client advocacy.
A planned change to Medicare coverage of pneumatic compression devices (PCDs) that would have severely restricted patient access to the devices at home has been put on indefinite hold, thanks in part to the efforts of an alliance that includes APTA.
Had it been implemented, the final local coverage determination (LCD) would have imposed restrictions for PCDs that would only allow their use after a 6-month period of "chronic and severe" lymphedema, and would have attached other requirements including the presence of lymphedema into the trunk or chest, the use of manual lymphatic drainage prior to PCDs, and the use of medications. Additionally, the new policy would have denied PCDs to patients who experience any kind of improvement through conservative therapy. The requirements were set to become effective on November 1.
In an October 13 statement to the Medicare Durable Equipment Medicare Administrative Contractors (DME MACs) responsible for the change, the Alliance of Wound Care Stakeholders wrote that "many of the new requirements have no basis in either published medical literature or professional standards of practice," and that the proposed LCD "virtually eliminates access to medically necessary equipment for a significant portion of Medicare beneficiaries" who need the devices for treatment of lymphedema and venous ulcers. APTA is a member of the alliance.
The alliance also asserted that the final policy released in October was "significantly different" from the draft policy released in 2011, and that no additional public comment period was provided.
On October 16, the DME MACs announced that the change would be placed on indefinite hold. The brief announcement stated only that "Additional clinical information published since the release of the draft policy is being reviewed."
a significant victory for beneficiaries who need PCDs and the physical
therapists who are providing treatment," said Gillian Leene, JD, senior
regulatory affairs specialist at APTA. "In the end, the alliance was able to
halt a policy that not only lacked support in medical literature, but also
would have been damaging to patients and severely restricted access to an
effective home treatment option for this progressive and chronic condition.”
Help promote National Physical Therapy Month, spruce up your social media posts with snazzy graphics, and bust a few myths while you're at it—all with a few clicks.
As part of its "7 Myths About Physical Therapy" campaign, APTA is offering free online ad graphics that you can copy and share on social media channels. It's a fun and cool way to get the word out that physical therapy can change lives in ways that might surprise some people.
Get your graphics today, and let the mythbusting begin.
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