"APTA is pleased with the decision of the federal court to approve the final settlement in the class action 'Improvement Standard' lawsuit (Jimmo vs Kathleen Sebelius), which upheld the right of patients to continue to receive reasonable and necessary care to maintain their medical conditions and prevent or slow decline," says APTA President Paul A. Rockar Jr, PT, DPT, MS, in a statement issued today. "We look forward to working with the Centers for Medicare and Medicaid Services (CMS) and its contractors to ensure the appropriate and equitable application of patient care as outlined in the settlement. We believe this final settlement reinforces the fundamental right established in the Medicare statute that affords patients the right to receive the services necessary to treat their diagnoses or illnesses."

The final settlement directs CMS to revise its Medicare Benefits Policy Manual to set a maintenance coverage standard and launch a national educational campaign to explain the clarified benefit to its contractors, providers, and beneficiaries. "APTA is eager to serve as an active partner as the agency begins this work. Over the next several months, we will provide clinical and professional expertise to CMS to define appropriate treatment in accordance with our professional standards," Rockar says.

While CMS works to publicize changes and new resources, APTA will actively educate members on how to give appropriate care as defined by this final settlement.

The candidate webpage now is available. Learn about your candidates for the 2013 elections to national office by browsing the candidates' biographical information and reading their written statements. Contact Angela Boyd with any questions.

The Indian Health Service (IHS) is accepting applications for its Loan Repayment Program (LRP). This program offers health care professionals, including physical therapists, the opportunity to pay off qualified student loans to meet the staffing needs of Indian health programs. There is an estimated $20 million available for awards during Fiscal Year 2013. The LRP awards up to $20,000 per year in exchange for a minimum 2-year service obligation, plus 20% of federal income tax on the award (see payments and examples). 

Applications are accepted and evaluated monthly until funds are exhausted. February 15 is the first award cycle deadline. August 16 is the last award cycle deadline. Visit the LRP website for more information, eligibility requirements, and to apply.

The February issue of Health Affairs explores the burgeoning field of activating and engaging patients in their health and health care. Studies show that more informed and empowered patients have better health outcomes, and there is some evidence that they also have lower health care costs.

One study featured this month found that patients with the lowest level of "activation"—that is, those most lacking in the skills and confidence to be actively engaged in their health care—had average costs that were 8 %-21% higher compared with patients with the highest level of activation.

Another article reports on how offering online health care for patients with simple conditions saved money for a prominent Minnesota health plan. Launched in 2010, "virtuwell" provides 24-hour online access, diagnosis, and treatment (including prescriptions) by nurse practitioners for about 40 simple conditions, such as sinus infections, urinary tract infections, and pink eye.

Private and public sector leaders also weigh in with their perspectives on strategies to lower health care costs, improve quality, engage patients, and enhance outcomes research.  

Due to popular demand, the deadline for the Innovation Summit: Collaborative Care Models has been extended to March 6. Don't miss out on the opportunity to participate in this groundbreaking virtual event that will bring together physical therapists, physicians, large health systems, and policy makers to discuss the current and future role of physical therapy in integrated models of care.

Check out the programming, including the speakers and panelists who will provide you with the information needed to get involved in accountable care organizations, patient-centered medical homes, bundled payment models, and private payer and employer-sponsored initiatives.

Interested in attending a viewing party in your area? APTA will soon list viewing parties and their locations at www.apta.org/InnovationSummit/ViewingParties/.

APTA's newly created Leadership Development Committee (LDC) is seeking members to serve in this capacity. If you or someone you know is interested in developing the organizational structure for an APTA leadership development program, you may wish to add your name in the pool for consideration. There are 7 committee member openings for 1- or 2-year terms starting in April. Contact Elizabeth Grotos with questions about the LDC.

To answer the call for these opportunities, members must first complete a volunteer interest profile found on the Volunteer Interest Pool webpage. Once your profile is created, you may review the current opportunities and answer the questions specific to each committee.  The deadline to respond to this call is February 20.

A training regimen to adjust the body's motor reflexes may help improve mobility for some people with incomplete spinal cord injuries, according to a study supported by the National Institutes of Health.

The study involved 13 people who were still able to walk after incomplete spinal cord injuries that had occurred from 8 months to 50 years prior to the study. All had spasticity and an impaired ability to walk. The goal was to determine if these individuals could gain mobility by learning to suppress a spinal H-reflex, which is elicited by electrical stimulation rather than by a tendon stretch.

Participants in the study received electrical stimulation to the soleus of their weaker leg while standing with support. The first 2 weeks of the study involved baseline measurements of the resulting reflex. During the next 10 weeks, 9 participants underwent 3 training sessions per week, during which they viewed the size of their reflexes on a monitor and were encouraged to suppress it. A control group of 4 participants received the stimulation but no feedback about their reflexes. Before and after these sessions, the researchers measured the participants' walking speed over a distance of 10 meters and monitored their gait symmetry with electronic shoe implants.

Six of the 9 participants in the training group were able to suppress their reflexes. Their walking speed increased 59% on average, and their gait became more symmetrical. These improvements in speed and symmetry were not seen in 3 participants who were unable to suppress their reflexes, or in the control group. Many participants also spontaneously told the researchers they were noticing improvements in daily living activities. About 85% of these comments came from people who were able to control their reflexes after several weeks of training.

Study author Jonathan Wolpaw, MD, said he views reflex conditioning as a complement to current rehabilitation practices. The technique could be tailored to focus on specific reflexes that affect different muscle groups and, in some cases, to increase reflexes instead of decrease them. In its 2006 study, his group found that enhancing soleus H-reflex was beneficial for rats that had spinal cord injuries predominantly characterized by weakness without spasticity.

Aiko Thompson, PhD, who also authored the article, said she plans to study how durable the effects of training are, but such research presents a design challenge. "Once people noticed their mobility had improved, they started exercising more and getting involved with other types of therapy. Those activities are likely to have additional benefits and will be difficult to separate from the long-term effects of our reflex conditioning protocol," she said.