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  • From the 2018 House of Delegates: Envisioning a Community

    If there was a single takeaway from the 74th gathering of the APTA House of Delegates (House), it's this: the House is working cohesively to see to it that as APTA approaches its centennial, the association continues to embrace its #BetterTogether ideal and lives out its commitment to making bold moves.

    Backed by a new mission statement rooted in community-building, the House took actions that point to the kind of community the association will build—one that's inclusive, collaborative, compassionate, and unafraid to take on issues that would impact pursuit of APTA's transformative vision. The actions taken by the House make it clear: for the foreseeable future, APTA will be an outward-facing organization that understands its capacity to be a change agent.

    Notable motions adopted by the House touched on the following topics:

    Sexual harassment
    In a unanimous vote, the House strengthened APTA’s position on sexual harassment in all forms, encouraging incidents of harassment to be reported, with permission of the affected individual, to that ensure others are not similarly harmed. Debate on the motion was marked by several delegates sharing their own experiences with sexual harassment.

    Person-centered services
    A resolution adopted by the House positions APTA squarely in opposition to policies that would permit a provider to deny services to a patient based on a provider's religious or personal objections to the patient that may be based on the patient’s age, gender, nationality, religion, ethnicity, socioeconomic status, sexual orientation, health condition, or disability.

    Essential health benefits
    The House adopted an APTA position that establishes the association's commitment to a specific set of comprehensive services it believes should be included in all insurance plans available to an individual across the lifespan and without limitations based on preexisting conditions.

    Elimination of the improvement standard
    The House charged the association with developing a long-term plan to pursue the elimination of the improvement standard—the idea that services are payable only if they result in the improvement of a patient's condition—in all settings and payment situations. The concept, debunked in Medicare thanks to the Jimmo v Sibelius settlement agreement, is used widely in other payment models.

    Physical therapist service delivery
    In a charge aimed at recognizing that physical therapists often provide person-centered services that are outside of the traditional episode of care model, the House directed APTA to explore revisions to the Standards of Practice for Physical Therapy that embrace concepts of long-term, lifetime, and ongoing relationships with patients.

    Professional well-being
    The House charged the association with developing a strategy to address issues that affect the overall well-being and resilience of PTs, physical therapist assistants (PTAs), and physical therapy students.

    The role of PTs and PTAs in disaster management
    The House directed the association to better define the role of PTs and PTAs in disaster preparation, relief, and recovery, and to promote this role to key stakeholders.

    Many other actions taken by the House were part of a 2-year effort to comb through all existing APTA House documents to bring them up-to-date, incorporate them into similar documents, or eliminate them. Topics addressed included durable medical equipment, clinical education, collaborative relationships with veterinarians, PTA supervision, mentoring, and pro-bono services.

    APTA members can view videos of the 2018 House of Delegates online once the archive is posted later this week. Final language for all actions taken by the House will be available by September after the minutes have been approved.

    What's New at MoveForwardPT.com, Summer 2018

    APTA's consumer information website, MoveForwardPT.com, is a continually expanding resource where patients can learn about the many conditions and patient populations physical therapists (PTs) treat. The site includes everything from condition-based guides, podcasts, tip sheets, and videos, to the popular and "Find a PT" tool that allows patients to locate a member PT in their area. It's also home to APTA's national award-winning #ChoosePT opioid awareness campaign and toolkit.

    Bottom line: MoveForwardPT.com is always evolving, and a great resource for members to share with patients and others to help increase public understanding of all that the profession has to offer.

    Here are some recent additions to the site:

    Move Forward Radio podcasts

    Lifecycle of the Pediatric ACL Injury
    Neeraj Baheti, PT, DPT, is a board-certified clinical specialist in sports physical therapy and a board-certified clinical specialist in orthopaedic physical therapy. In this episode he discusses who is more predisposed to these injuries and what they can expect in terms of recovery.

    Bowel Health: What You Should Know
    Jenn Davia, PT, DPT, is a board-certified clinical specialist in women’s health and director of education for the Section on Women’s Health. In this episode, she takes on the topics of bowel health, including breaking bad habits, importance of proper positioning, and tips to achieve o bowel health.

    Tai Chi and Physical Therapy
    Kristi Hallisy, PT, DSc, board-certified orthopaedic clinical specialist, reveals how she incorporates tai chi into clinical practice and outlines how its vast benefits help herself and her patients.

    Once a Physical Therapist, a Young Woman Navigates New Life With Quadriplegia
    Elizabeth Forst, PT, DPT, was in her early 30s,working as a traveling physical therapist, when the simple act of diving into a pool changed her life forever.

    Washington Spirit’s Joanna Lohman Reflects on her “ACL Journey”
    The Washington Spirit midfielder reflects on the physical, mental, and emotional aspects of her rigorous ACL recovery.

    Combat Athletes and Physical Therapy
    Former amateur and professional combat athlete and current instructor Kirstin Schmidt discusses the injuries she endured during her career, and how physical therapy not only kept her fighting, but became 1 of her tools to staying healthy. Her physical therapist, Jessica Probst, PT, who participates in combat sports and treats combat athletes joins the episode.

    Tips

    5 Tips for Creating Good Habits While Toilet Training Your Child

    6 Sports for People with Parkinson Disease

    5 Exercises to Reduce Knee Pain

    What is Pitcher’s Elbow?

    Did You Know?

    New Research Shows: Physical Therapy First for Low Back Pain Curbs Opioid Prescriptions and Lowers Costs

    New and Updated Condition-Based Guides

    Cuboid Syndrome New

    Female Athlete Triad

    Hamstring Injuries

    Hyperkyphosis

    Multiple Sclerosis

    Osteoporosis

    Pain

    Snapping Hip Syndrome

    2018 NEXT: Movement System Finding Its Way Into Education and Research

    As far as Paula Ludewig, PT, DPT, PhD, is concerned, the idea of anchoring physical therapy's identity in the movement system is, to put it simply, a big deal. "This is a huge opportunity for our profession," said the University of Minnesota professor and researcher. "We're at the doorstep of making significant change."

    The question is, just how does the profession get the door open?

    That was the idea at the heart of a presentation on incorporating the movement system into curriculum and research offered at APTA's 2018 NEXT Conference and Exposition in Orlando. Presenters offered 3 distinct perspectives: one from a physical therapist education program that has been infusing movement system concepts into its curriculum and other programs for years, one from a program that more recently accomplished what might be called a retrofit of its curriculum to create stronger links to the system, and one from a researcher and teacher who recounted her own transition away from the "pathoanatomic" perspective. The common thread: embracing the movement system concept can lead to stronger education programs, more useful research, and more effective practice.

    In her presentation on the longstanding incorporation of movement system concepts at Washington University in St Louis (WUSTL), professor Gammon Earhart, PT, PhD, outlined an approach that is now "the seat of everything we do in our department," informing not just education, but research and practice.

    According to Earhart, the first practical application of movement system concepts at WUSTL began with continuing education offerings. From there the concept expanded to residencies and fellowships, and finally worked its way into entry-level DPT training. Movement system concepts are now a part of every course offered in the program, she said.

    Likewise, the university's research efforts underwent a shift toward a more integrated system, resulting in the Department of Physical Therapy's Movement Science Research Center, a centralized facility that allows multiple disciplines to take a team approach to research.

    Eventually, the ripple effect touched the program's practice-related activities, making movement "the primary outcome and primary intervention," Earhart said. For example, patients who presented with back pain were offered another avenue of treatment: rather than focusing solely on exercises aimed at addressing a condition, PTs worked with patients to modify the ways they move in their everyday activities, such as loading a dishwasher or moving a vacuum cleaner.

    Sara Scholltes, PT, PhD, FAPTA, is a graduate of the Washington program and well-versed in the movement system approach, but she found herself teaching at the University of Montana's physical therapy program—which wasn't. Faculty in the program agreed that the school's curriculum needed to make a change, but where to start?

    In the end, it boiled down to tearing down silos, Scholtes said. Rather than structuring curriculum around isolated coursework (first semester, basic sciences; second semester, more of the same; second and third years, subjects seemingly cut off from each other), faculty began thinking about how movement system concepts and critical reasoning skills could be infused throughout the program. Classes were structured in ways that incorporated knowledge gained in other classes—and instructors were free to evaluate that combined knowledge. "The question 'is this exam cumulative?' didn't really matter anymore, because everything is cumulative," Scholtes said.

    For Ludewig, the transition to a movement system approach was personal. As a researcher focused on shoulder issues, Ludewig was driven by what she described as a pathoanatomic approach—"first I get the diagnosis, then I look at the impairment."

    The problem with this approach, Ludewig pointed out, is that it doesn't square with reality: patients don't present in homogenous groups that are cleanly identified within certain diagnostic buckets. They do present with various movement impairments that may share similar characteristics. Those perspectives make a difference. "When you address it from the pathoanatomic perspective, approaches [and] clinical reasoning are all over the place," Ludewig said.

    Instead, Ludewig began looking at impairment first, getting a bead on how patients were moving and associating those movement patterns with hypermobility, hypomobility, or what she termed "aberrant motion." It's a concept anchored in the movement system, and though use of the concept hasn't fully caught on at her school, Ludewig sees a transition happening, calling the shift a "work in progress."

    "We still care about pathoanatomy," Ludewig said. "But it's further down the food chain in how we think about it."