O Comes Before P But Not Always in Therapy

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Typically, most places will list departments in alphabetical order; however, not in the therapy world.

Though “O” alphabetically comes before “P,” you will rarely see Occupational Therapy before Physical Therapy. I believe this is because the majority of the public is more aware of what PT actually is. I have jokingly referred to OT as being the “other” therapy. I get so excited when I meet someone who actually understands what OT is and what I do.

I’m a bit jealous that my fellow PTs don’t have to constantly explain what they do or feel the need to justify the benefits of their services. The name itself, occupational therapy, really doesn’t give the average person a good idea of what OT encompasses. I have worked in the geriatric setting for over 25 years and have heard it all. “Oh, honey, I’m retired. I don’t need you.” Well, actually you do, and let me tell you why!

What is Occupational Therapy?

OT focuses on the whole person with the ultimate goal of maximizing a person’s independence. Trying to get someone to view their occupation of living, what does that entail? What physical aspects (mobility, vision, limited ROM, or neurological movements) are preventing someone from being more independent?  What cognitive aspects (STM deficits, dementia, perceptual deficits) are holding them back? Are there any environmental factors, such as a cluttered area, poor spacing, fall hazards, or ergonomics? There are so many things that we do on a daily basis that we automatically perform. However, when someone is sick or injured, that is when these “occupations” get challenged.

How Can Occupational Therapists Help?

As occupational therapists, it is our job to help identify the factors that limit our patients to perform their daily routines. Whether that includes simple ADLs, figuring out ways for the patient to continue employment, or problem solving ways to continue to pursue activities of interest. To be a part of someone’s success in improving their independence and quality of life is one of the reasons that I love being an OT.

Sometimes all it takes are adaptations to make life easier. Use of adapted equipment, modifying the environment, and compensatory strategies are all techniques specific to OTs. Having been in the assisted living/independent living setting for almost four years now, I have been able to grow relationships with my clients and have enjoyed watching them in their daily occupations. Even after discharge from OT, it is great to be able to engage with them and make sure they are succeeding. However, it is also great to be able to observe any regressions and to help them identify when therapy may be warranted again.

I love it when I receive referrals from my former clients regarding other residents. Not only did I help one person improve, that person is now more aware of what OT is and looks out for others. I feel like I am doing my best to let others know what OT is and how it can potentially improve someone’s independence and quality of life. Now, if only I can get the “O” to come before the “P.” Okay, okay….now that’s just crazy talk!

Kate Beaty, OTR, is an Occupational Therapist in the Senior Living setting for Tx:Team.  She has spent the majority of her career in the geriatric setting, whether in nursing homes, assisted livings or sub-acute rehabilitation.  She really enjoys the relationships that she fosters with her clients and loves to help them achieve their functional goals.

How Can OT Help with Low Vision

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What is low vision?

Low vision is permanent vision loss from an eye disease or condition that cannot be corrected by standard treatments like glasses or contacts, medications, or surgery. With impaired vision, it becomes very difficult to complete tasks such as reading, navigating home and community environments, managing medications, managing calendars and appointments, managing finances, preparing meals and snacks, driving, recognizing faces for social participation, using household appliances like dishwashers, washing machines, and microwaves, and so much more.

What can one do to prevent low vision?

The best way to prevent low vision is to have routine checkups with an optometrist or ophthalmologist and, if diagnosed with an eye condition, adhere to the prescribed care plan laid out by the doctor. The three most prevalent conditions resulting in low vision are macular degeneration, glaucoma, and diabetic retinopathy. If one has a family history of eye conditions, it is crucial to have routine eye exams. It is also important to manage your health conditions, for example, controlling blood sugar is extremely important in preventing diabetic retinopathy. Once these eye conditions are present, they cannot be reversed, but further impairment can be prevented. This is why it is so important to follow the doctor’s instructions once diagnosed with an eye disease.

How can therapy help?

Since low vision is permanent, occupational therapists are not able to restore lost vision, but we can help those with low vision best utilize their remaining vision to be as successful and independent as possible. Occupational therapists perform home assessments to identify potential hazards and make appropriate modifications for safety and success. Some examples include adjusting lighting, removing clutter, and adding a contrasting color to doorways, steps, or thresholds. Occupational therapists may also modify the task, teach new skills, and utilize technology to improve daily function. Visual scanning and tracking techniques may be taught to better utilize remaining vision or, one may be introduced to adaptive tools and technology.

Each condition resulting in low vision impacts the visual field differently and have their own unique set of challenges. Occupational Therapists understand these conditions and how they impact the visual field. Occupational Therapists combine this knowledge with an individualized approach in order to provide training and modification in the client’s home and immediate surrounding community for optimal performance of the activities that are meaningful to the client.

Anna Pung, OTR is an Occupational Therapist in the Senior Living setting.  She has a Master of Science in Occupational Therapy from the University of Alabama at Birmingham (UAB) and Bachelor of Science in Psychology from Mississippi State University.  Shespecializes in low vision, dementia, fall prevention, orthopedics, and neuro rehab. Anna is very passionate about working with individuals throughout the aging process to maintain independence and high quality of life.

Meet Bob Haan

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Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Bob Haan, Vice President of Clinical Operations and Quality, and hear his story of his time with Tx:Team:

 

Low Vision: Helping You See a Brighter Day

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Low vision can cause difficulty in seeing detailed letters and numbers when reading, recognizing the slope of a curb, steps, or facial features, and distinguishing between similar colors, such as black and blue. Adults who have one of these problems may have trouble maintaining their independence and completing typical day-to-day activities.

Occupational Therapists can help people with low vision to continue living in their own homes and complete daily tasks, such as showering, dressing, cooking, grocery shopping, managing finances, and getting around in the community.

How can an Occupational Therapist help?

OTs will evaluate a person’s environment at work and at home to determine how it can be altered to make the most out of a person’s remaining vision.

  • Optimize lighting on areas and objects that present risks for falls.
  • Reduce clutter in rooms to increase safety while moving around.
  • Educate on how to use other senses to compensate for vision loss.
  • Recommend assistive devices that aid in completing daily tasks.

What can friends and family or a person with low vision do?

  • Support them by adapting their home to keep it safe and functional.
  • Help them access community resources, including talking books, audio reader services, and centers for the blind.
  • Keep up to date about the person’s vision ability.

 

Prevention is Key

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Prevention of onsite work injuries is the key to keeping employees safe, healthy, and productive. In the manufacturing setting, common injuries include overuse or repetitive injuries and overexertion injuries often associated with lifting. Education and vigilance helps to decrease these injuries.

Lifting using proper body mechanics should be taught during the orientation process along with different ways the manufacturer has provided to reduce or avoid lifting in the first place. Many employers provide high-low tables, pallet jacks, and rollers to decrease pushing and pulling force required along with other tools to reduce strain. An on-site physical therapist can provide the lifting education in tandem with the employer providing information on lifting or force reduction tools provided by the company.

Training team leaders to watch for repetitive use injuries can also go a long way to keeping employees pain-free and on the job. When an employee is bending or reaching in the same way over and over again, hour after hour, this can lead to injury. Training the leaders to recognize the signs of overuse and alert the employee of alternate ways to complete the task can decrease the repetitive strain on muscles and joints. An example could be alternating which arm reaches for a particular part or shifting body weight from one foot to the other every few minutes for stationary tasks. A physical therapist can provide this training to the team leaders, help brainstorm ideas for reducing the strain, provide education, and assist with periodic observations of the task.

Jessica Tharp, PT, MPT is a Physical Therapist in the Employer Based Clinic setting. Jessica received her Master’s Degree in Physical Therapy from the University of Indianapolis. Throughout her career, she has treated a variety of various orthopedic and neurological diagnoses. Jessica has significant experience in treating back and neck pain as well as hip, knee, ankle, and shoulder injuries, including post-surgical rehab of the hip, knee, shoulder, and spine.

Meet Katie Guerdan

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Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Katie Guerdan, Manager of Human Resources and hear her story of her time with Tx:Team:

Physical Therapy to Reduce MSK Spend

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Over the past several years, MSK spend has been on the rise and in many employers’ health plans, it is the number one expense. It is our mission at Tx:Team to alter this trend by recommending the addition of physical therapy solutions. Physical therapy has been shown to reduce the need for imaging, medications, and unnecessary primary care and specialist visits, all of which have a massive impact on MSK spend.

Tx:Team’s outcomes are consistently in the top 10% in the U.S; we average a Net Promoter Score of 97; and our costs are 25-40% less than retail. If you’re interested in using physical therapy as a way to reduce MSK spend for not only your health plan, but for your employees and their family members as well, contact Tx:Team today using the form below.

 

    Please provide your email below to continue the conversation with Tx:Team.

    Patients Love Us and We Know Why

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    Since 1983, Tx:Team has focused on providing our partners and our patients the best in quality services. 

    “We believe that everyone should have the opportunity to live the healthiest life possible. By harnessing the collective power of our therapists’ hands and minds to heal, we create an environment of health, wellness, and vitality for our patients, our associates, our partners, and our communities.”

    It is easy to assume or make statements that we give great care. Without the data, how do we know? Tx:Team takes great pride in the fact that our therapists deliver the highest in quality rehabilitation services. So, how do we know? We can prove it.

    Tx:Team uses numerous systems to measure patient satisfaction and patient outcomes. These systems include Focus on Therapeutic Outcomes (FOTO), CMS Merit-based Incentive Payment System (MIPS), patient satisfaction scores, goal attainment, and net promoter scores. The information we collect helps us to measure how we are doing and if necessary, where we can make improvements.

    Why do we do this? We want to be sure we are continually providing the best clinical services with the highest form of customer service.

    FOTO – Focus On Therapeutic Outcomes is an outcomes tracking platform used by our Employer Based Clinics, Frederick Health outpatient clinics, and our team at Putnam County Hospital. Similar to standardized outcome measures like the DASH and the Oswestry, FOTO looks at the change in score on surveys completed by patients throughout the episode of care. FOTO is unique in that they use their database of over 7 million episodes to provide a risk adjusted comparison of outcomes. Our results are compared to the average change and number of visits of patients who are similar based on 13 risk adjustment criteria. FOTO also collects patient satisfaction and net promoter scores as well as any comments patients want to submit. Results are ranked by clinic and therapist against all other 23,500 therapists using their platform.

    MIPS – Merit-based Incentive Payment System. A “gift” from CMS, MIPS measures functional outcomes. The patient is given a survey to measure what their current function is and then fills out the same survey when  progress reports are due and at discharge. Our final score is based on the percentage of cases that fail to progress above the minimum threshold for each measure. MIPS also measures change in pain from start to finish with an expected 2 point decrease. In place of automatic increases to the MPFS for all providers, CMS implemented MIPS as the only way providers can receive an increase. However, participation doesn’t guarantee a positive adjustment. MIPS is a budget neutral system which means providers who produce better outcomes are awarded positive fee schedule adjustments funded by the negative adjustments assigned to weaker performers.

    Patient Satisfaction – These scores measure several different things and most importantly give us a measure of overall satisfaction. How satisfied a patient was with their therapist by asking if they would recommend them to another person? Are we courteous, responsive? Do we respect patient privacy? Are our associates professional? Is there a limited amount of waiting time for patient appointments? Surveys also provide an opportunity for the patient to leave comments about their therapy visit.

    Goal Attainment – We have been addressing goals since the day we saw our first patient. These goals are a key in measuring and attaining patient satisfaction. Our goals must be patient centered, involve their input and celebrated when they are achieved. The patient must be aware of how they are performing in relation to the goals and educated when the goals are in “Therapy Speak” as to how they relate to making the patient’s life better. A best practice is to use the MIPS and FOTO tools to write functional goals where the patient may be having difficulty.

    Net Promoter Score – These scores are all very important and deserve a pat on the back, but they are also helpful in exposing where we may have some room for improvement. Digging deeper, into scores by individual therapist can help us learn from each other and develop company-wide “best practices.”

    The big question is…how do we stack up? The answer? Very well!

    1. Tx:Team has received the award of “Exceptional Performer” by the Center of Medicare Services (CMS) for the past 3 years (2020, 2021, 2022). The most recent score of 100 in 2022 places us in the top 1 percent of Outpatient Physical Therapy clinics in the country.
    2. In 2022, our Patient satisfaction scores have been recorded as a consistent 98% – 99% throughout the year.
    3. “Would you recommend your therapist to others?” 100% of our patients said they would definitely recommend.
    4. Awards – One of our employer-based clinics, IU13 Clinic in Pennsylvania has earned the top level of recognition within FOTO (Focus on Therapeutic Outcomes). This is an impressive accomplishment since this award requires meeting 12 months of consistent outcomes performance benchmarks. The award is called The Center of Excellence Award.

    Patient outcomes and patient satisfaction. There is a correlation!

    It has been said that a happy patient has better outcomes, participates in his or her therapy sessions, and has fewer cancellations. Happy patients can actually get better faster. The goal of all associates at Tx:Team is to provide the best clinical therapy services and delivering those services with the highest form of customer service. See why “working with us is good therapy.”

    New Roles and Promotions at Tx:Team

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    We are pleased to announce the promotion of several associates into new positions at Tx:Team. Please join us in congratulating them on their new roles!

    Bob Haan has been elevated to the position of Vice President of Clinical Operations and Quality. Bob started with Tx:Team in July of 1999 as a PRN Physical Therapist in the skilled setting. He was later promoted to Senior Team Leader and in 2009, was named Director of Rehabilitation Services. Bob’s extensive knowledge and experience as Director of Rehab, along with his involvement and oversight of our quality assurance systems throughout the company, have prepared him for this new role. He will be responsible for overseeing our employer-based clinics and Indiana hospitals, and will manage quality, compliance, clinical and operational reporting, and operational excellence for all business units.

    Ann Hightower has been elevated to the position of Vice President of Internal Operations. Ann joined Tx:Team in May of 2002 as part-time help for the education department. Over the years, she has worked in accounting, education, human resources, information technology, and marketing for Tx:Team. When it became evident that this was going to be more than a summer job, she was promoted to Director of Marketing, and later to Director of Internal Operations. In her new role, she will continue to look for ways to streamline Tx:Team’s marketing and human resources processes, focusing specifically on company growth, efficiency, measuring outcomes, and maintaining effective internal systems.

    Mike Holway has been elevated to the position of Director of Senior Living. Mike joined Tx:Team in March of 2019 as the Manager of Senior Living and has been responsible for all clinical and administrative operations, client engagement, and personnel oversightwithin the Bridge Senior Living portfolio of communities. He is passionate about our industry. Mike’s hard work and track record of success as Regional Manager have prepared him for his new role as Director. He will continue to oversee our growth andinnovation as a leading provider of rehab services within the Senior Living Community setting.

    We are proud of Bob, Ann, and Mike, and look forward to working with them closely in their new roles. Congratulations, all!

    Female Athletes and ACL Prevalence

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    As a former female division 1 gymnast, I personally experienced and witnessed many types of injuries. I had a few teammates who had recurring injuries that impacted their ability to continue the sport they loved. Seeing the sub-par rehabilitation process in a college setting without physical therapy interventions available, re-injury was extremely common. Many of these recurring injuries involved the knee and internal knee structures such as the ACL, PCL, MCL, and LCL. 

    ACL injuries are becoming more and more common in the young athlete, but did you know that female athletes are up to 10 times more likely to experience an ACL injury compared to men? This may be due to the anatomy and biomechanics of the female knee joint. Often due to wider hips and a smaller groove at the bottom of the femur where the ACL inserts, the ACL in the female knee may experience greater stress and further restriction during twisting, jumping, changing direction, and landing movements compared to men. Other contributors to increased risk of injury include weakness of the posterior chain musculature (glutes and hamstrings) and ligament laxity during hormone cycles. Recent studies have found that woman may be more susceptible to ACL injury just prior to ovulation compared to the follicular phase due to increased ligament laxity.

    The most common form of treatment following ACL injury is a reconstructive surgery using a graft from either the patient’s own patellar tendon, hamstring, or an ACL from a cadaver. Although an athlete may go through ACL reconstruction, it does not guarantee normal functions of the knee or prevention of subsequent knee injury. In recent studies, it has shown that about half of athletes who underwent ACL reconstruction return to high level sports, and only about 20% of these younger athletes will return to higher level sports in the first year following injury. Given these findings, it is extremely important that ACL rehabilitation encompasses deficits related to surgical interventions as well as initial cause of injury occurring prior to surgery.

    Current generalized ACL rehabilitations programs may not have all-inclusive motor training, and neuromuscular re-education needed to safely allow return to sport within one year’s time. It has been statistically proven that proper recruitment and strength of the posterior chain as well as muscles that stabilize the knee will decrease risk of  re-injury in the young athlete with a prior ACL tear. Physical therapists have the training and knowledge to specifically pinpoint weakness and instability within the hip and knee complex, analyze gait and movements patterns, and build sport specific training programs to assist in injury prevention of the young athlete. 

    In early rehabilitation, it is crucial to protect the graft site, and begin regenerating the quad musculature. Research shows that following knee injury or surgical interventions there is a reflex response to inhibit muscle activation called Arthrogenic Muscle inhibition (AMI). Physical therapy can assist in targeting the muscles that have been affected during this reflex inhibition process. Some examples include quad setting, resisted terminal knee extension, straight leg raises with a knee extension brace until the patient can complete a straight leg raise without knee flexion. Other exercises to assist overall hip and knee stability include closed chain activity such as partial squats, step ups, single leg balance activities, and bridges. It is critical for the physical therapist to ensure the patient is completing exercises without compensatory strategies and progressing toward proper movement patterns. 

    Due to the high prevalence of re-injury, as well as muscular inhibition following knee injury, it is highly recommended that athletes, specifically women receive intensive rehabilitative care following ACL repair. Without specific neuromuscular re-education, proper movement pattern restoration, and addressing pre-injury mechanical deficits, young athletes are at risk for re-injury or significant time lapses as they attempt to return to sport. Physical therapy can provide young athletes with the education and tools they need for success as they return to the sports they love. 

    Amanda Lievendag, DPT, CMTPT is a Physical Therapist in the outpatient setting at Frederick Health Physical Therapy & Sports Rehab. Amanda’s professional interests are Sports Orthopedics, Sports Rehab, Trigger Point Dry Needling, and Spine Rehabilitation. She is a high energy physical therapist who has specialized experience with post-op, sports injuries, return-to-sport training, overuse injuries, and general wellness with athletes and patients of all ages.