Congratualtions to this year's winner of the Golden Goniometer

To the Dominican, and Beyond!

A little over a year and a half ago my class was approached with the opportunity to travel to the Dominican Republic to assist the people there with any physical concerns we could. As a part of a team from Northwoods Church teaming with Solid Rock Missions, we would travel down for a week long medical mission trip. I jumped at the chance to not only serve the people there but also to gain more practice in using the skills I'm learning in PT school.

During our preparation time, the earthquake that shook Haiti to crumbles put a change in our plans. Now, instead of only going to the Dominican, some of our group would travel to Haiti as well. The town where Solid Rock had contacts is only a few hours away from the border to Haiti. This provided an easy starting point to bring physical therapy assistance to the people suffering from that tragic day in Port Au Prince.

I was part of the group that stayed in the Dominican for our trip. The guesthouse we stayed in is part of a compound that built a clinic where patients could travel from all around to receive chiropractic, medical, and dental care from us. The physical therapy aspect was actually served at a local clinic.

There we had the opportunity to evaluate and treat patients that had traveled from as far as 3 hours just to be seen once. The main therapist from the clinic said people were lined up the day before we arrived because they were so anxious to get treatment from us. The limited time we spent with them was truly life changing, for both parties involved.

Since we have been back, I know I have been thinking about returning. The trips through Northwoods have been so full, we Bradley students did not have a chance to go this last time. We still wanted to help out in anyway we can. Last weekend we performed with a band our professors are a part of to put on a benefit concert for Solid Rock Missions. So half a dozen PT students put on our musician hats and covered ten songs. During our set, we passed around a donation bucket encouraging people to donate to a good cause. We were able to raise over $300 from just one night of fun.

In addition to helping the people in the Dominican, this trip also helped us sharpen our skills. We had just been learning techniques we were able to apply directly to patients. We were also more comfortable with direct patient contact due to more experience in this area. This inspired us to bring a little of the Dominican home to us.

Around this same time there was an article published talking about Student Led Pro-Bono PT clinics. This was very encouraging to us because we felt we could do something similar. We wanted to be able to provide services to people who need it, while at the same time sharpening our clinic skills, just like we did in the Dominican. This idea had already been brewing in our department director's mind, so when we brought it up it was very well received.

At this time, we are working to partner with Heartland Community Clinic in Peoria to allow us to provide some of those PT services to people who cannot otherwise receive it. We are not trying to compete with area businesses, but rather provide services to patients who perhaps do not have insurance coverage or have met their maximum benefits.

This project will take a lot of dedication from both the students and faculty involved. Having this partnership form will hopefully lead to a continual relationship between the Bradley PT department and Heartland that will foster leadership and growth in the PT students while providing care to the underserved in the Peoria community.

Fall 2010 Golden Goniometer

And this year's winner of the Golden Goniometer goes to EJ Hodel, Meg Martindale, Angela Boundy and Natalie Larsen for their work on the Ottawa Ankle Rules. Congratulations, gang! Well done!

AAOMPT Conference--San Antonio

Keith Scott and I, 3rd year students, just returned from this year's AAOMPT conference in San Antonio. We were there to do a poster presentation which entailed judges evaluating our study and 56 others. Talk about feeling like you're in the midst of a practical!

Anyway, I wanted to talk about how invaluable of an experience the conference was. But in order for you to fully realize how much this conference affected me, allow me to share a little about my background. I have been a chiropractor since 2002 and had decided in 2007 to go back to school for PT for many reasons. I have always been drawn to orthopedics, obviously, but was never really drawn to evidence-based practice; until spine class in the summer of 2009. Joe and Cheryl's class opened my eyes to EBP in a way that has clinically changed the way I will practice from now on. Basing my clinical decision making on the evidence rather than on what a guru says has truly given me confidence with patients that I never really had before. I have become a certified evidence junkie. I subscribe to 2 "push" services and can't get enough. One of the consistent patterns that I am seeing in the literature is that more and more studies are pointing to the efficacy of combining manipulation and exercise. I digress. Back to the conference.

AAOMPT Conference
Friday's keynote address speakers: Stanley Herring, MD; Chad Cook PT, PhD, MBA, OCS, FAAOMPT; Josh Cleland, PT, PhD.

Herring systematically laid out arguments for positioning PT as a first line of defense for musculoskeletal conditions and how we as a nation have spent disgusting amounts of money at improving spine care with little to no improvement in outcomes (cost has mounted as quality has declined).

Cook has authored many research articles, written or contributed to multiple texts, and is editor of the Journal of Manual and Manipulative Therapeutics (JMMT). His keynote address was on the best test for diagnosis of the spine and why its important. In his address he discusses the importance of differential diagnosis, diagnostic accuracy, and the best tests for diagnosis. He discussed the importance of the reference standard that is used to compared the proposed test and how it can make or break the validity of the test. Surprisingly, there are relatively few tests that have withstood the rigors of statistical analysis.

Cleland's talk was entitled "Manual Therapy: if it works, why isn't everyone doing it?" He discussed the evidence for manual therapy and the barriers that PT's need to overcome to incorporate it into their practice.

That was just Friday's addresses. There were breakout sessions all day Saturday as well, and into Sunday morning. All in all the talks were very dynamic and informative. They also had the student special interest group (sSIG) there to get the students more involved. There were exhibitors on hand with everything from rehab products to fellowship programs to journals....free pens galore.

It was such an incredible experience being around some of the greats in the research world. After seeing some of the same names over and over in the literature and then to finally see them in person it was definitely a room full of rock stars.

If you've made it this far I hope to end with one final note of encouragement: get involved. Joe and Cheryl have brought to Bradley an incredible enthusiasm for evidence-based practice. In the (near) future there will be many opportunities to improve your hands-on skills. Keep an eye out for the manual therapy club (coming up yet in Oct), Explain Pain seminar (spring 2011), and the AAOMPT student special interest group (sSIG) on campus (in progress).

As an additional plug for the manual therapy club, if you know that you're leaning toward orthopedics, specifically manual therapy PT, I'd remind you that it's a skill that must be practiced hundreds of times to develop the motor pattern. In chiropractic school we had about a year and a half of manipulation training and admittedly I wasn't completely comfortable for at least a year in practice. I can't stress enough the importance of getting your hands on willing participants. Get your fears out of the way now so you become proficient at it and can confidently treat patients using the best evidence. Hope to see you at the club meeting...

BU DPT 5k

Like to run? Prefer to walk? You can do both!

The BUDPT 5k will be held on September 25th, 2010 @ 9:00 a.m.

The Doctor of Physical Therapy Class of 2012 is sponsoring a 5k walk/run to help raise money for a variety of events. The money raised will defray some of the costs associated with traveling to our national conference in February 2011 and graduation expenses.

Please support the Department of Physical Therapy and run or walk in the 5k. Set a new PR on this flat, fast course! You will have the opportunity to win prizes and all will receive a t-shirt.

Register by September 17th. Registration is $15 for students, $20 for non-students. Click here to download the registration form.

Also available soon: Class of 2012 cookbooks featuring our favorite family recipes!! Please contact dmcooper@mail.bradley.edu for more information.

CSM revisited: Head trauma types: Blunt Force, Acceleration/Deceleration, and Blast

The Federal section of the APTA works to provide support for those who deliver quality physical therapy in Federal Medical facilities. As one can imagine, these PTs spend much of their time working with war veterans, many who have had a traumatic brain injury along with other injuries. The course at CSM was listed as “Balance at a high level: Vestibular training for the Amputee.” While much of the vestibular training is commonly used, the reason why these men with amputations require vestibular training is unusual. Kim Gottshall, PT, PhD, ATC and retired Colonel, US Army Reserves presented this training on this topic to about 150 PTs and PTAs at CSM. The information focused mostly on mild traumatic brain injuries and common associated symptoms.
The fact is blast type head injuries are fairly new. With new technology in body armor, the thorax is protected saving the life of the soldier, and helmets provide some protection from blunt force trauma and/or coup-countercoup (acceleration/deceleration) type head injuries. However, the blast type head injury, created by the shock-wave of the blast is different, and very little study has been done on this topic. The study of the other two types has been building for two to three decades, and there may be little to correlate with blast injuries.
In addition to body armor technology, the other factors that lead to this “signature” injury of the current two wars (Iraq and Afghanistan) is that much of the warfare is urban, as well as that improvised explosive devices are the weapons of choice for the opposition. The shock wave effect creates a sheering injury in the vestibular end organs, as well as a significant release of excitatory neurotransmitters. The result is oxidative cellular stress and direct stimulation of apoptotic pathways. Part of the presentation, then, is multiple site involvement. This means that there may be peripheral and central damage and resulting symptoms. Also common are cognitive difficulty and hearing loss or tinnitus. “Dizziness” is often reported as well, but the type and quality of the dizziness associated with blast injuries is still not characterized.
With lack of clinical research in this area, the current suggestions are to recognize that the neurological exam may result in findings that do not fall into a known pattern and to be as thorough as possible. In addition, quantifiable testing is helpful, such as using computerized dynamic posturography and VOR equipment if available. There are four suggested groups: 1. Post traumatic positional vertigo. 2. Post traumatic exertional dizziness. 3. Post traumatic migraine associated dizziness. 4. Post traumatic spatial disorientation. Blast head injuries also tend to have more cognitive difficulty and more hearing loss along with these different combinations of diagnoses.
Rehabilitation should be focused on the results of the examination. Video was shown and those with amputations were able to complete even the highest demands of rehabilitation with the prosthesis. Dr. Gottshall reported a study that she recently completed. While the exact study methods and procedures were not outlined, several notes were made about the subjects. The main observation was that cognitive rehabilitation seemed to correlate positively with vestibular rehabilitation. In addition, patients perceived improvement before functional gains were made. Finally, there is a temporal component to vestibular rehabilitation.
I look forward to seeing the published studies to come on the nature and sequelae of blast head injuries. For more information about the Federal section of the APTA: http://www.federalpt.org/ A full text article on what is known about
blast head injuries can be found at: http://www.pdhealth.mil/nlAttachments/DHCC-Uploads/21769.Taber.et.al.06.J.Neuropsych.Clin.Neurosci.Blast-rel.TBI.pdf

For other resourses, you can contact me at aalton@mail.bradley.edu

Sensory deficits post stroke

CSM revisit: Sensory deficits post stroke: best practice treatment
Jane E. Sullivan, PT, DHS from Northwestern University presented compelling evidence that Physical therapists need to be treating sensory dysfunction after stroke (Post Stroke Sensory Dysfunction, or PSSD). First, this is truly common, although it is rarely addressed by PT outside of proprioception (where is your arm? Are you sitting up straight? Where are your feet? Etc). In addition, the loss patterns do not follow motor loss patterns, and so these do need to be tested.
A study done by Connell in 2008 found that there was high agreement between different body areas for each modality, but there was low agreement between modalities in each area! This means PTs need to test each modality. Tyson et al in 2007 found that stroke severity and weakness are significantly correlated with PSSD, a finding later corroborated by Connell in 2008.
Also correlated with decreased sensory were outcomes such as increased length of stay, decreased bowel/bladder independence, decreased ability to perform ADL’s, etc. There were many studies cited in this presentation which link low sensory function with discharge placement, slow recovery of motor function, and even mortality.
The good news is this: the neurological system is moldable and trainable. We know that motor patterns can be learned; so too can sensory. There is natural recovery, anatomical redundancy, and bilateral pathways all improve the prognosis.
The reliability and validity of sensory tests were explored, and while there are some issues in this area, the following recommendations were made: 1. Screen everyone (post-stroke) for all modalities including stereognosis. 2. Formally test if linked to movement dysfunction and goals. 3. Standardize your exam.
Obviously, there is a need for more research, but there are promising studies that link improved upper extremity sensation with improved balance outcomes. Electrical stimulation studies have shown excellent potential for “waking up” the sensory system, with improvements noted in spasticity, force, perception, selective movement, as well as balance and gait. Vibration, thermotherapy, intermittent compression, graphesthesia and discrimination tasks and passive movement all show improvement (passive range of motion shows fMRI but not clinical improvement). Finally, these changes persist! There is yet to be any meaningful dose-response trial, however.
The parameters recommended at this time across interventions are: Brief (20-30 min – they will get tired!), and repetitive (3-5 days per week) for several weeks. With any of these treatments, practice mastered tasks first and last, take breaks, and aim for limbic involvement and active attention. Reduce the stress in the environment so the patient may attend to the task as well. A quiet nervous system will respond more dramatically to changes, and above all, PRACTICE!
** for references feel free to contact me at aalton@mail.bradley.edu

Combined Sections Meeting: Concussions and Mild Traumatic Brain Injury

This presentation featured four speakers about a very timely topic: concussions. ESPN has even had NFL players and others as guests to discuss this issue, including self-monitoring of athletes and team policy on the return of players to the field after concussion.
The message is becoming clear very quickly: These injuries are extremely serious and need to be treated as such. Not only are they serious, but it is an injury that has the potential affect all populations and all PTs, regardless of the specialty.
The first Speaker, Kevin Guskiewicz, PhD, ATC, FACSM gave background about concussions. There are about 1.6 to 3.8 million sports-related TBIs each year (Langlois et al, 2006), and that is only sports related. They have a cumulative effect and can have enduring consequences if not managed properly. It is estimated that 50% of these injuries go unreported in this “silent” epidemic (Giza, 2001; Guskiewicz 2003, 2007; Collins, 2003, McCrea, 2005).
The basic evaluation is the same as any other injury, including cranial nerve testing, cognition, coordination, history and physical, as well as basic PT evaluation. He cautioned that return to sport should not be considered if there was any loss of consciousness or amnesia, OR if the person is young or high school age, or if they are still experiencing signs or symptoms. However, any other return to play guidelines have not been made with evidence basis. There is work being done to rectify this.
Finally, severity of the injury cannot be determined initially. Because concussions are defined as a loss of function, not damage to structure, the severity is graded by how long the symptoms last, and how severe they are.
The strategies for addressing deficits are the same as any brain injury, remembering that the nervous system is plastic and can and will be affected by practice and rich environments.

The second speaker was none other than neurosurgeon Dr. Cantu of Emerson Hospital, who has treated many famous people with traumatic brain injury. He posited that there is really no such thing as a “MILD” traumatic brain injury. His focus was technical, as one would expect from a neurosurgeon, but the gist was that multiple concussions, especially those that do not heal correctly, can result in erratic and psychotic behavior and a syndrome called Chronic Traumatic Encephalopathy (CTE).
We have seen this play out in the news: the wrestler Chris Benoit who killed his wife and child and then killed himself, or the Steelers’ player who drove his car into an oncoming tanker truck. The problem is there is no way to diagnose CTE without an autopsy, where the presence of Tau proteins is noted.
Dr. Cantu, along with several others, is at the forefront of this in the national discussion. His goals are to better define and diagnose brain injury, develop guideline for treatment and return to sport/activity, and to educate the public about the seriousness of these injuries. He and his colleagues are lobbying congress and the court of public opinion to put this issue on the priority list for public and global health initiatives.

Third was Susan Whitney, a PT from University of Pittsburg Medical Center. Her focus was clinical: describing common symptoms and treatments for balance disorders associated with concussion and post-concussion syndrome. Dr. Whitney also shared some evaluation tools that are helpful in diagnosis and planning.
She also described some of the studies the UPMC is conducting and the results of the intervention protocols they are developing. Promising results are being reported with a program of gaze stabilization and standing balance and ambulation exercises.

The fourth speaker was Chris Nowinski, a Harvard graduate whose WWE wrestling career was cut short by a concussion. His goal was to provide a patient’s perspective of TBI. He described his last concussion, stating that he had been to eight doctors when the symptoms did not subside, and that it was finally Dr. Cantu who asked “How many times have you had your ‘bell rung’ or saw stars?” not the question that the previous doctors had asked (“how many concussions have you had?” – none diagnosed!).
After his rehabilitation, Chris teamed up with Dr. Cantu and his colleagues to help spread the word about this serious injury. He wrote a book with fellow wrestler Jesse Ventura called “Head Games” to explain to athletes why this is not an injury you should play through.

The program was extremely interesting and informative on a very well-timed topic. For more information about concussion prevention and the current work by Dr. Cantu and Chris Nowinski, go to: http://www.cdc.gov/ncipc/tbi/physicians_tool_kit.htm and http://www.sportslegacy.org/




Ist speaker references:
Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M. Cumulative effects of concussion in high school
athletes. Neurosurgery 2002;51(5):1175-9; discussion 80-1.
Giza CC, Hovda DA. The Neurometabolic Cascade of Concussion. J Athl Train 2001;36(3):228-35.
Guskiewicz KM. Assessment of postural stability following sport-related concussion. Curr Sports Med Rep
2003;2(1):24-30.
Guskiewicz KM, Marshall SW, Bailes J, et al. Association between recurrent concussion and late-life cognitive
impairment in retired professional football players. Neurosurgery 2005;57(4):719-26.
Guskiewicz KM, Marshall SW, Bailes J, et al. Recurrent concussion and risk of depression in retired professional
football players. Med Sci Sports Exerc 2007;39(6):903-9.
Guskiewicz KM, McCrea M, Marshall SW, et al. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. Jama 2003;290(19):2549-55.
McCrea M, Guskiewicz KM, Marshall SW, et al. Acute effects and recovery time following concussion in collegiate
Football players: the NCAA Concussion Study. Jama 2003;290(19):2556-63.
Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006;21(5):375-8.

BUDPT Class 2011 in San Diego

PT students and professionals from all over are attending the 2010 APTA Combined Sections Meeting (CSM) in San Diego this week. You can read their 'journals from the road' featured here on Bradley's home page. Many of our own Bradley students and faculty will be presenting their original research!

Physical Therapy... en Espanol!

Check out this video made by Bradley Health Science student, Melissa Buness. Melissa is bound for a professional DPT program next year. She created this video articulating the benefits of physical therapy in Spanish as part of an undergraduate Independent Study project in the Health Science Major.

Physical Therapy in the Dominican Republic

You may have seen an article written in PT Priority by Heather Hall, BU DPT '11, about a trip to the Dominican Republic in March of 2009, or perhaps you read her blog while she was there. Recently another physical therapy team from Bradley returned to San Juan de la Maguana. I had the pleasure of accompanying Dr. Dawn Hall, PT, PhD, Abigail Walk, BU DPT '10 and Dorothy Fernandez, BU DPT '10, along with several others on an adventure to a city 3 hours from Santo Domingo and near the Haitian border during our Fall Break.

Everyday we examined patients in San Juan at a rehab facility associated with a local hospital. This clinic provides physical therapy to patients in the area, however in most cases the people cannot afford the 'luxury' of these services. The need for physical therapy appears to be the same as in the United States. By my best estimate, San Juan proper is about 130,000 people, and the rehab facility is the only one between San Juan and Santo Domingo (about a three hour drive.) It would be like having one PT clinic within 200 miles...only the drive to get there would much more interesting with partially paved roads and intermittent livestock crossings.) Diagnoses included SCI, CVA, BKA and patients with numerous neuromusculoskeletal issues, including many complaints of mechanical neck and LBP. In addition we saw a number of patients with diagnoses we probably just wouldn't have the opportunity to manage in the United States. For example a man with neurofibromatosis had a 40# tumor removed from his leg. Had the tumor not been removed, the man would have undergone an amputation, and my perception is prosthetic limbs in this part of the Dominican Republic are not readily available to all. Another patient had significant scarring on his chest and axillary region from a burn he received as a child. As a direct result of this, he has had limited function in his right upper extremity for the majority of his life. Because of the widespread access we have to quality health care here in our own country, conditions like these would be addressed much earlier in a patient's life and long before mechanical problems developed. Dorothy, Dawn and Abigail were involved in pre and post-op management and assisted in both surgeries. In just a week's time they were able to make a pretty significant difference in the lives of these patients.

Another cool thing on this trip was simply the opportunity to examine new patients, re-examine current ones and to teach health care providers another approach to patient management. During our short stay the physical therapy team addressed the needs of more than 70 patients, and the surgical team performed 37 surgeries. Also while we were there the entire Mission Awareness Team delivered over 1600 pounds of food!

On our last night we had dinner with those who had played a key role in making our trip a success. They graciously thanked us for our service, but I assure you, the pleasure was ours. We are looking forward to returning and future opportunities in both teaching and patient care. Our next trip is scheduled for late February, early March. We would love to have you join us! Please feel free to email me for additional details: csparks@bradley.edu

Saving a Life to Change a Life

"Life changes when your child's doctor tells you your daughter won't walk, or use her right hand and will always need assistance for daily tasks. You begin a journey to find ways to allow your child to live as independently and normal as possible. You learn that there are barriers that you hadn't anticipated and become passionate to find solutions to remove as many obstacles as possible. PAWS Giving Independence has given our family hope for our daughter's future independence.
Since Naomi can't use her right hand, a simple task like removing her coat becomes possible with the help of Sasha, her service dog. Holding a door open to let her wheelchair pass through is also a task that Sasha is training to do for Naomi. Picking up dropped items like a cell phone, remote control, wallet or keys is probably our most used task for Sasha. The assistance is empowering for Naomi because she isn't always calling upon other people or feeling as though she is interrupting the activities of others to come to her rescue. Above all, Sasha has bridged a social gap between Naomi and non disabled people in the community and in social settings. Everywhere Naomi goes with Sasha, people are drawn to make conversation.
I didn't realize how substantial the social barrier was for our daughter until she recently started beaming about how popular she feels when Sasha is with her."

History

The Bradley Physical Therapy Department was instrumental in helping three Bradley students start a non-profit organization in September 2008. Michelle Kosner, Brandi Arnold and Eric Swanson came to the physical therapy department looking for help to build the philanthropic association known as Paws Giving Independence. Paws Giving Independence rescues dogs from animal shelters, trains them to become service dogs for children and adults with disabilities, and places them free of charge to the families. Their motto is "Saving a Life to Change a Life".

The purpose of PGI is to train service dogs to physically assist people with various disabilities. Dogs complete simple tasks for their owners such as picking up dropped items, turning on lights or opening a door. These tasks would be difficult or impossible for these individuals without assistance. PGI's ultimate goal is to provide support to encourage independence for the dogs' owners. In addition, the dogs can help to bridge a social gap between those with a disability and those without, providing a small connection between the disabled and non disabled communities.

When Amy, a 24 year old woman with quadriplegia, received a dog, she commented that prior to this people would first see her wheelchair and now they see her dog. She notes people are always stopping to talk with her about her companion and to ask questions. She states she felt as though no one ever acknowledged or engaged her in public before this.

Obtaining a Service Dog

Similar organizations may charge between $10,000 and $15,000 per dog. However, PGI is different because it places its dogs free of charge. PGI's service dogs benefit individuals with spinal cord injury, muscular dystrophy, arthritis, developmental delays, cerebral palsy, balance problems, and more.

PGI offers two types of dogs: service dogs and companion dogs. Service dogs have been specially trained to assist a disabled person with certain daily tasks such as picking up an object from the floor. The service dog has access into all public settings. In-home companion dogs are given to children who may suffer from anxiety or depression or someone with autism or Down's syndrome. The dogs give a sense of constant companionship. However companion dogs are not certified to work in a public setting.

Since trained dogs are given to their owners free of charge, PGI is run exclusively from donations and endowments. Each dog has various expenses such as adoption fees, vaccinations, medications for heartworm, grooming, vests and patches, leashes, collars, insurance, and food. PGI is a 501 (C) (3) corporation and all donations are tax deductible.

Training Process

Most dogs come to PGI as rescues from local shelters. PGI contacts the shelters to see if they have any dogs that would potentially make good service dogs. The rescued dogs are then placed in a foster home for six months to one year before they are formally placed with an individual. During this time, foster families are required to attend class once a week with their foster dog to teach the dog basic obedience commands it will need to later assist someone with a disability. New skills are practiced during class and are to be reinforced and practiced in the foster home. Foster families must also commit to training them on how to behave in a home. Once the dog passes the public access test, the family will then be given permission to take the animal in restaurants, stores, movie theaters, and more to complete the final training process.

By the end of the training process, dogs are able to open/close a door, turn on/off a light, carry a backpack, pick up a dropped item, brace for transfers, retrieve a telephone, pull a wheelchair, assist with dressing/undressing, and ultimately provide independence and support.

Other Information

You can learn more about Paws Giving Independence NFP or donate at their website: http://givingindependence.org/

Follow Us On Facebook!

Written by:
Michelle Kosner, Founder, Paws Giving Independence and 1^st Year DPT Student
Victoria Gestner, Senior student, PR, Bradley University

Should PTs Screen for Eating Disorders?

Upon reading an article regarding the physical stress theory, I couldn't help but think about how important understanding basic science is. I remember so many times throughout undergrad thinking "how is this even important?"However, it comes down to the fact that basic science is essential, and we need to remind ourselves when we are working in the clinics of the 'basics' when considering the source of our patients' problems.

In this article on physical stress theory, I was drawn to a section regarding how physiological factors influence the ability of our tissues to adapt to physical stress. This authors covered medication, age, pathologies, and obesity, yet much to my surprise they failed to mention the other extreme: low weight as a result of disordered eating.

A 2008 study by Barrack et al reports that there is an association with increased dietary restraint and low bone mineral density. This study included 93 female cross country runners ranging from age 13-18. Cross country runners cause moderate to high stress on their bones daily (regularly,) and the addition of dietary restrictions could potentially lead to injuries and decreased ability of the tissue to handle that stress.

My point being that there is a significant amount to consider regarding basic sciences when treating patients like these. For example, Gonzalez et al. mentions that people with low weight/eating disorders commonly have an abnormal variation in electrolytes, low blood sugar, and decreased calcium due to these dietary restrictions. Well, we all know when we take the time to consider our basic sciences that our muscles require ATP(comes from things that increase our blood sugars) to contract and relax. Low electrolytes can lead to an alteration in the sodium potassium ion channels. Lastly, calcium has a direct effect on muscular contraction considering its interaction with the sarcoplasmic reticulum, trasverse T-tubules, troponin, and tropomyosin. Aside from muscles, calcium is also a key component to the bones.

Presumably, this can be overwhelming to keep into perspective at times, but when we are managing patients in the clinic it is important to decipher the hints they are throwing at us. Caloric restriction and disordered eating ARE problems that can go undiagnosed. If left unchecked for long enough they can be damaging to the musculoskeletal, integumentary, cardiopulmonary, and neuromuscular systems. For example, a person who is restricting his or her caloric intake is picking and choosing certain foods with little thought about which nutrients he is going to get that day. A weight paranoid person is going to cut out calories however she can. Dairy products can be high in fat and calories and therefore neglected all together. Patients may forego drinking calcium rich milk when they know they can drink water with zero calories. If we consider basic science, isn't it possible that this lack of calcium from dairy products will affect bone regeneration and muscular function in the musculoskeletal system? How then will this patient's tissue respond to the stress of a work out?

When we look at the integumentary system, we know that a basic component of skin is protein. Therefore when our patients are restricting sources of protein is it reasonable to think this would have a negative effect on wound healing? Prolonged nutrient deprivation can also have serious effects on the cardiovascular system. A common problem that occurs with eating disorders is bradycardia. Long term disordered eating can also lead to cardiac failure. What if we push our patients to get better and their heart cannot handle the extra strain? The neurological system is affected at an even deeper level. Commonly, depression is associated with eating disorders. Depression alters the flow of chemicals within the brain. Most of us have seen the pharmaceutical television commercials which state, "depression hurts". Additionally, many times there is a lack of energy which can lend itself to inactivity and lead to muscular atrophy. Depression can also be a part of a vicious cycle which causes a person to not eat.

I am not sure that I would say that eating more or less than normal is unhealthier than the other. If taken to the extremes both are extremely unhealthy and create a new category of stresses put upon the tissues in each of the systems. The key is good nutrition and the input of proper physical stress. I think my main point of all of this is that regardless if your patient is young, old, eating too much, eating too little, on medications etc. it is important that physical therapists get 'back to the basics.' Rehabilitation is still dependent upon minute factors such as these. So here's my question: If we are what we eat or what we do not eat… shouldn't we be screening for eating disorders in our patients? How do we know if we are inputting the proper amount of physical stress? Are we even looking and considering how a patient's personal nutritional situation impacts the results of their therapy? How can we truly help our patients if we do not know for sure... if we are not asking the questions? It's food for thought!

Stormie Prather, SPT

^1st Year DPT student

Welcome to BU DPT

A famous line from Gone with the Wind came to my mind when I was invited to write the inaugural posting for this BU DPT Blog. With apologies to Prissy, the house servant, and Scarlett O’Hara, “I don’t know nothin’ about birthin' no blogs, Miss Scarett!” Well, that is not entirely true in that I do have a blog of my own that I started on my trip to Copenhagen, Denmark a few years ago. The last time I made a post to it was in December, 2008! I’m afraid it has died a premature death. Let us hope for more frequent communication here.

This blog represents continuing evolution in the development of the Doctor of Physical Therapy program at Bradley University. In the words of the BU DPT blog creator, BU DPT faculty member Ms. Cheryl Sparks, “My hope is the blog will also serve to educate and elevate the profession as a whole and will identify an online presence for Bradley PT in the field of orthopaedics.” “Topics not directly related to ortho could include current events, issues, and growing pains we are experiencing in the profession. My perception is students spend a fair amount of on YouTube, Facebook, and Twitter that they really gravitate towards this type of learning environment. Therefore, my hope is this blog will stimulate active online learning, help to foster healthy debate with the use of the evidence and educate many within our profession.” These are lofty aspirations indeed--ones that are worthy of our pursuit. With that in mind, I’d like to post my first question here in hopes of learning more about using blogs as a learning tool: Students ( and current PT professionals), Do you spend “a fair amount of” time on YouTube, Facebook, Twitter, and other social networking sites or is this estimation grossly exaggerated? What do you think of the idea of this medium (online social networking) as a learning environment? Is it effective or are we co-opting a leisure time activity in the name of teaching and learning? Do you come online to learn in a social network setting? If you all would be so kind as to respond to my query by identifying yourself as a PT student, current PT, and/or both along with an estimation of how much time you spend, on average, each week on social networking sites for fun. I would also be interested in how much time you think you are “forced” online to social networking sites in the name of learning? Also feel free to comment on the notion that blogs and social sites such as Facebook, Twitter, etc. are effective learning laboratories.
We are looking forward to the exchange of some useful information on this blog as well as robust and healthy debate. I would like to say thank you to Cheryl Sparks for inviting me to write this inaugural post and for invigorating our department with energy and enthusiasm. Let the fun begin.