Research Day Presentation - Spring 16'

     Hey, everyone! This post contains video from a platform presentation I gave on Research Day - Spring 16' at the University of St. Augustine for Health Sciences, St. Augustine, FL campus. The presentation was on a patient case report that used a health promotion and prevention model for a patient with osteoporosis. The presentation has an emphasis on physical therapists appropriately implementing nutritional education into practice. 

- Dr. Berner, DPT, CEAS

Research Day Presentation - Spring 16' from Patrick Berner on Vimeo.

Two Weeks of Ergonomic Fun! Few Key Points

     Hey, everyone. This is going to be hopefully a real informal post about my ergonomic experiences the past two weeks. So lets dive right in. Last week I took the CEAS I: Ergonomics Assessment Certification Workshop to get my CEAS (Certified Ergonomics Assessment Specialist) credentials, which was followed up by attending the 16th Annual Applied Ergonomics Conference these past few days. So to say the least, I learned about ergonomics and then truly learned about ergonomics. I want to share mainly a few of the things that popped out these past two weeks.

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     One of the main reasons I love the concept of ergonomics is because it revolves around preventing injury. It’s about making a work environment that fits the employee while reducing their fatigue, stress, and risk of injury. The most important thing to remember is that we are all of different shapes and sizes, so a one size fits all workplace design does not work. Ergonomic setup needs to be individualized, and that doesn’t mean using a tool or buying a chair that’s labeled “ergonomic.” The practice of ergonomics is very detailed and after the things I saw this week, it is highly engineering oriented. But we as physical therapists can surely be a part of it. 

Sitting vs. Standing

     So there has been a lot of talk recently about the benefits of standing instead of sitting all day. Well, I’m sorry to tell you that there is not any strong research to support this, and none of the professional ergonomists are recommending to stand all day long. But what they do recommend is being ACTIVE during your workday and taking “ergo breaks.” 

     During one of the conference sessions, John Kerst shared “5 Ways to Make Your Desk Job Less Sedentary.”

• Alternative Workstation (Sit to stand or lean to stand)
• Coffee & Water Cup Size (Decreasing coffee size or increasing water, more bathroom trips)
• Try Walking Meetings (Said to increase brain activity)
• Integrate Technology Assist (Step counter, Fitbit, alarms to get up)
• Vary Your Posture
  • 20 minutes of leaning/sitting
  • 8 minutes of active standing (weight shifting)
  • 2 minutes of walking around)
• Education (Increase knowledge deficits on posture and physical fitness)

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“Ergo breaks” can consist of getting up and moving around, as well as targeted stretches depending on your occupation. 

Work in the Perfect Zone!

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     Another speaker, Ben Zavitz, gave 10 “Everyday Ergonomic Solutions.”

1. Get things off the floor
2. Raise the employee
3. Use a wheel or roller
4. Lighten the load (material substitution or weight distribution)
5. Use mechanical assistance/ leverage
6. Tilt the workstation
7. Extend the tool
8. Use ergonomically engineered tools (it’s the features, not the name)
9. Daily oiling and preventative maintenance
10. Design hands-free options

     Education needs to be blended, especially when training for operations and safety. Kent Hatcher’s presentation, “Utilizing Blended Learning to Provide Effective Ergonomics Training,” pointed out the deficits in training an employee exclusively by computer-based technology or classroom setting. Practice makes perfect. He shared the 70:20:10 rule from the Center for Creative Leadership. Learning is 70% hands-on problem solving, 20% feedback and networking, and 10% classroom/ coursework.

     Every session that I attended and every speaker that I listen to had one thing in common, and that was addressing the issue early will yield the greatest outcomes. If a job looks like it may be harmful, puts an employee in an awkward position, or requires continuous repetition, make adjustments before an injury occurs.

    There was also a big focus on wellness and the implementation of various types of programs within companies around the world. Being an area that I wish to practice in, there will be many future posts regarding this topic. I hope you found some of this information interesting. All the credit goes to the presenters of the 16th Annual Applied Ergonomics Conference and CEAS instructors. 

Thanks for reading!

- Patrick Berner, SPT, CEAS

It’s Time for a Credentials Check! PT/DPT vs CPT and RDN vs Nutritionist

Hey there! So this blog post kind of grew off of a tweet I made yesterday,

“If we tryin to ‪#prevent, why are the 2 powerhouse professions of ‪#Move & ‪#Fuel not collaboratin? ‪#NNMchat ‪#GetPT1st ‪#PT ‪#RDNday ‪#FreeTheYoke”

     I’m talking about the professions of Physical Therapy and Dietetics, which truly are powerful professions that unfortunately go unrecognized for all they can do. With chronic lifestyle diseases continuing to rise, why are we not collaborating? Why are we not giving patients or clients the best of both worlds? Diet and exercise have been proven over and over again to help prevent disease and improve the quality of life, yet I rarely see a PT and an RD working together or even know what the other has to offer. The typical response being that a PT helps the elderly woman walk down the hall while the RD is making their meals. This just isn’t the case. The amount of education, training, and quality control that goes behind earning these credentials is extensive.

     To really highlight how extensive their training is, I’m going to compare them to the public’s immediate response when asked, “who do you go to for help with diet and exercise?” Well a personal trainer or nutritionist, duh! And I want to say that I’m not putting these professions down because there are certified personal trainers (CPT) who do a tremendous job. However, from a consumer’s perspective, I would want an individual that comes highly qualified. I’m going to keep these comparisons brief enough to make my point; otherwise, this post could get more complicated than it needs to be.

Physical Therapist (PT) - All new PTs are now required to hold a Doctor of Physical Therapy (DPT)

Requirements (1):

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• Complete a 4-year bachelor’s degree
  • The major of the degree doesn’t matter as long as requirements are met for PT school application, appropriate courses in anatomy, chemistry, physics, etc.
• Complete a Doctor of Physical Therapy degree from an accredited CAPTE (Commission on Accreditation in Physical Therapy Education) program, typically 3 years to complete
  • “curriculum may include, but are not limited to, biology/anatomy, cellular histology, physiology, exercise physiology, biomechanics, kinesiology, neuroscience, pharmacology, pathology, behavioral sciences, communication, ethics/values, management sciences, finance, sociology, clinical reasoning, evidence-based practice, cardiovascular and pulmonary, endocrine and metabolic, and musculoskeletal.”(1)
  • Along with roughly 1,200 hours of clinical experience
• Pass a national examination, which is given by The Federation of State Boards of Physical Therapy (FSBPT), to become board certified
• Become licensed in the state of practice
• Practice under a code of ethics, set forth by the American Physical Therapy Association (APTA)
• Complete approximately 30 hours of continuing education every 2 years, depending upon the state
• Can hold certification in specialized areas, such as orthopedics, neuro, sports, pediatrics, etc.

Certified Personal Trainer (CPT)

Using the National Strength and Conditioning Association’s (NSCA) certification requirements (2):

• 18 years old
• High school diploma
• CPR/AED Certified
• Possibly a background in exercise science 
• Pass a written examination
  • Focused on fitness assessment, program planning, exercise, and safety

Registered Dietitian (RD) or Registered Dietitian-Nutritionist (RDN)

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Requirements (3):

• Complete a 4-year bachelor’s degree in dietetics from a program that is accredited by ACEND (Accreditation Council for Education in Nutrition and Dietetics), which is a part of the Academy of Nutrition and Dietetics (AND)
  • The degree is heavily geared towards food science, biochemistry, medical nutrition therapy, food management, and much more
• Complete an ACEND accredited dietetic internship, roughly 1200 hours, distributed among healthcare facilities, community health, and foodservice distribution
• Pass a national examination, which is given by the Commission on Dietetics Registration (CDR)
• Become licensed in their state of practice
• Practice under a code of ethics, set forth by AND and CDR
• 75 hours continuing professional education (CPE) every 5 years
• Can hold certifications in specialized areas such as geriatrics, sports, diabetes, renal disease, cancer, etc.
• Most states nationwide require an RD credential, along with state licensure, to perform nutritional counseling and prescribe diets. 
  • Check out this Link for more information

Nutritionist

Requirements:

• Having a passion for nutrition.
• There is no legal protection over this term, as there is with RD and RDN.
• This individual could potentially have a degree in food science or nutrition.
• Not much else to say about this one.

     As you can see, these two professions are truly powerful in the field of human movement and nutrition, providing the keys to preventative healthcare. Both of these professions go to extreme measures to ensure highest quality of care and competency. These credentialed individuals have thousands of hours of education and training under their belt with the ability to do more than walk someone down the hall and cook up some food. So I ask you again, why are these professions not collaborating to provide the best approach to a preventative lifestyle?

Thanks for reading.

- Patrick Berner, SPT

(Soon to be DPT graduate with a degree in dietetics ready to make a change!)

References:

1.  Clark M. Physical therapist (PT) education overview. American Physical Therapy Association. http://www.apta.org/PTEducation/Overview/. Accessed March 10, 2016.

2.  National Strength and Conditioning Association. CPT certification - certified personal trainer - personal trainer certification. https://www.nsca.com/Certification/CPT/. Accessed March 10, 2016.

3. Academy of Nutrition and Dietetics. What is a registered Dietitian Nutritionist? http://www.eatrightpro.org/resources/about-us/what-is-an-rdn-and-dtr/what-is-a-registered-dietitian-nutritionist. Accessed March 10, 2016.

Every Healthy Pregnancy Should Include Visiting a Physical Therapist

     As awareness continues to build on the benefits of seeing a physical therapist for low back pain, it should not be forgotten that physical therapists can help with numerous other conditions. One of those conditions being a very natural phenomenon, pregnancy. Even with pregnancy rates on a decline, the latest study shows “98.7 per 1,000 women aged 15-44” are becoming pregnant(1). That remains to be a large number of women that may experience the following symptoms during or after their pregnancy(2): 

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•    Low back pain
•    Pelvic girdle pain
•    Weight gain
•    Gestational diabetes
•    Urinary incontinence (uncontrolled bladder)
•    Preeclampsia
•    Leg Edema (swelling)
•    Deep vein thrombosis (blood clots)
•    Depression
•    Morning sickness
•    Fatigue
•    .... The list goes on

     The purpose of physical therapy intervention is to prevent or reduce the occurrence of these symptoms. A systematic review performed by Kampen et al. found physical therapy intervention to be effective in the treatment and prevention of pregnancy symptoms(2). The results indicated that the skills of a physical therapist can accurately address the following(2):

• low back/ pelvic girdle pain
• weight gain beyond recommendations
• urinary incontinence 

     These symptoms can be addressed with targeted exercises, such as Kegels for urinary incontinence. The guidance of a physical therapist should be sought to ensure proper performance of these particular activities and receive adequate education about safe movements. 

     Also, don’t forget that nutritional intake is crucial during pregnancy, for both mother and child. Seek the help of a registered dietitian for nutritional meal planning. 

- Patrick Berner, SPT

1. Fox M. U.S. Pregnancy rate hits record low, data shows. NBC NEWS. December 11, 2015. http://www.nbcnews.com/health/womens-health/u-s-pregnancy-rate-hits-record-low-data-shows-n478381. Accessed February 4, 2016.

2. Van Kampen M, Devoogdt N, De Groef A, Gielen A, Geraerts I. The efficacy of physiotherapy for the prevention and treatment of prenatal symptoms: a systematic review. International Urogynecology Journal. 2015;(11):1575. 

Save Our Children. The Decline of Physical Education.

     Today I wanted to share briefly some information I became aware of two weeks ago. I had a very informative meeting with an elementary school physical education teacher. I was shocked by what I had learned, and I am sure you will be too. I will not mention the school, nor the parish or county because I assure you that this is a national issue.

     Now I ask you to think, how much time during a week do children receive physical education? I initially thought they got approximately 30 minutes a day. You would think that is a fair amount of time, close to what I received growing up. I then thought okay maybe only three times a week. Again, I was wrong. Children at this particular school receive 35 minutes of physical education ONCE a WEEK. I was outraged to say the least. And a majority of this time is spent moving the children from a classroom setting to the field and back.

     Furthermore, I learned that children's grades in physical education are now solely based on objective testing and not physical achievements. The Presidential Physical Fitness Award, a program many of us undoubtedly participated in while going through elementary school, is no longer being used. The computer tests now used prompts students to answer such questions as the correct sequence of a hop or skip; however, this does not test their coordination of the activity.

     There needs to be a drastic increase in the amount of time children are receiving physical education. Children need to be educated how to properly use and maintain their body in order to live a long and healthy life; increasing the time spent on other subjects does not help a child who already lives a sedentary lifestyle. Yes, all education is important, but physical activity has proven to enhance the function of mind and body. If you are a parent or guardian and not demanding more time for physical education, you are adding to the current decline in our children's physical activity.

     It is time to speak out and make an actual change!

- Patrick Berner, SPT

Your Body Needs Sun, But Does Not Need Skin Cancer

     With summer approaching, I wanted to briefly touch on sun exposure and skin cancer. For this blog, I have embedded video and direct links that can explain this information more clearly. CancerResearchUK.org does a tremendous job at educating on this subject and also on various other cancers. 

So is there a safer time to go outdoors?     YES                                                                                                  

     One of the most interesting tips I found through their website is the use of the shadow rule. The shadow rule, also known as Holloway's rule, indicates that the sun's rays are strongest when your body's shadow is shorter than your own height. This typically puts the strongest sun rays between the hours of 10am and 3pm. 

Safely Enjoy the Sun

• Take advantage of the shade
• Cover up
• Minimize exposure during strong sun rays
• USE SUNSCREEN - at least SPF 15

Why Your Body Needs Sunlight

• Vitamin D production
• itamin D is needed for Calcium absorption 
• Calcium is a very important mineral needed for maintaining bone health, nerve transmission, muscle contraction, and deserves its own blog post.

     Monitor Yourself!

     Skin cancer is preventable and can be successfully treated with early intervention. Utilize the ABCDE's of identifying skin cancer, specifically malignant melanoma.

- Patrick Berner, SPT

Cancer Research UK. Sun, UV and cancer. Cancer Research UK. http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/sun-uv-and-cancer. Updated March 24 2015. Accessed May 10 2015. 

Melanoma Research Foundation. The ABCDEs of Melanoma. Melanoma Research Foundation. http://www.melanoma.org/understand-melanoma/diagnosing-melanoma/detection-screening/abcdes-melanoma. Updated 2015. Accessed May 10 2015.

PT Clarification Order: Physical Therapists Do More Than Treat Injuries

     I felt this topic needed to be addressed after a conversation I had with an old friend of mine, who worked as an ATC (athletic trainer) for an NFL team. We talked about how he chose his career path and what other professions he had thought about going into. He told me that he chose not to go down the PT path because he didn’t want to treat old people his whole life. I was outraged that another healthcare professional had no idea what physical therapists have to offer.

      After this encounter and many others of similar outcome, I was reassured that there is a general misunderstanding about the physical therapy profession. We do more than treat old people and individuals with an injury. I chose to share with you the practice act of South Carolina, primarily because I appreciate the accuracy of the statue’s wording. However, you can find the reference to prevention within PT practice act’s across the country.

 “ "The practice of physical therapy" means the evaluation and treatment of human beings to detect, assess, prevent, correct, alleviate, and limit physical disability, bodily malfunction, and pain from injury, disease, and any other bodily or mental condition…” (South Carolina Physical Therapy Practice Act, 2014). 

S.C. PT Practice Act     Louisiana PT Practice Act     Florida PT Practice Act

      Physical therapists have the skill set to be a part of the fight against preventative disease and promote a healthy lifestyle for the entire population. There are PTs working for companies nationwide that conduct functional capacity evaluations and pre-employment screenings in order to identify individuals prone to an injury. Those at risk are rehabbed or undergo work hardening in order to prevent any serious injury. PTs can also be found promoting wellness and increasing quality of life within the school system and community programs.

      The point is that physical therapy deals with preserving the human body, not just repairing it.

 - Patrick Berner, SPT