Whole Body Vibration Basics for physical therapists

Whole Body Vibration Basics for physical therapists -
So, as many of us know, I am the director of clinical training for Whole-Body Vibration Vibraflex WBV) Platform -form. I firmly believe in the benefits and uses of WBV, and I think he has a very comprehensive role in what many of us are doing. At this point, I do not see it as a fad or something that will come and go simply because it is not something that can be duplicated by any other method. We will talk about the mechanics of what a WBV platform is, how the body reacts to it, the many uses evidence-based to WBV and fundamental differences between some of the business units that are available.
There was a strange path that led me to become interested in WBV first. He was in my second year of physical therapy school when I was offered my first job of the sports training professional basketball. The team was the New Jersey Shorecats in Asbury Park, NJ led by Rick Barry. Now I was not there for Rick Barry as some veterans remember, but in case anyone is wondering, Rick is not a bad guy in any way. I heard the stories, but as with many types of celebrities, what is portrayed is probably closer to the opposite of the truth. Well, between 1998 and 06, I was fortunate to have worked in professional basketball every year, 2 relays in the NBA with the Nets and 76ers. And above all as a certified athletic trainer, I have been privileged to become very familiar with patella tendonitis, anterior knee pain mandatory suffered by most athletes in jumping sports.
As a young enthusiastic clinician, I made all the ultrasound, cross-friction massage, right leg raised as I was taught, and most guys have improved. Of course, they were also at rest, and that young super humans, it was on my head to understand that the rest was what was the better, not the fake rehab. When I got to the Sixers in 03, he was at the same time that I entered the screen of functional movement and using the principles with the team. Apart from the brilliance to understand the integrated motion and regional interdependence of FMS and its training methods, there was one thing about the FMS that really got me caught. Whatever FMS score, when we saw the bar or heavy movement got faster, the pattern would disparage a harmful pattern. It was in their head like a learned movement. All recycling motive was not enough to combat the literally billions of jump shots from an NBA player had taken the time they were 5 or 6 years. The reason is that poor squat suddenly perfect jump always thwarted what we were doing with our training. We needed another tool to break the pattern of movement in learning level. How could we keep screwing brain movement?
Enter Whole-Body Vibration. One of the training centers that some of the guys went in the summer had a WBV platform, so I would shake up and leave. He was terribly uncomfortable, and my players did not really use it for the same reason. But if it were available to them, I had to learn about it, which I did. One thing I learned is that one of the main principles of the VTC is the activation of stretch reflex, which of course is a spinal reflex. The stretch reflex suggests that when placed on a sufficient degree of stretch, a muscle contracts to counteract the elongation.
Therefore, the muscles contracted as a result of a spinal reflex when the machine. The contract signal began on the floor, went to the spinal cord, then back to the effector muscle. The brain was out of the equation. The brain fortress had on the movement of muscles has been lifted. I also thought a long time that I could get into the position I wanted, I could activate the stretch reflex and train the muscles we wanted for a good squat and lunge hip-dominant pattern. And we could keep the central neurological control away from the model.

we therefore obtained a platform in the summer of '05, and '05 -'06, we had zero missed games patella tendonitis. I will not sit here and say one thing that we did was the result of anything good or bad, but it was what got me in WBV. It became a huge interest of mine especially after the positive results in how we used it. And it was a little too good for the ego when Allen Iverson said that we would have that # @ & # ^ thing for the last 9 years.
So what happens when the machine turns on? Most WBV platforms are mechanical. I know of a machine that uses its kind to create the floor to vibrate. Anyway, vibratory or oscillatory movements in the soil of 5- to 60 times per second depending on the make and model. So, the ground vibrates, and ask if it's like the belt of the old 1970 that wrapped around your waste to shake the fat on you. Well, it is quite different.
Let's go back to the 1950s when Russia was extremely committed to space travel. Of course, in space, there is zero gravity, and as we know the deloading reliably body to bone loss. Russian cosmonauts used some of the first WBV platforms before going into space, and on their return, they had less bone loss than their colleagues who had not trained with vibrations. How did it happen?
This happened because when the WBV platform is, this stage is the difference of the Earth in relation to gravity. He is now a hypergravity environment. The combination of amplitude and frequency in which the platform is in motion (calculated by a multitude of serious equations) creates a "false Earth" which gives G Forces much larger than what is on the Earth. Gravity is a measure of the acceleration, and the earth, it is still 9.8 m / s2. We weigh what we weigh on Earth because 9.8 m / s2 says we do. This degree of traction against us requires additional degree of force generation for us to stand. If the WBV platform lets say 3 G, the acceleration is now close to 30 m / s2, it would theoretically take 3 times more force to maintain the position. It does not quite work that way, but why the cosmonauts that formed with WBV had less bone loss was because they were trained in a hypergravity environment before they went into space. They increased their bone density formation in a hypergravity environment, so when they lost the density zero G is in space, it was not as big an impact.
The equation F = MxA governs all strength training what we do. How to increase the strength of load mass. More plates on the bar means more mass, which is really just an extension of our weight, but we said before the acceleration remains the same on Earth. Now we have a tool that can increase strength without increasing the mass. G increase of the platform means that we can weigh more than what we weigh 1 G, and require more force to maintain the vertical position. The bar # 45 we have on the platform is not really more # 45. It feels that way because, back to my original "gravitation" to WBV, the brain is out of the equation.
So basically, by far, when a WBV platform begins to vibrate, we are witnessing a hypergravity environment created, allowing us the only possible way to manipulate the A to F = MXA.
What happens when we get on the platform? The body responds to vibrations based on the phenomenon of Tonic Vibratory Reflex (TVR). TVR said the following. When a muscle is subject to certain safety frequencies (below 30 Hz) vibration stimulus, stretching the muscle will respond by stretching reflex and offer a contraction. He also says that when a soft muscle vibrations met, it responds with the Golgi Tendon response by continued relaxation. So we can see that depending on the position of a muscle is, we can obtain a reinforcing effect or flexibility effect. It is somewhat against-intuitive when you think about it, but the TVR shows a stretched muscle will be stronger, and a relaxed muscle will relax.
There is a wealth of research that develops regularly to support the base effects of the strength and flexibility, as well as improving bone density profiles that we mentioned before. I would never say the formation of vibrations better than any other building tool, but research shows to be at worst equal. And now for those of us who have a disabled individual, be deconditioned or in pain or for any reason resistant using motifs responsible for training the force, we have a great tool for building effects without ever touching a weight.
By many accounts strength is secondary to power, and we know that our definitions. So, let's put things together. As the stretch reflexes shots, we get a muscle contraction. These ontractions occur in a hypergravity environment, so there's a measure to increase the strength of the contractions. And as this hypergravity environment is created by a frequency, it is the same frequency that says how many times per second the muscle contracts. submaximal loads carried at incredibly high rates of speed. This looks like the power of training for me. As a platform vibrates at 26 Hz, we get 26 contractions per second. Now we have another extraordinary tool to support training for power.
Our list of uses, including so far the practice based on evidence for others ...

• force
• The flexibility
• power
• bone density profile
• Profile hormonal Female
• post-training recovery
• cardiovascular measures
• Muscle excitability (Movement Pattern Rehabilitation)
• Increased blood flow
• Increases HGH and testosterone
• Decreases in cortisol
• fall prevention
• pain reduction by Descending inhibitory control
• Improved control of continence
• Gait training
• muscle activation in Neurologically challenged (stroke, spinal cord disease Parkinson) patients

no, it is not all good. There is an acclimation to the environment hypergravity that all people go through. Without the acclimatization phase, we can have similar effects we get from rollercoaster that go up 6-8 G. You can see what you had for lunch after eating.
As brilliant as training effects may occur through short training sessions, overtraining effects can be just as fast. When we train in a foreign environment based on increasing severity, an evidence-based approach is particularly important. Play around on a WBV platform or not following its independent research can ruin a comprehensive training program. Remember that WBV simply load by increasing the acceleration of F = MXA. You would not charge the bar (ground) for someone who could not move his body weight. Loading of the bar due to the acceleration is equally wrong choice
Contraindications include, but are not limited to :.

• processes inflammatory assets
• Acute thrombosis
• bone tumors
• unhealed fracture
• recent implant or arthroplasty
• Gallen, kidney or bladder stones
• known metastases
• Pregnancy

ot all WBV platforms are created equal. If a research article reported a frequency of 25 Hz on a platform that moves in a certain way, I think it is fair to say that another platform that starts at 30 Hz moves from a completely different way is not applicable to the effectiveness of the second machine. Keep in mind that the frequency and very regardless platform. I think that is unfortunate is that some of the main players WBV market as Powerplate and iTonic, use a lot of research from other platforms to support their own product. This last weekend during a break in SFMA I had a buddy of mine click randomly on 4 research links Health website Powerplate. Result 1: not even a research abstract or article; there was no mention of all the variables of the WBV machine or a newspaper. Result 2: Powerplate used in research, admitted through the end of the article that they received the machine free from Powerplate, probably not the most reliable research when it is financed by the company. Result 3: Gallileo used research, which is what is called Vibraflex in Europe. Outcome 4: Search again used Gallileo. Remember, my boyfriend's look at random, and had no prior knowledge to anything related vibrations. Check yourself and see what happens. We really need to understand that research on WBV is extremely dependent on the frequency, amplitude, type of platform used, and the position on the platform. To use search of a platform to support another is not only pretty unethical, in my opinion, but not applicable. It's not like the ultrasound machine Chatanooga that has all the same rules as the Dynatron.
The frequencies of WBV that independent research has shown positive results were in the 20s, mainly the high 20s. EMG research clearly shows that after 30 Hz, there is a huge drop in the strength of the contraction caused by the stretch reflex. A recent study in the Journal of Strength and Conditioning using Powerplate and frequencies of over 30 Hz showed a depreciation of the H-Reflex, which is the principle of muscle excitability. What this basically means that for a time after the use of higher frequency vibrations, it has become more difficult in fact to initiate a muscle contraction. frequency issues, and independent research dies at 30 Hz.
I'm not aware of any comparative study that showed a frequency program> 30 Hz outperforming a frequency of
So why use a platform higher frequencies, if less than 30 Hz is where the research is? The answer lies in the type of platform. There are 2 types of WBV platforms regarding the direction of how the vibration is transmitted: Vertical Vibration Power Plate as Wave iTonic, Pneumex, etc., and Rotational Vibration, which is only the Vibraflex. Powerplate actually moves in three planes, but 70% thereof is vertical, and it is recognized as vertical in the literature. 3 planes Vibration any vector vertically, so it is a rather sensational statement to suggest, as we move into 3 sections, a platform that moves in 3 planes is better. On a vertical platform, the floor will be essentially vibrate up and down. Thus, in the position in the vertical vibrations, you are literally on the floor in a hopping pattern. It happens so fast you do not reach the ground before returning to meet you.
On a platform of rotation, which there is only the technology is patented, the vibrating platform side to side like a teeter totter. The scheme is similar to a mutual approach or a bounding pattern. Now we have said before that research shows the success with less than 30 Hz, and this is true of the two vertical platforms and rotation. I suspect that the reason why some platforms do not subscribe to the research is because 1) the sensationalism of more is better, which is based on evidence, and 2) the vertical vibrations at the appropriate frequencies is terribly wrong with comfortable.
Why people complain of chattering teeth and bulging eyes on a vertical platform? Keep shoulder width and look down between your legs. There is a lot of nothing, right? Well, imagine a line of force, in our case vibration coming straight into your private area of ​​the ground. There are not a lot of muscle to absorb vibration through the principles of TVR. Thus, the vibration continues through the pelvis and the spine. Remember the bone is an elite conductor of vibration. Again very little muscle is in the immediate line of vibration, and continues to travel in the skull where there is nowhere to go. Dr. Rubin at SUNY-Stony Brook measured 3 G is in the heads of people involved with Power Plate. The increase in head acceleration should sound a lot like what our football players face many injuries and severe frontal collisions. People complain of eye pain, headaches and symptoms after concussive vertical vibration for this reason. Powerplate suggests using a deep squat model for the vibration of the head, but if the person can not deep squat? Poor models squat on toes and using buffers to dampen vibration limit the usefulness of these platforms. The effectiveness is questionable in the literature, and the negative effects of vertical vibrations are documented. I recommend reading the literature for yourself and not rely on flash control panels or amazing visas.
Thus is safer rotational vibration? Rubin only measured 0.2-0.3 G is in the head on a Vibraflex. Visualize the same shoulder width position. Now imagine two lines of vibration just from outside your feet traveling to your hips. As this happens through movement of teeter totter, vibration vectors glut medius and quadratus lumborum, the same muscles that we are in tune with what we are trying to improve the stance measures one leg. There are no close patients sensations through the head with the rotational vibration. This is supported by the scientific support of Rubin, as well as empirical data by individuals who had the opportunity to compare the vertical platforms and rotation.
Does the work vertical vibration? The research is very inconclusive. Is there a challenge to search very dominant that its security must be studied further? Yes.
rotational vibration Is Better? I think so, but I'm not the end all, be all when it comes to ibration. I'll change my tune in a millisecond if I was shown convincing evidence. And not articles or high users where the platform was given to them for free.
Whole-body vibration is a powerful and informative tool. Please continue your own research to verify for yourself the statements of this article and learning if it has a role in your practice.

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Charlie Weingroff PT, ATC, CSCS

Charlie Weingroff PT, ATC, CSCS is the director of athletic therapy to CentraState Medical Center in Freehold, New Jersey, and is the director of the Education clinic Vibraflex. Before returning to NJ, Charlie was the strength and conditioning coach for the Philadelphia 76ers in the NBA and spent a total of 10 seasons at different levels of professional basketball. Charlie is a physical therapist, certified athletic trainer and strength and conditioning Certfied & Specialist can be reached chweingroff@gmail.com.

Latest posts of Charlie Weingroff PT, ATC, CSCS ( see all)

• Whole Basics Body Vibration for physical therapists - 1 May 09

foreseeable disturbances: an innovative clinical perspective

foreseeable disturbances: an innovative clinical perspective -

INTRODUCTION

falls are the leading cause of nonfatal injuries and injury deaths in the United States, representing approximately 48% to 75% of all unintentional injuries reported for adults 65 years and older ¹ with a hip fracture incidence should risedue to the growth of the elderly population ²

. Most falls occur in or outside the house ³ resulting from the strength and mobility of persistent deficits that contribute to the decline in the balance, limiting the ability of independent function and further increasing the risk of recurrent injury. ⁴

fall risk depends on the interaction of many factors, and falls are particularly difficult to explain in the elderly who live an active and independent life. ⁵ Current tests are less able to explain the falls in active older adults than those described as frail.5 Timed mobility performance measures may not challenge adequately systems to detect key issues in fall risk situations in people having no deficits in the existing balance or display outward observable limits. ^{6, 7} The inability to balance and timed mobility performance measures to explain the fall is partly due to intrinsic ceiling effects, compromised the sensitivity associated with a lack of variability in the maximum scores performance and their lack of responsiveness to falls in active adults living in the aging community. ^{5, 8, 9} of new evaluation tools are required for a population of active aging. These tools should include measures based on the most difficult performance 5, including situations requiring reagents balance.10 researchers must test individuals as they react to external perturbations requirements. ¹⁰ Following a disturbance that could cause a fall, it must recover balance using a response strategy postural feet up, or protection compensation step. ¹¹

assessment and treatment paradigms disturbance attracted recent attention. ^{9.12 to 15} Designed with a reactive way in an attempt to mimic "real life" circumstances, the disruption of studies do not provide objective performance measures or step quantitative or procedures are clinically safe or practical use in multiple clinical settings.

The use of a foreseeable disruption assessment paradigm is supported by studies finding that the predictability and prior knowledge of the magnitude and direction of the perturbing forces do not alter the EMG latency motor responses of the lower limbs and have no effect on automatic postural responses. ^16.17 A valid predictable perturbation method, reliable, convenient, safe and clinically feasible (ICC = 0.94, ROC AUC = 0.992, sensitivity = 93%, specificity = 96.6%), has been described. ¹⁸

disturbance neurophysiology

predictable Scaling

people without neurological impairment scale in proportion to the extent of their automatic postural responses to the extent of their imbalance ¹⁹ . This scaling is based on direct sensory characteristics, such as initial rate of perturbation and anticipatory mechanisms based on the prediction of movement characteristics, such as amplitude of the estimated displacement ¹⁹ . The nervous system must be based on predictive mechanisms based on past experience

Replies :.

proactive and reactive proactive and reactive adaptations each have an important role in preventing falls. reactive adaptations can reduce the probability of a loss of balance will lead to lower, while proactive adjustments may eliminate the occurrence of a loss of balance altogether. ¹⁹ proactive adaptations can be very effective when management of disruption is predictable and can lead to undesirable movement patterns that maintain the balance in both disturbed and undisturbed conditions. ¹⁹ When the disturbances are less certain, reactive responses can play the dominant role to prevent a fall. So it can be argued that adjustments both proactive and reactive should be targeted in interventions to reduce the incidence of falls in the elderly. Proactive adaptation to the stability of movement is a first line of defense against falls, while the reactive responses are a second line of defense; both are important. ²⁰ Adaptive control of feed-forward stability is based on an internal model continuously updated COG appears to be used by young and old. ²⁰ Both proactive and reactive mechanisms are routinely used to control balance while walking, models organized in the center of muscle activity, and modulated based on information available sensory, biomechanical constraints, support surface conditions and objectives of behavioral and learning. ¹² anticipation mechanisms are based on a feed-forward motion plane used in predictable situations well learned, while reactive mechanisms are generated by the use of sensorimotor feedback used in unpredictable situations. ¹² Reactive postural control can be used to modify the movements already underway and can be either automatic (reflexive) trip, or volition in case a correction on its own feet placement initiative. ¹²

Feasible Region stability

With repeated disruptions posture, the CNS probably built new, or updates to existing internal representations to improve its control feed -forward while reducing the dependence of a person on the feedback correction mechanisms for recovery. ¹⁴ the relationship between the center of mass of a standing person (COM) and the support base (BOS) defines the limits of stability, which describes a "stable region". The BOS consists of the bounding box of each leg in contact with the ground and the area between the feet biped position. a related increase in body sway age is often cited as an indication of a decrease in stability, and has been associated with the decline in the elderly. However, no conclusive evidence indicates that people swaying with greater amplitude are less likely to regain balance after disturbance. ¹⁴ a possible stability region (FSR ) between the front and back of the loss of balance thresholds. ¹⁴ loss of balance occurs when a large-scale disturbance moves the COM state outside the FSR than in instead of hip strategies resulting in an ankle and compensation step and establishing a new BOS. ¹⁴ Unfazed locomotion is a series of volitional controlled before falling constantly need not advance step. ¹⁴

Plasticity

neuromuscular mechanisms of protection against falls can be developed or improved with appropriate adaptation training. With repeated exposure to disturbances, a newly acquired form, primarily predictive adaptive control emerges with a reduced dependence on the feedback correction mechanisms for recovery. ¹⁴ The CNS built, refines and updates an internal representation of potential threats that may occur in the environment. ¹⁴

detention

retention in the CNS is generally regarded as a function of long-term changes that occur in the neural circuits, a result of the consolidation process or to the stabilization of long term memory. This process supports the formation of new synapses, the synthesis of new protein and increase in strength of existing synapses in cortical and subcortical structures (basal ganglia, cerebellum) for tasks involving voluntary movements. ¹⁴ The retention of adaptive behavior can be conditioned by the sanctions imposed inappropriate response by the NSC and the potential for increased injuries. A very threatening environment would be sufficient to induce long-term retention of acquired motor behavior. New evidence supports applying disturbance mimicking real life situations as a form of motor training, with long-term effects on postural stability for the prevention of loss of balance and falls. ¹⁴ Seniors can quickly develop coping skills for fall prevention in a similar way as young adults. ¹⁴

The main advantage of the training on the disturbance-base is a reduction in the travel time, rather than the time required to detect instability and initiate the response. ¹⁵

repeated incremental foreseeable disturbances in permanent: RIPPS

Overview

According to a recent study ¹⁸ The test spring Scale (ESS): a reliable and Tool available to explain fall History , a clinically practical method of perturbation, are predictable. Based on additional foreseeable disturbances repeated in standing (RIPPS) RIPPS the method is a first attempt, the single failure protocol clinically developed to quantify the forward and not back no limits with applications such as assessment and paradigm treatment-induced growth. Designed with a means of feed-forward, the RIPPS method is both reactive and proactive, consisting of repeated cycles of plane forces loading and unloading progressive sagittal to emphasize the boundaries of the front and rear not to not postural responses. Starting at 1 pound size tensile force, each tower loading and unloading is increased by 1 extra pound limits of postural stability RIPPS determined by performance criteria. limits step forward and rear directional are quantified as a percentage of total body weight (TBW%) for purposes of documentation fall risk assessment and responses to increase the limit induced formation. Using% TBW to quantify the disturbance force is well established. ^{10-15, 18}

Instrumentation and Control

Disturbance forces are quantified by a linear spring pocket scale strain gauge calibrated in increments of 1 pound, is fixed to a large 5 inches padded belt fixed around the waist of the customer and connected to the examiner by a strap length of security of attachment of 4 feet. Disturbances are administered with the examiner positioned close to the customer, standing about 3 feet of a conformal support surface. Anterior direction limit test (step back) is performed with the examiner to the customer, while the posterior direction of test limit (forward stepwise) is performed with the client back to the examiner.

RIPPS Disruption Method

Loading traction belt forces are administered in a predictable, progressive, fresh, accommodative mode. Customers are continuously charged to withstand loading forces to their maximum and are reminded RIPPS the performance criteria.

Unloading occurs at every turn 1 pound extra load force housed progressive. Unloading is administered quasi-random manner in a counting window of 5, at the discretion of the examiner. Clients are constantly reminded unloading performance criteria RIPPS

RIPPS performance criteria

RIPPS loading forces must be accompanied by a flat or low heel -. single contact floor postural response, defined as accommodation. RIPPS unloading postural responses should not exceed a 3 step response.

End Points RIPPS

One final point RIPPS occurs when loading or unloading RIPPS performance criteria are not met for a tour given size value of the traction force.

RIPPS limit Directional Score

A RIPPS TBW% directional limit score is obtained for both anterior and posterior directions. A directional force limit value is derived from the previous round to the directional endpoint strength (failure) round. The directional limit TBW% score is calculated by dividing the scale of the spring measured the strength in pounds by the weight of the client's body.

RIPPS TBW% Performance Measurement

The lowest directional scores 2% TBW limit is the% Performance RIPPS TBW measurement of clinical significance.

RIPPS Clinical Applications

assessment

RIPPS the method is a specific area for up and strengthening postural responses.

10% of the value of the performance is very TBW RIPPS discrimiant fall state providing clinicians a fall risk screening tool very sensitive and specific identity capable of deficits that would otherwise be missed in the vibrant and active community of older adults. The% TBW RIPPS performance measure should guide the functional locomotion recommendations, objectives and treatment interventions, where stepper limit induced deficits are identified. The 10% of the RIPPS TBW value should be considered a minimum threshold performance value compatible with non-fallers known about the age of 65 with an average of 12.3% TBW ¹⁸ suggesting a step function "reserve" exists and could be feasible and should be a clinical result in special treatment from the age group 80-89 represents the largest sample subgroup in the study SST.

Despite the predictability, anticipatory design RIPPS method, reactive postural reactions are typical, dominating the anticipated postural responses in those individuals with compromised balance reflected apprehension, hip strategy excessive load, several steps in response to unloading and excessive upper end answers. Ceiling effects rarely occur using RIPPS evaluation method.

Induced Stepping treatment Paradigm

induced stepping was associated with greater retention of skills. ¹⁴

The RIPPS method offers a safe option for the formation of induced step for those 65 and older, requiring intervention has reached a RIPPS% or less TBW score to 10%, meeting the lower RIPPS directional limit score% of TBW. Once% deficit limit directional step RIPPS TBW was identified RIPPS induced formation stage would involve repeated cycles of blocks of loading and unloading at the waist progressive traction forces. Anecdotal evidence suggests that sustained% TBW values ​​equal to or greater than 10% over a period of 2 weeks for 3 consecutive treatment sessions may suggest the retention of newly acquired skills step by step. Further study is warranted to examine training protocols and acquisition of long-term skills and fall state. Handling of feed-forward and reactive responses would be possible by load disturbance changes / unloading strength intervals. -Gué Not training options are possible using sustained, continuous loading the foot flat housing limits to increase the scale or strategies ankle and hip stabilization. methods of lateral disturbance (feet up and stepping induced) can also provide evaluation measures and clinical training options.

Summary

The purpose is to introduce RIPPS percent of total body weight (TBW%) as a measure of clinical practice to balance evaluation purposes and treatment for fall risk. Research supports the reliability and discriminant validity of the 10% of the value of the performance of TBW RIPPS to explain the fall in the history of independent community active life of the elderly.

1. Centers for Disease Control Web site. Available at: http://www.cdc.gov/ncipc/factsheets/adultfalls.htm . Accessed July 30, 08.
2. Cumming RG, Nevitt MC, Cummings SR. Epidemiology of hip fractures. Epidemiol Rev. 1997; 19 :. 244-257
3. Arnold CM, Faulkner RA. The fall of history and the combination of timed test and going to fall and almost falls in older people with osteoarthritis. BMC Geriatr. 07; 7:17 (9 pages).
4. Binder EF, Brown M, Sinacore DR, Stega May K, et al. Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. JAMA . 04; 18 :. 837-846
5. Boulgarides LK, McGinty SM, Justice Willett, Barnes CW. Use of clinical tests and on the basis depreciation predict falls among seniors living in the community. Phys Ther . 03; 83: 328-339
6. Thrane G, Joakimsen RM, Thornquist E. The association between timed and go test and history of falls: The Tromso study. BMC Geriatr . 07; 7: 1 (7 pages)
7. E Nordin, Lidelof N, Rosendahl E, Jensen J, Lundin-Olsson, L. Prognostic validity of the timed test up-and-go, a modified version of get-up-and -go test, global judgment of personnel and fall history in assessing the risk of falls in residential care facilities. Age Ageing. 08; 37 :. 442-448
8. MR Lin, Hwang HF, MH Hu, Wu HD, Wang YW, Huang FC. Psychometric Comparisons of the timed "up and go", stand on one foot, the functional scope and Tinetti balance measurements in the community-dwelling elderly. J Am Geriatr Soc . 04; 52: 1343-1348
9. Pai YC, Wang E, D Espy, Bhatt T. Adaptability to disturbances as a predictor of future falls :. A preliminary prospective study. J Geriatr Phys Ther. 2010; 33 (2) 50-61.
10. Harris JE, Eng JJ, Marigold DS, Tokuno CD, CL Louis. the balance of relationship and mobility in the fall incidence in persons suffering chronic stroke. Phys Ther. 05; 85 :. 150-158
11. Schultz BW Ashton-Miller JA, Alexander NB. compensatory stepping in response to the size draws women to balance drunk and impaired driving. Gait Posture. 05; 22 :. 198-209
12. Tseng S, et al. adjustments unreactive impaired in the elderly. J Gerontol A Bio Sci Med Sci . 09; 64a: (7). 807-815
13. A Mansfield et al. Effect of a balance training program based on the disturbance compensation approach and handle responses in the elderly: A randomized controlled trial. Phys Ther . 2010; 0: (4). 476-91
14. Pai YC, sliding training Bhatt T. Rpeated: A new paradigm for prevention of slip-related falls among the elderly. Phys Ther . 07; 87 :. (11) 1-13
15. Mansfield A, Peters G, Liu BA, BE Maki. A balance training program-based disruption for the elderly: study protocol for a randomized controlled trial. BMC Geriatr . 07; 7: 12 (17 pages)
16. Badke MB, Duncan PW, DiFabio RP .. Influence of prior knowledge on automatic postural adjustments and volunteers in healthy subjects and hemiplegic. Phys Ther. 1987; 67: 1495-1500
17. Diener HC, Horak F, Stelmach G, et al .. Management and precuing amplitude has no effect on automatic postural responses. Exp Brain Res . 1991; 89 :. 219-223
18. DePasquale L Toscano, L. The test in spring scale: A reliable and valid to explain the history of the fall. J Phys Ther Geratr ., 09; 32 (4) :. 159-167
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Louis DePasquale PT, MA

Master of Arts Kinesiology, University of New York
physical Therapy certificate, Columbia University
BS physical Education, Manhattan College

Affiliations:
Good health system Relief term program Francis Schervier long Home health
Hebrew Home at Riverdale health Program Home long-term

Practice:
setting 30 geriatric home care

Publications:
• DePasquale L, L. Toscano "the test of the spring scale (ESS) A reliable and valid to explain autumn Story." JGPT 09; . 32 (4)
• R Bohannon, DePasquale L. "Operation of the physical scale of the Short-Form (SF) 36 :. internal consistency and validity with the elderly "JGPT 2010. 33 (1)
• DePasquale L," Disturbance neurophysiology. " Advance: for Physical Therapy and Rehabilitation Medicine 2011: October 17.
• DePasquale L, "Security in the balance" Physical Therapy Products November 2011.

Latest posts Louis DePasquale PT, MA (see all)

• preventing falls: current Perspectives, Tools with evidence - April 1, 2014
• performance measures: Does the performance Really Measure Up - April 1 2014
• foreseeable disturbances :? an innovative clinically - September 30, 08

OIG 2014 Work Plan includes physical therapy

OIG 2014 Work Plan includes physical therapy -

2014 Work Plan BIG
Image: OIG.HHA.Gov

the Office of the inspector General (OIG) released its work plan 2014 in late January. The 2014 OIG Work Plan includes physical therapy. Physiotherapists in private practice have again been identified as part of the scope of work.

This topic is in progress for several years so it is not surprising that physical therapy will be in the crosshairs again. Comments will be ongoing and this work is already underway for the 2013 Work Plan (which also represented a continuation of the work plan 2012). The 2014 Plan also indicate a new start. The reviews will be conducted by the OIG Office of Audit Services. Breathe a sigh of relief - it is the auditors, not investigators! Audits of BIG for physiotherapists in private practice will target the billing and payment to determine if they are in compliance with Medicare reimbursement regulations.

physical therapists Haute-use external physiotherapy

billing and payments. We will review the outpatient physical therapy services provided by independent therapists to determine whether they were in compliance with the Medicare reimbursement regulations. IGO-work Background Before that the claims of therapy services offered by independent physical therapists are not reasonable or medically necessary or are not properly documented. Our goal is to independent therapists who have a high utilization rate for outpatient physical therapy services. Medicare will not pay for items or services that are not "reasonable and necessary." (Social Security Act § 1862 (a) (1) (A).) The documentation requirements for therapy services are in CMS, policy Manual Medicare benefits, Pub. No. 100-02, c. 15, § 220.3. (OAS; W-00-11-35220, 00-12-35220-W, W-00-13-35220; various examinations, date of issue :. FY 2014, work in progress and new start)

Cross your fingers and hope your number is drawn. Well, that is something we all want, but the best idea is to be prepared, starting with having an active compliance program in place that not only provides an overview of Medicare billing and payments for all employees, but more important oversight to ensure that everything was done as planned. This includes an active compliance cycle: DETECT, CORRECT and PREVENT

OIG 2014 Work Plan includes physical therapy - What should I do

The good news ( if.? you can call it that) is that the OIG has issued a report last year about Spectrum Rehabilitation. This report includes witness information on how IGOs ​​and verification approaches, and details of the results related to outpatient rehabilitation. This review included the audit staff of the OIG and many medical examiners supplier MAC

If you are a therapist in private practice are the things that should be on top of your to do list :.

1. Have an active and effective compliance program in place . A compliance program is based on a compliance plan. If you do not have a compliance plan - quickly change the implementation of a plan the size of your practice and start with a risk assessment, a code of conduct and an employee training program, so that everyone understands and knows the behavior expected Medicare billing, coding and documentation rules. The presence of an active compliance program demonstrates a commitment to do the right thing, and it is necessary under the ACA (although the regulation has not been published). The best practice is to follow the advice of the OIG compliance guidance for doctors and small practices.
2. consider the report of the OIG rehabilitation spectrum. After completing the report select some categories and audit to audit the reply in your own practice. Keep in mind that these are not quality assurance, regulatory compliance but, as noted requirements related to the "Status" (which is the status of Social Security - or the "Act"). My suggestions would be to approach the care certification plan, ensure that the billing provider is the rendering provider, and the minute therapy are correctly calculated two ways (time codes and the total processing time).

This is the super bowl weekend - so take time to enjoy at the root of your team, or to enjoy commercials and half time show. But come Monday morning, join me on Monday, monitor, as we are pleased to have bills Erin, Director of External Affairs of the OIG as our special guest to talk about the 2014 work plan

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Nancy Beckley

Nancy J. Beckley is the president of Nancy Beckley & Associates LLC, a firm specializing in compliance outpatient treatment. The firm offers outsourcing the compliance risk assessment, compliance plan development, annual compliance training, and external audit, due diligence and investigative support. Customers are suppliers under Medicare review of the probe, the plans of progressive corrective actions, corporate integrity agreements, ZPIC investigations and RAC audits.

Nancy background includes 15 hospital years experience in the service management capabilities to two large rehabilitation facilities for inpatients with extensive managed care contracting and program management expertise. A therapist in the background and training, Nancy served as program director, director of the institution and administrator in both rehabilitation facilities for inpatients and outpatients.

She is a nationally recognized speaker in the field of rehabilitation of compliance, and presented to the Conference Provider Practice Compliance, Florida Compliance Conference, and the Healthcare Compliance Compliance Institute Association. It was described in a Healthcare Compliance Association webinar on the risk of hospitalization in outpatient therapy, and wrote three articles for compliance Today and written over 20 articles on the RAC program.

Mrs. Beckley area of ​​expertise includes:.

• Development of the compliance program, consulting, training, and the external auditor

• Medicare Regulatory requirements for suppliers outpatient therapy, including extensive experience in the investigation and Medicare certification for outpatient treatment providers

• auditing and consulting commitments under attorney-client privilege for risk assessment and the analyzes the potential recovery of responsibility

• Medicare program integrity initiatives: MACs, RACs, CERTs, ZPIC, critics of the probe before and after payment of examinations

• recognized expert national level on CORFs, served on the technical expert Group Medicare CORF

• outpatient Hospital board compliance, audit and training

• compliance diligence activities due in the acquisition and portfolio development to assess compliance risk Medicare

EDUCATION: University of South Florida, MBA; Harvard School of Public Health course for managed care executives; University of Illinois, m.s. University of Wisconsin, B. s

PROFESSIONAL ASSOCIATIONS: Board of Directors, National Association of Rehabilitation Agencies (NARA) Members, Healthcare Compliance Association; Contributing Editor principal RAC Monitor + monitor Monday; Compliance columnist for IMPACT Journal of APTA

PROFESSIONALCERTIFICATIONS: CHC, certified Health compliance by the Healthcare Compliance Certification Board

PUBLICATIONS AND PRESENTATIONS: Available on request

CONTACT: 414-748 -4376; Nancy@NancyBeckley.com;

Latest posts of Nancy Beckley (see all )

• Call Medicare Denials - 5 things you need to know - June 18, 2014
• therapy PQRS Panic - June 5, 2014
• Medicare Confusion G code - May 28, 2014
• Medicaid exclusion controls - May 7, 2014
• Checking Importance Exclusions - April 30, 2014

Call Medicare Denials - 5 things you need to know

Call Medicare Denials - 5 things you need to know -

Call refusal Medicare is likely to be a reality for all outpatient therapy providers this year. Therapy on the $ 3,700 cap is subject to 100% mandatory medical examination by auditors Recovery (ICAR) through 31/03/2013. In his comments, if favorable, will frustrate you at first, then anger can you then require you to file an appeal. Phone calls and emails today, customers and non-customers show growing frustration with the medical review process manual, some misunderstandings about the examination of 10 days in the prepayment review states, and entering suppliers in the appeals process have a rude awakening two-year backlog of appeals. I covered in this blog on the ALJ appeal Forum. It should not take more time and get right to the 5 things you need to know when to call Medicare denials

Call Medicare Denials -. Here are "5"

1. Medicare official appeals process, and your Mac will have PDF forms and interactive instructions to get you started. Also check the CMS website called complete rules and references.
2. RECOVERY (for post-payment review) will begin on 41st day from the date of the letter of demand if your Mac does not receive one of the following by the 30th day from the date of the letter of request full payment, a request for an extended repayment schedule. or a valid request for reconsideration
3. If you use ESMD (congratulations!) to submit to FCAC, you will return to the post for the appeal process. ESMD is expanding to calls in 2014, but we are not there yet.
4. Organize all documents and include a cover letter (last chance!) With an executive summary cases (think like an excellent D / C ratio), a refutation of the refusal and the documents index . Try to put items as evidence in early as possible in the appeal process
5. Despite 24 -. 30 months behind the ALJ hearings now, appeal your case if you have found tenable. CMS collects data about calls, and when you win (positive thinking), you interest on your payment.

Are you in calls due to refusal of RAC? Do you know that you will probably be in the calls because of adverse effects on hold? What questions do you have?

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Nancy Beckley

Nancy J. Beckley is the president of Nancy Beckley & Associates LLC, a firm specializing in compliance with outpatient therapy. The firm offers outsourcing the compliance risk assessment, compliance plan development, annual compliance training, and external audit, due diligence and investigative support. Customers are suppliers under Medicare review of the probe, the plans of progressive corrective actions, corporate integrity agreements, ZPIC investigations and RAC audits.

Nancy background includes 15 hospital years experience in the service management capabilities to two large rehabilitation facilities for inpatients with extensive managed care contracting and program management expertise. A therapist in the background and training, Nancy served as program director, director of the institution and administrator in both rehabilitation facilities for inpatients and outpatients.

She is a nationally recognized speaker in the field of rehabilitation of compliance, and presented to the Conference Provider Practice Compliance, Florida Compliance Conference, and the Healthcare Compliance Compliance Institute Association. It was described in a Healthcare Compliance Association webinar on the risk of hospitalization in outpatient therapy, and wrote three articles for compliance Today and written over 20 articles on the RAC program.

Mrs. Beckley area of ​​expertise includes:.

• Development of the compliance program, consulting, training, and the external auditor

• Medicare Regulatory requirements for suppliers outpatient therapy, including extensive experience in the investigation and Medicare certification for outpatient treatment providers

• auditing and consulting commitments under attorney-client privilege for risk assessment and the analyzes the potential recovery of responsibility

• Medicare program integrity initiatives: MACs, RACs, CERTs, ZPIC, critics of the probe before and after payment of examinations

• recognized expert national level on CORFs, served on the technical expert Group Medicare CORF

• outpatient Hospital board compliance, audit and training

• compliance diligence activities due in the acquisition and portfolio development to assess compliance risk Medicare

EDUCATION: University of South Florida, MBA; Harvard School of Public Health course for managed care executives; University of Illinois, m.s. University of Wisconsin, B. s

PROFESSIONAL ASSOCIATIONS: Board of Directors, National Association of Rehabilitation Agencies (NARA) Members, Healthcare Compliance Association; Contributing Editor principal RAC Monitor + monitor Monday; Compliance columnist for IMPACT Journal of APTA

PROFESSIONALCERTIFICATIONS: CHC, certified Health compliance by the Healthcare Compliance Certification Board

PUBLICATIONS AND PRESENTATIONS: Available on request

CONTACT: 414-748 -4376; Nancy@NancyBeckley.com;

Latest posts of Nancy Beckley (see all )

• Call Medicare Denials - 5 things you need to know - June 18, 2014
• therapy PQRS Panic - June 5, 2014
• Medicare Confusion G code - May 28, 2014
• Medicaid exclusion controls - May 7, 2014
• Checking Importance Exclusions - April 30, 2014

Physical provider, voice and occupational therapy services agrees to $ 38 million False Settlement Act of claim

Physical provider, voice and occupational therapy services agrees to $ 38 million False Settlement Act of claim -

SUPPLIER OF PHYSICAL, OCCUPATIONAL THERAPY SERVICES SPEECH AND AGREES TO 38,000 $ .000 REGULATION False Claims Act

As announced in a recent press release, healthcare services Extended, Inc. ( "Extendicare"), an operator of skilled nursing facilities, and its subsidiary, Step Progressive Corporation ( "Step Pro"), a physical supplier, speech, and occupational rehabilitation services, has reached an agreement to settle allegations that, in part, Pro Step billed Medicare for services medically unreasonable and unnecessary rehabilitation. In addition to the alleged substandard related resolution skilled nursing services, the settlement resolves allegations that Extendicare provided medically unreasonable rehabilitation and unnecessary beneficiaries to Medicare Part A, particularly during periods of reference of patient assessment, for this purpose for Extendicare to bill Medicare better per diem rates for patients.

In addition to the settlement agreement, Extendicare has agreed a Corporate Integrity with the Office of the Inspector General to promote respect for Medicare, Medicaid and other federal health programs. The Corporate Integrity Agreement ( "CIA") runs for a period of five (5) years and has significant obligations to Extendicare. These obligations include the requirements for establishing a compliance program and to appoint a compliance officer; appoint a compliance committee, among other things, to establish an internal quality audit and review program; establish a personnel review committee; and develop a code of conduct and written policies and procedures, including extensive policies and procedures for the provision, management and monitoring of rehabilitation therapy services. In addition, the CIA requires general training, training related to specific individual responsibilities, and training on quality of care issues. The CIA also requires that an independent review organization is committed to conducting independent reviews and Extendicare objectives of compliance obligations, including those related to rehabilitation therapy systems.

The above case is yet another illustration of the importance of ensuring that rehabilitation services are provided in accordance with all applicable federal laws and regulations. It also serves as a good reminder of the need for rehabilitation providers to continually examine whether their compliance programs are sufficient to promote a culture of respect and avoid regulatory review.

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Paul J. Welk

Paul is president of technology Tucker Arensberg Health law Attorneys / Health information Industry Group and focuses his practice on corporate law and Health care. As such, it represents physiotherapists, doctors, dentists, nonprofit organizations, professional organizations and other entities and commercial companies.

Some of the operations and recent clients, he has worked on include the representation of

• multiple physiotherapy professional associations State on a variety of issues
• private multiple physiotherapy practices with the development and implementation of property succession plans
• a venture capital firm with the dollar acquisition of shares of a target company $ 13 million
• therapy providers multiple physical in successful calls third-party payers
• multiple buyers of real estate assets and associated dental practices
• multiple physical therapy providers regarding the transfer of partial ownership and trading of governance and Documents shareholders
• physiotherapy multiple providers with assets and stock acquisitions and disposals
• a manufacturing company to negotiate a purchase of shareholder disputes and stocks
• a service provider to negotiate a yearly service contract for $ 5 million
• a listed company regarding the merger of two wholly owned subsidiaries
• two listed companies regarding the ongoing review of the distribution contracts, supply and service
• a seller of a skilled nursing and real estate related
• Several regional networks of rehabilitation providers on a variety of issues including training and ongoing operations
• a large physician practice in its sale to a health system

practice Areas: business and corporate law, health law, mergers and acquisitions

articles and presentations: Paul regularly lectures and writes on topics related to business law and health and is the author of foundation of the legal impact, a regular column in the American Physical Therapy Association impact Magazine Private Practice Section

associations and activities. Paul is a member of the Chair of Pennsylvania American physical therapy associations and past physical Committee of the American Association of therapy on risk management and member benefits. He is also member of the Medical Ethics Committee Bloomsburg supply, the School of Physiotherapy Advisory Board Duquesne University, the Pennsylvania Bar Association, and the American Lawyers Health Association. He is an assistant instructor at the School of Physical and a registered physiotherapist in the Commonwealth of Pennsylvania University of St. Francis

Jurisdictions: .. Paul is licensed to practice law in Pennsylvania

Education and background: Paul received his bachelor of science and a Masters in physical therapy with honors from Duquesne University and his law degree with honors from the University of Pittsburgh. He was Associate Editor of the University of Pittsburgh School of Law Journal of Law and Commerce and received the CALI Excellence Award for the future and Esther F. Teplitz Awards for academic achievement in the law program health. Paul graduated from the University of Pittsburgh School of Health Law Certificate Program Law.

Latest posts by Paul J. Welk ( see all)

• Phase 2 of HIPAA ongoing checks - March 25, 2016
• Websites and the Americans with Disabilities Act - An often overlooked risk - March 14, 2016
• HHS publishes guidelines on patient access to records under HIPAA - February 2, 2016
• physical supplier, voice and occupational therapy services Agrees to $ 38 million False Claims Act Settlement - November 12, 2014
• A Free Ride to PT - What is the risk - October 15, 2014

Addressing chronic diseases such as Physical Therapist - Part 4

Addressing chronic diseases such as Physical Therapist - Part 4 -

Given that chronic disease is a major problem causing a financial burden on our economic health system is the first step. Recognizing the underlying causes of chronic disease is the second step. The implementation of a program, the fight against chronic disease in your practice of physical therapy, with patients is mandatory if we are to have an impact on the prevention of these diseases and help our patients improve function and quality of life.

A 48 year old patient who comes to us with osteoarthritis of the knee, which is 80 pounds overweight, can make stationary bike, straight leg raises, quad games, and closed chain activities kinetic, but until they significantly decrease their body weight unwanted effects from cumulative forces on the knee will continue.

Presentation of your patients to the idea that their lack of proper exercise, food choices and body weight are important contributors to their problem will open the door to address the causes of their condition. Inform your patients about the benefits of a change to healthier lifestyle, including weight loss increase exercise / activity and providing your patients with the following information.

Inform your patients than just a 5-10% reduction in their current weight will significantly improve health parameters, including:

• pressure reduction 5 mmHg blood
• HDL Increase 5 mg / dL
• 40 mg / dL reduction in triglycerides
• .5% reduction of HbA1c

Let your patient knows that there is evidence that physical activity may be associated with a lower risk of several common cancers, including colon and breast cancer.

Tell your patient that regular exercise reduces blood pressure in about 75% of hypertensive people with an average decrease of 11 and 8 mm Hg for systolic and diastolic blood pressure respectively.

Tell your strong evidence of patient randomized controlled studies that moderate physical activity combined with weight loss and improved diet can confer a 50-60% reduction in risk of developing diabetes in people already at high risk.

also let your patients know that studies show an inverse association with consumption of fruits and vegetables and the risk of cardiovascular disease and all-cause mortality.

Finally, offer to help your patient set goals of realistic weight loss, 5-10% initial weight demonstrated health parameters improvements. Provide your patient with a wellness package that helps them track their exercise and provides information about healthy food choices. Offer to help your patient to monitor their weight loss and lifestyle changes involving exercise and food choices as they progress with their physical therapy program.

This type of intervention is on the person "whole" and has the potential to have both an immediate positive impact on your future and patient. As physical therapists, we really become an instrument to heal our patients when we treat chronic diseases

The impact of chronic diseases -. Part 1

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Jeff Gilliam, PT, PhD, OCS

Jeff Gilliam PT PhD: is a specialist in weight loss, who studied in detail in the areas of health behavior, exercise physiology and nutritional biochemistry at the University of Florida. Jeff taught a course at the University of Florida called "Search Applications to obesity and weight loss." He also taught for UF DPT program to promote health and well-being "and" Evidence Based Practice III '. His doctoral research was in the area of ​​effective behavioral interventions for obesity and its associated diseases. He is the founder of choice of doctors for weight loss Loss a program of life / Successful weight, which can be found in more than 40 clinics in the US Southeast. He is currently clinical director of ReQuest Physical Therapy (Gainesville, Florida) and integrates the loss of life program / weight in physical therapy for his patients to help them achieve their healthy body weight.

Jeff Gilliam is an orthopedic specialist certified by the American Board of Physical Therapy Specialties.

Last Post by Jeff Gilliam, PT, PhD, OCS (see all)

• lessons of the Biggest Loser ... Holding in lean body mass is essential to reduce the suppression of resting metabolic rate - June 28, 2016
• Why do we gain back the weight we worked so hard to lose? Lessons from the Biggest Loser -. May 23, 2016
• The Food and inflammation - March 21, 2016
• are your Gut Microbes make you sick? and overweight - January 26, 2016
• Holiday Weight Gain and dangers associated health - December 16, 2015

Passive Recruitment - Comparison of Healthcare recruitment methods - Part 2

Passive Recruitment - Comparison of Healthcare recruitment methods - Part 2 -

In the previous article, I discussed several key recruiting methods. I think there are two major categories of recruitment techniques - passive and active recruitment recruitment. In the previous article, we compared a mixture of active and passive popular techniques :. E-mail, direct mail, job sites on the Internet and newspaper ads

It is important to pre-plan a recruitment sequence. As mentioned above, there is no better way to recruit. You must evaluate your program and determine the techniques that reach your target audience. Below, I have defined active and passive techniques. Most clinics will have to consider a mix of both types to achieve success

Part 2 of this series will deal with passive techniques. while Part 3 will discuss active techniques. First, let's define and list some passive and active techniques.

Passive Recruitment

passive recruitment requires a level of interaction from the recruiter / employer. passive recruitment methods include such things as: job boards on the Internet, newspaper ads, newspaper ads, status in the community (for example, hospitals are health care facilities visible), the expertise in community (you are recognized as a leader in the field), social websites (eg Facebook), and business newsletters.

active recruitment

active recruitment requires a higher level of ongoing activity by the recruiter / employer. active recruitment methods include things such as :. incentive programs for employees, postcard mailers, cold calling, current employment programs, student internships, open days (requires a lot of preparation work), scholarships, and using recruiters outside

passive recruitment methods include:

display Internet job Board

These job boards are suitable for advertising to a national audience. We do not recommend non-health care sites such as Monster.com; since the publication of those will often create tracks of someone without health care qualification. There are some companies that guarantee your job board placement on dozens of different sites. While many job sites may seem like a lot; I think by posting on a few selected sites is the key necessity. You must be sure you are marketing heavily in sites that specialize in the health care community. For therapists, we recommend JobsTherapy.com, PTJobs.com and professional associations (LDAO, APTA, ASHA) for therapists. There are a multitude of nursing sites, but these are not as dominant

Newspaper Ad

Ads in newspaper work, sometimes for nursing. but they rarely work for therapists. These are probably best used by hospitals to nursing, and support staff, in urban areas

Journal Ad

advertising effective reviews can be very expensive. because they require recurring advertisements larger. They work if you repeat the big announcements for months to build your brand. Large companies often publish and strong.

Writing articles

Keeping your name in the professional community will build your professional reputation. This is the passive recruitment and can repay in time, with people who want to work for the experts.

employee incentive programs

It is good to have your employees recommend colleagues ... assuming they recommend someone you love.

Social media sites

Social media is relatively new and many people are trying to understand an affordable approach to recruitment. At this point, I think they are positive for promoting your name to the employees of friends. I also believe that these sites are useful as a link to show people more about your business and opening. Use QR codes and other methods to enable research of tech-savvy candidates out direct mail to find your social media page.

Employee Incentive Programs

If you have a good organization, your employees can be a great resource to their friends. Incentive programs can be tailored to your needs and those of your staff. They can be directly related to recruitment (as referral bonus or a signing bonus) and staff development / brand (such as training programs and training). Tailor and mixing programs; and announce them in your recruitment documents.

Final Thoughts

Passive techniques are effective but tend to be less aggressive in recruitment. I want to consider recruiting be similar to clinical practice. You evaluate your patient, use the clinician knowledge base, determine a treatment program, and then use a mixture of home program techniques for active treatment. Recruitment is similar, you must evaluate your program, what tools you have, then set up a mixture of techniques.

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Steve Passmore, DPT

Dr. Steve Passmore graduated as a physiotherapist in 1977 and has had a unique career from clinical, management, operational, counselor. In 02, he created Recruitment healthy dissemination tools and services targeted later. These companies specialize in recruiting and marketing tools for health care (mainly nurses and therapists). We helped facilities for rent hundreds of therapists and nurses each year.

For more information, contact Steve at spass@healthyrecruiting.com, visit our Web site at www.recruitingtherapy.com, or call 888-993-9675. Also available is an in-service training on the job for conferences and our book, "Recruiting health care: Unlocking methods and magic - 2nd Edition", available via Amazon in paper or Kindle version of

.

Latest posts of Steve Passmore, DPT (see all)

• When should we use Email in recruitment - June 13, 2016
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• Passive Recruitment - Comparison of health care methods Recruitment - Part 2 - March 28, 2016
• Compare health Methods recruitment - Part 1 - January 11, 2016
• recruiting between generations: Part 2 - recruitment plan - May 21, 2014

Prevention of hamstring injuries - Part I

Prevention of hamstring injuries - Part I -

I worked with a college running back last summer contemplating leaving football because of chronic injuries hamstrings from high school and throughout his first two years of university. This young man had actually well-developed hamstrings, was exceptionally strong, and had a great flexibility hamstring. He should! He had worked on the strength of the hamstrings and stretch religiously for three years. Here's what he said to do again and again by his high school coach, team doctor college athletic trainer and strength coach.

muscle strains are not always the result of this muscle is tight or low. Many times, the injured muscle works fine right up to the causal event. What we need to do first is to look at injury mechanisms.

During sprinting or kicking, experiences hamstring stretch through the hip, as it flexes, and through the knee as it extends. Eccentric thigh resistance plays a role at this stage, the leg essentially deceleration to maximum length. There was an excellent article in the most recent NSCA Strength and Conditioning Journal (Brughelli M, J Cronin) on this very subject. They were essentially look the voltage curve of the length of the thigh and the location of the peak voltage of an athlete. Injuries tend to occur during the descending part of the curve, and what they found was that the injury reduction has coincided with the increase of the optimal length of thepeak tension. In other words, produce more voltage eccentric hamstring muscle lengths. There were several studies submitted to back this

A variety of eccentric hamstring strengthening exercises were given, see for details

My favorite: ..
Stability Ball hamstring Curls bridge +

Single Leg bridge + hamstring Curls

hips should remain extended throughout the loop portion of the lift. Hip extension is a secondary function of the group hamstring. This leads me to my next point.

A second mechanism of injury comes as lead foot athlete makes contact and should propel the athlete again. track athletes are often taught to "reach and pull" with the leg before increasing stride. Bad idea. It goes back to the voltage curve length again. The hamstrings are stretched to the maximum, and must perform maximum contraction to pull the body of sprinter on that leg. It is a concentric contraction at this point, but the hamstrings are passively insufficient, which means lying too to generate the appropriate force.

None of the exercises special needed here. Just form or rehab your athletes by teaching them "push" rather than "pull". This will allow the glutes and quads are involved in a greater measure load off the hamstring. the leg lead will now land properly on the athlete to the appropriate extension of the hip, greater stride and speed.

a third mechanism has to do with the synergistic domination. Many muscles are often responsible for some movement in this case we are talking about the extension of the hip. Synergistic domination involves a muscle on the other feed. Hip extension is supposed to be the work of buttocks but what often happens is that the hamstring muscle group becomes dominant. This does not at all what they were designed to do and are therefore more poorly worked. Thus, the athlete with strong hamstrings and chronic strains can really blame his weak glutes (Sahrmann).

Here are some simple tests to determine the thigh domination on the buttocks.
Prone Hip Extension (aka test the ignition system)
palpate glutes and hamstrings, ask the athlete to perform an elevation of the right leg. Glutes should shoot first, otherwise the athlete's hamstring dominant. You might find the athlete can not even voluntarily pull the glutes without kicking in the hamstring.

Double Leg Bridge

Feel glutes and hamstrings yet, ask the athlete to lift the hips. As before glutes and hamstrings shouldinitiate should provide minimal assistance. We've probably all had someone cramp in the hamstring muscles try a bridge. It is a problem. The athlete should really be able to contract the glutes and lift your hips with little or no participation hamstring at all.

So now that we have established hamstrings domination, how can we rewire athlete?

Double Leg Bridge with Foam Roller

roller passes under the thighs just above the knees. Have the athlete perform a glute first set, and then lift the hips. It is almost impossible to contract the hamstring muscles in this position.

Double Leg Bridge

athletes presses through the heels with toes up (which increases the contribution of the quad, but conversely inhibits hamstring). Squeeze glutes and lift hips, manually cue the athlete to keep the hamstrings off.

Single Leg Bridge

By pressing through the heel to the toes up. Then tighten glute raise again attempt to extinguish the hamstrings.

I will also have the job of the athlete time lying down in time as well try to contract the glutes first, then perform the hip extension. This can be done right or bent knee. If the knee is bent, the therapist or trainer should support the lower leg. If the athlete is really struggling with this press him have his leg in your hand to engage the quads and inhibit the hamstrings and tighten the glutes.

1. Brughelli M, J. Cronin prevent hamstring injuries in sport. NSCA Strength and Conditioning Journal. 08; 30: 55-64
2. Shirley Sahrman. "Diagnosis and Treatment of Movement Impairment Syndromes." Mosby 02.

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Joe Heiler PT, CSCS

Joe Heiler MSPT is the owner and content manager SportsRehabExpert.com, a site dedicated to the advancement of education rehabilitation and performance professionals. The site focuses on orthopedic and sports physical therapy subjects through webinars, audio interviews, articles, manual therapy and exercise videos, and more.

Joe is also the owner of Elite Performance Physiotherapy and Sports in Traverse City, MI specializes in orthopedics and sports medicine, as well as training of athletic performance. It is Graston Technique (GT) and a certified instructor GT SFMA FMS and trained, and is passionate about a number of soft tissue and manual techniques, including Trigger Point Dry Needling and manipulation.

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The future of the PT - Will it be everything it should be

The future of the PT - Will it be everything it should be -

One thing we can all agree with independently our where we find our personally? me is that the need for physiotherapy services does not decrease. Demand for our services will be there for the foreseeable future. Here are two good news and bad news. Just as the good news is obvious the bad news is preventable. The bad news or negative potential consequence is that we rest on our laurels and / or believe that the application itself to ensure our future. If we believe that demand will result in the payment (resulting salaries), drive the appropriate reference in both types of patients and in the time of the referral, and enhance direct access, then we can be in a future disappoints.

Being properly paid both reimbursement and wages is already a problem many face. With rising health care costs, we can not rely only on the request conduct of wages and the payment deserved level. The health system can not afford to just pay more without tangible results suppliers - so financial savings. More in future posts on this subject.

The application also will not conduct reference models. Patients with diagnoses that we can help will, but currently are not routinely referred will not magically be sent to us more appropriate number, or at a more appropriate time. Patients seek us directly because demand is high because the understanding of what we do is not level with the public it must be.

Thus, in order to take our rightful place in the health care system in the future will require more than having a strong demand for our services. What do you think it will take for our future is as bright as it should be? How can we get our fair financial reward? How can we become the preferred supplier for all patients, we can help? How can we patients seek us directly? Your thoughts please !!

We'll take these questions and more in 2014. One of my favorite quotes that fits here:

"The answers in life are dead, the issues of life that move us forward. "- Michael Gerber

Here is a Great 2014 and can it be prosperous for you in all the ways that matter !!

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Jeffrey W. Hathaway, PT

Old certified E -Myth Coach, certified TQM

Jeffrey W. Hathaway graduated from Ithaca College and was a PT for 23 years. He has owned clinics as well as advice and support for businesses. He has extensive consulting experience in the management of accidents. Midway in his career, Mr. Hathaway came out of the field of physical therapy to study and then consult in the field of organizational development. This includes: conflict management, management of the agreement, team dynamics, communication skills, the dynamics of change and negotiation skills based on interest. He also became a certified trainer and E-Myth business coaching provided to the many different types of business owners. Most recently, Mr. Hathaway reentered the field of physical therapy and took over one clinic PT and grew to a total of 6 clinics in 6 years.

Company Info
PT PRO-Active (4 New York Locations) | Breakthrough PT (NC Places) | RedefiningPT.com PRO-Active / Breakthrough PT is one of the first practices authorized in practice based on evidence by Evidence in Motion. We orthopedic ambulatory practices looking to build their practices around evidence of the highest level available and redefine PT in the eyes of reference sources and their patients.

Latest posts of Jeffrey W. Hathaway, PT (see all)

• the future of the PT - is it all it should be - 31? January 2014

physiotherapy provider Entry into HIPAA Settlement

physiotherapy provider Entry into HIPAA Settlement -

US Department of Health and Human Services Office for Civil Rights (OCR) recently announced another measure execution . Specifically, OCR has opened a compliance review of Concentra Health Services (Concentra) upon receiving a report that an unencrypted laptop was stolen in Missouri Physical Therapy Center of Springfield. The survey found that Concentra had already recognized in multiple risk analyzes the critical risks exist. While steps have been taken to address risks, OCR found efforts to be incomplete and inconsistent. The investigation by OCR also concluded security management processes are inadequate to protect patient information. Concentra has agreed to pay OCR $ 1,725,220 to settle potential violations and adopt a corrective action plan to highlight their refurbishment these findings.

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Paul J. Welk

Paul is president of technology Tucker Arensberg Health law Attorneys / Health information Industry Group and focuses his practice on corporate law and Health care. As such, it represents physiotherapists, doctors, dentists, nonprofit organizations, professional organizations and other entities and commercial companies.

Some of the operations and recent clients, he has worked on include the representation of

• multiple physiotherapy professional associations State on a variety of issues
• private multiple physiotherapy practices with the development and implementation of property succession plans
• a venture capital firm with the dollar acquisition of shares of a target company $ 13 million
• therapy providers multiple physical in successful calls third-party payers
• multiple buyers of real estate assets and associated dental practices
• multiple physical therapy providers regarding the transfer of partial ownership and trading of governance and Documents shareholders
• physiotherapy multiple providers with assets and stock acquisitions and disposals
• a manufacturing company to negotiate a purchase of shareholder disputes and stocks
• a service provider to negotiate a yearly service contract for $ 5 million
• a listed company regarding the merger of two wholly owned subsidiaries
• two listed companies regarding the ongoing review of the distribution contracts, supply and service
• a seller of a skilled nursing and real estate related
• Several regional networks of rehabilitation providers on a variety of issues including training and ongoing operations
• a large physician practice in its sale to a health system

practice Areas: business and corporate law, health law, mergers and acquisitions

articles and presentations: Paul regularly lectures and writes on topics related to business law and health and is the author of foundation of the legal impact, a regular column in the American Physical Therapy Association impact Magazine Private Practice Section

associations and activities. Paul is a member of the Chair of Pennsylvania American physical therapy associations and past physical Committee of the American Association of therapy on risk management and member benefits. He is also member of the Medical Ethics Committee Bloomsburg supply, the School of Physiotherapy Advisory Board Duquesne University, the Pennsylvania Bar Association, and the American Lawyers Health Association. He is an assistant instructor at the School of Physical and a registered physiotherapist in the Commonwealth of Pennsylvania University of St. Francis

Jurisdictions: .. Paul is licensed to practice law in Pennsylvania

Education and background: Paul received his bachelor of science and a Masters in physical therapy with honors from Duquesne University and his law degree with honors from the University of Pittsburgh. He was Associate Editor of the University of Pittsburgh School of Law Journal of Law and Commerce and received the CALI Excellence Award for the future and Esther F. Teplitz Awards for academic achievement in the law program health. Paul graduated from the University of Pittsburgh School of Health Law Certificate Program Law.

Latest posts by Paul J. Welk ( see all)

• Phase 2 of HIPAA ongoing checks - March 25, 2016
• Websites and the Americans with Disabilities Act - An often overlooked risk - March 14, 2016
• HHS publishes guidelines on patient access to records under HIPAA - February 2, 2016
• physical supplier, voice and occupational therapy services Agrees to $ 38 million False Claims Act Settlement - November 12, 2014
• A Free Ride to PT - What is the risk - October 15, 2014