Annual Conference Program

Speaker: Rhea Cohn, PT DPT

Dr. Cohn has worked as a clinician, educator, senior manager, and consultant. Dr. Cohn spent almost twenty years as a practicing clinician in a variety of settings and spent four years inside the managed care industry. Following that experience, she worked at APTA for twelve years and is recognized for her expertise in payment and policy issues. Most recently, Dr. Cohn was an Assistant Professor and Assistant Director of Clinical Education at the George Washington University Doctor of Physical Therapy program. She introduced students to a broad view of the healthcare industry including payment and policy issues and professional development including Ethics. Rhea spent seven years as a member of the Maryland Board of Physical Therapy Examiners and was an invited member of the initial FSBPT workgroup for the Physical Therapy Compact.. She has been a member of APTA’s Ethics and Judicial Committee (EJC) since July 2019 and is the current Chair. She is also a member of the Board appointed Task Force to Review Core Ethics Documents.

Course Description: Successfully treating patients with complex medical histories can be a challenge. However, good outcomes can be obtained by having a good understanding of what assessments need to be performed to establish a viable treatment protocol, the role aberrant physiology is contributing to their symptoms, and how various manual therapy techniques can be used to improve their condition. This course will outline the steps and the research-based treatment rationale needed to achieve successful outcomes with these difficult patients.

Learning Objectives
1. Assess the pertinent information in the complex patient’s medical history and perform a scan exam.
2. Develop an appropriate manual therapy treatment plan for complex patients.
3. Understand how manual therapy can successfully treat the complex patient’s aberrant physiology.
4. Understand how to use layer palpation to localize the somatic dysfunctions to be treated.
5. Determine which manual therapy techniques will be most effective when treating a particular complex patient.

Course Outline/Timed Agenda
0-20 minutes: Introductions
20-50 minutes: Topic 1: Assessment and treatment plan development with demonstration of scan exams
50-100 minutes: Topic 2: Physiological principles and how aberrant physiology can contribute to the complex patients’ symptoms
100-130 minutes: Topic 3: lmportance of providing a good layer palpation to localize the source of the found
130-160 minutes: Case Studies
160-180 minutes Q&A Session

Speaker(s) Information

Robert Cohen, P.T., M.A. is a 30-year veteran physical therapist, who runs a cash-based manual therapy practice specializing in all aspects of manual therapy. He also has a Master’s Degree in Exercise Physiology. He is a founder of BayGrass lnstitute, a CEU course provider for licensed or certified healthcare providers..

I began my professional education at American University, graduating Summa Cum Laude with a degree in Physical Education, in 1981. I earned a Masters of Arts in Exercise Physiology from the University of Maryland at College Park in 1987 and in 1992 graduated with honors from University of Maryland Baltimore with a Bachelor of Science degree in Physical Therapy.

Upon graduation from AU, I spent a decade in the adult fitness field performing exercise prescription, supervision, and wellness counseling. I was recognized as a certified fitness instructor by the American College of Sports Medicine. This training with an emphasis on physiology helped push me towards the manual therapy path. Four years after receiving my physical therapy license, I opened my private practice in 1996 using manual therapy exclusively.

In order to further my manual therapy skills, for most of my career I have attended or taught 4 to 5 manual physical therapy post-graduate education courses annually – 5 times the amount required by the Maryland Board of Physical Therapy Examiners to maintain my license. In total, I’ve attended close to 100 post-graduate courses in my career. I am also an avid reader of the current scientific literature to keep abreast of changing trends and the latest research findings.

In addition to my clinical practice, I lead several teaching and mentorship programs to share the knowledge I have amassed with professional colleagues. These projects include leading a manual therapy study group for the past 8 years and mentoring small groups of therapists that wish to increase their understanding of the intricacies of manual therapy.

In 2017, I founded the BayGrass Institute to provide licensed or certified healthcare practitioners with continuing education in the many areas of manual therapy through interactive and hands-on sessions. We feel strongly in the value of the Institute that teaches a philosophy that focuses on the interconnectivity of the body that has been lost in the many branches of specialized medicine today.

These professional and educational experiences blend with my life-long interest in sports, recreation and fitness, and healthy living. I enjoy many outdoor activities with my wife, including hiking, walking, running, cycling, kayaking, and soccer.

https://robertcohenpt.com
https://baygrassinstitute.com

Course Description: Ramsay Hunt Syndrome is caused by the same virus that causes chicken pox and shingles, the varicella-zoster virus. Patients present with a rash at the ear or mouth and facial paralysis. Additionally, patients may report tinnitus, hearing loss, facial pain, altered taste, facial numbness, vertigo, dizziness, nausea, vomiting, and/or present with nystagmus. The degree of functional impairment depends on the degree of facial and vestibular involvement; however, patients frequently develop dry eyes, have dysarthria, and report dizziness. Older adults may be at higher fall risk due to the impairment of the vestibular system. Facial rehabilitation may include active and passive range of motion, massage, exercise, and the use of modalities. Vestibular rehabilitation may include gaze stabilization and balance exercises. The physical therapy examination and intervention of older adults with Ramsay Hunt Syndrome will be presented; however, the examination and treatment techniques are appropriate for all adults. Medical management will be discussed as an interprofessional approach is important to have a successful outcome.

Learning Objectives:
After this presentation, the learner will be able to:
1. Understand the medical management of Ramsay Hunt Syndrome.
2. Select the appropriate examination components for a patient with Ramsay Hunt Syndrome.
3. Interpret the examination results to create an appropriate plan of care for a patient with Ramsay Hunt Syndrome.
4. Explain the rationale for the interventions selected for a patient with Ramsay Hunt Syndrome.

Course Outline / Timed Agenda
20 minutes Signs & Symptoms of Ramsay Hunt Syndrome
20 minutes Medical management of Ramsay Hunt Syndrome
45 minutes Examination of Ramsay Hunt Syndrome
45 minutes Rehabilitation of Ramsay Hunt Syndrome including facial rehab and vestibular rehabilitation
50 minutes Case reports of older adults with Ramsay Hunt Syndrome with facial paralysis and vestibular symptoms (small group and large group discussions)

Speaker(s) Information

Linda B. Horn, PT, DScPT, MHS is an Assistant Professor and Director of Academic Affairs at the University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science. Dr. Horn has over 30 years of clinical experience in a variety of clinical settings including acute care, outpatient, and home care. She primarily treats older adults with a balance and vestibular disorders. She is an ABPTS Board-Certified Clinical Specialist in Geriatrics since 2015 and Neurology since 1993. Dr. Horn is a national lecturer on fall prevention as well as balance and vestibular disorders in the adult population. She received a BS in Physical Therapy from the University of Maryland Baltimore, Master of Health Science from the University of Indianapolis Krannert School of Physical Therapy and Doctor of Science in Physical Therapy from the University of Maryland Baltimore. She is active in the APTA at the state and national level.

Jodi Maron Barth, PT, CCI, is a co-founder of The Center for Facial Recovery and The Foundation for Facial Recovery. She is one of only a handful of recognized Facial Palsy therapists in the United States. She is a licensed physical therapist with over 40 years of experience in the field of out-patient rehabilitation with a specialization in facial palsy. Jodi has co-authored multiple research articles in the field of facial palsy as well as co-authored a book Fix My Face: Expert Advice for Maximizing Recovery from Bell’s Palsy, Ramsay Hunt Syndrome, and Other Causes of Facial Nerve Paralysis. She is a co-creator of the Mirror Book™ and Face2Face™ app as well as developing synkineedling  , a treatment technique for reducing facial synkinesis. Jodi has spoken nationally and internationally in the area of facial palsy. Most recently she presented at the International Facial Nerve Symposium and was awarded the best paper award.

Course Description
Axial Spondyloarthritis is an often-overlooked cause of chronic back pain. The EIDA Project raises awareness and educates non-rheumatologists about clinical features that may suggest the presence of axial Spondyloarthritis. The goal of this program is to shorten the diagnostic delay, which is currently 5-8 years on average, by increasing awareness and knowledge of axial spondyloarthritis (axSpA) among non-rheumatology healthcare professionals who are caring for patients with chronic back pain to promote the timely referral of patients. Our ultimate goal is to improve long-term outcomes in axSpA by reducing the time from symptom onset to diagnosis and to provide patients with the benefits of early effective therapy.

The second part of the course will focus on the physical therapy guidelines, treatment and management of axial spondyloarthritis.

Learning Objectives – Part A

1. Develop an awareness of axSpA as treatable cause of back pain,
2. Recognize an inflammatory back pain pattern as a typical presentation of axSpA,
3. Identify other common clinical features of axSpA that occur outside the spine,
4. Gain knowledge of basic principles of diagnosis and treatment of axSpA as applied by rheumatologists.
5. Understand appropriate testing for a patient with chronic back pain suspected of axSpA and apply criteria for referral to rheumatology
6. Develop an awareness of axSpA as treatable cause of back pain,
7. Recognize an inflammatory back pain pattern as a typical presentation of axSpA,
8. Identify other common clinical features of axSpA that occur outside the spine,
9. Gain knowledge of basic principles of diagnosis and treatment of axSpA as applied by rheumatologists.
10. Understand appropriate testing for a patient with chronic back pain suspected of axSpA and apply criteria for referral to rheumatology
11. Gain knowledge and understanding of current international guidelines as applied to physical therapy interventions, treatment and management protocols in the treatment of axSpA.

Part B: 

1. Develop an awareness of axSpA as treatable cause of back pain,
2. Recognize an inflammatory back pain pattern as a typical presentation of axSpA,
3. Gain knowledge and understanding of current national and international clinical practice guidelines in the assessment and        management of axSpA and how that impacts physical therapy practice
4. Understand appropriate testing for a patient with chronic back pain suspected of axSpA and apply criteria for referral to physical therapy
5. Gain knowledge and understanding evidence of specific physical therapy interventions, treatment and management protocols utilized in the treatment of axSpA 
6. Gain knowledge of current literature on therapeutic exercise prescription in inflammatory arthritis and axSpA
7. Understand and discuss barriers impacting physical therapy interventions in management of axSpA [age, sex, gender, obesity. education] and strategies for optimization
   
   

Course Outline / Timed Agenda

Part A:

• Speaker introduction (5 minutes)
• Epidemiology, Classification, and Clinical Manifestations (15 minutes)
• Treatment (10 minutes)
• Comorbidities (10 minutes)
• Delay in diagnosis (15 minutes)
• Q&A (5-10 minutes)

Part B: Physical Therapy In axSpA 

• Current axSpA  guidelines as they pertain to the Physical Therapist (PT) (10 min)
• Treatments commonly used in PT practice and impact on axSpA (10 min)
• Challenges and barriers to effective PT intervention (10 min)
• Exercise prescription and treatment progression in axSpA  (10 min)
• Q and A (5-10 min)

Speaker(s) Information -Angelo Papachristos, BSc, BScPT, MBA
St. Michaels Hospital -Unity Health Toronto

Course Description:
Pelvic girdle pain is extremely common in the antepartum population with 56 72% prevalence throughout pregnancy and 60-70% prevalence within the third trimester. This pain can evolve into persistent pain and continue into the postpartum period in 20% of these individuals (Clinton 2017).

Clearly, the antepartum and postpartum population benefit from physical therapy intervention and can be treated in the typical, orthopedic clinic. But is current evidence-based practice being used for these populations? A recent study by Dufour et al from 2018 – found evidence-based practice is not being used consistently. The study concluded that most PTs were aware of the evidence including the clinical practice guidelines for antepartum population, but were not using it within their own clinical practice.

This course helps bridge the gap between research and clinical practice for the antepartum population. It will focus on the common treatment myths including reexamining the biomechanical model and introducing the pain science model instead. Other evidence-based practice will be examined including risk factors for pelvic girdle pain, evaluation techniques, appropriate exercise prescription and manual techniques.

Agenda:
2:30-2:45 – Introductions, review of pregnancy-related pelvic girdle pain, and discussion of current practice patterns
2:45-3:30 – Literature review and debunking common myths for the antepartum population
3:30-4:15 – Demonstration and practice of evaluation techniques, manual therapy modifications, and therapeutic exercises for the antepartum population
4:15-4:30 – Mini-case study and final questions

Objectives:
1. Identify the risk factors and clinical presentation for pregnancy-related pelvic girdle pain
2. Demonstrate appropriate examination techniques, manual therapy modifications, and therapeutic
exercises for the antepartum population
3. Implement evidence-based practice into clinical care for patients with pregnancy-related pelvic
girdle pain

Speakers:
Kim McCole Durant PT, DPT
Dr. Durant is the Director of Clinical Education and Assistant Professor at University of Maryland Eastern Shore. She attained her orthopaedic specialist certification (OCS) from APTA in 2016 and competed her fellowship in Orthopaedic Manual Therapy from Regis University in 2018 in Denver, Colorado. She is on the executive board of the Pelvic Health Special Interest Group for AAOMPT. Recently, Dr. Durant has presented at other national and state conferences about bridging the gap between orthopaedics and pelvic health.

Meghan Musick PT, DPT
Dr. Musick earned her doctorate of physical therapy from the University of Maryland in 2010. In 2014 she completed the orthopedic manual therapy residency program through Evidence in Motion; then attained her orthopedic clinical specialist certification from the APTA in 2016. In 2018 she completed the pelvic health residency program through EIM; and has since been on a mission to assist in educating fellow orthopedic therapists on the impo rtance of routine pelvic floor screening. Most recently, Dr. Musick has started a pelvic health program at her local hospital and has developed a continuing education course for in-house staff.

Background: Peripheral neuralgias can have a significant negative impact on function and may lead to allodynia, kinesiophobia, or chronic regional pain.1 Neuralgias affecting the medial leg may be the result of trauma, surgery, inflammatory conditions, or compression by interfacing musculoskeletal structures, and are especially common following knee surgeries and surgeries utilizing saphenous vein grafts. One proposed contributor to neuralgia-associated pain is endoneurial hypoxia, to which peripheral sensory neurons are more vulnerable than motor neurons. Improving neural microcirculation is therefore an important goal of rehabilitation for the condition. Exercise and repeated neural mobilization techniques incorporating nerve tension/relaxation have both been shown to promote increased perfusion to nerve tissue and promote nerve health, but there currently exists a lack of evidence supporting the effectiveness of neural mobilizations for treatment of neuromusculoskeletal condition, or the effectiveness of physical therapy for managing lower extremity neuralgias.

Patient is a 48-year-old female with 3-month history of right (R) medial ankle pain, tightness, and mild swelling.

Past medical history (PMH) includes R distal tibia fracture, being treated for 8 sessions in an outpatient physical therapy clinic.

Purpose: Determine the effectiveness of strengthening for interfacing muscles, in conjunction with graded neurodynamic tension, to manage pain and improve activity tolerance for a 48-year-old female patient with a 3-month history of distal lower extremity neuralgia.

Author Information
John Morgan PT, DPT, DMA
Physical Therapist
MedStar Health

Background: There is a strong need for skilled mentors in the clinical setting. This need is not only for physical therapists and physical therapist assistant students but for novice clinicians and those clinicians who have transitioned to different treatment settings. To address this need and the persistent disparities in healthcare, addressing the minority experience of both students and clinicians is paramount. This is imperative to build a community of practice that provides a safe educational, employment, and healthcare experience for all.

One mechanism to achieve a supportive mentor-mentee relationship is to ensure that the individuals have been vetted for compatibility. Expectations for the mentorship also need to be clear and mutually agreed to. By using instructional scaffolding supports, a mentorship plan can be crafted and used as a roadmap toward the established outcomes.

Purpose
The purpose of this special interest presentation is to provide the outcomes of a support model to establish a strong mentor-mentee relationship in both clinical education and employment settings. Based on the speaker’s experience as a clinic manager responsible for interviewing and onboarding and as a Director of Clinical Education (DCE), I will present the implementation of a process of scaffolded supports to enable a successful clinical mentee-mentor relationship. 

Author Information
Sabrina Altema PT, DPT, OCS
Clinical Assistant Professor, Director of Clinical Education
Howard University

E. Anne Reicherter, PT, DPT, PhD
Board Certified Clinical Specialist in Orthopaedic Physical Therapy
Certified Health Education Specialist
Education Consultant  

Background: High intensity gait training (HIT) has become a standard of practice for treating patients with neurologic diseases including cerebrovascular accident (CVA) and spinal cord injury (SCI). HIT during inpatient CVA rehabilitation significantly improves balance, walking endurance, and walking speed outcomes (1). Additionally, it has been shown that implementing task specific training at high intensities results in greater walking speeds for patients with SCI (2). Motor scores on the Unified Parkinson’s Disease Rating Scale improve when HIT is implemented in patients with Parkinson’s Disease (3). Parkinson’s Disease (PD), a progressive neurologic disease affecting the basal ganglia, causes bradykinesia, rigidity, resting tremors, postural instability, and gait abnormalities. Most types of physical exercise can have a beneficial effect on motor signs and quality of life for patients with PD (4). There is currently limited evidence specifically on potential effects of HIT on balance and walking outcomes in patients with PD. This case study will examine the utilization of HIT in a patient with PD in the inpatient rehabilitation setting.

Purpose: The purpose of this case study is to describe the implementation of HIT with a 71-year-old male with a past medical history of PD and dementia admitted to inpatient rehabilitation following T11-S1 extension of fusion due to increased low back pain and bilateral radiculopathy. The patient managed his PD with Sinemet for several years prior to admission and continued medication regimen upon admission. The patient previously lived in an independent living facility and was independent with mobility with a rollator. The patient required moderate assistance for transfers and ambulation upon admission and progressed to being independent with rolling walker for all mobility at the end of his stay. The patient discharged to a subacute facility due to cognitive deficits with plans to shortly transition to assisted living facility.

Author Information
Kacey Kennedy DPT
Physical Therapist
Medstar National Rehabilitation Hospital

Background: There is a continual shortage of physical therapists and other disciplines with the knowledge and skills to provide high quality early intervention services for children with developmental delays and disabilities and their families. Pre-service curricula introduce concepts for early intervention practice to physical therapists and other providers, but these programs are unable to dive into the unique skills and practices such as routines-based early intervention, primary service provider practice, the coaching approach to service delivery, and teaming practices needed by most contemporary early intervention programs. The use of a certificate program can be the step for physical therapists to learn the skills needed for early intervention practice in an interdisciplinary environment. This presentation describes the evaluation results and lessons learned the Georgetown University Certificate in Early Intervention (GUCEI) program that has successfully educated service providers across disciplines in early intervention practice.

Purpose: The Georgetown University Certificate in Early Intervention (GUCEI) program has provided training in the skills and knowledge of early intervention practice for physical therapists and other disciplines since the 2012-2013 academic year. The students who have successfully completed the program have been a diverse group who include practicing providers and graduate students in their final year of their preservice program in physical therapy, occupational therapy, speech-language pathology, service coordinators, administrators, and educators or special instructors. Students are expected to gain knowledge of the intent and implementation of IDEA, the needs of children with complex disabilities, family centered care, cultural and linguistic competence, evidence-based practices, team based decision making, natural environment practices, and skills to create an eco-map, administer a routines based interview, administer and interpret standardized developmental tests, write participation based outcomes, implement coaching, lead and participate in IFSP meetings, and be a team member. The results of evaluation of the program and the employer surveys will be presented.

Author Information
Rachel Brady PT, DPT, MS
Assistant Professor, Director
Georgetown University Certificate in Early Intervention Program