It is important to listen to your client and always hone your skills. Listen to this testimony of a client.
All of us know of parents, grandparents, neighbors, anyone that comes into your mind that you have noticed a change in their posture over the years. Is this now happening to you? Maybe? Changing posture is a very insidious occurrence. We don’t physically notice the changes until we can no longer reach high up in the cabinet for that special bowl we need. Or, our lower back becomes stiff from sitting for even as much as 20 minutes. Or we can no longer squat to the ground as we were once able. Or turning your head as you back up your car is now either stiff or painful. You then develop alternative methods because you can no longer perform these movements. Why is this? Losing the range of motion in any one joint causes changes and alterations in many other areas in your body that you are not aware of! This is especially true when there is not a traumatic event to associate the changes with. Let us review a few reasons why this occurs and then a few methods to combat the soft tissue changes that ultimately change our posture.
Soft Tissue Has Power!
Normally, we do not think of our soft tissues has having power, but they certainly do. Fascia, the newest accepted organ of the body is meant to be strong, elastic, and slide and glide as we move. It has a covering, whether thick or thin, over every part and parcel in our body. Fascia is strong and is known to have contractile powers, yet not eccentric abilities. Eccentric means the ability for a tissue, as in muscle to contract, yet become long at the same time. This means that fascia once contracted repeated over time may have the tendency to want to remain in the position. This is one reason that creates abnormal forces on tendons and joints. With this being said, static postures that is your worst repetitive motion, awkward postures, highly repetitive motions without rests, unexercising, incorrect food intake, emotional stressors, all together form to create changes within your body that you cannot detect until; until you cannot turn your head normally until you cannot squat to the floor normally until you cannot reach high into the cabinet for the bowl, and until you feel that stiffness upon standing when only sitting for 20 minutes. All of this changes your posture. Now you may notice that increased thoracic curve if looking in the mirror, or your shoulders are so far forward, you have these indents between your pecs and collar bones.
Regain Your Power Over Your Soft Tissue!
I am not the pessimist or fatalist. I am heralding a trumpet call for any individual that really wants to create optimal changes in their body. Even if you have Parkinson’s, you can maintain optimal postures for much longer periods of time. My husband is proof of this. What are some methods to create changes for an optimal body posture? It does demand commitment of daily work, 5 – 10 minutes. Your diligence will pay off. Will the changes happen quickly? It takes the time it takes. The more time you put into this the faster the results. And, no, the results are not permanent. This is a lifestyle change. First, you want to take a baseline of where you are in your joint motions:
Since pictures are worth a thousand words, here are movements that are considered normal and you should strive for:
Thank you SFMA for this picture!
These movements should not cause pain! Do not attempt if you already know you have joint movement challenges in any of these areas. This is meant to bring to your attention how malleable we can still become.
STRATEGIES TO INCREASING YOUR OPTIMAL POSTURE AND MOVEMENT
Many of us have challenges in one or more joints. Choose the least restricted joint and begin to slowly use a dynamic movement, rather than a prolonged stretch, to increase the range of motion. Laying down is a great method to use for neck, shoulders, hips, knees, and low back. Remember, this is how babies begin to increase their range of motion and strength; they are laying down first because they do not have the trunk control sit up. So, babies begin by wiggling and jiggling, and discovering a hand, a foot, and work on that movement. They do not know they are exercising and increasing in the range of motion along with muscle strength and control.
The best method is to contact a professional to educate, teach, and empower you to optimize your soft tissue so you have power over your soft tissue!
Everyone is learning throughout their day whether it is intentional or not. On topics that we are well acquainted with, we actually run the risk of missing out on additional information of that same topic. There are nuances, or undertones that all topics encompass. As a result of how well we think we know a topic, the risk of repeatedly missing the extraordinary additional perceptions and depth that the topic offers increases.
What might be a good example to describe this phenomenon?
As a physical therapist, we will see/treat many individuals with the same diagnosis, the same complaint, using the same verbal description. Of course, therapists have treated this type of complaint for possibly years. Yet, are we missing something? Have we been able to reduce the number of visits with longer-lasting outcomes? If not, then chances are, we are missing the nuances of what is taking place inside the client. One size fits one is my motto. Therefore, it behooves us to delve deep into how tissues realty moves inside.
We should not assume, even if we are considered “experts” in a field, that we should not continue to review into the depths of our field
As environmental health and safety professionals, there are so many compliances, rules, processes, and procedures, that we must remember on a daily basis. If an employee or two has expressed complaints regarding a specific task of a job, again, what are the nuances of that job that can be altered to bring about better productivity and less fatigue or soreness in the individuals.
Never think you know your subject matter enough. Continue to look at the same topic through different eyes, different perceptions, different discriminatory inspection. You will certainly come away with a more complex and intricate understanding and improved methods of solving daily challenges and tasks.
ACE your communication! How to Recognize, REFINE, Resolve Colleague and Team Expectations and Communication Challenges
Lori: “Brad, can you email me that information by this Friday, so the project can be completed?”
Brad: “I am so busy and will not be at work tomorrow. I’ll see what I can do.”
This is a common communication exchange in everyone’s life. Should Lori expect the information from Brad she asked for by a specific date? Yes? No? Whenever we communicate answers that are ambiguous, such as, “I’ll see what I can do”, “I am not sure…”, “I think I might”, “Let me get back to you”, we are not communicating very well. The above short examples are open ended without any definitive answer in response to the person asking the question that requires a definitive answer.
These forms of communication often lead to frustrations between co-workers, doubts of co-workers, and the typical office gossip between co-workers. All leads to further break down of communication and work productivity.
How can someone’s ambiguous response be properly delt with that shows respect, confidence, and demonstrate the satisfied interdependence for that co-worker; or team? Whether you are working in a team situation, work closely with specific colleagues, or need to collaborate with someone you do not know yet, the principle of agreed communication expectations is foundational.
Agreed Communication Expectations = ACE
The concept on agreeing on expectations in communicating is not new, not a new religion, not groundbreaking for the 6 o’clock news. Yet, this topic continues to be written about in books that are on best sellers’ listings. There still is Dale Carnegie’s best-selling book, “How To Win Friends and Influence People”, published in 1936 with over 30 million copies sold worldwide. This book is one of the best-selling books of all time. According to Wikipedia, it was number 19 in 2011, on Time Magazine’s list of the 100 most influential books. And there are Dale Carnegie Communication classes now offered. Another best-selling effective communication book, “Crucial Conversations” by Kerry Patterson, Joseph Grenny, Ron McMillan, and Al Switzler, another New York Times best seller with over 3 million copies sold. With hordes of e-books, Kindles, Audible and the good old fashion book, combed with living in a society where technology is at our fingertips on our phones, laptops, pads, and desktops, why is communicating with each difficult? The title of the blog, Yes = Yes, No = No is the giveaway to agreed communication expectations, or ACE.
How ACE Works
The timetable to start effectual communication is anytime: anyone can require this principle, reinforce this principle, retrace this principle in a chronology of communication with another. Setting and agreeing on communication standards that includes updates, reminders, and to be able to speak up to another when the communication is not clear without being rejected, (as we are all subject to not stating clear thoughts!), that builds the success of communication, which, builds the productivity, respect, and admiration for one another. Below are 2 examples of how two or more people can agree on terms of communicating without the feeling of misunderstanding or that feeling of ambiguity of whether the expectation will be met or not.
Agree that responses to requests need to be a “Yes” or “No” answer
Of course there are instances when a simple “Yes” or “No” needs to be accompanied by negotiating a different timeline, or amount of information that was requested, or some other difference where the two, or group, can agree and then rely on. Ultimately you need to answer a “yes” with the appropriate delivery times, or “no, but I can next week, on such n such a day”.
You Cannot be “Just meat and potatoes” for responding to others
If you are the individual supplying the request, and you think you may need more time or cannot supply the entire bulk of information, then state just that and state the reasons why. This is where you cannot be that “Just meat and potatoes” person, meaning that short answers or quips is what you are about and that is how you communicate. When at work, often, you do need to fill many gaps with proper reasonings to others, so they are informed of your request for change of date of requests or amount of information you can provide. We must take into consideration that in large organizations, the same department is also divided into silos. Signifying that just because you have certain knowledge, another team member, or co-worker will not. We cannot assume others have the same internal knowledge, no matter how trivial, that we have.
Repetition Builds Collaboration Confidence
I remember when matriculating for my physical therapy degree, most of the younger students would whine and complain about hearing the “same thing again”. What they did not understand was that information repetition was building their ability to use that same information in a variety of ways. Working situations are no different. Ensuring that everyone is supplied and has responded to either requests, or changes of information, or changes in timelines are vital for not just the success of a specific project; it builds the success for better working relationships. People that work well together will accomplish much more and more efficiently.
ACE your communications!
Our society is more than full of forms: application forms, loan forms, insurance forms, and the beloved, consent form. We are so inundated with forms, almost daily, we become somewhat numb, or the level of automaticity raises to the point we do not carefully read what we sign.
The other facet to a consent form, is the development of a form. This short blog will refer to consent forms for mainly outpatient physical therapy clinics. With growing regulations at the state and Federal levels, growing methods to offer, and growing patients, a consent form is a foundational piece to any clinic.
What Should a Consent Form Contain?
Most clinics prefer to keep a consent form as simple as possible, yet, in the wake of our recent and continuing challenges of the invisible beast, outpatient clinics now have additional opportunities to offer patients. All, in my view, should be explained, disclosed, and signed by each patient, with a copy handed to them for their own records.
Basic Material in a Consent Form
- HIPAA Privacy Acknowledgement
o Includes who and who not to divulge medical history to
o Some clinics prefer for HIPAA statement to be separate
- Clinic policies of treatments that maybe used
o Should always state patient have right to refuse
- Risks and benefits of treatments
- Attendance policy
- Places for date, time, and signature of patient or legal guardian signature
Additional Items in Consent Forms
Therapy clinics are now adding a “release of liability”, “hold harmless”, in the consent forms. In a search of forms that are online at many physical therapy clinics, the liability waiver is increasing as compared to consent forms 5 years ago.
Also added to consent forms, or are additional consents for electro stimulation, traction, or other modalities. Some clinics create a completely different form to sign, as not all patients will utilize that modality.
The topic of interest today is the telehealth consent. This is a new and upcoming form in the utilization of outpatient physical therapy and deserves some small comments. Such questions as; can you use Apple Iphone Face Time or Duolink as a telehealth method? As both ends are strongly encrypted, so far these forms of “telehealth” are allowable. Maybe not so in the future. The caveat to any telehealth visit, is the consent and understanding that the patient at home allows and understands that if he/she does not live alone, the medical conversation may be overheard and seen. It the patient wishes for the telehealth conference to be private they must ensure that on their end. The conversation should be recorded, and consent must be attained in the consent form and at the beginning of the call. This protects both parties. As this technology is new, with many many grey areas still to be configured, voice recording important; and, if the clinic is using a telehealth 3rd party company, the entire recording of voice and video can be captured.
Take Home Points?
- Semi-annually review all types of patient forms.
- Apply telehealth to the consent form, even if the use of an Iphone would be utilized.
- Obtain consents for recording conversations, even with just a follow up phone call.
- Strongly consider the Liability Waiver addition. Sometimes it is important that patients understand they are the more active person in the therapy duo. The feedback of the patient in every exercise, modality is important. If the patient is not successful, neither will your business.
- Begin to look for that 3rd party telehealth system that fits into your budget. Many clinics visualize the need, but to actively use it is another.
- Strongly consider the patient signing a consent and liability waiver each visit. This is important as patient’s values, ideologies, and expectations changes. Having them sign the form with each visit again rolls back to the statement that it is the patient who is the more active person in the therapy duo. This serves as a strong reminder.
Forms are the foundation to a strong business model. Do NOT throw money away.