Technological Advancements: Aiding or Replacing Physical Therapists?

This week, my blog entry is once again directed at exploring the blogosphere and commenting on two entries from outside blogs. The entries explore two technological advancements that may one day become standard in physical therapy. Technology is constantly evolving, which is why it is very important to stay updated on the latest advancements. The first entry discusses a new robotic surfboard that is being used to aide in physical therapy. The second entry explores a new robotic exoskeleton that performs physical therapy onto the person it is attached to. While they are both advancements that may one day be used in physical therapy, they differ in that the robotic surfboard assists the physical therapist, but the robotic exoskeleton replaces the physical therapist. My comments on the two entries can be found below.

Comment on “Virtual Surfing Used in Physical Therapy”

First of all, I believe this is a great technological advancement that has a very bright future in the physical therapy field. With its great range of motion and requirement of the user to exercise balance, the robotic surfboard appears to have great potential to be a very effective treatment tool. It is perfect for treating patients with lower body injuries, especially those with ankle and foot impairments. The robotic surfboard could bring fun and excitement to an otherwise dull and boring treatment room. Incorporating this device into treatment programs will probably not appeal to the elderly, but children and young adults will definitely opt for it. One of the key benefits to this device and the many devices similar to it is that it allows patients to concentrate away from the pain and more effort into the treatment. Patients would ultimately forget they are even in a treatment session which would make the treatment experience that much more enjoyable. I have to agree with you that this technology cannot be a replacement of the standard treatment/healing process; it can only assist it. This is a very crucial point because many people look at these technological advancements and think that they can replace standard physical therapy treatments. They can, however, be effectively incorporated into a treatment program that a physical therapist prescribes.

Comment on “Smart Tech to Cut Physiotherapy Waiting Times”

While I do see this as remarkable technology, it is hard to imagine that this piece of machinery can be used as a replacement for a physical therapy treatment with a physical therapist. This device is exceptional to say the least, and there are numerous potential applications of this device in aiding in therapy. The device can be of great value to therapists; they can treat patients without physically doing the treatment. They can strap the device onto the patient, dial in the proper settings, and continue to another patient while the device performs the treatment. It is in this manner that I agree that the device can cut waiting times for patients since more patients can be treated at once. I do not, however, agree that this device can be used in replacement to a physical therapy session with a doctor. The treatments need to be performed with a doctor around. The device can be incorporated into a therapy session, but it should not replace it. There are countless risks that I think are overlooked in the post. What if the patient gets hurt during treatment, what do they do with no doctor around? What if the device malfunctions and does something wrong; what is the patient to do? How can the patient make sure they are doing the right movements during the therapy? I believe it is necessary for this device to be used in conjunction with therapy sessions with a doctor in a medical office. This way the doctor is always around in case any problems occur, any questions arise, or just to make sure the treatment is going smoothly. Like I stated earlier, I do agree that this device can cut waiting times, but I don’t agree with the way it is proposed to do so. I do not believe it is right, nor safe, for treatment to be performed outside of a doctor’s office without a doctor present. Even if the device is used within doctors visits, wait times can still be cut because multiple patients can be treated at once. In my opinion, this is one of the many potential benefits of this new technology.

Therapy Caps: A Notion of the Past?

New legislation has been introduced that marked a watershed in the ongoing battle for the removal of Medicare therapy caps. The bill, titled the Medicare Access to Rehabilitation Services Act of 2007, was introduced in the Senate and House of Representatives on January 31, 2007. The bill calls for a complete removal of the law that placed caps on Medicare outpatient physical therapy, occupational therapy, and speech-language pathology. The law is a huge stride for Medicare beneficiaries across the country; this is the first attempt at a permanent fix to the Medicare therapy cap problem. The therapy caps were originally introduced in the Balanced Budget Act of 1997. Besides obvious budget problems, one of the main reasons the caps were introduced was to fight against over treatment of patients by doctors, but many factors were overlooked with the introduction of the legislation. Legislation was passed in 2006 to put these caps into effect, but they also authorized Medicare to exercise an “exception process.” These exception processes involved extending treatment passed the caps “if they meet diagnostic and clinical criteria.” In December 2006, new legislation was introduced, the Tax Relief and Health Care Improvement Act, which extended the exception process for the year of 2007. These legislations were just temporary fixes for the problem.

The new bill calls for a permanent fix; it calls to completely wipe out the therapy caps. Scott Ward, the president of the APTA, commented that “passing this important legislation to completely repeal the therapy caps is the best long-term policy solution- rather than passing 1-year fixes.” Currently, the limits are set at $1,780 for physical and speech therapy combined and $1,780 for occupational therapy. What this means for patients is that once they reach this therapy cap, they are forced with the difficult decision of paying out of pocket for the treatments or avoiding the necessary treatments altogether. People with serious injuries who require extensive ongoing treatment are mostly affected by these caps, and avoiding necessary treatment may put them in the surgery room. As Ward stated, removal of the therapy caps “would eliminate the ongoing threat to seniors and individuals with disabilities who may have to pay out-of-pocket expenses or alter the course of their care by changing providers or facilities.”

The new legislation is the result of intensive efforts made by the AOTA (the American Occupational Therapy Association) as well as members of Congress. The bill is gaining wide support from both Republicans and Democrats across the Senate and House of Representatives. In the senate, the chief sponsors are Senators John Ensign (NV), Blanche Lincoln (AR), Ben Cardin (MD), and Susan Collins (ME). In the House of Representatives, the chief sponsors, led by Representative Xavier Beccerra of California (pictured above), are Representatives Phil English (PA), Mike Ross (AR), Chip Pickering (MS), and Roy Blunt (MO). Representative Ross (pictured to the right) stated “whether a person receives speech, occupational or physical therapy, it should be a decision made between a doctor and patient, not by accountants monitoring a set limit.” This is a crucial point and is one of the main reasons behind this new bill. The current “exception process” extension expires on December 31, 2007, and for the new bill to be addressed before then, the AOTA, along with other organizations, require considerable grassroots action in order to encourage members of Congress to support the new legislation. It is not going to be an easy journey, but if successful, it will mark the end of physical, occupational, and speech therapy caps for good.

Video Games and Therapy: Another Look

This week, my blog post is directed at commenting on two other blog posts from outside blogs. The two posts explore outside uses for video game technology by applying it into physical therapy. As a potential future physical therapist, this is a very important new topic as it may one day become a standard in physical therapy practice. I wanted to explore the blogosphere to find out what is being said about the concept of combining physical rehabilitation with technology that is generally used for pleasure and entertainment. In the first blog post, the author discussed how an engineering science student developed a physical therapy video game through a system which incorporates a modified Play Station 2 video game console, which was being used to help a young girl who suffers from hemiplegic cerebral palsy physically rehabilitate. The author of the second blog post explored the potential uses of the new video game system, the Nintendo Wii, which included weight loss and physical therapy. You can either follow the links to the original posts to see my comments or continue reading.

Comment on "Game Tech Proves Therapeutic for Young Girl":

The device created by William Li is not only remarkable, but I believe it holds a strong future in terms of being applied into physical therapy programs. In my research of the topic, there are similar machines all across the world being built and tested successfully. In Megan Sherwin’s case, nothing is more important than for her to keep her left arm and hand moving. The method that was proposed of putting her right arm and hand in a cast to encourage movement in the left is preposterous. That would basically immobilize the young girl since that is her only strong side that she uses to perform all her daily functions. The option of having the young girl perform therapy by playing a video game is probably much more appealing both to the girl and her family. This allows the girl to perform all her daily functions by using her strong side, while rehabilitating her weak side. This is a huge benefit to the device created by William Li and devices like it; it opens doors to new and exciting ways in which physical therapy can be approached.

Comment on "Is the Wii Really Good for Your Health?":

I believe it is very important to not downplay the Nintendo Wii’s fitness and therapy potential. The physical movement and exertion that the Wii provides should be looked upon as a benefit rather than a nuisance. The system’s design, which puts the user’s movements at the control of whatever they are playing, allows it to easily be adopted into a physical therapy setting. Although this advantage is mentioned in the post, I think it is important to recognize the far reaching benefits. In the future, physical therapists can come together with game developers and create video games for the Wii that are targeted at various physical therapy exercises. Because of the Wii’s popularity, the Wii has already found itself in millions of people’s households. Combining the fact that the Wii is already set up to be controlled by user’s motion and that it is very widespread among households really opens the door and makes it possible for a physical therapy application in the near future. The system does not have to be modified; the only thing that has to be done is that a game needs to be made. It is amazing to think that one day your physical therapist can actually prescribe you to play a video game on your Wii as part of your physical therapy!

Canines and Physical Therapy: A Successful Collaboration

Throughout the world, dogs are well known for their ability to help mankind in many ways. They have been used for hunting, tracking, search and rescue, assisting the deaf and physically challenged, and leading the blind among many other things. The bond between man and dog has been evident for thousands of years, but only until recently has the idea of dogs aiding in the physical rehabilitation of humans come about. Dogs all across the United States are being specially trained and used in conjunction with physical therapy programs. These type of dogs fall under the category of “therapy dogs” (pictured to the left). There are two categories in which therapy dogs help humans- through Animal Assisted Activities (AAA) and Animal Assisted Therapy (AAT). A.A.A. are just simple programs in which people and animals interact. On the other hand, A.A.T. involves the animal actually playing a crucial role in a person’s emotional or physical therapeutic activities. This is an involvement of physical therapy.

There are many ways in which dogs can be utilized in these special physical therapy programs. The dogs can play a very simplistic role in which they just walk with the patient or just sit while the patient pets them (as you can see in the lower two pictures). A more complex role the dog can play is to perform specific motions with the patient or play various interactive games such as catch. Many patients believe that these activities do not even feel like physical therapy, rather just normal everyday activities. Glenda Hinton, a 63 year old patient at the Forsyth Medical Center, suffered from a stroke which left her right hand curled and stiff. A therapy dog was introduced to her, and, with her injured hand, she began to pet the dog by raking her hand along its back. Glenda was more worried about hurting the dog with her stiff hand rather than paying attention to the fact she was actually receiving physical therapy. Moving her hand in various motions became essential to her therapy. Another hospital which is currently experimenting with utilizing dogs within their physical therapy programs is the Women’s and Children’s Hospital in Lafayette, Indiana. For the past six months, a seven year old golden retriever has been incorporated into the physical therapy program at least twice a month for pediatric rehab patients. Phyllis Comeaux, director of pediatric rehab services at the hospital, pointed out a benefit to the program, “sometimes they don’t realize that what they’re doing is therapeutic… their focus is on the dog.” In a nearby hospital, Lafayette General Hospital, a similar program has been experimented with for quite some time. A 90 year old patient who was admitted for therapy in the hospital, Betty Sirkis, interacted with a therapy dog during one of her physical therapy sessions. Betty played a game of fetch with the dog, where she threw a tennis ball and it would then go to retrieve it. The various movements involved in this simple activity are once again crucial to her rehabilitation. A therapist at the clinic commented that “with the dog, they’re not thinking about what they can’t do.”

This type of therapy is specifically beneficial to younger patients. A head trainer of a team of therapy dogs, Melissa Kielbasa, stated “therapy dogs … provide both emotional and physical therapy for kids. These dogs like to play and snuggle, and they make kids feel good.” Younger patients are often distracted and unwilling to perform therapy. It becomes a task and something they definitely want to avoid doing. With a dog being involved in the program, the younger patients are more willing to participate in the sessions and put forth effort into them as well. As for patients of all ages, they respond more positively and enthusiastically when a dog is involved; it makes the exercises seem more interesting, attractive, and enjoyable. Patients are also distracted from the pain that is associated with many exercises that they have to perform. There are many benefits to dogs being used in physical therapy programs, and it is exciting to see what the future holds for this interesting merge.