The APTA brought its annual Combined Section Meeting to San Diego for four beautiful days from Feb.17-20, and ADVANCE was there to cover the action. More than 7,000 attendees enjoyed great weather and all that the conference had to offer.

CSM 2010 kicked off with the American Board of Physical Therapy Specialties Opening Ceremony: "Opening and Closing Doors - An impact of Clinical Specialization." The following morning, ADVANCE conducted video interviews with APTA President R. Scott Ward, PT, PhD, as well as APTA director of public relations Emilio Rouco that will be available for viewing on the ADVANCE Website this month.

Dr. Ward discussed how the events of 2009, positive and negative, affected the APTA along with what the organization hopes to accomplish this year. Rouco, meanwhile, talked about developments regarding the APTA's branding campaign, "Move Forward - Physical Therapy Brings Motion to Life."

Spotlight on Capitol Hill
The legislative update session at CSM always draws an informed and inquisitive crowd and this year's presentation was no exception. Titled "APTA Advocacy: From Congress to the Statehouse," the session was presented by Kelly Lavin, MHA, APTA director of federal government affairs, and Angela Chasteen, APTA associate director of state government affairs. Lavin and Chasteen discussed APTA priorities in health care reform, including insurance reform (coverage), payment reform, system-level reform, as well as new innovations and investments. Lavin lamented the stalemate in Congress on a variety of health care issues, however, and noted "Even before the snowstorm that just hit, Washington was completely paralyzed."

The most pressing issue is the $1,860 Medicare outpatient therapy cap that went into effect Jan. 1 and was initially imposed by the Balanced Budget Act of 1997. Congress has responded six times in the past to prevent Medicare beneficiaries from being negatively impacted by the cap policy. However, the 111th Congress failed to stop the cap from going into effect this year. While both the House and Senate versions of health care reform legislation addressed the cap by extending the exceptions process temporarily, failure to enact reform has resulted in many senior citizens nearing or surpassing the arbitrary limits less than three months into the next year.

"Unfortunately we are under the therapy cap right now but are working night and day to change it," emphasized Lavin.

At the state level, APTA continues to focus on direct access, PTA licensure, protection from infringement, POPTS, PT practice act modernization and providing legislative, advocacy and grassroots support to chapters.

Chasteen concluded the session by emphasizing how PT professionals can get involved with APTA legislative efforts. Avenues include the APTA Grassroots Network, Legislative Action Center, Federal Advocacy Forum and State Government Affairs Forum. More information is available at

Concussion Conundrum
In a session titled, "Concussion and Mild Traumatic Brain Injury," speakers Barbara Hoogenboom, PT, EdD, Susan L Whitney, PT, PhD, NCS, ATC, FAPTA, Robert Cantu, MD, Kevin Guskiewicz, PhD, ATC, and former pro-wrestler Christopher Nowinski elaborated on the message that an injured athlete's brain needs sufficient rest time before he is able to return to the field.   

Dr. Guskiewicz stated that an athlete's risk of sustaining another concussion after an initial injury increases "exponentially." Return to play should only be considered when all the following guidelines are met, he stressed:

  • The athlete is 18 or older; 
  • The athlete has no loss of consciousness;
  • The athlete has no amnesia; 
  • There are no other symptoms;
  • The athlete passes all functional tests.

If a therapist is unsure, he told the audience, withhold the athlete from returning to play. PT professionals have many options to help raise awareness, such as speaking to local community, school and church groups. Even youth hockey or football programs can serve as platforms to increase education and awareness.

Students and New Professionals
"Student and New Professional Forum: Key Survival Skills for the New Physical Therapist," drew a packed house of enthusiastic attendees. Leslie B. Glickman, PT, PhD, director of post professional programs at the University of Maryland department of physical therapy and rehabilitation science, Baltimore, was the speaker. Dr. Glickman emphasized overcoming generational differences and marveled that by 2020, five different generations could be interacting in the workplace together.

These include the Traditionalists (born between 1900 and 1945), Baby Boomers (1946-1964), Generation X (1965-1981), Millenials (1982-2000) and the generation born since 2000 that has yet to reach high-school age. The audience was mostly comprised of Millenials and Dr. Glickman tailored her discussion toward the generally recognized competencies of this generation, including multitasking, working well in groups, adapting quickly, absorbing information rapidly, driving change and being technologically savvy.  

Prosthetic Focus
Another session, "Research Innovations to Improve Amputee Care," was presented by the Federal PT Section of APTA. Presenters Benjamin Darter, PT, PhD, and Jason Wilken, MPT, PhD, discussed current research efforts to improve prosthetics and how to best use virtual reality technology to enhance rehabilitation. Researchers at The Intrepid in San Antonio, TX, also aim to accurately measure outcomes for the young, traumatic amputee population.

They are further committed to making prosthetics as comfortable and functional as possible. Dr. Wilken explained that 60 percent of the amputee population will experience a fall at least once annually. In fact, many of these falls happen among younger patients because those amputees tend to push the limits more than their older counterparts

Oncology Issues
Early detection and effective treatment has led to increases in breast cancer survival rates. This means physical therapists must now screen outpatients for cancer (even if they don't have a history) and recurrence or late-effects (if they are a survivor), said speakers at "Medical Screening for Oncology-Related Issues in Outpatient Physical Therapy." Presenters Mary Lou Galantino, PT, PhD, MSCE, Laura Gilchrist, PT, PhD, Victoria Marchese, PT, PhD, G. Stephen Morris, PT, PhD, Kirsten Ness, PT, MA, MPH, PhD, and Meredith Wampler, PT, DPTSc, described the signs and symptoms of several different forms of cancer. They also provided a "CAUTIONS" list:

C- Changes in bowel or bladder habits.

A- A sore that does not heal.

U- Unusual bleeding or discharge.

T- Thickening or lump.

I- Indigestion/difficulty in swallowing.

O- Obvious change in wart or mole.

N- Nagging cough or hoarseness.

S- Supplemental signs/symptoms.

Cancer can cause late-effects on the neurological system, including persistent pain after surgery, fibrosis of neural and supportive tissue after radiation treatment and chemotherapy-induced peripheral neuropathy (CIPN). The following musculoskeletal effects may also occur: skeletal hypoplasia/deformity, muscle hypoplasia/fibrosis, joint contractures, limb length discrepancies, amputation, pathological fracture, coliosis/spinal deformities, dermatologic/cosmetic changes, second malignancy, exostosis/osteochondroma, osteonecrosis and osteopenia. Be mindful of implications on the body's various symptoms, the speakers advised.

Brian W. Ferrie, Beth Puliti and Rebecca Mayer are on staff at ADVANCE.


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