And so it begins-Baylor's new "hybrid" DPT program will start in 2018

[scrawnyguy]

Bottom Line Up Front: Baylor is starting a new hybrid DPT program that mirrors the one at South College.

I think most of us knew this was inevitable after South introduced this model a couple of years ago. I am a little surprised, however, that it is happening so soon. The first class at South hasn't graduated or even attempted the boards yet. I figured more established schools would at least want to see if this model was effective before they decided to follow suit. What happens if half or even 25% the kids who graduate can't pass the boards? John Childs has been dubbed the program director and I know his name carries a lot of weight in the industry but it still seems risky. He was also a driving force behind the creation of the program at SC. I have to wonder whether the Baylor program is going to be associated heavily with EIM like South is. John is the CEO at EIM and that would most definitely be a conflict of interest.

Thoughts?

Baylor’s Graduate School Will Launch Doctor of Physical Therapy Program in 2018

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[jadedphysiotherapist]

Bottom Line Up Front: Baylor is starting a new hybrid DPT program that mirrors the one at South College.

I think most of us knew this was inevitable after South introduced this model a couple of years ago. I am a little surprised, however, that it is happening so soon. The first class at South hasn't graduated or even attempted the boards yet. I figured more established schools would at least want to see if this model was effective before they decided to follow suit. What happens if half or even 25% the kids who graduate can't pass the boards? John Childs has been dubbed the program director and I know his name carries a lot of weight in the industry but it still seems risky. He was also a driving force behind the creation of the program at SC. I have to wonder whether the Baylor program is going to be associated heavily with EIM like South is. John is the CEO at EIM and that would most definitely be a conflict of interest.

Thoughts?

Baylor’s Graduate School Will Launch Doctor of Physical Therapy Program in 2018

If they can't pass boards then they're done. That being said, boards aren't that hard. These models starting at halfway marks are ridiculous. There will be absurd market flood in the 2020s. Watch.

I don't have a problem with condensing curriculum length, but there should be an apprenticeship license with match contracts to businesses, hospitals, etc. for a one year timelength with livable pay following the two years and tuition payment.

Medicine is notorious for superfluous training pathways, but other fields shortening timelength and not creating a gradual progression to independent practice literally will just throw off supply and demand. If the six month internship is in one setting then that's not bad, but literally no exposure in other settings doesn't really help students understand how patients move and what healing timeframes are. Setting intervention goals to healing timeframes takes a while of practice as well.

I liked Novas four year hybrid model. I really see this going the way of pharmacy and law.

If a post professional year becomes necessary and I can find tuition somewhere that won't make me want to hurl and is actually in line with using federal lending in a responsible manner then my opinion will change.

 

[starrsgirl]

I'm a huge advocate for changes like this and I know I say that at risk of being in a minority. I'm a non traditional student, military veteran (married to military) . When I looked to go back to school, there were so many options for me to do distance learning in other fields but not PT. I looked at DNP, PA, pharmacy....all had distance programs. It's very difficult to relocate a family when the other spouse works, it's even harder when the other spouse is constantly moving. I'm a huge advocate of distance programs and opening up access to programs, especially in rural areas (I've been stationed in 2 so far with no real advanced schooling options). I fell apart in my traditional undergrad, couldn't find my way, didn't connect to the classes. I went back and did a masters online and LOVED the online model. I do classes as I want, at my own time and to the exact depth I need. I retained about 0% from undergrad and retained a ton from my masters, just because I was doing it for me in a way that stayed in my head. When I went back to PT school, being in class was a huge waste of time for me. My school had required attendance and that really irked me (the medical school doesn't). I sat in the back and messed around online. I did fine in school, but had to do the learning in my own way and time. I don't believe we need to have just one style of teaching....there are many ways to teach and to learn.

This type of hybrid setup will always require in person labs and clinicals. Having just attended a 3 day intense workshop, I would also argue I learned WAY MORE from that 3 day course than my sporadic musculoskeletal labs spread out over a semester. The immersion in a lab and consistent practice makes a huge difference. Clinicals will be clinicals....some good and some not so good.

I'm not worried about South college students passing boards. The boards are the boards....if you have a good GRE score and a good GPA you are likely going to do well on the boards. They don't capture the type of clinician you are, just your ability to study and passed a standard test.

I'm a fan of the 2 year model...I felt like my school has a 2 year model than they simply take 3 years to deliver....tons of wasted time and low intensity semesters. That's an expensive waste of time in my book. Get in, get out and get working! (I like Nova's 4 year model too...allows you to work and keep debt load down).

As for a surplus market....well, I think we are already touching that without the online programs. The online programs aren't creating that. Every state is adding programs and most programs are plussing up rapidly. To me, that's a larger issue looming.

 

[jadedphysiotherapist]

I'm a huge advocate for changes like this and I know I say that at risk of being in a minority. I'm a non traditional student, military veteran (married to military) . When I looked to go back to school, there were so many options for me to do distance learning in other fields but not PT. I looked at DNP, PA, pharmacy....all had distance programs. It's very difficult to relocate a family when the other spouse works, it's even harder when the other spouse is constantly moving. I'm a huge advocate of distance programs and opening up access to programs, especially in rural areas (I've been stationed in 2 so far with no real advanced schooling options). I fell apart in my traditional undergrad, couldn't find my way, didn't connect to the classes. I went back and did a masters online and LOVED the online model. I do classes as I want, at my own time and to the exact depth I need. I retained about 0% from undergrad and retained a ton from my masters, just because I was doing it for me in a way that stayed in my head. When I went back to PT school, being in class was a huge waste of time for me. My school had required attendance and that really irked me (the medical school doesn't). I sat in the back and messed around online. I did fine in school, but had to do the learning in my own way and time. I don't believe we need to have just one style of teaching....there are many ways to teach and to learn.

This type of hybrid setup will always require in person labs and clinicals. Having just attended a 3 day intense workshop, I would also argue I learned WAY MORE from that 3 day course than my sporadic musculoskeletal labs spread out over a semester. The immersion in a lab and consistent practice makes a huge difference. Clinicals will be clinicals....some good and some not so good.

I'm not worried about South college students passing boards. The boards are the boards....if you have a good GRE score and a good GPA you are likely going to do well on the boards. They don't capture the type of clinician you are, just your ability to study and passed a standard test.

I'm a fan of the 2 year model...I felt like my school has a 2 year model than they simply take 3 years to deliver....tons of wasted time and low intensity semesters. That's an expensive waste of time in my book. Get in, get out and get working! (I like Nova's 4 year model too...allows you to work and keep debt load down).

As for a surplus market....well, I think we are already touching that without the online programs. The online programs aren't creating that. Every state is adding programs and most programs are plussing up rapidly. To me, that's a larger issue looming.

The MD programs lack required attendance because the students Dwnld PPTs and study for step 1 while memorizing and dumping the PhD PPT slides for exams. That's how their market works. They get their skillset in residency and partly through rotations after stratification from that one test. Many learn high yield work on their own without lecture and listening to PhDs

Do you really think hybrid models can make you a good therapist? You are touching, correcting, and physically testing (ROM, dermatomes, myotomes, reflexes, CN assessment, gait abnormalities, vestibular interventions) all day. Our lab coursework was designed for that but so was our msk coursework, there ex, neuro, and tests and measures classes. For anatomy we had to go in for hours upon hours at a time touching and pulling on portions of cadavers to learn the exact anatomical locations. When I teach patients their anatomy, I literally have flashbacks to that coursework as it has directly guided my assessment, palpation, etc. Required attendance preps you for clinic hours as well. You get literally thrown in there and have to adapt and learn fast

Did your program have extra work with faculty outside of class time?

 

[jesspt]

Do you really think hybrid models can make you a good therapist?

The qualities that tend to make one a good therapist are inherent, not learned IMO. The delivery vehicle for the information necessary to pass the boards may not make very much difference. I guess we'll see.

 

[TheIron]

The qualities that tend to make one a good therapist are inherent, not learned IMO. The delivery vehicle for the information necessary to pass the boards may not make very much difference. I guess we'll see.

For sure. I would say the biggest gripe I have with PT school is the amount of time I'm just being "talked at." There have been days where I had straight lecture for 8 hours. I would have loved to have some of that online so I can go at my own pace. Lecture has been shown to have the lowest memory retention rate out of all teaching styles, so I am not opposed to having some classes online provided frequent in-person labs are incorporated into the curriculum.

I also get that everyone has different learning styles and may not be successful with online coursework. I understand the backlash against hybrid programs, but I don't think it's as black and white as people think it is.

 

[jadedphysiotherapist]

For sure. I would say the biggest gripe I have with PT school is the amount of time I'm just being "talked at." There have been days where I had straight lecture for 8 hours. I would have loved to have some of that online so I can go at my own pace. Lecture has been shown to have the lowest memory retention rate out of all teaching styles, so I am not opposed to having some classes online provided frequent in-person labs are provided.

I also get that everyone has different learning styles and may not be successful with online coursework. I understand the backlash against hybrid programs, but I don't think it's as black and white as people think it is.

If your school is doing only lecture rather than hands on breakouts, one on one group splits with faculty then that's a program problem. That's very common tho and I will say that board passage material does take only two years......we really need reformation of the matching and clinical training systems

 

[DPTinFL]

I'm a product of a "hybrid" program and welcome the addition of more programs. There are so many non-traditional candidates out there that would make great PTs but just cannot attend a regular program for whatever reason and never become PTs.
My class was composed of seasoned trainers, massage therapists, ATC, and PTAs. We met 2 weekends a month for hands on lab, cadaver dissection, practical testing, regular testing, and some lectures. Nobody in my class had trouble with the board exam. And yes, it takes a certain type of person to attend a hybrid program, a more mature and motivated student. To be honest, our PT skills were much better than the traditional students which I noticed during some blended lab time.

The "hybrid" programs will continue to be filled by mostly non-traditional students and will do just fine.

 

[NewTestament]

I'm not as concerned about these hybrid programs for several reasons:

-Most of the skills you will learn will be on the job. I've learned far more in the two years since graduation than I did in PT school. I don't use most of the "hands-on" skills I learned in school. Great students don't necessarily translate to great clinicians.
-If these hybrid programs are attracting non-trad students, you will not see a decline in the quality of PT's.
-Is there any correlation between cost/quality of PT school and quality of clinician? If students from hybrid programs continue to educate themselves and learn new skills, then the school where they earned their degree is irrelevant.

 

[jadedphysiotherapist]

I'm not as concerned about these hybrid programs for several reasons:

-Most of the skills you will learn will be on the job. I've learned far more in the two years since graduation than I did in PT school. I don't use most of the "hands-on" skills I learned in school. Great students don't necessarily translate to great clinicians.
-If these hybrid programs are attracting non-trad students, you will not see a decline in the quality of PT's.
-Is there any correlation between cost/quality of PT school and quality of clinician? If students from hybrid programs continue to educate themselves and learn new skills, then the school where they earned their degree is irrelevant.

Then there needs to be a one year posttraining program at the very least before a letloose. Place a case number basis for competency within that timeframe.

Learning PPTs and rehabbing ACLs for six months competently doesn't exactly work right after didactic completion.

I like the idea of mentorship and I love the idea of making the debt drop down and stop shuttling students randomly across the country to find housing for two months as well.

Probably a good time to combine everything and organize things along calendar years to create a good system. University pump out at arbitrary timelengths isn't exactly an intelligent idea when financial livelihood during lending occurs on a yearly basis from July to July as set by congress.

It can also make transitions to settings difficult as future clinicians won't know how much ramp up time people need to be competent following hiring

I prefer for us not to be viewed along similar lines as nurse practitioners in the health field........questionable training programs and a lack of solid linearity across curriculums

Although their lobby for representation would be nice

 

[starrsgirl]

The MD programs lack required attendance because the students Dwnld PPTs and study for step 1 while memorizing and dumping the PhD PPT slides for exams. That's how their market works. They get their skillset in residency and partly through rotations after stratification from that one test. Many learn high yield work on their own without lecture and listening to PhDs

Do you really think hybrid models can make you a good therapist? You are touching, correcting, and physically testing (ROM, dermatomes, myotomes, reflexes, CN assessment, gait abnormalities, vestibular interventions) all day. Our lab coursework was designed for that but so was our msk coursework, there ex, neuro, and tests and measures classes. For anatomy we had to go in for hours upon hours at a time touching and pulling on portions of cadavers to learn the exact anatomical locations. When I teach patients their anatomy, I literally have flashbacks to that coursework as it has directly guided my assessment, palpation, etc. Required attendance preps you for clinic hours as well. You get literally thrown in there and have to adapt and learn fast

Did your program have extra work with faculty outside of class time?

Couple of points: I do not think spending hours and hours pulling up things from cadavers or being good at dissection has great carryover to being a good therapist. Many schools are moving away from that model precisely because of the time to dissect versus efficiency of learning. Is anatomy important? Yes, absolutely. Can we learn what we need to learn in a more efficient manner? I think so. There are schools that have the students do less of the hands on dissection and more analysis of already dissected cadavers. And schools that are using a virtual dissection model platform. I personally spent no extra time in the anatomy lab because of my work/family schedule. I had classmates who spent hours on Saturdays/Sundays finishing up dissections. We all did pretty well in anatomy and my ability to explain anatomy to patients is just as strong (I studied a lot at home with an online app Essential Anatomy).

Also, required attendance does not prep you for clinic hours. Real work preps you for clinic hours. I've already worked 70 hour work weeks in other fields. Forcing me to sit in a chair and be a passive, receptive student for 8 hours a day does not correlate at all with the work I will be doing. Many of my classmates were shocked by the "real world" grind when they transitioned from classroom to clinic. It's a very different kind of load, pace and responsibility.

Yes, my school offers extra work with faculty outside of class time. Because of my schedule, I chose to do work that I did completely from home (developing online learning modules, literature review research). Some of my classmates did in person work with faculty but this work is not required, and only represents a small % of the graduating class.

 

[jadedphysiotherapist]

Couple of points: I do not think spending hours and hours pulling up things from cadavers or being good at dissection has great carryover to being a good therapist. Many schools are moving away from that model precisely because of the time to dissect versus efficiency of learning. Is anatomy important? Yes, absolutely. Can we learn what we need to learn in a more efficient manner? I think so. There are schools that have the students do less of the hands on dissection and more analysis of already dissected cadavers. And schools that are using a virtual dissection model platform. I personally spent no extra time in the anatomy lab because of my work/family schedule. I had classmates who spent hours on Saturdays/Sundays finishing up dissections. We all did pretty well in anatomy and my ability to explain anatomy to patients is just as strong (I studied a lot at home with an online app Essential Anatomy).

Also, required attendance does not prep you for clinic hours. Real work preps you for clinic hours. I've already worked 70 hour work weeks in other fields. Forcing me to sit in a chair and be a passive, receptive student for 8 hours a day does not correlate at all with the work I will be doing. Many of my classmates were shocked by the "real world" grind when they transitioned from classroom to clinic. It's a very different kind of load, pace and responsibility.

Yes, my school offers extra work with faculty outside of class time. Because of my schedule, I chose to do work that I did completely from home (developing online learning modules, literature review research). Some of my classmates did in person work with faculty but this work is not required, and only represents a small % of the graduating class.

So what do you propose is the solution? I've conceded that hybrid models might work fine for the didactic and it really only takes two years to pass the initial boards. That being said, how do you measure clinical competency? What do you propose as clinical rotation reform and apprenticeship models? Even for just competency, there is a general entrylevel ramp up time in the physical therapy industry given that insurance is killing us. And yes I mean killing compared to predecessor caseloads. I would not feel comfortable performing without a CI or mentor until I have seen cases from entry to d/c multiple times to develop pattern recognition on the recovery time to baseline function.

P.S. I know 2 month rotations don't always fulfill that but it's what we currently have with the ridiculous matching system. I'm aware that you may not be at the confidence level I said above for some jobs following graduation

One last thing.....I think maintaining some core rigor level of anatomy is incredibly important. That is what differentiates this field from everyone else in healthcare. The only ones who know it better and utilize it every day are surgeons who focus on their compartment of the body. There is also something to be said for doing hands on breakout sessions during the eight hour day and developing team based problem solving lectures with other students. Duke does this although they should drop tuition 15 grand.

 

[truthseeker]

Couple of points: I do not think spending hours and hours pulling up things from cadavers or being good at dissection has great carryover to being a good therapist. Many schools are moving away from that model precisely because of the time to dissect versus efficiency of learning. Is anatomy important? Yes, absolutely. Can we learn what we need to learn in a more efficient manner? I think so. There are schools that have the students do less of the hands on dissection and more analysis of already dissected cadavers. And schools that are using a virtual dissection model platform. I personally spent no extra time in the anatomy lab because of my work/family schedule. I had classmates who spent hours on Saturdays/Sundays finishing up dissections. We all did pretty well in anatomy and my ability to explain anatomy to patients is just as strong (I studied a lot at home with an online app Essential Anatomy).

Also, required attendance does not prep you for clinic hours. Real work preps you for clinic hours. I've already worked 70 hour work weeks in other fields. Forcing me to sit in a chair and be a passive, receptive student for 8 hours a day does not correlate at all with the work I will be doing. Many of my classmates were shocked by the "real world" grind when they transitioned from classroom to clinic. It's a very different kind of load, pace and responsibility.

Yes, my school offers extra work with faculty outside of class time. Because of my schedule, I chose to do work that I did completely from home (developing online learning modules, literature review research). Some of my classmates did in person work with faculty but this work is not required, and only represents a small % of the graduating class.

Regarding anatomy, I admit that I'm old-school but your knowledge of anatomy is not just about memorizing lists of things, it is, in part, understanding the three dimensional relationships between structures from different systems. i.e. nerves, muscles, bones, vessels, fascial planes etc . . . I just don't think you get that from a computer program or an app on your phone or a book. you need to stick your whole hand in the cold, clammy, stinky adductor hiatus to appreciate how tight some of the little tunnels and openings can get to fully appreciate the anatomy.

 

[NewTestament]

Regarding anatomy, I admit that I'm old-school but your knowledge of anatomy is not just about memorizing lists of things, it is, in part, understanding the three dimensional relationships between structures from different systems. i.e. nerves, muscles, bones, vessels, fascial planes etc . . . I just don't think you get that from a computer program or an app on your phone or a book. you need to stick your whole hand in the cold, clammy, stinky adductor hiatus to appreciate how tight some of the little tunnels and openings can get to fully appreciate the anatomy.

Maybe for some, but programs like Anatomage create that 3-D experience that you're talking about without the hassle of dissecting an actual cadaver. I don't feel like I am a better PT because I saw a cadaver several years ago. A cadaver requires you to put on gloves, put up with the obnoxious stent, and spent hours dissecting the thing just to see the parts. You can use an online program anywhere, you don't need to wear gloves, and you can add or remove the labels to challenge yourself. With a cadaver, you're never quite sure what you're talking about.

 

[Grizzlyman]

Baylor has had a shortened law school that targets non trads for over 20 years. They have experience in building programss for non trads.

I am a huge fan of online courses. I took all my math courses this way in undergrad. I found it much easier to just dive in and learn vs listening to a teacher. I love the idea of using professors for labs and break but learning information on my own time.

 

[truthseeker]

Maybe for some, but programs like Anatomage create that 3-D experience that you're talking about without the hassle of dissecting an actual cadaver. I don't feel like I am a better PT because I saw a cadaver several years ago. A cadaver requires you to put on gloves, put up with the obnoxious stent, and spent hours dissecting the thing just to see the parts. You can use an online program anywhere, you don't need to wear gloves, and you can add or remove the labels to challenge yourself. With a cadaver, you're never quite sure what you're talking about.

I guess we will have to agree to disagree.

 

[DesertPT]

Having just attended a 3 day intense workshop, I would also argue I learned WAY MORE from that 3 day course than my sporadic musculoskeletal labs spread out over a semester.

Like many people I thought that covering a semester's-worth of information in 3-4 days rather than spreading it out thin over the course of entire semester would make it harder to learn/retain, but after having experienced both I realized that the high-intensity seminar format works just fine. I think having an excellent teacher (ie actually has talent for teaching) that really is an expert in the subject matter is critical when you are covering information at a fast pace for a long duration of time. At the end of the day if the total number of hours of instruction are the same, I think the all-day format can actually be pretty effective.

 

[DesertPT]

And when I first heard of South College's model as a pre-PT I was definitely disturbed. I still am not a supporter of for-profit PT schools popping up as that is what signaled the demise of the pharmacy job market and others, and history will definitely repeat itself with PT. However, after sitting through endless hours of having slides read to me in a traditional lecture format, their condensed/online-hybrid format really isn't looking too bad. I absolutely scoffed at the idea of an online PT school a couple of years ago, but honestly at least a third of my DPT curriculum could have been delivered to me from the comfort of my sofa and I would have been no worse off for it.

I don't necessarily think all non-lab classes should be online. Many of our lecture classes had intermittent hands-on activities sprinkled throughout the lecture which does help apply what you are learning. But for classes that are straight-up here's the slides, memorize and regurgitate, just throw it all up on Youtube and let's get 'er done.

 

[DesertPT]

I'm not as concerned about these hybrid programs for several reasons:

-Most of the skills you will learn will be on the job. I've learned far more in the two years since graduation than I did in PT school. I don't use most of the "hands-on" skills I learned in school. Great students don't necessarily translate to great clinicians.
-If these hybrid programs are attracting non-trad students, you will not see a decline in the quality of PT's.
-Is there any correlation between cost/quality of PT school and quality of clinician? If students from hybrid programs continue to educate themselves and learn new skills, then the school where they earned their degree is irrelevant.

Ding ding ding. My opinion on all of the above has definitely shifted to exactly what is listed here now that I've actually experienced most of PT school and talked to a lot more clinicians. Finding a job you can learn in and a source of mentorship as a practicing new grad will make a lot bigger difference in what kind of clinician you become than what instruction format your 1st year pathophys class was in.

I will admit I am actually one of those people who actually learns a lot by listening to lectures, and most of the online classes I took in undergrad were lame lame lame. But that's because the level of rigor was low. If the level of rigor is the same for a DPT class, doesn't make much difference if you sit through in person or via webcam. I think both options should be available. With the technology we have so conveniently available now there really is not a good excuse for them not to be. And for people who don't learn by listening to someone talk, the traditional lecture format really sucks and we could do a lot better job providing options to accommodate different preferences, especially considering how much we are paying for all this.

 

[DesertPT]

Also, required attendance does not prep you for clinic hours. Real work preps you for clinic hours.

DING DING DING DING DING!!!

Any idiot can sit in a chair alternating between listening and playing Game of War on their iPad while someone stands at the front and reads slides for 4 hours with regularly scheduled potty breaks every 50 minutes.

Managing to sit through your lectures has no correlation with being a good worker.

 

[NewTestament]

And when I first heard of South College's model as a pre-PT I was definitely disturbed. I still am not a supporter of for-profit PT schools popping up as that is what signaled the demise of the pharmacy job market and others, and history will definitely repeat itself with PT. However, after sitting through endless hours of having slides read to me in a traditional lecture format, their condensed/online-hybrid format really isn't looking too bad. I absolutely scoffed at the idea of an online PT school a couple of years ago, but honestly at least a third of my DPT curriculum could have been delivered to me from the comfort of my sofa and I would have been no worse off for it.

I don't necessarily think all non-lab classes should be online. Many of our lecture classes had intermittent hands-on activities sprinkled throughout the lecture which does help apply what you are learning. But for classes that are straight-up here's the slides, memorize and regurgitate, just throw it all up on Youtube and let's get 'er done.

Ger 'r done? Are you from Texas now?

One third of the DPT curriculum? At least one third. I remember sitting through so many lectures while reading my notes, or reading something else (message forums, economics, history, biographies, blogs). I learned everything I needed on my own, and learned a few interesting facts. I didn't pay attention because I knew the retention rate was so low. I could go online and watch old videos of the same lecture. Why did the professor have to give the same lecture every year? Recorded webinars are not recorded once a year. They're recorded once and they're downloaded thousands of times.

Maybe I'm just being a millennial and I have too much faith in the internet, but I think schools are still stuck in 1980, and not in 2017, when so much of the content could be delivered remotely. Lectures are boring and old-school with low retention rates. Some skills need to be taught in person (manual therapy, transfer skills, etc.) but many skills don't (manual muscle tests, ther ex, etc.). And the skills that could be taught can be taught in 1-2 days. I still can't believe how much time we spent practicing MMT's that we would never use (have you ever tested the flexor pollicus longus?)

Yes it helps to have hands-on activities "sprinkled" throughout the lectures, as you say, but it comes at a cost. Being present can cost money: housing, transportation, time off, lost income, study time, etc. Everything is a trade off. For more and more people, leaving the work force for three years to sit in classes that could be delivered remotely is not a good trade off.

 

[starrsgirl]

Ger 'r done? Are you from Texas now?

One third of the DPT curriculum? At least one third. I remember sitting through so many lectures while reading my notes, or reading something else (message forums, economics, history, biographies, blogs). I learned everything I needed on my own, and learned a few interesting facts. I didn't pay attention because I knew the retention rate was so low. I could go online and watch old videos of the same lecture. Why did the professor have to give the same lecture every year? Recorded webinars are not recorded once a year. They're recorded once and they're downloaded thousands of times.

Maybe I'm just being a millennial and I have too much faith in the internet, but I think schools are still stuck in 1980, and not in 2017, when so much of the content could be delivered remotely. Lectures are boring and old-school with low retention rates. Some skills need to be taught in person (manual therapy, transfer skills, etc.) but many skills don't (manual muscle tests, ther ex, etc.). And the skills that could be taught can be taught in 1-2 days. I still can't believe how much time we spent practicing MMT's that we would never use (have you ever tested the flexor pollicus longus?)

Yes it helps to have hands-on activities "sprinkled" throughout the lectures, as you say, but it comes at a cost. Being present can cost money: housing, transportation, time off, lost income, study time, etc. Everything is a trade off. For more and more people, leaving the work force for three years to sit in classes that could be delivered remotely is not a good trade off.

Well said!!! Don't accept the way things are done just because it's the way things have always been done in the PT community. Especially with rising tuition costs/mediocre pay, we have to look for other reasonable options. Making PT school more flexible and efficient allows students to help offset tuition costs by working, or being out of the workforce for less time.

 

[DesertPT]

Ger 'r done? Are you from Texas now?

One third of the DPT curriculum? At least one third. I remember sitting through so many lectures while reading my notes, or reading something else (message forums, economics, history, biographies, blogs). I learned everything I needed on my own, and learned a few interesting facts. I didn't pay attention because I knew the retention rate was so low. I could go online and watch old videos of the same lecture. Why did the professor have to give the same lecture every year? Recorded webinars are not recorded once a year. They're recorded once and they're downloaded thousands of times.

Maybe I'm just being a millennial and I have too much faith in the internet, but I think schools are still stuck in 1980, and not in 2017, when so much of the content could be delivered remotely. Lectures are boring and old-school with low retention rates. Some skills need to be taught in person (manual therapy, transfer skills, etc.) but many skills don't (manual muscle tests, ther ex, etc.). And the skills that could be taught can be taught in 1-2 days. I still can't believe how much time we spent practicing MMT's that we would never use (have you ever tested the flexor pollicus longus?)

Yes it helps to have hands-on activities "sprinkled" throughout the lectures, as you say, but it comes at a cost. Being present can cost money: housing, transportation, time off, lost income, study time, etc. Everything is a trade off. For more and more people, leaving the work force for three years to sit in classes that could be delivered remotely is not a good trade off.

Excellent argument. As I mentioned above, I actually do try to pay attention in lecture (most of the time anyway) as I do tend to remember more of what I hear than most people (though still probably less than 10%). I must admit, though, if attendance had not been mandatory at my school, I likely would have skipped more lectures than I attended as I can get through them in at least 30% less time in video format by speeding up the video, pausing and rewinding as needed and skipping redundant sections or slides that are being read word for word. The only advantage of mandatory attendance for me was to prevent me from procrastinating and letting material pile up, which I know I would do if I weren't forced to attend. For those that are not procrastinators and/or are more self-driven to study than me, and for those who prefer to ignore lecture completely and study handouts etc on their own, which is common, traditional lectures really suck.

The format I am most in favor of is one where traditional class/lecture is held but attendance is not mandatory, the lecture including both audio and on-screen slides with annotations is captured by a "smart podium" (which most classrooms have now) and uploaded to Blackboard or the like, and everything that is going to be potentially testable is also provided in handout format including course notes/slides and reading material as needed. Supplementary/FYI resources are provided/suggested for those who need clarification on something or want to delve deeper, and the teacher is available in person or by email consistently for questions. I had a couple of classes in undergrad like this (rare birds indeed) and they were fantastic. Audiovisual, written and verbal resources are all provided and everyone can pick and choose to use some, all or none of the above as they see fit to learn the material as they please. With the convenience level we have with technology today, there is really no excuse to not offer classes in a more flexible format with all these options available.

If the standard is the same for everyone (passing the test), and you as a teacher have written a test that adequately/validly measures whether a student has learned enough to meet the course objectives, why should you care what format they learned it in? What is being gained by making people who don't want to be there sit in a chair all day if the standard as established by your measurement methods is the same? Learning does not occur in the absence of salience, and salience is minimal when someone has no desire to be there.

It's not like a job where attendance is required because you are being paid to be there. The opposite is true, and the notion that students are paying to be there and so they should physically be there is fallacious. Students are paying for the degree and for the provision by faculty of resources, information and assessment methods needed to gain and document the knowledge one is supposed to have after receiving that degree.

If I were king of the world the above format for lecture would be combined with all day in-person lab courses held maybe 3 days a month that taught all necessary lab material in a time efficient manner. The rest of each week is left open to allow students to study at their own pace, attend lectures as they choose, get together with classmates to practice techniques, etc. We are supposed to be professional students who have already demonstrated the ability to complete a college degree and who should be autonomous providers at graduation, but we are essentially herded around exactly the same way we were in high school.

As to your other comment, I also have wondered, "should learning goniometric techniques that PTs eyeball 90% of the time and the intricate details of manual muscle testing systems that were developed in the 50's and have since been shown to have minimal reliability and validity really require 45 hours of lab time?"

And no, I only wish I was cool enough to say I'm from Texas... Also, pardon the long post, turned into a bit of a rant on me.

 

[NewTestament]

The format I am most in favor of is one where traditional class/lecture is held but attendance is not mandatory, the lecture including both audio and on-screen slides with annotations is captured by a "smart podium" (which most classrooms have now) and uploaded to Blackboard or the like

.

This is one example. The technology is there, and has long been there, to deliver the same information online. Lectures are old-school, archaic, and ineffective. The professor has better things to do (research, treat patients) than to give the same lecture every semester.

What is being gained by making people who don't want to be there sit in a chair all day if the standard as established by your measurement methods is the same? Learning does not occur in the absence of salience, and salience is minimal when someone has no desire to be there....We are supposed to be professional students who have already demonstrated the ability to complete a college degree and who should be autonomous providers at graduation, but we are essentially herded around exactly the same way we were in high school.

Exactly. I always resented the fact that we had to be somewhere at a particular time just like we were in high school. Sitting in class might be detrimental for some students. It was for me. I could have used that time to memorize material. Sometimes the professor added material to the notes, but not always. And why didn't the professor say everything he needed to say in an online webinar that everyone could watch at his own convenience?

As to your other comment, I also have wondered, "should learning goniometric techniques that PTs eyeball 90% of the time and the intricate details of manual muscle testing systems that were developed in the 50's and have since been shown to have minimal reliability and validity really require 45 hours of lab time?"

I haven't used a fraction of the MMT's I learned and unless I have a patient with a TKA or TSA, I hardly ever use the goniometer. If I do use it, I don't do as exactly as we are taught in skills.

 

[DesertPT]

.

This is one example. The technology is there, and has long been there, to deliver the same information online. Lectures are old-school, archaic, and ineffective. The professor has better things to do (research, treat patients) than to give the same lecture every semester.

Good point. There are students who do better with in-person though, which is why I like the idea of a multi-option format. If webinar only lowered tuition costs notably though, I would say the pros outweigh the cons and let's scrap in-person all together.

 

[jadedphysiotherapist]

.

This is one example. The technology is there, and has long been there, to deliver the same information online. Lectures are old-school, archaic, and ineffective. The professor has better things to do (research, treat patients) than to give the same lecture every semester.



Exactly. I always resented the fact that we had to be somewhere at a particular time just like we were in high school. Sitting in class might be detrimental for some students. It was for me. I could have used that time to memorize material. Sometimes the professor added material to the notes, but not always. And why didn't the professor say everything he needed to say in an online webinar that everyone could watch at his own convenience?



I haven't used a fraction of the MMT's I learned and unless I have a patient with a TKA or TSA, I hardly ever use the goniometer. If I do use it, I don't do as exact as we are taught in skills.

Wut

 

[DesertPT]

Wut

Don't be like @NewTestament. Remember those finite details you spent all those hours cramming the weekend before a practical. Know that it will be crucial when you are in clinic for you to remember exactly how your instructor expected you to use a goni to measure subtalar eversion PROM and double inclinometers to get an isolated measurement of thoracic flexion AROM. Also make sure you don't forget how to differentiate weakness of the peroneus tertius from the peroneus brevis, screw that one up and it's game over for your ankle sprain pt. I often reference my notes to remember the exact alignment landmarks of a medium-size goni for measuring ROM of forearm supination as precisely as possible, I'm sure you'll do the same, since knowing whether your pt is lacking 12 degrees vs 16 degrees of supination AROM makes a big difference in the interventions that should be selected, as I'm sure you are aware. Lastly, take some time to consider whether you will use Daniel's & Worthingham's method or Kendall's method when differentiating between a 2+ vs 3- serratus anterior, I found that my outcomes for both ortho and neuro populations improved dramatically when I re-evaluated my method on this one.

I could go on and on but I think you get the point...

 

[jadedphysiotherapist]

Don't be like @NewTestament. Remember those finite details you spent all those hours cramming the weekend before a practical. Know that it will be crucial when you are in clinic for you to remember exactly how your instructor expected you to use a goni to measure subtalar eversion PROM and double inclinometers to get an isolated measurement of thoracic flexion AROM. Also make sure you don't forget how to differentiate weakness of the peroneus tertius from the peroneus brevis, screw that one up and it's game over for your ankle sprain pt. I often reference my notes to remember the exact alignment landmarks of a medium-size goni for measuring ROM of forearm supination as precisely as possible, I'm sure you'll do the same, since knowing whether your pt is lacking 12 degrees vs 16 degrees of supination AROM makes a big difference in the interventions that should be selected, as I'm sure you are aware. Lastly, take some time to consider whether you will use Daniel's & Worthingham's method or Kendall's method when differentiating between a 2+ vs 3- serratus anterior, I found that my outcomes for both ortho and neuro populations improved dramatically when I re-evaluated my method on this one.

I could go on and on but I think you get the point...

K. Taking detailed goni and MMT measurements is actually important although adherence directly to the specificity for school isn't.

The academic side of things is to maintain a gold standard knowledge base. Yes, there are a lot of problems, but medical students also could care less about the fourth part of the Krebs cycle when practicing in the ER. A pharmacist could care less about the exact millimeter titration in the CICU when they are in retail.

PhDs don't use many of the fine details learned in their graduate school coursework when in their research field.

Academics do influence practice patterns and thought processes though. It took me a very long time to understand subtle gait deviations that can affect a runner and make them stop their activity, but with a running analysis and an app to slow it down I could now decently focus on form correction until repetition and motor learning kicked in again.

Double inclinometers actually aren't bad or that difficult to use by the way. Ill agree with a lot of your other comments

 

[jadedphysiotherapist]

....also if a patient is lacking supination or pronation then that can affect their work. IP ROM is very detailed but if you don't want to have your patient develop arthritic changes later on, it may be better to not remain in a ROM that has bone on bone.

.....also weakness in peroneus longus and brevis could be much indicative of a peripheral nerve injury lateral and more superior to peroneus tertius.

I get your annoyance at a lot of the details particularly with the 2+ and 3- LOL...........but another part of me feels that your clinicals might suck currently.

Just be aware that if you aren't docking measurements....you don't get paid....and if your CIs round up on everything....well, that can lead to an audit

 

[NewTestament]

I foresee a day when all lectures are recorded live. Students could watch the lectures in person or online, but would have the choice. Students who watched online could see and hear the professor and the slides. All students could ask questions anonymously with instant messaging and watch the lectures later. Why can't they do this now?

Fine details could be important in some cases but usually not in most cases, and they're certainly not worth mastering at the expense of more critical skills. What's more important is your subjective evaluation, the questions you ask, the alliance you build with the patient, and interpreting the data. You can collect too much data. Critical thinking trumps objective measurements any day of the week.

 

[DesertPT]

....also if a patient is lacking supination or pronation then that can affect their work. IP ROM is very detailed but if you don't want to have your patient develop arthritic changes later on, it may be better to not remain in a ROM that has bone on bone.

.....also weakness in peroneus longus and brevis could be much indicative of a peripheral nerve injury lateral and more superior to peroneus tertius.

I get your annoyance at a lot of the details particularly with the 2+ and 3- LOL...........but another part of me feels that your clinicals might suck currently.

Just be aware that if you aren't docking measurements....you don't get paid....and if your CIs round up on everything....well, that can lead to an audit

No good sarcasm goes unpunished here on SDN I see...

 

[ptisfun2]

.

This is one example. The technology is there, and has long been there, to deliver the same information online. Lectures are old-school, archaic, and ineffective. The professor has better things to do (research, treat patients) than to give the same lecture every semester.



Exactly. I always resented the fact that we had to be somewhere at a particular time just like we were in high school. Sitting in class might be detrimental for some students. It was for me. I could have used that time to memorize material. Sometimes the professor added material to the notes, but not always. And why didn't the professor say everything he needed to say in an online webinar that everyone could watch at his own convenience?



I haven't used a fraction of the MMT's I learned and unless I have a patient with a TKA or TSA, I hardly ever use the goniometer. If I do use it, I don't do as exactly as we are taught in skills.

I do not disagree with most of what has been posted in this thread, and have been asking my colleagues to think about exploring a hybrid option, but to offer a few comments from the other side of things.
1. Most of the faculty in a PT program have been PTs for several years or decades. Students have been PTs for 0 days. I think there is a bit of faith students that that faculty actually know what they are doing, and have done this before you got to school, and will continue after you leave.
2. Attendance policies are typically University policies. Faculty are supposed to follow University policy. Much like faculty have no say in tuition, faculty have no say on University policy. Just like any employee, we follow the rules that are part of our condition of employment.
3. On this point I will speak for myself. I was hired to teach some content, get extramural funding to support my salary, and publish 5 - 6 papers per year. Teaching is less than 50% of my job, and each faculty member at my University has a specific allocation toward teaching, research, and service. I am certainly not opposed to learning new things, and like to think I am a bit smarter than the average 40 year old. I found PT school pretty easy and stress-free, PhD was stressful, and challenging at times, but able to work through it. Trying to become an effective teacher is the HARDEST thing I have learned. If you see why I was hired, I was not hired for teaching acumen or expertise....I hadn't taught at all when I was hired as a faculty member. Now I attend faculty development workshops (like an inservice you may have attended on a rotation), read when I can about teaching, and try to talk with colleagues with PhD in education for best practices, but when you are a PT, think about to how efficiently and quickly you are able to take information you get from a colleague or an inservice and consistently and effectively you apply it to your patient population. It requires practice, time, and a stepped and measured approach, which is often tough to do with other work demands.
4. As any faculty member will tell you, 1 student doesn't think practicing each MMT is necessary, 1 student thinks there should be a lot more practice, 1 student thinks there should be a little more practice, 1 student thinks there should be videos to show technique, 1 student wants to watch the instructor with close up cameras, 1 students thinks because they were a tech they already know how to 'do PT' and can just estimate strength with MMT...I hope you get my point. However many students are in your class...that is how many opinions there are. The faculty has to figure out how to meet CAPTE standards, protect the public, not piss off a clinical instructor, give a good education, etc.

Sorry for the long post. This thread obviously hit a nerve

 

[jesspt]

Taking detailed goni and MMT measurements is actually important although adherence directly to the specificity for school isn't.

Why?

It took me a very long time to understand subtle gait deviations that can affect a runner and make them stop their activity, but with a running analysis and an app to slow it down I could now decently focus on form correction until repetition and motor learning kicked in again.

Data please - does implementing treatment based on findings from a running analysis result in better outcomes that not using the slow mo analysis?

 

[jadedphysiotherapist]

Why?



Data please - does implementing treatment based on findings from a running analysis result in better outcomes that not using the slow mo analysis?

You don't think MMT and Goni values should be recorded?.......

Second point was to say that the specificity of anatomy help me perceive movement dysfunction better. Don't worry about what a preference is for running biomechanics

 

[jesspt]

You don't think MMT and Goni values should be recorded?.......

Second point was to say that the specificity of anatomy help me perceive movement dysfunction better. Don't worry about what a preference is for running biomechanics

Didn't say they shouldn't be recorded. Not sure they need to be particularly precise.

What is movement dysfunction? How do you define it, given there is so much variability in how we choose to move/perform different tasks?

 

[truthseeker]

SOOO off topic but I really appreciated the tongue in cheek-ness of DesertPTs post.

I look at it this way. We evaluate someone and if something is " kinda funny lookin' " we investigate further. (reference to the movie FARGO when the sheriff is interviewing the two barflys that had a roll in the hay with the bad guys. " cudga describe the second guy?" "he was kinda funny lookin' " referring to the Steve Buschemi character)
Measuring things reliably is important to define deficiencies and I don't think anyone here really can argue that, but 14 deg. is not really different than 16 deg. But 120 is very different than 155.

 

[NewTestament]

Didn't say they shouldn't be recorded. Not sure they need to be particularly precise.

What is movement dysfunction? How do you define it, given there is so much variability in how we choose to move/perform different tasks?

Don't you think that's a big limiter of "movement analysis"? That's one criticism I have of SFMA/FMS. If you look hard enough you can find something wrong with anyone. If it's not causing pain or discomfort, don't touch it. At least that's my philosophy.

 

[jesspt]

Don't you think that's a big limiter of "movement analysis"? That's one criticism I have of SFMA/FMS. If you look hard enough you can find something wrong with anyone. If it's not causing pain or discomfort, don't touch it. At least that's my philosophy.

Yes. Look at how many "movement dysfunctions" you see in CE courses in a totally asymptomatic population.

All of my patients have a "movement dysfunction" likely because they all have pain.

 

[DesertPT]

Sorry I got this thread on a huge tangent. Back on topic.

I do not disagree with most of what has been posted in this thread, and have been asking my colleagues to think about exploring a hybrid option, but to offer a few comments from the other side of things.
1. Most of the faculty in a PT program have been PTs for several years or decades. Students have been PTs for 0 days. I think there is a bit of faith students that that faculty actually know what they are doing, and have done this before you got to school, and will continue after you leave.
2. Attendance policies are typically University policies. Faculty are supposed to follow University policy. Much like faculty have no say in tuition, faculty have no say on University policy. Just like any employee, we follow the rules that are part of our condition of employment.
3. On this point I will speak for myself. I was hired to teach some content, get extramural funding to support my salary, and publish 5 - 6 papers per year. Teaching is less than 50% of my job, and each faculty member at my University has a specific allocation toward teaching, research, and service. I am certainly not opposed to learning new things, and like to think I am a bit smarter than the average 40 year old. I found PT school pretty easy and stress-free, PhD was stressful, and challenging at times, but able to work through it. Trying to become an effective teacher is the HARDEST thing I have learned. If you see why I was hired, I was not hired for teaching acumen or expertise....I hadn't taught at all when I was hired as a faculty member. Now I attend faculty development workshops (like an inservice you may have attended on a rotation), read when I can about teaching, and try to talk with colleagues with PhD in education for best practices, but when you are a PT, think about to how efficiently and quickly you are able to take information you get from a colleague or an inservice and consistently and effectively you apply it to your patient population. It requires practice, time, and a stepped and measured approach, which is often tough to do with other work demands.
4. As any faculty member will tell you, 1 student doesn't think practicing each MMT is necessary, 1 student thinks there should be a lot more practice, 1 student thinks there should be a little more practice, 1 student thinks there should be videos to show technique, 1 student wants to watch the instructor with close up cameras, 1 students thinks because they were a tech they already know how to 'do PT' and can just estimate strength with MMT...I hope you get my point. However many students are in your class...that is how many opinions there are. The faculty has to figure out how to meet CAPTE standards, protect the public, not piss off a clinical instructor, give a good education, etc.

Sorry for the long post. This thread obviously hit a nerve

Awesome points, especially number 4. To some extent I think your point also speaks to what I was saying about course being created that have as many formats of instruction available as possible to meet as many student preferences as possible. As to the actual specific content of the course, you're right that it's probably impossible to fully please more than a small minority in any given case.

The point you raise about faculty not having any formal training in teaching is a pervasive problem throughout higher education. Once you get beyond the community college level, possessing actual experience in and talent for teaching is often not a job requirement, and almost never is at the graduate level. I have sat through many painful courses led by inexperienced instructors, and don't think I got what I was paying for in those classes. I have no doubt that the course was equally painful for the instructor if not more so, and I have no doubt that many of those instructors improved dramatically as time has gone by, although I think some people just possess inherent talent for teaching that others do not. Anyway, this is not a problem specific to PT school and not the topic of this thread, but I'm glad you brought it up.

Other than lab courses, the majority of undergraduate courses at all three institutions I have attended (all public if that matters) have not had compulsory attendance. Some had points associated with attendance, but typically it was (at least theoretically) possible to pass without attending. Is it common for universities to have a policy that attendance at graduate courses is mandatory but undergraduate instructors can do what they want?

 

[jadedphysiotherapist]

Didn't say they shouldn't be recorded. Not sure they need to be particularly precise.

What is movement dysfunction? How do you define it, given there is so much variability in how we choose to move/perform different tasks?

I like precision...maybe that's me.

As a servicer, what are you doing to make a living? Increasing/Decreasing functional impairments (strength, breathing capacity, endurance, flexibility, elasticity, symmetry, coordination, proprioception, responsiveness, adaptation to stimuli). If a disease process or an injury is contributing to an impairment that is not creating a 3 dimensional movement pattern resembling a baseline prior to the disease due to pathology in the neuroendocrine, neurological, integumentary, musculoskeletal/ortho, neuromuscular, or sensory systems, then it is movement dysfunction.

The grey area is what about patients doing activities in a way that can lead to degenerative changes or puts them at risk for injury? That's what's hard. The use of predictive factors as well as risk and relative risk or odds ratios can help with clinical decision making though

Yes. Look at how many "movement dysfunctions" you see in CE courses in a totally asymptomatic population.

All of my patients have a "movement dysfunction" likely because they all have pain.

So CE courses can be trash tho depending on your beliefs and practice patterns.

Is the pain leading to compensation or asymmetry that didn't exist prior to the pain?

If not then they don't have movement dysfunction.....but it's possible that therapy will decrease their symptoms due to the unpleasant stimulus at which point using oswestrys etc. is a good measurement

Sorry I got this thread on a huge tangent. Back on topic.



Awesome points, especially number 4. To some extent I think your point also speaks to what I was saying about course being created that have as many formats of instruction available as possible to meet as many student preferences as possible. As to the actual specific content of the course, you're right that it's probably impossible to fully please more than a small minority in any given case.

The point you raise about faculty not having any formal training in teaching is a pervasive problem throughout higher education. Once you get beyond the community college level, possessing actual experience in and talent for teaching is often not a job requirement, and almost never is at the graduate level. I have sat through many painful courses led by inexperienced instructors, and don't think I got what I was paying for in those classes. I have no doubt that the course was equally painful for the instructor if not more so, and I have no doubt that many of those instructors improved dramatically as time has gone by, although I think some people just possess inherent talent for teaching that others do not. Anyway, this is not a problem specific to PT school and not the topic of this thread, but I'm glad you brought it up.

Other than lab courses, the majority of undergraduate courses at all three institutions I have attended (all public if that matters) have not had compulsory attendance. Some had points associated with attendance, but typically it was (at least theoretically) possible to pass without attending. Is it common for universities to have a policy that attendance at graduate courses is mandatory but undergraduate instructors can do what they want?

From my experience graduate is usually required while undergrad may not be. You may also find that graduate classes also have people that care significantly more about their coursework and field more

 

[truthseeker]

there are million ways to swing a golf club. Some are better. Jim furyk has a funky swing, but he does it the same every time. there are ways to make golfers more consistent. Its the same thing for lifting, running, throwing, sitting etc . . . if a patient comes in and has some sort of problem, I try to help them be more consistent.

Our bodies like the middle, baby bear, moderation. we need to be able to go the edges of the middle and return to the middle. If we live at the edge of the middle (near momma or papa bear) we are more likely to develop itis's or pains for whatever reason. Same concept as the directional preferences with back pain. If they prefer to sit, teach them flexion, if they prefer to stand, teach them extension, if they prefer to walk, get them moving. its not rocket science. I get that there are lots of other factors (biopsychosocial) that influence pain but biomechanically if we can help get people toward the middle of the baby bear zone, nociception will decrease, we can deconstruct the pain neurotags and help people restore their lives.

 

[jesspt]

Is the pain leading to compensation or asymmetry that didn't exist prior to the pain?

That's my point. How will I ever know this? My patients come to me after onset of symptoms. I don't know what they were like prior to onset of pain.

 

[jadedphysiotherapist]

That's my point. How will I ever know this? My patients come to me after onset of symptoms. I don't know what they were like prior to onset of pain.

You ask them prior level of function questions and go with clinical reasoning

 

[truthseeker]

You ask them prior level of function questions and go with clinical reasoning

forgive me but I think what JessPT is saying is if we are talking about measuring asymmetry and wondering if it came first and caused symptoms or came as a response to symptoms we cannot know if we didn't see them before they had symptoms. they may well have functioned very well with asymmetry and they might not necessarily have known that they were asymmetrical. the point being that it is a chicken and egg paradox

 

[jesspt]

forgive me but I think what JessPT is saying is if we are talking about measuring asymmetry and wondering if it came first and caused symptoms or came as a response to symptoms we cannot know if we didn't see them before they had symptoms. they may well have functioned very well with asymmetry and they might not necessarily have known that they were asymmetrical. the point being that it is a chicken and egg paradox

This.

And getting bogged down in the unknowable is not helpful for the clinician and probably worse for the patient.

 

[jesspt]

SOOO off topic but I really appreciated the tongue in cheek-ness of DesertPTs post.

I look at it this way. We evaluate someone and if something is " kinda funny lookin' " we investigate further. (reference to the movie FARGO when the sheriff is interviewing the two barflys that had a roll in the hay with the bad guys. " cudga describe the second guy?" "he was kinda funny lookin' " referring to the Steve Buschemi character)
Measuring things reliably is important to define deficiencies and I don't think anyone here really can argue that, but 14 deg. is not really different than 16 deg. But 120 is very different than 155.

[Marge bends over next to the overturned car, as if she's looking at something on the ground]

Lou: You alright there, Margie?

Marge Gunderson: Oh, I just think I'm gonna barf...

Marge Gunderson: [standing up again after a moment] ... Well, that passed. Now I'm hungry again.

 

[jadedphysiotherapist]

forgive me but I think what JessPT is saying is if we are talking about measuring asymmetry and wondering if it came first and caused symptoms or came as a response to symptoms we cannot know if we didn't see them before they had symptoms. they may well have functioned very well with asymmetry and they might not necessarily have known that they were asymmetrical. the point being that it is a chicken and egg paradox

I get what you're saying but that's also why you give outcome measures and ask about the onset of the complaint. If therapy can work in your opinion then go for it. If after a period of time there aren't outcome score or subjective report differences then your service isn't best so cut the rope.

If a psychologist is trying to work with someone that struggles with emotional instability and doesn't get subjective reports of something getting better, then maybe their service isn't working. It follows similarly

 

[truthseeker]

I get what you're saying but that's also why you give outcome measures and ask about the onset of the complaint. If therapy can work in your opinion then go for it. If after a period of time there aren't outcome score or subjective report differences then your service isn't best so cut the rope.

If a psychologist is trying to work with someone that struggles with emotional instability and doesn't get subjective reports of something getting better, then maybe their service isn't working. It follows similarly

No argument with that at all. I'm not sure that was the point though. The point is that nobody is symmetrical yet not everyone has symptoms. Asymmetry does not equal dysfunction. dysfunction does not equal asymmetry. Sometimes all we have that is measurable is the outcome measure that is the patient's perception of their function/pain etc . . .

If you have someone come in and their gastrocs are tight (5 degrees in prone for example) and you teach them stretches and they get to 15 degrees, and their shin splint pain gets better, then you measured the right thing and addressed the right thing. IF they get more flexible and their symptoms don't improve, then it might be their shoes, or their foot structure, or their training habits, or their brain.

Furthermore, some people are super tight everywhere yet we don't see them because they don't have any symptoms because they manage their tightness and function quite well.

this is one of the reasons it is hard to define our profession because there are fewer "if X, then Y" scenarios than we were led to believe in school.

 

[jesspt]

As usual, @truthseeker nailed it.

And now that we've totally high-jacked this thread:

Earlier you stated:

the specificity of anatomy help me perceive movement dysfunction better.

It's my opinion that we cannot know how patients move prior to the onset of their symptoms, because they come to us after they are in pain (in most outpatient settings). If I don't know how they moved previously, I can't say with any reasonable certainty that the "movement dysfunction" I see is a cause, if it is an effect, or if it is neither of those things. "Movement dysfunction" seems to be a total garbage can term that serves to primarily be a buzz word for CEU courses that promote looking for these things. Most of these types of treatment approaches have not validated their particular "system" at all, let alone looked at their reliability.

It took me a very long time to understand subtle gait deviations that can affect a runner and make them stop their activity, but with a running analysis and an app to slow it down I could now decently focus on form correction until repetition and motor learning kicked in again.

90% of the runners I treat have already had one of these assessments and almost all of them are told the same two things: increase your cadence (take smaller steps), and decrease your vertical displacement. I save them the trouble of a running gait analysis (and $200) and tell them to start working on those things from the outset.

I don't find a slow-mo analysis valuable. Perhaps you have data that indicates otherwise.

Patients come to us in pain. Treat that first without labeling these things ("movement dysfunctions") that probably don't really matter that much clinically nad may contribute to a nocebo - "My last therapist told my that one of my hips are rotated, probably because of my bad posture. Does that mean I'm going to get hip arthritis?"

 

[jadedphysiotherapist]

As usual, @truthseeker nailed it.

And now that we've totally high-jacked this thread:

Earlier you stated:



It's my opinion that we cannot know how patients move prior to the onset of their symptoms, because they come to us after they are in pain (in most outpatient settings). If I don't know how they moved previously, I can't say with any reasonable certainty that the "movement dysfunction" I see is a cause, if it is an effect, or if it is neither of those things. "Movement dysfunction" seems to be a total garbage can term that serves to primarily be a buzz word for CEU courses that promote looking for these things. Most of these types of treatment approaches have not validated their particular "system" at all, let alone looked at their reliability.



90% of the runners I treat have already had one of these assessments and almost all of them are told the same two things: increase your cadence (take smaller steps), and decrease your vertical displacement. I save them the trouble of a running gait analysis (and $200) and tell them to start working on those things from the outset.

I don't find a slow-mo analysis valuable. Perhaps you have data that indicates otherwise.

Patients come to us in pain. Treat that first without labeling these things ("movement dysfunctions") that probably don't really matter that much clinically nad may contribute to a nocebo - "My last therapist told my that one of my hips are rotated, probably because of my bad posture. Does that mean I'm going to get hip arthritis?"

Slow motion is excellent for neuromotor following neurological injury. Use auditory cues and show the patient how they are moving so they can think about foot placement as they do it.

Sports running from ortho pain or msk injury is different rehab compared to a neuromotor approach and relearning progression