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Kyndall
Boyle
Assistant Professor - Physical Therapy
Education
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Cynthia
Lewis
Assistant Professor - Physical Therapy
Education
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Susan
Chinworth
Associate Professor - Physical Therapy
Education
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Kyndall Boyle, Cynthia Lewis, Susan Chinworth
Nationally recognized physical therapist Ron Hruska
presented a 16 contact-hour program entitled, Postural
Restoration Overview (PRO) at Elon University in April 2003.
The program included 1. a framework for examining for
postural asymmetries in the transverse plane and 2.
therapeutic exercise interventions to restore symmetry
utilizing therapeutic exercise (myokinematics). It was
presented to Masters of Physical Therapy (MPT) students,
several local physical therapy clinicians and Department of
Physical Therapy Education faculty. The program was offered
at no charge to clinicians and was one of the courses
available in the electives module for the MPT students. It
prepared learners to participate in a service learning
opportunity on the campus of Elon University also in April.
The service learning opportunity consisted of free
examinations for Elon faculty, students, and staff. Each MPT
student was paired with a DPTE faculty member and/or local
physical therapy clinician for each examination. This way,
students could benefit from the active hands-on engagement of
the physical therapy service as well as the faculty
mentorship. Those that received an examination benefited from
the skilled examination and recommendations given. After the
program and service learning examinations were completed, an
additional one day course was offered for the participants of
the PRO. This included a review of the didactic content and
an opportunity for development of psychomotor skills during a
laboratory session.
The program was assessed in several ways. MPT students and
area clinicians who attended the program were given a survey
at the beginning of the program and another survey upon
completion. The survey included two "real" paper
case study examples: one involving a problem of the upper
half of the body, and another involving a problem of the
lower half of the body. The program participants had to list
what examinations procedures for the given case and
interventions (treatments) they would use.
The overall results of the examination and intervention
procedures chosen for each case were drastically different
from pre-course to post-course. The underlying theme for the
examination of the two case studies was the addition of
procedures chosen to assess for transverse plane position of
the pelvis/femur and trunk/rib cage. The underlying theme for
the intervention of the case studies was a focus on restoring
symmetrical bony position of the pelvis and trunk rather than
a focus on stretching "tight" muscles and
modalities to decrease pain. These results showed a dramatic
change in fundamental clinical management of patients.
The survey also asked the question, "How do you
perceive this information will influence your future practice
in physical therapy?" Several responses follow:
"This course has challenged me to think outside my
previous orthopedic school of thought and to look at the
whole patient more than the single diagnosis."
"I feel like I have a whole new perspective on what I
as a PT have to offer a patient to not only fix localized
pain/problems but to change how their whole body functions in
the environment."
"I will look even closer at asymmetries and
respiration, and I have some new techniques to try to restore
more symmetrical function."
"It has made me rethink about the uniqueness of the
right and left sides of the body as it relates to movement. I
have stopped assuming that both sides are symmetrical. I feel
the evaluation techniques are more logical." "This
information will influence my future practice by allowing me
to perform a more complete evaluation. It has made me aware
of the fact that the site of the patient's pain may not
be the cause of their pain. For example, anterior knee pain
may be coming from the pelvis, not the articulation of the
patella and femur."
"A great way to look differently at examination and
treatment. A great shift."
"I will make a huge attempt to further my education
regarding this subject material. In the clinic, I will
utilize evaluation techniques to fully assess the patients
asymmetries."
"I have been following pelvic techniques for years but
have just been introduced to the diaphragm
influence."
"It will make me look differently at my patients and
think on another plane of thought."
"I will alter my view of the Thomas and Ober's
Tests. Particularly, I may include some of the exercises
presented to activate particular muscle groups which I feel
may better accentuate those fibers more than other
exercises."
"I want to read ALL the great references given in the
course manual. I want to take other courses to get hands-on
experience to integrate my head knowledge. Super, GREAT
instructor and course!"
"I am more apt to assess pelvic and femoral movements
for upper extremity and thoracic problems. I will do an
examination of the trunk rotation, hip internal rotation and
hip adduction, ribs and their movement."
"It has challenged me to use my previous orthopedic
background as a guide to start my examination but to look
further at how the patient functions holistically and how
they breathe."
"Opened up to different paradigm, different way of
thinking. Motivates me to learn more about postural
restoration to be able to apply it successfully in the
clinic."
"This has shifted my treatment paradigm from outside
in. I will become more aware of pelvic/thoracic alignment in
every patient. I won't be as concerned about "the
diagnosis." I will be more open minded about the whole
patient. For example, a knee patient will be treated with
adductor, glut max and hamstring exercises as needed to
straighten alignment instead of doing exercises to stretch
and strengthen tight and weak muscles
respectively."
"As a new grad, I think this course has definitely made
me think more about the interventions I will perform as a
therapist. It will also make me look harder at the underlying
causes to patients problems."
Volunteer participants who received the free physical
therapy examination also completed a survey. On a Likert
scale, 100% of the participants felt they benefited from the
examination. Eighty percent strongly agreed and twenty
percent agreed. One hundred percent stated they had utilized
the information given to them (therapeutic exercise, activity
modification recommendations etc.) from the examination.
Sixty percent strongly agreed, and 40% agreed they were
utilizing the information. Participants were asked if they
would have seen another health care practitioner in they had
not come to the clinic. Sixty percent said yes, and 40% said
no. Those who said no attributed their decision not to see
another practitioner to convenience, money, location and the
quality of chiropractors in the area. Those that said yes,
attributed their decision to see another practitioner to the
need for care if their condition did not get better. One
individual attributed his decision to the anticipated need
for a new prescription of Celebrex and muscle relaxers. He
stated that after doing the exercises given during the
examination, he felt the medications were unnecessary. There
were a myriad of positive written and verbal comments made
about the program. Some examples are listed below.
-----Original Message-----
From: John B Wadsworth (with permission)
Sent: Monday, April 14, 2003 2:58 PM
To: Elizabeth Rogers
Subject: Thanks for the program
Ms. Rogers,
I want to thank you, your faculty, the students, and guest
faculty Ron Hruska for the wonderful time I had at the CE
course this past weekend. You have a great facility, faculty
and students. Having moved here from Iowa and being a past
adjunct faculty at the University of Iowa for years as well
as past associate professor at the University of Kentucky, I
understand the great things you and your faculty are doing at
Elon University. The way the CE courses were run and having
the clinicians, NCAPTA, and Alumni come is, in fact,
implementing what many other programs only dream about. It is
a great way to reward those who are committed to teaching
clinical education. The education, cross education, and
interactions of everyone is priceless.
If I could figure out how to reduce lodging and meals, I
would be willing to support paying Elon a general fee for
overall access of my staff to attend those courses. Maybe It
could even be linked it to having them work on their DPT.
Maybe a proposal of so many dollars per year paid by our
hospital would entitle our department to obtain so many
credits per year for staff active in your transitional
program. Just brainstorming....as I like to do. I do feel
there will be a lot of creative venturing in the future for
us to try and get all our staff to the DPT level. If we could
figure out that model it might be something others would by
into. I am committed working to have our staff ready for the
future. I know there will be some creative pathways
developed. You and your faculty are to be commended for the
creative ways you are designing and implementing educational
programs for our profession.
I will certainly put April on our departmental calendar next
year to assure our staff attend hope that it will be
continued. I do hope other programs are seeing the creative
ways you give back to those who give of their time to
clinical education.
Thanks again to you, your faculty, and presenters for
commitment, innovation, and forward thinking.
John B. Wadsworth, PT, MA
Director of Rehabilitation Services
Spruce Pine Hospital
Spruce Pine, NC 28705
Unsolicited comments on the bottom of the post course
survey.
"Thank you for inviting clinicians in the community to
participate in this program. I found it very
informative."
An MPT student, "The program pulled all our learning
and information together, it really tied everything
together."
A student who was a volunteer subject during the program,
"I was "sore" on my left side afterward, I
slept like a baby that night. It was better than any massage
I have ever had. I want to learn more about it."
