PT Faculty Member Receives Hybrid Learning Grant
Spotlight on Electives: Hand and Upper Extremity Rehabilitation
Narrative Review of PT Approaches To Balance and Gait Training In People With Lower Limb Loss Published By Dr. Christopher Kevin Wong and PT Students
Seven DPT Students Honored As Columbia Commons Scholars
PT Faculty Members Receives Supplemental Grant From MDA For NIH Study
Spotlight on Electives: Current Concepts in Sports Rehabilitation
Spotlight on Electives: Women's Health
Women's Health Research Soars at Columbia PT
Marijuana Use, Suicide, the Opioid Crisis… Dr. Christopher Kevin Wong Presents at Innovations in Translating Injury Research into Effective Prevention
Report from the Field: American Physical Therapy Association 2018 House of Delegates Meeting
Two DPT Students Create Exercise Class for Breast Cancer Patients and Survivors at CUIMC
June 7, 2018: We are pleased to announce that core faculty member Wing Fu, PT, MA, PhD, has been selected as a recipient of a 2018 Hybrid Learning Course Redesign and Delivery Grant for her proposal, “Developing students’ clinical reasoning through a hybrid doctoral course with low-cost patient simulations.”
The grant is funded by the Office of the Provost with the aim of supporting the development of innovative and technology-rich pedagogical strategies as well as improving the learning outcomes at Columbia University in all disciplines.
Dr. Fu applied for the grant to transform the Complex Medical Conditions course to a fully hybrid model in the fall of 2018. The course will adopt an active learning approach and incorporate patient simulations. It will create a structured learning environment to enhance and assess students’ clinical reasoning, a critical attribute of physical therapists in the contemporary healthcare environment. The assessment findings will help provide research evidence towards teaching and learning of clinical reasoning.
In addition to in-kind support from the Columbia Center for Teaching and Learning, Dr. Fu will receive grant funding to cover project expenses, including educational research.
The first patient she treated for an upper extremity injury was in 1973. A Philadelphia police officer was shot at close range in both elbows and suffered nerve and joint injuries. Her second patient lost the back of his hand, also due to gunshot wounds. That was how Sue Michlovitz, PT, PhD, FAPTA, Certified Hand Therapist, became interested in rehabilitation of the hand and upper extremity.
Hand therapists treat a wide range of patient populations and problems that include arthritis, crush injuries and other trauma, complications of diabetes (tendon and nerve issues), and issues that result from spinal cord injuries or stroke. Additionally, Dr. Michlovitz works with musicians and visual artists. She also works with athletes, particularly college athletes. Injuries in athletes range from hand fractures to shoulder dislocations.
Dr. Michlovitz has been teaching the Hand and Upper Extremity Rehabilitation Elective at Columbia since 2008. The 1.5-day course focuses on treatment of patients who have injuries or diseases that result in impairment, functional loss or disability of the hand and upper extremity. Students are required to have successfully completed the Management of Orthopedic Conditions I and II courses, since material covered in those courses as well as anatomy serves as a starting point for class discussion, which includes non-operative and post-operative care of tendon, nerve, bone and joint disorders.
Over the 10 years that Dr. Michlovitz has been teaching the course, it has evolved to keep pace with changes in the practice, such as surgical innovations and post-operative care practices. She uses an online component to post cases and other materials for the students to review prior to class. Additionally, she brings an occupational therapist into the class since they are key in rehabilitation of the hand and upper extremity. (Dr. Michlovitz points out that 85% of hand therapists are occupational therapists; 14% are physical therapists, and 1% are both). There is a lab component, which requires the student to make three different types of splints: for the thumb, wrist and trigger finger.
Hand and upper extremity rehabilitation is a highly collaborative field, as it involves working with surgeons and occupational therapists, and others such as athletic trainers. Dr. Michlovitz would like to see more physical therapists that are knowledgeable about treating the hand and upper extremity. She hopes that her students will be excited about the opportunity to work in this area, and be motivated to seek out further educational opportunities or residencies. She appears to be succeeding. Kyle Zreibe, CUDPT 2019, commented, “This course gave me great perspective on the roles that physical therapists play in treating dysfunctions of the hand. The highlight of this elective was the chance to learn how to make custom-made orthoses for all the different joints in the fingers and wrist. I look forward to continuing to develop these skills while in clinic.” Kayla Coutts, also CUDPT 2019, added, "I learned more about how OTs and PTs can work together in practice."
Outside of teaching, Dr. Michlovitz, who has been named in 2018 as a Catherine Worthingham Fellow of the APTA, goes on medical missions to Guatemala with the non-profit organization Guatemala Healing Hands Foundation. There, they treat children with congenital issues or traumatic injuries. She enjoys collaborating with people from other countries, getting to know different cultures and making new friends.
When she’s not teaching, treating patients, or traveling, Dr. Michlovitz is pursuing an MFA in media arts and photography at Maine Media College, Rockport Maine.
Narrative Review of PT Approaches To Balance and Gait Training In People With Lower Limb Loss Published By Dr. CHristopher Kevin Wong and PT Students
Students from the Columbia University DPT class of 2018, and Dr. Christopher Kevin Wong, PT, PhD, have published a narrative review of physical therapy approaches to balance and gait training in people with lower limb loss. One finding that stands out is the paucity of randomized controlled studies that included more than 40 subjects.
The strongest evidence was for unstable surface balance training and gait training programs that included strength, coordination, and functional training. However, the evidence suggests that a range of methods including manual therapy to the hip and lumbopelvic region, core stabilization exercises, and resisted gait training have positive effects.
In the narrative review, the authors provide clinical suggestions that address all domains of the International Classification of Functioning (ICF) in a logical sequence with the acronym PANACEA: Passive structures, such as joints; Active functions, such as muscle strength; Neuromotor function, such as coordinated movement patterns; Awareness of those motions, so that the person can practice and monitor themselves; Capacity for function, such as the cardiopulmonary capacity for sufficient performance and the cognitive capacity to understand; Environment specific training, so that training can translate to community life; And, Action to be taken by the individual, which involves their motivation and other factors. You may access the article via the link here.
Wong CK, Sheppard JK, Williams KL. Balance and gait training to community-dwelling people with lower limb loss: a narrative review with clinical suggestions. Phys Ther Rvw, 2018;23: Epub April 4, 2018.
Seven DPT students were among those who participated in a special ceremony on Tuesday, May 2 which marked the conclusion of the Columbia Commons Narrative Medicine program.
This program brings together faculty and students from all eight professional CUIMC health schools and departments to learn how to facilitate effective health care teams. This is the seventh year of the campus-wide seminar which originated with a grant from the Macy Foundation and is now supported by the Columbia Commons: Collaboration Across Professions team headed by Rita Charon, MD, PhD. The program aims to develop ways for people from multiple health care disciplines to work together.
The seminar addresses urgent questions about health, illness and care, and presents many different perspectives on these issues. The eleven week-long seminars focus on topics such as aging and the end-of-life; health care justice and care of the underserved; relationships and spaces of care; and spirituality and healthcare. Through small group work, the students develop narrative skills such as close reading, attentive listening and creative writing. In doing so, the participants develop trust in, and respect for, their colleagues. At the conclusion of the seminars, participants are designated “Columbia Commons Scholars. “
We congratulate the following DPT students who are now Columbia Commons Scholars:
Kayla Coutts (DPT II)
Jonathan Grace (DPT I)
Anna Easterling (DPT I)
Frances Jih (DPT II)
Shannon Joyner (DPT III)
Ralph Rodriguez-Torres (DPT I)
Kyle Zreibe (DPT II)
The event featured reflections from many of the participants on their experiences. The commentaries were as diverse as the participants and ranged from traditional reflections to poetry.
Kayla Coutts, CUDPT 2019, commented on her experience. “The seminar 'Relationships and Spaces of Care' allowed me to gain further appreciation for the importance of communication among healthcare professions in order to benefit patients. We all have individual goals, but we need to think about the overall goal for each patient and how we can help them get there. It is not just creating relationships with patients that matters, but creating relationships with our partners is just as needed.”
Learn more about Columbia Commons.
We are pleased to announce that core faculty member Jacqueline Montes, PT, EdD, NCS, has been awarded a supplemental grant for her NIH K01 study, “Oxidative Capacity in SMA (Spinal Muscular Atrophy)”
The grant is funded by the Muscular Dystrophy Association (MDA) with the aim of addressing the issue of recruiting patients who cannot afford travel expenses. The MDA recognizes that travel to clinical trial sites can pose a serious financial burden to those who wish to participate in clinical research. Dr. Montes applied for the grant in order to help alleviate the cost burden of such travel and provide equitable access to the study for all interested SMA and mitochondrial myopathy patients.
The award is for $67,620 and provides a stipend of $1,470 to cover travel expenses for each participant and a caregiver or companion for both study visits. To date, study inquiries largely come from internet resources, such as clinicaltrials.gov, and a good portion of eligible candidates live outside of the greater New York area. For example, several potential participants from California, Florida and Minnesota have expressed great interest.
Providing a patient allowance that facilitates travel from outside our region will make participation feasible for many patients and thus allow the study to meet its target enrollment.
Sports medicine isn’t just for the professional or elite athlete. The global sports medicine market is expected to reach USD 12.5 billion by 2025, according to a report by Grand View Research, Inc.
Additionally, fitness awareness initiatives over the last several years have led to more people participating in sports and fitness activities, making them susceptible to injury.
The Columbia DPT program offers a popular elective that prepares students for this booming area of physical therapy. Adjunct faculty member Rami Said, PT, DPT, MEng has been teaching the course for the past 6 years, with coordination support by core faculty member Jean Timmerberg, PT, PhD, MS. Both Drs. Said and Timmerberg are board certified orthopedic specialists.
The course is designed to give the student in their final year of study an introduction to treating athletes of all levels, from the novice to the elite and professional. Dr. Said bases the course curriculum on the requirements of the APTA’s Sports Section. The focus is on types of movements (e.g., running athlete, overhead athlete, etc.,) and also covers topics such as the female athlete, concussion, and athletic field management. This represents a change from a more sports-specific curriculum because, according to Dr. Said, “there is much overlap in the techniques involved in treating injuries in different sports. The elective mixes all of the tracks.”
Colleen Maguffin, Class of 2018, said, “Dr. Said truly demonstrates his passion for sports while providing information about injury, assessment, and treatment approaches."
Sports has always played a big part in Dr. Said’s life. He was a basketball player in high school and college. As an undergraduate, he was assistant coach at his alma mater, Cooper Union in New York City. He continues to be involved in the sport and is now head coach of Cooper Union’s women's basketball team. “Basketball was my release from stress,” he points out.
Dr. Said evolved the sports elective from a lecture/presentation-based class that spanned a single weekend. It is now a 12-week course encompassing lectures, presentations, and labs. Dr. Said brings in experts to address the students. He noticed that they “paid attention” to guest lecturers such as other PTs, doctors, and faculty members with specific areas of expertise. He combines student presentations with “active learning.” That is, the students participate in discussion of a given topic, and a subsequent lab in which they get hands-on practice of the material being discussed. This year, students had the opportunity to present, in groups, on a sport of their choosing.
What Dr. Said hopes that students will take away from the elective is the confidence to treat athletes of any level, and having had a grounding in general orthopedic principles in sports PT, they will be motivated to look further into more specific areas. He also notes that students with specialized experience such as the sports elective have “a big plus” when applying for competitive fellowships or residencies. Current and former students agree.
Julia Rosenthal, DPT Class of 2017, is currently a physical therapy resident at the Harkness Center for Dance Injuries in New York City. “I see high level performers every day,” she said. “Taking the sports elective gave me foundational tools to understand the biomechanics of various high level tasks, overuse injuries, and other critical aspects of athlete management such as bone health and nutrition.”
“As a current sports resident at Vanderbilt Orthopedic Institute and Belmont University, Nashville, TN, I think the elective was valuable in exposing students to the sports setting,” noted Alanna Salituro, DPT 2017. “Collegiate athletics is a difficult area to break into if you have not had experience. I also think it is valuable for the athletics department to see how sports PTs can fit into the continuum of care and act as compliments to the athletic trainer and team doctor. “
Dr. Timmerberg commented, “Students have been able to enter high level athletic clinical education experiences feeling prepared and confident in being able to contribute to the sports medicine team.” Current student Kathryn (K.T.) Prominski, Class of 2018, commented, “Since I have been in my final internship, I have had the opportunity to treat runners, swimmers, rock climbers, and baseball players. While my learning has a long way to go, this course prepared me to treat my athletic clients and collaborate with other clinicians to return them to their sport efficiently and safely."
Nicholas Rolnick, Class of 2017, said, “As a cash-based private practice owner, (The Human Performance Mechanic, New York, NY) my clients, many being athletes, pay me for results. The sports elective has been one of my go-to resources for understanding the demands of sport and how to approach it from a physical therapy and treatment perspective.”
Dr. Jean Timmerberg summed it up. “While many athletes are treated on the field by various members of the health care team, the majority of sports-related injuries are treated in the outpatient setting. It is therefore imperative that physical therapy students are aware of the biomechanical demands of various sporting activities, have the ability to evaluate and identify movement dysfunction, and incorporate the best evidence in the development of a treatment plan. Dr. Said builds on students’ strong orthopedic foundation, creates a positive learning environment and provides students with invaluable experience."
Note: Dr. Said is a 2007 graduate of the Columbia University Program in Physical Therapy. See his alumni video profile here.
For physical therapists, the field of women’s health “has exploded” during the last five years, according to adjunct faculty member Dr. Lila Abbate. “Every private practice wants to be into this.” Dr. Abbate is preparing physical therapy students in the Columbia DPT program to enter this burgeoning area of physical therapy. “Many graduating DPTs are going directly into this field.” And within women’s health, there are sub-specialties such as cancer treatment, athletics and post-partum.
Dr. Abbate teaches the Columbia PT program’s 7-week elective in women’s health. The course is coordinated by core faculty member Dr. Martha Sliwinski, PT, PhD. [link to faculty page] It covers basic anatomy, focusing on general pathologies related to pelvic health in women. It includes key women’s health areas such as bone health, obstetrics and gynecology, chronic pelvic pain, bladder and bowel dysfunction, nutritional dysfunction, cancer rehabilitation and fibromyalgia. The course targets women from adolescence, childbearing, peri-menopause, menopause, through geriatric years. Also covered are men’s and children’s health issues as they relate to the pelvis.
Columbia’s course incorporates orthopedic techniques, something that makes it unique. Dr. Abbate, who has been teaching this course for 7 years, developed this approach through her interest in hip pain and its causes. “Ten years ago, women’s health courses were typically not ortho-based.”, she noted.
Students learn to diagnose the difference between a pelvic floor issue and an orthopedic issue in a patient. While Dr. Abbate’s course does not involve internal examinations, Dr. Abbate wants her students to feel empowered that they have the knowledge to treat women’s health issues and also be able to determine whether or not the patient should be seen by a specialist. The class requires a final project. Once completed, the student has a presentation and patient handouts they can use as resources when they are practicing. It is a cumulative effort, bringing together all aspects of women’s health.
Dr. Abbate pointed out that the course syllabus is organized in order to prepare the student to consider further courses and eventually take the WCS (Women’s Health Clinical Specialist) test for certification. Stephanie Viola, CUDPT 2017, reflected on her experience with the course. “The women's health elective gives students a great overview of pelvic floor PT. I felt much more prepared after taking the elective especially when I went on to take continuing education courses in pelvic floor.”
Dr. Sliwinski commented, “Dr. Abbate brings to Columbia students a unique opportunity for expanding their skill set prior to graduation. Taking this course has afforded several of our graduates to begin practicing in the field or apply for a residency program.”
Another program graduate practicing in women’s health, Monica LoConti, CUDPT 2017, said “Dr. Abbate’s class provided me with a solid foundation. I am a confident and successful pelvic health therapist today because her course set me off on the right foot!”
PT faculty member Dr. Cynthia Chiarello, PT, PhD has long been engaged in research on musculoskeletal facets of women’s health with a particular interest in abdominal and pelvic function. Currently, she is partnering with Dr. Farah Hameed, Rehabilitation Medicine’s Medical Director for Women’s Health, to study pregnancy-related pelvic girdle pain (PPGP). They are examining women throughout their pregnancy to see whether an exercise program targeting the core musculature improves pain and function. They are also initiating research into the prevalence rates of PPGP in New York City.
A well-known expert on diastasis rectus abdominis, (DRA), the abnormal abdominal muscle separation at the linea alba, Dr. Chiarello continues to study this condition. She is investigating the normal width of the linea alba under different loading conditions using ultrasound imaging in collaboration with Dr. Christopher Visco, Ursula Corning Associate Professor of Rehabilitation Medicine Research. A component of this work on the abdominal musculature was presented as a poster at CSM this past February in New Orleans by two DPT III students, Elizabeth Abercrombie and Carley Schleien. Additionally, Dr. Chiarello has been invited to speak on the role of DRA to trunk function at the International Continence Society Meeting this August. Together with Kari Bo PT, PhD of Norwegian School of Sport Sciences, and Sinéad Dufour, PT, PhD, of McMaster University, she will be presenting a session entitled, “Pregnancy-Related Musculoskeletal Conditions: The Pelvic Floor and Linea Alba Connection.”
This past year, Dr. Chiarello assumed the role of Editor-in-Chief for the Journal of Women’s Health Physical Therapy (JWHPT), and is focused on restructuring. She has recruited a full editorial board, conducted the first strategic planning meeting, and upgraded information for authors and reviewers. She plans to take the journal from three issues yearly to a quarterly next year in preparation for indexing. When asked what she enjoys most about her work with JWHPT, Dr. Chiarello replied, “I am excited to share my passion for research with others in the profession to help them advance our knowledge of women’s health.”
Marijuana Use, Suicide, the Opioid Crisis… Dr. Christopher Kevin Wong Presents at Innovations in Translating Injury Research into Effective Presentation Conference
PT faculty member and Program Associate Director Dr. Christopher Kevin Wong, PT, PhD presented his research on falls among people with limb loss at the 6th annual Innovations in Translating Injury Research into Effective Prevention Conference, held this Spring.
The agenda included researchers investigating a wide range of subjects, from the impact of marijuana and alcohol on motor vehicle accidents to the spike in suicides after media coverage of Robin Williams’s death and other public health concerns.
Dr. Wong’s work--funded by a Center for Injury Epidemiology and Prevention pilot grant--found that the risk of falls is much greater when a person's perception of their ability does not match the reality of their physical ability. He commented, “being in the injury epidemiology community has broadened my research perspective and sharpened my focus on making a larger impact.”
Report from the Field: American Physical Therapy Association 2018 House of Delegates Meeting
by Dr. Martha Sliwinski, PT, PhD
The APTA House of Delegates (HOD) is similar to other legislative bodies such as Congress. The HOD formally deliberates policy, and has the power to charge the Board of Directors (BOD) to carry out activities on behalf of the Association.
This year, over a 3-day period in June, the APTA House of Delegates held its annual meeting. It was a busy one, attended by over 400 delegates representing their respective states. Elections were held, and 58 motions were presented and voted on. The number of motions up for vote this year was a challenge, considering there were only 19 in 2016 and 14 in 2017.
Additionally, the Special Committee to Review House Documents formed a volunteer pool to conduct a review of old policies in an effort
to “clean house.” The Special Committee put forward motions for vote based upon their review along with Components, (representing individual states or groups of states working collaboratively) and the Board of Directors for the total of 58 motions.
Following are some of the policies that were passed and why they are important:
PROVISION OF PHYSICAL THERAPY INTERVENTIONS AND RELATED TASKS:
There are interventions that are performed exclusively by the physical therapist. They include, but are not limited to, spinal and peripheral joint mobilization/manipulation and dry needling, which are components of manual therapy; and sharp selective debridement, which is a component of wound management.
Why it’s important: This motion will assist states that are moving forward legislation for additional interventions that may currently not be legal to perform in their state, such as dry needling.
PHARMACOLOGY IN PHYSICAL THERAPIST PRACTICE:
Physical therapist patient and client management integrates an understanding of a patient’s or client’s prescription and nonprescription medication regimen with consideration of its impact on health, function, movement, and disability. It is within the physical therapist's scope of practice to administer and store medication to facilitate patient and client management. Goals that may benefit from the use of medications include, but are not limited to: Reducing pain and inflammation, promoting integumentary repair and/or protection, facilitating airway clearance and/or ventilation and respiration, facilitating adequate circulation and/or metabolism, and functional movement.
Why it’s important: This motion will assist therapists in providing optimal care to clients who for, example, may require refrigerated medication, without the burden of the client bringing the medication to each treatment.
AMERICAN BOARD OF PHYSICAL THERAPY RESIDENCY AND FELLOWSHIP EDUCATION RECOGNITION
The American Physical Therapy Association recognizes the American Board of Physical Therapy Residency and Fellowship Education as the agency for the accreditation of physical therapy residency and fellowship education programs.
Why it’s important: Passing of this position statement will facilitate development of residency programs for the process of accreditation.
Practicing physical therapists and physical therapy students can influence the HOD by expressing opinions. Being a part of the HOD is important in helping our profession move forward. Encourage your peers to be active! Here are some things everyone can do:
- Attend Chapter Meetings
- Attend District Meetings
- Email a delegate
- See something, say something
- Feel something, do something
Watch the 2018 Presidential address online at APTA.org, and get inspired.
PT faculty member Dr. Martha Sliwinski is a member of the APTA House of Delegates representing her home state of New Jersey.
Barbara Trencher was last year’s Velocity Ride fundraiser winner and the first rider to kick off the 2017 Velocity Ride with Dr. Gary Schwartz, Chair of the Cancer Center and the event’s leader. She’s also a breast cancer survivor, former corporate lawyer, and member of the Columbia DPT Program’s Class of 2019. Along with classmate and Velocity teammate Sarah Urke, who lost her father to cancer during her first year in the program, the two started a pro-bono exercise class for breast cancer survivors and patients at the Columbia University Irving Medical Center called CancerFit, with support from Dr. Gary Schwartz. Located within the Cancer Center, breast cancer patients and survivors can come in for a drop-in, complimentary, patient-focused exercise experience.
Getting the program established was no easy task. Neither Urke nor Trencher had any prior personal training experience and had never led an exercise class. However, they did extensive research and came up with a format. When pitching their program initially, they approached several medical centers, including CUIMC, to no avail. Trencher is a member of the student team at the Columbia RunLab, elective, so she and Urke took their project to Dr. Colleen Brough, PT, DPT, board certified in orthopedics, the RunLab’s founder and director, who lent her support. They met with other PT faculty members who also supported the project wholeheartedly. With some help from Dr. Brough, CancerFit finally became a reality at the Medical Center.
It has been established that 1 in 8 US women will get breast cancer in the course of her lifetime, and it’s only within the last 10 years or so that physical therapy has become available for those with this disease. Trencher and Urke produced three pilot programs, with great success. “The patients come back”, noted Urke. “It’s good for them to be with others who have had or are going through this experience. It offers an organic support group and a chance to help one another.” The benefits also reach beyond the class itself. One patient even requested the playlist so that she could practice the exercises at home.
Trencher commented that physical therapy changed her own outlook as a cancer patient and made a difference in her recovery. “Aside from the physical benefits, after being on the receiving end of all these treatments, it’s something that you can do for yourself”, she said.
CancerFit gives patients a fairly high intensity interval training exercise experience. According to Trencher, “It’s good for cancer patients to exercise to mitigate the toxic effects of chemo and get the heart rate up. Stretching is good because it gives the class members an opportunity to stretch out the scar tissue.” In September the program will begin another 8-week drop-in series. Eventually, Trencher and Urke hope to integrate different types of exercise, including yoga, into their classes.
The schedule for the Fall series is as follows: Fridays 9/28, 10/5, (no session 10/12, 10/19, 10,26), 11/2, 11/9 11/16, 11/30. Time: 10:30-11:30AM, Location: Plus One Group Fitness Room, NYP.
For DPT students who participate in the CancerFit elective, the course will deliver real-life, experiential learning in a clinical context, and will fill a need for evidence-based, supportive care for CUIMC breast cancer patients and survivors.
Urke reflected on their experience thus far and goals for the program. “It is surreal to think that what started as a dream has evolved into a full-fledged program. Seeing how much the participants enjoyed the class made almost two years of planning worth every second. We look forward to collaborating with the breast cancer team to host this fall’s session. Our goal is to expand the program to include all cancer patients and offer more class options.”
This year, Sarah and Barbara are again riding in Velocity, which will take place on October 7. Barbara reports, “We are especially excited and motivated to raise a lot of money because in addition to research, Velocity funds integrative services like CancerFIT. Right now, our team is in second place and has raised over $12,000!”
For further information on CancerFit and the upcoming series of classes, contact email@example.com.
We are pleased to announce that PT faculty member Dr. Jacqueline Montes was awarded an MDA (Muscular Dystrophy Association) clinical trial travel grant to help support the costs of patients traveling to participate in a trial to study oxidative capacity and exercise tolerance in ambulatory SMA.
In a previous study, Dr. Montes’ team found that exercise does not improve function or fitness in ambulatory SMA children and adults despite increases in exercise ability. Understanding the underlying mechanisms preventing the expected improvements is necessary to design appropriate treatment strategies for SMA patients to benefit from exercise.
There has been laboratory evidence to suggest that mitochondria are affected by lack of the protein SMN. A reduction in oxidative capacity disproportionate to lean mass and disease severity would further support evidence of mitochondrial depletion in SMA. Alternative exercise training strategies and/or concomitant targeted therapeutic intervention may be necessary to achieve an aerobic conditioning effect.
The results from this 6-month observational study of 42 patients (14 ambulatory SMA, 14 ambulatory mitochondrial myopathy, and 14 healthy controls) would provide preliminary data, using non-invasive methods, on oxidative capacity in ambulatory SMA patients and disease controls to aid in the design of exercise intervention studies. Furthermore, this information would link previous laboratory and preclinical findings of mitochondrial depletion in SMA to the clinical condition and provide important information for future studies designed to improve oxidative capacity and fitness in SMA patients.
For more information about the MDA travel grants, visit https://www.mda.org/research/funding-opportunities. To learn more about Dr. Montes’ research, you may contact her directly at firstname.lastname@example.org
In the spring of 2014, Dr. Risa Granick was months away from her hard-earned retirement from directorship of our physical therapy program, construction on the Vagelos Education Center had barely begun, and the idea of moving from NI8 down the street to the Georgian was a twinkle in nobody’s eye. Guatemala trips were only once a year, and I was a very eager first year PT student ready to start changing the world.
In my graduate school application essay, I wrote about my aspirations to travel abroad as a clinician, so I doubt it was coincidence that I was interviewed by Dr. Martha Sliwinski, (known to her students as “Dr. S”) who oversees the Program’s service learning activities. Thanks to her, I matriculated into Columbia knowing I would apply for the Guatemala trip the second the opportunity presented itself.
Several memories pop into my head when I think back to my Guatemala trip as a student—assessing vitals on the Mayan women and men at the Elder Center, leading stretches to a group of weavers with low back pain, watching internationally-competing athletes play wheelchair-basketball (savage!)—but what permeated that trip was a sense of embracing the unfamiliar. The expression Dr. S would repeat, “birth by fire,” seemed particularly apt. Never put together a wheelchair from scrap parts before? Now’s a great time to learn. First time leading a lab on ankle joint mobilizations? Here’s a class of eager Guatemalan students, give it a go. I remember thinking that any one of the tasks on our itinerary could have been overwhelming, but somehow, surrounded by supportive classmates, everything was not just manageable, but a thrill. I did plenty of trial and error, I thought on my feet, and I collaborated with my fellow students to figure out best strategies. I cannot overstate the value of practicing these skills in this context. Reflecting on the experience now I almost think the Guatemala trip should be a graduation requirement.
Throughout that week in the spring of 2014, Dr. S was right behind her students with a smile of encouragement that seemed to say, “You’ve got this. I trust you!” Such was the attitude I attempted to carry with me this August when I returned to Guatemala as an instructor with Dr. Lisa Yoon.
Dr. Yoon was a terrific mentor for me this trip, for which I thank her. She trusted me to use my two years of clinical decision making to guide several activities throughout the trip, and encouraged me to put my own signature on them.
While there were several similarities between the student and the instructor experiences, one stands out beyond all others: The kindness and the gratitude of the Guatemalan people we had the privilege to work with. Without exception we were greeted warmly by each non-governmental organization, school, and home we visited. Our words and actions carry tremendous value on this trip, and this is not something to be taken lightly. If my first experience in Guatemala could be summarized as exciting and humbling, my second could be described as encouraging. I got a taste of how much planning goes into this trip to make it meaningful for the people we work with, as well as educational, worthwhile, and safe for the students who partake.
My goal for two of the end-of-day group reflections I led was to frame the trip from a perspective of expanding cultural competence, and I urged the students to consider how best to maximize our impact. This was how the trip was framed for me as a student, and I appreciated how full-circle that journey had become.
I was given an opportunity to support others as they led the majority of the hands-on work themselves. I learned that perhaps the reason why Dr. S appeared so at-ease during my first trip was because of the skills, flexibility, and positive attitudes of the students chosen to go on it. The Columbia students I had the pleasure of working with in Guatemala, apart from their warmth and amiability, were confident and capable. If I could give myself a piece of advice for a future trip it would be to take an even further step back. Columbia DPT students have got it under control.
It’s hard to describe the time I spent in Guatemala from August 16th-23rd. A short term service trip? Medical mission? The 8 days we spent with the incredible Dr. Galen Schram? “Fun” doesn’t capture the laughs our group shared during our tortilla making contest. “Educational” doesn’t describe the countless things I learned from Dr. Yoon, Dr. Schram, and my classmates. My time in Guatemala was all of those things and more.
As a physical therapy student, I start off with goal setting. It provides me with a clear endpoint for the patient and paints a picture the patient and their dreams. “I just want to work.” “I want to be able to walk.” “I want to be able to lift my child without back pain.” The goals of the Guatemalan children and adults I worked with were similar to the goals of the children and adults I have treated in the U.S., which reminded me that our worlds aren’t so different. Humor and kindness are universal languages, key to connecting with almost everyone.
Physical therapy is all about functionality. We had the privilege of going on some homecare visits to see several children in Guatemala. At one house, I was struggling to create interventions for a little girl using one blanket on the floor. One of my classmates asked if the girl had any toys we could use, to which we were given a resounding “no.” We were able to stretch many of her extremely tight muscles, place her into multiple weight bearing positions, and educate her parents and an accompanying local physical therapist on future intervention ideas as well as provide recommendations for how she should be positioned during the day. But would the family be able to do it? Both of the parents and the grandmother work, so the answer was no. She would continue to lie on the bed for most of the day. That kind of experience made me realize the importance of functionality in patient interactions while providing tasks patients are both capable of and willing to do.
The very reasons I chose physical therapy are the very reasons it can be frustrating on a short trip. Dentists can fix teeth in one session, doctors can perform surgery, and nurses can administer medication within a day. But physical therapy is a process, not an event. In my short time at Guatemala, I learned about a country still mending itself after a civil war. I experienced the potential of physical therapy in a community health setting, and I learned more about the kind of physical therapist I want to be. It was an amazing experience!
Pregnancy-related musculoskeletal tissue injury is common and ranges from strain on the pelvic ligaments to injury to the pelvic floor and changes associated with the fascial system, including widening of the linea alba, called diastasis rectus abdominis (DRA). It is important to explore pregnancy related musculoskeletal conditions, specifically from the perspective of understanding the potential relationship and relevance of pelvic floor function to the linea alba.
PT faculty member Dr. Cynthia Chiarello presented a workshop on August 28th as part of a group of international experts on pelvic floor at the International Continence Society (ICS) Philadelphia 2018 conference. Her topic was “Morphology and biomechanics of the linea alba and pelvic floor: Connecting the System.” She presented theoretical models and biomechanics to integrate musculofascial systems of the trunk and pelvis as a backdrop for understanding DRA. Other presenters were: Kari Bø, PT, PhD, Norwegian School of Sport Sciences, Oslo, Norway; Stéphanie Bernard, MScPT, PhD Candidate, Université Laval, Quebec, Canada; Sinéad DuFour, MScPT, PhD, McMaster University, Ontario, Canada.
The workshop, entitled “Pregnancy-Related Muscoluskeletal Conditions: The Pelvic Floor and Linea Alba Connection,” was well attended by health professionals representing many countries and disciplines (medicine, nursing, physical therapists, etc.) who are interested in understanding pregnancy-related musculoskeletal tissue changes and related impairments.
Dr. Chiarello commented, “The ICS conference was a wonderful opportunity to connect with medical professionals from all over the world. It was particularly rewarding to experience the enthusiasm of international PTs for improving women’s health and well-being regarding musculoskeletal dysfunction of the trunk and pelvis.”