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
June 7, 2018: We are pleased to announce that core faculty member Wing Fu, PT, PhD, MA, 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 taken the Management of Orthopedic Conditions course, since material covered in that course 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 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 but cite lack of funds as a barrier for enrolling.
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, OCS, MEng has been teaching the course for the past 6 years, with coordination support by core faculty member Jean Timmerberg, PT, PhD, MS, OCS. [link to dr. timmerberg's faculty page]
The course is designed to give the student in their final year 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. 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, MS [link to faculty page] 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.”