Written with the contributions of Linda Robinson, MSN, RN, CPXP, and Grace Schore

October marks National Physical Therapy Month, a dedicated time to recognize the pivotal role of physical therapy in patient care. With their expertise in strength training, core exercises, and a range of therapeutic techniques, physical therapists play a vital role in healing the body and enhancing well-being. They empower patients with invaluable tools to consider in their treatment journey, fostering holistic and effective approaches to recovery and preventive health. This month serves as a reminder of the profound impact physical therapy has on the lives of countless individuals seeking to improve their quality of life.

Linda Robinson, MSN, RN, CPXP, Vice President of Clinical Excellence at MDM Healthcare , recently hosted the dynamic physical therapy duo, Andrea Brogden, PT, DPT, and Amy Godfrey, PTA, on our podcast, PX Space.

Brogden and Godfrey, members of the dedicated team based at CORA Physical Therapy in Ponte Vedra Beach, Florida, collaborate to address their patients' physical limitations and concerns.

Brogden underscores the significance of understanding each patient's unique goals during the initial diagnosis.

"These goals can be as straightforward as the ability to comfortably roll out of bed, rise from a chair, or even run a marathon.”

She utilizes these goals as a guiding beacon, fostering a realistic perspective.

“We’re not aiming for a marathon next week; but let’s consider it six months down the road,” she said.

The team employs various metrics, including pain levels and incremental weekly objectives, alongside regular reassessments to monitor the patients’ advancements during their treatment.

"We assess factors such as range of motion, muscle strength, and overall mobility, all aligned with achieving those set objectives," Brogden noted.

One of the topics discussed was treating back pain, which, according to Brogden and Godfrey, is one of the primary concerns shared by those seeking treatment at their clinic.

“It is a very prevalent and common complaint reported by at least 65 million Americans. In fact, about 23% of the world's population suffers from back pain. Back pain can stem from something super mild to incredibly significant, and it can be very traumatic in our lives,” said Brogden.

As the evaluating therapist, Brogden's role is to determine the cause of pain. From there, she creates a treatment plan that Godfrey executes.

“We like to align the body first because when a patient is not in alignment, that can cause shooting pain into the lower or upper extremities. After we get everything aligned, we work on strengthening the core, starting with gentle exercises before progressing,” said Godfrey.

Godfrey discussed how she builds on the progress patients make with each session. As the treatment progresses, patients are gradually challenged to try some Pilates-inspired moves to build core strength.

Both Brogden and Godfrey agree that patients need to feel involved and in control of their treatment.

“I feel like that brings a lot of comfort to a patient, knowing where they are in the process and how we’re going to heal it,” said Brogden.

New tools have recently emerged to help patients in the office. Godfrey is trained in both Augmented Soft Tissue Manipulation (ASTYM) and Graston. These techniques find restrictions in soft tissue and can regenerate them at an accelerated rate. While stimulation was a popular technique in the past, Brogden noted that the team uses a range of techniques in their treatment plan, including dry needling. Dry needling is a technique similar to acupuncture, where small needles are inserted into muscle “trigger points” to relieve pain and irritation. Brogden has recently been certified in dry needling.

Written with the contributions of Linda Robinson, MSN, RN, CPXP, and Grace Schore

In a recent article published by the National Institute of Health (NIH), it was revealed that the incidence of incivility directed at nurses had exceeded 46%, with one-third of nurses reporting exposure to physical violence. Despite nursing consistently ranking as the most trusted profession, the issue of incivility remains a persistent challenge.

Nursing leaders are taking proactive measures to address workplace incivility, and in a recent discussion, Linda Robinson, VP of Clinical Excellence at MDM Healthcare, spoke with nurse executive and incivility expert Connie Montalbo, DNP, MBA, RN, NEA-BC.

Montalbo is a distinguished Nurse Executive with decades of experience. With an impressive career spanning multiple healthcare settings, she is a dynamic leader and change agent dedicated to fostering a more respectful and collaborative culture within the nursing profession. She is also an Incivility Expert and founded "End Incivility Today" in February 2019, a platform where she applies her expertise to address the pervasive issue of incivility in nursing. Her mission is to coach leaders in putting an end to passive leadership and disruptive behavior, emphasizing that doing so will not only improve the workplace culture but also positively impact quality of care, staff engagement, and financial outcomes. Prior to her entrepreneurial endeavor, Connie served as the Chief Nursing Officer and Vice President of Clinical Operations at B.E. Smith, overseeing various clinical areas for over five years. Her career also includes significant roles as a Nurse Executive at a variety of hospitals. Her extensive experience in diverse healthcare settings, coupled with her dedication to ending incivility, makes her a valuable asset to the nursing profession.

Written with the help of contributing author Linda Robinson, MSN, CPXP, RN, Vice President of Clinical Excellence, MDM Healthcare

Surveys year-after-year report in the United States that blindness ranks in the top 3 of most feared health problems along with cancer and AIDS. Tragically, the Centers for Disease Control and Prevention (CDC) reports that approximately six million Americans have vision loss and one million have blindness. More than 1.6 million Americans who are living with vision loss or blindness are younger than age 40.

MDM Healthcare VP of Clinical Excellence Linda Robinson, MSN, CPXP, RN recently sat down with David G. Miller, MD, President and Medical Director of Cleveland Eye and Laser Surgery Center, to discuss ocular health, chronic eye diseases, and groundbreaking care to slow the progression of vision loss, prevent blindness, and even restore sight.

“Twenty-million people and growing with this disease; really, it's one of those fascinating statistics where the number of people are showing some signs of age-related macular degeneration may be 10% at 70, 25% at 80, and 50% of people hitting their 90s show some signs of age related macular degeneration,” said Dr. Miller. “So, if you're fortunate enough to have a long life, these things are just a much more likely risk.”

According to Dr. Miller, the realm of retinal surgery and diseases has increasingly shifted its focus toward macular degeneration over the past few decades. This heightened emphasis is largely tied to the aging demographic. The formal term for this condition is age-related macular degeneration (AMD), which has a genetic component prevalent in specific families and is notably linked to the aging process. This requires two key factors to align: a familial history of the condition, or the inheritance of specific genes from both parents, coupled with living long enough to encounter the ailment.

Given the rising lifespan of individuals, including the elderly population and the generation of baby boomers, more people reaching their 80s and 90s than ever before, macular degeneration has substantially grown into a prevalent diagnosis. Robinson spoke of her father’s struggles with AMD—most notably the inability to see what was in front of him, decreasing his quality of life. Losing the ability to drive, enjoy sports, and watch TV was extremely difficult for him. This, coupled with hearing loss, limited his ability to interact with the world around him. Robinson could tell that her dad felt very isolated because of his loss of sight.

“A disability acquired late in life, along with the whole aging process; it can bring on a lot of mental changes including possibly depression, which maybe your father was suffering from, whether it's hearing loss or visual loss, or your mobility as an elderly person,” said Dr. Miller. “Losing the freedom you used to have in life can be quite life-altering, and naturally quite depressing.”

These types of symptoms are not uncommon to see with AMD patients.

Dr. Miller describes the visual field of a patient with AMD.

“The macula is the center part of the retina, the retina is the inside lining of your eye. And it's kind of like the film screen in a movie theater. It's where the image is projected so that your brain can see it. And if you can imagine the middle of the movie screen being kind of pockmarked or moth eaten. That's what you're seeing when you're a macular degeneration patient. And as the disease progresses, those, mothy areas kind of coalesce together and form one big blank spot in the middle of vision, these patients can drop to the level of what is called legal blindness.”

He further describes how patients can navigate through a room and can see through their peripheral vision that someone has entered a room but cannot recognize their face. Patients over time become unable to read, write checks, watch TV, drive, etc. They can, however, function in their own home but require assistance.

Dr. Miller went on to explain the two types of macular degeneration.

“There's dry disease, and there's wet disease. And people often confuse the term dry eye with dry macular degeneration. That's completely unrelated, and dry eye is a very common condition.”

He explained, the term dry macular degeneration is used in contrast to wet macular degeneration. Both conditions affect the same part of the retina, known as the macula. In dry macular degeneration, the macula experiences a gradual deterioration, similar to “hair loss or balding.” The cells within the macula progressively decrease in number, leading to what's referred to as atrophy.

On the other hand, he explains, wet macular degeneration often follows a prior phase of dry disease.

“The macula responds to losing those patches of the macula, your eye tries to almost heal itself and grows abnormal blood vessels into that space that then break open leading to bleeding and scarring. So, the breaking open, bleeding, and leaking are the terms that go with wet macular degeneration.”

He continues to add that both types can result in similarly poor vision over time. Wet macular degeneration tends to cause more sudden and acute visual loss, often occurring within months. Conversely, the progression of dry disease is generally slower, taking about a decade to significantly impair vision.

Fortunately, there are treatments available for wet macular degeneration, which can help mitigate the rapid vision loss associated with this form. While treatment options for dry macular degeneration are somewhat limited, there have been breakthroughs in this area as well. It's important to recognize that even though “the majority of patients experience the dry disease, the more severe damage is done by the wet disease itself.”

Robinson brought up how her father who suffered with wet macular began to see things and make up stories around what he saw. She was concerned that it was dementia, but Dr. Miller explained the phenomenon of Charles Bonnet syndrome and how it is a topic at his office weekly. He explained how the brain is kind of fabricating these images.

“You get this very fragmented image on your retina,” said Dr. Miller. “It’s the movie screen, but, you know, literally half the movie screens missing. So, your brain fills in the blanks, and makes a whole image.”

He states that patients and their families are reassured to hear that this is a natural response to macular vision loss and they are not developing a psychiatric illness. Currently there are no medications specifically targeted at addressing Charles Bonnet syndrome. He also added that it is true that losing central vision can lead to disorientation. The combination of age-related mental changes and the loss of clear vision can leave patients less connected to time, space, and their surroundings.

Dr. Miller recommends maintaining good health to prevent macular degeneration. Research indicates that people who exercise regularly, uphold healthy blood pressure levels, refrain from smoking, and maintain a nutritious diet with ample dark green vegetables exhibit a reduced risk of age-related macular degeneration. Certain vitamins also appear to offer protective effects, and there's a potential role for them in prevention. Dr. Miller also recommends monitoring your vision regularly starting in your 40s.

“Macular rarely strikes both eyes at the same time. A simple test you can do is “once a week when you're reading the Sunday paper with a cup of coffee, you close the left eye and you read the headlines and a couple of paragraphs and then your right eye and do the same thing with both eyes can do that you're probably 98% Certain nothing bad is happening. And if something is wrong, or those eyes can't read, go see someone.”