Therapist Profile — Kelsey Martindale, PT

By Jamie Funk, Therapy Recruiting Resource

I am pleased to introduce Kelsey Martindale, a physical therapist who has been a key member of the therapy team at St. Joseph Villa in Salt Lake City for the past two years. “Kelsey is passionate about making the lives of our LTC residents better. She loves to work with neuro patients, especially those with Parkinson’s disease and other movement disorders. She takes our core value of celebration seriously and likes to plan events and parties for our team outside of work. She is flexible, kind, giving, generous and considerate. She is part of what makes me want to come to work every day,” says Lisa Brook, our dedicated and passionate rehab director at SJV.

Kelsey graduated from the University of Utah’s DPT program and was inspired to become a therapist while working in a store selling running shoes. She enjoyed working with people on biomechanics and injury prevention. Simultaneously, she was going to a physical therapist for treatment and realized that PT would be a challenging career that would allow her to grow and continue to learn.

Kelsey loves her team at SJV. “I feel like we are all unique individuals who have a special way of working together. There is a fundamental undercurrent of serving each other and our residents. We can take on a task easily and meet our goals and expectations, but this ultimately is not the driving force of our job. We do well because of who we are as people, not because we are obsessed with matrix. Everyone has it in them and wants to be here every day,” she explains. “If I could change one thing about my job it would be to spend more time with my patients and less time in documentation — and to know what happens to the patients that we work so hard with once they leave SJV.”

Patient care, hugs, gratitude from patients, helping people know they are not alone, and knowing that she can make a difference even if it is small help Kelsey stay energized and passionate about her work. Kelsey has an amazing 6-year-old daughter who she loves to spend time with when she is not at work. She also enjoys traveling, watching sports and spending time with people she cares about. She says she is not a homebody! Her favorite Disney character is Mulan because she rose above everyone’s expectations of her and was strong, powerful and beautiful all at the same time.

Kelsey’s favorite thing about being part of our organization is that the people here want to be here. The culture of caring, celebrating and working together is present every day and in every meeting. “Celebration is valued here and our facility is especially great in all areas of CAPLICO,” she says.

Kelsey believes that she is the very best version of herself when she is at SJV working with her colleagues and residents.

Keystone Student Programs: A Record-Breaking Year

By Kai Williams, Therapy Resource, Director of Keystone Therapy Student Programs

Passion for learning is an actionable term that many of our therapists and therapist assistants display throughout their day-to-day. This can be evident through your engagement in learning from others and teaching. Oftentimes, we have clinicians who shy away from accepting a therapy student due to fear of it affecting their productivity, or they may have insecurities in their ability to provide expert clinical training. From the perspective of many students, they truly value the time they are able to spend with clinicians. Didactic work only takes students so far; it is the true clinical experience that produces the confidence and backing of their clinical capabilities.

Keystone has developed a student program that not only provides students an opportunity to intern at our facilities, but also allows us to forge purposeful relationships with our local university and community college partners to aid in the enhancement of our profession. So far in 2019, Keystone has had a total of 58 students of a variety of disciplines and from a variety of academic institutions. Through the partnership of our Texas therapy programs, we have garnered a reputation of excellence. We have taken on a variety of clinical research studies to help look at ways to better serve our patients within the SNF setting. Some of those studies have included the effects of certain modalities and the impact it has on fall prevention, as well as the effectiveness of standardized assessments as predictors of outcome performance.

The skilled nursing setting offers exposure into post-acute care that some students often have a misconception about. Our clinicians have set the standard high, and each therapist/therapist assistant offers a level of rigor to their students, so once they complete their affiliation, they are better prepared for life as a licensed professional. Our utmost priority is to prepare the next generation of therapists/therapist assistants to enter our profession with readiness.

We also have received operational and clinical strength amplification from the time spent with interns, improving productivity for several therapists/assistants and creating a greater level of confidence in their patient care delivery and interaction with other colleagues. Through the Keystone student program, we have also had many of our students return and become employees within our organization. We’ve even had some that we met as students later become a staff therapist and then transition into the role of Director of Rehab. Talk about full circle!

 

From Therapist to Executive Director: The Why and the How

By Chad Long, Therapy Resource

Post-acute health care is making a massive shift this October with Medicare’s change to the Patient Driven Payment Model (PDPM), where patient clinical characteristics drive the reimbursement and functional outcomes determine success.

Along with the payment model changing, we are in the midst of a significant population shift (often referred to as the Silver Tsunami) in which we have a growing number of older people, many of whom need a greater number of health care services.

“The Silver Tsunami is already rolling in and projections from the U.S. Census Bureau point to 2030 as a milestone year in which older people will actually outnumber children for the first time in history.” Tom Sullivan, March 15, 2019

https://www.healthcareitnews.com/news/silver-tsunami-coming-healthcare-time-prepare

“As the number of senior people rises in many economies of the world, the need for long-term care and aging-in-place services will increase.” Reenita Das, Aug 11, 2015

https://www.forbes.com/sites/reenitadas/2015/08/11/a-silver-tsunami-invades-the-health-of-nations/#494f73d53efd

So who will help champion the changes in health care delivery and ensure clinical and operational success in Post-Acute? Why not Therapy Professionals?! As licensed therapists and therapy assistants, we have a unique opportunity to move into Skilled Nursing Operations (Nursing Home Administrators, Executive Directors, CEOs, etc.) and work in a new capacity within the Interdisciplinary Team.

Within the Ensign Affiliated Facilities, we are seeing a growing number of Directors of Rehab moving into Operations and having great success. So why would therapy professionals be good candidates for Administrators in Training and, eventually, Executive Directors? At a recent Service Center meeting, led by Spencer Burton, a few reasons were discussed:

Why DOR to ED:

  • Clinical backgrounds
  • Mini-business leader (HR, Compliance, Billing, Maintenance, etc.)
  • Balance of clinical and financial
  • Multipliers
  • Vision -> Path: Perspective — Push to goals
  • Teaching, coaching, developing people
  • Creative
  • Likeable
  • Challengers
  • Communication skills
  • Well-versed in Ensign culture

Guess who is a Therapist and Facility Operator?

  • Salma Moore: Arroyo Vista
  • Ryan Goldbarg: Victoria Ventura
  • Matt Scott: Mission Hills
  • Brian Rupert: Villas at Sunny Acres
  • Doug Haney: Bella Vita
  • Amy Guiterrez: La Hacienda
  • Ediel Barrera: McAllen Transitional
  • Marissa Parker: Legacy
  • Kyle Martin: Kirkwood
  • Kumar Pradeep: South San Antonio
  • Amber Thompson: New Braunfels
  • Travis Jones: Cornerstone

So what are the requirements to become a Licensed Nursing Home Administrator? Well, that depends on the state in which you live. However, there are a few common requirements. Typically, you must be 19 to 21 years of age, have a bachelor’s degree, complete an Administrator in Training Program (or have a master’s degree in a health-care-related field) and successfully pass the National and State Nursing Home Administrator Exam. Below is a list of basic requirements, per state, and a link to the National Association of Long Term Care Administrators Boards.

If you are interested in growing in a different career path from therapy to more facility operations, please contact Jamie Funk at JFunk@EnsignServices.net, or talk with your facility administrator. Let’s be the change we want to see in our organizations and in health care!

A Dry Needling Success Story

By Evette Ramirez, PT, DPT, Keystone Therapy Resource/DOR Legend Oaks, Waxahachie, TX

Dry needling is a technique that has many uses, although it is often confused with acupuncture, which follows the principles of Chinese medicine. Dry needling is a technique in which varying lengths and gauges of acupuncture needles are used at nerve roots, nerve pathways, homeostatic points, muscle bellies, scars and/or the area of motor endplates as treatment areas.

The dry needling technique follows the rules and knowledge of the human anatomy and has a background derived from traditional medicine. It has been shown to help promote physiological homeostasis and allow the body to maximize self-healing of soft tissue dysfunction by creating a small lesion in the tissue, triggering an inflammatory process and healing. Dry needling should be practiced by a clinician who has had thorough training in needling techniques, has a strong knowledge of the human anatomy, and knows and understands precautions and contraindications so as to avoid doing harm.

Mr. A is a 76-year-old male who has had chronic pain for years. Years before coming to reside in our facility, he was treated by a pain management doctor for chronic pain in his back with radicular pain radiating into his bilateral quads. Our client was treated unsuccessfully for his pain. He also had a stimulator implanted, which he also reports did not help. This stimulator stopped functioning years ago when the battery ran down. He reports he has been unsuccessful in convincing any surgeons to remove it.

Due to his chronic condition, he came to reside with us at Legend Oaks of Waxahachie. At the time, he was not able to ambulate without assistance and the use of a walker. His condition continued to deteriorate, and walking became more and more difficult. His pain became so unbearable that he was having trouble sleeping. Functional transfers were difficult, and he began to develop muscle tightness in the bilateral hamstrings.

Mr. A received rehab services and made some progress, but he would begin declining once rehab services were discontinued due to a plateau in progress. Intermittently, there were complaints of hand pain, spasms and tightness, which was also treated. Along with these complications, he had a diagnosis of Parkinson’s, which was also progressing, and a neurology consult was acquired to assist with medication management and monitoring for progressively worsening tremors.

After I took the dry needling course through Integrative Dry Needling, he was the first person I wanted to work on. I explained to him what I wanted to do, which would be to start with his primary problem area. I placed him on the treatment table in a side-lying position and palpated his lumbar spine. I explained to him what to expect as far as sensation during the needling. I palpated L5 and the PSIS. Two finger’s width distance laterally from the spinous process of L5 is where I placed the guide, angled toward the spine, and inserted the 2-inch needle.

I did this bilaterally, inserting the needle until I felt the needle reach a bony barrier. As the needle was being inserted, I felt resistance. The sensation felt like rigid barriers being crossed. I described the sensation as feeling like pushing a needle through layers of paper — feeling resistance, then a slight “pop” and then free movement of the needle until the next layer was reached. I did this from L5–L3, bilaterally. He had an area at T12 that was also a problem area and was flared up that day. I inserted a 1-inch needle at that level, 1 inch from the spinous process, angled toward the spine. This was done as an “in-out” procedure. I inserted each needle until I felt a bony barrier. The entire treatment only took a few minutes and he reported only a mild ache at L5. He then completed the rest of his PT session for strengthening, manual stretch to B lower extremities progressing to WB activities.

The next day, our client’s roommate came to us and told us to keep doing whatever we did to his roommate because it was the best sleep either has had in a long time. He explained that typically, whenever Mr. A would even roll over in bed, he would call out in pain. Mr. A then came into the therapy gym with the biggest smile on his face. He said that within hours, his pain had decreased from a reported 8/10 to 4/10 and he hadn’t felt so little pain in years. He also reported having had a full night of sleep, and reported he could not remember the last time he felt so rested. We continued needling twice a week, primarily along these same areas.

The next week, our client was feeling much better where the back pain was concerned, but he was still having leg and quad pain. Along with needling his back, I added needling to the bilateral quads, hamstrings and IT bands with a 2-inch needle, again using the in-out technique. He reported feeling the needle on his quads during the needling but no other sensations. He then proceeded with his PT session.

The next day, he reported a decrease in quad pain, and the PT who was working with him reported improved ROM in knee extension bilaterally with manual stretch (as well as improved tolerance), improved standing tolerance and ability to stand more erect.

As he continued to receive PT services, he had a flare-up of hand pain and cramping. Pain was reportedly increased while maneuvering his wheelchair throughout the facility. In the past, OT had worked with him and had even attempted splinting with some improvement in pain level, but none of the relief would last once OT services had ended.

By this time, one of my staff PTs had also been trained in needling by IDN and asked him if he would allow her to needle his hands. He agreed to try because of the success with decreasing his back and radicular pain. She chose to needle at two homeostatic points in the bilateral UE. She needled at the deep and superficial radial points, which are along the path of the radial nerve. She needled at the forearm, distal to the radial head, then in the trigger point in the muscle between the thumb and forefinger, the dorsal interosseous muscle. This trigger point is also one that you will often hear of people pressing to relieve headaches and other pains.

He had an immediate reaction, with an extreme sense of euphoria and relief of the pain in his hands. He was kept in the therapy gym for monitoring, as we had not experienced anyone with this type of reaction. His vital signs were all within normal limits. Within a few minutes, he was back to feeling “normal,” and the pain in his hands had gone from 8-9/10 to a 4-5/10.

Mr. A has progressed so that he is off of routine pain medications and now takes them only PRN, when he has a flare-up. He continues to increase in function, with decreased pain at rest and with activity. ROM and coordination as well as tolerance to standing and ambulation continue to improve. We are working to lengthen the time he can go between needling sessions, and he is on more of a maintenance program for needling and pain management.

9 Ways to Break Out of Your Boring Exercise Rut

 

By Angela Ambrose, Contributing Writer

When you’re tired of doing the same old exercise routine, it’s easy to make excuses and skip workouts. Only 23 percent of adults meet the 2018 Physical Activity Guidelines set forth by the U.S Department of Health and Human Services. They strongly recommend:

  • At least 150 to 300 minutes of moderate aerobic activity or 75-150 minutes of vigorous-intensity aerobic activity weekly
  • Strength training of all major muscle groups two or more days per week
  • Stretching and mindfulness activities such as yoga, tai chi or qigong
  • Balance training to prevent falls

Adding more variety to your workouts can help you meet all of these important exercise guidelines each week. Not only will you find more enjoyment, but you will also be more likely to exercise longer and more consistently. Spice up your exercise routine by trying two or three of the following options:

  1. Find a workout buddy — After a long, exhausting day at work, a supportive friend can give you that little nudge you need to get off the couch and get moving. Because you will need to coordinate schedules with your partner, your exercise time will be plugged in to your calendar ahead of time, making it a higher priority. Doing an aerobic workout with a motivating partner has the potential to double your performance, according to a study by the Society of Behavioral Medicine.

2. Try a group fitness class — Even if you’re exercising in a crowded gym, you can still feel lost and lonely if you’re climbing on the stair stepper in a dark corner or lifting weights by yourself. Most health clubs offer group fitness classes taught by nationally certified instructors. The group energy is contagious and can help you push through an especially challenging workout. From barbell and kickboxing to dance and yoga classes, you’ll find a wide range of options to build aerobic endurance, muscular strength and flexibility.

3. Get outdoors — Numerous studies show that exercising in the fresh air and sunshine elevates your mood, reduces tension and motivates you to work out longer and harder than exercising inside.

4. Join a team sport — When you were a kid, you never worried about counting steps or calories. You played catch, kickball or Frisbee simply because you enjoyed being with friends. Make exercise fun again by joining a recreational sports league such as softball, soccer or basketball or by taking up tennis or racquetball. Team sports are particularly beneficial because they create social connections and friendly competition. A study published in Mayo Clinic Proceedings shows that participating in partner and team sports is associated with longer lifespans than exercising alone because they combine the benefits of physical activity with stimulating social interaction.

5. Break it up into smaller portions —“I just don’t have time.” This is the No. 1 excuse for not (Insert Photo 5) working out regularly. Research shows that “exercise snacking” — engaging in small “snack-sized” portions of exercise throughout the day — can be an effective way to increase your physical activity, especially on days when your schedule is jam-packed. Taking the stairs instead of the elevator or walking to the corner restaurant for lunch all count as exercise. Too tired to hit the gym after work? Have an exercise “snack” of push-ups or sit-ups before dinner, instead of that plate of nachos.

6. Listen to upbeat, motivating music — When you listen to fast tempo music with a strong beat, your body naturally wants to follow the rhythm of the music. Energizing music can distract you from discomfort, increase your exercise intensity and increase your endurance as much as 15 percent, according to Costas Karageorghis, Ph.D., a leading expert on exercise and music research. Select music with the tempo or beats-per-minute (bpm) that correspond with the exercise you’re doing. The song’s bpm should mirror your target heart rate, according to the American Council on Exercise. (See chart for recommendations.)

7. Set SMART goals — Setting goals can help keep you motivated, but they work best when they’re clearly defined. For example, if your goal is to lose weight or build more upper body strength, use the SMART guidelines to make it specific, measurable, attainable, realistic and set within a defined time frame. Having trouble coming up with a motivating fitness goal? Sign up with a friend for a community walk, run or bike ride to support a charitable cause.

 

8. Track your progress — Download a free mobile fitness app to record your exercise progress, and wear a fitness tracking device such as a Fitbit or Apple watch to get instant feedback. Wearable technology may motivate you to increase your physical activity and serve as a daily reminder to keep moving.

9. Build up intensity slowly — If you’ve been sedentary for a while, gradually increase the exercise intensity and time you spend working out. Start with exercises like brisk walking, swimming or leisurely biking that pose minimal risk of injury. Enlist the help of a personal trainer, if you would like more guidance and a customized workout plan.

Variety adds more excitement and challenge to your exercise routine. If you’re having fun in your workouts, you’re more likely to log extra steps, burn more calories and go well beyond the U.S. Physical Activity recommendations, as well as your own personal fitness goals.

WELL Challenge! Share your own stories about how you’re adding variety to your workout!

  1. If you have Instagram: From your Instagram account, share a picture and caption and remember to hashtag both #CAPLICOwell #CAPLICOnation
  2. Or, using your smartphone: Visit EnsignTherapy.com, click “WELL” at the top of the page, then click “Share your Story” from the top of the WELL Site. There you’ll find room to share a short story and upload a picture from your phone.

We look forward to seeing your inspiring stories as a collaborator to our WELL Project.

For more information on this topic or the latest health and fitness news, visit AngelaAmbrose.com or follow Angela on Facebook (@AmbroseHealthyLiving).

Can Heart Rate Variability Be Improved in Those with Heart Failure Through Gratitude Journaling?

By Cory Robertson, PT, DPT, Therapy Resource

According to a study out of the University of California, San Diego, the answer is no, and yes. How can that be, you ask? Keep reading to get the details and the findings of the study: A pilot randomized study of gratitude journaling intervention on HRV and inflammatory biomarkers in Stage B heart failure patients.

Patients with Stage B heart failure are those who have a structural abnormality of the heart but have not yet developed symptoms. Thus this stage is a therapeutic window of opportunity to deliver interventions to prevent the progression of the disease and to maintain quality of life.

Studies suggest a strong connection between gratitude and well-being. The area of behavioral cardiology is increasing focus on positive psychology like gratitude and how it affects physical health. More studies are needed using objective measures of physical health to understand the disease-buffering effects of gratitude. One of those objective measures studied in this paper is heart rate variability (HRV). As we know, HRV is a measure to quantitatively assess variation in heartbeat intervals that is often used to detect changes in the autonomic nervous system. Psychological factors like mood, satisfaction, depression and chronic stress are related to the autonomic nervous system, suggests the research. So can gratitude journaling improve HRV?

Seventy patients with Stage B HF were randomized into two groups: a gratitude journaling group, and a “treatment as usual” group for a period of eight weeks. Participants were assessed at pre-, mid- and post-intervention for inflammatory biomarkers from a blood draw, basal HRV data obtained, as well given a gratitude and exercise activities questionnaire.

After eight weeks, these data were re-acquired; also, both groups were assessed for HRV responses to a specific gratitude journaling task. Here is the wording of the journaling instructions, and if you’re like me, just reading the instructions summons a sense of well-being: “For the next eight weeks, you will be asked to record three to five things for which you are grateful on a daily basis. Think back over your day and include anything, however small or great, that was a source of gratitude that day. Make the list personal and try to think of different things each day.”

Basal HRV measures between groups after eight weeks showed no significant differences — though at the eight-week assessment during the specific journaling task, there were medium to large effect sizes between the groups’ HRV. So assessing the different groups’ HRV separate from the act of gratitude showed no difference, but during a gratitude task, there was a significant difference. The authors surmise that “increases in parasympathetic cardiac tone … [during] journaling may reflect state changes that occur while contemplating items or feelings of gratitude during daily life.” Moreover, the gratitude journaling group had a significant reduction in inflammatory biomarkers, which are related to morbidity and mortality in patients with HF.

I’m grateful for this research and for the opportunities to learn more about the heart and how I can do something to help my heart function. Do you think reading research regarding gratitude and its benefits also improves HRV?

 

LSVT Live in Colorado

By Maryann Bowles, Therapy Resource — Colorado

The ENDURA Market in Colorado gathered 10 of their physical and occupational therapists to complete their LSVT BIG live training together at the Villas at Sunny Acres. The group spent a full day going through treatment and practice of the evidence-based neurologic patterns and movements for the treatment of symptoms associated with Parkinson’s disease.

Specifically, research shows that LSVT BIG treatment can lead to faster walking with bigger steps and arm swings, better balance and more ability to twist at the waist. Clinicians also report that LSVT BIG often helps people with buttoning their clothes, writing and other smaller-movement (“small motor”) tasks, as well as large (“large motor”) movements like dressing, getting up from a seat and getting into bed.

Because PD makes it harder to remember to use these bigger movements consistently, treatment includes a lot of repetition and progressive challenges, as well as daily home practice and assignments for using bigger movements in everyday life.

Ultimately, LSVT BIG helps improve the mismatch between what you feel you’re doing and what you’re actually doing, making you more confident, comfortable and empowered. With one month of hard work, LSVT BIG can open doors to a more active and independent life.

The ENDURA market therapist will now have a local network of fellow therapists to help support their development of a strong Parkinson’s and movement disorder treatment program in their buildings.

Partnership With Recreational Therapy

In Utah, we are fortunate enough to have a Recreational Therapy Resource, Kami Archibald. Kami is a great partner with our therapy teams to find ways to further enhance the lives of our residents. Through this partnership, our facility Rec Therapists are becoming an integral part of the therapy teams. This all started when they asked to be educated about our “therapy world,” productivity and how Rec Therapy can support us.

We started with Recreational Therapists and Therapy Teams coming together to find ways to partner for group treatments. The groups are then scheduled on the activities calendar. By partnering with recreational therapy, it was an easy “in” for our therapy teams to start integrating group treatment into clinical practice. Additionally, it allowed the therapists to screen participants who are not on therapy caseload for any declines or needs for therapy intervention.

It also created a way for our therapy teams to better understand the role of Rec Therapists and how they are critical to the success of our facilities. Once they understood what Rec Therapy was focused on, they quickly realized that the partnership and designing of tailored activities was a perfect functional maintenance program opportunity. This allowed our patients to maintain functional levels after being discharged from therapy and it gave our recreational therapists tools to have successful participation in groups. A specific example was integrating our Abilities Care Approach with Rec Therapy by being advocates of the life story boards during their activities and groups. It allowed the Rec Therapists to have very specific, meaningful information on each resident to enhance the experience.

As Kami conducts facility visits and training with the facility recreational therapists, she includes the therapy teams and shares best practices. Kami also supports MOCK surveys by doing both resident and resident council president interviews to follow up on the “hot topics” and make sure they are being addressed properly. Having this partnership has definitely improved the quality of life for our residents along with creating a greater appreciation of our recreational therapy partners.