Nypta newsletter mar apr 18 by APTA New York

March/April, 2018 Volume L, NO. 20

Empire State Physical

Therapy

The O fficia l N e ws l et t e r o f t h e Ne w York Phy si cal The rapy A ssoci at io n , In c.

IN THIS ISSUE

2018 Lobby Day is a Call to Action Cover Story (page 1, 3)

Achieving a More Perfect Practice Environment President’s Letter (page 2, 6)

Awards Description, Criteria and Form (page 4-5)

Photo taken at Lobby Day 2017

2018 Lobby Day is a Call to Action By Jacob I. McPherson, PT, DPT, MSCS, Public Policy Committee Chair

2018 Leadership Development Workshop (page 7)

Member Spotlight: Kathy Birnbaum, PT (Retired) (page 8)

2018 Winter Board of Director's Meeting Report (page 10)

Ethical Considerations in Using Social Media in PT Practice (page 12-13)

2018 Mini-Conferences Schedule (page 18)

Osteoporosis: Get the Facts (page 19-24)

www.nypta.org

Greetings fellow members and Happy Spring! The 2018 NY Legislative Session is officially underway and our legislative team has been gearing up for its start. Our priority bills have been reintroduced within the legislature and we are monitoring other bills which may impact physical therapy. We are now looking for support from our members and will track the progress of our bills as we approach the main event each year – LOBBY DAY APRIL 17th! I am excited for this opportunity to start building energy and support for our legislative activities happening over the next few months. Lobby Day 2017 was one of our most successful lobbying events in several years. By the end of the session we were able to see passage of both the DPT Title Protection and PTA/Workers’ Comp bills by the legislature. The highlight of last year’s efforts came when the Title Protection bill was eventually signed into law. As we look toward this year’s advocacy events we are eager to pick up where we left off! We have added a new Legislative App to our arsenal of tools and encourage everyone to download the PT Action app from your app store. This will provide convenient access to legislator information as well as bill language and talking points for our bills.

March/April, 2018 • Empire State Physical Therapy 1

Achieving a More Perfect Practice Environment

President’s letter

Volume L, No.20 March/April, 2018

EM P II R E M P RE E A L L PPHHY YS SI I CC A

S TS AT TAET E

T THHE ER A R PA YP Y

Volume XXXIX, No.(8), November/December, 2005

Publisher

Hello my fellow members, I hope that you are all doing well as winter 2018 continues to remind us that spring is not quite here yet. As I sat at my window watching the last storm leave its snow/ice mix behind, my mind began to wander. I found myself thinking of our profession. Those of us who were around or grew up in the 1960s will remember a huge hit recording by a group called The Monkees. The song was called, Daydream Believer. As I sat at my window that day in my mind I thought about a wonderful world of Physical Therapy practice in NYS. My daydream that day was one of practicing my profession in a more perfect environment. An environment where PTs are able to evaluate and treat a patient/client without a physician referral and without limitation with regard to number of visits or the duration of the episode of care. An environment where all patients had greater access to physical therapy care in part because of unrestricted direct access and lower co-payments for those services. An environMichael Mattia, PT, DPT, MS, MHA ment where our PTAs who are the only recognized extender of our care are recognized by the NYS Workers Compensation system, so that the services rendered by our PTAs is valued and reimbursed.

“We can make our dreams and visions a reality if we work together and use our collective energy” Mike

An environment where we collaborate with other healthcare providers who value our specialized skills and understand the difference between working together and infringement upon our scope of practice. An environment where our elected officials recognize the value that physical therapists and physical therapist assistants provide to the health care delivery system in NYS and our ability to make a positive impact on the health and wellness of our communities. Well my friends, I may like my music, and I believe in all of the visions that I have presented to you in the few words I’ve shared with you so far, but, it is a daydream that is close to becoming reality. As I write to you, we have multiple pieces of legislation introduced that if passed, would allow for unrestricted direct access and lower co-payments for our services which will tear down a financial barrier for patients who seek our care. We have already passed legislation twice that provided recognition of our PTA colleagues in the NYS Workers Compensation System. Unfortunately, both times the bills were vetoed by our governor who, at best, is resistant to any changes made to the System without total reform. We continue to work with other healthcare providers to ensure that all healthcare professionals in our state are able to provide their services to our communities while not continued on page 6 2 Empire State Physical Therapy • March/April, 2018

New York Physical Therapy Association 971 Albany Shaker Road Latham, NY 12110 Phone: 518.459.4499 • Toll-Free: 800.459.4489 Fax: 518.459.8953 www.nypta.org

Editor / Designer Gloria Baker Empire State Physical Therapy is published 6 times yearly, with combined January/February, March/April, May/June, July/ August, September/October and November/December issues. Its purpose is to provide physical therapists, physical therapist assistants and physical therapist/physical therapist assistant students with accurate and timely information relevant to the practice of physical therapy. The editor reserves the right to edit all communications. Anonymous letters will not be published. Views expressed are those of the author and do not represent the formal position of NYPTA unless expressly stated.

Editorial Board Catherine Talbett, PT, DPT, PCS, Cert. MDT Alanna Pokorski, PT, DPT

Advertisements

All advertisements in Empire State Physical Therapy must comply with the ethical standards of the APTA. Acceptance of advertisements in this publication does not imply endorsement.

Submission of Material for Publication Submissions should be sent via email to Gloria Baker, Editor, at gbaker@nypta.org. Submissions are subject to the discretion of the editorial board.

Subscriptions

NYPTA members automatically recei ve this publication. Nonmember subscriptions are $100 (US) or $150 (non-US) annually. This price includes sales tax, shipping and handling.

Deadlines Editorial and advertising deadlines are the first business day of the month prior to the month of publication.

Chapter Officers

President Vice President Treasurer Secretary Speaker Chief Delegate

Michael Mattia, PT, DPT, MS, MHA Tracy Sawyer, PT, DPT Keri Gill-Smith, PT, DPT, CLT-LANA JJ Mowder-Tinney, PT, PhD, CSRS, NCS Lynn Rivers, PT, PhD James Dunleavy, PT,DPT, MS

Chapter Directors Brooklyn/Staten Island Catskill Central Eastern Finger Lakes Greater New York Hudson Valley Long Island Southern Tier Western

Michael Masaracchio, PT, PhD, OCS, FAAOMPT Jill Taylor, PT, GCS Jonathan Small, PT, DPT Sarah Gardner, PT, OCS Andrew Bartlett, PT Rebecca Kalb, PT, DPT, SCS Nannette Hyland, PT, PhD Robert M. Streb, PT, PhD John Winslow, PT, DPT, MTC, ATC, OCS Jacob I. McPherson, PT, DPT, NCS

Chapter Office Staff

Executive Director Kelly Garceau kgarceau@nypta.org Communications Manager Gloria Baker gbaker@nypta.org Meetings, Marketing & Membership Manager Carla Rosenbaum crosenbaum@nypta.org Administrative Assistant Kate Teidman kteidman@nypta.org

www.nypta.org

2018 Lobby Day is a Call to Action continued from page 1

Our Direct Access expansion bill which was introduced late last year will have more time to gain recognition and support this session. Also, our revised Copayment Reform language will also be a priority item for us again this year. The full legislative agenda can be found on our webpage https://nypta.site-ym.com/group/PP. Talking points will be updated and appointments will be made but what is truly vital to our success is YOUR PARTICIPATION!! Firsthand accounts from PRACTICING CLINICIANS, ACTIVE EDUCATORS, BUSINESS OWNERS, AND ADMINISTRATORS are what resonate with members of the legislature. We need to increase the number of practicing therapists and therapist assistants advocating both in Albany and at the district-level. Our success hinges on our ability to educate our legislators on issues impacting both OUR profession and their constituents. In addition to participation in Lobby Day I would like to continue to encourage members to participate in local meetings with your legislators. If you are unable to participate in Lobby Day a local meeting is an excellent opportunity to establish a rapport and connection with your member of the legislature. This will also re-introduce our issues to them so that at Lobby Day they can be followed up with to discuss the issues further. Stay tuned for additional information related to the logistics of Lobby Day as well as updated talking points for meetings with your legislators. Your legislative liaisons will be hard at work setting up our appointments and making transportation arrangements. Your time away from clinics, practices, classrooms, or rehab departments will prove a worthwhile investment if we can move these issues. Please come to Lobby Day or your local meetings armed with personal stories demonstrating our value to patients and the public. It is you, our membership, whose continued commitment and passion for physical therapy will make the difference!! Sincerely, Jacob I. McPherson, PT, DPT, NCS, MSCS, Public Policy Committee Chair

Communicate to Your Legislators NYPTA and its members are looking for legislators to support: Unrestricted direct access to physical therapy (S.6024/A.7873)

• Provides less expensive, more timely care by licensed professionals.

Elimination of the high-copays for physical therapy services (S.5764A/ A.059A) • Allows for greater patient access to physical therapy services

Detailed talking points can be found at: https://nypta.site-ym.com/group/PP

www.nypta.org

March/April, 2018 • Empire State Physical Therapy 3

AWARDS COMMITTEE SEEKS NOMINATIONS Any Chapter member or district may submit nominations. It is important that all nominations be well supported with information about the nominees’ activities that indicate their appropriateness for the award. To be considered valid, all nominations must be submitted on the official form by April 13, 2018. Multiple entries may be submitted. The following is a list of descriptions of NYPTA awards:

1. Dr. Marilyn Moffat Distinguished Service Award. This award recognizes an NYPTA member who has made an outstanding contribution to physical therapy. The recipient will have demonstrated consistent service to the development of the physical therapy profession, beyond that which is inherent in being a member of the profession. This commitment of service is demonstrated by contributions to the profession in the following areas: 1. The profession of physical therapy in any of the following areas: a. Education. The recipient has fostered the development of quality learning experiences that promote sustaining and improving the physical therapy profession, including teaching in areas such as academic, in-service or continuing education; development and implementation of teaching methods; administration of a PT program. b. Clinical research. The recipient has initiated or participated in laboratory and/or clinical research that has promoted the development of the physical therapy profession and has published or disseminated the results of such research. c. Service. The recipient has demonstrated service to the profession in patient care, consultation, administration or education as a liaison to other health care organizations and/or committees. 2. The APTA or its components: The recipient has promoted the organization and its goals. 3. Community: The recipient has demonstrated involvement in organizations such as service organizations; local, state or federal government in an elected or voluntary capacity.

2. NYPTA Lifetime Service Award. The recipient shall have demonstrated a commitment to the profession of physical therapy by serving NYPTA: 1. Throughout their physical therapy career on an ongoing, consistent basis. 2. Through service primarily to the Chapter in any elected or appointed capacity but may also include District or National activities. 3. By providing contributions that are worthy of mention and which will be judged on the basis of results and not merely the duration or continuity of that service.

Chapter Award General Criteria: 1. Candidates must be members in good standing of the APTA and may be nominated by any member of the New York Chapter. However, candidates for the New York Chapter Appreciation Award need not be APTA members. 2. Nominations must be submitted on the official form found on page 7. 3. Unsupported nominations will not be considered. 4. A committee appointed by the Board of Directors will consider all nominations and choose recipients. 5. Recipients of the Dr. Marilyn Moffat Distinguished Service, New York Chapter Appreciation, Public Relations and Merit Awards will be notified two weeks prior to the Delegate Assembly to ensure their presence during the presentation of awards. 6. All awards will not necessarily be presented each year.

4 Empire State Physical Therapy • March/April, 2018

3. Leslie J. Wood Outstanding Service to Chapter Award. The recipient will have made outstanding contributions to the New York Chapter in promoting the organization and its goals.

4. Merit Award. The recipient will have made meritorious contributions in one of the following capacities: as a member of the Chapter Board of Directors, as a task force or committee Chairperson, or by committing time and resources to the Chapter and the profession. 5. Doreen Frank Legislative Award. The nominee shall have demonstrated consistent, outstanding participation in the legislative arena by promoting initiatives that preserve, protect and advance the practice of physical therapy in NYS. Activities shall include the following: a) attendance at Lobby Day b) interaction with legislators re: current legislative issues c) promotion of and participation in PAC activities d) involvement in legislative activities on a district and/or chapter level.

6. Public Relations Award. The recipient will have fostered public awareness of the profession of physical therapy through utilization of the media, community activities, special events or promotion of PT Month, etc. Nominations may be submitted for Districts, individuals, facilities or schools, and must be substantiated by written information, photographs, brochures/printed materials or copies of articles, etc. Activities of Chapter committees are not eligible for consideration.

7. New York Chapter Appreciation Award. This award is not limited to physical therapists or APTA members. The individual will have fostered the ideas and/or ethics of physical therapy through service to the New York Chapter or the profession. 8. Outstanding Service to District Award. The recipient will have made outstanding contributions to a district.

9. Leadership Development Award. Recipients of this award should exemplify the spirit of leadership development within the profession through, but not limited to, the following: a) Participation or promotion of mentor/protégée relationships; b) Participation or promotion of attendance at the Leadership Development Workshop, Delegate Assembly, Lobby Day or other association leadership activities; c) Creation and implementation of innovative ideas for developing leaders within the profession; c) Creation and implementation of methods to keep the spirit of leadership alive throughout the professional life cycle. The following outlines further specifications for this particular award: a) Nominations may be submitted for Districts, individuals, facilities or academic programs; b) Nominees should be Chapter members; in the case of facilities or academic programs, the individual spearheading the effort should be a chapter member; c) Nominations must be substantiated by written information including data collected regarding numbers of individuals affected by the leadership efforts; d) Members of the Chapter Leadership Committee are not eligible for this award while in office.

www.nypta.org

NYPTA Awards Nomination Form All portions of this form must be completed for the nomination to be valid. The form may be photocopied to accommodate multiple entries. Please send this form to the Chapter office: NYPTA / 971 Albany Shaker Road / Latham, NY 12110 Attn: Awards Committee. • • • Deadline for submitting nominations: April 13, 2018. • • • Please print or type Nominee’s name:_____________________________________________________________________ District:_____________________________________________________________________________ Award:  Dr. Marilyn Moffat Distinguished Service Award  NYPTA Lifetime Service Award  Leslie J. Wood Outstanding Service to Chapter Award  Merit Award  Doreen Frank Legislative Award  Public Relations Award  New York Chapter Appreciation Award  Outstanding Service to District Award (only one individual to be submitted by each district)  Leadership Development Award

Association activities: These include elected or appointed positions at the national, chapter and/or district levels, and involvement in committees, task forces, etc. Please provide as much information as possible, including dates. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ How do the candidate’s contributions affect eligibility for the award? Please be specific. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ (For Public Relations Award only) Please describe activity in detail and submit materials as specified in award criteria: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Nominations submitted by: (individual, committee, board member, district)

_____________________________________________________________________________

www.nypta.org

March/April, 2018 • Empire State Physical Therapy 5

Achieving a More Perfect Practice Environment infringing upon the very special care that physical therapists and physical therapist assistants provide. We have also seen that our elected officials and community leaders are recognizing the transformative power of physical therapy and our ability to impact our communities with regard to the opioid epidemic. So, you see my friends, my vision or daydream is closer to reality than one may think. What we need to make my dream come true is each and every one of you. I frequently speak of our collective energy. As we enter into the spring, we will work with our legislators to advance our legislative plan, we will hold our Delegate Assembly to elect our leaders, and we will work on governance to prepare for our Chapter’s role at the national level through our delegation to the APTA House of Delegates. Our chapter needs each and every one of you to get involved and to be an active participant in the activities that will be taking place over the next few months. We need you to attend Lobby Day 2018, which will be held on Tuesday April 17th. We need you to make a visit to your local assembly and senate representatives at their district/home office to discuss our initiatives and legislation, we need you to make calls, write letters or send an email when needed. We need you to support our Political Action Committee or PAC. Without funding, advancing our legislative plan is a very tough lift. I urge each of you to visit the Chapter website to see how you can be a more proactive member, and I ask each of you to attend a district meeting. Your local district meeting is where the real grassroots efforts live. It is where every member can find their way as a more active participant in everything that is offered by our wonderful Chapter and the APTA. It is at the district meeting that you can arrange to make local legislative visits and arrange for your participation along with a mentor. My fellow members, we have made significant progress over the last few years, and we are getting closer and closer to making my “daydream” a reality. I know we can make our dreams and visions a reality if we work together and utilize our collective energy. We are truly “better together”. Work alongside me and all of our fellow members as we advance PT practice and advocate for our patients and communities. I guess in the end, I am a “daydream believer.” What about you? I urge you to join up, join us and join in. Let’s make our visions reality.

Research Committee Vacancy

The Research Committee is currently seeking a new committee member to join the Research Committee starting July 1, 2018. The primary responsibilities of the Research Committee are to review abstracts for the Chapter Conference, organize and implement a research-related program at the Chapter Conference, review applications and recommend funding for the Arthur J. Nelson Research Designated Fund, and serve as consultants to chapter members for research activities. Responsibilities also may include other special projects related to objectives established by the committee. Although members of the committee are often physical therapists who have earned advanced research degrees, membership is open to clinical experts who can provide input and clinical perspective when reviewing abstracts, grant applications, and when assessing the needs of the membership with regard to research mentorship. Terms of appointment are 4 years. If you are interested in being considered, please forward your resume or curriculum vitae electronically to research@ nypta.org. Further, feel free to contact a current member of the committee if you have any questions about service on the Research Committee. Laura Z Gras, PT, DPT, DSc, GCS (Chair) lgras@ithaca.edu Michael D. Ross PT DHS OCS (Incoming chair) mross@daemen.edu Gary Brooks, PT, DrPH BrooksG@upstate.edu Ayse Ozcan Edeer, PT, PhD ayse.edeer@dc.edu 6 Empire State Physical Therapy • March/April, 2018

www.nypta.org

2018 Leadership Development Workshop By Audrey Paslow, PT, DPT, NCS, Leadership Committee Chair

The Leadership Committee is excited to announce the annual Leadership Development Workshop! Scheduled for Friday, May 11th, from 12-4:30 PM, this activity is meant for any member interested in learning more about the governance at both the state and national levels. This dynamic learning experience gives participants multiple opportunities to observe, interact and engage in the NYPTA governance process. Physical Therapists and Physical Therapist Assistants can receive 4.25 CEUs for attending the Leadership Development Workshop in conjunction with staying to represent their local district as a Delegate or attending the Delegate Assembly as a guest observing from the gallery. We are honored to welcome back our Keynote Speakers, Dr. Matt Hyland and Dr. Lynn Rivers. Dr. Matt Hyland will present “Engagement in the Profession: Contributing to the Vision for Physical Therapy” and Dr. Lynn Rivers will present “Governance in the APTA: Tools to be Effective in Contributing to Decision-Making for the Profession”. Both speakers will offer insight from their personal experience and key perspectives of issues facing our profession as we move forward. In addition to lecture, participants will get the opportunity to observe the Board of Director’s meeting with the Executive Committee, District Directors, and Committee Chairs immediately followed by the opportunity to personally meet and speak with the various members of the BOD. The Friday afternoon session concludes with participants actively engaging in a Mock Delegate Assembly addressing motions that will be discussed at the DA the next day. After the end of this two-day leadership opportunity, PTs, PTAs, and students will leave empowered with the knowledge of how individual members can step up, get involved, and have an impact on the growth and direction of their state and national organization! Each District may sponsor individuals to attend; the Committee will additionally sponsor one individual from each District to attend the workshop. To register, please speak with your local District Chair. There is no fee to register; don’t wait to sign up!

A Look Back at the 2017 Leadership Development Workshop

www.nypta.org

March/April, 2018 • Empire State Physical Therapy 7

Member Spotlight: Kathy Birnbaum, PT (Retired)

How long have you been a member of the NYPTA? What is your best experience thus far? I have been a member of NYPTA since I was a student at Ithaca College, making this my 41st year of membership! I would say that being a part of the governance of the association has been interesting, and educational over the years. My first active participation was as Continuing Education Coordinator for Hudson Valley District. I am honored to say that the Outstanding Service to District was created to recognize Liz Gaynor and I, as co-chairs of the CE committee. It is a very exciting feeling to know that the award continues today and the nominees are well known at a district level. I have participated on district, chapter and national levels, and always learn something about organizations, this association and myself. Tell us a little about your background, and how your path led you to where you are in your career today. What's your favorite moment of your career so far? I have a sister who is developmentally disabled, my maternal grandfather had polio and my paternal grandmother had severe arthritis--she used to travel from Albany to Yonkers for gold injections! Those first hand experiences with ability challenges and a volunteer opportunity at my sister’s residence led me to the profession of PT. There are so many favorite moments of my career, and the common theme is seeing former “patients” in the community and hearing the positive feedback of their experience with PT. We all like positive reinforcement of what we do--and that is why being Chair of the Awards Committee is important to me. It is an opportunity to give someone a favorite moment in their profession. What is a typical day like for you? In my “retired” days, I continue to visit my mother, a nursing home resident, explore my long time hobbies of sewing and embroidery, and keep active at the district and chapter levels. What are you passionate about? Sharing joyful moments is always top on my list, whether I am sending a comic to a friend that reminds me of something we did together, or calling my children to tell them to go out and look at the beautiful full moon. What else would you like your fellow NYPTA members to know about you? For inside information, meet me at the Delegate Assembly for the presentation of the Awards!!! And before that, send in nominations for your colleagues. What is your favorite app or social media outlet? I recently joined Facebook...and I think that’s as far as I can go. What is your guilty pleasure? My husband Ken and I have daily competitions for The Jumble and Jeopardy.

8 Empire State Physical Therapy • March/April, 2018

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March/April, 2018 • Empire State Physical Therapy 9

The 2018 Winter Board Meeting Report by J.J. Mowder-Tinney, PT, PhD, Board Secretary

On January 20, 2018, the New York Physical Therapy Board of Directors (BOD) held a web-based meeting. Multiple motions were passed at the meeting. • Four motions approved amendments to update Committee procedure manuals to reflect the committee’s current practice. These manuals were for the following committees: Research, Awards, Finance and Practice Committees. • Motion to approve moving $1,797, which was encumbered in the Special Projects account, to the NYPTA Excess Reserve Account. The campaign utilizing these funds had concluded and needs to be moved to be able to be utilized for future special projects. • Motion to approve the House of Delegates Delegate Manual. • Motion to approve the Nominating Committee Chair, or his/her designee, be funded to attend the Spring Board of Directors meeting. • Motion to submit a motion to the Delegate Assembly stating: the term of office for Chapter Delegates shall begin in the year of election/elections on the date of submission of Chapter Delegate roster to APTA and shall end upon submission of the delegate roster the following year. The Generative Discussion for the meeting was robust and included extensive discussions regarding the best way that the NYPTA could support the special interest groups (SIGs). This was particularly focused on supporting the newly rejuvenated Student SIG and included discussing items for funding options. There were general discussions regarding challenges with reimbursement rates, an update regarding New Jersey being the 18th state where Licensure Compact legislation was approved, and revisiting ideas of ways to reach out to non-members to increase membership. In addition, the benefits of reinstating District Liaisons was considered along with increasing the role of the Awards Committee in relation to National Awards. Thoughts were shared regarding the funding of Delegates and different ways to provide support. The meeting included committees requesting feedback from the Board of Directors. The request was made by the Program Committee for general feedback and suggestions regarding the 2017 conference. The Public Policy Committee invited suggestions on the labeling of bills stating the committee is looking toward branding or labeling bills clearer to waylay any confusion of their meaning. Finally, the Marketing and Engagement Committee provided an update on the Opioid Campaign and the multiple opportunities that have allowed the progression of this important campaign. The meeting was concluded with Good and Welfare. Respectfully submitted by J.J. Mowder-Tinney PT, PhD

10 Empire State Physical Therapy • March/April, 2018

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March/April, 2018 • Empire State Physical Therapy 11

Ethical Considerations with the Use of Social Media in Physical Therapy Practice by Andrew Opett, PT, DPT, Ethics Committee Chair

It has been estimated that up to 81% of the United States population had a social media profile in 2017. This was an increase from just 24% in 2008.1 It can be argued that the use of social media has improved the healthcare system in many ways by allowing patients to be better informed about their provider, provider network, and their overall care.2,3 In recent years there has been an increase in the use of social media by physical therapists for purposes including but not limited to marketing, patient education, and blogging. This has been accomplished through platforms such as Facebook and Twitter, which would be considered personal networks, and Linkedin which would be considered a professional networking platform, to name a few.4 Despite the advantages of these platforms in healthcare settings, they must be used responsibly in order to avoid legal and ethical dilemmas. Pitfalls and concerns regarding the use of social media platforms that have been reported in the literature include patients stalking their providers, providers disclosing sensitive personal health information, and providers and students posting disrespectful and inappropriate comments regarding patients under their care.2 A 2009 study found that among medical schools that were surveyed, 60% reported incidents of students posting unprofessional comments about their patients.5 It is imperative that healthcare organizations delegate a committee or task force to oversee the activity on social media platforms. Despite the fact that physical therapist education programs include content on ethical and legal issues, employee orientation and training programs should include content on ethics and defining the boundaries between personal and professional life. Not all instances of unethical behavior through social media activity are deliberate. An article by Parsi and Elster2 offers case examples of unethical behaviors in the medical profession. Consider the following case scenarios that have been adopted from this article and modified to represent a physical therapy setting2: Case scenario #1: A physical therapist is treating a patient with a dermatological condition that she is unfamiliar with. She asks for and is granted permission to photograph the affected area, however she does not disclose to the patient what she plans to do with that information. The therapist then posts the photograph to Facebook in the hopes that coworkers and colleagues that she is connected with can assist her with the patient case. Despite the fact that there is no identifiable patient information in the picture, an ethical dilemma does exist in that the patient was not informed of what would be done with the picture and a colleague or coworker could likely figure out the identity of the patient because of knowledge of that therapist’s case load. Case scenario #2: A pediatric physical therapist is providing care to a patient and after some time the patient’s mother sends a request to connect or “friend” with the therapist on Facebook. The therapist recognizes the potential ethical concern with this and declines the request as it challenges personal and professional boundaries. Because she does not want to disappoint the mother, she considers the use of Linkedin, which is a professional networking site rather than a personal one. This scenario could be considered unethical, particularly if the patient’s mother uses this social media platform to reach out to the therapist directly. Furthermore, if multiple patients are connected to this provider they may also be connected to each other, which would reveal their identity. In 2012, the APTA House of Delegates established a position regarding standards of conduct in the use of social media (HOD P06-12-17-16). This position encourages physical therapists, physical therapist assistants, and physical therapy students to be professional in their use of social media, safeguard identifi-

12 Empire State Physical Therapy • March/April, 2018

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Ethical Considerations with the Use of Social Media in Physical Therapy Practice by Andrew Opett, PT, DPT, Ethics Committee Chair

able patient/client information, and be cognizant of personal and professional boundaries. The position also mentions that if an individual discovers inappropriate or unprofessional behavior that has been posted by a colleague, the individual has the responsibility to bring it to the attention of the colleague so that the inappropriate material can be removed. Lastly, the Code of Ethics and for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant should be followed when engaging in the use of social media. A link to this HOD position statement is included below for further reading. Physical Therapists, Physical Therapist Assistants, and students are encouraged to read and understand these documents before engaging in social media in order to avoid ethical dilemmas or misrepresentation of themselves, their organization, or the APTA. These topics are also good for healthy discussion among colleagues in order to maintain the highest ethical and legal standards in Physical Therapy Practice. References: 1. https://www.statista.com/statistics/273476. Percentage of US Population With a Social Media Profile from 2008-2017. Accessed 2/12/18 2. Parsi K, Elster N. Why Can’t We Be Friends? A Case-BasedAnalysis of Ethical Issues with Social Media in Healthcare. American Medical Association Journal of Ethics. 2015;17(11): 1009-18. 3. Denecke K et al. Ethical Issues of Social Media Usage in Healthcare. IMIA Yearbook of Medical Informatics. 2015;10:137-47. 4. Ventola LC. Social Media and Healthcare Professionals: Benefits, Risks, and Best Practices. Pharmacy and Therapeutics. 2014;39(7):2014. 5. Chretien KC, Greysen SR, Chretien JP, Kind T. Online posting of unprofessional content by medical students. JAMA. 2009;302(12):1309. Link to HOD P06-12-17-16 : https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Ethics/ StandrdsConductSocialMedia.pdf

Students Meeting with Senator Gillibrand Aide Third Year physical therapy students from SUNY Downstate Medical Center, met with Senator Gillibrand’s aide, Greg Smiley. During the meeting, the students discussed legislative issues of importance to physical therapists, and their patients on the federal level. The key issue discussed was the Medicare Cap for PT/OT, and the need for its repeal to ensure patients have access to timely and appropriate care. Students who attended the meeting were: Micah Sommers, Alex Maymon, Jeong Yun Kim, Michelle Andoy, Ellie Nutter, Mary Feng, Melissa Goldstein Davis, Dino Acuri, Bernard Boakye, Adelina Kurinets, Jeremiah Fleming, Haipei Li and Katya Alenichko

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March/April, 2018 • Empire State Physical Therapy 13

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March/April, 2018 â&#x20AC;˘ Empire State Physical Therapy 15

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16 Empire State Physical Therapy • March/April, 2018

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News & Announcements

M2018 Mini - Conferences The NYPTA has heard what members are asking for, and we are delivering! Requests to have continuing education courses held throughout the state have resulted in the second year of the NYPTA Mini Conference Series. We are thrilled to offer locations in Long Island and Schenectady, that will feature full day continuing education seminars. • September 15th – Danford’s Marina Hotel, Port Jefferson • October 20th – DoubleTree Hotel, Schenectady

More information on each mini-conference can be found on the following page.

Congratulations to Greater New York District - the 2017 Recipient of the Golden Goniometer Award! This year’s winning district had a variety of submissions, including creating an NYPTA team of 63 participants to participate in a 5K, which raised $2,450.00 for cancer research. The district also hosted a student social, challenged all district members to change their social media profiles to the #ChoosePT frame, posted #ChoosePT statistics on social media accounts, and created video PSAs on why patients should choose PT as a safe alternative to opioids for

NYPTA dues may be tax deductible. Below is the portion of your dues that is not deductible as an ordinary and necessary expense to the extent that APTA and NYPTA engage in Lobbying: The non-deductible portion of your Chapter dues is 12% The non-deductible portion of your National dues is 21%

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Upcoming Events Lobby Day April 17, 2018

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Spring BOD May 10-11, 2018 Holiday Inn Saratoga Springs, NY 12866

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Delegate Assembly May 11-12, 2018 Holiday Inn Saratoga Springs, NY 12866

To report suspected cases of professional misconduct or unlicensed practice of the professions, call 800-442-8106 or email conduct@mail.nysed.gov.

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March/April, 2018 • Empire State Physical Therapy 17

2018 Mini-Conferences Overview September 15th – Danford’s Marina Hotel, Port Jefferson Course Title: Rehabilitation of Balance and Vestibular System Disorders Presented by: Arturo Miguel, PT, MS, MBA Course Description: Rehabilitation of Balance and Vestibular System Disorders is an evidence based introductory course that will train clinicians in identifying balance and vestibular impairments and formulating comprehensive treatment plans for their patients in an inpatient and outpatient setting. This course will include a detailed review of balance senses and balance strategies as well as discussion of balance screens and treatment considerations. In addition, there will be a brief introduction into vestibular therapy including anatomy and physiology of the vestibular system, oculomotor screening and treatment techniques. The material will be presented in lecture, demonstration, lab and video format. CEHs: 6.5 Online Registration: Will be available late summer

October 20th – DoubleTree Hotel, Schenectady Course Title: Get Your Head in the Game: Rehabilitative Strategies to Address Concussions Presented by: Audrey Paslow PT, DPT, NCS Course Description: This introductory course will cover the basics involving concussion management evaluation and treatment strategies for the physical therapist. The speaker will present a multi-faceted evaluation approach, the domains of health affected by concussion, and the treatment strategies that accompany each evaluation technique. This includes assessment of the cervical spine, oculomotor and vestibular evaluations, balance assessment, and finally, addressing the importance of including exertional testing and retraining with a specific protocol. The speaker will include information on health literacy and learning as it affects this population, as well as a break-out sessions of patient case examples to work through. CEHs: 6.5 Online Registration: Will be available late summer

18 Empire State Physical Therapy • March/April, 2018

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Osteoporosis: Get the Facts

by Jeri W Nieves, PhD and Shari Silverstein, RN, MS, CNS

Osteoporosis Definition and Epidemiology Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength primarily reflects the integration of bone quality and bone density. Osteoporosis is clearly a public health concern. In the US, approximately 1 in 2 women and 1 in 4 men over the age of 50 years will have an osteoporosis-related fracture. In the US approximately 54 million Americans have low bone mass or osteoporosis placing them at risk for osteoporosis related fractures. Vertebral fractures may cause pain, a loss of height (> 1.5 inches height loss) and kyphosis or a Dowager’s Hump. Multiple vertebral fractures in the thoracic region may result in restrictive lung disease and lumbar fractures can cause alterations in abdominal anatomy leading to digestive discomforts. Over 500,000 vertebral fractures occur each year in the US. Hip fracture, the most serious consequence of osteoporosis, usually occurs in older adults as a result of a fall and typically requires surgery. About 300,000 hip fractures occur in the US each year. Twenty-four percent of patients die in the year following a hip fracture as a result of complications. One in five of those who were ambulatory before their hip fracture requires long-term care afterward; and at six months after a hip fracture only 15 percent of hip fracture patients can walk across a room unaided. A major concern is that once an individual has a fracture the risk of a subsequent fracture is substantially increased. For example, hip fractures are associated with a 2.5 fold increase in the risk of future fractures. In the year following vertebral fracture, there is a 20% increase in the risk of another vertebral fracture. Therefore, it is imperative to treat an individual with osteoporosis medications after having a hip or spine fracture if we want to prevent future fracture. Osteoporosis is not inevitable and steps toward prevention can reduce the burden of this disease. In the Surgeon General’s report on Bone Health and Osteoporosis (2004), he stated, “Much of this considerable burden can be prevented…by applying what is already known about early prevention, assessment, diagnosis and treatment”. The goal of the New York State Osteoporosis Prevention and Education Program (www.nysoppep.org) is to provide healthcare professionals with current, evidence-based information about osteoporosis, this will help facilitate a collaborative approach to prevent and treat osteoporosis. www.nypta.org

March/April, 2018 • Empire State Physical Therapy 19

Osteoporosis: Get the Facts

by Jeri W Nieves, PhD and Shari Silverstein, RN, MS, CNS

Pathophysiology of Osteoporosis: Bone is a living and growing tissue and is constantly being renewed in a process called remodeling. The remodeling process is complex but includes two main types of cells, osteoclasts and osteoblasts. Osteoclast cells cause bone resorption and their main action is to remove old bone. The osteoblast cells form new bone. The process of remodeling helps to repair any skeletal micro-damage. Bone building occurs during growth when more bone is laid down than removed. Bone mass is maintained when bone formation equals bone resorption. Bone loss occurs when bone resorption exceeds bone formation. Certain metabolic states, such as low serum calcium, will lead to excessive bone resorption to increase the calcium supply. Biochemical markers of bone turnover are also released during this process and these can be measured in blood and /or urine. These measurements can help determine how rapidly bone is being resorbed or being formed. Bone turnover markers can be used to determine if an individual with moderately low bone density should be treated with a medication. Bone turnover markers can also help monitor how well an osteoporosis medication is working. These tests cannot be used to diagnose osteoporosis. Commonly used bone turnover markers include serum c-telopeptide (CTX) for bone resorption and osteocalcin for bone formation. Bone specific alkaline phosphatase, urine N-telopeptide (resorption) may also be used and propeptide Type 1 procollagen or P1NP (formation) is not yet commercially available. Risk Factors for Osteoporosis Risk assessment should be the first step in taking an active role in the prevention, diagnosis, and treatment of osteoporosis. Many risk factors for osteoporosis cannot be modified, while others are modifiable. Risk factors that cannot be modified include: • Fracture after age 50, with minor trauma • Family history of a first-degree relative with osteoporosis and/or fracture • Female gender (although men get osteoporosis, too) • Advancing age (women greater than 65, men older than 70) • Ethnicity (higher risk in Caucasian or Asian individuals) • Early menopause (surgically or naturally occurring) at age 45 or younger • Height loss of more than 1.5 inches. Examples of diseases and medical conditions that cause bone loss and/or increase the risk of osteoporosis include: • Malabsorption (inflammatory bowel disease, celiac disease, liver disease) • Hyperthyroidism and hyperparathyroidism • Diseases associated with immobility or bed rest for more than 6 months (stroke, Parkinson’s disease, multiple sclerosis) • Rheumatoid arthritis. 20 Empire State Physical Therapy • March/April, 2018

www.nypta.org

Osteoporosis: Get the Facts

by Jeri W Nieves, PhD and Shari Silverstein, RN, MS, CNS

Some medications that lead to bone loss, increasing the risk of osteoporosis include: • Steroid medications > 5 mg/d of prednisone for >3 months • Excess thyroid hormone replacement • Certain anti-seizure medications (Dilantin or phenytoin, Depakote) • Aromatase inhibitors for breast cancer • Androgen deprivation therapy (ADT) for prostate cancer • Long-term use of medroxyprogesterone acetate (Depo-Provera) The following medications are being evaluated for their risk of osteoporosis: • Oral medications for diabetes (TZDs) • Excessive use of proton pump inhibitors • Selective serotonin reuptake inhibitors. To optimize bone health it is generally recommended that individuals who take these medications take the lowest doses possible to control the underlying disease/condition. Healthcare providers may consider selecting another medication that has less potential to adversely affect the skeleton. In addition, it is also important that these patients be considered for bone density test as indicated. There are several risk factors for osteoporosis that can be modified. These include: • Inadequate intakes of calcium and vitamin D • Being physically inactive • Smoking • Excessive alcohol use. Therefore, the following actions to promote strong bones for life provide strategies to reduce the risk of osteoporosis and associated fractures. Actions to Promote Strong Bones for Life All individuals should be advised to eat a varied, nutrient-rich diet including several servings of fruits and vegetables each day. It is also important to consume enough calcium and vitamin D for optimal skeletal health. Consumption of calcium from a variety of foods is recommended. If an individual cannot get enough calcium from food alone, calcium supplements may be added in order to meet the recommendations. Calcium from food (preferred source) plus any supplements (if needed) should be combined to see if the calcium recommendation is being met. There are many foods that contain calcium including dairy foods, non-dairy foods, and calcium-fortified foods. For overall health, it is important to recommend fat-free or low-fat dairy products and other foods. Dairy products include milk, yogurt, cheese and mixed cheese dishes. Non-dairy foods that supply calcium include canned salmon and sardines (eaten with bones); green leafy vegetables (bok choy, dandelion greens, collard greens, kale, mustard greens, turnip greens), dried figs and some nuts (almonds, roasted soy nuts). There are many fortified foods (foods with calcium added) such as fortified cereals, cereal bars, orange juice, soymilk, and tofu. www.nypta.org

March/April, 2018 • Empire State Physical Therapy 21

Osteoporosis: Get the Facts

by Jeri W Nieves, PhD and Shari Silverstein, RN, MS, CNS

Adequate Vitamin D intake helps optimize calcium absorption at all ages, and may have a direct effect on the skeleton, and possibly improve muscle strength. The amount of calcium and vitamin D that is recommended each day is listed below according to a personâ&#x20AC;&#x2122;s age. Table 1: Calcium and Vitamin D Recommendations Calcium and Vitamin D Recommendations Age Calcium (Daily)* Vitamin D (Daily)** 1 to 3 years 700mg 600 IU (400 IU until age 1) 4 to 8 years 1000 mg 600 IU 9 to 18 years 1300 mg 600 IU Men 19 to 70 years 1000 mg 600 IU Women 19 to 50 years 1000 mg 600 IU Women 51 to 70 years 1200 mg 600 IU Men and women 71+ 1200 mg 800 IU *mg = milligrams, IU= International Units *Calcium and Vitamin D recommendations for all ages based on the Dietary Reference Intakes, National Academy of Science, 2010 Many healthcare providers recommend more vitamin D than the above amounts, particularly if an individual is at risk for vitamin D deficiency or has low serum 25(OH)D levels. Vitamin D is produced endogenously when unprotected skin is exposed to the sun. However, there is no vitamin D production when sunscreen is used as recommended. It may be difficult to obtain the recommended levels of vitamin D from food. Vitamin D is naturally present in a few foods such as salmon, halibut, mackerel, tuna, and other fatty fish. In the United States, the most common source of vitamin D is milk that is fortified with 100 international units (IU) vitamin D per 8-ounce glass. Supplementation is often necessary to meet the recommendations, especially in breastfed infants, non-milk drinkers, and older adults. Some calcium supplements and most multivitamins contain vitamin D either as vitamin D3 (cholecalciferol) or vitamin D2 (ergocalciferol), both of which are similarly efficacious as sources of vitamin D for most individuals. Serum 25-hydroxyvitamin D (25OH-vitamin D) levels can be easily measured and current evidence is mixed as to whether 30 ng/ml (75 nmol/L) or 20 ng/ml (50 nmol/L) may be the optimal level for bone health. Promote physical activity every day: In children and young adults, exercise is necessary to build strong bones. After peak bone mass is reached (usually by age 25), exercise plays an important role in maintaining bone mass. In older adults physical activity can help increase muscle mass and coordination to prevent falls. An ideal exercise program for fracture prevention combines the below exercises/activities. Weight bearing exercise. Any physical activity in which the body works against gravity helps build bone mass in youth and maintains it in adulthood. Muscle strengthening exercise. This builds muscle and helps support the skeleton which can improve or maintain bone strength. It is very important to educate older patients to avoid harmful movements when doing strengthening exercises. 22 Empire State Physical Therapy â&#x20AC;˘ March/April, 2018

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Osteoporosis: Get the Facts

by Jeri W Nieves, PhD and Shari Silverstein, RN, MS, CNS

Balance exercise. Balance training may help reduce the risk of falling. Tai Chi is a great example of a balance exercise. Postural training exercise. These exercises can help minimize stooped posture resulting from osteoporosis. Stretching exercise. Stretching helps maintain the motion needed to prevent a loss of balance. As always, safety is important in any exercise program, below is a list of Safe Activity Guidelines that we use. √ Exercise in a pain-free range of motion. √ Exercise in your best posture. √ Breathe through the exercise; do not hold your breath. √ Exercise with smooth, steady movements. √ Always keep a slight bend in your arms and legs. √ If you have had a broken bone or total hip replacement, follow the precautions your physician or physical therapist has given to you. √ After muscle-building exercises, muscles soreness up to a few days is common, but be conscious of exercises that might be producing more persistent pain and consult your physician or physical therapist about whether this exercise is right for you. For individuals with osteoporosis and or history of fracture it is important to avoid certain movements and positions during physical activity and daily activities. These include: Spinal flexion: Instruct your patients to avoid forward bending/flexing of the spine during all exercise and movements. Bending of the spine puts undue stress on each of vertebrae and could cause a fractures. This could include movements where the back is curved too much like toe touches, curl sit-ups, and reaching for the floor with straight legs. Excessive spinal rotation: This is especially important when in a standing or seated position when there is weight through the spine. Heavy Lifting: To prevent injury, it is imperative that heavy lifting is avoided. Teaching proper body mechanics for lifting such as bending knees is helpful in preventing injury for this high risk population. Avoid smoking Anyone with a history of smoking more than one pack of cigarettes per day for more than five years or any individual who currently smokes, is at an increased risk for osteoporosis and related fractures. Quitting smoking is an important way to reduce fracture risk. Your patients can obtain information about how to can quit smoking or using tobacco products; by visiting the NYSDOH Smoker's Quit site: www.nysmokefree.com or by calling 1-866-NYQUITS (1-866-697-8487). Minimize alcohol intake According to several studies, moderate alcohol intake (one drink per day for women and two drinks per day for men) may actually be beneficial for bone health. On the other hand, chronic and heavy drinking (alcohol abuse) clearly increases the risk of falls, osteoporosis and related fractures in both men and women.

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March/April, 2018 • Empire State Physical Therapy 23

Osteoporosis: Get the Facts

by Jeri W Nieves, PhD and Shari Silverstein, RN, MS, CNS

Safety precautions to prevent falls Safety strategies to protect the skeleton are important for individuals of all ages. If someone has been diagnosed with osteoporosis, they can easily fracture as a result of a fall. Individuals at risk of falling should be identified and encouraged to participate in a fall prevention program and have a safety evaluation of their home environment (www.cdc.gov). Bone density testing when indicated A bone mineral density test (BMD test) is a quick, painless, low-dose X-ray that measures the mineral content of the bone and determines the bone density of the skeleton. Dual energy x-ray absorptiometry (DXA) of the hip and spine is the gold standard for diagnosing osteoporosis. A BMD test is the only way to accurately determine if an individual has osteoporosis before a fracture occurs. Treatment of osteoporosis when indicated There are several FDA approved medications for the treatment of osteoporosis. The goal of osteoporosis therapy is to maintain BMD and to prevent fractures. The addition of physical activity with these medications, along with a varied, nutrient-rich diet, are key to successful fracture prevention. NYSOPEP- Your Resource for Healthy Bones The New York State Osteoporosis Prevention Education Program (NYSOPEP) is an educational initiative within the New York State Department of Health committed to helping build stronger bones for life by providing current evidence-based bone health education to the general public and healthcare providers. The NYSOPEP website: www.NYSOPEP.org is a comprehensive, science-based resource for reliable information about the prevention, diagnosis, and treatment of osteoporosis.

24 Empire State Physical Therapy â&#x20AC;˘ March/April, 2018

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New York Physical Therapy Association A Chapter of the American Physical Therapy Association 971 Albany Shaker Road Latham, NY 12110

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March/April, 2018 â&#x20AC;¢ Empire State Physical Therapy 27