Podcasts about pt ot

Enhancing RCM Efficiency with AI Agents and Advanced Document Capture Solutions Join host Stuart Newsome for an Office Hours session as we explore how AI-powered document capture and AI agents are eliminating documentation bottlenecks, reducing manual data entry, and improving claim accuracy across healthcare specialties. Learn how AI is transforming RCM efficiency for radiology, labs, PT/OT, cardiology, and more! Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Join Stuart Newsome as we explore how AI-powered document capture and AI agents are eliminating documentation bottlenecks, reducing manual data entry, and improving claim accuracy across healthcare specialties. Learn how AI is transforming RCM efficiency for radiology, labs, PT/OT, cardiology, and more!Brought to you by www.infinx.com

Navigating PT/OT eligibility verification, prior authorizations, and annual re-evaluations presents unique challenges that can disrupt workflows and delay reimbursements. In this episode, Lora Pada, AVP of Client Success, Nishant Kakkar, Associate Director of Operations, and Prachi Sharma, Senior Manager of Operations, share their expertise on overcoming payer-specific hurdles, leveraging automation for efficiency, and implementing best practices to optimize revenue cycle management.

In this pre-recorded session, Infinx experts Lora Pada, Prachi Sharma, and Nishant Kakkar discuss the operational challenges PT/OT and orthopedic practices face with insurance verification and prior authorization. Learn how automation and AI are transforming workflows to drive efficiencies and improve practice performance.

Many therapists feel as though they have limited upward mobility in their careers. Graduate programs understandably focus on direct clinical practice and understanding evidence-based practices.Unfortunately, this leaves many clinicians unprepared to navigate policy work, salary negotiations, or running a business. This makes many therapists less confident in advocating for reasonable caseloads or better compensation because they feel they have limited options for earning a living. That's why I invited Rachel Archambault to episode 194 to talk about how state and local policy impacts clinical disciplines and how therapists can expand their career options. Rachel Archambault M.A. CCC-SLP is an award-winning speaker and consultant for trauma-informed care as well as a licensed speech-language pathologist (SLP). She collaborates with service providers (SLPs, doctors, PT/OT, etc.), parents, businesses (schools, hospitals, universities, rehab), and communities to incorporate trauma-informed care into their setting. In 2018, Rachel was an SLP at Marjory Stoneman Douglas High School in Parkland, FL when an internationally publicized traumatic event happened at her workplace. After wondering how she could better work with her students (and self) who had undergone trauma, she found trauma-informed care. Her lived experience of trauma in combination with her profession allow her to bridge the gap for SLPs and other service providers who want to learn about and implement trauma-informed care in any setting. Rachel is a neurodivergent SLP, (PTSD & ADHD) and advocates for mental health trainings for SLPs. Rachel uses her unique journey to help put a face to trauma for healthcare providers, parents, and universities.In this conversion, we discuss:✅Negotiating salary for SLPs at the district level and giving public comment. ✅Making a case for districts to hire additional clinicians; including how to show the negative impact of high caseload numbers. ✅How to stay informed and understand how state and local policy impacts your ability to provide quality services. ✅Common knowledge gaps for clinicians; including people management, business operations, sales, marketing, and personal finance. Listen to Rachel's previous interview on De Facto Leaders here: EP 115: Trauma-informed care for therapists, teachers, and school leaders (with Rachel Archambault) Link here: https://drkarendudekbrannan.com/ep-115-trauma-informed-care-for-therapists-teachers-and-school-leaders-with-rachel-archambault/You can learn more about Rachel's services or how to book her for a speaking engagement here: https://www.ptsdslp.com/Follow her on Instagram here: https://www.instagram.com/ptsd.slp/Follow her on Facebook here: https://www.facebook.com/PTSD.SLP/Connect with her on LinkedIn here: https://www.linkedin.com/in/rachel-archambault/Listen to the Speech Science Podcast here: https://www.speechsciencepodcast.com/episodesIn this episode, I mention the School of Clinical Leadership, my program that helps related service providers develop a strategic plan for putting executive functioning support in place in collaboration with their school teams. You can learn more about that program here: https://drkarendudekbrannan.com/clinicalleadership We're thrilled to be sponsored by IXL. IXL's comprehensive teaching and learning platform for math, language arts, science, and social studies is accelerating achievement in 95 of the top 100 U.S. school districts. Loved by teachers and backed by independent research from Johns Hopkins University, IXL can help you do the following and more:Simplify and streamline technologySave teachers' timeReliably meet Tier 1 standardsImprove student performance on state assessments

Ever feel a little worried or extra pressure when seeing a patient who has already been to another pelvic PT/OT?  Here's the secret: We care a lot about the patient's experience, thoughts and what they feel like was beneficial.We don't care at all about what the other provider thought or was working onIn fact, a lot of times these patients are easier because they know what has worked in the past and what they didn't like.  They're literally telling you exactly what they're hoping for and expecting from your session!We ask early on in the session about their experience with their previous provider.  If you aren't asking about this on your intake form, make sure you are!Now if the patient is coming from another provider, either they a) had a great experience, loved the person and aren't able to go to them for some reason outside their control, or b) weren't getting better and having great results.Either way, you're not just going to duplicate what that other provider was working on!  You're bringing your own experience, evaluation, skills and treatment philosophy to the person.And this means you don't have to 'connect' or 'collaborate' or reach out to a past provider!Check out the full 'sode for all the details - you don't have to feel intimidated when seeing a patient who has been to another provider!PelviCon 2024 - Recording Tickets Now Open!If you couldn't make it in person this year, make sure you get the early bird discount on the recordings!  You'll get $50 off (only $347) on 14 unique talks from 8 world-class speakers, the PelviCon e-manual, and a Certificate of Completion for 15 contact hours!Get it at www.pelvicon.com!About UsNicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health.   PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016.  It grew quickly into one of the largest cash-based physical therapy practices in the country.Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes.  Together, Jesse and Nicole have helped 600+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them! Get in Touch!Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!

In this episode, we're thrilled to welcome Pedro Teixeira, founder and CEO of Prediction Health, for an in-depth conversation about how AI is revolutionizing healthcare documentation and patient care. Pedro takes us through the innovative journey of Prediction Health, starting from its inception to its current state-of-the-art tools like Practice Intel and Sidekick, which are transforming how clinicians work.Pedro shares the mission behind Prediction Health and how it all started with a passion for computer science and AI long before these technologies became mainstream. We explore how their tools are integrated seamlessly with existing EMR systems, making documentation faster, more accurate, and less burdensome for healthcare providers.We also discuss the broader impact of these tools on patient outcomes, clinic efficiency, and even the hiring process in healthcare. Pedro dives into the significant reduction in documentation time, improved billing accuracy, and the potential to reduce clinician burnout—benefits that make Prediction Health a game-changer in the industry.Finally, we talk about the future of AI in healthcare, including exciting features like the HIPAA-compliant Ask AI tool, and how these advancements are setting a new standard for patient care. Whether you're a healthcare provider, clinic manager, or just curious about the intersection of AI and healthcare, this episode is packed with valuable insights.Tune in to learn how Prediction Health is helping clinicians focus on what they do best—caring for their patients—while AI takes care of the rest.Key Topics:The evolution of Prediction Health and its missionHow Practice Intel and Sidekick are changing the game in healthcare documentationThe role of AI in improving patient outcomes and clinician efficiencyThe future of AI in healthcare, including the HIPAA-compliant Ask AI toolHow Prediction Health can help reduce clinician burnout and improve the work-life balance of healthcare providersDon't miss this episode if you're interested in the future of healthcare technology and how it can improve your practice.Pedro L. Teixeira, MD, PhD, is the co-founder and CEO of PredictionHealth, a healthcare technology company using AI to streamline clinician workflows and reduce administrative busywork. With a PhD in biomedical informatics and an MD from Vanderbilt University, Dr. Teixeira set out with colleague and co-founder Dr. Ravi Atreya, MD, PhD, to leverage machine learning and natural language processing to make it easy for clinicians to deliver the best care to every patient every time, and together they founded PredictionHealth in 2017. Under their leadership, PredictionHealth has developed AI-powered solutions to improve PT/OT efficiency and documentation compliance, allowing clinicians to focus more on patient care. If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

If you have less than 5 years of pelvic health experience, what should you be prioritizing?We got so many messages after last week's episode on '20 pet peeves' about internal.  Many of you asked what courses to take or where we had learned these different techniques.So we wanted to put together a 'sode for all of you who are new(er) to pelvic health.  Three major things we cover in this 'sode1)  Where you work matters, especially early in your career.If you can, prioritize regular mentorship from a clinician you respect!  And make sure you're actually receiving the mentorship that was promised.2)  Branch out in your con-edIt's sometimes tempting to just take the next 'basic' con-ed course (2, 2a, 3, etc.).  But really challenge yourself with your con-ed.  Learn from people you respect.  And branch out from the regular path.3)  Be curious and courageous enough to exploreThere's no one 'right' way to treat!  You need to find what works for you - your skills, your personality, your education and your patients.  And the only way to do that is to experiment!Try different things and see what works!  Doing different and diverse con-ed can give us more of a 'green light' to try new things and find our own Clinical Ethos with our patients.PelviCon Online Vulvodynia Symposium!If you treat vulvodynia, don't miss out!  We're bringing together the brightest minds in medicine, from physicians to psychologists to sexual medicine providers to pelvic rehab for a comprehensive, online Vulvodynia Symposium!You can find all the details here, and get on the 'interest list' for more info! (www.pelvicon.com/symposium)About UsNicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health.   PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016.  It grew quickly into one of the largest cash-based physical therapy practices in the country.Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes.  Together, Jesse and Nicole have helped 500+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them!  Get in Touch!Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!

Tyrese Maxey drops a playoff career-high 46 points to keep the Sixers season alive, with a thrilling overtime win over the Knicks, 112-106. Maxey scored 22 of his 46 in the fourth quarter and overtime to lift Philadelphia to victory. Tobias Harris and Joel Embiid added 19 each and grabbed a combined 22 rebounds. The 76ers will host New York in Game 6 on Thursday night in Philadelphia. Devon Givens and Rich Hofmann react postgame with Derek Bodner and Kyle Neubeck joining live from New York. Learn more about your ad choices. Visit podcastchoices.com/adchoices

This week, Rachel interviews Heidi Rabe, an SLP who specializes in supporting AAC users with complex bodies who use switches and scanning to communicate! Heidi shares a wealth of information about scanning and switches, including how to evaluate if a student needs a switch, working with PT/OT to find the right switch spot, using partner-assisted scanning, and more!   Before the interview, Chris and Rachel discuss a question from a listener about a student who is “adding random words” (and how the least dangerous assumption is that it's purposeful and meaningful, and we should get to the bottom of it)!   Key ideas this week:  

Thank you for joining us today in a discussion about incorporating yoga into therapy! Erin interviewed Chandler Tyrrell, OTR/L, CSRS who practices in northern Virginia in both inpatient rehab and outpatient settings. She fell in love with yoga after her first class and knew she wanted to become certified. She also found a calling in occupational therapy and saw the benefit of having both specialties in her background to be extremely helpful for people with neurologic conditions. Chandler became certified with LoveYourBrain as well, a non-profit that works to improve the lives of people with brain injuries.   In today's show we discuss: How Chandler uses both yoga and traditional OT treatments in her practice Who benefits the most from having yoga as a part of their program and how to tell if they will What LoveYourBrain is and what their yoga training was like What challenges she faced when organizing group yoga classes at work in the neuro population (ie spinal precautions, flexibility limitations, mobility levels, impulse control, etc) How she incorporates both yoga and intensity into her sessions to maximize outcomes and benefit What some of the research is saying about using yoga with PT/OT and in which populations How to get started with breathwork and yoga even if you aren't yoga certified with some simple things to try now Follow Chandler on Instagram: @chanroegge  Feel free to DM her with any questions!   https://www.loveyourbrain.com/yoga https://www.loveyourbrain.com/research https://pubmed.ncbi.nlm.nih.gov/22836351/ https://pubmed.ncbi.nlm.nih.gov/24985393/ https://www.sciencedirect.com/science/article/abs/pii/S0965229914001502?via%3Dihub https://pubmed.ncbi.nlm.nih.gov/16731221/ Insight timer: https://insighttimer.com

I was interviewed last week by my business coach Taki Moore for our monthly Black Belt Hot Seat on the strategies that took my coaching business from $35K months to over 1 million per year.I've spent 100's of thousands on business coaching so I can pass along what I learn and test out to my clients for just a fraction of what I've invested in my business.3 Key Strategies I learned from Black Belt that really helped grow my business - and have helped 100's of others grow theirs1) Upgrade how I run my coaching calls and client events2) 6 week game plan - having a focus, tracking my sales and sticking to the plan.3) Evergreen onboarding and kick off call, delayed 1-on-1 call with me until after the created a Game plan, agree to platinum promise and upgraded welcome sequence - helped with retentionAt the end Taki asked for 3 Lessons or pieces of advice for other business coaches1) Automate - emails, onboarding/kick off call2) Be relentless & stick to the plan3) No matter how hard it feels, keep going.4) 80% is Good Enough - perfection is a business killerIf you are a PT/OT with an online fitness, health or business coaching program, want to scale up beyond $20K/month and have room for more new clients I'd love to chat with you to see if our time, income and impact systems can help. Just go to www.CallwithAaron.com and book in a time to talk.

8 Weeks to Enjoying Natural Running – The MOVEMENT Movement with Steven Sashen Episode 182 with Rafael Salazar II Rafael E. Salazar II, MHS, OTR/L. “Rafi” is a licensed Occupational Therapist based in Georgia. Rafi has worked in a variety of settings, from orthopedic and musculoskeletal rehabilitation, to academia, and even healthcare consulting. He spent the majority of his clinical experience working at Charlie Norwood VA Medical Center, where he was the lead clinician and clinical education coordinator for the outpatient specialty rehab program. In this role, he treated many veterans with chronic pain and helped to establish an interdisciplinary pain management program. He has worked on projects ranging from patient engagement initiatives to marketing communication campaigns to a multi million dollar project assisting the State of Georgia's Department of Behavioral Health and Developmental Disabilities transition individuals out of state institutions to community residences. He has worked as an independent healthcare consultant since 2017, as the Principal Owner of Rehab U Practice Solutions, helping healthcare organizations and private PT/OT clinics develop effective patient engagement and retention strategies. Rafi also hosts The Better Outcomes Show, a podcast that explores the possibilities of a new healthcare and is the author of Better Outcomes: A Guide to Humanizing Healthcare. He has a passion for helping people overcome their limitations & pain to return to doing the things they love. He's on a mission to make healthcare human again. Rafi also authored the book The Natural Runner: 8 Weeks to Pain-Free Running.  Listen to this episode of The MOVEMENT Movement with Rafael Salazar II about how to enjoy natural running in 8 weeks. Here are some of the beneficial topics covered on this week's show: - How barefoot running doesn't cause people to have more injuries. - Why adding support and cushioning to shoes creates more problems than it solves. - How getting the sensory input of walking informs your movement patterns. - Why there is a connection between the footwear you choose and the function of your feet. - How immobilizing your feet leads to intrinsic muscle wasting. Connect with Rafi:  Guest Contact Info Facebookfacebook.com/ProactiveRehabWellness Instagram@proactive_rehabilitation Links Mentioned:pro-activehealth.com Connect with Steven: Website Xeroshoes.com Jointhemovementmovement.com Twitter@XeroShoes Instagram@xeroshoes Facebookfacebook.com/xeroshoes

Contributors: Andrew White MD & Travis Barlock MD In this follow-up episode Dr. Andrew White, a practicing psychiatrist with an addiction medicine fellowship, and Dr. Travis Barlock, an emergency physician at Swedish Medical Center, discuss mental health holds, psychiatric placement, pharmacologic vs. non-pharmacologic treatments, and outpatient care of psychotic patients. If you missed it, be sure to listen to part I for details on the management of psychotic patients in the ED. Educational Pearls: Mental health holds should be approached on a case-by-case basis; this includes assessing safety risks immediately, over a 24-hour period, and chronically over the last few months. Lastly, collateral information is useful in assessing a mental health hold.   What happens after patients get placed in inpatient psychiatry? Typically an antipsychotic is started; in the absence of metabolic risks, patients will often be started on Zyprexa, especially in oral dissolvable form. Doses of Zyprexa ODT start at 2.5 - 5 mg per day.   If psychotic patients do not pose direct harm to the environment, they do not necessarily need to be medicated. However, patients will often need medication at some point; for example, some people may be calm during their psychosis but unable to feed themselves or perform other ADLs.   The goal of pharmacologic treatment for psychosis is to save the brain; each episode of psychosis damages the brain. Oftentimes, patients will be started on long-acting injectables like aripiprazole or risperidone to give patients 30 days of treatment with one shot.   Non-pharmacologic approaches to psychosis are challenging given the nature of the disease. There have been attempts at therapy for psychosis but not have not been hugely successful. Options for support include PT/OT, family support via organizations like NAMI, and other resources for families of patients with psychosis.   Outpatient care of patients with psychosis includes contextualizing the events. For example, many people who experience brief psychotic episodes do not go on to develop schizophrenia so it is important to identify a prognosis. On the other hand, someone who has worsening symptoms over several months may require more aggressive treatment.   The primary goal of outpatient management of older patients is to reduce the adverse effects of long-term treatments. The CATIE trial in the early 2000s showed that only 25% of people were on antipsychotics by the end of the trial; it is more important to engage patients than focus too much on medications' adverse effects. Summarized and edited by Jorge Chalit, OMSII | Studio production by Jeffrey Olson, MS1  

Rafael E. Salazar II, MHS, OTR/L (Rafi) is a licensed Occupational Therapist based in Georgia. Rafi has worked in a variety of settings, from orthopedic and musculoskeletal rehabilitation, to academia, and even healthcare consulting. He spent the majority of his clinical experience working at Charlie Norwood VA Medical Center, where he was the lead clinician and clinical education coordinator for the outpatient specialty rehab program. In this role, he treated many veterans with chronic pain and helped to establish an interdisciplinary pain management program. He has worked on projects ranging from patient engagement initiatives to marketing communication campaigns to a multi million dollar project assisting the State of Georgia's Department of Behavioral Health and Developmental Disabilities transition individuals out of state institutions to community residences. He has worked as an independent healthcare consultant since 2017, as the Principal Owner of Rehab U Practice Solutions, helping healthcare organizations and private PT/OT clinics develop effective patient engagement and retention strategies. Rafi also hosts The Better Outcomes Show, a podcast that explores the possibilities of a new healthcare and is the author of Better Outcomes: A Guide to Humanizing Healthcare. He has a passion for helping people overcome their limitations & pain to return to doing the things they love. He's on a mission to make healthcare human again. He is also the CEO of ProActive Rehabilitation & Wellness, a multidisciplinary outpatient physical rehabilitation clinic serving patients experiencing musculoskeletal pain and dysfunction.  

PT/OT/SLP Compact Update for Travel Therapists! What are the PT Compact, OT Compact, and SLP Compact? How do they work? And what are the implications for travel therapists? Join us as we go over exactly how the compact licensure works… who's eligible… the process to apply and maintain compact licensure… and various ways that compact licensure affects travel therapists. We also address common misconceptions about the compact licensure! Don't make these same mistakes! Tune in to learn more!

One area my guest, Tyler Roman feels speech therapy sometimes struggles is fitting into the IPR puzzle. Many patients want to focus on motor recovery and are not yet experiencing difficulties in daily tasks they were completing prior to their hospitalization. Many times CEUs/blog posts focus on the acute setting or functional cognition with home health/outpatient focus. Tyler recommends talking to your PT/OT counterparts and see where breakdowns in ADL/IADLs are occurring during therapy. Also, adapt “traditional” therapies to incorporate feedback from teammates to address breakdowns. Check out additional resources at: https://www.speechuncensored.com/podcastepisodes/149

My guest is Heather Evans. She battled infertility for 4 years and then became pregnant with boy/girl twins (Hannah and Gavin) via their fourth round of IVF and an egg donor. She went into premature labor and delivered them at 24 weeks, 1 day (1.5 pounds each). They spent four months in the NICU including 7 weeks on a ventilator, both had brain bleeds, multiple infections, my son had heart vessel surgery, and both twins came home on oxygen. Her son has been diagnosed with cerebral palsy (although he now walks, runs, etc. without even using his braces), and he had a selective dorsal rhizotomy surgery four years ago. Both twins have ADHD, Hannah is working through some sensory and social/emotional work, and Gavin gets PT/OT/speech. She is also a pelvic floor physical therapist which means one of her specialties is treating pregnant and post-partum women. She has two books called Learning to Breathe which is her NICU story. The most recent (just out a month!) is called the NICU Mama Survival Guide, and it combines her NICU experience with her knowledge as a pelvic health PT to guide mamas in their post-partum recovery WHILE their baby is in the NICU. Show Notes:  Here is Learning to Breathe: https://www.amazon.com/Learning-Breathe-story-micropreemies-defied/dp/1543072151/ref=sr_1_1?crid=13F9WHCA6YHL&keywords=learning+to+breathe+heather+evans&qid=1643683247&sprefix=learning+to+breathe+heather+evan%2Caps%2C100&sr=8-1 Here is The NICU Mama Survival Guide: https://www.amazon.com/NICU-Mama-Survival-Guide-Post-Partum/dp/B09MGJ7RSX/ref=sr_1_1?crid=25VLHVRUPU8VA&keywords=the+NICU+mama+survival+guide+heather+evans&qid=1643683289&sprefix=the+nicu+mama+survival+guide+heather+evans%2Caps%2C89&sr=8-1 I currently have two Instagram accounts. My family/book account is @learningtobreathebook My physical therapy account is @heatherevansdpt This Show is Sponsored by... Baby MORI creates all the essentials a parent needs, crafted from soft, safe & sustainable materials. Baby MORI aims to make parenting simpler through innovative designs, such as two-way zips and extendable sleeping bags. Cooper loves these jammies and I love that they are darling AND functional! All their products are designed to be the highest-quality, long-lasting and worn, washed and passed on again & again. Get 30% off soft, safe & sustainable clothing and essentials for babies & kids with code MOMS when you go to https://babymori.com/collections/extraordinary-moms-podcast.

Morgan and Lori share the historical role of the SLP in the burn population and how they created a protocol from their clinical experience, collaboration with PT/OT colleagues, and applying research. The post 219 – Beyond the Burn: Standardizing SLP Practice Part 2 appeared first on Swallow Your Pride Podcast.

Morgan and Lori share the historical role of the SLP in the burn population and how they created a protocol from their clinical experience, collaboration with PT/OT colleagues, and applying research. The post 219 – Beyond the Burn: Standardizing SLP Practice Part 2 appeared first on Swallow Your Pride Podcast.

Alex was days away from his first day of college (2020) when tragedy struck.  A jet ski accident left him with a severe traumatic brain injury, 3 broken ribs, a broken jaw, a broken clavicle, fixed and dilated pupils, and a punctured lung.  Given his Glascow Coma Score of 3 (lowest possible score nearly always indicating no chance of survival), and the loss of most of his blood volume, his father was greeted in the ER with the news no parent wants to hear, "We need to prepare you."  Despite the worst possible prognosis, Alex has overcome impossible odds.  Miraculously, he is alive, he has a new relationship with the Holy Spirit, he is working, he is running, and has plans and big dreams for college in 2022!   In this episode Alex shares: -How the accident affected his body and memory. -The people God sent into his life that had a huge impact on his healing. -The beautiful new relationship he has with the Holy Spirit, who clearly guides him. -Being featured on the local news several times and meeting the people that intervened on that crazy day (watch link below to see a few of the key people that are part of this miracle). -How contracting the big bad virus was actually a blessing for him (crazy!).  His doctor was amazed. -How prayer and worship music was so powerful in his journey (see playlists below). -How life is different now, a new career path and new dream. -His gratitude to God, to his care providers at Atrium and at the Shepherd Center (Atlanta), and especially his parents, for doing everything in their power to help.   Some of the therapies Alex has utilized in addition to PT/OT for his healing include hyperbaric oxygen treatments, neurofeedback treatments, speech therapy, vision therapy, vestibular therapy.   Thank you Alex, for allowing me to share your beautiful testimony!  Prayers for continued healing and for all that God has for you in your next steps!   News story of Alex meeting the healthcare providers at Atrium one year later: https://www.wbtv.com/2021/08/20/what-miracle-jet-ski-crash-survivor-reunites-with-doctors-who-saved-him/   Video of Alex's story by Atrium Health: https://www.youtube.com/watch?v=u6pCXZeDaPI   Alex's playlist: https://music.apple.com/us/playlist/single-vision/pl.u-leyl1BLfYRoLxy   You can reach out to or follow Alex on instagram at: https://www.instagram.com/alexakking/

PT + OT: Break Silos, Crush Goals Want to make sure you stay on top of all things geriatrics? Go to http://PTonICE.com/resources to check out our Free eBooks, Lectures, & the MMOA Digest!

WE HAVE A SPONSOR! Check them out here: www.GrowGeneration.com Kyle Malone and Cam Clark are back to be your guides to the galaxy far, far away! Join them as they dig into all of the upcoming Star Wars projects. A long time ago... In this not far, far away galaxy I ran a weekly Star Wars column called The Cantina. The end of each piece was called "Last Call" and topics rotated and eventually included a once-a-month podcast reviewing all of the Star Wars films leading to a release day group review of The Rise of Skywalker. Afterward, we reviewed Season 2 of The Mandalorian. Now, that glorious podcast has returned under the title of the original column and for the foreseeable future, we'll be bringing weekly news, theories, reliable leaks, and more! The Mandalorian had been an amazing success for Disney, Lucasfilm, and the Disney+ streaming service, and they were looking to capitalize on it. For the first time since December 2017, the fandom seemed more united than divided, but it hasn’t lasted. From the unenthusiastic reactions to The High Republic and controversial firings to Legends and non-canon movies and shows (like the Ewok Adventures and Star Wars: Droids) getting acknowledgment from Disney, something strange is going on. Join us on this new journey into the galaxy far, far away, and the hopefully bright future of Star Wars… YOU WILL SUBSCRIBE AND HIT THE NOTIFICATION/FOLLOW BUTTON! This is the way... May the Force be with you! Join our Discord: https://discord.gg/PyrzzmrceY Question(s) of the week: Open invitation to come on and debate Kyle, Cam, and/or Mike about anything in Star Wars. Let's bring back OPEN discussions, stop spreading fires, and defeat Emperor Palpa-green... I mean Ken... Palpatine. Also, are you enjoying The Bad Batch? Lastly, what story do you want to see in Andor? Catch the last episode here: https://open.spotify.com/episode/4EAaBoMLXCGXDT1y8dq3Ya?si=lfBtkwyXREa-A6h5CLkJYQ Website: www.LRMOnline.com Kyle Twitter: https://twitter.com/ThatKyleMalone Cam Twitter: https://twitter.com/LRM_Cam

Questions Answered on the Podcast: 1.   What do Athletic Trainers do? 2.   What is the difference between an Athletic Trainer and a PT/ OT? 3.   Where can an Athletic Trainer work? 4.   What is an Athletic Trainers role in Work and Industry? 5.   What type of degree do you need to be an Athletic Trainer? 6.   What types of task or activities do ATC perform with Sports Teams? 7.   What is an Injury Prevention Screen? 8.   What happens if someone is suspected of a concussion? 9.   How can athletes prevent dehydration?

Autism Therapies can be an alphabet soup, much like so many things in our world. Jessica and Kelsey start with PT, OT, and SLP to give a short description of all three. Books of the Week Affiliate Links High-Functioning Autism and Difficult Moments: Practical Solutions for Reducing Meltdowns - https://amzn.to/370EKoa No More Meltdowns: Positive Strategies for Managing and Preventing Out-Of-Control Behavior Illustrated Edition - https://amzn.to/34RkoL9

Have you been hesitant to begin delegating tasks in your business? Courtney Smith is a dual PT/OT, turned copywriter who is passionate about helping private practices thrive with effective direct marketing to clients, in a referral-dominant healthcare system. She is also somewhat of a matchmaker in that she matches up healthcare entrepreneurs with virtual assistants (VA). In this episode, we talk about how delegating can help you, what you need to know about hiring the right VA and advice for people just getting started with outsourcing. Courtney and I discuss: How she got started in doing non-clinical work The services her business offers and her vision for her business What email marketing and copywriting is (and how it can help your business) How she's building a network of virtual assistants for healthcare entrepreneurs Why a lot of VAs don't post their prices How you can find the right person when hiring a VA Advice for people who are hesitant to outsource The best ways to communicate with VAs Her biggest fail learns in her own business What's going really well for in her business Resources from this episode:The Office On Call Courtney's Instagram Courtney's LinkedIn Courtney's Facebook courtney@theofficeoncall.com Trello Voxer ClickUp Systems Saved Me Business Bedrocks Group Coaching Program lauraparkfig@gmail.com

Have you been hesitant to begin delegating tasks in your business? Courtney Smith is a dual PT/OT, turned copywriter who is passionate about helping private practices thrive with effective direct marketing to clients, in a referral-dominant healthcare system. She is also somewhat of a matchmaker in that she matches up healthcare entrepreneurs with virtual assistants (VA). In this episode, we talk about how delegating can help you, what you need to know about hiring the right VA and advice for people just getting started with outsourcing. Courtney and I discuss: How she got started in doing non-clinical work The services her business offers and her vision for her business What email marketing and copywriting is (and how it can help your business) How she’s building a network of virtual assistants for healthcare entrepreneurs Why a lot of VAs don’t post their prices How you can find the right person when hiring a VA Advice for people who are hesitant to outsource The best ways to communicate with VAs Her biggest fail learns in her own business What’s going really well for in her business   Resources from this episode:The Office On Call Courtney’s Instagram Courtney’s LinkedIn Courtney’s Facebook courtney@theofficeoncall.com Trello Voxer ClickUp Systems Saved Me Business Bedrocks Group Coaching Program lauraparkfig@gmail.com

Home Health Contract Show: How did Armand (PTA) and Patrice (OTR) get their 1st HH Contract? Do you have that itch in your heart and in your head to start a business? Start here and start now! In this episode: 06:10 – Armand and Patrice's background story. 09:50 – How did they found out about Bert’s Home Health Contracting? 13:50 – How many years have they been PT/OT? 14:15 – Were there certain criteria that wanted to follow when they were searching for a business? 20:20 – If you don’t make a profit you don’t have a business – you have a hobby. 21:50 – What was holding them back to start their own business (before knowing Bert)? 24:49 – Why will I work with Bert? 28:00 – How did Armand and Patrice get a contract in 3 weeks? 28:20 – Week 1. 30:45 – Week 2. 32:15 – Week 3. 33:25 – What are your pains that drive you to make a change in your career? 38:45 – Bert’s corridor principle. 41:00 – What will Armand and Patrice say to colleagues that are on the fence of starting their own business? 46:25 – What did home health contracting do to Bert’s life? 47:30 – How did Armand and Patrice overcome that lack of self-belief? 52:40 – Be careful who you share your dreams with. – Bert 55:50 – Those who do not want to take risk work for those who do. Call or Text Bert directly at #972-649-9909 Watch Bert’s FREE 4-Video Series at www.rehabpreneur.com/mikechua --- Send in a voice message: https://anchor.fm/althealthcareers/message

Home Health Contract Show: Is it bad to make a PROFIT as a PT, OT, or SLP? Do you feel guilty if you make a profit out of the service you render? It is time to change your mindset. Making a profit is extremely IMPORTANT! In this episode: 02:50 – If you don’t make a profit you will find yourself disappointed as opposed to being fulfilled. 04:00 – You didn’t go into business to break even. 11:40 – With this PGDN, is home health contracting still profitable? 14:00 – We have to make a profit in order to stay in business. 14:45 – Profit isn’t a purpose, it’s a result. To have purpose means the things we do are of real value to others. – Simon Sinek 16:30 – How do home health contractors make a profit? 17:50 – Sample computation. 21:20 – When you see someone who has turned his passion into a profit, ask yourself, “Why not me?” – Donny Deutsch 24:25 – In the end, all business operations can be reduced to three words: people, product, and profits. – Lee Iacocca 26:55 – Do not hire someone you do not like. 31:30 – Business is all about solving people’s problems – at a profit. – Paul Marsden 34:00 – Your sense of accomplishment as a therapist will turn into a DISAPPOINTMENT if you don’t make a PROFIT. 39:35 – Profit is always better than wages. You can check FREE video series on how Home Health Contracting works www.rehapreneur.com/mikechua Call or text Bert directly at #972-649-9909 --- Send in a voice message: https://anchor.fm/althealthcareers/message

The Non-Clinical PT is the #1 resource for rehab professionals who want to use their degrees in non-clinical ways. We provide: - Education - Resources - Networking Opportunities - Career Coaching Our goal is to keep clinicians feeling excited about their careers by providing unique opportunities. Support this podcast

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So it's festival time, hope all you guys are doing well. In today's edition we have anand sir, a physiotherapist practising in Canada. This podcast is co-hosted by miss smruti, manager of MH INDIA. IN this podcast Anand sir shares his views about wellness, preventive health, role of physiotherapy in various settings. © 2018 MH INDIA All Rights Reserved About our founder(Dr Hara Prasad Mishra)- He is a medical doctor by profession having educational training from National institutes ( AIIMS Delhi , NIMHANS BANGALORE, University of delhi ) & also from international institutes ( John Hopkins, University of Sydney, yales University). He has participated in various national and international medical conferences. He has qualified all major entrances of science stream for engineering (IIT-JEE) and medical (AIIMS,AIPMT)with top ranks at all India level in 2015. He has a you tube channel called MH INDIA,which focuses on mental health and complete well being. He is also a strong proponent of mental health innovation and education.He believes that a convergence of clinical neuroscience , neuropsychiatry,data science, exponential technologies, pharmacogenomics and pharmacoinformatics can result in transformational change in the field of global mental health.He strives to make psychiatry more integrative and holistic in near future and looking forward for challenging opportunities in this field. He also has a great passion for healthcare informatics and healthcare information technology. *******Follow us on ********* LinkedIn profile id of Dr Hara Prasad Mishra https://www.linkedin.com/in/dr-hara-prasad-mishra-7a318b112 Facebook profile id of Dr Haraprasad Mishra https://www.facebook.com/haraprasad.mishra.10 Email- mh18india@gmail.com Website- https://mhindia-drhpm.godaddysites.com/ Facebook- mhindia (https://www.facebook.com/mh.india.581 Twitter link:- Check out MH India-Dr HPM (@DrHpmMhIndia): https://twitter.com/DrHpmMhIndia?s=09 Instagram link:- I'm on Instagram as @mhindiadrhpm. Install the app to follow my photos and videos. https://www.instagram.com/p/CAOCnMwDTZY/?iqgshid=188leumo7aip0 Anchor app link- "BRAIN ROAST WITH DR HPM" https://anchor.fm/Drhara-prasad-mishra You can read our articles on MEDIUM https://link.medium.com/f3e4dotF78

As a practice owner, you want to increase your revenue. The solution to increase your revenue is StrataPT's Industry-Leading Collections & Revenue Cycle Management. Their revenue cycle management service is guaranteed to increase your revenue. On average, practice owners experience at least a 15% increase due to the billing efficiency and results that our team delivers! This is possible through their All-Inclusive System -- one system to manage your entire practice. Plus, spend less time documenting with their simple and customizable templates that saves you time (so you can spend more time with your family). ________ Today's episode sponsor: www.CashBasedPhysicalTherapy.org If you are looking to start or expand your private pay practice... Or, if you're an established practice frustrated with low insurance reimbursement... And, you just want to provide excellent care to your patients, while achieving time and financial freedom, then check out: www.CashBasedPhysicalTherapy.org

From the words of JohnJohn's mother and father..."Before JohnJohn's diagnosis, we had never even heard the word retinoblastoma. This cancer is scary because it's rare (approximately 250 cases per year in the US), because it occurs primarily in children under the age of 5, and because there are only a select group of doctors and hospitals that know and understand how to treat it. ​But we are lucky because it is treatable, and there have been incredible advancements in the treatment options within the last decade. Just over 10 years ago, the most effective, and pretty much only, way to treat retinoblastoma was through enucleation (removal of the eye). Sometimes this is still the best treatment option based on size or stage of the tumor(s). Systemic chemotherapy and radiation were also commonly used in different combinations.​Then in 2006, Dr.’s Abramson and Gobin developed a method of treatment that delivers chemotherapy directly to the eye via an intra-arterial procedure. This game-changing treatment has been remarkable in saving vision, and eyes, in patients that qualify.​We were fortunate to have a very supportive network of family, friends, and colleagues that made it possible for us to seek cross-country treatment with Abramson and Gobin at Memorial Sloan Kettering Cancer Center in New York. But even with the financial and emotional support this journey has not been easy, it’s expensive, time-consuming, and physically draining.​JohnJohn completed his IAC treatment for his one large tumor in September 2018. Since then he has received laser treatment for 4 additional small tumors in his other eye. Even though we are in a good place right now, there are still immediate and lifelong risks. He has eye exams under anesthesia (EUA's) every 4-6 weeks until age 5 to check for additional tumors, bi-annual MRI's to make sure the cancer has not spread beyond the eyes, and will be monitored for the rest of his life for a handful of other related cancers. As he grows he will also need PT/OT to help with his development and vision impairment. Because of our experience, we want to do our best to pay it forward and support other families who are facing the same struggles." You can learn more about JohnJohn and his journey to support kids facing retinoblastoma at eyefight.org.​Our family members founded Eye Fight for Kids in JohnJohn's honor, to provide financial assistance to families with a child or children who are undergoing treatment for retinoblastoma. Funds will be given directly to selected families to offset the medical, travel and personal costs incurred while in treatment.

This podcast covers a history of burn rehabilitation, the challenges in rehabilitation, team approach, importance of early PT/OT involvement, evaluation of rehabilitation, transition to outpatient care, and longterm burn rehabilitation outcomes.All episodes offer continuing education credits (CE). To earn free EMS and nursing CE's go to our custom education website and create an account. Website: https://burncenters.cloud-cme.com/default.aspxPlease email foundation@burnfdn.org if you have any questions, need help or have suggestions for future education events.If you have any questions for our special guests on the showy can contact them through their email addresses:Michael Serghiou- mas@silon.comJonathan Niszczak- Niszczak12@gmail.comThank you for all that you do! Be safe, The Burn and Reconstructive Centers of America (BRCA)Addendum: "Rehab starts the minute the patient arrives to the Burn Unit", "The surgeon needs to anticipate therapeutic needs and design the operative interventions and importantly the bandaging to allow optimal mobility...as well as considering the progress a patient is making in a certain function and avoid operating in that region at that juncture to avoid set backs in therapy", "A good practice is to have the Rehab goals for the patient clearly delineated at the bedside for the patient, patient’s family and nurses so they all can see and follow through". - Dr. Fidler. Disclaimer: The content, information, opinions, and viewpoints contained in these educational materials are those of the authors or contributors of such materials. While the BRCA Foundation, Inc. (“Foundation”) and its committees take great care to screen the credentials of the contributors and make every attempt to review the contents, the Foundation MAKES NO WARRANTY, EXPRESSED OR IMPLIED, as to the completeness or accuracy of the content contained in the educational materials or on this website or in any podcast. The reader of these materials and listener of the podcast uses these materials at his or her own risk, and the Foundation shall not be responsible for any errors, omissions, or inaccuracies in these materials, whether arising through negligence, oversight, or otherwise. Reliance on any information appearing on this site and/or this podcast is strictly at your own risk.The information and education material contained herein is meant to promote the general understanding and dialog of burn [trauma] topics by healthcare professionals. Such information is not meant or intended to serve as a substitute for clinical training, experience, or judgment. This information and material is provided for general educational purposes only and should not be considered the exclusive source for this type of information. This information and material is intended for healthcare professionals and not intended for patients or individuals. Copyright © 2020 BRCA Foundation, Inc. All rights reserved. No part of this publication may be reproduced without written permission.

John Modica is a Registered Nurse who was working as a travel nurse in Alaska when he got frustrated with trying to keep all his documents with 5 different staffing agencies in order. When he lost a dream travel position due to not having his documents in order, he began lamenting to his friend Dave. Dave just so happened to be an entrepreneur and healthcare data migration expert. When he listened to what John was saying he found it hard to believe that healthcare workers didn’t have some sort of digital wallet. So as luck and a great problem would have it, John and Dave came up with the idea of digital wallet for healthcare professionals. What is unique about this platform is that the software tracks your licenses, certifications, compliance information, work history, recommendations and more. Originally the idea was to help nurses who worked for multiple staffing agencies, but as the software started to evolve, it became increasingly clear that the application was going to be quite broad. The platform has application for staffing agencies, recruiters, universities, and even for other health care professionals such as respiratory therapists, echo technicians, radiology techs, PT/OT and so much more. Nurses can sign up for free on this platform. To sign up go to the website: www.KamanaHealth.com Don’t Miss Moments: → How John came up with the idea for Kamana Health → How John built his team → The journey John took to get this idea from conception to profitable → What Kamana means and why they chose this name

Dr. Amy Schiffman and Dr. Alex Mohseni talk with the team from Fox Rehab (https://www.foxrehab.org/) about physical therapy, occupational therapy and speech pathology and uncover all the hidden issues, challenges, and secrets of this huge industry. If you are a senior-serving professional or medical provider who orders PT, OT or Speech services for your clients, you need to listen to this episode. Alex and Amy cover the following topics: Speech Therapy vs Speech Language Pathologist In-home PT, OT and speech therapy for geriatric patients Part A rehab vs Part B rehab When and why do you flip from Part A therapy/rehab to Part B rehab? How do you continue to qualify for Part A therapy? Who decides whether a patient has reached their therapy goal - the ordering provider or therapist? What does a physical therapist do? What does an occupational therapist do? What does a speech therapist do? PT vs OT vs Speech Functional independence Activities of daily living What does Medicare pay for with Part B PT, OT and Speech Therapy Two requirements for Medicare to pay for Part B rehab: medical necessity and skilled need The Therapy Cap for PT and Speech Part B works on a calendar year basis How to get an exception to the Therapy Cap for PT, OT and Speech Pathology Coding and billing PT, OT and SLP encounter CPT codes What is a low-tech augmentative communication device? What is the common work file in Medicare rehab? How often does a physical therapist usually go to a person's home? What is the patient responsibility or copy for Medicare Part B rehab and physical therapy? Part B rehab is not home health Which types of providers refer to Part B rehab the most? Most common reasons for referral for Part B Rehab all revolve around falls: gait, balance, and weakness Do not have to be homebound for Part B rehab in the home Common mistakes when referring to rehab How to write an order for PT, OT, or speech and what CPT codes to include Part B rehab does medication reconciliation How to order DME What is a 3-in-1 commode How long does it take to get a hospital bed paid for by Medicare FoxRehab.org

Patrick Toy and Rob Vining discuss the updates with Medicare/CMS now coming out with reimbursement for Telehealth PT/OT/SLP practitioners! Make sure to register for the new educational series "Telehealth Billing for PT/OT/SLP: Billing Concepts and Procedures for Insurance Reimbursement for Out of Network and In-Network" located at www.TelehealthPT.com/telehealthbilling This evergreen content will help the rehab professionals who own or are starting their own private practice and are looking to understand and start billing insurance for in-network or out of network.

Organic Non-opioid Care for Chronic Pain – Dr. Jason Jones Elizabeth City, NC Chiropractor In case you just started taking opioids prescriptions for controlling chronic pain, then you might want to try out a non-opioid method for caring for chronic pain. This is because over-dependence on opioids can lead to addiction and overdoes which comes with several diverse side effects. But Chiropractic utilizes safe methods to tackle chronic pain. The non-opioid treatment for chronic pain includes the following: Cold and heat Cold can be essential soon after sustaining an injury to relieve pain, reduce inflammation, trigger recovery, and reduce muscle spasms. Heat increases relaxed muscles and raises your pain threshold. Exercise Staying fit physically, irrespective of certain pain, can play an important role for individuals with some of the most typical pain conditions, including arthritis, low back pain, and fibromyalgia. Weight loss Several painful health-related conditions get more critical by excess weight. Thus, it makes more sense, that losing weight could assist in relieving certain kinds of pain. Occupational therapy (OT) and physical therapy (PT) OT and PT assist in improving your capability to carry out activities of daily living, like bathing, dressing, and eating. Transcutaneous electrical nerve stimulation (TENS) This method uses an extremely mild electrical current to prevent pain signals from going to your brain from your body. Ultrasound This type of therapy works by directing sound waves into bodily tissues. It is most times utilized for improving blood circulation, promoting healing, and decreasing inflammation. Cold laser therapy This is an FDA-approved therapy for treating pain conditions. The cold laser releases pure light of a wavelength that is absorbed into an affected or injured area and might minimize inflammation and accelerate tissue repair. Mind-body techniques Mind-body relaxation methods are typically used at healthcare centers and hospital-based pain clinics. They consist of: Meditation Mindfulness Progressive muscle relaxation Breathing exercises   Tai chi and Yoga These exercise and mind-body practices use meditation, breath control, and movements to strengthen and stretch muscles. They might assist with chronic pain conditions like low back pain, fibromyalgia, headaches, or arthritis. Biofeedback This machine-assisted method of caring for chronic pain helps people take charge of their body reactions and responses, including acute and chronic pain. Chiropractic is a non-opioid treatment for caring for chronic pain since it helps in improving your body’s function and also helps your body to heal itself. Acupuncture Acupuncture has to do with putting tremendously fine needles into your skin at precise points on your body. This method might relieve pain by discharging endorphins, (the natural painkilling chemicals in the body). It might also help in influencing serotonin levels, the brain transmitter in charge of mood change. If you want non-opioid treatment and care for a chronic pain you are experiencing, then visit Dr. Jason Jones at our Chiropractic Office in Elizabeth City, NC. We help to correct your body’s alignment to relieve and care for your pains.

Patrick Toy and Rob Vining discuss the new educational series "Telehealth Billing for PT/OT/SLP: Billing Concepts and Procedures for Insurance Reimbursement for Out of Network and In-Network" located at https://www.TelehealthPT.com/telehealthbilling This evergreen content will help the rehab professionals who own or are starting their own private practice and are looking to understand and start billing insurance for in-network or out of network.

Melissa Keller is the Speech Teletherapy Coordinator for Therakids, P.C. She has taken on this new role over this past school year as the company has expanded from PT/OT school contracts and now includes SLP in their business. Melissa explains the process of securing contracts, performing teletherapy, and continuing services during the pandemic. Tune in to ClinicChats! Music from https://filmmusic.io "Cheery Monday" by Kevin MacLeod (https://incompetech.com) License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Physicians and other senior-serving professionals trying to operate within the complicated Medicare ecosystem must be constantly learning, as the landscape, rules, tools, and vendors are in constant flux. We interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. In this Mastering Medicare episode, we cover: How you qualify for Medicare Qualifying for Medicare via ALS Qualifying for Medicare via ESRD on dialysis Qualifying for Medicare via SSDI disability Medicare and VA insurance History of Medicare Inpatient hospitalization Rehab aka SNF aka nursing home Home health Hospice Medicare copays and cost sharing for hospitalization Medicare part A annual deductible Medicare cost sharing with rehab SNF Medicare part A home health What is Home health? Home health 485 form What is skilled nursing? What does part A PT/OT do? Copay for part A PT OT Home health "taxing effort" Certification of being homebound home health Certification periods for home health Recertification of medicare part A home health Home health aides Home health 45 minutes twice per week Will Medicare pay for wound care supplies? Medicare hospice What is hospice Will Medicare pay for hospice Qualifying for hospice Hospice certification periods What does hospice cover and pay for Hospice payment model Who pays for a hospice patient if they go to the ER? Hospice is a risk bearing entity Hospice certification and recertification periods What does it mean to be admitted to a hospital

Say WHAT??? We can earn a 6 fig. salary only working 10-20 hours a week?? with Kara Kettering Welke Do you wish to work a minimum of 10 hours a week and still earn six figures? If your answer is “YES!” then this episode is for you. Kara and Shana talk about having the time and clinical freedom and still earn six figures using a platform, Optonome. If you haven’t heard about it this episode will discuss what it is and answer your questions. In this episode or AHC: 02:00 – Introduction of Shana Young 04:10 – Stories of OTs 09:20 – Therapy business builders helping build businesses from the ground. 11:00 – How can Optonome guarantee you to make a six-figure salary within 24 months. 14:45 – Optonome is also your back office. 16:30 – Who has heard about Optonome? 19:10 – OT, PT, RN, SLP you can start your own community-based home health care with Optonome. 23:10 – How Optonome started. 24:10 – Optonome helps take away a lot of fraud. 25:35 – Create affordable housing for adults with disabilities is one of the main goals of Optonome. 26:30 – Optonome has its own real estate side. 28:20 – There is no competition in Optonome. 30:40 – Kara asked Shana: What did you do on a weekly basis when you were starting out? How many hours did you actually work? 32:35 – Healthcare professionals should still maintain a work-life balance. 33:55 – Optonome helps with time and clinical freedom, gets you to a six-figure salary. 35:00 – Question: If I partner with a PT/OT, how would I be able to be a part of earning income apart from working as a direct support professional?36:40 – Supportive employment 37:25 – Certified Investigator 39:50 – Question: Do you write the ISP or the behavioral plans and goals?

How to Sell Cash-Based PT (OT and ST) at a High Ticket With Dustin Howard How changing one’s mindset can land you on a high ticket sale? Find out how you can sell a high ticket to clients by making them feel better. In this episode of Alternative Healthcare Careers: 01:40 – How to sell high ticket Physical Therapy really fast 02:15 – Make people feel good 03:20 – Take pain or pain points away from people (physically or emotionally) 05:10 – A lot of sales is a mindset issue 06:00 – If you are capable of making someone feel better, you are capable of selling higher ticket 07:45 – [Question from audience] What price is considered high ticket? 08:50 – Get people to invest in themselves and change their mindset 11:40 – Do whatever your patient needs you to do (make them feel amazing) 12:20 – [Question from audience] What is the average income of the client population do you target? 13:00 – Get your target clients to get interested in what you are doing 15:00 – Do not over complicate things. Go out of your own way and make someone feel better. 16:00 – Break away from the norm of physical therapy, occupational therapy, and speech therapy 16:50 – Help people solve their problems and you get to charge for it 17:30 – Respect yourself and charge what you are worth 18:00 – PTs, OTs, STs solve complex problems 18:50 – Solving problems big enough for people and the price becomes irrelevant

TOP 12 Pack of 2019 - A PT, OT and Exercise Scientist walk into a podcast @ Sacred Heart University

Matt Condon is the CEO of Bardavon Health Innovations, a company to provide innovative, clinically-based solutions to enable employers to identify and connect with the best medical practices in their marketplace through a proprietary cloud-based clinical intelligence system.  Bardavon has a mission to change healthcare with data, transparency, innovation, and integrity. They have grown from about 30 to 170 associates in the last two years. Bardavon Health Innovations is dynamically disrupting the healthcare industry by transforming the way Patients, Providers, and Payors interact with each other in the Workers’ Compensation marketplace. As the leading national specialty PT/OT network, Bardavon’s mission is to improve the quality of healthcare by creating an ethos of transparency that revolutionizes the continuum of care by way of its innovative proprietary cloud-based software bNOTES®. Website: www.bardavon.com

Michele Kramer, LCS Therapy Quality Assurance Specialist joins Victoria Henson, Clinical and Quality Specialist from Encore Rehabilitation to discuss collaboration strategies for therapy, nursing and MDS assessment, communication and accurate coding of Section GG on the MDS.

Not everyone will be a candidate for outpatient total joint replacement.Elie Ghanem, MD discusses how we screen patients for different factors such as motivation, physical conditioning, family and social support, and general medical condition. He shares how we have collaborated with our partners in anesthesia to afford our patients high quality pain control via spinals and peripheral nerve blocks while allowing them to ambulate aggressively with PT/OT in order to meet their needs at home.

In this podcast, Drs. Matt Herold and Dave Larson address the ever increasingly important issue of geriatric emergency care, and how a geriatric emergency department may be the wave of the future. This is another installment in the Ridgeview CME Lehmann lecture series. Enjoy the podcast! Objectives: Upon completion of this CME event, program participants should be able to: Describe demographic trends impacting emergency care. Recognize 'geriatric syndromes' and their role in the evaluation and management of seniors in the emergency department. Review current national and local strategies for developing care coordination for seniors in the emergency department. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2-weeks.  You may contact the accredited provider with questions regarding this program at rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit:  CME Evaluation: 2019 Lehmann Lecture: Innovations in Emergency Care for Seniors (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.” FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.   Show Notes: Drs. Matt Herold and Dave Larson address the ever increasingly important issue of geriatric emergency care and how a geriatric ED may be the wave of the future. This is another installment in the Lehmann lecture series. Dr. Jim Lehmann is a retired internist at Ridgeview and Lakeview Clinic, and this series commemorates his many years of incredible patient care. Enjoy the podcast!   CHAPTER 1:   1. There are a lot of elderly people now.   2. They are unique.   The fastest growing demographic in this country are people over the age of 65. In Minnesota, the average age of emergency patients will dramatically increase. This equates to an even larger proportion of our patients being elderly. But not just elderly patients — significantly more ill patients in this age group than previously recognized and addressed.    Our current system is not sustainable, and we need to plan around this, and one of the ways is how we address our senior patient population. Primary care shortages, patient complexity, reimbursement issues and less time with patients in the clinic leads to more ED visits. In our Ridgeview Waconia campus, 1/3 of our patients are over the age of 65. In a few years it will be 75 years and older. Admit and transfer rates are more than 40% in those 65 and over. They also sit in the ED much longer due to this. Patients also bounce back more frequently in this population and this also affects reimbursement. What are the challenges in this patient population: medical complexity, social issues that go beyond a short ED evaluation, atypical presentations and the ubiquity of polypharmacy.    There is a paradigm difference. Our senior patients require, and actually deserve a different setting than the more "fast-food" experience of patient comfort offerings. For our more straight forward patients, throughput is vital. In our older patients who may be spending more time in the ED, how do we make it more agreeable and comfortable.    Dr. Herold illustrates three cases:    In case number one, an elderly gentleman presents with a fall. Upon evaluation he has a rib fracture. He is admitted. Treated with tylenol and morphine. Sent home because he’s doing well. At home he can’t get out of bed. He is readmitted. Develops fever, SOB. Pneumonia, IV antibiotics. Sent home on Levaquin. He returns to the ED now delirious.    Another elderly patient comes in with abd pain and urinary symptoms. Takes warfarin. Labs look okay with UTI noted on UA. CT abdomen is c/w cystitis. Cipro x 1 week prescribed. Coumadin held 2 days (although he didn’t actually hold the med). He returns with frank hematuria and urinary retention. Hospitalized for CBI.      Another patient, an 89 yo female with COPD. Nebs, prednisone, watched in ED and discharged. Returned next night and is SOB. Doxycycline added. Sent home again and her daughter states she is anxious. She's placed on low dose lorazepam, just for at bedtime. Two days later she is somnolonent and in acute resp distress. Placed on bipap and improves, once again discharged. 4 days later she fell because of being lightheaded. As it turns out, she gets caught up on her many feet of O2 tubing, and brakes her arm. Another fall happens in the hospital. Her Hgb is 7.8, down from 10. A bleeding ulcer is found.     More to come on these patients and how we can better care for them in the context of a geriatric emergency department. Stay tuned for Dr. Larson, who will talk about this very subject, and how to help make it come to fruition.   CHAPTER 2:     Dr. Larson discusses a paradigm shift in how we care for our senior patients. Coordination of care must improve and build a better system overall. Geriatric EDs are an innovative direction in emergency care. A new team approach specifically for our older patients who require different services. Comfortable beds, better lighting, noise improvement, etc. So, how is it actually working and currently being done well?  An ED in Patterson, NJ, at a large urban hospital was of the very first to develop a geriatric ED.  Dr. Mark Rosenberg spearheaded this endeavor. It was motivated by an experience he had in a ED with his own mother.     Goals in mind include:  1. Improve care of geriatric patients.  2. Better discern who will benefit from impatient care.  3. For those who do not require inpatient, to better coordinate their care at home. The overall goal is: reducing hospitalization.     Staff and provider education, coordination of care from both the medical and the community sides are all crucial. Interestingly, they were able to achieve these goals by staying budget neutral. Comfort in the ED is a priority. All patients 65 or over from home or assisted living facilities are placed in cohorted rooms in the ED that are quieter. It is staffed 12-hours a day, but it actually correlates with most geriatric presentation times to an ED. Natural lighting, wall murals or windows if possible. The role of a navigator, typically a nurse or nurse practitioner, is vital. Screening evaluations for falls, dementia and delirium help set the stage for all further care. Contacting the patient on 1, 3 7 and 30-days post-discharge is done by the navigator as well.     Social services' role in the patient's care is much needed as well. Polypharmacy was even recognized by Dr. Seuss. So pharmacy review of medications and the use of the BEERS criteria are of utmost importance.    Staff education and ongoing education of the many parameters of the special needs of our senior patients is an essential part of maintain a geriatric ED. A guideline by ACEP and AGS, as well as ENA, was published and is a critical resource for geriatric emergency care. Cost containment is key here as well.  We must address this elephant in the room, and the goal here is to reduce admissions and bounce backs with this new program. Attracting patients to a specialty center and improving the triple aim: improved patient care experience, improved health populations and reduced per capita cost of care.  Why the ED?     It is where patients go when things are going wrong, acutely, but also sub-acutely and chronically. Physician and nurse champions, patient advisor, nurse navigator, PT/OT, social work and pharmacy in the ED. Education for patients, protocols and a QI process are needed to actually become accredited as a geriatric ED.   CHAPTER 3:    Geriatric syndrome is a real thing. It may involve a combination of fall, delirium, frailty, and dehydration. It is a broad topic and concept. It relates to multifactorial conditions that lead to an older person being vulnerable to situation challenges. Dr. Herold used a lot of big words, like sarcopenia, and hemostenosis, to describe this. Essentially he points out that with more stressors placed on an elderly patient, the more likely one or more systems will break down. There is a disparity between mechanism of stress or injury and severity of the physiologic outcome. Distilled down, there are 8-domaigns of geriatric emergency medicine. They include: 1. Atypical presentation.  2. Cognitive/behavioral disorder.  3. Emergent intervention modifications.  4. Medication management.  5. Transitions of care.    6. Pain management. 7. Palliative care.  8. Effect of co-morbid conditions on all of the above.  This was from a paper cited from about 10-years ago. So, how can we now do better with the original patients Dr. Herold presented?  1. Our rib fracture gentleman is followed by RT. A better assessment than a "road test" with proper screening for overall function.  2. How about better [bigger] font for discharge instructions, improved ability to schedule an outpatient lab test as well as a post visit or check-in by the Nurse Navigator.  3. Screening resources for mental health and neglect. Is she anxious because she doesn't want to be home alone? Pharmacy integration and home care coordination may prevent the inevitable bounce back.   FINAL COMMENTS: Final comments were made by Dr. Jim Lehmann, the namesake for this special CME series, at Ridgeview Medical Center, where he practiced for many years.  Thanks to Drs. Matt Herold, Dave Larson, and Tara McMichael for presenting this today.  Also special gratitude goes to Dr. Jim Lehmann, and his many years of service and excellent patient care. Emergency care is stressful and complex. There is much to consider when tending to older patients and their inherent special circumstances. All the more reason to continue to be innovative with our care strategies going forward; not only in the ED, but in all departments, and at home.  

What would happen if a PT and OT and an Exercise Scientist all broke down the came case report?  Well wonder no more!  We went live at Sacred Heart's Physical Therapy program with PT Paul Ullucci, OT Sharon McCloskey, and Exercise Scientists Chris Tabor to break down two case report from all three professional angles. Then we went out and had beers. Special thanks to Chris Petrosino  

This week on "Life After Stroke with Christopher Ewing", we chat with Dr. Stuart Glassner, a former social worker with a desire to help people as much as he can, who decided to become a doctor specializing in the brain and stroke. He is the former Neurocritical Care Director at University of Florida - Jacksonville and is now at UCSF -Fresno as Neurocritical Care Attending Intensivist and soon-to-be Fellowship Director. His areas of expertise are in acute stroke management, health disparity and early rehabilitation. He works regularly with an amazing group of providers including other physicians, PAs/NPs, Neuro Nurses, PT/OT, Speech Therapy and Social Workers. Topics covered in this episode, include: - What actually happens as soon as we have a stroke and arrive at the hospital? - Hemorrhagic strokes, they may be more common than we think! - The various types of hemorrhagic strokes. Yes, there are different kinds of hemorrhagic strokes! - What is the basal ganglia area in the brain? - What is the pons area of the brain? - What is Spasticity? - Pain and stroke - Strokes and drug addiction - Post Stroke Depression. Why do some people feel an increase in depression following a stroke? - The increase in stroke among young people - an emotional shout out from Christopher and more. "Life After Stroke" is a hit radio show hosted by Emmy Award winning TV host, motivational speaker, and stroke survivor, Christopher Ewing. Each episode is recorded during an actual stroke support group and features interviews with doctors and therapists, as well as the chance for stroke survivors to be able to share what's on their mind. Clothes provided by Zappos Adaptive. From shirts with magnetic buttons to tennis shoes with zippers by top designers like Tommy Hilfiger, Nike, Levi’s and more! Shop ZapposAdaptive! For more information, just go to www.TheStrokeChannel.TV, or download The Stroke Channel TV app, FREE in the Google Play and iTunes App stores!

Resources: http://pediatrics.aappublications.org/content/early/2015/12/07/peds.2015-3679 https://www.ncbi.nlm.nih.gov/pubmed/?term=24004439 This topic is a little different from our didactic-focused interventions. However, for those of us who participate in rounds or any experiential education in patient care, I think it is an important question. When I think about rounds, I think about how beneficial it can be for all participants. The process encourages attendings or faculty to teach, residents to both teach and learn as part of practice, and students to learn. However, I have also seen a less enthusiastic approach to rounds. Sometimes, it is just getting through the morning to move on to discharges, clinic follow up, etc. So, I started thinking-how can we make rounds a more well-rounded experience? Bedside rounds, or family-centered rounds in pediatrics, can be defined as conducting attending rounds, including patient presentations and discussions, in the patient’s room with nursing and family present. If you look around an ICU team (as an example) and consider the amount of salaries standing in a circle (physicians, residents, nurses, pharmacists, case managers, social workers, dieticians, PT/OT, and more)-it would behoove us to make the best use of each professional’s time. Areas of education in rounds include skills such as bedside physical examination teaching, effective communication, and encouragement of trainee independence. A first step to improving the educational experience on rounds is to have a specific plan/road map. Preparation instills confidence in both the teacher and the learner and facilitates the learning process. It allows you to maximize the learning outcomes rather than just repeating the same process day after day. Defining each person’s role on the team has multiple benefits to improving education on rounds. This ensures that each person is involved, breaks down barriers between educator and learner, engages the team, maintains interest, ensures efficient rounds, validates the learner’s input, and allows equal opportunities between learners. Devise a plan beforehand on what can be taught to act as a guide but still be flexible to improvise. No two days of rounds will be the same. Having a plan also allows for good time management and prioritizes educational opportunities to focus on the learner’s needs. I have seen this be successful in a variety of ways. For example, presentations and team goals can be set at the beginning of the week. Each presentation is then planned and topics are decided on, therefore providing clear expectations. Some attendings will choose to review a certain article in the main journal of their expertise. It becomes a group discussion facilitated by the attending and allowing the attending to provide his/her expertise. Some residents have created quizzes based on topics discussed during the week. Other residents may opt to review an OB strip each week or an EKG each week just to provide exposure to the team. If you are able to collaborate with another department, maybe your team visits radiology once weekly, pathology once weekly, or microbiology once weekly. One resident I worked with had a focus on physician wellness and started each day of rounds with DzGratitude Roundsdz where each team member said something that they were grateful for..... Full content available at twopillspodcast.com

Jeff:  Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations. Nachi: Although this isn’t something we encountered too frequently – it does seem like I’ve been hearing more about snake bites in the recent months. Jeff: I actually flew someone just the other day because the local ED ran out of CroFab after an envenomation in Western PA. Nachi: Yeah, this is definitely more than “just a boards topic,” and it’s really important to know about in those rare circumstances. In terms of incidence, there are actually about 10,000 ED visits in the US for snake bites each year, and 1/3 of these involve venomous species. Jeff:  That’s a good teaser, so let’s start by recognizing this month’s team – the two authors, Dr. Sheikh, a medical toxicologist, and Patrick Leffers, a pharmD, and emergency medicine and clinical toxicology fellow. Both are at the University of Florida Jacksonville, and they reviewed a total of 120 articles from 2006-2017, in addition to reviews from both Cochrane and Dare. Nachi: And don’t forget our peer reviewers this month, Dr. Daniel Sessions, a medical toxicologist working at the South Texas Poison Center, and our very own editor-in-chief, Dr. Andy Jagoda, who is also Chair of the Department of Emergency Medicine at Mount Sinai in New York City. Jeff: What a team! But, let’s get back to the snakes. As some background, from 2006-2015 there were almost 66,000 reported snake exposures and 31 deaths from snake envenomation in the US.  Of course, this number likely underestimates the true total. Nachi: And there are two key subfamilies of venomous snakes to be aware of – the Crotalinae – or pit vipers – which includes rattlesnakes, copperheads, and water moccasins; and the Elapidae – of which you really only need to know about the coral snake. Jeff:  And while those are the only two NATIVE snake subfamilies to be acutely aware of, don’t forget that exotic snakes, which are shockingly popular pets -- they can also cause significant morbidity and mortality. Nachi:  Oh, and one other quick note before we get into the epidemiology – most of the recommendations this month come from expert opinion, as high quality RCTs are obviously difficult.  In addition, many of the studies were based in other countries, where the snakes, the anti-venoms and their availability, and the general healthcare systems are different from those that most of us work in. Jeff:  Unless we have listeners abroad? Do we have listeners in other countries? Nachi: Oh we definitely do... but we are going to be a bit biased towards US envenomation today. In any case, venomous snake bites occur most frequently in men aged 18 to 49 during warmer months with provoked bites occurring more frequently in the upper extremities and unprovoked bites in the lower extremities. Jeff:  In one study of poison center data from the last decade, nearly half of all victims of snake bites were victims of unknown type snakes.  However, of those that were known, copperheads were the most common, while rattlesnakes caused the most fatalities – 19 of 31 in this dataset. Nachi:  In a separate study of snake bites in the early 2000s, 32% of exposures were from venomous snakes and 59% of those resulted in admission. That’s remarkably high. Jeff:  Snake bite severity depends on several key factors: the amount of venom, the composition of the venom, the body size of the bite victim, the victim's clothing, the size of the bite, comorbid conditions, and the timing and quality of medical care the victim receives. Nachi:  To be a bit more specific - First, the amount of venom will depend on the species of snake, with variations even occurring within the same species.  Secondly, while there is a correlation between rattlesnake size and bite severity, there is much more at play.  Some snakes can even vary the amount of venom based on threat risk – with defensive bites having different profiles than bites to strike prey. Jeff: I found it pretty interesting that  an estimated 10-25% of pit viper bites are considered dry bites, that is, ones in which no venom is released. Nachi:  Right, this is just one reason why all victims shouldn’t immediately get anti-venom, but we’ll get there. Jeff:  We definitely will.  As we already stated – venom composition varies greatly.  Pit vipers produce a predominantly hemotoxic venom.  Systemic effects include tachycardia, tachypnea, hypotension, nausea, vomiting, weakness, and diaphoresis.  Neurotoxicity is rare and is usually due to inter-breeding between species. Nachi:  While rattlesnake bites are associated with higher morbidity and mortality, the more common copperhead bites typically only cause local tissue effects.  More serious systemic findings such as coagulopathy and respiratory failure have been reported though. Jeff:  So that’s a solid background to get us started.  Let’s talk about the individual snakes.  Why don’t you start with the crotalinae family – aka the pit vipers. Nachi:  Sure – the crotalinae includes rattlesnakes, cottonmouths (also known as water moccasins), and copperheads.  These make up the vast majority of reports to the poison centers.  They can be identified by their heat sensing pits located behind their nostrils (hence pit vipers).  As a general rule, you can also identify the venomous snakes by their triangular or spade-like head, elliptical pupils, and hollow retractable fangs. Jeff:  wait, so you want me to walk up to the snake and ask to see if their fangs retract… yea, no thanks. Nachi: Haha, of course not, I’m just giving you some of the general principles here. In contrast, non-venomous pit vipers have rounded heads, round pupils, a double row of vertical scales, and they lack fangs. Jeff: In terms of location, rattlesnakes are found in all states but Hawaii, and cottonmouths and copperheads are distributed mostly throughout the southern and southeastern states, with copperheads also extending further north, even into Massachusetts. Nachi: Moving on to the Elapidae –  there are 3 species of coral snakes, only two of which you need to know about, Micrurus fulvius fulvius or the eastern coral snake and Micrurus tener or the Texas coral snake.  Of the two, the eastern or Micrurus fulvius fulvius produces more potent venom. Jeff:  As you may have guessed by their names, the eastern coral snake is found in the southeastern united states, specifically, east of the Mississippi -- whereas the Texas coral snake lives west of the Mississippi. Nachi:  Venomous North American coral snakes can be recognized by the red and yellow bands around their bodies whereas their nonvenomous counterparts can be recognized by their characteristic black band between the red and yellow bands. I’m sure you’ve heard the popular mnemonic for this… Red touch yellow kill a fellow, red touch black, venom lack. Jeff:  I have heard that one, and it’s not a bad mnemonic. Just remember that this is more of a guideline than a rule, as it doesn’t always hold true. Nachi: Coral snakes also tend to chew rather than bite thanks to their short, fixed, hollow fangs.  Locally, bites can lead to muscle destruction thanks to a certain myotoxin.  Systemic signs of infection include nausea, vomiting, abdominal pain, and dizziness.  Jeff: The venom also contains a neurotoxin which can lead to diplopia, difficulty swallowing and speaking and generalized weakness. Nachi: Complicating matters even further, the onset of these symptoms may be delayed for many hours. Jeff:  Alright, so I think that about wraps up the background.  Let’s move on to the meat and potatoes of this article, starting with the differential. Nachi:  For differential this month, we are really focusing on differentiating a venomous snake from a non-venomous one. Jeff: Oh yeah, this is where you want us to ask the snake if it can retract its fangs, right? Nachi: Ha very funny – Although the type of snake may be obvious if the patient owns the snake, for most cases you see in the ED, the type of snake won’t be clear. Try to get a description of the snake and consider your local geography. Some patients may even bring the snake in with them. Jeff: yea, no thanks. As for prehospital care, it’s actually pretty interesting stuff as recommendations have changed many times.  You may have heard of the recommendations for incision / excision, use of venom extraction devices, tourniquets, chill methods and even electroshock therapy – well these methods are all OUT. Nachi:  Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them.  Instead,  since no treatment has been shown to improve outcome, you should prioritize prompt transport. Jeff: And while we definitely don’t want to encourage ill-advised attempts at capturing the snake, taking pictures at a distance may be helpful in identifying it.  Oh and the authors do note- pretty terrifying stuff coming up here so brace yourself - even if the snake is dead the bite reflex is still intact… Nachi: And that’s why I work in city hospitals… Jeff:  There’s also a bit of controversy here with regards to pressure immobilization, which is definitely something I thought we were supposed to do in the prehospital setting. Apparently in other countries, like Australia, prehospital providers frequently employ pressure immobilization – that is, wrapping bandages proximally up a splinted limb to impede lymphatic toxin spread. Nachi:  Right, but in Australia, not only are the snakes more venomous but the hospital transport distances are much longer, so, basically they sacrifice the limb to potentially save a life.  In the US, with our current indigenous snake population and the relatively short transport distances, this isn’t justified at all! Jeff:  Take home: based on the current literature, the American College of Medical Toxicology, other experts, and Drs. Sheikh and Leffers recommend against pressure immobilization in lieu of prompt patient transport to definitive treatment. Nachi:  Good to know – alright so now we have the patient in the emergency department, let’s begin ED care.  As always – IV, O2, Monitor including end tidal CO2 if you suspect a neurotoxic or exotic snake bite.  Of course, avoid using the affected limbs for vitals… Jeff: If not done already, remove any constrictive clothing or jewelry and mark the leading edge of pain, edema, and erythema both above and below the bite.  If EMS has placed bandages, leave them in place until antivenom and resuscitative equipment is ready. Nachi:  And definitely involve the poison control center or a medical toxicology service early as they are an amazing resource. It’s an easy number to remember.. 1-800-222-1222. If you just type “poison control center” into google, that number will come up immediately. Jeff: Hypotension should be treated with isotonic fluids and, as usual, anaphylaxis should be treated with the usual cocktail of antihistamines and epinephrine at first IM and then via infusion if refractory. Note that antivenom will NOT reverse anaphylaxis on its own. Nachi:  When eliciting a history, there are a number of important factors to look out for, including – time and location of the bite, description of the snake, tetanus status, comorbid conditions, medications and allergies, any systemic or neurologic symptoms, muscle cramps, perioral tingling or numbness, metallic taste, history of previous snakebites and any reactions to previous envenomation or antivenom treatment. Jeff: Moving on to the physical exam, when examining the wound, look specifically for local tissue effects which occur in over 90% of patients after pit viper envenomations.  In such cases, you would expect pain, erythema, swelling, tenderness, and myonecrosis beginning at the wound site and then spreading via the lymphatic system. Nachi:  In addition, specifically with pit viper envenomations, monitor the patient for possible compartment syndrome as the venom can lead to local tissue destruction, increased cell permeability, third spacing of fluids, and bleeding.  And remember that while the local compartment may be hypertensive, the patient may also have systemic hypotension. Jeff: Just to reiterate what I said before – hypotension may indicate severe anaphylaxis and its not necessarily just due to third spacing.  Regardless, the treatment is the same – epinephrine. Nachi:  Good point, but let’s focus on compartment syndrome for a minute.  True compartment syndrome is actually quite rare --- its really subcutaneous hypertension with preservation of otherwise normal compartment pressures that you’re most likely to see.  Compartment syndrome should therefore only be diagnosed by actual compartment measurements and not just the exam.  However, if you are dealing with compartments that can’t be measured, like in the fingers, you’re only choice is to be guided by the exam… Jeff:  Risk factors for compartment syndrome in the setting of a snake bite include envenomations in small children, involvement of digits, application of ice or cold packs, and delayed or inadequate antivenom administration. Nachi: In terms of respiratory effects of envenomations – they aren’t common.  Both bites to the head or neck and neurotoxin containing venom are potential causes. In the setting of respiratory failure, be prepared with advanced airway maneuvers like nasotracheal intubation or cricothyroidotomy. Antivenom will not reverse respiratory failure. Jeff: Neurologic effects may be present upon arrival but may also be delayed up to 12 hours in the case of eastern coral snake bites. Nachi: It’s noteworthy that in one study of almost 400 eastern coral snake exposures, the onset of systemic symptoms occurred on average 5.6 hours after the bite.  So definitely remember that repeat exams and observation will be tremendously important. Jeff:  The actual neurologic symptoms to look for depend on the snake.  Coral snake venom can produce a descending flaccid paralysis characterized by motor weakness, especially of the cranial nerves.  Similarly pit vipers, especially the Mojave rattlesnake, have also been associated with muscular weakness of the cranial nerves and even respiratory insufficiency. Nachi:  Pit viper envenomation can also lead to myokymia which is repetitive small muscle fasciculations.  Unfortunately, this myokymia may not respond to antivenom administration and myokymia of the chest well and torso can necessitate intubation in extreme cases.  Both myokymia and myonecrosis may lead to rhabdo in the case of significant envenomations. Jeff:  Pit viper envenomation can also cause hematologic effects.  Fibrinolysis and platelet consumption at the bit site can lead to decreased fibrinogen and thrombocytopenia.  In severe cases this can lead to systemic bleeding and even hemorrhagic shock.  Those on anticoagulants and anti-platelet agents are at increased risk. Nachi:  Dermal effects such as edema, ecchymosis, bullae, and bleeding are not uncommon, but up to 50% of coral snake bite victims may have none of these. Jeff:  And to round out this section – just be aware that rare effects such as osteonecrosis, ischemic stroke, massive PE, and septic shock have all been reported. Nachi: Let’s move on to diagnostic studies.  Most patients require a CBC, coags, and a fibrinogen concentration.  Those with systemic toxicity should also have their electroyltes, CPK, creatinine, glucose, and urine tested. Jeff:  And while the data is somewhat mixed, one study suggests that all patients with pit viper envenomations need their coags checked, not just those with severe symptoms as in one series nearly 90% of patients had missed coagulation abnormalities.  The clinical consequences of this aren’t clearly explained, so the authors don’t make a specific recommendation. Nachi:  In terms of imaging, a chest x-ray should be obtained in those with respiratory symptoms and ultrasound may even have an expanding role here for tracking edema, looking for fluid collections, and assessing deep muscle compartments and vascular flow. Jeff: I feel like we should get some entry music for every ultrasound reference because it seems to make its way into just about every episode. Nachi: What would it sound like? You bring this up every month. I’ll look into something for a future episode. If any of our listeners have a suggestion, shoot us an e-mail at emplify@ebmedicine.net. In terms of monitoring and observation, this is important, ALL patients with suspected pit viper envenomations should be observed for 8-12 hours with the leading edge marked every 15-30 minutes. Jeff:  In addition, serial diagnostic testing may also be needed as such changes will be used to guide treatment.  In those with systemic symptoms, lab testing will be required every 4-6 hours prior to discharge. Nachi:  Before we move onto treatment – let me quickly mention grading.  There is no universal grading system.  The snakebite severity score, the minimum-moderate-severe score, and grade 1-4 score which consider symptoms, exam findings, and lab abnormalities have all been studied.  None have been validated and none track changes, so the authors recommend relying on severity of symptoms and progression of symptoms to guide treatment. Jeff:  The crux of treatment for pit viper envenomations is with supportive care and anti-venom. Nachi:  FabAV or CroFab is the antivenom of choice for pit viper envenomations.  This antivenom is made from extracting the Fab portion of anti-venom antibodies from envenomated sheep and processing them with papain. Jeff:  Since the sheep are injected with venom from the western diamondback, eastern diamondback and Mojave rattlesnake as well as the cottonmouth, the FabAV is most effective against venom from these snakes, however it does have cross reactivity to other immunologically similar venoms. Nachi:  Indications for FabAV include a more than minimal local swelling, rapid progression of swelling, swelling crossing a major joint, evidence of hemotoxicity, signs of systemic toxicity including hemodynamic compromise, neuromuscular toxicity, and late or recurrent new-onset coagulopathy. Jeff:  Initially, dose FabAV as a bolus of 4-6 vials, IV.  With life threatening envenomations or those with cardiovascular collapse, double the starting dose to 8-12 vials.  The goal is arresting progression, improvement in coagulation abnormalities, and resolution of systemic symptoms. Nachi: Although FabAV will reduce the duration and severity of symptoms and lab abnormalities, it will not reverse tissue necrosis and may not reverse neurologic effects. Jeff:  Once the symptoms have been controlled after the bolus dose or a second bolus dose, maintenance dosing of 2 vials every 6 hours for 3 doses is recommended to prevent recurrence. Nachi:  So to reiterate.  4-6 vial bolus to start, doubled in severe cases and then 2 vials every 6 hours for 18 hours after that. Jeff:  You got it. Nachi:  And like most, maybe all medicines, there are side effects and contraindications to be aware of.  Hypersensitivity reactions and serum sickness to FabAV have been reported as 8% and 13% respectively.   Most are mild and can be treated with your standard bundle of steroids, antihistamines, fluids and epi. Jeff:  Risk factors for developing allergic reactions to FabAV include  a known allergy to papaya, papain, chymopapin, pineapple enzyme bromelain, and previous allergic reaction to FabAV. Nachi:  Although FabAV isn’t produced using copperhead venom, it may be effective in severe envenomations and in one study, FabAV reduced limb disability compared to placebo. Jeff:  Therefore, the authors very reasonably advise that you should use the patient’s clinical picture and individual factors rather than the snake species to guide your treatment. Nachi:  Interestingly, compartment syndrome should be treated with the initial 4-6 vial dose of antivenom and not necessarily a fasciotomy.  Fasciotomies have not been shown to improve outcomes and are reserved only for those failing anti-venom treatment. Jeff:  The reason for this is that antivenom may reduce tissue pressures obviating the need for fasciotomy.  In addition, fasciotomy wouldn’t affect muscle necrosis that is occurring so fascia removal really doesn’t solve anything. Nachi:  And just as anti-venom can be used to treat elevated compartment pressures, it can also be used to treat coagulopathy. Jeff:  Blood products should be used for those who are actively bleeding or severely anemic as venom does not discriminate and will destroy whatever blood it comes across. Nachi:  Recurrent and late onset coagulopathy after FabAV treatment has also been well described.   Although not exactly clear why, some speculate that it occurs for one of 4 reasons. 1) because the half life of FabAV is shorter than that of the venom, or 2) because the venom is initially stored in the soft tissues and then slowly released over time or 3) because the venom has a late onset component, or lastly, 4) there is delayed dissociation of the venom-antivenom complexes.  Regardless of the mechanism, late onset coagulopathy can be treated with FabAV. Jeff:  Luckily, bleeding associated with coagulopathy and bleeding associated with late onset coagulopathy are both extremely rare.   Nachi:  Moving on to coral snakes.  Coral snake bites should be treated with NACSA or North American Coral Snake anti-venom.  This antivenom halts or at least limits the progression of muscle paralysis and shortens the clinical course. Jeff:  Most experts recommend NACSA treatment with the first signs of systemic toxicity and not for all comers.  This recommendation is backed by the literature as in one observational study those treated with prophylactic NACSA did less favorably as compared to those who got it only after symptoms onset.  This is probably because NACSA doesn’t reverse neuromuscular weakness and only limits progression. Nachi:  And it’s not like you are just sitting by and watching while doing nothing – focus your initial treatment on wound care, pain control, and then observation for the development of systemic symptoms.  The exact length of observation will depend on the snake, but should be somewhere between 8 and 24h. Jeff:  As for dosing – the initial NACSA dose is 3-5 vials IV for both peds and adults with a repeat dose if the initial symptoms don’t improve. Nachi: Side effects and adverse reactions occur somewhere between 8-11% of the time with dermal reactions being most common and anaphylaxis being the most severe. Jeff: There is also one last anti-venom to be aware of – Coralmyn, for coral snake envenomations.  Coralmyn is a polyclonal antivenom F(ab’)2 coral snake antivenom, developed because the current lot of NACSA has technically expired although the date has been extended numerous times.  It’s currently in a phase 3 trial, so keep your eyes out. Nachi:  Other non-antivenom treatments that have been tested include acetylcholinesterase inhibitors and trypsin at the bite site – both should be considered experimental at this point. Jeff:  To wrap up the treatment section, let’s talk exotic snakes.  You may recall from the intro that these have a higher morbidity and mortality compared to native species. Nachi:  You will have to rely on your local poison control center or toxicologist for advice and you may even need to turn to the zoo or aquarium for antivenom, if it exists at all.  Patients with bites from exotic snakes should be monitored, likely in the ICU, for up to 24 hours as toxicity from some venom may have a delayed onset of up to 20 hours. Jeff:  Scary stuff, hopefully the patient knows which type of exotic snake they own and you don’t have to sort through a million google images to try to get to the bottom of this.  Anyway, there are 3 special populations to discuss.  First are pregnant patients. Nachi:  The authors cite a 1.4% incidence of snake bites in pregnant patients.  They note that this is low, but from my perspective, this seems shockingly high – why would a pregnant person ever get anywhere near a snake, seems just ill advised… Jeff:  haha, true.   But regardless, treatment is the same with antivenom as needed for all the same indications.  With fetal demise rates as high as 30%, in addition to maternal monitoring, the fetus should also be monitored. Nachi:  That number may seem high, but keep in mind that that’s from studies in other countries with more venomous snakes, so it’s likely to be lower in the US.  But the point remains, that antivenom is generally recommended to be given if the mother has indications for treatment, as poor fetal outcome is tied directly to the severity of envenomation in the mother. Jeff: Continuing right along, the next special population to discuss are pediatric patients.  Because dosing is based on the amount of venom delivered and not on patient specific factors, dosing is the same for peds and adults. Nachi:  How rare – so few meds seem to be the same for peds and adults.  The last population to discuss are anticoagulated patients.  Patients on antiplatelet or anti-coagulants are at increased risk of bleeding after pit viper envenomations and therefore should have their coags checked every 2 days following the last dose of FabAV. Jeff:  I think we’ve at least mentioned most of this months controversies, but it’s probably worth quickly reviewing them since they mostly dispel common myths. Nachi:  Good idea.  Incision and suction of snake bites is nearly universally not recommended. Jeff:  In the absence of ischemia, fasciotomy for snake bites is not recommended, even with elevated compartment pressures.  Instead treat compartment syndrome with anti-venom and save the fasciotomy for true cases of ischemia refractory to antivenom. Nachi:  With a known or suspected coral snake envenomation, due to shortages of NACSA, wait until the patient develops symptoms instead of empirically treating all bite victims. Jeff:  Maintenance dosing of FabAV continues to be debated.  The manufacturer recommends 2 doses every 6 hours for 3 doses while some experts recommend only maintenance dosing as needed.  It’s therefore probably safest to punt this to whatever poison control center or toxicologist you speak with. Nachi:  I feel like we are plugging the poison center a lot, but it’s such a good free, and usually very nice consult to have on your team. Jeff: Nice consultant – what a win!  Moving on to the cutting edge.  There is a new Crotalidae antivenom called Crotalidae Immune F(ab’)2 or, more simply, Anavip.  It should be available in the next few months.  The dosing will be 10 vials up front over 60 minutes followed by an additional 10 vials if the symptoms having been controlled.  4 more vials may be given for symptom recurrence.  Patients must be observed for a minimum of 18 hours after initial control of symptoms. Nachi: This would be a really nice development as Anavip has a longer half life and therefore should reduce the rates of late coagulopathy and decrease the need for maintenance dosing, follow up, and repeating coags. Jeff:  And finally, like we mentioned before, injection of the trypsin has been tried as a bridge to antivenom, as has carbon monoxide, which may mediate degradation of fibrinogen dependent coagulation. Nachi:  Alright, so let’s talk about the disposition next. Victims of pit viper envenomations should be monitored for 8-12 hours from the time of the bite.  They will need baseline labs and repeat testing ever 4-6 hours.  IF there is no progression of the symptoms and repeat testing is normal, the patient can be discharged. Jeff: Victims of coral snake bites should be admitted and observed for 12-24 hours regardless of symptoms. Nachi: Victims of rattle snake envenomations who initially develop hematologic abnormalities and are treated with FabAV should have repeat testing done in 2-4 days and 5-7 days. Jeff:  Wounds should also be closely followed to avoid complications and long term disfigurement and disability.  PT/OT may be necessary as well. Nachi:  Perfect, let’s round this episodes out with a review of the key points and clinical pearls from this month’s issue. There are about 10,000 ED visits in the US for snake bites each year, and 1/3 of these involve venomous species. Pit vipers produce a predominantly hemotoxic venom. Both local and systemic effects can occur. Systemic effects include tachycardia, tachypnea, hypotension, nausea, vomiting, weakness, and diaphoresis. In general, venomous snakes have a triangular or spade-like head, elliptical pupils, and hollow retractable fangs. In contrast, non-venomous snakes have a rounded head, round pupils, lack fangs, and can have a double row of vertical scales on the tail. Venomous North American coral snakes often have adjacent red and yellow bands, whereas their nonvenomous counterparts usually have a characteristic black band between the red and yellow bands. For prehospital care in the US, the following strategies are not recommended: incision or excision, use of venom extraction devices, tourniquets, chill methods, and electroshock therapy -- and they can all actually worsen outcomes.  Prehospital providers should focus on rapid transport. Be cognizant of compartment syndrome, but measure compartments when possible, as some envenomations present similarly but have only subcutaneous hypertension. Neurologic effects can be delayed up to 12 hours after coral snake envenomations. Symptoms can include a descending paralysis. For diagnostic testing, consider a CBC, coags, fibrinogen level, electrolytes, cpk, creatine, glucose, and urine studies.  All patients with envenomation should be observed for at least 8 hours. Mark the site of envenomation circumferentially to monitor for changes. Management of patients with snake bites should be treated with supportive care, pain control, and specific antivenom when indicated. FabAV or CroFab is the antivenom of choice for pit viper envenomations. Although FabAV will reduce the duration and severity of symptoms and lab abnormalities, it will not reverse tissue necrosis and may not reverse neurologic effects. Be aware of the possibility for a hypersensitivity reaction or serum sickness to FabAV. Treat with steroids, antihistamine, IV fluids, and epinephrine as appropriate. Coral snake envenomations can be treated with NACSA, which halts or at least limits the progression of muscle paralysis and shortens the clinical course.  Side effects to NACSA include dermal reaction as the most common -- and anaphylaxis as the most severe. Patients with bites from exotic snakes should be monitored, likely in the ICU, for up to 24 hours as toxicity from some venom may have a delayed onset of up to 20 hours. You may have to turn to your local zoo for help with anti-venoms here. Management of pregnant patients is the same as nonpregnant patients with regards to snake envenomations. Dosing of antivenom is based on the amount of venom. Dosing is the same regardless of the age of the patient. All patients requiring antivenom or with suspected envenomation should be admitted.  Seek consultation with your regional poison center and local toxicologist Jeff: So that wraps up the September 2018 episode of Emplify. Nachi: As always - the address for this month’s credit is ebmedicine.net/E0918, so head over there right away to get your credit.  Remember that the  you heard throughout the episode corresponds to the answers to the CME questions. Jeff: And don’t forget to grab your free issue of Synthetic Drug Intoxication in Children at ebmedicine.net/drugs specifically for emplify listeners. Feel free to share the link with your colleagues or through social media too. Next month we are talking sepsis and the ever frequently changing guidelines so it’s not something you want to miss.  Talk to you soon   Most Important References 4. *Lavonas EJ, Ruha AM, Banner W, et al. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop. BMC Emerg Med. 2011;11:2-227X-11-2. (Consensus panel) 6. *Bush SP, Ruha AM, Seifert SA, et al. Comparison of F(ab’)2 versus Fab antivenom for pit viper envenomation: a prospec­tive, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila). 2015;53(1):37-45. (Randomized controlled trial; 121 patients) 7. *Gerardo CJ, Vissoci JR, Brown MW, et al. Coagulation parameters in copperhead compared to other Crotalinae envenomation: secondary analysis of the F(ab’)2 versus Fab antivenom trial. Clin Toxicol (Phila). 2017;55(2):109-114. (Ran­domized controlled trial; 121 patients) 8. *American College of Medical Toxicology, American Acad­emy of Clinical Toxicology, American Association of Poison Control Centers, European Association of Poison Control Centres and Clinical Toxicologists, International Society on Toxinology, Asia Pacific Association of Medical Toxicology. Pressure immobilization after North American Crotalinae snake envenomation. Clin Toxicol (Phila). 2011;49(10):881-882. (Position statement) 10. *Wood A, Schauben J, Thundiyil J, et al. Review of eastern coral snake (Micrurus fulvius fulvius) exposures managed by the Florida Poison Information Center Network: 1998-2010. Clin Toxicol (Phila). 2013;51(8):783-788. (Retrospective; 387 patients) 48. *Cumpston KL. Is there a role for fasciotomy in Crotalinae envenomations in North America? Clin Toxicol (Phila). 2011;49(5):351-365. (Review) 75. *Walker JP, Morrison RL. Current management of copper­head snakebite. J Am Coll Surg. 2011;212(4):470-474. (Retro­spective; 142 patients) 81. *Kitchens C, Eskin T. Fatality in a case of envenomation by Crotalus adamanteus initially successfully treated with polyvalent ovine antivenom followed by recurrence of defibrinogenation syndrome. J Med Toxicol. 2008;4(3):180-183. (Case report) 118. *Hwang CW, Flach FE. Recurrent coagulopathy after rattle­snake bite requiring continuous intravenous dosing of anti­venom. Case Rep Emerg Med. 2015;2015:719302. (Case report)

Housekeeping While I'm typically an Android guy, I must say I have been impressed by the quality of the service I've gotten from the Apple Podcasts team. They've been responsive and helpful whenever I've had to work with them. And now, they are even faster. Generally it takes up to 2 weeks to get a new podcast in the Apple Podcasts store. It took them just 6 hours to add Strokecast. Please leave a rating and/or review for the Strokecast here. Being in the Apple Podcasts store means you can easily subscribe from an iPhone or iPad and never miss an episode. It also means that most other popular podcast apps for the Android or Samsung phone platforms also know about the Strokecast. You can subscribe in pretty much whatever app you use to listen to podcasts. Strokecast is also on Spotify. If you use Spotify on your mobile device, just search for Strokecast and it will pop right up. Tone and Spasticity  Infomercials and popular media talk about how the latest diet or the newest bow-nordi-master machine will help you build muscle and get toned. Tone in muscles is actually a bad thing in the PT/OT world. A muscle with tone is basically flexed all the time. It's contracted and in a state of tension. When my fingers curl up in a tight ball and won't release, it's because I have too much muscle tone. It my arm gets toned, that mean the muscles tighten and it curls up, useless. Tone in my legs will prevent me from bending or unbending my hip, knee, or ankle. Or cause my toes to curl up in my shoe. A muscle with tone is useless. One goal of the exercises I do with PT is to prevent tone from setting in. Working on range of motion, joint flexibility, and muscle strengthening prevents tone. What most people think of as tone is probably definition. They want to see the muscles. We often make our muscles visible be flexing them. Tone is when your muscles essentially flex themselves and then stay that way, even when you want them to stop. Imagine flexing your bicep and then keeping it flexed all day as you go about your business. That's why you don't want tone in your muscles. Treatment There are a number of ways to address tone. Some popular ones include: Movement therapy Stretching Tiring it out Massage Relaxation/mindfulness Accupuncture There are also medicinal solutions. Baclofen is a pill that can reduce tone. It can affect the whole body, though, and one of the main side affects is fatigue. Since many stroke survivors are already dealing with fatigue, this can be a challenge. Of course, not everyone experiences the side affects, and it can be a great solution. Medtronic also makes a Baclofen pump. A surgeon implants it in the abdomen and runs a tube into the spine so the pump continually deploys small amounts of Baclofen into the spinal fluid. It can be a little more targeted than the pill, and because the dosage is much lower it has few side affects. The dosage is lower because unlike a pill, it doesn't have to make its way through the digestive system into the circulatory system, and then into the nervous system. On the other hand...surgery. Botox is also an effective treatment.  Based on Botulinum Toxin, Botox is used to treat both wrinkles and tone. The director uses electrodes to monitor the firing of nerves in a muscle, and then injects Botox directly into the toned muscle to put many of the nerves to sleep for a few months. This relaxes the toned muscles and gives the other muscles a chance to recover. Hack of the Week It took me a while to figure out how to take my shirt off, and not just because people scream when I do. It simply wasn't a skill we needed to focus on the hospital. Here is my current process. Reach straight back over my head with my good hand -- follow the path of an imaginary Mohawk. Grab the back of my shirt collar. Pull that over my head. Take my right sleeve in mouth and pull the sleeve off my right arm. Grab the left sleeve with my right hand to remove that. This process also works with jackets and hoodies. It works best with long sleeves, but my short-sleeved t-shirts work out okay, too. I just skip the sleeve biting there. Where do we go from here? Do you have any tips or stories you'd like to share on a future episode? Email me at Bill@strokecast.com. I'd love to hear from stroke survivors, caretakers, medical professionals, and more. Share your thoughts on Episode 3 in the comments below. On the Apple platform , please leave a rating or review. Share this episode with anyone who might be interested. Don't get best...get better.

Margaret Kaplan, PhD, OTR/L

Margaret Kaplan, PhD, OTR/L