Jimmy: Welcome to FOXcast PT, a podcast for clinician’s made by clinician’s. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org
And there we go. This is the very first episode of FOXcast recorded at APTA CSM. And we’re here with a friend of mine. I have to do you your fancy intro though. A pioneer innovator prolific writer and passionate clinician who’s been a driving force in the area of geriatric rehabilitation since the beginning. She literally wrote the book on geriatric PT. Dr. Carole Lewis. Carole, welcome to the show.
Carole: Well, thank you. I’m glad to be here.
Jimmy: A pretty cool setting.
Carole: Very cool setting.
Jimmy: Just you me and 17,000 of our closest colleagues, walking by way waving. Everybody online is the Facebook Live broadcast. So you can say hello there as well. How do you tell people who maybe who haven’t been to a CSM or haven’t been to a CSM in a while. What this thing has turned into and what it feels like when you’re here?
Carole: Well, it’s the ability to be with thousands, multiple thousands, of your peers. And you know what: I love every time I pass somebody, they’re talking about physical therapy which I could do 24/7. But literally, you walk in the bathroom and someone would saying something about PT, at the bars, I mean everybody so passionate.
Jimmy: Especially at the bars. Also joining us, my colleague and podcast regular now here at FOXcast PT, Dr. Will Dieter, Will welcome to the show.
Will: Thank you, Jimmy. I like hanging out with you. Can’t get enough of me? And also Carol is here, so I have to be here.
Jimmy: Now the Facebook Live crew is getting a little taste. But we have an audio audience as well. Describe my suit. How would you do it Carol?
Carole: Oh my gosh, I’d say it was orange? A little orange, it’s FOX Orange.
Will: It reminds me of the movie “Dumb and Dumber” just a little bit. I can’t get the out of my head. Figure out what’s in it.
I love it. I think that’s great I don’t know where you got it. Did you have it made?
Jimmy: I’ve got a guy, a suit guy! So, Carole you’re never still. You’re always doing things and you’re creating and innovating and that’s why literally as we’re standing here at CSM. People are walking by and pointing, and I can hear them whispering, “That’s Carol Lewis.” Now you have a new book a new e-book and I know we talked about this when you were in the formulation process and you’re like, “I got something coming” and now here are we with the book. So describe it.
Carole: Well, it’s out. I went to every publisher and asked if they could do it. Only one said yes because there’s no paper. So it’s 2,000 pages which you don’t have to read all of them, along with 400 videos. So when we talk about a technique you push the video and it pops up.
Jimmy: Say that number again how many pages and how many videos.
Carole: 2000 pages, 400 videos.
Jimmy: And that’s what we want as clinicians.
Carole: The best thing is when a technique is given or an eval or any kind of examination, you push the reference and it goes to the URL, so that you can actually see the PubMed citation to look at the strength of the evidence which is incredible. Because people tell you things but it could be based on nothing, it could be based on a very small study. So it’s nice to know the strength of the evidence. I mean, we want to give the best care. So if it’s that accessible that you can touch a reference and see that it’s really strong evidence I should be doing that. So I’m excited there are 40 authors, three editors that coedited with me. It was a work of love. And we’re having a party. We’re having a party today to celebrate it.
Will: Carol, talk about: I was in school here… I don’t know… six seven years ago and I remember reading textbooks and talk about putting evidence based information in a form that it’s easy to understand. It is usable. It’s actionable and really learning in a format where the evidence is there. You’re seeing the technique and it’s easy it’s quick. And again, it’s actionable and usable. I look through the book and I just think what I was picking up out of it: just those the little pieces of information, how to really apply that to patient care, was just unbelievable compared to just reading information.
Jimmy: Are you more of a book guy or video guy, Will? Does it depend on what you’re talking about?
Will: I would say I’m visual. I mean I can read the book. I can get it. But, I got to read it a couple of times and sort of break it down. I thought Carole’s work in that book and that type of format. I was getting it and I was reading through it and I felt like I didn’t have to read it three times to get the concept. I saw it as well how it works like a small video on it I got a reference. And I just felt really good about it.
Carole: It’s nice to have it reinforced in a video. Thank you for appreciating that.
Jimmy: And, look at the things that we do. When you’re when you’re trying to describe a technique or a movement in words or pictures. There is a profession for that’s called technical writing it’s very difficult and it doesn’t always come across. And you want to be PT using evidence, clear, concise. A video can go a long way right with making sure you got that. What’s good. So where can people find it give us the details.
Carole: Wolters Kluwer, you can get it on Amazon. I’m actually not sure you could totally download it there. But you go to a vital source or you go to Wolters Kluwer and you get the book it’s called, “Physical therapy for the Older Adult” on Amazon. But it’s such a big book you can’t really download it to a Kindle. You get two downloads so you can put on your phone.
Jimmy: So at CSM talking about the book here at the FOX booth but you’re also you guys together Will & Carol. You guys are doing a presentation together. We gave a preview a little while ago with Will on the show we teased it. For people walking by when is it and where is it? And then we’ll get into it.
Carole: It’s Friday at 3:00 in room RO6.
Jimmy: Give us the title and then we’ll dive in.
Carole: OK. It’s the “Functional Standards For Optimal Aging” and we’re going to go over the moving target screen.
Jimmy: That’s the screen we kind of alluded to a little bit in a previous episode. What’s the big picture?
Carole: Well we are completely missing a huge part of the population that we need to be out there working with. I know people have said that. So what we did was we pulled something together that therapists could use. It has to do with the annual visit. It has to do with keeping older people well. And you know if you’re 20 and injure yourself about you’re better doesn’t matter what you do. But if you’re a 60 and you injure yourself it’s not the same age and your body does start to decline. So if you can do things to keep your body from declining I mean just you know I show a picture of a 60-year old triathlete and his cross section of his muscle fiber is better than a 20 year old. So you know you can really stay healthy. But people don’t know what to do. And we have the answers. It’s not just cardio, it’s not just strengthening, it’s not just flexibility. It’s all of those and balance and posture. You got to put it all together. This is for me been a labor of love for years.
Jimmy: Yeah I can’t tell at all that you’re passionate about it. So you’ve got this conundrum. We have a lot of knowledge. We know what they need. We know it works as you’re talking about the cross-sectional muscle description of the triathlete 60 year old is better than 20 year old. We know what we do works. This is evidence based we’re not debating that. And then how do we transmit this? How do we put this into practice? That’s what your moving target screen does. And I love it. We’ll talk about it. You can do it in 30 minutes. That’s a big deal because now we’re in real life territory because clinicians hearing this are going great. Great evidence based, covers all bases. Can I do this for real? And yes it can be done in 30 minutes. What does it really do? What would you describe it looking like a session or a screen?
Carole: Well again it’s available for free. MovingTargetScreen.com and the first pages just a history. What are the things that keep them from exercising or what medications are they taking? Their diagnoses, BMI, O2 Saturation, heart rate, and blood pressure
Will: And very quick stuff like you said the things that are really impactful quick. We’re not spending 30 minutes just gathering every type of psychosocial piece of information possible. Right.
Carole: I’m sure there’s stuff we’re missing but we tried to pick the ones that are most important.
You got a killer giant first leap on this. Then we get into the screen and what’s what’s included?
Jimmy: OK so we’ve still got the first page sorry, we have a lot more information just on the first page.
Carole: It is not just any falls. There’s a fall is not a fall is not a fall. So we look at you know, somebody could trip it just catch their balance somebody else can fall and end up breaking a hip going into the hospital. So there’s levels of fall based on the Johns Hopkins falls scale that they did the expert analysis and they came together for a consensus. Then you get to the actual screen. So we look at posture we have two tests for posture we look at flexibility we have upper body lower body. Then we do balance. So we do four different types of balance. Because balance is just not one thing. What if what if you have the vestibular or problems a TUG talk might not pick it up. So we look at four aspects of balance. They’re fast tests that have predictive numbers and norms and then we go to endurance a quick two minute test for a endurance and then we go strength for areas where we can make a difference like rotator cuff, the quads, core, back.
Will: Things that people don’t always really necessarily think about with older adults.
Carole: But if you ask somebody it’s so important. Every therapist will tell that it’s important, but do they measure it? With something that’s quantifiable.
Jimmy: Measure, treat and retest.
Carole: Yeah we know it’s important and then we don’t measure it. How could that be?
Jimmy: All evidence based which we love. Some people love the citations want to make sure they know where this comes from, and this has got it. So you just tied together all the things we should be employing with older adults, in one 30 minute screen.
Carole: And the second piece is what do you do with it.
Sure. You know I don’t get to you have recognize it’s a screen so you can consult the person. You could say, “You think you’re working out but you’re not running at your heart rate max.” Let’s go over what that should look like. Maybe the the little high intensity interval training. You’re strengthening but you’re doing nothing for your rotator cuff. That’s why it’s weak. That’s where your shoulder hurts. And if there’s too many things it’s a great way to say, “You need a full physical therapy program”. You have these deficits treat them now before they become horrible deficits.
Jimmy: Ounce of prevention, pound of cure. I love that. Very excited about this the tease was good. And then you know hearing a little I guess a little bit of passion from from Carole
Carole: Just a little.
Jimmy: Passion meter actually just broke, it fell off the other side.
Will: That was her whole back a little bit too.
Carole: The exciting thing is what Will is going to present. Tell them what you’re going to present.
Will: The course goes through the screen. One of the things I love about is all of the evidence base piece the assessments but it’s kind of talking about how to look at it how to communicate it to somebody how to explain to them what the issues might be. I think as a profession we don’t do a good enough job of that. I think at times we know what it is in our head and we can’t really get to the person and have them take an actionable effort towards rectifying something. But the last piece is a marketing and it’s talking to physicians and talking to older adults talking to whoever it is that you want to market this to. But talking about motivation and talking about how to really structure a talk in a way where you’re going to get them to understand what it is. Get them to buy into it. Because ultimately it’s like anything else right if somebody else tells you have to do it. Ok I might do it I might not. And even if I do do it I’m probably not going to follow up with it. If you’re doing it because you want to do it or because it’s meaningful to you or there’s some kind of connection to it and you understand what it’s going to do for you long term which is what I think does a really good job of. You’re going to come up with something in a plan together with that person that’s going to make a difference in their life moving forward.
Jimmy: It’s all about that why.
Will: In essence what the end of the talk is about is how to motivate somebody and how to how to sell it. You know because it’s comprehensive. You’ve got some people doing way too much. We’ve got a lot of people not doing enough. This lands squarely in the middle right in a really good spot. And it’s proactive. It’s wellness based. We’re talking about all of these little micro injuries that are kind of causing all these issues that maybe people aren’t even noticing.You show them this and they’re seeing it and they realize there’s a problem right. So being able to motivate them and all of this is part of the course and that’s I think one of the other big pieces of this is is that the screening and the motivational piece.
Jimmy: Right. Last thing we want to get to research and evidence based practice. Staying on top of it and being the best clinician for older adults. It’s something you’re hugely passionate about.
Carole: We have to keep contining to do it. I think our profession is getting so much better about it. You know when I used to teach years and years ago probably before you both were born. I had maybe one slide on research. There wasn’t much. And it’s hard keep up. I mean that’s my biggest concern. And I actually believe you know and I’ve said this before I checked that CBS would mandate functional tools in the 1980s and everybody laughed at me. And then it happened. Well I think they’re going to be mandating that we show the evidence behind what we’re doing. They’re going to require that. That you can’t just do calf stretches. Explain why you’re doing that or where the evidence comes from that right now.
Jimmy: February 22nd 10:00 a.m. Carol said it and when it happens we can reference back to that.
Carole: There you go. There you go.
Will: It’s got we roll the tape yeah.
Jimmy: It’s got to, it’s got to go there. Yeah that’s what we transition to a DPT programs. That’s why everything we do has to have a component of. OK great. Can you prove it? Did someone else prove it can you replicate it? So of course it’s going to go to, Where’s the evidence behind what you’re doing? We like to say we have a very robust background of evidence. Great. So I think we’re in a good spot because it’s going to come, Carol just said it at 10:50am.
Jimmy: All right. So we have a FOXtail, part of the show at the end. Get it foxtail?
Oh my goodness. OK.
We’ll go to both of you guys. Why are you still passionate about working with older adults?
Carole: My story is very personal. I’m gonna cry. When I was little my grandmother and grandfather were the ones that really took care of me. They introduced me to all these wonderful older people. And I just, I watched how they’re nurturers and they care so much and they created a wonderful country for us. I walked in to places where these people are not treated well and they did so much to make our life as good as it could be. And I think we owe it to them to make their lives as good as it could be.
Jimmy: You’re gonna make me cry. That was beautiful. Absolutely. If there’s ever a reason to do something, if that’s not it. If that didn’t just cause you to choke up a little bit. You don’t have a pulse. That’s a great result. OK. Wow. Good luck following that Will. Same question.
Will: I have a personal story as well. My own grandmother she towards the end her life. I remember her saying to me many times, “You know Will, I’m living but I’m not living.” But you know she was very sad about, it made me very sad. So I know at a very young age I sort of knew I wanted to make sure these people had good quality of life. So I think it’s that and the other side the other pieces I just don’t think anybody else is really doing it. I don’t think enough people are doing it and I think it needs to happen I think for the future of health care it should happen. There’s several different reasons but I just don’t think enough people are doing it. I think that’s what makes me passionate about it is that I think we need to stand up and be the people that are doing it. You guys have forged the path. And I think we need to continue to do that and keep raising the bar higher.
Jimmy: And I think at a very micro level doing things like this, having this conversation sharing it. You know this show is free and you should share with anybody can you know you’re giving away you Know all the resources that you give away. That’s the way to get it done. Carole, Well Dieter appreciate you guys coming on the show and leading off our CSM coverage 2018. Thank you.
Carole: My pleasure it was fun!
Will: Thanks Jimmy.
Jimmy: Thanks for listening to FOXcast Physical Therapy. A clinically excellent cast. Brought to you by FOX
