House of Delegates 2.0
Introduction to 2013 Motions by Speaker of the House Shawne E. Soper (from http://www.apta.org/HOD/2013/)
In one month, the APTA House of Delegates will convene for its 2013 session.
During last year’s session (my first), social media played a role for the very first time. The House discussed and ultimately adopted what began as RC 23-12 and is now the Standards of Conduct in the Use of Social Media. Going into my first House session, I naively thought that it wouldn’t be a big deal if I used social media. Honestly, I didn’t think anyone would really notice. I was wrong. Many House members had concerns when I (and others) participated in social media discussion before and during the house. Live-tweeting candidate interviews was particularly objectionable, I learned. Social media was new to the House, and questions were understandable. We all learned from the process. I’ve already written about all this, so I won’t was time rewriting it all here (but I encourage you to read this and especially this to get up to speed on social media during the 2012 HOD).
All of this is to say…
We’ve come a long way in one year.
This year, for the very first time, all motions that will be brought forward in the House of Delegates are available for viewing and comment by members, non-members, and the public via the 2013 House of Delegates Web Page. The page has a link to language for each motion, including information on which Chapter/Section brought the motion forward. And, for those of you who are on Twitter, @APTAtweets has established a hashtag for each motion, so you can tweet about or follow online conversations on motions that particularly interest you. I am loving this page versus the members-only House Community Group, which I find extremely clunky, unintuitive, and difficult to follow. But that’s just my opinion, and that’s the point – these new initiatives open up MULTIPLE, interactive channels for communication so that everyone can engage in the process, whatever their membership status or online/social media preferences.
So here’s the deal:
There are no more excuses for being uninformed or for not engaging in the process.
Every single physical therapist should go to the online House Community or the 2013 HOD Web Page. Read through the RC’s. Take note of who brought the RC forward (or those who are co-sponsoring) and if you have questions, contact those people. If you want to discuss a motion or have questions or comments, contact your Delegate – it is usually easy to get contact information for your Chapter’s delegate by contacting your Chapter or visiting your Chapter’s web site.
If you’re not that into social media or have something to say that can’t be said in 140 characters or less, leave a comment on the House Web Page. If you’re a Twitter user, start a conversation on Twitter using the hashtag for the motion (and, ideally, #APTAHOD as well).
I’m a Twitter user, and I am frequently struck by the passion of the physical therapists and students who engage in Twitter discussions about our profession. But I still see a disconnect between the intensity of the online discussions (which always include lots of ideas about what the APTA and the profession should be doing) and the lack of participation in the House of Delegates (where one can actually shape what the APTA and profession is doing). The House of Delegates is where policies are made, our organization’s leaders are elected, our profession is defined, and decisions are made about how to move forward. For members. By members. Whether you want to post or tweet, have lunch with your Delegate to talk about a motion, reach out to an APTA leader (incidentally, Nicole Stout is now a prolific Twitter user), or become a Delegate yourself; opportunities are there and they are real.
Engage.
Meet Ray
This morning, I met Ray. Not in person, but through the beautiful network that is social media. His story was posted by a pediatric physical therapy colleague, and was so moving for me that I wanted to share it here. Ray’s video tells the story of a child who – like all children – wants to participate in life with his family and friends. He has spinal muscular atrophy, a rare degenerative neuromuscular disease. He will not get better, but Ray’s family simply wants to make him the best he can be for as long as he can be. They need help funding an addition to their house so Ray can use his power wheelchair to move around his home and play with his brother, Ethan.
I have had the privilege of knowing many children like Ray, and I have seen the difference that mobility makes in their lives. I have also experienced firsthand the frustration families face when trying to fund the equipment (including special vehicles, ramps, and home additions) needed to provide their child with the simple freedom that almost all of us take for granted – mobility. Want to help give Ray freedom? Click here: http://homefreehome.org/our-projects/build-freedom-for-ray/
@Twitter in #PTedu
I’ve got Twitter on the brain.
Today I’ve been putting the finishing touches on a manuscript describing research I did using Twitter in my Professional Interactions course last year. And I’m gearing up to start a new Twitter project with the same group of students when they go out on their clinical internships starting Monday.
I am passionate about using social media in physical therapy education. I believe it is a professional technical competency that all physical therapists should possess. I believe the next generation of health care consumers will demand that providers have a social media presence. I believe it gives us the opportunity to share our profession with the world and a means to write our own online story. I believe – as Dr. Natasha Burgert said in a recent seminar I attended – that my social media presence gives me the opportunity to amplify positive health care messages and drown out the bad ones. I believe reading social media makes me smarter and more humble. I believe that using social media as a professional makes me a better digital citizen, and that teaching my students to be better digital citizens is part of my job as an academic faculty member.
But sometimes it is hard to convince the nonbelievers.
Make no mistake, while I believe in the power of social media in health care and education, I get that social media isn’t something that everyone enjoys. I do not believe that all “good” health care providers should blog, tweet, and post. In fact, it’s probably a good idea that some of them don’t. I believe there is as much (if not more) value in “lurking” as there is in creating content. And I believe that it is enough for some providers to simply have the knowledge that there are conversations happening online, even if they rarely join those conversations. But, these days, I don’t think ignorance is an option.
Starting next week, I will ask a group of students to use Twitter to talk to me, each other, and the world while on their clinical internships. And about a month later, I will ask a brand new group of physical therapy students to tweet about their new role as a health care professional. You may assume that because these students are young (most are in their mid-20s), that they are social media power users. That they “get” Twitter and are ready to go forth and tweet as health care providers.
You would be wrong.
All of them use social media (mostly Facebook) in their personal lives, but many are still not ready to make the leap to using social media for professional communication. As with any group of people, there are power users who are eager to jump in. But there are also students who are completely uncomfortable with using social media in a professional manner. Some of them are private and don’t want to open a Twitter stream to the world. Some of them don’t yet have the confidence to put their knowledge out there for the Twitterverse to evaluate. And some don’t want to do it because it’s just one more thing to do.
I get it.
But I want them to get that there is a method to my madness. That I’m not just using technology for the sake of it or because I think it’s fun. I want them to understand that I think using social media – whether they tweet or post daily or simply lurk occasionally – will make them better physical therapists. They can build connections and an online community. Reach out to patients and potential patients. Stay up-to-date on the latest health information. They will learn that these forums can provide enormous value, and they may even decide to start providing a little value of their own.
As I’ve spent most of the day reading and writing about social media in health care and education, I opened my Twitter stream and decided to click over to the Millenial Medicine Symposium hash tag (#MMed13) to see what conference-goers think the future holds. There happened to be a discussion on health care social media going on, and one tweet almost perfectly sums up the reason I use social media as a health care professional, and my reason for incorporating Twitter into PT education:
Twitter in #MEDED: learning is influenced by watching how other concisely share what they are hearing. #mmed13 #CMEchat
— Brian S. McGowan PhD (@BrianSMcGowan) April 26, 2013
When you participate in social media discussions, your world becomes bigger. You discover new information. You find an online community. You can use group think to solve problems. You gain new perspectives. You learn.
And I would add to Dr. McGowan’s tweet that learning is also influenced by how you concisely share what you are hearing. When you create a professional, thoughtful tweet or post, you’ve learned something in the process. You’ve analyzed information, taken it apart, and put it back together in 140 characters or less. You have grown and you have contributed and you understand that information in a way you never did before.
Health care social media can be an incredibly powerful tool, but it requires an open mind, some old-fashioned intellectual curiosity, and a little fearlessness.
I hope my students will give it a try.
What do babies do in the first year? A lot!
During the spring semester, I get to introduce second-year DPT students to “normal” motor development as part of their Control of Human Movement course. I created this 5-minute video (starring my three boys: Max, Charlie, and Bobby) for my students as a quick review of motor milestones in the first year.
As I note in the video, motor development is a complex and individual process influenced by individual differences, environment, and even culture. What I present here is meant to be a quick review, and is certainly based on the study of motor development in WEIRD cultures. Do you know any children who developed differently than what is presented in the video? Or who may have even skipped one (or more) of the milestones discussed?
Swaddling your newborn
Created using The Keep Calm-o-matic: https://www.keepcalm-o-matic.co.uk/p/keep-calm-and-swaddle-on-3/
As many new parents will tell you, swaddling can mean the difference between a happy, rested baby and cranky, sleepless nights. In fact, one of my favorite parenting books - The Happiest Baby on the Block by Dr. Harvey Karp – lists swaddling as one of the “5 S’s” to help babies keep babies calm and help parents survive the the first 12 weeks of infancy – the so-called fourth trimester. But why?
During pregnancy, the baby is contained in an environment (the womb) where she is constantly being held. She is contained from almost every direction, and – particularly during the final weeks of pregnancy when things get pretty tight in there – is unable to move without experiencing some resistance. After birth, the baby is (quite literally) pushed into an environment where she isn’t contained all the time and where her limbs can move freely. While this freedom of movement is important for developing the muscles for rolling, sitting, crawling, and walking, it can be unnerving for baby. Free movement of the limbs can give the baby the sensation that she is falling, triggering the Moro (startle) reflex (see this post for more info on newborn reflexes). A generation ago, when babies were typically placed on their tummies to sleep, the problem of flailing arms and legs wasn’t a big problem. Gravity pressed the arms, legs, head, and body against the mattress, provided womb-like resistance to movement and a sense of comfort for baby. However, in the early 90′s, we learned that it was much safer for babies be placed on their “Back to Sleep” (for more on what is now known as “Safe to Sleep,” click here). While back sleeping is an important recommendation and has had a significant effect on reducing the risk of sudden infant death syndrome (SIDS), gravity works against the baby in this position. Instead of pressing the limbs against the mattress and their little bodies, gravity pulls the limbs away from the body which results in flailing motions and startling. Babies simply feel less secure in this position and most don’t sleep well without their arms and legs contained. That’s why most babies need a way to transition from the comfort of sleeping in a cozy womb to learn to sleep while fighting against pesky out-of-womb issues like gravity and moving limbs. That’s also why many frustrated (and tired) parents find that the “only way” their baby will sleep is if they’re being held (and grandparents often aren’t much help – they didn’t put babies on their backs to sleep and so many didn’t swaddle). With back-sleeping, you have to trick the baby into thinking she’s being held. Enter swaddling.
From a developmental perspective, swaddling is absolutely safe (and can even be helpful), but there are some things to consider before you swaddle. Because the arms are generally considered the “trigger” for the startle reflex, the arms and upper body should really be the focus of the swaddle. In fact, care should be taken NOT to bind the baby’s legs tightly together when swaddling. Newborns have shallow hip sockets, which means their hips can dislocate much more easily than an older child’s or adult’s. Keeping the legs apart is a stable position for the hip (this is also a consideration in baby wearing – I’ll cover this in a future post). Forcing the legs together is a more unstable position and increases the risk of hip dislocation. So care should be taken when swaddling to keep the legs wrapped loosely while tightly wrapping the arms and trunk. This can be tricky (especially for a wiggly older baby), which is why I love fool-proof products such as the SwaddleMe blanket or the Woombie that firmly contain the arms while leaving the legs in a loose pouch. However, you don’t need a special product for the perfect swaddle – all you need is a good-sized blanket with just a little bit of stretch (I love Aiden & Anais Swaddle blankets and have also had good luck with basic waffle-weave receiving blankets). These blankets should provide plenty of warmth without overheating baby, but – if you think your baby may be a bit warm – you may want to undress her down to a t-shirt or onesie before swaddling.
First, lay the blanket on the floor or bed and fold the top corner down.
Next, lay the baby on the blanket with his shoulders at the top of – or just slightly below – the fold.
Fold one side over the baby’s trunk, going over the arm on the same side and UNDER the arm on the opposite side. Tuck the blanket firmly under baby and give the loose end of the blanket a tug to keep everything tight.
Take the bottom corner of the blanket and bring it over the uncovered arm/shoulder. Tuck it under the shoulder/upper arm, creating a nice loose pouch for the legs to move. Make sure both arms and shoulder are contained – the whole point is to make sure the baby can’t work his arms out of the swaddle. I also like to make a small fold over the top of the remaining “tail.”
Take the remaining tail of the blanket and wrap it tightly around the baby’s arms, bringing it back around the front. Give it a good, firm pull. Don’t be afraid to make it nice and snug around the arms!
Tuck the loose end in to complete the swaddle.
And there you have it!
So how long should you swaddle? Swaddling is most helpful during the first 3-4 months of life, but some babies continue to need swaddling for a few more months (which is perfectly safe as long as they are still unable to roll over while swaddled). Once babies begin to gain more control of their movement, they are usually able to get into their own preferred position of comfort while sleeping and are less likely to startle, so the swaddle is not longer needed. I was effective in weaning both of my older sons from the swaddle at 4-5 months by swaddling with one arm out, then the other arm out, then getting rid of the swaddle completely.
Of course, swaddling should only be used for calming a fussy baby and during sleeping. When baby is awake, he should be unwrapped so he learns how to move and control his limbs on his own. Laying down on an old-fashioned blanket on the floor during play time should give plenty of opportunity for movement and exploration, and all young babies should practice “tummy time” several times a day while awake with supervision.
A swaddled newborn is a happy newborn!
Primitive reflexes (or, cool party tricks you can do with your newborn)
I’ve taken a several-month hiatus from blogging, but with good reason. In December, I welcomed this little guy to my family.
Look at those cheeks!
The fatigue of late pregnancy and the early newborn weeks – combined with a busy work schedule, my two older boys and husband, and a host of other “real-life” obligations – left me little time for blogging over the past several months. But I’m ready to re-enter the blogosphere. And, since I’m living with a newborn and will be teaching physical therapy students about infant development later this spring, it makes perfect sense to create a series of posts on newborn development. Today’s post is on primitive reflexes.
Primary standing & stepping
When most people think about reflexes, they think about sitting on the table in the doctor’s office getting hit on the knee with a rubber hammer. Those types of reflexes are called deep tendon reflexes and are completely different than the primitive reflexes I’m writing about today.
Primitive reflexes are a set of involuntary movements that are typically seen in the newborn infant. These reflexes originate in the lower, more primitive parts of the central nervous system (hence the name primitive reflexes). Parents are often surprised and sometimes even entertained when I show them primitive reflexes in their baby – because they are involuntary, they can be elicited in a newborn baby almost any time and are often times quite strong. But primitive reflexes are more than cool newborn party tricks (Look, Grandma! I’m 2 weeks old and I can stand!). They give healthcare providers important information about a baby’s neurological function.
Asymmetrical tonic neck reflex
When a baby is born, the higher centers of the central nervous system – areas that allow for voluntary movement – are not fully developed. This means that lower areas of the brain are in control and primitive reflexes dominate movement. In the first few months of life, the presence of primitive reflexes tells us that the lower portions of the central nervous system are functioning as they should. If primitive reflexes are absent or otherwise abnormal (weak or asymmetrical), we may suspect neurological injury or dysfunction in these lower areas of the central nervous system.
By 6-12 months of age, the higher, more sophisticated areas of the brain mature and voluntary movements dominate. In older babies, we expect primitive reflexes to integrate or “disappear” as more purposeful movements emerge. If we continue to see primitive reflexes in the older infant, we suspect that the higher centers of the brain may not be developing normally. Persistence of primitive reflexes can inhibit future development, making it difficult for the baby to learn to roll over, creep and crawl, reach and grasp, stand, and walk. Of course, primitive reflexes never really disappear – they continue to “live” in the lower brain and spinal cord and are simply masked by more mature brain function. This is why primitive reflexes may also be assessed in an older child or adult with neurological disease or injury – the reappearance of primitive reflexes may indicate damage to higher centers of the brain.
Plantar grasp
The following primitive reflexes are frequently tested by physicians, nurses, and physical and occupational therapists as part of a newborn neurological exam:
- Asymmetrical tonic neck reflex (also known as the “fencing” reflex) – When baby’s head is turned to the side, he assumes a “fencing” posture by extending one arm in front of his face and bending the other arm behind his head.
- Rooting/sucking – When the skin next to baby’s lips is stroked, she turns her head to find the stimulus and attempts to “latch” on and suck.
- Palmar and plantar grasp – Pressing into the palm of the hand or ball of the foot causes the baby to grasp with his fingers/toes.
- Primary standing and stepping – When held in a supported standing position, the newborn “stands” and even takes some steps.
- Galant reflex – Stroking along the side of the baby’s spine causes the spine to curve toward that side.
- Moro reflex – When the baby’s head is dropped backward, it elicits a “startle” (he quickly extends both arms), recovery (arms back to midline), and a cry.
For more information or to see primitive reflexes in action, check out the video:
Kids and football – my thoughts as a physical therapist and a Mom
Creative-commons licensed photo by Flickr user stuseeger
Yesterday, the medical journal Neurology published a study suggesting that professional football players are 4 times more likely to die from the Alzheimer’s disease and ALS (Lou Gehrig’s disease) than the general population. This is just the most recent addition to a growing body of evidence linking football to neurodegenerative disease.
As a pediatric health care provider, this body of research continues to be alarming and thought-provoking. As a mother of two boys* (and another on the way), it is terrifying. And complicated.
My husband and I both grew up in small towns where football was a huge part of the community. I was a member of the high school pep band and attended every single home high school football game. I loved those Friday nights when it seemed that everyone in town had come to the football field to cheer on the local team. My husband was a player for his team and has fond memories of the physical challenges of the sport as well as the camaraderie he developed with his teammates. We both continue to enjoy the game, and watch our Mizzou Tigers faithfully during football season. If – when we were expecting our first son in 2006 – you would have asked us if we thought football was too unsafe to allow our son to play, we both would have laughed. But a lot has changed since then, and there is now strong evidence (most released just within the last few years) that the repetitive trauma experienced in football is linked to depression, memory loss, suicide, and neurdegenerative disease. My husband and I have had many thoughtful conversations about this issue, and we are both unsure we can ever let our sons play. We agree that we will encourage other sports and interests and will be perfectly content if our sons never want to play. And we certainly won’t sign them up to participate in local youth football leagues, where – at least in our community – children as young as 8 years old practice up to 6 hours a week in full pads. But we haven’t decided what we will do if one of our boys asks us to play in junior high school. Luckily we have at least 7 years to make that decision.
Many have argued that the study published yesterday applies only to professional football players, elite athletes who take much harder hits for many more years than your average youth football player. That may be true in this case and, of course, research and statistics are tricky things. You can’t make decisions based on one study, and – at the end of the day – statistics are good at telling you what will happen to a group of 100 people, but not necessarily good at telling you what will happen to an individual. But isn’t about just one study or one group or one individual. Boston University’s Center for the Study of Traumatic Encephalopathy has an entire list of published studies on the effects of concussion and repetitive head trauma on young athletes. They are just one of the research teams finding that in football players – particularly those in “speed positions” who experience the hardest hits and are at greatest risk for concussions and repetitive head injuries – brain structure and function are altered. It is hard to ignore heart-wrenching stories (like this one) of boys who have died because their brains were damaged from the repetitive head trauma experienced in football. And consensus is growing among the medical community that football is bad for kids – it seems that every time I turn around, a pediatrician or orthopedic physician has written a blog post outlining why she won’t let her own children play football (see this one by Wendy Sue Swanson, MD).
Many supporters of youth football concede that the risks of neurological damage are increased, but argue that they are still small. They say that kids can get hurt doing a lot of things, that their child enjoys the sport. They cite the benefits of football – the exercise and physical activity, learning to be a part of a team, to be disciplined, to push themselves – and they choose to let their son play. I don’t think those parents are necessarily wrong. Parenting (and life, really), is about weighing benefits and risks and making informed – and often difficult – decisions. But I would argue that kids can get all those things – exercise, team building, discipline – from other activities that don’t carry the risk of head injury (I would also argue that – given the Greg Williams “Bountygate” and recent events at Penn State – the culture of football seems to be a lot more about winning games than caring about the mental and physical health of children and players, but that’s a post for another day).
I don’t judge the parent whose child plays youth football, but I do think he would be remiss if he didn’t educate himself and thoughtfully consider the risks and benefits associated with the sport. Taking an “I played and I turned out just fine” attitude doesn’t cut it – we have to set aside the fond memories and emotions we associate with the game and take a real look at the science and evidence before us. We have a lot more information than we did 10 years ago, and we are fortunate we can use that information to make better decisions for our children. And in our family, I think the decision is no football…for now.
*I in no way intend to be sexist or offensive by only referencing boys in this post. I know that girls do play football and I encourage parents of female football players to also seriously consider the evidence before letting their child play. But because that is a very rare occurrence – and because all research referenced in this post was done on boys – I chose to male pronouns throughout this post.
