Archive | April 2013

@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:

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

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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.

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First, lay the blanket on the floor or bed and fold the top corner down.

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Next, lay the baby on the blanket with his shoulders at the top of – or just slightly below – the fold.

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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.

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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.”

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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!

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Tuck the loose end in to complete the swaddle.

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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.

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A swaddled newborn is a happy newborn!