AUGUST 2020
StriveHub Fab 5 “Alyssa Griffo was wonderful. She was very professional, personable, and excels at her profession. My therapy was a pleasure because of her. I had physical therapy once previously with a different provider who made me feel like a product on an assembly line, and strung me along promising therapy will end next week for over a month. Thank you!” - East Hampton
A LITTLE DISTANCE...
I spoke with my brother Paul the other day. He is on an extended trip to Aarhus, Denmark, welcoming his first grandson into the world! Kai was born on June 26th and thankfully all are happy and healthy. My nephew Jared and his wife Helena chose the name Kai because it is short and pronounced the same in both languages. Short was critical, as the Danish typically use full names instead of nicknames or abbreviations. Kai Christianson Balavender is still a mouthful, yet not bad considering Aleksander is more traditional! Technology has allowed us to stay connected and I have enjoyed pictures, videos, and an occasional “live” call via Zoom. It's been great to be so far from each other and yet feel so close. In anticipation of my “Great Nephew,” I had been following the news in Europe as well.
Fortunately, Denmark has done a remarkable job to date managing COVID-19. In my conversation with Paul, we talked about how life is being lived in Denmark compared to the United States. Paul explained that Danes are rule followers and accepted masks and social distancing as a personal responsibility to keep themselves and their country safe. It appears this adherence to safety guidelines has been incredibly effective in stifling the virus. When last we spoke, the small, relatively spread out country of just under 6 million had less than 50 cases of the virus and people are living relatively “normal” lives.
PTSMC Celebrates Clinical Excellence!
Congratulations to John Galer (Guilford), Erik Schmitt (Westbrook), and Channing Harwood (Plainville) for earning their OCS (Specialist Certification: Orthopaedics)! A great accomplishment for PTSMC’s first residency class!
We also talked about how different the news cycle and politics are in the two countries. At one-point Paul said, “It’s been refreshing to be away from CNN and the relentless coverage of the pandemic.” To be honest, it’s almost impossible for me to avoid the news, science, and politics of the Coronavirus. That said, since our conversation I have attempted to “step back” a little from the coverage as well.
“Brian Vo is an outstanding PT but more importantly he genuinely cares about his patients. He was highly recommended to me by colleagues and friends and I second those recommendations!” - Windsor
“I can't thank you enough for everything you have done and continue to do for me. Your knowledge and kindness have gone above As we each continue to navigate our own paths during this time, and beyond. I will be forever grateful to I hope you and your families remain healthy and I hope you can everyone who worked with me. Especially Joe fill more and more of your life with happier experiences and (Allen) and Christina (Mogelnicki). You activities. were both so wonderful. Thank you!!!” - Newington I accept that COVID-19 will continue to impact our lives and PTSMC for an unforeseeable length of time, longer than any of “My therapist, Katy (Sullivan) is just the us had anticipated or hoped, however part of my future effort to best. She has a great personality and keeps create a little distance will be reflected in my PULSE contribumy mind off what she is doing to me, thereby tions. In the future, I am going to do my best to avoid the virus making me less nervous and, I feel, enabling a in this newsletter, because as Kai has shown me, when you’re more accurate read on my pain level. She is able to take a step back, you can see there is still so much extremely skilled at her job.” - Orange happening that is worthy of our attention, and so much to be grateful for. “I cannot say enough about the care I have received from Kasey Adinolfi and her staff at Stay healthy and thank you for all you do! PTSMC in Wethersfield. Based on past experiences, I was quite skeptical when my primary physician referred me to PT for neck pain. From my initial evaluation with Kasey, I Alan knew I was in good hands. Kasey and her staff are hilarious and really care about their patients. They take time to explain the treatment in a way that is easy to Patient Trends understand...Kasey and I began having virtual visits 3 times a week, and I truly have gotten so much stronger.” - Wethersfield New Patients per Month
YOU’RE INVITED Sacroiliac Joint Pain
Evidence-based diagnoses and treatment THURSDAY, AUGUST 6 from 7-8pm a virtual GoTo presentation
Visits per Month
with Dr. Sandeep Johar, DO Neurosurgery, Orthopaedics & Spine Specialists, Sports Medicine & Interventional Pain Management If you are interested in attending our first “Virtual Doc-Talk” please email Peter.Decoteau@ptsmc.com by August 4th.
CLINICIAN’S CORNER APPLYING THE MDT APPROACH
By Brian Greer, PT, DPT, DIP. MDT Physical Therapist at PTSMC Watertown Imagine this clinical scenario: Your new patient walks in with a script for R MCL sprain. The patient reports knee pain that has been present for about 3 weeks, around the time that they started running again. After your evaluation which includes a positive valgus stress test, weakness, and decreased knee ROM, you determine that the patient does in fact have an MCL sprain and you move forward, treating accordingly. This scenario may sound very familiar, as it should. It appears to be a sound clinical reasoning based on these few details. Three weeks later, the patient is not improving. The wheels in your head start turning; is the assumed “sprain” actually a more significant injury? Do you refer back to the orthopedist, who then discusses an injection, more imaging, and potentially surgery? This might not sound too farfetched, and in fact I think it is a reasonable situation that would be appropriate, if the patient actually fit this mold. Another possibility, however, is that this patient who came in with an apparent MCL sprain actually has a mechanical lower back problem, causing pain and limitation in their knee. The patient may have a hard time believing this, seeing as they have no pain in their back at all, and unfortunately, many clinicians may have a hard time believing it as well. Rosedale et al1 published an article in 2019 investigating extremity pain of spinal source (EXPOSS). In this study, 369 consecutive patients with isolated extremity pain were examined with the Mechanical Diagnosis and Therapy (MDT) classification system, more commonly known as the McKenzie Method. Clinicians performing the assessments included faculty-level, diploma-level, and certified-level McKenzie clinicians. Through a MDT assessment, using a “baseline-test-retest baseline” approach, clinicians were able to determine which of these patients had symptoms that were of spinal origin, and those which had symptoms of extremity origin. All of the subjects included met the following criteria: - Isolated extremity pain (subjects with neck, mid or low back pain were excluded) - Subjects believed that the extremity was their source of the pain The results of this study found that 43.5% of patients with extremity pain had their symptoms referred from the spine. The following is a breakdown of each region of pain with spinal origin. As an example, for clarification, out of the subjects in this study with elbow pain, 44% had symptoms that were referred from the spine.
While it is recognized that more research needs to be done on this topic, let this be a reminder to screen the spine, thoroughly. It may not be enough to have a patient with isolated knee pain bend their spine forward, backward, and side to side once in each direction. Mid-range movement with insufficient repetition or force could provide false information that their symptoms are not spine related. Well trained MDT clinicians will potentially bring such a patient through multiple repetitions of lumbar flexion in sitting with overpressure, sustain the patient in prone lying in extension for up to 5 minutes, or even mobilize the lumbar spine on day one in order to expose the extremity symptoms. These tests, among others, are just some of the ways in which EXPOSS patient may be identified. Many extremity orthopedic special tests have poor psychometric properties and, in the presence of spinal disorders, have the tendency to be falsely positive.2,3,4 Multiple studies highlight the high prevalence of incidental extremity imaging findings in the asymptomatic populations, indicating that the clinician should be hesitant in basing clinical decisions on such findings. If that patient with an “MCL sprain” has knee symptoms while standing at rest, and those symptoms reduce with 40 repetitions of right lumbar side glide against the wall, there is a small chance that their MRI confirmed MCL sprain is causing those symptoms. It is not out of the ordinary for a high number of repetitions to be required to reduce these symptoms, and it only takes a few extra minutes in your exam. Getting caught up in a busy schedule can make it easy to become complacent with trusting a script, and treating accordingly. We owe it to our patients to understand the true source of their symptoms. We should give ourselves a valid reason to provide an intervention by proving to ourselves and our patients where their symptoms are coming from. The MDT approach to differentiating between the spine vs extremity source of symptoms is not based on imaging or solely pain location. It is rather based on the symptomatic and mechanical response to repeated end range movements or sustained positions. Next time you encounter that tricky extremity patient that you just can’t quite figure out, get some baselines, move their spine, and let the patient’s true symptomatic response confirm where their symptoms are originating. They will believe that their knee pain is coming from their back if they leave the clinic pain free. References [1] Richard Rosedale, Ravi Rastogi, Josh Kidd, et al. (2019): A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS), Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2019.1661706 [2] Reiman M, Goode A, Hegedus E, et al. Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis. Br J Sports Med. 2013;47:893–902. [3] Schellingerhout JM, Verhagen AP, Thomas S, et al. Lack of uniformity in diagnostic labeling of shoulder pain: time for a different approach. Man Ther.2008;13:478–483. [4] Heidar Abady A, Rosedale R, Chesworth BM, et al. Consistency of commonly used orthopedic special tests of the shoulder when used with the McKenzie system of mechanical diagnosis and therapy. Musculoskelet Sci Pract. 2018;33:11–17.
COMPLIANCE UPDATES: PROVIDER STANDARDS ON INSURANCE Oxford - Daily scanning of flowsheets no longer required. Scan once sheet or are completed. ALL BCBS Plans (including Advantage Plans) - Denials for Therapeutic Activities even with 59 modifiers. When appropriate, substitute coding to Therapeutic Exercise or Neuromuscular Re-Education. All Medicare Advantage Plans - Medicare 8-minute billing rules (direct and indirect time). - Signed Plan of Care. - Students services are non-billable for direct or line of sight supervision. Forwarded notes appear as provided care.
HUMAN RESOURCES Time Off Accruals
Sick Time and Vacation Time for June and July Sick and Vacation accruals have manually been entered for June and July based on the number of hours worked according to PTSMC policies: 20-29 hours, 30-39 hours, and 40 hours fulltime. Years of service were recognized when calculating the accrual amount. Accruals have been paused for previously eligible employees who are currently working less than 20 hours a week. The balance that is on your Time Off icon in Paychex is up to date.
CURRENT JOB OPPORTUNITIES Physical Therapy Aide Danbury Naugatuck Orange Southbury Waterbury Watertown West Hartford
Patient Services Coordinator East Hampton Essex New Haven Wethersfield
Check www.PTSMC.com/job-openings for our most up-to-date postings, and feel free to share! Call Karen or email at karen.havlicek@ptsmc.com if you are interested in a position.
NEW EMPLOYEES
Memorial Day and July 4th Holiday Balances have been adjusted for employees who were not eligible for the Memorial Day and July 4th holidays.
November and December Holidays
The November and December Holidays for 2020 and New Year’s Day Holiday for 2021 will be observed as follows: Thursday, November 26th Thanksgiving Friday, December 24th Christmas Friday, January 1st New Year’s Day
November and December Vacation Requests
Employees can submit time off requests for November and December, however, please be aware that the approval is not completed until September 25, 2020
Mylena Cruz, Essex PT Aide
Annemarie Gigante, Fairfield PT Aide
Dan Ginsburg, Guilford PT Aide
Taylor Goodhue, Essex PT Aide
Kelsey Matthews, Plainville PT Aide
Naelah Miller, Middletown PT Aide
The following is the vacation approval process. Employees may submit a vacation time request at any time during the year. The submission and approval deadlines for November and December requests are listed below. Employees may only request time off during one holiday of the November and December request period. Submission Deadline September 15, 2020
Director Approval Deadline September 25, 2020
The approval considerations for prime-time vacation requests are as follows: • Time available • Seniority • Length of time requested (preference given to extended time vs. one day) • Appropriate staffing levels maintained
Welcome Back!
Employee Verification of Employment
If your clinic receives a call from a bank or mortgage lender asking to verify a current employee or former employee status, please refer the caller to Human Resources. Explain to the caller that you or your Director cannot verify employment. If your office receives a Verification of Employment form, please fax to the admin fax number or scan and email to Sandra at Sandra.Boccialetti@ptsmc.com.
References for Employees
If your clinic receives a call asking for a reference for a former employee, please refer the caller to Human Resources.
Emma Rusconi, Guilford PT Aide
Katie Newtown, West Hartford Physical Therapist, former student and PT Aide
PTSMC UPDATES! Great things have happened over the last few months both personally and professionally for members of the PTSMC family. Here are some updates!
Congratulations to Shradha Rana, Middletown PT, for welcoming a baby boy! Neil S. Rana was born on June 23, 2020 and weighed 7 lbs, 6 oz.
Congratulations to Jonna Tomasello, Westbrook PSA, for welcoming a baby girl. Gianna “Gia” Averie Tomasello was born on July 1, 2020.
AUGUST BIRTHDAYS Kevin Connellan Colleen Menard Michelle Kijewski Maddie Edmunds Sarah Alkire Sean Walsh Craig Katko Cierra Hungerford Erik Schmitt Tom Kassan Olivia Tarca Leslie Riviere Tyler Naef Wesley Chen Elton Purvis Jack Pearce Leah Szot Bella Olmstead Erik Olsen Caitlin Greco Nick Almonte Casey Smith Bryan Baker Andrew Kalach Stevie Fell Tracy Caligiuri Sylwia Danowski
3 5 8 11 11 11 15 16 16 16 19 20 20 20 21 22 22 24 24 25 25 27 28 29 29 30 31
Plainville New Milford Wallingford Naugatuck New Haven Waterbury Essex Admin Westbrook West Hartford Windsor New London East Hampton Avon Westbrook Groton Wethersfield New London Southbury Westbrook Orange Branford Westbrook Fairfield Waterbury Waterbury Newington
AUGUST ANNIVERSARIES Congratulations to Liz Walton, Naugatuck PSC, who got engaged to Mark Raimo Jr. on March 14, 2020.
Congratulations to Wanda Figueroa, Accounts Payable Representative, for graduating from Capitol Community College with an Associate of Science in Accounting!
Arabella Goralski Ariana Caruso Carson Mendoza Casey Smith Christine Boyd Destinee Boyd Jacey Bissell Jenna Lagana Katherine Chaber Lauren Jameson Lauren MacDonald Madelyn Vianney Matt DaCosta Michelle Linicus Mike Krukiel Redmond Cahill Ron Buchetto Stephanie Terrace Vanessa Silva
PT Aide & PSC PT Aide PT Aide PT Aide PT Aide PSC PSC PT Aide PT Aide PT Aide PSC PT Aide PT Aide PT Aide Physical Therapist PT Aide Athletic Trainer PT Aide PT Aide
Newington Naugatuck Branford Branford Groton Fairfield Branford Middletown Naugatuck New Haven Essex Middletown Naugatuck New London Plainville Branford Westbrook Westbrook Middletown
Ashley Tighe Liz Walton Meaghan Brunelle Nic Sauerbrunn Nicole Kowalski Tatjiana Cvjetinovic
Physical Therapist PSC Assistant Director Physical Therapist PT Aide PT Aide
Wallingford Naugatuck Windsor Windsor Avon Waterbury
Kristen Forster
Director of Operations Admin
STUDENT PROGRAM UPDATE We’re pleased to welcome the following students completing clinician rotations with PTSMC! Michelle Merwin (Quinnipiac University) is in New Haven hosted by Andrew Perazella. Brooke Marconi (SHU) will be working in Middletown with Rob Bass. Analissa Mandile (URI) will be working in Southington with Dana Earle. Sylwia Danowski (Berkshire Community College) will be working in Plainville with Kevin Connellan.
What Happened in AUGUST of 2000? August 25, 2000 - Bring It On, the top movie in August 2000, was released.
August, 2000 - Now That’s What I Call Music! 4 was the top album of the month, featuring hits like “Larger than Life” by the Backstreet Boys, “(You Drive Me) Crazy” by Britney Spears, “Candy” by Mandy Moore, and “All the Small Things” by Blink 182. Now That’s What I call Music 74 was released this past May.
Clinics that Opened in AUGUST No clinics opened in August!
The
Extra MILE By Kristen Forster, Director of Operations
What makes a real smile? When wearing a mask, your eyes, eyebrows and body language speak volumes. Take a minute to look in the mirror and smile with your mask on. What are your eyes saying? There are two types of smile: a genuine smile and “social smile” (aka a fake smile). The genuine smile is also called the “Duchenne smile,” named after the French scientist Guillaume Duchenne. A Duchenne smile involves contraction of both the zygomatic major muscle (which raises the corners of the mouth) and the orbicularis oculi muscle (which raises the cheeks and forms crow's feet around the eyes). The Duchenne smile has been described as "smizing", as in "smiling with the eyes."
Spirit day
Newington
Plainville
Next Month
RIVALRY DAY - Thursday, August 20th We want to know - are you a Red Sox, Yankees, or Mets fan? Show your pride by wearing your favorite team's gear and we'll see which team has the most PTSMC fans. PTSMC COVID-19 IMPECCABLE EXAMINATION In 2018, PTSMC implemented an Impeccable Examination for our clinics as a way to ensure the appearance and safety protocols of every facility met the highest standard. As 2020 brought about unexpected change, we adapted the document to follow our organizational focus to provide a safe and clean working environment. The COVID-19 Impeccable Exam was created as a guide and checklist to ensure PTSMC is following internal expectations and CDC guidelines within our clinics. Some of you may have seen this and already reviewed it in your clinic! It is not intended to receive a grade, rather to heighten awareness and bring to light things your clinic may not have yet! See the last 2 pages of the PULSE for a copy of the checklist. Thank you for all your hard work and dedication to ensure a safe environment for our patients and employees. Please do not hesitate to contact Ryan Balavender or Mallory Mason with any questions.
SoCIAl Media Sensation Josh McAdams, Danbury Partner & Director Josh McAdams gave a tour of the new Danbury clinic! Learn more about Josh and check out the state-of-the-art clinic at www.ptsmc.com/videos.
Maskology
MENTAL WELLNESS Where to Begin
The new leaving home routine: Keys: Phone: Wallet: Mask: Here are some tips to remember your mask. 1.Have a rotation of 2-3 go to masks that you grab each time you leave home. 2. Keep an extra in your car, your purse, work bag, and gym bag. 3. Have a mask station near the door you use most. Make your basic mask more protective: 1. Fold your mask in half. 2. Tie a knot in each ear loop, staying as close to the corners of the mask as possible. 3. Open the mask. 4. You’ll see a small opening at the sides of the mask, so tuck those sides in. 5. Tutorial: https://www.tiktok.com/@oliviacuid/video/6841373365500955909 source=h5_m Easy homemade bandana mask: 1. Fold bandana in half 2. Fold in thirds 3. Loop scrunchies or elastics each 1/3 of the way in, on the sides 4. Fold side over the scrunchie and tuck one inside the other 5. Tutorial: https://www.instagram.com/p/B-imlin Bo49/?utm_source=ig_web_copy_link Mask hurting your ears? Try a mask that has over the head large elastic straps, or one that ties over your head.
Or try out a breathable neck guard that is easy to wear but still stays up.
Feeling claustrophobic? Look for a mask with structure or seam on the front, so it pops away from your face but is still tight on the edges.
And look for one with a built in nose bridge, or add one to your mask.
These days there has been, and will continue to be, a lot to take in emotionally. The mental strain uncertainty creates is not easy to manage. Anxiety, stress and fatigue are naturally occurring feelings. Know that this is OKAY. Know that you are not the only one feeling this way. In the recent words of Olympian Michael Phelps, “It is OKAY to NOT be OKAY. ” If you connect with any of this, take a moment to recognize it, then start here. It is easy to let these feelings take over, but if you are ready to shift out of that hole and are tired of Covid-19 keeping you up at night, here is an easy place to begin. Cigna has two webinars that explain simple steps towards feeling better. Each webinar has copies of the presentation and handouts to keep that break down strategies for managing these feelings. Handouts are attached to the PULSE email. 1. Managing Anxiety Webinar: https://event.webcasts.com/viewer/event.jsp?ei=1291736&tp_key=5d5d655479 Overview: Anxiety is understandably high as we continue to learn more about the spread of COVID-19. The information below may be helpful in managing the fear you may feel. It’s important for you to prioritize your own self-care to help you cope with any unsettling emotions this situation can bring. Self-care means making the choice to act in healthy ways rather than just reacting to events. Here are some self-care reminders that you may find helpful. Those of you with kids might be worried about how they are handling this. Kids today are as exposed to the news cycle as adults are, but they have less life experience to interpret what they’re seeing and hearing. Your job isn’t to shelter them from the news; it’s to help them understand and process it. Children of all ages want reassurance that their family will be safe The handout from this webinar is equipped with strategies for managing fears, and how to physically, mentally and emotionally cope. 2. Resilience in Challenging Times Webinar: https://event.webcasts.com/viewer/event.jsp?ei=1298569&tp_key=a354121052
Here is an awesome link for various fun masks and where you can buy them: https://nymag.com/strategist/article/best-fabric-masks-to-buy-online.html Reminder! Be sure to wash cloth masks with your weekly laundry (at least) or hand wash:
Overview: Being mindful means bringing your focus to the present moment, not jumping to worries about the past or future. By practicing the simple act of bringing our minds back to the here and now, we can train our brains to not leap so quickly to anxious thoughts when we’re stressed. We can gradually learn to be with and accept ourselves and situations without passing judgment. This can help us feel calmer and better able to manage difficulties. The handout from this webinar is equipped with physical, mental and emotional coping strategies.
PTSMC COVID-19 IMPECCABLE EXAMINATION A checklist to help PTSMC Clinics stay focused and vigilant in maintaining a COVID-19 safe environment. Location:
Date:
Use this document as a checklist. Check the box if your clinic complies with the statement. Yes, this is being done/ have this in the clinic (check the box) No, this is not being done/do not have this in the clinic (leave blank)
Entrance & Welcome Center
Temperature taken for every patient Every patient has a mask on The “Covid-19 Questions” are asked to each patient Hand Sanitizer is available at entrance/Front Desk area Welcome Center chairs are spaced 6 feet apart Welcome Center magazines removed Candy jar, Keurig and other communal items removed There is a protective barrier between Front Desk and patient interaction areas (sliding glass, sneeze guard) Patients impede the 6 feet rule only to exchange paper or payment Visual social distance markers are used where possible, spaced out every 6 feet
Gym & Treatment
Increased frequency of ventilation from central ventilating system Increased outdoor air circulation where & when possible Patients bring their own filled water bottle Tables and equipment are spaced 6 feet apart if space allows Patients maintain 6 feet distance from other patients Dividers are used if equipment is less than 6 ft apart and needed for patient use at the same time Use of bubblers or water fountains are limited to single use cups Hand sanitizer is available and easily accessible for patient use
Signs
Displayed in entrance: “Patient Rules” “Do the 5” “Covid-19 Questions” “Mask Required” “State Advisory” Displayed in clinic: “Stop Wash or Sanitize Your Hands” “Why Wear a Mask” “Wash Your Hands Facts”
Cleaning & Disinfecting Practices
Doorknobs and light switches are sanitized frequently Treatment tables are disinfected after every use All equipment is disinfected after every use Restrooms are disinfected with higher than normal frequency Wipes are available in restrooms to disinfect vanity surface and fixtures after use
Employee Protocol
Temperature taken upon arrival Mask is required to be on before entering clinic Gloves are available for all employees Wash hands/use hand sanitizer after each patient contact Social distancing of 6 feet apart encouraged Employees avoid being in direct line of patients face when possible
Additional comments:
Overall: