Interview with Dr. Justin Dunaway, DPT… Part 1

Dr. Justin Dunaway DPT, OCS, Cert. SMT, Cert. DN is one of those individuals that makes me want to give much more than I get. Aside from his role as a staff Physical Therapist at One Accord Physical Therapy, he is an Executive Board Member of the Arizona Physical Therapy Association, AND President of STAND – The Haiti Project. I highly encourage you to learn more about & donate to STAND Haiti, click here for more info. 

This is an inspiring & very informative 2-Part Interview. Enjoy Part 1!


Lets start at the beginning – the beginning of your day. What is your daily morning routine? Describe the first hour of your day starting from the moment of waking.

I wake up and jump in the shower (usually late) while my amazing, brilliant, also a PT girlfriend makes coffee and breakfast. We usually sit at the breakfast bar and talk about nothing, or skim the news or Medscape for something to discuss; or bounce plans and ideas back and forth about Haiti. Then I jump in the car and head to the office.

Share with us the story of how you ended up in the wonderful world of Physical Therapy.

I was actually raised to be an engineer and take over a family run business. At 15 years old, I began work in our shop. Over the next decade I did every job there was to be done: sweeping floors, running manufacturing machines, welding, drafting, and working on traveling road crews. I had a mind for mechanics, but did not enjoy the work, whether it be at a desk staring at blue prints or in the factory doing 90 hours a week of manual labor. I was a mediocre student through high school, much more interested in cross country and track and field than class.

Once I graduated, I started into engineering school where I was a less than mediocre student and hated all three years. At that point, I was going to school full time and working for my father in the summers. My mother was a firefighter and an EMT in the small town I grew up in. I was spending all my time in my Dad’s shop or school, but thought it would be nice to spend some time doing what my mom loved. I got my firefighter and EMT certificates and started working in the same department as my Mom during the hours I wasn’t on campus. I really enjoyed the excitement of the firefighter work and fell in love with the aspect of helping people medically.

A few years later, I picked up a job at the local high school as the cross country and distance track coach. Again I enjoyed the work, but found working with the injured athletes to be the most rewarding. This is where I got my first exposure to the profession of physical therapy and decided that PT was the thing that combined my life long training in mechanics, my love of helping those in need, and my strong interest in injuries.

After three years of mechanical engineering, I switched to Exercise Science and quickly moved to the top of the class. With a lot of hard work, even more luck, and probably some influence of people that will never admit it, I somehow got into PT school despite my poor performance during my first undergraduate years in engineering.

Tell us about your fellowship. Why did you decide to do it? And, looking back on it, how has it change you as a Physical Therapist so far?

I decided to do a fellowship because it is the highest level of training and credentialing you can receive as a clinician. I believe the program will make me a better therapist and give me access to the best clinical mentoring. It will also lend credibility to me professionally: as a mentor, an educator, and while working in advocacy for our profession.

I am still in the middle of the fellowship and my mentorship hours have not yet begun. I believe this will be an important piece, tying together all the skills and didactic knowledge into clinical decision making and expert practice. And for this, I’m excited.

You were an instructor with SMI. What drew you to this group? And, how has SMI impacted you as a Clinician and as a Professional?

SMT-1 was one of the first continuing education courses I took after graduation. Coming from a strong mechanical background, there were many concepts we were taught in physical therapy school about specificity and biomechanics that I never quite bought into. Dr. Dunning was the first to present concepts more in line with some of the beliefs I had and then followed it with large volumes of well presented research. Dr. Dunning is a straightforward, no BS, dynamic educator, as well as a strong advocate for our profession. I immediately felt that this organization had the potential to change the profession for the better.

SMI has had huge impacts on every aspect of my career: as a clinician, educator, PT advocate, and humanitarian. In the clinic, I now possess evaluative and hand skills that allow me to very successfully treat conditions that I struggled with fresh out of school. I have a very good understanding of the literature as it relates to the spine and feel that I have really developed the ability to consume and critically appraise research; all through the SMI.

I have also had the opportunity to develop the skills involved with creating and delivering seminars, from start to finish. This has been an exciting and challenging endeavor, from which I have discovered how much I enjoy teaching.

The story of “Dry Needling in Arizona” isn’t well understood by many in the field (including me). Can you expand on this history for us? Also, include take-aways from this experience that can/should be applied to similar cases in the future.

This is a great question that I wish more people were asking. We had many successes and failures during this multiple year battle and learned a lot of things that would be very useful for other states to know.

Physical Therapists (although very few) have been practicing Dry Needling in Arizona since the late 70’s. In 1998, the Arizona Acupuncture Board of Examiners was formed; and in October of 2011, they filed their first complaint with the PT board against a PT performing Dry Needling. The PT was deemed to be practicing within his scope and the complaint was dismissed. Over the next few years, more complaints were filed, including ones specifically against Sean Flannagan (co-founder of MPTA) and Sara Demeure (vice president of the AzPTA). I was called before the Acupuncture Board for a complaint against my license (along with many other PTs), which were ultimately dismissed as the Acupuncture Board has no jurisdiction over our licenses.

In response to this increased volume of complaints, the AzPTA formed the Dry Needling Task Force, led by Sean and Sara, whose goal was to create an operational definition for DN and present this to our Licensing Board for adoption. The PT board also held three public stakeholder meetings to collect information from the public (PTs, LAcs, and consumers) about Dry Needling and acupuncture. At this time, the Acupuncturists began a large and effective grassroots campaign, using the internet and local news papers/news stations to disseminate information about the ‘dangers’ of physical therapists performing Dry Needling. They argued that PTs were causing life threatening injuries via the ineducated misuse of acupuncture needles. In October 2013, our board voted unanimously that Dry Needling was within the scope of physical therapy and this should have ended this issue.

However, this was also our board’s sunset review year. During our sunset review hearing, representatives from the Acupuncture community came forward, stating that we were a threat to public safety and that this issue needed to be resolved before they could vote on continuance of our board. This was a completely unexpected attack and it shifted the battle from a board versus board issue to a legislative issue. At this time, the Manual Physical Therapy Alliance was formed and we generated a grassroots campaign of our own, working with the AzPTA to help educate the legislature and advocate for our scope of practice. We created a petition to not only gather support, but also to identify people who were willing to speak up and be active. We met with legislators, created educational materials, wrote research based position statements, testified at house and senate health committee meetings, worked with lobbyists, and ultimately helped shift the legislators’ opinions from supporting the Acupuncturists’ to passing a bill placing DN in PT statute, which was signed into law on April 2014.

We are particularly proud of the language used to define Dry Needling in our statute, which, unlike many other states, does not limit Dry Needling only to trigger points, but allows for needling of all neuromusculoskeletal and connective tissue.

Some of the most important things that I learned:

– PTs are not keeping a pulse on what’s happening in their states and the Association is not good at disseminating information to people not looking for it. Each legislator we met with said the same thing, “I understand what you’re saying and you’re right. The problem is I have several hundred letters from acupuncturists and their patients, and maybe ten from your side.”

– A patient speaking to a legislator is far more powerful than any of the lobbying we PTs ever did.

– Just because we know we hold a Doctorate, are experts in neuromusculoskeletal conditions, and are evidence based practitioners does not mean that the people writing and voting on the laws have any idea what we do and what we know. The only thing they know is what they are told. If all they hear is Acupuncturists telling them that we are taking a weekend course in needling and killing people, that’s what they believe.

– The biggest thing I learned is how big an impact a few voices can have in the right place and right time. There are so many times that the wording of a law was changed, a vote shifted, a legislator switched sides because of what was said.  The idea that a few people are not enough to change the course of things is insane. We need to be our own biggest advocates, because no one is doing it for us.

What is the MPTA? How does it fit into the current ecosystem of Physical Therapy?

The Manual Physical Therapy Alliance is an organization that was born out of the need to rally  grassroots support from physical therapists, patients, business leaders, and politicians in Arizona during our battle with the Acupuncturists over Dry Needling. Sean Flannagan, myself, and a few others felt that while the Arizona PT board and association were working very hard to win this battle, there was not enough involvement from stakeholders in the state. We felt that this lack of involvement could be attributed to people not knowing what was going on or how to help.

The bigger plan for the MPTA is that it will become a resource for advocates nationwide. PTs will be able to share information and experience, offer strategies and advice, and collaborate on current legislative issues.

We also foresee the MPTA being a resource for clinicians, students, and patients alike. This will be an informational database covering topics from legislative alerts, physical therapy news, clinical education, continuing education, consumer education, and research.

The aim is to make it an organization that really advocates for the profession and patients, a one stop site for information on all these things.

Favorite Books and/or Authors?

Other than journals and blogs I don’t get much reading in, however I did recently have my entire life consumed by the Game of Thrones books which was a very good break from professional life.

Staying in the world of Physical Therapy, what important truth do very few people agree with you on?

We know nothing… or at least very little. There are so many beliefs and concepts out there that people cling to so strongly. They dig their heels in, defending certain concepts as if they were solid ground. There are a multitude of different camps in our profession and so many explanations for the same occurrence or outcome that are so different. And when we dare to venture outside of our profession, we are challenged with entirely new sets of justifications and approaches to the same concept that are again so different.

In my practice, I have been privileged to interact with a variety of clinicians, professions, and cultural views on medicine. There is one experience with a Doctor of Oriental Medicine that comes to mind at this time. She was giving a lecture to provide needling PTs with an appreciation of the differences between the eastern and western philosophies. I had just so happened to wake up that morning with what I had diagnosed as a unilateral locked cervical facet. I had significant pain and loss of mobility in my neck. Once the lecture was over, she announced that she would perform a demo on a patient and I quickly volunteered. She completed a full subjective interview, followed by tongue and pulse diagnoses, gave me an eastern medicine diagnosis, and placed one needle in my right shin and two in my thumb. After fifteen minutes, she removed the needles. My pain had decreased to 1/10 and I had regained nearly full range of motion. By the next morning, my symptoms had resolved entirely. The PTs were baffled, frustrated, angry even. They suggested a placebo effect, the non-specific effects of treatment, that I was faking, etc…

But the bottom line was: she had assessed me, treated me, and I got better. We can all speculate on the mechanisms at play. Perhaps my elements were out of balance, there was a strong placebo effect, or a bombardment of nociceptive info to the dorsal horn which altered motor neuron activity allowed muscle relaxation and improved mobility, etc. But at the end of the day, we don’t know which it was, or that it was any of those…none of us.

The only thing we do know, all of us, is that we can take a patient, apply a treatment, and make them better.

Part 2 will come out next week!

Until then, make sure you’re following Dr. Justin Dunaway on twitter: @DrDunawayDPT.

And connect with me @Cinema_Air.

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What Would MacGyver Do?

I wrote a guest post for Strive Labs titled “What Would MacGyver Do?” about some lessons we can learn from this 1980’s icon.


 MacGyver has been an icon of resourcefulness ever since he first hit TV decades ago. While we may not be able to cobble together lifesaving devices using toothpicks and chewing gum, there are some worthwhile lessons to be learned from Angus (can you believe MacGyver’s first name is Angus?? Me neither…). Let’s look at 2 filters of MacGyver wisdom; the first one is from a company that makes soap: Method.

Method grew from “a very dirty San Francisco flat” into a very successful brand and company. Their mascot was, and still is, MacGyver. “What Would MacGyver Do?” is one of their core values. Here’s how they described it: [read more]…

Edo, Nelson, & I chat about the new KinetaCore Educational Center

Dr. Edo Zylstra, PT, DPT, MS, OCS, IMSP recently reached out to me about the latest KinetaCore evolution: The KinetaCore Educational Center in Ashburn, VA launching on March 19th.You can find some introductory information about it here, and the interview you are about to read will go in-depth into the intentions, hopes, and experience of the new Facility. He partnered with Nelson Min, PT, MS, ATC to launch this First-Of-Its-Kind facility. Not only is Mr. Min a lead instructor for KinetaCore, but he is also a practicing clinic-owner. Many of you are already familiar with Dr. Edo Zylstra; if not, then check out our first interview.

Congratulation & Good Luck to KinetaCore, Dr. Zylstra & Mr. Min on their latest venture!

Enjoy the interview!


First, let’s get to know Nelson Min. Nelson, what lead you into the wonderful world of Physical Therapy?

Nelson: I am very blessed to be a physical therapist.  I think the PT’s I came across early on were amazing people and they had a strong and lasting influence in my pursuit of being a physical therapist.  I grew up in Delaware and they have an incredibly strong PT program there at the University of Delaware.  These were some amazingly skilled PTs who had such a good presence in the community.  They were also such a close knit group.  I just saw how interactive and rewarding this field can be because of these individuals who were really good PT’s and even better people.

Nelson, tell us about your history with KinetaCore. How did it start? And, how has it grown to where it is today?

Nelson: One of the keys to being a good PT is drive for continued learning.  There is so much to learn and I am continuously amazed at how much good info is out there.  I really enjoy taking continuing education courses and I realized that the more I progressed in my training the more these highly respected educators recommended incorporating dry needling into my skill set.

I took my first course at Regis University in 2009.  The professionalism and expertise of Edo and his staff for that class was such an inspiration.  The immediate results I noticed on my self over a weekend were undeniable.  Dry needling is such a great adjunct to any physical therapist and I knew I had to be a part of this company.

So, Edo & Nelson, there’s a new venture that’s about to launch on March 19th. Tell us about The KinetaCore Educational Center. What motivated its formation? And, what is it that you hope this will do for the profession of Physical Therapy?

Nelson: Functional Dry Needling® has changed my practice and how I practice.  It has made my already successful clinic into an even more successful and thriving one.  We want to share this with as many PT’s out there to hopefully make them even more successful in their businesses.

We also want to share this technique with the public.  It helps with such a diverse number of dysfunction that patients deal with, improved function is the goal but it also helps with pain and increased mobility and muscle function to name a few other benefits.  It has dramatically helped me in improving my patient’s outcomes.

We started the Kinetacore Education Center to achieve the goal of educating our profession with this technique in a setting that promotes the learning experience.  What typically happens with con-ed is to offer it in a PT clinic or facility and adjust it to the needs of a con-ed course.  In other words, you work with what you have available.  Our teaching center has no associated clinic. The design is for learning.  Three HD ceiling projectors and total surround sound gives any participant clear audio and visual regardless of their vantage point.

The other speakers we will be featuring include some of the most influential and sought after educators in our profession.  These educators have incredibly tight schedules and share a passion of advancing our profession.  We now have a facility where we don’t have to worry about the logistics of closing a PT clinic which often interferes with hosting some of these professionals.

How did/do you choose the instructors for the new KinetaCore Educational Center? What qualifications and qualities are you looking for?

Nelson: We are looking for instructors who have a passion for the advancement of our profession.  We look for skilled, intelligent and caring individuals who invest in the goal of advancing our profession with this technique and want to further our understanding of its mechanism and how to teach it more effectively.

All instructors are trained in Functional Dry Needling (FDN®) and require one year of clinical use before being considered as an instructor.   They are then required to go through a training process over three separate audits to safely and carefully progress them to independence in supervising and instructing. The training process concludes in a final check off with our senior instructors (Edo if possible)  to ensure quality and consistency with what and how is it presented.

We require that you are trained in our technique to be able to teach our system of dry needling.  These gifted individuals usually stand out during training process and it usually comes as no surprise when they first inquire about the opportunity.

I’m glad you mentioned not just the clinical aspect, but also the business dividends of Functional Dry Needling®. What is KinetaCore doing to promote Dry Needling to increase public awareness in the US?

Nelson: Edo has done such behind the scenes work with working with the APTA and several state boards to help incorporate dry needling into the state’s scope of practice acts .  He is one of the individuals who drafted the resource paper on dry needling for the APTA in 2012 and was recently accepted to be a part of the Federation of State Boards of Physical Therapy Dry Needling task force.  I think Edo brings public attention to this skill the right way by approaching this from the top down.

We also want to empower our participants.  Our website is a labour of love with marketing materials and electronic brochures.  The most important part of the website, however, are the educational videos that are constantly being updated for continued improvement of techniques and also the “Find a Therapist” feature.  This allows the clinician to market their practice.  Our google ranking is so fine tuned that our participants who sign up for the website membership can expect to get a number of people finding them through this feature on the web.  Ultimately, we feel the best way to market this technique is by delivering a good product which is a skilled PT  focusing on safety and proper technique.

Our goal is to be the support for all of our participants in this.  We have a system for participants to communicate with our instructors to answer any questions that may come up as they integrate this technique into their practice.  Each lead instructor receives dozens of emails a day from our past participants with solid questions.

How expansive will the course offerings range?

Nelson: We will be offering our course series of Functional Dry Needling® level 1 and 2, and Functional Therapeutics throughout the year.  In addition we will be hosting several manual therapy courses including Extremity Manipulation by Gail Malloy, The Changing Dynamic of the Scientific and Clinical Rationale for the Treatment of Selected Knee conditions by George Davies, Spinal Manipulation by Louie Puentedera, and SFMA for dry needlers by Kyle Kiesel.  I am still working on adding more courses spanning a vast topic range for the remainder of this year and next.

Edo:  I also have a goal to open up this teaching model and center up to other medical professions to give them a cost effective way to host educational courses for their specific professions as well.  That is as goal that we will try to realize over the next few year.

To the best of my understanding KinetaCore requires 200 treatment session of practice/experience after Functional Dry Needling® Part 1 prior to taking Part 2. Why is it set up this way? And, is this something KinetaCore pushes for when lobbying for inclusion of Dry Needling in State Practice Acts across the US?

Nelson: As expected the skill of handling a needle for people coming into our FDN1 course can be pretty limited.  Our bottom line is safety so we limit some of the more challenging muscles to level 2. Muscles that we feel need a more refined skill level to treat are placed into the level 2 course.   We require 200 practice sessions for our participants so that they are better prepared for the requirements of the level 2 course.  We feel that this skill level can only come about with practice.

Walk me through what it would be like to take my first course at the KinetaCore Educational Center. Class size, number of instructors per course, course progression, lab/hands-on time, etc.

Nelson: The class size varies but shouldn’t affect the learning experience because of our adherence to an average instructor to student ratio of 1 to 7.  We have a rule with our participants that if they feel they are not getting enough supervision, they need to indicate this so we can fulfill their needs.  It is the responsibility of both the instructor and the participant to make sure they have the optimal learning environment.  Exposure to as many instructors as possible gives the participant a much broader understanding of the application of the technique, so we purposefully rotate instructors and have the participants work with various body types through the weekend.

The first part of the course is our didactic lecture in order to lay down the framework of dry needling with its history, theory, research and integration.  We are then in lab for the remainder of the course systematically covering the entire body by regions in our small group labs.

Each of these small groups is first led by our instructors reviewing anatomy and then demonstrating technique.  We then have our participants pair up and practice the demonstrated technique for that region while carefully sweeping the room providing close supervision.

At the end of the second day, we have everyone go through another review process so that they can pair with another partner and get a different instructor to watch them.  We just want each participant to get as much supervision from multiple instructors as possible.

On the third day, each participant is tested both practically and theoretically.  There is no guarantee of passing and we have options for people who do not pass the testing.  We take this very seriously and give our students as much time as possible to practice, often staying late on Friday and Saturday evening working with our participants and giving them more one on one instruction.

Is there anything else you would like to share about the KinetaCore Education Center that we haven’t addressed?

Nelson: Our teaching center was designed to offer the best in continuing education.  We have some high end AV to show our detailed lecture notes as well as an interactive approach to see the anatomy simultaneously.  There are some high end anatomy apps out there now very conducive for learning and we incorporate them with our lectures and labs for a wonderful learning experience.

Because of the layout of the course, there is no bad vantage point.  You get a great view of the screen regardless of where you sit.  We have high end audio spread out uniformly throughout the venue as well so you get a clear sound regardless of where you are sitting as well.

Edo:  This is our first venture specifically developing a center devoted to higher learning for the medical professional.  If this is successful, I anticipate this as a first of many centers around the United States.  We are so thankful for all the support we have received from our families, friends and colleagues as we go faithfully into this adventure.

Thank you Edo & Nelson for this informative interview, as well as for allowing me the opportunity to share it with my audience. I wish both you the best of luck in your latest venture!

Connect with Dr. Edo Zylstra and Nelson Min on Twitter: @EdoZylstra & @NelsonMin2000

Also, find me at @Cinema_Air.

Scotch Nights of 2014-2015

I decided to make 2014 a year of exploration into the variety of Scotches – single malts & blends. It took a progression for me to start appreciating Single Malts & some Blends. The first Scotch I tried was Johnnie Walker Black – couldn’t finish it. The flavour was too strong and way too smokey for me. Later I tried Oban, Dewars, and Chivas – all 10-12 years. The Glenlivets and Glenfiddiches were the also among first Scotches I appreciated. The exploration only deepened from there. Initially, I added 2 ice cubes per drink, diluting the flavour, allowing me to finish the drink. Today, I prefer my Scotch (mostly) neat. It’s now 2015, and the Scotch samplings continue!

Listed below are my preferences. This could change with my next tasting. Also, this page will be updated periodically.

Single Malts:

Balvenie 12 Year Old DoubleWood is a pretty good Speyside. It’s warm and sweet, while delivering flavours of vanilla, sherry, and mild spice. A bit when plain compared to Islays, but also holds its own full taste.

Hakushu 12 was a bit underwhelming. This was my first foray into Japanese Single Malts. On the nose & visual you quickly realize it isn’t going to be full-bodied or heavy. The nose reminds me of the outdoors – forest, leaves. On the tongue it’s easy up front, but harsh in the back. Careful with water or ice on this one; it’s a bit too delicate for more than a few drops of water. If I were to narrow this down to 3 words, then those words would be: easy, delicate, and unfulfilling.


MacAllan 12 is easily my #1 choice overall. Smoothest of the smooth, with enjoyable flavours – vanilla, dry fruits & sherry, all balanced with smokiness and with enough spice to keep it fun. This was also the first Single Malt I truly enjoyed. 1 or 2 drops of water really opens up this Speyside.

Glenlivet 12 is a Speyside that costs less than the MacAllan 12 and provides enough flavour to keep you sipping. It doesn’t have the same buttery smoothness, but goes down easy. I also find this a bit dry, but sharp on taste. Solid entry into Single Malts. Glenlivet 12 was the first bottle I purchased – and so, it holds a special place for me.

Laphroaig 10 is truly a delicious Scotch, and my favorite of the Islays. I think it tastes higher than its price tag. Smokey, but not over-powering, and packed with enough deliciousness to keep you interested for a looong while. Flavours that come to mind are peat, salt, and a bit of lemon.

Amrut: Technically speaking, this is not a Scotch. It’s a whiskey from India, but completely worth the money. Seriously delicious stuff. Try the “Fusion” variety if you can – it’s their most delicious offering. Be prepared for peat and bold spice. Of course, it’s spicy – it’s Indian!

Blends:

Johnnie Walker takes the cake on blends. My order of preference: Platinum > Blue > Green > Black > Red. The Red is honestly pretty disgusting taken by itself; might be the perfect mixer, though. The Platinum was less smokey than Black, but less mellow than the Blue.

From what I could tell, the Cask mattered more than the Region the Scotch originated from. That’s not to say the Region didn’t matter – its flavour still comes through, but you really need a discriminating palate to differentiate it to the Region…not something I can do consistently. I’ve changed my mind – I’m getting better at picking up regional differences; the casks definitely still tilt the flavours.

Scotches have such a variety of flavours and finishes. This alone keeps me interested in the next bottle I pick up.

Let me know if there’s a particular Scotch you enjoy. Maybe I’ll make that my next purchase.

Slàinte!

#scotchPT twitter thread!

@Cinema_Air

For The Love of Movement

From Awareness by Osho:

“…you move because to move is sheer joy, you move because movement is life, you move because life is energy, and energy is movement. You move because energy is delight – not for anything else. There is no goal to it, you are not after some achievement. In fact you are not going anywhere, you are not going at all – you are simply delighting in the energy. There is no goal outside the movement itself; movement has its own intrinsic value, no extrinsic value.”

@Cinema_Air

Interview with Kendra Gagnon, PT, Phd

I have always been intimidated by Pediatric Physical Therapy. It takes a unique skill-set and perspective to become an effective Pediatric PT; also, it takes a special person to practice in this field and then step into the academic domain of Pediatric PT. Kendra Gagnon is one of those special individuals. Although she still practices on a limited basis, Kendra spends most of her time as an Associate Professor for the DPT program at Rockhurst University in Kansas City, MO. In addition to her blog, she also has a fantastic series of videos on her Youtube Channel that I heartily recommend you check out.

She also has a passion for tech & social media integrated into Physical Therapy clinically and academically. Enjoy the interview!


So, what did you have for breakfast today?

Pears, sausage, and blueberry pancakes. I am not a morning person at all, but – lucky for me – my husband is an early riser and cooks a hot breakfast for me and our three boys every morning!

Back in PT school I was recommended to spend an afternoon with a Pediatric Physical Therapist. It’s a whole other world that takes unique skill sets of communication that I was completely lacking. What led you into the world of Pediatric PT?

I’ve wanted to work with children for as long as I can remember, but I didn’t want to be a teacher (which is a bit ironic since I’m now a professor…). And I was always interested in health care but didn’t want to be a doctor. So I thought I was going to be a speech therapist when I started University of Missouri. My first semester, I took an Introduction to Health Professions course. During one of the class sessions, a physical therapist came to talk to us and he happened to share his experience in pediatrics. I didn’t know much about physical therapy, and I had no idea that there were physical therapists that worked with children with developmental disabilities. After his talk, I did a little research, did a couple of pediatric PT observations, and I was totally hooked!

What concepts from the world of Pediatrics do you think translate well into PT for grown-ups?

There are a couple of things I think we pediatric therapists do really well. First, we are really good at looking at context and participation. We don’t really care if a child can climb the “stairs to nowhere” in the PT clinic. Can they get up the stairs to their bedroom to get ready to go to sleep at night? Can they safely get on and off the school bus? Those are the things that we hone in on.
I also think we are really good at teaming with other professionals and even working on sneaking other professional’s goals and activities into our sessions. For example, if I know a child I’m working with is learning to sign the words for different colors with her speech therapist, I’m going to incorporate that into my PT session as well. I’m not sure that concepts like natural environments, participation, and transdisciplinary teams are unique to pediatric PT, but I don’t see them as much in other specialty areas. I think pediatric PTs were sort of forced to embrace these ideas since so many of us practice in schools and early intervention settings, where we are required by law to provide educationally-relevant, family-centered services in natural environments. But I really think it makes us better at making a real difference in our clients’ daily lives. I would really like to see PTs who work with adults embrace some of these ideas as well.

Tell us about your transition into teaching. How did you end up spending much of your time in Physical Therapy Education?

After I had been practicing about 5 years, I knew I wanted to advance my career; do something more. My degree was an MPT, so I saw two paths to advance my education and credentials: get a transitional DPT and a PCS, or get a PhD (or EdD or similar). I really enjoyed being a CI and thought I would be good at teaching PT students, and I frequently got feedback from others that I was a “natural teacher.” There was an opening in the PT program at the University of Kansas Medical Center, so I sent in a CV and met with the Chair of the PT Department at the University of Kansas Medical Center, Lisa Stehno-Bittel. I didn’t get the job…I didn’t even get an interview. I was SOOOOO not qualified. But I hit it off with Lisa and she encouraged me to apply to their PhD program and start teaching in their Department at a Graduate Teaching Assistant. That grew into a faculty position, and the rest is history.

There’s a rumor that you required mandatory Twitter participation for your students in the past. Why do you feel so strongly about engaging on Twitter?

The rumors are true! I have run a couple of courses with students where I required participation in online discussions via Twitter. I actually have a case study on this coming out in the Journal of Allied Health next month – you can check it out if you want more details about what I’ve done. I’m not sure I feel strongly about engaging in Twitter specifically, but I do feel strongly that today’s health care providers need to learn to navigate social media in a professional capacity. In DPT education, we teach students about professional interactions in person, on the phone, via email… But we largely ignore the fact that almost every single student, health care provider, patient, and potential patient uses social media in some capacity. Our students need to think about what they will do if a patient asks to “friend” them, a colleague shares identifiable health information in a tweet, or a patient comes to them with a blog post they found through “Googling.” Twitter is a nice platform for synchronous and asynchronous discussion, and doesn’t feel quite as personal or intrusive to ask students to use Twitter as it might to ask to connect with them on Facebook. On Twitter, students can access information, build a network of professionals with similar interests, and practice public professional interactions and scholarship. Even if they never use Twitter again after the class, I hope the activity forces them to think about professionalism and social media and provides an understanding of the opportunities and drawbacks of using social media for professional purposes. I co-authored a Perspective in PTJ on this topic with Carla Sabus and have written about it on my blog.

Let’s say you suddenly found yourself in a position to develop a new DPT Program. How would it be different than what is presently available? And, why would you make those changes?

Oh boy. That’s a big, fat, loaded question. I recently gave a talk on the future of DPT education, and I asked that same question…”If you could take DPT education apart and put it back together again, what would it look like?” Getting a DPT takes a long time and is really expensive. Programs keep growing, and placing all of those students in clinical internships is increasingly challenging. It seems like there is agreement that the current model isn’t sustainable, but it’s harder to find anyone who has a solution or who is actually willing to do anything about it. I think technology might be the real game-changer. Even 5-10 years ago, it was hard to imagine a way to deliver PT education that didn’t require butts in seats for X amount of hours. And even when online learning began to take off, it was largely asynchronous and dehumanized. Instructors simply posted slides, readings, and quizzes on a learning management system and ran a few discussion boards. And this type of learning was really limited to those who had the resources for a computer and internet access. The rise of high-speed internet, mobile devices, and WiFi has brought the possibilities of “anytime, anywhere learning” to almost everyone and gives instructors the opportunity to use video to create and share more engaging learning materials and provide synchronous, real-time learning and interaction. With all that in mind, I think an ideal DPT program would be shorter than 3 years and would be delivered via a hybrid model (online and in person) to allow more flexibility for learners. I’m also really intrigued by the idea of competency-based learning, where progression through the program is based on successful completion of its components rather than a set amount if time. The program would have to stay within current accreditation standards, but I would like to see fewer, longer internships and more authentic experiences integrated early into the curriculum. A two-year DPT program followed by a one-year residency seems like a win-win to me – students spend less time and money on the degree and there is less burden on clinicians to take students for internships. Students get more mentored clinical practice and potential employers have a pipeline of residents-in-training who then become residency-trained therapists. I am really excited to be part of a team associated with Evidence in Motion that is currently trying to get a 2-year DPT model like this off the ground. Stay tuned!

Pediatric PT has weaved through a few different philosophies & theories over the last couple decades. What are the stand-out themes that come to mind?

No one likes to talk about theory…it’s not very sexy. But I kind of geek out about it. A big influence in pediatric physical therapy over the last couple of decades is Dynamical Systems Theory. We used to think that the central nervous system was the primary driver of motor development, and that’s really the premise that traditional NDT is based on (integrating reflexes, normalizing tone, etc). But the emergence of Dynamical Systems Theory in the mid-1990s sort of broadened our view of development. Now we know that, while the brain is a very important component in motor development, there are other systems that are equally important. We began to understand that, when we see a movement “abnormality,” it isn’t the result of a deficit so much as it is the best solution the child can come up when all their body systems work together to complete a task in a given environment. And, maybe more importantly, we became more aware of the influence of the environment on the child. This has given rise to a more task-oriented approach to providing therapy services. So I think pediatric physical therapy practice has become a lot less about simply treating neurological deficits and more about supporting the child’s strengths, providing interventions to address impairments, and modifying the environment to set the child up for success.

What do you think are the biggest challenges in Physical Therapy today? And, how might they be tackled?

Perhaps it’s my bias since I sort of “live” in the academic world, but I think DPT education is probably the biggest challenge facing our profession right now. And it’s not just about physical therapy – really the entire higher education system in the US is in crisis. Suffice to say that there are going to need to be big, broad, painful disruptions in education before we can even make a dent.

You were very active with the Kansas Physical Therapy Association. What were your biggest take-aways from this experience?

I have been involved in the Kansas Physical Therapy Association (as the Standard & Practice Committee Chair and a Delegate) and the Section on Pediatrics (I am currently the Communications Committee Chair). When people ask me about the benefits of APTA membership, I immediately start talking about the value of State and Section involvement. I have learned so much about the APTA and PT practice in general through my involvement. And, more importantly, I have met a lot of great physical therapists and have formed some great relationships and collaborations.

Favorite books and/or authors?

I’m a big Malcolm Gladwell fan… The Tipping Point, Blink, and Outliers were all great reads.
Of Mice and Men is probably my favorite classic.

Let’s fantasize. Imagine a world 5 years from now that closely integrates technology and Physical Therapy. What types of tech do you imagine influencing and integrating with PT? And, what impact could this tech have on our profession?

There are so many exciting advances in health care technology, but I’m sort of obsessed with telehealth right now, both as a health care provider and as a patient. I am really interested in the idea of a “Virtual Visit” and initiatives such as “Flip the Clinic.” As a pediatric PT who has spent part of her career driving long distances to visit children in rural, underserved areas, I could really see the value in being able to video conference with a family, teacher, or caregiver to provide movement and mobility strategies for their child. And as a mother myself, I would LOVE to be able to videoconference with my kids’ doctor so he could just take a look at that rash without me loading everyone up and driving 25 minutes to his office to see him. I think this intersects with health tracking & wearables. If I’m hypertensive and wear a fitness device that notices my blood pressure is elevated, it could “ping” my doctor who could then contact me to set up an appointment, adjust my medications, etc. And perhaps my wearable device could even offer anticipatory guidance to suggest a restaurant for lunch with healthy options or guide me to the nearest fresh food market. To me, there is so much amazing potential there. These are complex issues with lots of legal, ethical, and financial pieces to consider. But none of the barriers seem insurmountable to me and I am excited to see how telehealth and health tracking come together to improve health care and outcomes.

Life is an adventure. Tell us about one of your most memorable adventures.

About 5 years ago, my husband and I took a 9-day trip to Italy. My husband’s family is Sicilian, so we decided to spend a night in Camporeale, the little village (pop. 2000-ish) where his great-grandparents lived before they came to the United States. Our rental car didn’t have GPS and we weren’t able to get any signal on our mobile phones, so we got lost on the way. We eventually found a nice old man in a grocery store who helped us find our way, learned that the owner of the Bed & Breakfast where we were staying and my husband were probably long lost cousins, and ended up spending the evening being served a 10-course Sicilian meal (and lots of Italian liqueur!) at a local family restaurant that opened up after hours just to feed the two Americans who had rolled into town. I don’t think they often had tourists there. We had an amazing two days in a little town where literally no one spoke English but were as warm and welcoming as anywhere I’ve ever been.

Thanks for sharing your insights and experiences! I admire the deep involvement you have with our profession, as well your commitment to the Pediatric domain of Physical Therapy and the integration of tech & social media into the classroom. All the best!

Connect with Kendra via twitter: @KendraPedPT

And, find me: @Cinema_Air