One of the key challenges for outpatient clinicians is efficiency - doing what patients need and get good outcomes, while at the same time looking after the practice bottom line. Some treatment approaches may be a great idea from a clinical impact perspective, but they may not be feasible or affordable. That is a pity. We need to find a way to deliver the best treatment and make it affordable and feasible. Innovative companies help us here by making devices that deliver the clinical outcomes while at the same time freeing up the clinician's hands or improving the bottom line in other ways.
I want to highlight a couple of these.
Many patients in back or neck pain benefit greatly when you pull on the vertebras. There is research to support the approach, loads of patients will tell you how much it helps them and it’s relatively simple to execute. Clinicians like chiropractors and physical therapists do it all the time with their hands. That is all good and well, but those hands get tired.
Solutions like over-the-door traction and inversion tables were introduced that solved this problem, but they were not able to re-create the delicate pull-release pattern of the clinician’s hands (also see this blog post). So industry created mechanical traction devices (also called spinal decompression devices) that were capable of recreating this manual work. These devices are now small, mobile, compact and affordable. The result is a true win-win: patients receive the traction that benefits them while therapists save their hands. An added bonus is that the clinician is now able to do other stuff like write up an evaluation or progress note while traction is occurring.
Patients who have suffered a stroke recover function over time. A big factor in how much of it they recover is how much feedback they receive during the recovery period. Clinicians working with stroke patients provide feedback all the time with their voice (“Well done!”), their hands (tapping, rubbing, pushing, pulling, prodding), their instructions, etc. But this is time-consuming and it’s also really hard to do effectively. Feedback needs to be timely and reliable, it must be there right when the patient needs it and it must always be delivered in the same way and at the same time. To respond to this need, industry has introduced all kinds of feedback devices that assist clinicians and patients to do this. There are pressure biofeedback devices that will tell you how hard the patient is pushing in a certain direction, like this example of using it for tongue strengthening. Feedback is essential. Technology like this helps deliver it in a cost effective way.
Shortwave diathermy is another good example. Heating tissues is a good therapeutic approach, but commonly available tools like hot packs and ultrasound only heat the superficial tissues. What to do when wanting to heat tissues that are deeper than just an inch or two? Think of the hip, the shoulder, or the paraspinal joints. Really, most of the anatomical areas that we want to treat fall into this ‘deep’ category. The only non-invasive tool that we have is shortwave diathermy. It works similarly to the microwave in the kitchen, causing the tissues in reach of the electromagnetic energy to vibrate and heat up. The good news is that the reach of the wave is well beyond 2-3 inches. In addition, the application is unattended so the clinician can attend to something else while the shortwave diathermy treatment is going on. See here and here for examples of such technology.
Electrical stimulation helps to decrease pain. It also helps to increase muscle strength. It also delivers sensations, which help the brain reorganize its nerve routing after an injury like a stroke. The clinician treating a stroke knows that both sensory stimulation and electrical stimulation of the muscle are desirable to help the stroke patient recover function. With electrical stimulation this becomes easy to do. See here and here for some good examples of how this works out in practice.
The bottom line for us clinicians? Leverage the technology that is out there! Utilize it to solve some of these clinical dilemmas that you face every day. You can do more WITH technology than you can do without it.
Yorick Wijting, PT, DPT received his degree in Physical Therapy in the Netherlands and later his DPT at the University of St. Augustine in Florida. He has practiced physical therapy in various care settings across Europe, South Africa and the United States. He has extensive training and practical experience in electrotherapy and teaches nationally and internationally to medical professionals on its therapeutic use. He is passionate about helping clinicians discover how technology can enhance their efficiency and treatment outcomes.