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Head FiRST

Steve Wolf leads challenge to integrate technology into physical therapists' training

By Martha Nolan McKenzie

Story Photo

Randy Trumbower, MPT, PhD, (left) and Steve Wolf, PT, PhD, FAPTA, FAHA (right) work together on the FiRST initiative. Photography by Jack Kearse

In 2009, the American Physical Therapy Association convened a meeting – the Physical Therapy and Society Summit (PASS) – to gain input from more than 24 different professional, governmental and consumer groups to review their perceptions of physical therapy and recommend changes compatible with how the profession needs to operate in a changing health care landscape. One of the key recommendations to emerge was that physical therapists need to become much more knowledgeable about the advances in science and technology that have direct applications to their practice.

Those recommendations could have died on the vine if not for some organizational concepts initiated by Steve Wolf. The Emory professor embraced the challenge emerging from PASS and created the FiRST initiative – Frontiers in Rehabilitative Science Technologies. "Whatever success FiRST has had or will have is almost entirely attributable to Steve," says Marc Goldstein, EdD, director of Research Services for the APTA. "He was as instrumental as is humanly possible in creating the initiative, recruiting the team to craft it, making presentations and even meeting with the new APTA CEO to explain how important it is to keep the initiative going. The absolute truth is, if Steve hadn’t picked up the gauntlet, the PASS summit would have come and gone, the results would have been published, and that would have been the end of it."

Wolf and the interdisciplinary team he recruited first identified four content areas they deemed critical to the future of the profession: bioengineering; regenerative rehabilitation; genomics, and telehealth. He then persuaded the research and education arm of the APTA to provide funding to bring together experts both inside and outside the physical therapy profession to generate information in each of the content areas.

"We recognized the knowledge base of most physical therapy programs is not well-equipped to deal with these content areas," says Wolf, PT PhD, FAPTA, FAHA. "We want to make the information we generate available to everyone through podcasts, webinars and presentations."

At the most recent APTA conference, eleven hours of FiRST programming was presented. Here’s a quick look at the presentations:

Bioengineering

The greatest change in rehabilitation practice during the past 30 years has been engineering technologies that provide clinicians more efficient and effective techniques to treat persons with physical disabilities. Randy Trumbower, MPT, PhD, assistant professor in the Emory DPT program, led three presentations discussing the implications of emerging bioengineering technologies on contemporary physical therapy practice and education.

"Bioengineering is everything that is related to FiRST," says Trumbower. "How can we converge engineering with physiology for rehab purposes?"

Over the course of three hours, Trumbower gave an overview of emerging trends in robotics, haptics, and virtual reality technologies. He discussed robotics and virtual reality technologies in patient care and education and outlined educational resources available to therapists.

Regenerative rehabilitation

Regenerative medicine focuses on the development of treatment interventions designed to repair, replace or regenerate tissues and/or organs to restore lost or impaired function. More than ever before, the enthusiasm surrounding regenerative medicine is being matched with clinical deliverables, and the number of clinical trials in regenerative medicine is growing at an unprecedented rate. As more of these technologies reach bedside, there will increasingly be a need for trained physical therapists who can help oversee the quality, safety and validity of these new clinical treatments.

Trumbower co-presented two sessions on regenerative medicine. He discussed stem cell populations commonly used in regenerative medicine and introduced the concept of "regenerative rehabilitation," particularly for neurological applications.

"We are finding in research that many of the theories in rehabilitation are very important for the success of regenerative medicine," says Trumbower. "How do we exercise our patients who are going to have stem cell implants or organ implants? At what point do we stress those tissues as they start to grow? Physical therapists are at the cutting edge of finding those answers."

Genomics

Advances in the science of genomics over the past 20 years hold much promise for managing and providing effective interventions for many common diseases. Studies have indicated that genetic factors influence many, if not most, of the diseases commonly encountered in clinical practice by physical therapists. Genes appear to influence not only risk for disease, but also progression, outcomes and response to rehabilitation interventions.

Allon Goldberg, PT, PhD, director of the Physical Therapy Department at the University of Michigan – Flint led two sessions on genomics. "We covered everything from basic definitions to the Human Genome Project," says Goldberg. "We discussed how certain variations in genes might predispose someone to develop a disease, such as lumbar disk degeneration. In the end, what we are really talking about is personalized rehabilitation protocols tailored to a person’s genetic profile.

"The whole idea of the FiRST initiative is to educate physical therapists on emerging trends in science, so we have been putting a lot of articles and educational materials on genomics on the web," continues Goldberg. "You can access them at apta.org/genetics."

Telehealth

Telehealth is the ability to use telecommunication technology (real-time videoconferencing or store-and-forward/remote monitoring) in physical therapy models for care. Alan Lee, PT, PhD, DPT, CWS, GCS, associate professor in the DPT program at Mount St. Mary’s College presented on telehealth."Some professionals are hesitant using technology because they see it as a way of replacing the technician," says Lee. "I don’t see that at all. It could be used as a way to continue care after the patient completes the physical therapy sessions. We as physical therapists should not sit back as other professions learn to use this technology. For therapists who want to learn more about it, we have uploaded a lot of information to apta.org/telehealth."

Wolf and his team plan to keep the momentum of the FiRST initiative moving forward. "It is important that physical therapists are not just the consumers of new technologies but are part of their development," says Trumbower. "We need to be active contributors and to be on the cutting edge of new treatments. That is what FiRST is all about."


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