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April/May 2000

Elaine Trefler, OTR/L, MEd, FAOTA

Long-Term Rehab Expert Added to EAB

Rehab Management is proud to announce a new addition to the editorial advisory board, Elaine Trefler, OTR/L, MEd, FAOTA. Trefler is an associate professor at the University of Pittsburgh, School of Health and Rehabilitation Science and Technology. She has focused her career on providing assistive technology to people with disabilities. Speaking on functional outcomes of wheelchair seating and positioning in the elderly, Trefler was a plenary presenter at the 16th International Seating Symposium in February.

Therapist Salaries Stay Flat

Because of the growing number of physical and occupational therapy graduates entering the field and the changes in reimbursement, therapist salaries are remaining the same or decreasing, according to a recent story in Rehab Continuum Report.

On the other hand, rehab experts are noting an increasing shortage of nurses and nurse’s aides. Gene Bianco, president of the Pennsylvania Association of Rehabilitation Facilities, Harrisburg, notes that the current shortage is a reaction to the nursing cutbacks of the early 1990s and it has led to increases in nursing salaries in some regions.

The forces dramatically affecting the leveling of therapist salaries are that rehab facilities are employing more therapy assistants instead of hiring therapists, who are more expensive, due to the cutbacks set by the Balanced Budget Act and the prospective payment system, and the large rise in therapy schools and graduating students.

PTs have especially felt the crunch of their stagnating salaries because they have historically been in high demand, which has inflated their salary level. Nancy J. Beckley, MS, MBA, president of Bloomingdale Consulting Group, Valrico, Fla, comments, “About 100% of the people I have talked with have indicated that PT salaries have remained the same or have decreased. The people who have maintained the same salaries say they have increased productivity so their cost per unit has decreased.”

The downsizing and salary-leveling trend is supposed to continue, with mental health and speech-language pathology also being affected. As a result, many therapists who are used to seeing their profession grow and prosper are disappointed.

Jack A. Carroll, PhD, MHA, president and CEO of Sheltering

Arms Physical Rehabilitation Hospital, Richmond, Va, says, “What we have is the equivalence of sticker shock. As employee satisfaction surveys plummet to the basement and a growing proportion of therapists begin to feel the impact of reduced hours, reduced pay, and/or reduced employment opportunity, there are understandable attitudes of disappointment, frustration, and, in some cases, even anger.

“Management must acknowledge that therapists’ frustration might ultimately be reflected in less than optimal patient interactions. These times will truly test the professionalism and work ethic of the rehab team. Quality outcomes are generated by individuals who enjoy their work and their workplace. Management needs to encourage dialogue.”

With the influx of change into the rehabilitation industry, therapists will be forced to make some major career choices. Carroll suggests that therapists answer the following questions when searching for career guidance:

What was my true motivation for entering my profession?

What is my internal standard/expec- tation for quality and productivity in service delivery?

Is my internal standard for service delivery and productivity honestly relevant in today’s marketplace? Am I in agreement with my employer’s philosophy on these issues?

How flexible am I in trying a new way that is decidedly different from my training and/or experience?

Can I work in a truly competitive marketplace where my employer expects me to add business develop- ment abilities to my clinical skill set?

Study Tests Botox for Pediatric Spasticity

Franciscan Children’s Hospital and Rehabilitation Center in Boston, through the Departments of Physical Therapy and Rehabilitation Medicine, is conducting a study, “Botox® Outcomes and the Implications for Pediatric Physical Therapy.” Partially funded by a clinical research grant from the section on pediatrics of the America Physical Therapy Association, the study is being led by Maria Fragala, MS, PT, in conjunction with Kara Russo, MSPT; Helene Dumas, MS, PT, PCS; Maggie O’Neil, PhD, PT, MPH; and Jeff Rabin, DO. Fragala explains, “The purpose of this study is to document disability and patient satisfaction outcomes following botulinum toxin A (Botox) injections in children with cerebral palsy and lower extremity spasticity. This study will evaluate changes for individual children and for functionally based clinical groupings of children, as well as examine the impact of Botox injections on physical therapy service delivery.”

Botox is a neurotoxin produced by Clostridium botulinum, which inhibits the release of acetylcholine at the neuromuscular junction. Botox as a modality for treating spasticity was first documented in 1993 and is intended to prevent muscle contractures and joint deformities, improve joint flexibility, and improve function or ease of care, potentially reducing medical costs and improving a child’s and family’s quality of life.

According to Dumas, Fragala, O’Neil, and Rabin, the preliminary clinical observations from the study reveal that Botox is effective for minimizing impairment and improving function for children diagnosed with HIV encephalopathy, traumatic brain injury, stroke, genetic syndromes, and spinal cord injuries, as well as for children with cerebral palsy.

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