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August/September 2003

NATA Presents First Consensus Statement on Heat-Related Illnesses
In an effort to educate the public and alleviate misconceptions regarding heat-related illnesses, representatives from 18 leading medical, nutritional, and sports medicine-related organizations recently formed the Inter-Association Task Force on Exertional Heat Illnesses to create a document on factors that contribute to exertional heat-related conditions. These experts presented this first-ever consensus statement at the National Athletic Trainers' Association (NATA) conference in St Louis in June.

Douglas J. Casa, PhD, ATC, FACSM, chairman of the panel, presented the unified statement, which addressed basic issues related to prevention, recognition, and treatment of heat-related illnesses such as dehydration, exertional heat stroke, exhaustion, cramps, and exertional hyponatremia. Casa noted that the collaboration effort lasted for more than 4 months, but the consensus statement deviates from previous medical sources. "It's very user-friendly," he says. "It is a five-page document which anybody can glance through and be able to apply."

NATA expects the report to "encourage increased and accurate education regarding heat illnesses for athletes, coaches, parents, and medical staffs." It provides tips on how to recognize symptoms, recommends treatment procedures, and suggests when patients with exertional heat illness should resume physical activities. Casa identifies the new concept of "cooling first, transporting second" when handling heat stroke victims. "It's the first 40 to 60 minutes that we call the ‘golden hour' in terms of whether a person with heat stroke dies," he says. More than 300 people die of heat-related illnesses every year, according to the Centers for Disease Control and Prevention (CDC). Organizations that participated include the American Orthopaedic Society for Sports Medicine, American Academy of Pediatrics, American College of Sports Medicine, the CDC-Nutrition and Physical Activity Program, and the US Army Center for Health Promotion and Preventative Medicine.

PTs Go to Washington

In a key event of the American Physical Therapy Association (APTA) National Conference, held in Washington, DC in June, an estimated 2,000 PTs, PTAs, and students joined together to rally in support of proposed direct access legislation.

The rally featured speeches by Sen Blanche Lincoln (D-Ark) and Rep Earl Pomeroy (D-ND), both sponsors of the direct access bill, HR 793/S 493. Also speaking at the rally were APTA president Ben Massey, Jr, PT, MA, and APTA CEO Frank Mallon, who both emphasized the necessity for direct access to physical therapy under Medicare, while urging rally participants to explain the benefits of such legislation to members of Congress, with whom they held meetings later in the day.

In his address, Mallon said physician referral for physical therapy is "unfair, inefficient, and costly," and called the direct access push "common-sense legislation that's going to make the quality of life better for every American."

During the rally, speakers also urged participants to encourage their representatives to delay implementation of the proposed Medicare therapy cap. On July 3, the Centers for Medicare & Medicaid Services issued a memorandum delaying implementation until September 1, 2003.

ATA Launches Free Online Service
The Alliance for Technology Access (ATA), San Rafael, Calif, has launched The Hub, a free interactive service that provides data on assistive technology products and services.

ATA, a national network of assistive technology resource centers, vendors, community-based organizations, and individuals, launched the site to provide a central information exchange for sellers and users of technology tools. Currently, ATA members can offer information about their technology products and services on The Hub, with more than 87 US and international technology vendors taking part, including Apple Computer, IBM, Microsoft, and Sun Microsystems.

The Hub can be found online at: www.ATAccess.org/hub.

Coalition Seeks To Improve Access to Assistive Devices
A newly formed coalition is vowing to improve access to assistive devices, such as prosthetics and orthotics, for people with disabilities.

The Independence Through Enhance-ment of Medicare and Medicaid (ITEM) Coalition, Washington, DC, is made up of more than 65 organizations, and plans to work to raise awareness and build support for policies that will improve access to assistive devices, technologies, and related services to people of all ages with chronic conditions and disabilities. Initially, it will work to enhance Medicare and Medicaid's coverage policies, with an aim of later addressing related coverage issues under the policies of other federal and private payors.

The coalition's early activities have included submitting comments to the Department of Defense on proposed changes to the TRICARE regulations, which enhance assistive device coverage, as well as testifying before the Interagency Working Group on Assistive Technology Mobility Devices. The group is made up of disability associations, aging organizations, consumer groups, labor organizations, voluntary health associations, and nonprofit provider associations. Members include the American Association of People with Disabilities, Christopher Reeve Paralysis Foundation, Brain Injury Association of America, United Cerebral Palsy Associations, and the American Academy of Physical Medicine and Rehabilitation.

In the Works: Operating Wheelchairs With Brain Power
A wheelchair being developed by Swiss and Spanish scientists allows users to control the machine with their minds through the use of electrodes. The system will use electrodes embedded in a skullcap worn by the patient to transmit messages from the brain to a computer, which passes them on to the wheelchair via a wireless link, according to the researchers.

Jose Millan of the Dalle Molle Institute for Perceptual Artificial Intelligence, Martigny, Switzerland, along with researchers at the Swiss Federal Institute of Technology in Lausanne and the Center for Biomedical Engineering Research, Barcelona, Spain, are testing the system with a wheeled robot using commands to turn left, right, or go forward. The wheelchair also includes built-in intelligence to ensure the robot does not collide with anything.

If successful, it would be the first mind-controlled system able to operate an object as complicated as a wheelchair, according to the researchers. The news of the wheelchair was first published in the British journal, New Scientist.

Exercise Reduces Risk of Foot Ulcers in Diabetics
Diabetics who do more standing, walking, and other activities on foot are at less risk for developing foot ulcers, according to a study published in the July issue of Medicine & Science in Sports & Exercise, a journal of the American College of Sports Medicine.

Researchers from the University of Washington and the University of Missouri at Columbia spent 2 years working with 400 diabetic patients, ages 45 to 84, with a history of foot ulcers. The researchers had the patients report time spent sleeping, reclining, sitting, standing, walking, or performing exercises. Patients who reported being on their feet at least 7.5 hours a day were 80% less likely to develop a foot ulcer than the least active participants.

The researchers, however, have not yet determined which activities besides walking are safe for those with diabetes and foot numbness.

Study: Pain Eased by "Natural" Feeling
The sights and sounds of nature can ease patients' pain, according to a study conducted at the Johns Hopkins School of Medicine, Baltimore.

Noah Lechtzin, PhD, and his fellow researchers analyzed questionnaires filled out by 80 patients who had undergone bronchoscopies in 2001; 41 of the patients looked at murals by their bedsides and listened to taped nature sounds as they underwent the procedure. The remaining 39 patients underwent the procedure without the therapy.

The results showed that 43% of patients who looked at the mural were more likely to report pain control as good or excellent, even after controlling for such factors as pain medication, health, race, and education.

New Guidelines for Pressure Sore Prevention
The Wound, Ostomy, and Continence Nurses Society (WOCN), Glenview, Ill, has released the Guideline for Prevention and Management of Pressure Ulcers, the second in a series of four wound care documents to be released over the next 2 years. The new clinical guideline is intended for use by nurses, physicians, therapists, and other health care professionals who work with people who have pressure ulcers. The guideline supports clinical practice by providing consistent evidence-based clinical information with the goal of improved cost-effective patient outcomes.

The guideline is based on a review of more than 200 articles, and a level-of-evidence rating has been assigned to specific recommendations based on the rating system used by the Agency for Healthcare Research and Quality.

Magnetic Therapy: Detrimental to Physical Performance?
The Journal of Strength and Conditioning Research has reported that magnetic therapy in the form of shoe insoles does not improve physical performance, and in fact can be detrimental.

Magnetic therapy supporters contend that it helps athletes perform at their best by relieving pain and fatigue. But the study, which involved 14 male soccer players from the University of Central Arkansas, showed that the scores of those who wore magnetic insoles showed no significant improvement compared with scores of those without the magnets.

The tests measured the athletes' performance in the vertical jump, 40-yard sprint, and bench press, as well as soccer-specific exercises. Half the athletes then wore shoes with magnetic insoles during practice and games for 7 weeks.

In the headlines...
It's getting easier for people with disabilities to travel, or so says Albert R. Hunt, in a July 30 Wall Street Journal article. Hunt, whose oldest son was severely injured 5 years ago and now uses a wheelchair, attributes the improvements in accessibility-especially in the United States-to new laws, greater public awareness, and increasing interest by businesses. A survey taken by Harris Interactive last year, Hunt reports, found that disabled Americans would spend at least $13 billion more annually on travel and tourism if there were more accessible accommodations. Many companies and destination spots have taken notice; however, most airlines and many foreign tourist sites remain difficult, Hunt says. Still, in places like Disney World and Las Vegas, "the color of your money is no different if you're deaf or in a wheelchair."

In an in-depth, two-part series in The Washington Post, Tamara Jones and Anne Hull describe the difficult rehabilitation of an emerging group: veterans of the Iraq war. In Ward 57 of Walter Reed Army Medical Center, Washington, DC, recently injured soldiers are fighting "more private struggles." The rehabilitation staff in the ward are also facing challenges. For example, Isatta Cooks, a physical therapist, has developed a strong relationship with Garth Stewart, who lost part of his leg to a land mine, despite the anger he often displays. "For the wounded soldiers on 57, physical therapy is a confrontation with pain and humiliation," Jones and Hull write. "In their minds, the soldiers are still elite athletes capable of marching 15 miles with 40-pound rucksacks. PT is the hard truth, with three-pound dumbbells."

For a state with budget woes like California, overspending on wheelchairs is not helping the problem. According to a lengthy Los Angeles Times report, the cost of supplying wheelchairs to disabled, elderly, and needy Californians has more than doubled over the past 5 years, and last year alone the California Medical Assistance Program, or Medi-Cal, bought 16,723 chairs for $66.1 million. Times staff writer Tim Reiterman reports that the problem derived from the lax accounting practices Medi-Cal employed when the economy was strong. Now that the state is in a $38-billion budget crisis, officials "face an entrenched system and a vocal lobby of advocates who assert that changes could threaten the mobility and independence of the disabled." However, the solution will not be found in drastic cuts, says Assemblywoman Barbara Matthews (D-Tracy), "we don't want to cut benefits but want to make sure people are not taking advantage of a system that is too loose."

U.S. News & World Report revealed its annual hospital rankings in July. Topping the rehabilitation hospitals list, as they did last year, were, in order, The Rehabilitation Institute of Chicago; The Institute for Rehabilitation and Research (TIRR)–Houston; and the University of Washington Medical Center, Seattle.

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