lorem ipsum dolor issue #, date october 2019 volume 8

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President’sMessage

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I am sitting outside a lecture hall at theWorldCongress of Sport Physiotherapy, reflecting onsome of the phenomenal presentations byprofessionals from around the world. I amcontemplating the vast differences in ourpractice styles, locations, and clientele- yetnoticingcommonalities.Apredominantthemeisadaptability, a state of flux where physicaltherapists thrive, yet we must somehowregulate. In any given clinical scenario, someunexpected factor may interfere with ourintended treatment plan. Without giving it asecond thought, we re-evaluate, critically-examine the situation, and adapt. That clinicalscenario feels rather reflective of the currentstateoftheSCPT.Council is in the midst of hiring our newExecutive Director & Registrar. We appreciateyourpatienceandunderstandingaswepreparefor her to step into her role. There were 38applications.ThedecisionwasmadebyCouncilto hire an externalHuman Resources companyto guide our hiring committee through atransparent, professional, customizedprocess. The HR company used our jobdescription to create screening rubrics andinterview templates specific for this position,leavingtheactualworktoourhiringcommittee.Theextensiveprocess isnearly complete,and Iwanttosincerelythankthehiringcommitteeforthe incredible amount of work this has

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near future. Although we have to changecourse on the concepts that had beenpreviously proposed, I do believe that we canbuild upon those ideas to help our memberspractice safely, effectively, and with the highstandardsofcarethatthepublichasassociatedwithPhysicalTherapistsinSaskatchewan.As I contemplate who we are as physicaltherapists, some characteristics that come tomindarethoseofhard-work,collaboration,anddedication. It has been inter-twined in everypresentation at Congress. I see it daily in ourprofession, the MOMENTUM newsletter is asuperb example. A special cheers to theCommunications Committee for puttingtogether MOMENTUM. I hope you enjoy thisissue. If you have any comments or queries,pleasedon’thesitatetoreachout.

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been.Whileourofficemaynothavehadthesmooth summer we had anticipated, weadapted.BrandyGreenhasdoneanexcellentjobinherinterimEDRrole.With the Fall colours settling in, we are alsocomingtotheendofourcurrentStrategicPlancycle. Council has been creating a newStrategicPlanthatwillcarryus through2020-2023. We are excited to have the drafttogether, and are in the process of outliningimplementation guidelines, to be completedbyournext EDR. Our newplanwill require ashift in our current thought processes andorganizationalmanagement. As a Council, weset our focus on the future, anticipatingchanges in health care delivery, professionalexpectations,aswellastherole,structureandoperations of theCollege- all underpinnedbytheimportanceofmaintainingSelf-Regulation.Unfortunately, we received notification thatour omnibus bill did notmake it through thegovernment in the last sitting, and with theupcomingelection,thereisnoguaranteewhenor if it will. In lieu of this, Council and theContinuing Competency Committee will bededicating a weekend in November to workwith an expert in the area of professionalcompetency.Ourgoalistodesignaplan foraprogramthatcanbe implemented in thevery

P1.President’sMessageP2.PlagiocephalyP4.ElectionSeason

TableofContents

SCPT October2019Volume8Issue2

RespectivelysubmittedbyDayshaShuya

P5.WorkingWithinYourCompetencyP6.FAQs


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Headshapeconcernsand torticollis continuetobeagrowingconcerninSaskatchewan.Inthepast,positionalplagiocephalywasestimatedat1 in100.Today,plagiocephalyaffectsnearlyhalf of all infants while 1 in 10 are recommended to beevaluated for treatment. Research indicates that betteroutcomesareachievedanddecreasedresourcesare requiredwith earlier intervention. Early detection and education arepivotal for better outcomes. There is also an increased focusonpreventionbyprovidingmore information tonewparentsand health care practitioners who work with younginfants. Providingmoreawareness onhead shape has led toincreased referrals and decreased treatment required due tothebenefitsofearlierintervention.Headshapeconcernshavebeen identified by family doctors, public health nurses,othermedical professionals as well as direct referrals from theparentsandfamilies.

Definitions

The most common head shape concerns seen by physicaltherapists are positional plagiocephaly, brachycephly or acombination of both. Positional plagiocephaly is theasymmetric flattening on the posterior aspect of thehead.Associatedfeaturescanincludeananteriorearshiftandfacial asymmetries including forehead bossing, fuller cheek,and smaller appearance of one eye. Brachycephaly is thesymmetricalflatteningacrosstheentireposterioraspectofthehead.Associatedfeaturescanincludeincreaseinvaultheight,parietalwideningandprominentears.

Oftenplagiocephalyhasanassociated torticollis. Torticollis isan abnormal posturing of the neckwith lateral translation oftheheadon the body. It isoften seenwitha rotationandalateral tilt preference. Torticollis is a description of a postureand NOT a diagnosis. Most often the sternocleidomastoidmuscleisinvolved.

Causes

Plagiocephaly and brachycephaly can be acquired orcongenital.Acquiredplagiocephaly/brachycephalyisaresultoffrequent pressure on one aspect of the head as a result ofpositioning.Baby’sskullbonesaremalleableandseparatedbysuturesallowingthebraintogrowanddirectthegrowthoftheskull. These features make the infant skull susceptible to theinfluence of external pressures, particularly in the first threemonths of life when the skull is most malleable. During thistime,we see thegreatestamount of skulldeformation as it isalsowhentheinfantsspendthemajorityoftimeontheirbacks(back to sleep campaign, car seats, swings, etc.). If there isconsistentpressureononeaspectofthehead,thebraingrowthand consequent skull growth will be directed to the otherareas. 85% of cranial growth happens in the first year oflife.Sometimebetween18-24months, theanterior fontanelleclosesandskullgrowthslows.Changestoheadshapearenearlynegligibleoncetheanteriorfontanellecloses.

Congenital head shape concerns can result from acraniosynostosis,whichisacongenitalanomalycausedbyearlyclosureofoneormoresutures,resultinginlimitedordistortedhead growth. These may be an isolated finding or could beassociated with a genetic syndrome and require an urgentassessmentwithaneurosurgeon.

Torticollis can also be acquired or congenital. Acquiredtorticollis is a result of positioning. Asymmetrical tonic neckreflex andenvironmental influences, suchas theback to sleepcampaign and increased use of car seats and swings, increasetheincidenceoftorticollis.

Congenital torticollis can be caused by intrauterine crowding,difficult labors causingmuscledamageor ischemic injuriesdueto abnormal vascular patterns. These may present with acontracture or psuedotumour. Abnormal spine development

Plagiocephaly:TheImportanceofAppropriateReferrals


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(Continued)

such as a hemivertebrae, scoliosis, unilateral atlanto-occipitalfusions,orconditionssuchasKlippel-FielsyndromeorSprenglesdeformitymayalsocauseacongenitaltorticollis.

WhentoTreat

Both torticollis (acquired and congenital) and positionalplagiocephaly/brachycephaly can be treated by physicaltherapists through education, stretches, muscle release,strengthening, repositioning programs and monitoring change.For physical therapists with experience in development,management would also include assessment and monitoringgrossmotordevelopment.

WhentoRefer

There are a number of red flags for babies who are seen withhead shape concerns that require a referral. Any child with asuspicionofacraniosynostosisshouldbesentbacktotheirfamilydoctor to assess and refer to neurosurgery. Other conditionsthatcanbeassociatedwithheadshapeconcernsinclude:geneticsyndromes, developmental dysplasia of the hip (DDH), grossmotordelay,cerebralpalsy,brachialplexusinjuryorotherswhichall would require a referral from their family physician to theappropriatespecialists.Plagiocephaly/brachycephaly isamarkerfor elevated risk of developmental delay and should always bescreened.

Positional plagiocephaly and brachycephaly may require cranialremoldingorthosis(helmet).Headshapesthatarenotimprovingand/or have anterior involvement (facial asymmetries) and asignificantearshiftshouldbeconsideredforahelmetingreferral.

Torticollis that is not resolving also may need a referral to aphysical therapist specializing in development. A TOTcollar canbe fit by an experienced PT to address persistent acquiredtorticollis. They also may need to be sent back to their familydoctorforimagingtoruleoutanabnormalx-rayofthespine.Eyeexamsandhearingscreensmayalsobeindicatedifachildisnotrespondingtotreatment.

Helmeting

Cranialremoldingorthosis(helmets)aredesignedtoredistributethe forces on the head to direct cranial growth. The cost iscovered by Sask Health but require some commitment by thefamily.Theyanticipatea3-6monthcommitmenttobeworn,23hours per day, with follow-ups every 1-3 weeks foradjustments. The optimal window to initiate helmeting isbetween 5-8 months with best results when started by 5-6months.Thereiscurrentlyoneorthotistwhofitshelmetscoveredby Sask Health in Saskatchewan and he is located inSaskatoon.Privateorthotistsoutofprovinceprovidethisservice

but the family would have to cover the costs (estimated$2500).

Who/HowtoRefer

Arequisitionforacranialremoldingorthosisassessmentmustcome fromapediatrician.Manypediatricians requireanMDreferralbutsomeacceptreferralsfromPTsordirectlyfromthefamilies. It is best to get to know your community and thequickestprocesstoassessforareferralaswaittimescandelaytheprocessenoughthatthechildmissesthe idealwindowtoinitiatehelmeting.

If youhavea child that you thinkneedsa referral, youcouldalso contact the local Children’s Program for furtherinformationandassessmentbyaspecializedPT.Whenmakingareferral,dosobysendingareferralletteroutliningtheissue,treatment to date, outcomes, and any specific requestsregarding assessment/treatment. Whenmaking the referral,be sure to include a copy of the parent's signed consent forsharingof information. SHA is in theprocessof standardizingreferralformsacrosstheprovince,solookfortheseinthenearfuture.Parents can also self-refer into the Children’s Programs forassessment by a pediatricphysical therapist, all they have todo is call the program centers. They would still require apediatrician’sreferralforhelmetingifitisrequiredthough.Children’sProgramsexistatWascanaRehabCenter inReginaandAlvinBuckwoldChildDevelopmentPrograminSaskatoon.The following link provides further information aboutcontacting these centers and accessing care for pediatricpatients throughout the province:https://momsandkidssask.saskhealthauthority.ca/

Resources

Avideoonplagiocephalypreventionforfamilies:http://www.sunrisehealthregion.sk.ca/default.aspx?page=128Pathwayswebsitehasfantasticresourcesfortummytime:https://pathways.org/topics-of-development/tummy-time-2/AgreatbrochureonTummyTimehttps://pathways.org/wp-content/uploads/2016/03/Tummy-Time-Brochure-English-2016.pdf

ThankyoutoJodiWalknerforwritingthisarticleandprovidingall the great resources! Thank you also to Kim Woycik forproviding information on pediatric therapy programming andreferrals. For a full list of References, please contact theCommunicationsCommittee.


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StartaConversationthisElectionSeasonAs October 21 approaches, talk of the federalelection and numerous campaign signs on lawnsaroundourcommunityarehardtoignore.When a representative comes knocking at yourdoor, as a physiotherapist there are questionswecan ask to better understand how each party’splatformwillaffectourworkaswellashealthcareon a larger scale.Providedbelowarestatistics toreference and conversation prompts to utilize,focusingon4differenttopics:Seniorshealth,Painmanagement, Indigenous and Rural/RemoteCommunities,andHealthCareFunding.Seniors’ Health – Physiotherapists have a provenrole in improving the quality of lives for seniorsliving in thecommunity.By2036,morethan62%of health care spendingwill be on thoseover theageof65.1Howwillyourpartyensure that seniorsgetthecaretheyneed,andwillphysiotherapyberecognizedasaprofessionessentialinthiscare?PainManagement –1 in5Canadians livewithchronicpain. Thecostofchronicpain isestimatedat$60billionperyear.2Howwillyourpartytacklechronicpainandthehighuseofopioids?IndigenousandRural/RemoteCommunities-IndigenouspeopleconsistentlyhavepoorerhealthoutcomesthanotherCanadians. 30% of the Saskatchewan population is rural/remote yet only 10% of physiotherapists practice in thesecommunities.3 How will your party ensure Indigenous people have access to the care they need, includingphysiotherapyservices?HealthCare Funding–Havingaccess tohealthcareservices,suchasphysiotherapy, isa topic that theSaskatchewanPhysiotherapyAssociationfocusesadvocacyeffortstowards.Doesyourpartyplanonincreasinghealthcarefunding?Ifso,aretherespecificprioritiestofocusonforthatfunding?Be direct, authentic and passionate with your conversation. Spend time in interactions with party representativesdiscussingissuesthatmattertoyou.Passionshowsthroughinconversation.Giveavoicetoourprofession,andstartaconversationwhenyouhaveachancethisOctober.Moreinformationcanbefoundat:https://physiotherapy.ca/election-2019-toolkitReferences:

1. ANewVisionforHealthCareinCanada:AddressingtheNeedsofanAgingPopulation2016Pre-budgetSubmissiontotheMinisterofFinance.CanadianMedicalAssociation;2016.https://policybase.cma.ca/documents/Briefpdf/BR2016-02.pdfAccessedOct2,2019.

2. Chronic Pain in Canada: Laying a Foundation for Action: A Report by the Canadian Pain Task Force. Health Canada, 2019.https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-force-June-2019-report-en.pdfAccessedOct2,2019.

3. BathB.GabrushJ,FritzlerR,DicksonN,BisaroN,BryanK,ShahTI.MappingthePhysiotherapyProfessioninSaskatchewan:ExaminingRuralversusUrbanPracticePatterns.PhysiotherapyCanada.2015;67(3):221-231.


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WorkingWithinYourCompetency

Competency is defined as “the ability to do somethingsuccessfully or efficiently”. In physical therapy, we oftenemphasizetheimportanceofknowingandworkingwithinyourcompetency, in fact it is clearly stated in both the Code ofEthical Conduct and the National Standards of practice that aphysical therapist “delivers only services that are clinicallyindicated for clients, and that he/she is competently able toprovide”.

For physical therapists, the NPAG Competency Profile forPhysiotherapists in Canada (2017) describes the essentialcompetencies required of a physiotherapist in Canadathroughout their career and specific milestones expected of aphysiotherapist at entry to the profession. However, it isimportant to understand that competency is a veryindividualized concept, and that it fluctuates throughout yourcareer depending on experience, current area of practice andcontinuing education. With this in mind, what exactly do wemeanwhenwesay“workwithinyourcompetency”?Standard 6 of the National Standards of Practice states, “Thephysiotherapist practices within her/his level of competenceand actively pursues continuous lifelong learning to maintaincompetence in existing and emerging areas of her/hispractice.” Thismeans that physical therapy clients can expectthattheservicestheyreceivearedeliveredbyaphysiotherapistwhoiscompetentintheprovisionofcareintheareaofpracticeinwhichtheyprovidetheseservices.Thisalsoindicatesthatthephysical therapist takes appropriate actions (e.g., referral toanother physiotherapist or health care provider) in situationswherehe/shedoesnothavetherequiredcompetencetodeliverqualityclient-centredcare.Standard2alsostatesthataphysicaltherapist should “advocate within her/his capabilities andcontext of practice for clients to obtain the resources theyrequire to meet their health goals”, which may require aphysicaltherapisttoseekoutappropriatereferraloptionsforapatient if the physical therapist feels that the patient’s needsarebeyondtheirpersonalcompetencytotreat.The Code of Ethical Conduct provides that beneficence guidesthepractitionertodowhat isgoodwithrespecttothewelfareof the client. In physiotherapy practice, the physiotherapistshouldprovidebenefittotheclient’shealth.Thisindicates,andis emphasized in The Code, that physical therapists will treatclients only when the diagnosis or continuation of theintervention warrants treatment and is not contraindicated.They are expected to assess the quality and impact of theirservices regularlyandpractice the profession of physiotherapyaccording to their own competence and limitations, referringtheclient toothersasnecessary.Whena referral isnecessary,physical therapists should practice collaboratively and

andcommunicateappropriatelywithcolleagues,otherhealthprofessionalsandagenciesforthebenefitofclients.Whenconsideringyourowncompetenciesandabilitytoprovidespecific services, you also need to respect the principles ofinformed consent by explaining service options provided byyourself and the potentialof referral to others, risks, benefits,potential outcomes, possible consequences of refusingtreatmentorservices,andbyavoidingcoercion.Inaddition,youneed to ensure that you have appropriate consent for sharingclientinformationpriortodoingso.With this inmind, it is important tounderstand that failure toappropriately refer patients to a more specialized practicephysical therapist or other health care provider, when it isindicated to do so, may be considered ProfessionalIncompetence and thus could potentially lead to disciplinaryaction.It is important to remember that the goal of all healthcareproviders is to improve their client’s/patient’s health withintheir scope to do so; therefore, if you are unsure about apatient’sassessment,diagnosisor treatmentplan reachout toyour colleagues within your profession and other health careprofessions.There issignificantresearchthatsupportsamulti-disciplinary approach to health care, with a focus oncollaborationofteammembersinordertoprovidethehighestlevelofcaretoyourpatients.References:CompetencyProfileforPhysiotherapistsinCanadaNationalStandardsofPractice(Standards2,3,4,6)CodeofEthicalConduct(ResponsibilitiestotheClient)


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FrequentlyAskedQuestionsTheSCPTofficereceivesanumberofquestionsfromitsmembers.Inordertohelpenhancethecompetencyofourmembership,theContinuingCompetencyCommittee(CCC)hasdecidedtoprovidetheanswerstosomeofthemorecommonquestionsinissuesofMomentumforeveryonetoread.

Question1:IfIworkinbothpublicandprivatepractice,whatcanI tellmypatientwhoisbeingdischargedfromthehospitalaboutservicesavailableintheprivatepracticeclinicwhereIwork?

Answer: Core Standards of Practice, Standard 7: Conflict ofInterest.PerformanceExpectations:a) Identify and manage any situations of real, potential orperceivedconflictsofinterest.Thisincludesbutisnotlimitedto:receivingfinancialorotherbenefits fromotherprovidersrelatedtoacceptingi. referrals,providingservices,orsellingproducts;ii. providing and/or accepting incentives to/from others togeneratereferrals,provideservices,orsellproducts;iii. receivingfinancialincentivesbasedonclientnumbers,servicevolumes,profits,etc.;andiv. self-referringclientsacquiredinthepublicsectorfortreatmentintheprivatesectorforher/hisownpersonalgain.

Asyoucanseefromsectioniv,tellingapatientabouttheservicesofferedintheprivatepracticewhereyouworkmaybeconstruedasreferringaclienttoyourownclinicforyourownpersonalgain.Such actions would go against our Core Standards of Practice.However,itisourclients’righttochooseaprovider.

Thismeansthattheclientcanstillchoosetogotoyourclinic,you just can’t actively encourage them to choose your clinicoveranother physical therapy clinicor refer themdirectly totheclinicwhereyouwork.Providingclientswithalistofclinicsavailable in the community will allow them the freedom tochoose from any of those clinics, including the clinic whereyouwork,andavoidapotentialconflictofinterest.

Question 2: Can I provide services when another physicaltherapist (or other health care practitioner) is also providingtreatment?

Answer:SCPTRegulatoryBylaws(2018)Concurrenttreatment21. Nomembershallprovidephysicaltherapytreatmenttoaclientwhere:(a) theclient isreceivingtreatmentfromanotherhealthcareprovider who has a dissimilar or conflicting treatmentphilosophy,approachorclientcareobjectives;(b) the other healthcare provider treating the client has notbeennotified;or(c) the physical therapy services provided constituteduplication.

As you can see fromour regulatory bylaws, you can provideservices when another physical therapist is also providingtreatment as long as you abide by the aforementionedregulations.Thisalsorequiresthephysicaltherapisttocontactthe other provider for consent to co-treat as both providersneed to be in agreement. If co-treatment is occurring,communicationneedstooccurbetweentheprovidersinordertopreventduplicationof services.When sharing informationbetween the providers, consent needs to be obtained fromtheclient.

RespectfullySubmitted,KarlaHorvey,CCCChair

SaskatchewanCollegeofPhysicalTherapists105A–701CynthiaStreet,SaskatoonSK,S7L6B7

p. 1.306.931.6661BrandyGreen,InterimExecutiveDirector&Registrar,[email protected]

TammyMacSymetz,Operations & RegistrationManager,[email protected]

TaraFriedenberger,AdministrativeAssistant,[email protected]

lorem ipsum dolor issue #, date october 2019 volume 8

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