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From:   Jon Ruttenberg, M.S., PT, President: Oak Tree PT, LLC <pt@oaktreept.com>
Subject:   Therapy & Research News from Oak Tree PT, LLC
Reply:   pt@oaktreept.com

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Oak Tree PT, LLC Newsletter Volume 3; Issue #1
September 2005

Dear Jon,

After a long break, we finally return! We proudly present you with an exciting new aspect of our business: Oak Tree PT Seminars, offering three popular seminars that generate a lot of buzz:

Improving Balance and Decreasing Fall Risk Using T'ai Chi

Practical Pilates for Clinicians

Shiatsu for Therapists Who Treat Acute and Chronic Pain.

Oak Tree PT Seminars is committed to taking you out of the run-of-the-mill seminar experience. We bring you fresh perspectives, new tools, and proven techniques that are just beginning to be discovered by a growing number of therapists.

Each of our instructors wants you to leave your seminar at the end of the day feeling personally satisfied and confident that you can apply the techniques you learn with a high degree of expertise as soon as you return to the clinic. To that end, we limit the size of each class to 35 participants, so that every student can enjoy a personalized one-on-one, hands-on experience with our seasoned instructors.

For course descriptions, locations and dates, go to www. oaktreept.com/seminars. You can also enroll in a seminar online at our website.


As always, the Oak Tree PT Newsletter presents information related in some way to physical therapy and health- related issues. We hope that you find it interesting, informative, topical, and timely.

We want your feedback on any of the topics presented here, and on any topics that you would like to see addressed in the future. Please send in questions relevant to our focus -- we answer them in our "Readers' Forum."

For other topical articles and tidbits, please visit the Oak Tree PT BLOG.

In this issue...
  • Featured Article


    We’ve all seen the ads that seem slightly sleazy: They urge us excitedly to, “Take our pill and lose weight while you sleep!” Now some exciting research suggests that you can forget the pill and just take a nap. Nobody actually calls it “The Sleep Diet”, but it appears that you can slough off some of those fat cells by catching more zzzzzs.

    It’s all about maintaining a balance between two key hormones that control hunger: Ghrelin, produced in the gastrointestinal tract, stimulates appetite while leptin, produced in fat cells, makes us feel full and signals the brain to stop eating.

    Eve Van Cauter, PhD and her team found that sleep deprivation drives leptin levels down significantly (reducing the ability to feel that “full” sensation) and it drives ghrelin levels up significantly (increasing that hungry feeling). The study of 12 healthy men, reported in the December 7, 2004 Annals of Internal Medicine
    also reports that after sleeping only four hours, the men’s eating patterns changed, showing a 45% increase in their choices of candy, cookies and cake over fruit, vegetables and dairy products. Coincidentally, their (hungry) ghrelin levels jumped 71% compared to a night when the men slept nine hours.

    Professor Van Cauter said on cnn.com, “We don’t yet know why the food choice would shift”, but she speculates that, “Since the brain is fuelled by glucose, we suspect it seeks simple carbohydrates when distressed by lack of sleep.”

    Van Cauter found in a 1999 study published in the Annals of the New York Academy of Sciences that “sleep debt was associated with decreased glucose tolerance, elevated evening cortisol levels (Editor’s note: Elevated cortisol levels also correlate with increased hunger and stress levels), and increased sympathetic activity.” She concludes that, “These results indicate that sleep loss can . . . facilitate the development of chronic conditions, such as obesity, diabetes, and hypertension”.

    In a second study published in the December 2004 Public Library of Science, Dr. Emmanuel Mignot and colleagues examined 1,000 people in the Wisconsin Sleep Cohort Study. They found that people who consistently slept five hours or less per night had on average 14.9% more ghrelin (increased appetite) and 15.5% lower leptin levels (decreased stimulus to stop eating) than those who slept eight hours a night. (Editor's note: Do these numbers suggest that sleeping five hours or less could lead to approximately one-third more calorie intake?)

    Furthermore, the number of hours that the subjects sleep inversely correlates with their levels of body fat, as measured on the Body Mass Index. Those study participants who sleep the fewest hours weigh the most. The authors conclude that getting 2 – 4 hours of sleep per night makes one 73% more likely to become obese, while those who sleep 10 hours or more per night decrease their likelihood of becoming obese by 11%.

    So, it’s really true: When you snooze you lose!

    (Editor’s note: I definitely stayed up way too late writing this article!)

    For more information about getting a better night’s sleep and other interesting sleep articles, please visit the National Sleep Foundation


    Could the road to better balance and lower blood pressure be paved with cobblestones? A provocative study out of the Oregon Research Institute suggests exactly that.

    The idea for this study emerged while the researchers were traveling in China, where they observed a fascinating phenomenon: “We noticed in several cities we visited that people were walking on cobblestone paths, and people were standing on them, and sometimes dancing on them, doing weight- shifting,” said John Fisher, who led the study.

    The Chinese have walked on cobblestone paths for centuries, and many of them make it a regular practice, believing that the stone surfaces stimulate acupoints on the soles of the feet, in much the same way as acupuncture and acupressure.

    In order to quantify the therapeutic effects that they observed anecdotally, the researchers created synthetic mats, which “contained hard plastic replicas of smooth, small- to medium-sized river stones embedded randomly on the surface.”

    108 “healthy, physically inactive, independent-living older adults” exercised for 60 minutes, three times per week for 16 consecutive weeks. The experimental group participated in a varied regimen of cobblestone-mat walking; warming up and cooling down with light walking and full-body stretching.

    The control group's workout was a conventional walking program of similar “exercise intensity, attention, and training intervals”, using the same warm-ups and cool-downs as the experimental group. Both groups exercised at a level considered “fairly moderate to somewhat hard” (equivalent to 11-13 on the Borg (6-20) Scale).

    The researchers were interested in Balance, Physical Performance, and Resting Blood Pressure. They measured balance using Functional Reach; and three different, and progressively more difficult stances:

    1) Side-by-side stance: Feet side by side and touching
    2) Semitandem stance: One foot placed forward with the heel in line with, and adjacent to, the toes of the other foot
    3) Tandem stance: Heel of one foot directly in front of and touching the toes of the other foot

    The physical performance measures:

    1) Time taken to perform five consecutive sit- to-stand transfers from a chair
    2) Time taken to walk 50 feet
    3) Timed Up and Go (TUG)

    After the 16-week intervention, the cobblestone-walking group significantly out- performed the conventional walking group; with better scores on Functional Reach; standing balance; consecutive chair stands; 50-foot walk; and significantly lower blood pressure.

    People walking on cobblestones must wear proper shoes in order to avoid injuries such as ankle sprains; nevertheless, the authors endorse this exercise as very safe and highly effective.


    In the interest of finally getting this newsletter out to you, we skip the short health-news blurbs this month, and bring you several items that might normally go in the Readers' Forum section. Granted, they may appear to be a little self-serving for Oak Tree PT, LLC, but we hope they tickle your interest anyway.

    Here we go, in order of most-to-least self- promotional:

    Download the new Oak Tree PT Toolbar.It contains links to search engines, our website and seminar page, our BLOG, and radio stations.

    It's free, with no spyware or viruses, does not open pop-ups or hijack your searches, and no personal information is required. It installs to your web browser, and it you can customize it to your own needs and tastes.

    Take a look at the Oak Tree PT BLOG. It covers many topics, along the same lines that you find in this newsletter, and it's a bit more "free-wheeling" as well. We welcome your comments on our BLOG site.

    Join the new Oak Tree PT Forums discussions on topics related to:

    1) Our seminar subjects
    2) Therapy-related subjects in the research literature
    3) Clinical anecdotal experiences

    Our first major topic focuses on the energy cost of walking according to an Eastern model versus the Western model of ambulation (We raise this subject in the Oak Tree PT seminar entitled, Improving Balance and Decreasing Fall Risk Using T'ai Chi).

    A "controlled fall": The center of mass moves forward of the base of support (while always moving onto a dynamic, unstable base of support).

    A "controlled weight-shift": ALWAYS keeping the center of mass within the base of support (while always moving onto a static, stable base of support).

    Editor's Note: I say that the Eastern model is inherently safer; that it is possible to perform consistently during everyday ambulation (without looking like a goofball); and that the energy cost is NOT higher than the energy expenditure of the Western model. However, I sure would like to see a study that supports my contention with hard evidence ;-}

    There is also a forum available for posting other clinical and therapy-related topics.

    Editor's Note: The same two articles about the Toolbar and the Forums appear in our BLOG, but none of the other BLOG articles duplicate the newsletter.

    NOW . . . (drumroll please!) . . . the BEST part of this section! Our question to you:


    An ergonomic Oak Tree PT pen to the one who supplies the best answer. Please post your answers in the "Miscellaneous" section of the Forums.

    We will publish the best answer, if there is one, in the Readers' Forum section of the next newsletter.

    In light of Katie Glaser- LeClere's article about performing Physical Therapy interventions on animals, the following Quick Take "weighs in" as both interesting and relevant:

    With Winter approaching, we can all use more exercise to keep the pounds off; and a 23-year-old African elephant named Maggie is no exception. Maggie lives at the Alaska Zoo in Anchorage, and the last time she jumped on the scales, she weighed 9,120 pounds!

    Her doctor says she needs to lose about 1,000 pounds in order to stay healthy, so zoo officials commissioned the first-ever treadmill for an elephant. It's 20 feet long and 8 feet wide, and it reaches a top speed of eight miles-per-hour.

    The big pachyderm begins training this month, slowly working up to a regimen of two hours per day on the treadmill. Assistant Zoo Director Pat Lampi describes Maggie as "pretty darn compliant" with her exercise program. So far, there has been no word from zoo officials about any possible plans for installing a large-screen television and a good music sound- system to help enhance Maggie's workouts.


    This spot features answers to questions and/or news of interest from our readers. Send your physical therapy-related questions, comments, and current therapy/health topics we can share to:

    If we answer your question in this column, we will send you an Oak Tree PT ergonomic pen. Please be sure to include your mailing address, to be used strictly for mailing the pen only, and no other purpose.

    I will also be happy to publish in this Readers' Forum any original, relevant, well-written articles submitted by readers. Just forward your material to:

    **Editor's note: This month we feature another news article from Katie Glaser- LeClere, MSPT, owner of Safe Home Pediatric Physical Therapy, LLC.

    Physical Therapists practicing in a growing niche field face some legal and ethical dilemmas. While PTs usually practice on humans, many therapists are now developing lucrative practices in animal rehabilitation. These practices apparently conflict with some state PT practice acts, and with state veterinary practice acts as well.

    One of the volatile issues involves language in many states' practice acts which limits physical therapy practice to individuals. This language excludes animals as potential recipients of physical therapy services.

    Steve Strunk is Vice President of the An imal PT Special Interest Group (APT SIG) within the Orthopedic Section of the American Physical Therapy Association (APTA), and Chair of the Maryland Animal PT Task Force. Last fall his group successfully changed the Maryland practice act terminology from individuals to patients or clients. This change now puts animal physical therapists in harmony with Maryland's PT practice act.

    However, the current veterinary practice act limits treatment of animals to those employed under the supervision of a veterinarian, so veterinarians now find themselves at odds with physical therapists: While veterinarians want to maintain their supervisory control, physical therapists want autonomy.

    Veterinarians say that physical therapists lack the educational preparation required for treating animals that all veterinarians must undergo. Physical therapists say that their rigorous training in neuromusculoskeletal rehabilitation prepares them to treat disorders of the neuromusculoskeletal systems whether they occur in humans or animals. The basic structures of those systems do not change between species, they say, and the therapeutic principles of treating those structures also remain basically the same. Animal physical therapists feel they can easily learn to recognize the anatomical differences between animals.

    As the law now stands, physical therapists working in a veterinary office may provide rehabilitative services to animals, but they may not bill those services as "physical therapy." Veterinary technicians and aides with little or no formal rehab education may also provide those services to animals which would be considered "physical therapy" if they were performed on humans. These services commonly include evaluation of physical status, and interventions such as aquatic exercise, electrotherapeutic modalities, and gait training.

    Other financial considerations may also present obstacles for therapists who may be considering developing a practice treating animals. While most physical therapists can obtain liability insurance relatively inexpensively, many insurance companies do not offer coverage for therapists who treat animals, even for those willing to pay extra premiums.

    Despite the controversy, many physical therapists find successful and rewarding careers in animal rehabilitation. While these therapists consider any of the larger animals "fair game" for therapeutic interventions, they most frequently find themselves treating the canine and equine populations.

    Many veterinarians do appreciate the educational and professional expertise of physical therapists for managing orthopedic and neurological conditions in animals. Until veterinarians and physical therapists reach an agreement, however, veterinarians can still provide rehabilitative services to animals using staff without experience or education in physical therapy or rehabilitation.

    Perhaps the most difficult obstacle for those practicing animal physical therapy may arise from within their own leadership organization. Because most states' practice acts do not support the practice of physical therapy on animals, the APTA finds itself in a position where it must re-evaluate continuing its support of the Animal PT Special Interest Group. For more information, visit the following sites:

    APT Special Interest Group, Orthopedic Section, APTA ht tp://www.orthopt.org/sigs/animal_pt_sig/

    APTA Emerging Practice: Collaboration with Veterinarians (Members Only) http: //www.apta.org/pdfs/practice/6.pdf

    Risk Management 101: Basic Risk Management Considerations for Animal Physical Therapy http://www.utc.edu/F aculty/David- Levine/LegalIssuesLetter.htm

    Katie Glaser-LeClere is a Physical Therapist and founder of S afe Home Pediatric Physical Therapy, providing PT to children and adolescents in the home and community. Safe Home's service areas include Frederick, Montgomery, Carroll, and Howard Counties in Maryland. Outpatient sites are located in Rockville and Frederick.

    EDITOR'S NOTE: When Katie first wrote me about her article, I thought she meant using animals to provide therapy for people; for example, Hippotherapy (using horses to improve, e.g., trunk stability and/or sitting balance in humans); or, something like the Eden Alternative. So, before she gently corrected me, I found the following cartoon:

    Finally, one last thought:

    The greater our knowledge increases, the more our ignorance unfolds.
    ---John F. Kennedy

    Back to Top

    Featured Article

    You know, being a Physical Therapist or Occupational Therapist isn't anything if it isn't living in the real world. We can't just tell our patients what to do from the ivory tower; we have to be realistic, we have to know our patients and know how they live.

    The following poem illustrates this principle pretty well, I think. It's from an old cowboy named Don Kennington.

    Don Kennington's official biography is predictably humble:

    Don was born and raised on a Idaho/Wyoming Cow Ranch where he herded cattle 20 years for the Bear Lake Cattle Association. He moved to Ogden, Utah where he was a horseshoer for 40 years, shoeing over 33,000 horses. He has been a Cowboy Poet 25 years, writing and performing his own poetry from coast to coast.

    Few men can claim as many friends. He is one of the best-loved and most talented poets in the West.

    He's a sought-after performer at gatherings, has won numerous awards, and has been featured at the National Cowboy Poetry Gathering in Elko, Nevada.

    If you have Windows Media Player, you should be able to open the audio file of Don reading his poem in his own voice on WGBH FM Morning Stories, or you can click on this link and hear it on their website.

    Either way, you can read it below, and maybe even print it out and put it on your wall . . . to help keep you in the real world. ;-)

    The Last Nail

    There's pain a throbbing in my back.
    Sometimes my knees are stiff and sore.
    Guess I'd better see the doctor
    Don't get around good any more.

    But, I know just what he's going to say,
    "You've got to quit that shoeing Don.
    I know it's something you enjoy
    But you've been doing it too long."

    But he just doesn't understand
    That it's the center of my life.
    I love it more than anything
    Except the kids and my dear wife.

    'Cause when I'm under that ol' hoss,
    I'm just as good as any one.
    Those folks think that I'm important
    We laugh and joke a-having fun.

    I've been out there shoeing horses
    And making friends o'er thirty years.
    And when Doc says, I ought to quit
    I start a fighting back the tears.

    'Cause I love a shoeing horses.
    Yeah, I suppose that sounds kind of dumb
    But then I feel good inside
    That's when I really am someone.

    My shoeing friends don't laugh at me
    And they don't call me stupid names.
    They treat me like I'm one of them.
    They act like we're all just the same.

    And when I see them somewhere else
    They usually honk and wave at me.
    And so I grin and wave them back
    Then I feel good inside you see?

    We're supposed to tend God's creatures.
    But some folks get a little rough.
    That's when some of God's creatures
    Live a life that's pretty tough.

    Like when you walk up to a pony
    And he's a-shaking like a leaf.
    You whisper and you scratch him,
    Ain't hard to tell he's had some grief.

    And you keep scratching and a-whispering
    'Cause you're trying to be a friend
    And that pony starts to relax
    And he starts to comprehend.

    Finally that pony licks his lips
    And you can feel him settle down.
    Then you won't have any trouble
    Working his feet up off the ground.

    And when that pony walks away
    His legs are swinging straight and true.
    And it really is amazing
    At what a little love can do.

    Oh, it hasn't been all roses,
    But for the most part it's been fun.
    I've met a lot of real, nice folks
    And come to love near everyone.

    Yeah, I've been kicked and knocked around
    By horses been abused a lot.
    That's when you've gotta keep yer cool,
    Use all the patience that you've got.

    So let me drive just one more nail
    And snug that shoe down good and tight.
    My back is hurtin some
    But I've just got to do it right.

    "There now. That's a little better.
    That pony's ready for the trail.
    But I won't be coming back
    'Cause I've just driven my last nail."

    1998, Don Kennington




    1 - 30
    Home and Sports Eye Safety Month
    Prevent Blindness America

    1 - 30
    Gynecologic Cancer Awareness Month
    Gynecologic Cancer Foundation

    1 - 30
    Healthy Aging Month
    Educational Television Network, Inc.

    1 - 30
    Leukemia & Lymphoma Awareness Month
    The Leukemia & Lymphoma Society

    1 - 30
    National Cholesterol Education Month
    National Heart, Lung, and Blood Institute Health Information Center

    1 - 30
    National Food Safety Education Month
    International Food Safety Council

    1 - 30
    National Sickle Cell Month
    Sickle Cell Disease Association of America, Inc.

    1 - 30
    Ovarian Cancer Awareness Month
    The National Ovarian Cancer Coalition

    1 - 30
    National 5-A-Day Month
    National Cancer Institute/ Produce for Better Health Foundation

    1 - 30
    National Pediculosis Prevention Month/ Head Lice Prevention Month
    National Pediculosis Association, Inc.

    1 - 30
    Prostate Cancer Awareness Month
    National Prostate Cancer Coalition

    1 - 30
    National Alcohol and Drug Addiction Recovery Month
    Substance Abuse and Mental Health Services Administration

    1 - 30
    National Osteopathic Medicine Month
    American Osteopathic Association

    1 - 30
    Sports and Home Eye Safety Month
    Prevent Blindness America

    1 - 30
    Reye's Syndrome Awareness Month
    National Reye's Syndrome Foundation

    1 - 30
    National Menopause Awareness Month
    Office of Women's Health

    4 - 10
    Suicide Prevention Week
    American Association of Suicidology

    STOP A Suicide Today Day
    Screening For Mental Health

    18 - 24
    National Rehabilitation Week
    National Rehabilitation Awareness Foundation

    18 - 24
    National Reye's Syndrome Week
    National Reye’s Syndrome Foundation

    Take A Loved One to the Doctor Day
    Office of Minority Health

    Family Health and Fitness Day USA
    Health Information Resource Center

    25 - 1
    National Adult Immunization Awareness Week
    National Coalition for Adult Immunization

    National Women's Health and Fitness Day
    Health Information Resource Center


    1 - 31
    National Physical Therapy Month
    American Physical Therapy Association

    1 - 31
    Halloween Safety Month
    Prevent Blindness America

    1 - 31
    Domestic Violence Awareness Month
    National Coalition Against Domestic Violence

    1 - 31
    National Breast Cancer Awareness Month
    National Breast Cancer Awareness Month Board of Sponsors

    1 - 31
    Rett Syndrome Awareness Month
    International Rett Syndrome Association

    1 - 31
    "Talk About Prescriptions" Month
    National Council on Patient Information and Education

    1 - 31
    National Medical Librarians Month
    Medical Library Association

    1 - 31
    Let's Talk Month
    Advocates for Youth

    1 - 31
    National Down Syndrome Awareness Month
    National Down Syndrome Society

    1 - 31
    National Celiac Awareness Month
    Celiac Sprue Association/USA

    1 - 31
    Healthy Lung Month
    American Lung Association

    1 - 31
    National Family Sexuality Education Month
    Planned Parenthood Federation of America

    1 - 31
    National Dental Hygiene Month
    American Dental Hygienists' Association

    1 - 31
    National Lupus Awareness Month
    Lupus Foundation of America, Inc.

    1 - 31
    National Spina Bifida Awareness Month
    Spina Bifida Association of America

    1 - 31
    Sudden Infant Death Syndrome (SIDS) Awareness Month
    First Candle/SIDS Alliance

    1 - 31
    Clean Air Month
    American Lung Association

    1 - 31
    National Orthodontic Health Month
    American Association of Orthodontists

    1 - 31
    National Liver Awareness Month
    American Liver Foundation

    1 - January 31
    National Glaucoma Awareness Month
    Prevent Blindness America

    2 - 8
    Drive Safely Work Week
    Network of Employers for Traffic Safety

    National Depression Screening Day
    Screening for Mental Health, Inc.

    9 - 15
    Fire Prevention Week
    National Fire Protection Association

    10 - 14
    National School Lunch Week
    School Nutrition Association

    12 - 20
    Bone and Joint Decade National Awareness Week
    U.S. Bone and Joint Decade

    SAVE (Stop America's Violence Everywhere) Today
    American Medical Association Alliance

    16 - 22
    National Radon Action Week
    U.S. Environmental Protection Agency

    World Food Day
    U.S. National Committee for World Food Day

    17 - 23
    National Health Education Week (Healthy Choices: Family Life Education)
    National Center for Health Education

    National Mammography Day
    American Cancer Society

    International Stuttering Awareness Day
    Stuttering Foundation of America

    23 - 29
    Respiratory Care Week
    American Association for Respiratory Care

    23 - 29
    Hearing Aid Awareness Week
    International Hearing Society

    Lung Health Day
    American Association for Respiratory Care

    Find a short synopsis of all Health-related bills before Congress, and/or all Medicare/Medicaid-related bills before Congress by clicking on the links.

    Who voted for/against the most recent bills in the Capitol? Check the vote tallies here.

    Want to find the names, addresses, phone numbers, and e-mail addresses of your elected representatives? Get all of that information by clicking this link: just enter your zip-code.



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