Spastic Cerebral Palsy Case Summary

As a New York Physical therapist, I urge you to veto measure AB 3551. This ill conceived legislation fails to understand the value of the current New York state law in curbing medical practices that may undermine the quality of care as it relates to physical therapists. As you are aware, Rep Jackie Spencer, the person who introduced the AB 3551, argued that self-referral by physicians increases cost (American Physical Therapy Association, 2014). He also stated that it encouraged an unnecessary use of services that do not promote the integrity of health care provision. If enacted, the law will eliminate financial incentives from the physician referral process. Rep Jackie Spencer is under the impression that the law will ensure that medical decisions will promote the patients’ interest. The lawmakers also have the impression that the financial incentives have encouraged physicians to expand the number of prescribed procedures, which is against the code of conduct of the profession. If enacted into law, it will complicate the work of physicians.

This frees up the physician’s schedule to see only the medically necessary patients, whereas PTs can share the load of musculoskeletal evaluations. Mitchell and Lissovoy published a study in 1994 on the cost effectiveness of direct access to PTs. They found that the costs for PT visits were 123% higher when patients were first seen by a physician as compared to when they were seen by a physical therapist directly. Establishing close working relationships between medical doctors and PTs, with a 2-way referral of patients, is essential to reduce not only unnecessary referrals, but also improve patient satisfaction and create an efficient process for reducing overall medical costs.

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

Periodic Paralysis Syndrome is a blanket term for a couple of inherited muscular disorders. The most common types are hypokalemic periodic paralysis and hyperkalemic periodic paralysis. Both of these are inherited and generally present from childhood, tho it is possible for symptoms to start showing later in adolescence. In hyperkalemic periodic paralysis, high levels of potassium in the blood interact with genetically caused abnormalities in sodium channels (pores that allow the passage of sodium molecules) in muscle cells, resulting in temporary muscle weakness and, when severe, in temporary paralysis. This disease may be caused by genetic defects in either the calcium channel or the sodium channel. Hypokalemic disease may be caused by genetic defects in either the calcium channel or the sodium channel (Medline Plus).

Hereditary spastic paraplegias (HSPs) are a group of clinically and genetically heterogeneous neurodegenerative disorders that share the primary feature of progressive lower limb spasticity and weakness, with sparing of the upper extremities (Blackstone et al., 2010). Although few epidemiological studies have been carried out, the prevalence of HSPs has been estimated to range from ~3-9 per 100,000 and the age of onset can vary widely, from early childhood to late in life (Salinas et al., 2008). The HSPs are classified according to the mode of inheritance (autosomal dominant, autosomal recessive and X-linked) and whether progressive spasticity occurs in isolation (uncomplicated HSP) or is accompanied by additional clinical features such as ataxia, seizures, cognitive impairment and peripheral neuropathy (complicated HSP) (Fink, 2013).

The Texas Nurses Association is a strong proponent of permitting APRN’s to practice with full authority using their clinical skills and education to their fullest potential (Cates, 2017, p. 2)l. The TNA is a member of the APRN Alliance, which encompasses four statewide associations (Cates, 2017, p. 2). The APRN Alliance joined forces with the Coalition for Health Care Access (CHCA). This coalition is comprised of “over 20 business, consumer-advocacy, and health care stakeholder groups” (Cusack, 2017, p. 2). Currently, APRN’s barriers include expenses associated with partnering physicians (Holmes & Kinsey-Weathers, 2016). Granting APRN’s full practice authority would results in a monetary loss to these physicians. The AMA and AAFP oppose the passing of HB 1415 (Hooker & Muchow, 2015, p. 89). The pushback from these organizations stands regardless of strong evidence of the positive outcomes with allowing APRN’s full practice authority.

Under the Affordable Care Act, more patients are becoming eligible for health insurance. With the influx of patients, private practices are spending less time with patients and more time with filling out paperwork to satisfy government requirements, all with the mandated intention of improving patient care.4 With this, I worry that as a future therapist, I will not be able to give my patients the one-on-one therapy and time that they deserve. If my patients do not get the therapy they deserve, I will simply be wasting their time and will not be practicing properly under my code of

Therefore, there is great need to have all stakeholders at both national and state levels to address these emerging challenges. This will help to achieve the triple objective of healthcare, which is to provide better care, ensuring better health, and reducing the costs of accessing healthcare (Hain, & Fleck, 2014). Among the barriers the authors point out include practice and licensure laws in various states, payer policies, and other physician related issues among others. Licensure and practice laws for the profession vary across the states. Nonetheless, the challenge lays in the way these laws and practices relate with the full practice authority governing practice and licensure (Hain, & Fleck, 2014). A big proportion of the country has only adopted certain parts of the legal requirements, creating a significant barrier for NP practice. The other challenge is the perception among some groups of physicians that NPs cannot provide quality and safe patient care at the same level as the physicians (Hain, & Fleck, 2014). This perception emanates from the notion that NPs do not receive a rigorous and longer training and education unlike other physicians. This hinders effective performance of nurse practitioners and greatly affects the work of professionals such as family nurse

I aspire to be an orthopedic surgeon with a specialization in spinal surgery; our research has allowed me to familiarize myself with this region. The research I perform is centered on trying to understand the molecular mechanism by which mutations in a neuronal kinesin cause Hereditary Spastic Paraplegia. Though it is basic science research it has a transitional target. As a laboratory technician, I perform many of the complicated procedures myself and aid the undergraduate researchers in their projects whilst collaborating with our personal investigator Dr. Thomas Huckaba. Under his mentorship my capacity for critical reasoning has grown exponentially. As of now, my primary project is discovering the cargo that is being transported by Kinesin

Felland, L., Lechner, A., & Sommers, A. (2013, June 6, 2013). Improving access to specialty care for Medicaid patients: policy issues and options. The Co

Practitioners pay large sums of money to liability insurance carriers. Reform could minimize these expenses and therefore decrease overall health-care costs. Currently, health-care practitioners feel they have been forgotten in health-care reform, but I think that if malpractice reform occurred, practitioners would be more agreeable toward healthcare reforms. Practitioners are concerned about the decreased reimbursements and loss of control in decision making that have resulted from the passing of the Affordable Care Act. Most practitioners will agree and are happy with the fact that more people are insured.

In the summer of 2015, I was enrolled at The University of Phoenix to start the summer program. Due to my mother having a terrible car accident, I pushed back my enrollment date since the car accident left my mother unable to walk. Not only that, I was left with the responsibility and care of my two younger siblings who have cerebral palsy. I called and talked with admissions and they pushed back the date for me to start school, after a couple of weeks passed I received a call from the school telling me I would loose my funding for school and it was important that I started on the next starting date. The following start date arrived and I started school every week I received a call from a adviser if I didn’t sign on to

According to Direct access utilization survey done by APTA in 2010 state with unrestricted direct access for more then 10 years 69% therapist report that their direct access patient contain only 10% of their patient population and this 10% consist of former patient, their relatives and friends. Even though most of the reimbursement companies including medicare doesn’t required initial referral from physician, 64.7% therapist identified reimbursements limitation is one of the primary reason behind lower number of direct access patient (APTA 2010). I work for one of the largest and lidding health care provider company in United state and company policy dictate that we have to have physician referral in order to evaluate and treat patient in all settings.

Cerebral palsy refers to a group of chronic disorders that involve degrees of brain damage that affect body control and movement. The term cerebral refers to the brain, while palsy describes a disorder that impairs the control of body movement. These disorders are not the result of muscles or nerves problems. Instead, they are due to impaired motor areas in the brain that disrupt its ability to control movement and posture. The condition typically appears within the first few years of life and it is not marked by regression. (Mecham, 1986)

The human body is made up of many organ systems that consist of organs and tissues of different anatomies and diverse nomenclature. These organs systems, organs and tissues are prone to thousands of diseases, and one of these diseases is cerebral palsy, which is a disease of the nervous system in simple terms. Research relating to cerebral palsy is carried out, whereby the disorder is described, along with its history, and how it affects the nervous system and the brain. The anatomy of the body systems involves with regard to this disorder, the effects of the disorder on these body systems and other body systems are also researched and discussed. Furthermore, the research focuses on the causes of cerebral palsy, its complications, signs, and symptoms, and the diagnosis of the disorder, along with its treatment and side effects of the treatment. A recap of the research focusing on prevention strategies, the anatomy and physiology of cerebral palsy and the nervous system is presented.