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    How school based therapists can improve public health

    It seemed to me, that a blog written at the beginning of the school year should be about Fit4Work, evaluation strategies, getting that programming going, and what we should be looking at. But I, as many of you, spent the first few weeks of school driving around, checking equipment, doing staff training and looking at my caseload. Which meant a lot of time in the car. While I did all this I listened to 2 podcasts that really got me thinking. And I decided, if they got me thinking, maybe they would influence you and so I have decided to share them. Because, really, they are so important.


    1. Mark Milligan is an orthopedic physical therapist who I met while participating in #summer of move (check out the hashtags on twitter it was a blast!). As a member of #Teamgsd we documented our physical activity to promote the importance of physical activity to improve public health. Mark spoke in a video Facebook chat last week on "Social Determinants of Health". I can't post a direct link, but go to Institute of Clinical Excellence and look for Mark's smiling face and you can listen there. Mark speaks about how the number one determinant of social health is your zip code. The link between financial affluence and public health is clear. A lack of access to heath care, good food, safe living environment directly affects health. These contextual factors of the ICF model are not only an important part of our physical therapy practice, but central to the success of our students and improved public health.

    2.  Hardwired by TED Radio Hour is a fascinating talk that summarizes 3 presentations about epic genetics. The speakers discuss how experiences modify the programming of genes and that experience and the environment modifies genes. Quotes that made me pull over include:

    -"Positive experiences affect DNA and improve health", negative experiences modify DNA and are linked to poorer health outcomes. 

    -"Adversity inhibits pre frontal cortex, amygdala fear response center (which increases your high risk behavior and puts you at risk for chronic disease)...if don't engage in high risk behavior you are still at risk heart diesease and cancer." Forgive the odd quotes here, I had to pull over and write them down :)


    The families we work with are not always thriving. Often they are trying to survive under chronic long term stress, and have continuously activated adrenal systems. This not only may be impairing their immune system but also may affect their ability to make decisions. In one city, all patients are screened for stress. In one case, a young girl who was failure to thrive, was experiencing chronic stress. Her parent was educated on the health implications of toxic stress, the family received counseling and other supports, and the girl began to gain weight and actually get on the growth curve. The family began to thrive.


    As pediatric physical therapists, we have all been students of the ICF model, and have been well schooled in looking at the environmental and contextual factors that support the success of the individuals that we work with. These two Ted Talks though, put a lot more meaning into the importance of providing support for those environmental and contextual factors; the concept that we are affecting the epigenetics of that person is mind boggling. And important.


    So as you start out this school year I make the following suggestion: as you work with families and teachers who are under stress, consider what you can do within your scope of practice to support that individual (suggestion of increased physical activity, exercise, yoga, breathing exercises?) and referrals to other practitioners (primary care doctors, nutritionists, social workers). Our students will be so much more successful, and Fit4Work will be better implemented when we consider the environmental and contextual factors as strongly as we consider their functional skills or their balance.


    Have a great school year! I have a slew of articles to share with you, and they will be coming soon :)


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