PT Health Study Monitoring Communities Risk For Illness/Injury with Wearable Technology
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If you're looking for a position somewhere in these pretty awesome fifty United States. All settings, all states plus DC. Finding that you are a US medical dot com, Great Show for Unite Sarah Cruiser and Marciel Silica here where it's about health study, even talking about this all week and pushing you to hear now here is now now we're in the future. The future is now. Joe Forget subscribe to the podcast. spotify Google podcast and now video casting. Mom said the face was made for radio. She wasn't lying. Video Casting Youtube facebook twitter at. CAST on social is it gets a serious news INC now. We don't do serious here. Let's bring in our guests. Tonight's let's bring in Sarah Cruiser. Mark Sydeklik. Era. buggering. Sarah Welcome to the show guys. Thanks for coming in. We've been talking about for a while very excited for this excited when I tripped across it on twitter very excited to know more on purpose, not diving deeper because I was. I want them to tell me so. Thank you guys for for taking some time out and being on the show I question always the hardest. We get the Harvard's out of the way. What are we drinking today? Undergoing his son. King Keller Hayes Local Indiana burry. On. Got The dogfish head sequence Ale the summer session Oh very. Throat Perfect Summer Sour I will let you know what I was in Virginia was pediatric physical therapist, and across the street was a dogfish head restaurant they had it was a brewery, but didn't really brute there, but they had it there, and so many of my patients. Parents would be like dropping them off good for an hour. My good to go like I will be very close like you're gonNA dock fashioned. No, like maybe listen you go into a brewery to have a beer while your kids with me getting sweaty and doing pt totally acceptable. I am drinking who I've never had. This had beers from Belgium. Obviously, but I've never had voodoo ranger imperial Ip. And? How do you go wrong with like cool squirrel artwork like that? The answer is you. Don't go wrong so I am pouring that in the glass still. Cheers to you, guys, we'll do a quick cheers. Cheers stink as we do the virtual chair. I like, but I like to dogfish head and my time across the street from a brewery, definitely in their the ninety minute Guy Kinda got into that all right, so let's go. Let's go big to small macro to micro PT. Health Study I somehow tripped across mark on twitter. You talking about it with somebody and I was like what is this? This sounds pretty cool, and then I found out. It's kind of like it's tied into like Mike Eisenhart. We've had on the show before and really population health, so so laid out for us. What's what's what's PC health study from you guys? Yeah thanks so I mean Internet show kind of goal is to take wearable devices in what we know kind of the. Possibilities in potential that is end connected with the other side of that is a providers, typically physical therapists onto a kind of lower the barriers between connecting healthcare providers patients in really in the short term year is is really looking at Kobe. What kind of opportunities there yeah I remember a couple a couple years ago and I mean it was blowing up probably in like Twenty fifteen twenty sixteen. They were just get them seen, and everybody else was trying to catch up. Up of course, right apple. The I watch was coming out and there we're we're. We're GONNA. Be wearable to remember asking the question and it wasn't cockiness or anything and I was like that's cool that you have all this data. Like what are you going to do about it? And of course the obvious answer? I was a PT Time. Forgive my ignorance. The obvious answer is like a bunch of data. WE'RE GONNA makes we're putting. We're research. That's that's the first thing. So I'm sure people like you are saying. Yeah, that's what we're. GonNa do so so PT Health Study. How are you guys looking at this wearable technology? What are you looking at? How are you looking at it? Lay it out for me. Yes, I mean. I just kind of like initials. Inception of it came probably more like really. I think a lot of us are less researchers than you might expect to the name health study. but we came in more from the like application side of things in a really at the combined with productivity on bike. EISENHART. We'd been looking at using these devices in kind of how we can. On the back end. Using software to essentially monitor population is mostly from the like injury risk management with companies. And really kind of as these. As the endemic ramped up on some things in the data with you know distress, risk of a kind of formula or kind of signs, popping up in the kind of things came from there. Sarah can go deeper. She's. She is more in on the kind of a nitty gritty of. The numbers side of things. Let's let's find the players on the show. We can skip assets. Held steady, but like Sarah Gimme your superhero backstory like tell us about you and how you how you came to where we are because I was being on this podcast, clearly the crowning jewel of your of your. Now, you and your background sir. I have, Very background veering from dance to Bodywork, and then ultimately P., T. as a second career, but I've long been interested. Yeah, I know. I've long been interested in sort of A. Can of health promotion upstream side of things on by day I work with older adults in their homes. Remote health in that way but I got involved with the a PHP t, the cadmium prevention health promotion therapies pretty early on and have helped steer the direction of that and grow the membership so That's how I got here to be involved with the T. health study. And kind of looking at how we can adapt. What we're all doing to a larger scale and get farther upstream. What's happening now isn't working like it all right? Mark Your Superhero backstory. How'd you come to the? How'd you come into this This crazy spot in the world. Yeah probably a lot of twists and turns me, but permit from a more traditional physical therapy, orthopedics background, and got a slowly wrangled in with my guys in heartened the folks at practicality really via adhd which is kind of? Prevention helped Promotion Academy. In. New York City working with productivity, doing mostly kind of prevention health promotion work with companies where we are kind of on trying to get on the early access and preventative side of things. So now we'll side of things together because you guys are talking about Sarah. Saying you're working in people's homes and really where people are that, that's near to my heart because my day job is working with Fox rehabilitation where we work with older adults in their homes. What what what better place would it be right I? Remember Coal Galloway. Gave a talk I was still a second year student and he's. pedes researcher and he said listen climate fake stairs in to nowhere in a clinic, or you could do it where they are, and that's where I think this PT, health steady is in terms of. You're not even you're GonNa Forget. You're wearing these wearables right? Every everybody's like I'm wearing a fit for the first week. And then you're just wearing a fit, which is great because I. Want you to forget about it, so let's talk about early detection with wearables. What are you guys looking at? How are you looking at it? What can you do or what will we be able to do? In terms of early detection with his data? We're getting from all these things that were wearing in carrying around with us. Yeah. That's a really good point to me about. Essentially being in people's homes. We're yeah, we're sort of getting an inside look at a variety of indicators on that we know correlate with physiologic stress of any kind of an we get this inside. Look at how people are essentially managing the daily life, the ups and downs, the stresses, the relaxation periods recovery work on, so we get a really good inside look at that, and then what were able to do is sort of take a big picture view of each and every participant in the project or anybody who's part of the PD health study. And get a sense of not just what stressors are happened to them how they're managing it an so we know that with acute illness as well as any kind of distress physiological cognitive. What have you? We see certain patterns and were able to use a pretty deliberate pattern recognition to determine when someone might be kind of teetering at that moment before they're not on the right side of health. And then provide outreach as needed and help bring them back down to a sustainable of risk using tools that we think PT's are. Perfectly equipped to use. We'll said I'll use a time for the noise like the. Crew. Nails about I. I'll bring something personal and I. Don't think I've talked about this on the show. Ended March I was in New, York City, and I I I left new. York City to come back to where I where I grew up. I'm staying with my brother. Now a day later. I got sick and I haven't been able to get a test yet, but so I cannot say I was co positive, but let's put it this way. I was a forty year old ironman triathlete kind of guy and wearing the garment like all the triathletes do. Let's say you spot. A triathletes were always wearing a garment or something that and I'm monitoring my steps and I would on a good day ten twelve K, and a really good day twenty if I'm working now. And I was on my back for five days. I think I took ten thousand steps in like five or six days, and that's literally I. Knew I was sick. But I was able to quantify it by saying dude. You have not moved at all. You've gone from bedroom two bathroom to kitchen and back. That's it not. That's how I realized. How sick I really was! Because when you're when you're a little bit sick, covert or otherwise, you're Kinda like wow I'm sick. But how sick am I and you know good on other people for for for forcing the Saint? Pay attention if you can't measure it, you. Had you know if you're improving it? I was on my back. I, mean ten thousand steps in six days, Noble Ueno, so the fact that you're able to to now really wrangle people into this and be able to early detect with wearables. Yes I'm all in one hundred percent. Go ahead mark I was just GonNa say I think it's. Like bringing up the step counting is also I think it's cool to look at how technology progress because some of the things that we're looking at you know it goes beyond the like typical all the wearables in back in the day of about steps in ten thousand steps this but now you know with a lot of them. Use Garmin devices, but there's just because we can, or we have access to that data, but any of the you know devices. Nowadays they are attracting heart rate on look at resting heart rate. You can look at a heart rate variability, which a little more about non. You can look at oxygen percentage respiratory. You look at sleep in quality. Sleep in really really like the entry level devices that you all of it one hundred dollars. You know like one time in. Realistically, the costs to look at pretty high quality data that has a lot of like implications for long term disease in an acute risk pretty cool. I was actually part of a University of Connecticut Study. I signed up to do my first ironman in into ten years ago, so twenty ten and they were like we'll give you a free Garmin. We'll give you a T shirt. I was like what free t shirt sign me up so literally they're like we just want you to wear watch and we're going to put a heart rate monitor on you. We'll go study these. These KPI's and I was like that wasn't in healthcare at. Radio DJ was KPI's. That sounds good. I have no idea what those are, but sounds good, and they actually made me I had to swallow. A core swallow pill, but it was like they could measure my core temperature like beep temperature, and that was weird, but That was that was ten years ago and that was a big deal, but you're mentioning mark. Hundred Bucks it's going to do. More than anything was doing back then. It's fantastic so Sarah. Let's talk about KPI's. What what are you measuring? Mark kind of tipped hand a little bit with a few of those. But what are you looking at? And what can they kind of tell us? Yeah, so I think a primary thing. Is definitely heart rate variability. You know we have several different algorithms that were used in a Garmon measures. Hurry, variability and sort of a stress number that they develop if you're not familiar with our variability. Back back on it. Her every ability is basically the feet to be different than time between every heart rate, so even though we think about our pulse rate as maybe sixty beats per minute. How many times your heart beats the actual variation between the our rates on Ekg? Their ease can win. There's a lot of variation. It's a sign that are para. Sympathetic system is pretty balanced with our sympathetic. Our are fighter. Flights Stumm when there is not a lot of variability than we tend to see, it's a higher sympathetic drive, which is what we relate with. Ramped up system kind of running on edge, and also a lot of conditions that we know are based on sort of a low lying chronic inflammation that is something that actors into her ability as well, but like mark said there are a lot of other variables as well air sleep, sleep quality We look at a lot of different things including comparisons, your own norms risk profiling all of these different factors, but what we know is that in acute illness we tend to see spikes in Our rate variability changes are resting heart rate, and we also see changes to how well our system recovers. Able to see that. That's a great. Thank you for doing it like that. For the the guys like me. who were like I understand what most of those words that you said but. Variability would be like. Yeah, my resting heart rate is fifty five, but how much because that's an average, right fifty five home. Good, but you're saying hey, how what's what's the variation? Because if if we're just averaging and getting to fifty five cool, but doesn't tell us anything, so you're saying the difference between the our airwaves if there's a lot of variability than there's some sympathetic and some parasitic, bring it down. You WanNa have a good even distribution, so hurry variability. How is it measured like? What like? What's a good number zero? You know I actually. Don't I don't know the actual numbers based on sort of a a millisecond difference I believe yeah. Yeah, all of the different watches are using their own algorithm because there are multiple different types of heart rate variability that you can measure I can't remember the names of be honest. Yeah, but I I think that you can take Napa loops. Sorry I got a little bit of Tech overlay. They're interested in your. Oh, it's fine, it's just the watches tend to take the different types of variability and put them into their own score. That's kind of an towards the lay person, often zero to one hundred. How stressed are you? How does your system Gotcha all right so when you have visa and also like sleep. And Sleep Quality I. Remember when the iphone start doing that that kind of APP and they. You know you're supposed to put your phone on the bed and it would tell like how much moving and I'm like. That's a little weird. So how would you describe the difference between sleep and sleep quality? It feels like sleep was just like how many hours are you mostly immobile sleeping within? There's quality which feels like Hari Hurry Variability Zach close. I think so. We look at Ram and and deep sleep as the quality and then light sleep as the less quality of sleep, and so we're looking for somewhere around forty percents. range is kind of a good standard good reason. Area to be in good. All, right so how? How you, enrolling people in health study houses, work, and the audience is as therapist, listening and watching. How can they get involved? What's bring them in? Because the more information you get the bigger the bigger pool of data, the better things are going to be. So I think sometimes it may be choosing. The word study was a little bit. Confusing or or May. Like thinking more like a collaborative project, I, think is probably more representative of what we want us to be. like with the with the goal of saying. We know this type of system can be helpful. You've seen the early signs of it. And we think it matters that physical therapists are involved in this type of kind of like carrot connection. so really were initially trying to enroll PD's in it to both helped develop the system as in like. Give us a little feedback in the early on. And then also kind of giving back some information in guidance you them in terms of. Really trying to edge them along towards this type of model of like looking at populations and managing people from this kind of upstream. Avenue. surreally enrollment is basically you go on easy health study dot org yet a little google form We send you email. Where if you have a device, you can sign right up meaning A. Compatible Garmin device? From the list that we give or you can by Vice. There's a little discount code just for joining on. You can then purchase device which. Count Bill Discount Bells this. Yeah so basically, the hundred dollar vices like the really low profile I think the Sarah. Do you have the other one walk? Yes, it's a lower profile on. It's free small zillow easy to sleep in Basically you get that device in the mail you start wearing it. You cannot. Detroit's this then once a week we send you a one to five question survey and then give you like a little video kind of education on starting to shift towards the thinking and what we can learn from the devices. You explained it really simply, but like wow, like think about this like we're able to collect real time like twenty twenty like I look where we are I, mean I don't know like I'm just trying to think when I was thirteen and I was like i. have a walkie talkie. Look Amazing I can hear my voice eight feet away. That's how far walkie talkies work. It felt like a million miles away, and you're connecting real collecting real time data from people and able to do with it, and that was the question I asked like in two thousand, Fifteen, twenty sixteen. Everybody's got a fitbit and step count. I'm just like all right. So. What like my? My? I luckily learned research from a professor's Jason Craig who's Irish everything. He said kind of prophetic. He's like what so what and now and I was like. What's that mean? He's like research. What what now and I was like? When you say with an Irish accent, it sounds way more. It sounds way more cool but that was my quirky, which is like that is cool. Kinda right so like who cares if know how many steps I'm taking, but now you guys are really starting to put it because these things are so widespread and available and cheaper, and probably getting more accurate, even at the cheaper level We're able to do things with I I'm GONNA I'M GONNA sign because I'm curious and the and the second part of that mark as you just mentioned. Is You give people a survey? That's more intaking, but you give them something education and that's our PT wheelhouse. Yeah and I think that's been the really cool thing as Gosh. How many weeks in are we now? It's hard to say. We started like getting the ball rolling probably late March like right when this started. We probably officially launched in April. But just to see some of the actually like not only shifts in line. People's understanding of an empty opportunity with a lot of these tools enemy of people in pediatrics, equal work in geriatrics. Like lots of different applications of populations. But also seeing our population shifts in terms of their have what they're reporting. Their health metrics to be in especially related to like distress overstress, which right now is like a top of mind because you know as we look at the data coming in on like if you give this virus like it really matters like easier system already revved up in like. Are you on the edge right now? Because things are gonNA, look a whole lot different. If you get the virus now versus if our if if you're a good spot, right if we can keep going. kind of under wraps to have been cool to watch. Even though like it's relatively healthy population, the people who are out. there. There's been a shift towards like you know. Yeah, doing good or a little bit better. So. That's been kind of need to wash through. That's a good point is like yeah, I'm in good shape right, but how you? What are you measuring, right? But like what's my heart rate variability versus resting heart rate how and when you get infected, or if you get infected with anything right because you guys are looking at this. Very timely on your part in terms of open it and people who are being impacted, but I mean this. This didn't come about because of COVID. My guess is you. Guys are working on as well before this because of population health, but but it looks like these things are since they're everywhere. They're constantly CL-. collecting data so now let's talk about this connecting providers with patients. How does that work? So I. think There's There's kind of the initial part that is involved in the PT. Health study itself Not You know most people like you said. You're wearing a device and you don't. You're only know what to do with that information right and so by connecting people who are wearing the devices with healthcare provider specifically. PT's really it's broad. Connecting them with a healthcare provider allows us to provide that context because most people may have that information coming in, but they don't really speak the language, and we're able to kind of provide outreach as needed in a way that breaks it down into actual English four people as well as the information that we're providing, but we also see this as something that can really be used by physical therapists on a large scale so. Therapists who are already working with A. Group of patients are in a community. This is something we think is scalable to be used by PC's across the country and really impact the health of a whole population, so going beyond connecting one to one provider to patient, but really connecting a provider or a group of providers to an entire community and that that's to us the big goal to win right there. MILLWRIGHT! Bell. MIC drop sound effects for you guys. As! You're saying that Sarah I'm thinking about the first time. I literally went from. I'm wearing something and it I started when I run and I stop, but I know how far I went, and that's cool. The first time I was like Oh. Wow, this is really useful I was training for a triathlon. An actually hired a coach who was a student at the time Kevin. WHO's hopefully listening to this but. He was great and I had the Garmon mapped to piece of software, and he saw every workout, and the fact that I knew that he was in Maryland and I was in New York City the fact that I knew that Kevin was going to see every workout. Every time I did the thing that I wasn't supposed to do. Hey, I want you to keep your hurry below here i. don't want you to go this far. It literally was like. Hey, don't do that because someone's GonNa because if I just call, it was to go I did I did everything you said and didn't. It didn't do anything bad I'm like he's GonNa. Know so it really it was. Kind of like you know this piece that kept in check and said okay. Let's let's actually follow the plan. This is being recorded in a good way, not in crew. Big Brother Way. It's being recorded on my permanent record. But I should pay attention to this. Because I signed up for the plan. The plan was do there, and it's being recorded so now you're doing that on such a mass scale like this is going to be fun like five years from now. This is going to be really fun to look at. Futures now and and I think. What we stare in our chatting. Earlier today in and we've talked about this. A lot of things developed, but. I think a lot of power now these devices. You know a lot. A lot of the devices that are out now is less than the performance aspect from like you know, show how far you ran or showed like how fast you've gone or rate as like that's like absolutely, it's great, but a lot of what we're seeing is the ability of these this type of system to a coach. People into recovering better coach people into a understanding their physiology a little bit in saying You know a when what are signs that like? I'm kind of pushing my body into the read a little bit, and when that happens like one, do I know it into? What things do you highway from that so what? In the I mean the the part of like connecting the provider is a Serra, mentioned a not only the like will. Sometimes we see things a little earlier than you do. In number two is like give context to like simple message of Lake is not that it doesn't take that much like. A thousand people in if ten people in a day spike like into a high risk zone, and you send a message that says hey, seeing a little something like what's going on. You know it's the power of something as simple as that to venture off conversation of like you know what he's having alike depressive episode in who like who knows but like the ability to to know like you know. Mike often. My eisenhart often talks about like just in time air. How do how do we know when like what is like the time it K-. To that person on this day. Because, if you're dealing with large people, it's just so hard to know who to ask when I'm and you can't happen upon everybody every day, so yeah, like one of those men. If you have someone in front of you or something happen you like if I just talk to that person talk at girl two weeks ago. So that just in time, care like very very important and the other thing you were saying mark is I think we're changing headphones? Is is See something, say something like. The smartest people I know in Rehab Technology. Literally say that has to be You have to solve a human problem with human solution. Right? Tech can be in the middle of that, but you can't solve a human problem with with tech solution can't so everything you just said there mark was like. You're seeing something as the provider. And then you were saying something it begins and ends with human. See something, say something. Yes, the thing that you were seeing was data from tech device, but you're able to then somehow start a conversation as a person with a person that could actually do something hopefully just in time, and that is the magic of I think technology, and where someone like this has has legs. That excites me. A love it. Model for future practice. So that's what you guys are doing now. That's that's now. The future is now as mark said. Got It. But model for future practice. Where's this thing going? Again two thousand, Fifteen, thousand, sixteen I was saying like that's cool, but what you guys are literally. Measuring and being able to communicate with people and actually make a big difference is because you're seeing something you're saying something. Where could what's? What are the things that you guys are saying? Wow, what if or when we get? This would have things in the future that that excite you Sarah. Oh I think just the ability to. Kind of step back a little bit I think what's amazing is like mark said we're not trying to push people into this place where they're always doing are sort of model health behaviors rather were able to step by see a huge population, and then basically just tell them. Hey It looks like rain. Maybe you should throw an umbrella in your bag. Because to me, I think I mean from my own sort of downstream PT perspective. That's what we really are doing to but it's difficult to do that in the current system, and so I think that when we give people the South African see. To take control of their own health, but give them little nudges. That really excites me. That's a great point which is early again full circle I the more podcast episodes I do the more by accident. Full Circle Moments every rain. There's like meeting people where they are right. which is what you do in practice? I work with older adults in their home, so you're meeting people where they are. They've got these things with them, or they've got their wearing them. And you're saying well. I'm meeting. You wear the here's what I'm seeing and by the way little cloudy to. To use that analogy little cloudy, maybe umbrella or hey little in the red zone. Why don't we brought back a little bit of what's going? Let me ask you question what's going on here? Is it stress or are you? Are you working? You got a busy week or talk to me and that's a question that starts conversation from one person to another, and that's where the magic happens. I love that. Let me ask you a specific question. Sarah you work with the results. ageism a stigma is well older adults. They don't know anything about technology that will counter that with saying that as time regularly with my Gammy, and she's ninety four and she will run circles around you on facebook so. That ain't coming here. Our like wearables in older adults. If you ask people that the average would be like Nope, not getting into it, but would you see as someone who really worked with older adults? I see as the range range of possibilities I definitely see a lot of older adults who are very in tune with technology are wearing APPALACHIA's even in seeking their phones I would love to see the technology and I think that it does exist for some features I would love to see the technology. Get to a point where there is Doesn't have to be a personal afe and be a broader a broader connection base so that people who aren't comfortable with technology can be part part of that I imagine the entire senior living communities having folks beyond wearables. You Know I. think that would be pretty incredible taking it out of a need, you know. Understanding that just simply because of age that some people may not have ever wanted to get involved with that technology, whereas some are really adept at it. I mean it's a great population to monitor especially as we're seeing huge changes in chronic conditions, drought any given week. Whenever. You know talk about that I. Literally Kinda get like you know when you have like your thing that you're like nine I'm not gonNA. Let this slide. Older, adults and technology. I'm like Oh. Yeah, I'm just like When you're done talking I got something to say. I'm like. Please do not put it past. Older adults like all the technology you have today was because of people in their general vented that stuff, so we're not put pass them to be able to figure stuff out by the way the stuff. Stuff that we're figuring out is getting better and getting more intuitive, so let's not discount older adults in terms of like well. They're too old. They can't figure it out. That ain't happening here in the future for practice. What do you think mark things that that are coming downstream that you that you're seeing where this thing can go? What do you think? Yeah I mean I think the fact of it is like. Somebody's going to figure out this whole preventions face in upstream care space. And, so it's really just a question of like. Are we willing to jump into that? Yeah, and it? It isn't a thing like. I don't know these these perspective Donald speak for everybody, but I feel like it's not about like everybody needs wearables in this is the solution to all our ails, but like it is a. It's an actionable solution. Now that's. Pretty darn cheap like somewhere in like less than a dollar a day range. To make some pretty significant health gauges or these like. Don't mind New York City street noise here where we're. Pretty significant changes or like keep out of the red zone as ruling a couple of times. Saying like. Is that like is a means of like health insurance an like. Are we willing to get involved with something like that because whether or not like technology like this is ubiquitous now? It's going to be in the future like it moving to just such an ease of use that it will be ubiquitous, the question questions. Are we comfortable in practicing in that manner in preventative care type model. Why not yeah. What you just Said said. There is question from the audience right now on facebook. Is this considered a form of telling health like never into like telehealth. And what is that monitoring and I know that Mount Sinai I got a friend over there. David Pacino Super Smart Guy put together some resources showing exactly how to do it. What billing codes to use to monitor progress in terms of like telehealth? Sorry, my phone rings while we're live on the air. Thanks, mom. But is this. Is this telehealth because you're monitoring? This is what do we ask questions? We monitored data. Is this considered a form of telehealth? I don't think I. Don't know what he's. There I don't really see it that way or at least, and it's like it's one of those gray areas probably. In, typically like the way we with it just like you know, we're often dealing eased like. Is this care or not try are like prevention practice and it's. It's like weird like walk the line gray area, but I mean officially like the FDA I think is the right doesn't consider it. Doesn't consider wearables like medical information. Donna it gets not like. It isn't at the threshold that need like Capri protection or things like that on Zimmerman. That's like one side of it but to me like could transition health console right? Yeah, totally. But I don't think it starts out with or at least most of your interactions and I would say ciragan price to this, but the vast majority of the interactions that a are kind of like advisors as they call themselves, have had with study participants like probably don't cross that threshold or on the like advising role like hey, here's what we're seeing like. Like, maybe think about these things and like you know if if you need more than it could progress on done. What do you think sir? Yeah I think that's exactly right. In fact, it's one of the things that we specifically trained people on. If they are on board with the health study. Is that what we're doing is really just providing nudges in. Our. Pre scope of practice and that's one of the things that makes it so accessible across state lines, even country lines. We have some folks across the Atlantic in our project already so there are certainly things that you see in the data that may urge you to take someone up to another level, but I would call that sort of an escalation and putting them then in sue the still probably upstream, but left population base, care and more one on one on. That's when you start to get into you know. Is this kind of a health coaching, or is this a telehealth type of situation more Rubinstein from Jersey jumping in there, saying yeah, more more monitoring and telehealth right now. PCS looking into codes for monitoring which is interesting agreed can be used with telehealth, and you know what some people are uncomfortable with grey areas, but as the future progresses like these grey areas you become more defined, and that's where the that's the gray areas where the magic happens right. When people tell you can't do something you shouldn't do something. Get curious as to why because no one's done it. Tell me more no one on it. Why because you're not supposed to supposed to who can't? and. That's the magic habits. Is I just think there's so much leverage in this with with having information and be able to start conversations and Sarah? Some in said, which is pre scope of practice and like? That's like the scope of practice, but it's cloudy out, and it's about in so like when it rains. That is my school practice seriously, and this is very. Very I'M GONNA I'M GONNA write that down preschool practice, which is like I'm. I'm not liable for any legal ramifications. But I that which is like hey, preschool practices, just like hey. I'm just seeing something as an observer of this data that you voluntarily gave me and like. Hey, if progresses to this, this is my skill. Set Mrs and my scope. Please come see me as a provider. Mark appreciate the the question. Are The comment right there? This is exciting. I like this. This is really cool. I like the fact that this kind of emerging technologies. What what are some things that you guys have learned so far but unisons? Would you say April or something like that like you've seen Did it go as planned when you guys started doing this? Either personally or as a group did it goes planned or how? How did it progress? I would say like if. Who's joined on the Mike is in her project. He knows what we'd lost twists and turns. It's. It's probably more bargain for. into. How much you're investing in it. But, we ever really cool group of people. It's been A. I. Don't know it's been really cool to see things kind of. Morphine developed from I think what I thought was going to be like A. You know like essentially like alarm bell like you're at risk kind of thing to really like A. Two way system that is You know a lot more interactive I think then I initially thought it would be. Early. In like to me, that's a more like. You know applicable system future. I hear what I hear to a system I hear conversation I have a degree in journalism and communications right and I hear to wait to a conversation. That's communication right so if you just got a notification your phone, that's one way that's good right, but if it prompts a response, and if if that message actually like Oh this is this is important like I mean Sarah couldn't have picked a better analogy with or or. Situation, which is like it's GonNa rain, it's Kinda cloudy like ooh. That's important to me because I don't WanNa get wet. That's the. I think the magic the magic where the magic happens, which is now still in the grey areas as we're talking about which is, we don't know we're going to do with it, but if it's important to me. because. I'm the most important person in the world in my world. Human if you can get into that conversation. That's that's fantastic. That's the conversation that. We're great in 'cause. That's where our magic happens. Sarah to you same question as a progressive course. You know it's going to be turney. But how how have you seen it from progress as long as you've been involved, PD study. I think you know as mark said any any EISENHART. Project is certainly sort of a world wins kind of coming together into the final storm of progress. But since fascinating to just look at the data, you know I am not an intuitive grasp, individual art major, so numbers don't aren't my forte, but I think that looking at what happens to people over time and sort of understanding the normal ups and downs and changes in stressors in physiology in seeing how people recover and how they respond when they you know. Know exercise on a low recovery day and things like that has just totally changed my perspective in one of the things that it's changed. My perspective on is people's ability to recover Sometimes they do get wet in. That's okay, because we can also still hand them a towel Ryden. Say it's cool dry off and this is how you're going to do it. Nancy Sarah going on that. Which is because you got wet doesn't mean well. We're done all right. An I say I'm Outta here. Don't will hand your towel. We can fix that, but it's that just in time or if you've gotten wet. Let's figure out what this means and what we can do for you fun, yes. Analogies works well mart. We're going to say I'm just going to say like it. I guess we as a team productivity because we've been watching our own data. Digging into the stuff in the background. A little bit for you know a couple years now, so it's not like I've seen it, but it's cooled. It's the every time when you see somebody spike in terms of their stress, levels measured by the heart rate variability scores in like just the amount of like how simple it mice can change direction so quickly and I think At least speaking for myself, oftentimes, because we starting to system that is seeing everybody when they're like two miles down the river like. Swimming for their life like. have had like ten liferafts thrown to them, but you're all like fake liferafts. Is something right so like? We're in this position where you're like, you can't help them. When you do need help emits this gigantic undertaking, but like if you. Find a person upstream that had just don't don't step in their ever. It's going to be a bad. It seems to easy. You didn't get rained on. You fell in the strain like. A hundred towels is going to help now and now as a PT when you're working with that patient, you feel for them because you're like us. If I just was able to talk to you two months ago, you wouldn't be wet. You wouldn't be soaking wet down that stream. And I think that's a perfect kind of analogy. To which is that string which is upstream, we talk about upstream and downstream costs right and some people think that the cost thing is as dirty thing. We should only focus on people, and it's like well man I like cornflakes, and like paying rent, but I also like helping people and I can actually help prevent them and the entire system from spending money then. Don't we all win and isn't that valuable? If that's valuable, you can pay me I. Don't want all of what we saved you. If. You gave me a little bit. I will give you a lot. I will give you the whole damn stream, and that's that's the thing that excites me about what you guys are doing is because you're looking up and down that stream. And you're saying. How can I save? How can I save this person from angst and personal misery? And how do I? How when you do that when that person's not wet in the Stream? The systems a little lighter I can help someone. I can spend some time monitoring. Someone else like this thing has been scale ability, and that's a question. I get a lot in my day. Job is like. Is it scalable? This is right. I mean you're monitoring remotely this? You're beating them where they are. Yeah Yeah. I mean to me for like I'm. Thinking like a private practice and like people who WANNA MAINTAIN! Connection to their communities. I I don't know it just feels like a no brainer, yeah! Or like it doesn't have to be this, but like I think the fact of like. We need to find a way to better connect communities in real way that starts to engage around. The idea of health did not around the idea of I'm injury ago. Right fixing I I can fix you. It's like man, but if you met me because I know some stuff that would have prevented this, yeah! So and I don't know it doesn't mean yeah. Our healthcare system is really good at fixing you know. Really bad stuff you know like like when you have Kobe. Do you want be in the hospital I mean? A lot of in hospital, but that the place you're going to be near the ones no. But. We're terrible at managing chronic disease in were terrible. You know you know nudging people along gently. You know over a year's time. Behavior Change takes a long time, so but your behavior changes now a conversation, not an appointment, not a meeting. It's a conversation about the thing that you're wearing the whole time. And that's meaningful. You can talk to me about something. That's meaningful to me as a communications guy like yeah, you have my attention now what you do with that attention? Okay, Hey, I'm seeing this and here's why that's important here. Here's what here's why that might be important to you. If you continue that path. You're not going to be able to run that ten K. in three months. 'CAUSE YOU'RE GONNA. Burn out. You're doing it. It's it's too much or whatever like. Make sure you grab that umbrella and you're the umbrella. The part is we get to be the umbrella. We don't want to be the towel. There's the line right we don't. The Damn umbrella. Our Yeah whatever I'll take that. Good work on you guys and everybody and how how many people are involved I wanted to make? It seem like it's just you guys. You have mentioned Mike, but I'm sure there's lots of people involved. What we got now. I think we have. From the actual steady team I think right now we're still at like maybe ten of the data investigators, and then a bit of a marketing team, but I'm starting to progress you. Need more of. Just I think interested parties the when you learn the system any joining. We need more participants after. We want more participants won't people to wear them and then people who wear them in start to join in? If they're interested, we want them to reach out to us as well because leaping, you know I mean when you talk about when you talk about the nudges and the types of information were providing to be umbrella. You know the thing about it is. This is these are health behaviors. That PT's know and they know how to do on, but when you're downstream, gets lost in the effort, and so we want people who you know, we need bodies wearing them for the data, and we also need want people who are interested in learning at restaurants. We can see where this takes us. Putin health study dot Org. If someone's interested in enrolling individuals to wear things I mean I feel like pt's would be the best. Drum. beat out there, saying hey, if you're wearing this and you wanted to get some feedback. So that's the website would you would wanNA push people to his PT health studied at work. Yeah so that's where anybody can roll in, and it doesn't have to be PT's now on my family member part of it, and you just vine, perspective and things like that. You can enroll on participant side, and that's really like I entries Steph one. In then sue now. We're having people who've been in the study from the start. As participants who are interested enough to say, Hey, this is cool like I. WanNa know more about the other end which is watching the data side? So folks who were kind of in this study already have basically I access to that training. So, that's training that's going through. Each bt. There essentially training these bts on how to use this type of system in really than that system is something you could integrate into your community. So mess though like actual like data side of it was developed activities so essentially that. Goes through them. And you can basically take what we're trying to develop in like Beta testing in Put that same thing in action in your communities, really the goal of like all right. We want to train an army like everybody. Go in like you know. Take it in your own direction on. You know lots of ways that it can be customized and used in. Two different manners, so I want to set a date I want to date six months from now I. WanNa have you guys back on this show six months from now and be like. Hey, we talked in July and now we're talking in January. What happened from here now? Because I wanNA see, I mean I I WANNA. Track this right? That's the whole. That's your whole thing. Track this study. It I'd I'd be so so eager and excited and curious to see where this thing is going to go. 'CAUSE I. Mean this I mean to me. It checks all the boxes. And Jimmy we can. We can bring your data on the screen and see. Over the last six months? Yes, how fantastic! Because you just said Jimmy will bring your data up right, and that's just said Oh over me, which exactly why? This is important. Talking about me, I am very much interested, but that's how everybody is thinking like Oh we're going to tell me how. Do you have my attention? What are you going to do with that attention? And you guys are figuring both the bengals out, so we're talking January six months from now and say hey. We talked back in July and we said this. Assis-. What did you learn since then I want the audience be along with us on this ride. 'CAUSE I want them to be at PT health studied at Org wants to be signing up and then you know beating that. Drum out there well, if you're wearing MME thing, why don't we do something with that data and you guys are doing stuff with the data because you have the skill set to do things with that data. Are you guys ready for three questions. Sure. That's a yes, answer you have to just. Let's to three questions right now, Three questions brought to you by our friends that are as medical staffing a you are a US medical dot com leaders in Hashtag. Travel physical therapy find them online there if you look in. The thing that you want to do which is be a great therapist around the country positions off states, all settings and Washington DC I got called out like all the states, but not the district gotta. Washington DC as well all right first question. We'll go to Sarah I first question's aware question. Where are you located right now? I am in Columbus Indiana all right, but if you can go anywhere, you want in the world and do whatever it is that you do. Where would you go in the country? I should say states. Where would you want to go? ORCAS island Washington. We're a what's ORCA. Silent that sounds. Off The coast of Seattle the most beautiful places I've ever been. I think. Vacation Destination Martinelli. You're in New York City where we going anywhere in the US where you're going. I. Think why I mean. Everything. It's. was. Rainforest I think. It's got everything. Just got excited because I mentioned Ukulele. Question one question two is a what question. What's something you've read watched downloaded like movie podcast book. Poems I. Mean something that the audience should go, Hey. I would find value in that Sarah. What do you think? This is related to health study. I think I just finished how to be an anti-racist by Kennedy recommended like how cool is it that like? We had we were having a moment right now in in the world, and and our reaction to it or a lot of people's reaction to it is project and go now. Nope, Nope, and a lot of other people's reaction is I'm going to buy the book and I'm GonNa. Learn something so like the people who were like rejecting their super loud. All Right? I can't convince you to not be louder and the other people who are like I'm GonNa Learn something. They're doing the quiet thing. I'm GonNa Learn something I'm going to buy the book. The cool part is we measure stuff right data and we go. It's a bestseller now and now it's being sold so well. Good good on you for mentioning that one yeah. Marco look following that one. You've washed. Read downloaded something that inspired you this is this is how I beef up by Netflix Queue or my reading lists anything. Okay one interesting new podcast. A PODCAST IS WELCOME? It's called no stupid questions with Ghana the freakonomics Guy. I know them. Not to questions, it's called no stupid questions in with psychologists. Who did all the great books about vulnerability? Guys come on. I'm visit Briny Brown. We're lingering. Economics. Grit and It's Rene Brown and Stephen Dubliner. There you go there it is. Are you prepared for? These questions twilight live radio. I like it more. More. It's a conversation where they ask one one question to each other in the both answer it. They're both kind of thoughtful people, and it's a fun little thing I like it all right cool. That's the what question and we always like to begin and end with WHO and people. Who is some of the audience should know more about and I. Asked that very open ended. Lee adults say like in therapy. It's just who's someone. The audience should know more about who's someone who does good stuff or should have some like. Let's learn from people like we start with aware, and then a what with a book thing now we're on people. Who should the audience Omar about? BB Miller. She's a modern dance choreographer and she's done remarkable things for cultural studies race awareness. She's not going to help me get rhythm. Though probably no one is going to help me. Get Rhythm, though but now no. Chase, Helping me, get rhythm, trust me mark same question. Who should the audience more about? I'll go with Burnett Brown again just. design. Number Name Brown kick. I'm thinking late to the party, but I feel like the conversations around vulnerability, and how we approach conversations like that are super relevant right now in this is like underlies live struggle. People have talking about things like Rayson. Islands and stuff like that. I like how you say I think I'm late to the party in anything, but here's the cool part is like. The. It's never too late. Like you might, you might have just missed something, but like yeah, jump in. which you're like, Hey, man, I've never read a book on how to be an anti-racist. It's like I. Never thought it was a problem. It's a problem. Read the book like Super. Late to read the book like. The game like I understand like that's what you have to admit. Hey, you know I didn't think it was a problem. I, now think it's a problem. Let's read the book. Let's get better. Questions a you are US medical dot com at leaders. Ashok sheltie now assigned for your MIC DRP moment we get the intense music. Let's do our part. Shots press the button. Party shop brought to you by our friends from the Academy of Orthopedic Physical Therapy. If you're thinking about leveling up your thematic physical therapy game, try won the Academy of Orthopedic PG Ortho PTA DOT Org. We've got some contests coming from them. If you WANNA, get free access to some of their own courses, we gave away current concepts of orthopedic. They've got a lot more. Check in Ortho dot org, so parting shot for you, guys. It's your chance for the mic drop moment either anything a sentiment. Would you WANNA leave with? The audience will go with Sarah. I share your party job. the healthcare system as it is right now doesn't really work and I think that this is an opportunity to drastically change the way we approach not only health and wellness, but care in general. It's just not working. Yeah, this is the moment where we've got the accessibility. We've got the chance to communicate in two ways, not just one two ways. That's why we like to have wheel houses physical therapists. If that's our WHEELHOUSE, grab it. Do Not let this moment at Sarah. Just mentioned. Get past us! Mark your parting shot where he for us. All right, so we're GONNA. Take a double shot now. So really because it's billing Sarah to say that. Yeah, I, mean I think we have the opportunity now in. We often talk about transforming society. Often talk about. How we want a little more pieces of by. And, so it's really a question of what what are you doing to you know? Take a little bit more of that. Doesn't need to be this, but this is an option. It's here. So if it sounds cool John. I like how you ask a question like right like if you want if you want the bigger piece of Pie like. What are you doing about it like I want? That's an adolescent behavior. I want but I'm not willing to do anything for it, but you're you're you're you're making it? Not Alexis, not an adolescent question, which is like what am I willing to do for it? Do something. It doesn't even you kindly enough said. This doesn't have to be for you, but do something. What are you willing to do? What are you? What are you capable of doing do that? And then we will have that chain that you are saying I want great. Would you want to give to get that that? I want Let's throw up that That website one more time. PT, Health Study Dot Org. Sarah Mark I appreciate you guys coming by and sharing what you guys are doing I really even more than that as I appreciate the fact that you are doing it. I'll give you one more. We go on the way out. Defects maybe how. I want to set a date. I want January six months from now, and it can be you guys plus Bring bring whoever you want. Bring the House Party we'll. We'll have a whole thing and I want to see where we've gone in just six months. Because things you should take years to progress, and now we know the rate of acceleration, which is crazy. Blow my mind. But I would like to. I want to set a day. Because now we can hold each other accountable and say art six months from now. We're GONNA. Talk again, so thanks so much for doing what you're doing and I appreciate it. Thanks for doing it for the population and making our profession look good. Cheers guys. Thank you. The PT Pine Cast Yes. Yes, the port, the show by telling a friend or by leaving review, a nineteen or Google play all right shooter day brought to you by the Brooks Institute of higher learning an innovator in providing advanced post. Professional Education Brooks IHL offering continuing education courses in numerous specialty area, six residency programs and Fellowship as well as challenging but rewarding internships, the H. L. Specializes in the translation of information from evidence to patient management. Learn what they can do for you to support your professional development at Brooks I H. Dot Org. Our home on the Internet. CAST DOT COM created by build. 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