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FPTA Orthopaedic & Sports Interest Group

(OSSIG)
Newsletter Editor
Carlos Ladeira PT, EdD, FAAOMPT, OCS
OSSIG Chairman

1st Newsletter Apr 7th, 2016


In this issue:
a. The OSSIG
b. Journal Clubs
c. Clinical Residences &
Fellowships
d. Concussion for PTs
e. Student Logo Contest
f. FPTA Spring Conference
2016 Orthopaedic Courses
g. Dry Needling for PTs
h. Legislative News &
Update

The OSSIG
The Orthopedics and Sports Special Interest Group (OSSIG) is
a physical therapy interest group of the Florida Physical
Therapy Association (FPTA) chapter of the American Physical
Therapy Association (APTA).
The OSSIG is a source for Florida PTs and PTAs to update
themselves as well as receive guidance with research proposals
and clinical residence development.
The mission of the OSSIG is to serve as an advocate and
resource for physical therapists and physical therapy assistants
practicing in the areas of orthopaedics and sports in the State of
Florida through excellence in education and professional
development.
Our members are PTs, PTAs, SPTs, and SPTAs from the State
of Florida. Please join us in our facebook page, twitter page,
and/or linkedin page, clinic below on our icons.

Page 1

We are offering an online journal club 4 times per year. We are giving 2 CEU credits for each meeting.
We had our first journal club meeting Feb 23rd, 2016. We discussed differential diagnosis for low back
pain with a real case scenario. We plan to run the club meetings at least 4 times per year. Our next
meeting should be May 2016, please check our facebook page for information in the first week of May
2016. Our meetings take place on Twitter Chat online (click logo above). We place articles and papers for
preparation for the journal club meetings ahead of time in our facebook page. If you want to receive credit
for the meeting you need to read the information and answer a few questions before you meet us online on
Twitter Chat. The answers to the case scenario need to be answered and emailed to the journal leader
before the meeting for you to receive CEU credit for participation.

RESIDENCES & FELLOWSHIPS


Our residencies are accredited by the ABPTRFE & our fellowships by the ABPTRFE and the AAOMPT
Residencies are postprofessional programs that occur after the graduate physical therapist has obtained
their license to practice. A clinical residency is designed to substantially advance a resident's expertise in
examination, evaluation, diagnosis, prognosis, intervention, and management of patients in a defined
area of clinical practice (specialty). This focus may also include community service, patient education,
research, and supervision of other health care providers (professional and paraprofessional). Often, the
residency experience prepares an individual to become a board-certified clinical specialist. Florida has 7
residencies in orthopaedic physical therapy and 1 residence in sports physical therapy.
A fellowship is designed for the graduate of a residency or board-certified therapist to focus on a
subspecialty area of clinical practice, education, or research. Florida fellowships are clinical programs that
advance physical therapists knowledge and skills in patient/client management within an area of
subspecialty. Applicants of a clinical fellowship program must have the following qualifications: 1)
specialist certification or completion of a residency in a specialty area, 2) substantial clinical experience in
a specialty area, and 3) demonstrable clinical skills within a particular specialty area. There are 2
orthopaedic manual therapy fellowships in Florida.
The OSSIG invited residence and fellowship program directors to talk about their educational programs.

The Brooks IHL/UNF Orthopaedic Residency


The Brooks IHL/UNF Orthopaedic Residency
The Brooks IHL/UNF Orthopaedic Residency is an eclectic, evidence based program that was the first
orthopaedic physical therapy residency program accredited by the American Board of Physical Therapy
Residency & Fellowship Education (ABPTRFE) within the state of Florida. The program focuses on five
pillars that include advancing the clinician in the following areas:
a. Clinical Practice (development of skilled psychomotor techniques as well as developing
sophisticated clinical reasoning algorithms that incorporate EBP, outcome measures, CPGs, etc).
b. Education (ability to perform education to many different learners as well as developing the skill to
become a lifelong learner).
c. Scholarly Activities (becoming a consumer and contributor to the scientific body of knowledge for
the physical therapist profession).
d. Professional Service (participating as a leader within the healthcare community).
e. Practice Management (providing best care within the realities of current practice settings).
Our residents practice 40 hours per week and the educational training takes place after hours. This
provides them with many more cases than programs who offer limited practice hours within their
program. Additionally, our program is fully funded by our System, so the residents are paid a full salary
(i.e. 100% of salary based on years of experience), receive all full time benefits, and pay no tuition.
Please go to our website to view additional information regarding our application process and full
curriculum: http://www.brooksihl.org/programs/residency-programs/orthopaedic-residency/

USF Health School of PT & Rehab Orthopaedic Residency


The mission of the USF Health SPTRS Orthopaedic Residency program is to provide physical therapists
with advanced didactic and clinical educational opportunities that will improve their ability to integrate
scientific knowledge and clinical practice instruction, and facilitate development of advanced diagnostic,
clinical decision-making, and hands-on clinical skills in orthopaedic physical therapy that fosters growth of
professionals by a team of educators committed to clinical excellence.
The residency begins in December of each year and runs for 13 consecutive months. The residency in
orthopaedic physical therapy provides advanced clinical training in the management of patients with
neuromusculoskeletal conditions represented in the Description of Specialty Practice.
The expected outcome of the program is an advanced-practice clinician with knowledge and clinical
reasoning skills advantageous for improved care, with optimum outcomes for individuals having
neuromusculoskeletal dysfunctions and movement impairments that result in activity or participation
restrictions. The curriculum of this residency is also designed to prepare physical therapists for the
Orthopaedic Physical Therapy Specialty Certification Examination.
Program strengths
a. Self-directed learning, using the APTA Orthopaedic Sections Residency Curriculum in addition to
weekly seminars regarding the current evidence in each of the anatomic regions.
b. Advanced knowledge acquisition in the areas of professionalism, ethics and value-based care,
leadership, and motor control and learning.
c. Engagement in community service as a preceptor in the student-run pro bono BRIDGE Clinic twice
a month.
d. Participation in academic teaching of the SPTRS Doctor of Physical Therapy students.
e. Participation in interprofessional clinical practice as a member of the Internal Medicine Acute
Musculoskeletal Clinic.
f. Development of a case report to add to the body of physical therapy knowledge.
3

USF PT & Rehab Orthopaedic Residency continued


Requirements for graduation
a. Complete APTA Self-Assessment Tools for Physical Therapists at orientation and completion of program
b. Complete Mentoring Evaluation Form quarterly for each Residency Mentor
c. Complete Didactic Learning Evaluation Form at the conclusion of each Didactic Module
d. Successfully pass three (3) Live Patient Evaluations (Upper Quarter, Lower Quarter, Spine) with a
score of 2.0
e. Successfully pass two (2) written examinations (Cervicothoracic/Upper Quarter,
Lumbopelvic/Lower Quarter) with a grade of 80% or higher.
f. Successfully pass oral component of these two (2) examinations (pass/fail).
g. Prepare a case report suitable for publication in a peer reviewed journal or presentation at a state or
national professional conference. This project is graded as Pass/Fail
Contact information: mailto:pt-residency@health.usf.edu Website: http://pt-residency.health.usf.edu

University of Miami Orthopaedic Residency


The University of Miami Orthopaedic Physical Therapy Residency Program provides a comprehensive didactic
and clinical education experience for clinicians seeking advanced training. The curriculum is centered around 3
pillars: primary care, manual therapy, and pain science. Practicing within the university health System
provides residents with exposure to a wide spectrum of orthopaedic conditions while working in collaboration
with a variety of physician specialty practices. Moreover, residents have opportunities to teach in the UM
entry level DPT program and participate in cutting edge research.
Admission criteria includes: proof of completion of a CAPTE accredited PT program; references supporting the
applicants clinical, decision-making, communication and teamwork skills; acceptance into the program is
contingent upon proof of active Florida licensure and eligibility for hire by the University of Miami.
Requirements for graduation: completion of a minimum of 150 mentorship hours; successful completion of 4
live patient exams, 2 OSCE exams, and 2 written exams; submission of a publishable case report or research
project.
Contact information: MWong2@med.miami.edu

Malcom Randall VA Center Orthopaedic Residency


The Malcom Randall VA Medical Center in Gainesville sponsors Orthopedic and Geriatric Physical Therapy
Residencies for DPTs wishing to pursue the highest quality post-professional training in these specialty areas.
Our faculty consists of individuals with recognized specialty practices in Orthopedics, Geriatrics, Womens
Health, Pain, and Military Physical Therapy. Our programs utilize standard and specialty physical therapy
practices combined with additional mentorship and didactic training to maximize exposure to the desired
content areas. Further, our program seeks to involve residents in consultation and combined decision making
with other members of the healthcare team to engage and demonstrate the strengths of the profession, truly
advancing the level of specialty practice. Applicants are required to be 1) exhibit a strong desire to attain
advanced knowledge and skillset in Geriatrics or Orthopedics, 2) be a graduate of a CAPTE accredited Doctor of
Physical Therapy program, 3) intended (or current) licensure in a state, territory of commonwealth of the
united states, and 4) be a United States Citizen. Interested individuals are encouraged to contact the director
4
and/or apply through RF-PTCAS!. Contact information: Mark.Carberry@va.gov

Other Orthopaedic Residencies


Florida Hospital Sports Medicine & Rehab Orthopedic Residency, Orlando, FL
Contact: Laura Podschun laura.podschun@adu.edu
James A Harley Veterans Hospital Orthopaedic Residency, Tampa, FL
Contact: John Seiverd john.seiverd@va.org
University of St. Augustine for Health Sciences, St. Augustine, FL
Contact information: Amanda Grant AGrant@usa.edu

UF Health Sports Residency


The UF Health Sports Residency has been accredited by the APTA as a post-professional residency
program for physical therapists in Sports specialty practice since 2010. The residency is located in
Gainesville, FL on University of Florida campus, offering a wealth of opportunity for post-professional
learning. The program offers mentoring with a team of Board Certified Sports Physical Therapists, patient
care at UF Health Rehab Center- OSMI, athletic venue hours with UF and local high schools, didactic
learning experiences, clinical research, teaching in the UF DPT program and treatment of Division I
athletes at the University of Florida.
Applicants must be eligible for PT licensure in the state of Florida by the program start date in August.
Two sports residents are accepted into the program annually. We are most interested in applicants who
are professional, passionate, friendly, and receptive to learning and feedback. We also prefer applicants
who have had sports experiences through internships, volunteering, or personal involvement. The
application cycle runs from October- May. Please refer to the residency web-page for specific annual
deadlines: http://www.ortho.ufl.edu/sports-physical-therapy-residency/. For more information, please
contact Michelle Musalo, PT, NCS; Residency Director; musalm@shands.ufl.edu

Fellowship in Orthopaedic Manual Physical Therapy


The Brooks IHL/UNF Orthopaedic Manual Physical Therapy Fellowship
In collaboration with the University of North Florida, Brooks IHL offers an ABPTRFE credentialed
Fellowship in Orthopaedic Manual Physical Therapy (OMPT). The program provides an eclectic,
evidence based educational experience for individuals interested in attaining highly specialized skills in the
practice area of Orthopaedic Manual Physical Therapy. In addition, our Fellows in Training (FiTs)
practice 40 hours per week and the educational training takes place after hours. This provides the FiTs
with many more cases than programs who offer limited practice hours within their program. Finally, our
program is fully funded by our System, so the Fellows in Training are paid a full salary (i.e. 100% of salary
based on years of experience), receive all full time benefits, and pay no tuition. The program focuses on
five pillars that include advancing the clinician in the following areas:
a. Clinical Practice (development of skilled psychomotor techniques as well as developing
sophisticated clinical reasoning algorithms that incorporate EBP, outcome measures, CPGs, etc).
b. Education (ability to perform education to many different learners as well as developing the skill to
become a lifelong learner).
c. Scholarly Activities (becoming a consumer and contributor to the scientific body of knowledge for
the physical therapist profession).
d. Professional Service (participating as a leader within the healthcare community).
e. Practice Management (providing best care within the realities of current practice settings).
Please go to our website to view additional information regarding our application process:
http://www.brooksihl.org/programs/ompt-fellowship/
5

Other Fellowship in Orthopaedic Manual PT


University of St. Augustine for Health Sciences, St. Augustine, FL
Contact information: Amanda Grant AGrant@usa.edu

Concussion
Update for PTs
Conrad Penner, BEd., BSc, MSc, DPT, FAAOMPT, MTC , OCS, , TPI Cert
Licensed health care professionals (LHCP), including physical therapists, commonly treat concussions.
Concussions occur most frequently in collision sports and especially football, rugby, hockey and soccer.1-4
Each year 1.6 to 3.8 million concussions result from sports injuries in the United States. Almost 9% of
High School sports injuries result in concussions.1-4 Concussion is a serious health issue for all athletes
regardless of gender or sport.1, 2
A concussion is a type of brain injury resulting from the head striking an object or a moving object
striking the head. It may also occur when the head experiences a sudden force without being hit directly.1
It is also known as a mild traumatic brain injury (mTBI).1, 3-7
The common signs of concussion include the injured athlete appearing dazed or stunned, moving
clumsily, answering questions slowly, loss of consciousness even if briefly, mood or behavior changes
from normal, or inability to recall events prior to or after the injury.1-7 Other common concussion
symptoms include headache or pressure in the head, nausea or vomiting, balance problems, dizziness,
blurry vision, light or sound sensitivity, feeling sluggish, hazy or foggy, confused or memory problems, or
just not feeling well.1-3, 7
Immediate testing of an athlete following suspected or known concussion includes Post-Concussion
Symptom Scale/Graded Symptom checklist (GSC) and the Standardized Assessment of Concussion
(SAC).1, 3 When administered early after injury, these tests have moderate to high sensitivity and
specificity in identifying sports concussions.1, 3 The Balance Error Scoring System (BESS) has low to
moderate sensitivity and moderate to high specificity in identifying sports concussions.1, 3, 4 Post injury
scores on these concussion assessment tools may be compared with age matched normal values.1, 3 Other
physical assessment may be required including cranial nerve testing, symptoms and mental status
assessment. Imaging is performed if symptoms are not abated after ten days.2
Risk factors for recurrent concussions occur most frequently among athletes who have a history of
concussion; longer duration of sports participation, and playing quarterback position in football.4 The
risk is highest in the ten days after initial concussion.3, 4
Following initial exam by field personnel, the athlete with a suspected concussion should be removed
from play immediately and should not be allowed to return to their sport until assessed by LHCP with
training in the diagnosis and management of concussions and in the recognition of more severe traumatic
brain injury.4, 5
6

Concussion
Update
Continued

Return to play criteria should be based upon the athlete being


asymptomatic off medication including a LHCP judging the athlete to be
concussion symptom free.3 Following medical clearance of the athlete, a
progressive physical activity program gradually returning the athlete to
their sport is implemented.5
References
1. American Academy of Neurology: Summary of Evidence-based
Guideline for Sports Coaches and Athletic Trainers-Recognizing
Sports Concussion in Athletes. 201 Chicago Avenue,
Minneapolis, Mn., 2013.
2. American Academy of Neurology: Summary of Evidence-based
Guideline for Clinicians, Update: Evaluation and Management of
Concussion in Sports. 201 Chicago Avenue, Minneapolis, Mn.,
2013.
3. Centers for Disease Control: Concussion Signs and Symptoms.
Washington D.C., 2015.
4. American Family Physician: Practice Guidelines: Evaluation and
Management of Concussion in Athletes: Recommendations from
the AAN. Apr1; 89(7):585-587, 2014.
5. Guskiewicz KM, et al. National Athletic Trainers Association
position statement: Management of sport-related concussion.
Journal of Athletic Training 2004; 39:280-297.
6. NCAA Concussion Guidelines: Diagnosis and Management of
Sport-Related Concussion Guidelines. NCAA.org/health-andsafety, 2012.
7. Guskiewicz, Kevin M., PhD, and Robert C. Cantu, MD.
"Chapter 24." 2009.Orthopaedic Knowledge Update: Sports Medicine 4.
Ed. Rben J. Echemendia. Vol. 4. Rosemont (IL): AAOS, 2009. 285-94.

Student OSSIG Logo Contest


We would like students (SPTs or SPTAs) to design and submit a logo for our special interest group. This
is a competition for the best logo to represent the FPTA OSSIG. Recommendations and Requirements:
1) Please use a vector-based program such as Adobe Illustrator if possible to design
the logo.
2) The image should have a minimum of 300 dpi (not pulled from the web).
3) The colors in the logo should be similar to the colors in the FPTA logo.
4) The logo with its associated wording should clearly represent the Florida Physical Therapy
Association and the Orthopaedic & Sports Special Interest Group. Someone who is not a physical
therapist should understand what the logo represents.
5) The deadline for submission of the logo is April 30th, 2016. Email the logo to cladeira@nova.edu
6) You will receive an email confirmation that we received the logo once it is submitted.
The winner will receive a hotel night and full registration for the Fall Conference in 2016.

lorem ipsum dolor

issue, date

Ipsum
a volutpat ornare, metus
FPTA Spring
Conference
sem tincidunt magna, eu varius
OSSIG Sponsored Courses
enim dolor id sem.

Vivamus vestibulum, lectus


interdum dignissim rhoncus,
nisi purus condimentum enim,
vitae ultrices felis nibh id pede.
Nam dictum lacinia diam.
Pellentesque venenatis.

Lorem ipsum dolor sit amet, consectetuer adipiscing


The FPTA, for the first time, had a conference in a cruise. The conference
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took place in the Royal
Caribbean
Enchantment
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(Bahamas). There Proin
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OSSIG:
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sapien, feugiat in, posuere eu, feugiat at, purus. Duis
fringilla, (PT,
auguePhD,
vel imperdiet
egestas,
1. Dr. Eric Chaconas
FAAOMPT)
and nisi
Dr. augue
Eric
vestibulum ante, vitae ultricies nisl neque non odio.
Shamus (PT, PhD) talked about management of cervical spine
lesions. They discussed screening of serious pathologies,
Mauris laoreet elit sed dolor.
osteopathic management of cervical lesions, and exercise
strategies for the cervical spine
2. Dr. Thomas Eberly (PT, DPT, FAAOMPT) and Dr. Eric
Douglas (PT, DPT, FAAOMPT, OCS) talked about thoracolumbar spine exercises and manual therapy for the autonomous
practitioner. They addressed the Norwegian principles of
exercise therapy, thrust manipulation for the lumbar spine, and
taping techniques for management of spine pain.

Pellentesque venenatis.

The conference was a success. Participants could attend a course in the


AM, relax by the pool or the beach in the afternoon; and then, attend
another course at 4 PM before having a great dinner at 8 PM. Everyone
appeared to enjoy the schedule.

Dry Needling for PTs

Teresa Bristol, PT, Cert. DN &


Dr. Thomas Eberle , PT, DPT, FAAOMPT

Dry Needling (DN) is a skilled intervention that uses a thin filiform needle to penetrate the skin and
stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of
Praesent laoreet, nunc pain
vel and movement impairments.1, 2 DN is a technique used to treat dysfunctions
neuro-musculoskeletal
porttitor elementum, sem nisi
incommodo
skeletal muscle,
fascia, and
ante, ut consequat
est connective tissue, and diminish persistent peripheral nociceptive input, and
mi et diam.
Praesent
dignissim of body structure/function leading to improved activity and participation.
reduce
or restore
impairments
tincidunt libero. Curabitur

3
Acupuncture
onpretium
the other
augue justo,
sed, hand is a derivative of Chinese medicine that dates back over 3,000 years.
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eget,on
pede.
Acupuncture
is based
the theory that health is determined by the balance flow of chi, which is present
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neque
libero,
tincidunt
in all living organisms. Chi is described as an energy source, which moves through the body along
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meridian
lines. Chi circulates through the body along twelve major Meridian pathways. 3 Acupuncture
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uses
these
pathways
toidtarget
ante.
In aliquam
ipsum
nisi. specific internal organs through the insertion of needles. The 12 meridians
are associated with the functioning of the internal organs. Based on traditional Chinese medicine,
imbalance of the internal organs causes musculoskeletal pain. Acupuncture may be used to help correct
these internal organ imbalances and manage musculoskeletal pain.3

Dry Needling for PTs continued


The utilization of DN in physical therapy is based on western medicine principles. 1, 2 The mechanical
Praesent laoreet,effects
nunc vel
and neurological
of DN include the alleviation and mitigation of spontaneous electrical activity or
porttitor
elementum,
sem
nisi
motor endplate noise, reduced
local and referred pain, improved range of motion, decreased trigger point
commodo ante, ut consequat est
irritability
both
locally
and distally, and normalized chemical milieu and pH of skeletal muscle. DN also
mi et diam.
Praesent
dignissim
tincidunt libero. Curabitur
has demonstrated
a positive effect on restoring local circulation. Centrally, stimulation of trigger points
augue justo, pretium sed,
has demonstrated activation of the periaqueductal grey and anterior cingular cortex in the brain. Further,
placerat vel, porta eget, pede.
enkaphalinergic, serotonergic, and noradrenergic inhibitory systems associated with A- (A delta) fibers
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through
segmental
inhibition
which all correspond to reducing a patients pain. 1, 2
adipiscing,
aliquam
ut,
nonummy in, nisi. Integer eu

Recent
publications
have
shown that DN may be effective in relieving pain and disability in a variety of
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id nisi.
conditions including low back pain, knee osteoarthritis, carpal tunnel syndrome, shoulder and cervical
pain as well as plantar fasciitis to name a few.4 A recent systematic review has shown that DN may help
PTs improve range of motion and musculoskeletal pain.5 The FPTA is currently working on the rights of
PTs to utilize DN in Florida (next article).
References
1. The APTA department of practice and state of government affairs: Physical Therapists and The
performance of Dry Needling, An Educational Resource Paper, 2012. Retrieved from
www.apta.org on Apr 5, 2015.
2. The APTA Public Policy, Practice, and Professional Affairs Unit: Description of Dry Needling in
Clinical Practice: An Educational Resource Paper, 2013. Retrieved from www.apta.org on Apr 5,
2015.
3. Sierpina VS & Frenkel MA: Acupuncture: A Clinical Review. South Med J. 2005; 98 (3): 330-337.
4. Dunning J, Butts R, Mourad F, et al. Dry needling: a literature review with implications for clinical
practice guidelines. Physical Therapy Reviews. 2013;000(000):1-13.
5. Liu L, Huang QM, Liu QG, et al: Effectiveness of dry needling for myofascial trigger points
associated with neck and shoulder pain: a systematic review and meta-analysis. Arch Phys Med
Rehabil. 2015 May; 96 (5):944-55.

Legislative News

Thomas Eberle
PT, DPT, FAAOMPT

The Florida Physical Therapy Association (FPTA) has been working diligently the last 5 years to update
our practice act. We were tremendously successful this year, passing a practice act expanding Direct
Access from 21 days to 30 days. Additionally, out of state referrals are now allowed as well as the ability
to introduce yourself as a doctor of physical therapy to your patients or the general public. Further, a few
years ago a law was passed to allow PTA schools to open without CAPTE accreditation. That law will be
reversed with legislation that passed in March that the Governor is expected to sign. Additionally, a new
2016 law governing the delivery of Telehealth will include physical therapists. By all accounts, this has
been the most successful legislative session for physical therapists on record.
The FPTA is planning an aggressive campaign for the 2017 legislative session to pass a Bill that will allow
Florida PTs to utilize this important modality. The prospective legislative battle is expected to be intense,
with several groups committed to opposing our DN bill. Even though physical therapists in over 30 states 9

Legislative News continued


are allowed to utilize this treatment modality, Florida is still looking for clarification if
physical therapists can perform DN. Floridas Attorney General or the Florida Board of
Physical Therapy Practice may make a ruling on this treatment. Alternatively, legislation
will need to be passed to provide physical therapists the ability to utilize this modality.
Hence, the FPTA needs membership support on two fronts. The first is for existing
members to discuss with physical therapists and physical therapist assistants who are not
members the importance of joining the APTA/FPTA. Additionally, encourage non-members to attend a
FPTA District meeting so they can further understand what the APTA/FPTA is doing to support our
great profession (and, by extension, supporting them). Second, we need all therapists to support the
Florida PT-PAC, which is our Political Action Fund. One hundred percent of the money donated to the
PT-PAC goes to fund the political campaigns of our legislative friends that are pushing our agenda
forward. This is an essential component to moving any legislation through the various committees of the
House and Senate of the Florida Legislature.
For more information associated with the FPTA legislative agenda, please visit www.fpta.org.

The End

10

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