Treating Parkinson’s Without a Cert: What Every Outpatient PT Needs to Know

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0:53 If you're ready to grow as a clinician, head to brooksihl.org. That is brooksihl.org. All right, if you think you need another specialist certification to treat someone with Parkinson's or that RTM is just another way to squeeze in some extra units, this episode might change your mind. Today's guest is the kind of PT who's helping the profession meet the moment from the clinic to the classroom to the emerging world of digital health. He treats movement disorders, teaches students, advises clinics on RTM, and still somehow has time for disc golf. From Arkansas to AI and everything in between, let's bring in our guest, Phil McKelvey.

1:34 Phil, welcome to the show. Thanks for having me, Jimmy. You've got a lot in there. I do want to start with the most important. How do I get better at disc golf? Because I'm good at throwing Frisbees, but for some reason I'm terrible at disc golf. What am I doing wrong? It's very different. Yeah, it's all about the technique. They're more like airplane wings than regular Frisbees. There's lots of great YouTube channels out there that can help you. Come to Arkansas. There we go. It's a great sport. So, Phil, snapshot of you. What's your superhero backstory so people catch up besides disc golf? Yeah, so I'm a PT in Central Arkansas. I married one of my PT classmates. We've been married for going on nine years.

2:15 She's an awesome therapist. And then we have two kids. I treat primarily neuro and vestibular disorders now, though I started out like your typical sports ortho guy out of PT school for more of my career than I've done this. Just had a little transition change. Yeah. And then I got interested in kind of the digital side of PT with an article in the APTA magazine about RTM. I'd randomly read it and I've just kind of been running down that rabbit hole for a while now and it hasn't stopped me yet. You've also got a little more family tree, a little PT family tree. I do. Yeah, absolutely. Yeah. So my father-in-law is a PT in Southeast Arkansas. I actually have a cousin-in-law who's a PT in Texas.

2:56 So there's a lot of us. Did you ask permission before you popped the question to your PT school classmate? Was that something that you did? I did. So I asked her mom and her dad together because I knew that would be important to them. As I asked that question, I was like, man, he might say no. Yeah, then what do we go? Yeah, I did. That must have been cool for him. And, you know, maybe we'll get him on the show eventually later. But that must have been cool from the side note, which is like, oh, that's awesome. Like she went to PT school. Look at that. She found another one of us. Or was he like, hey – never gonna be a millionaire we're gonna do good in the world change the world yeah wouldn't it be great if you know yeah no he was he's uh an awesome built-in mentor he's someone who's been in the profession for a long time but never became a dinosaur just keeps learning so i've i've i've thrown so many questions at him over the years that have been glad to have him in my corner so that's a great point is um dinosaur doesn't actually only mean old when you're talking about someone who's old and crusty There's a lot of people who I know who are, quote, older age wise, but I do not like they do not give dinosaur vibes.

3:59 And you're like, that's awesome. Like it's and it's life goals. Yeah, it's a choice because they plug in and keep learning. Yeah, which is why you could subscribe to this podcast just by going to Apple Podcasts. No, okay. But it is a good point, which is like the people who listen to not just my podcast, but podcasts in general or seek those things out, they're active, not passive. Those are the people who don't get crusty and rusty, like typically. Yeah. It's not just you pay the two thousand bucks for the weekend course. It's what do you do the other three hundred and sixty four days a year? Can you dip your toe? All right. Enough padding podcasts on the back. What do you let's go big picture question first. What do you think more? What do you wish more physical therapists understood?

4:42 about treating patients with Parkinson's disease. Especially, we talked about this before we hit record, especially generalists who might only see it once in a while, who might be like, I'm picturing some of my PT school classmates. I'm an ortho bro. And then they look at their schedule and they're like, what's this? What do you wish that person, those people knew more about that? Yeah. And those are the exact people this is for. This isn't for your neuro experts. They know probably no more than I do. I've I've done certifications on Parkinson's. I'm not against those by any means. I'm all for the amplitude based training, the power, the big, all that stuff. But if you're a generalist and you live in a rural area or you live in a city where and this had this relationship with someone, they develop Parkinson's and they want you and no one else.

5:24 You need to know that you just need to bump their intensity on whatever they enjoy doing. Especially if you're a rural therapist, they don't need, you got to find out what's going to be done safely for them. And maybe that looks like an exercise bike, but that doesn't look like an exercise bike, just pedaling around in a circle for ten minutes. That looks like doing interval sprints where you're twenty seconds on, forty seconds off as hard as they can go and then coasting. Sounds like a HIIT workout, bro. What are you talking about? It is a HIIT workout. Yeah. So if you're an ortho bro, and you've ever worked out a high level athlete and taking them through some cardio return, like you can do, you can do it. I'm not saying you're going to be as good as someone who only does this all the time.

6:05 Cause that's impossible, but you can give that person meaningful neuroplastic change and drive a really good session and, and, change their perspective on exercise whether you you know have done lsvt big power rock steady or just kind of you know know how to work somebody out get them in thirteen to seventeen on the rpe range and keep them there yeah and that'll that'll get you eighty ninety percent of the way there This is by no means knocking the LSV, the power, the rock steady. I use it every day. It's just saying that you probably have more skills in your toolbox than you give yourself credit for.

6:46 It might look different, but you probably know. So you mentioned intensity, right? is greater than protocol frequency. So let's see if I can remember these things. And my ex-phys professor will be excited. Sky Donovan, frequency and time, frequency, intensity, time, type, volume, progression. Those are your tools, man. Yeah. Those are your seven dwarfs, right? If you had to rank them, you're supposed to love all your fit VP equally, but what is the hierarchy of this? You've already said intensity, so we know the I is probably up there. What comes next? Frequency? It's probably number one. Frequency and time. Parkinson's Foundation recommends a hundred and fifty minutes a week for someone with Parkinson's as the floor.

7:30 It is a lot. It's thirty minutes five times a week and moderate to vigorous intensity. Getting going where you could maintain a walk but you're kind of you're having to talk a little bit like this maybe yes and then the the type to me is a little less important it's whatever is going to get you exercising that much the aerobic is the one that's talked about the most and i think that falls back to that's just the easiest to research um If you're if you're a former lifter and you want to get into some lifting, like still do some aerobic, but go ahead, lift some weights, knock yourself out. Like, I mean, don't really. But, you know, if that's your if that's what's going to get you going for one hundred and fifty minutes a week, like we need to get you going for one hundred and fifty minutes a week because the the the thing is, like, if you're not doing it, it's not going to do you any good.

8:19 So if I tell somebody you need to get on a bike one hundred fifty minutes a week or go for a walk, what's the point? You know? Yeah. I got to get, it could be dancing, you know, ballroom dancing or something like that. Like it doesn't have to look like exercise. It has to look like intensity, heart rate up, like moving quickly. But yeah, that's, that's where I would rate the, the most of those things. Yeah. What's the best exercise to do for insert, fill in the blank, the one you like doing, the one you're gonna do, right? Yeah. We've seen that research in low back pain for years, getting people moving, whatever it is, if they're going to stick with it, it's going to do better than maybe the perfect thing that they never do.

9:02 Yeah, the perfect exercise you never do. I know it's better than that. It's a pretty good exercise that you do a lot. My brother's big, man. He's six four. He's a big dude. He just doesn't like lifting that much. so he'd rather go skate at our local rink and do and he likes the Stairmaster for some reason so he goes is that bad for me I go Stairmaster it up bro I'm like Stairmaster now you want to get stronger on the ice you want to skate faster I want you to do some single leg stuff or I want you to deadlift or squat but like if you don't like it me throwing it at you now it feels like I'm judging you now we get into psychology of it I bet which really matters which really matters too. And it especially matters when you're talking about someone who suffers from a disorder that causes apathy and depression for a lot of these patients.

9:47 So if, you know, it's hard enough for me to go exercise and I don't have something like that hitting me down, a good percentage, I don't know the numbers, but these patients will deal with one of those two symptoms for a What were they again? Apathy and depression. Depression makes it hard to go along. Yeah, it's hard to get moving for anybody. But if you're if you're you know, if your diagnosis is making you a little apathetic, God, I don't know. How are you going to get that person to exercise and giving them something that they enjoy doing is going to really help get them going a lot more than just give them the perfect stuff. Yeah. We did mention things like power, LSVT, Rocksteady. And believe me, I've only heard good things about neurotherapists who've gone through those.

10:30 But what's a step before that? What's the first date? Is there something free? Is there someone with a badass YouTube channel or a badass Instagram? What do you got? Absolutely. There's some good free stuff for patients and clinicians. I really like Rogue Physical Therapy. They're in Orange County, California. They're in a big enough area where they just specialize in people with Parkinson's. That's all they do. And it's a lot of cash based. I think there might be some insurance based stuff there, but they have a free YouTube channel and they have a paid YouTube channel for patients. But if you're a clinician looking for some exercise ideas or a person with Parkinson's looking for some exercise idea, go hit up their free channel and Good artists create, great artists steal. Just take a lot of their ideas and put it into your patient.

11:12 And then there's one called Power for Parkinson's out of Austin, Texas. It's a nonprofit, P-O-W-E-R, not the Parkinson's Wellness Recovery Parkinson's. They have a lot of chair-based exercises, if that's the appropriate level for your patient or your your loved one with parkinson's and that's all free stuff so eat that up um i don't want to hype too many podcasts on your podcast but the i love neuro podcast has a bunch on parkinson's yeah that would be like those three resources just go to i love neuro and scroll through there there's you're gonna see within a year ten parkinson's podcast pick one on a topic that interests you and give it a listen always hype other podcasts i think that's right all podcasts raise other podcasts i do not think it is not straight if you listen to one podcast it's not like there's less cake for other people it's like more breeds more breeds more rising tides raise all boats Do not disagree there.

12:03 Definitely agree. What else am I not asking about this? Because we're going to switch topics, but I want to make sure we don't leave this until you're like, I really wanted to talk about this. What is the last thing you'd say to maybe this avatar of outpatient ortho person who might have someone on Parkinson's on their schedule? Anything I didn't ask that opened a door for you? uh you we covered most of it i would just say don't be afraid to push these people um they may seem like they're they're not there to work hard um i work with them every day and i can tell you like um they're some of the nicest people i ever meet i don't know what that is about someone who suffers from parkinson's but they tend to be incredibly nice and they tend to be willing to work incredibly hard because they see the benefits and know the benefits so don't don't feel like i can't push this person because you know um They're seventy years old and they've got a tremor and they've got this flat affect like that person can go.

12:57 Then they will go if you just coach them to get there, you know, progressively load them to that point. But don't feel like you can't push someone with Parkinson's. Yeah. Do not underdose safety first. That's right. Yeah. Right. And there's there's great. Like I said, I mean, a bike or a stepper, if that's what they can do for for the intensity part and you need to do some other stuff in sitting. Get their intensity on the bike or the stepper. That's fine. Okay. I like that. All right. Let's switch gears. Before we do that, let's just take a little quick break. All right. Taking a quick break. Got to help. We got to pay the bills, man. We got to keep the YouTube on here. Thanks to our friends at Empower EMR.

13:38 It's like the opposite of a clunky system that you secretly hate. Empower EMR is smooth, smart, and helps you run your clinic. not wrestle with it. Check them out at EmpowerEMR. That's EmpowerEMR.com. And I want you to know about good causes. We love good causes. We want to give a microphone to the good cause. This one's cool. It's called One More Wave. They help wounded and disabled veterans heal through surfing. Yes. I can already hear the PTs wanting to volunteer. It's there. It's not just surfboards, though. They're taking custom adaptive boards designed for each vet, It's therapy. It's waves. It's purpose.

14:19 Just check them out. Hit onemorewave.com to donate, get involved, or just watch someone catch a wave with a prosthetic leg and a huge smile and try not to get inspired or maybe shed a tear a little bit. So onemorewave.com. Let's change gears here with Phil. First of all, we got to paint the picture. What exactly is RTM and why should people care? You found out in a magazine and you were like, this is great. And then you dove in for the person who doesn't, who hasn't dove in yet. How do you paint the picture? Yeah, RTM is just remote therapeutic monitoring. So it's just a way for therapists to keep up with what's happening outside of the clinic, pain, home exercise adherence.

15:05 Some of them will do step counts, activity levels, and patient messaging, phone calls, or messaging through the app. So it's a lot of what we do already. If you're doing what I feel like I should be doing and creating programs and keeping up with the patient, it's just done in a way that's now billable. Yeah, that might sound overwhelming. I've heard from people who've been like, I hear what it is, but that feels like it's adding a lot more work, which if you're doing a SWOT analysis, that's like a weakness or a threat. But if you're smart, like some tech companies, they look at it like an opportunity. Here's this road with a bump in it. How do I make it smoother?

15:46 So there are companies who do that. There are organizations that go, hey, you do the PT part, we'll do the tech part. And when we merge, you're going to make more than... You're going to pay us something because we're doing work, but you're going to make more and be able to help more even after you pay us. So I want to throw that out there. There are apps and we can suggest some or whatever, but... That's out there. My next question for you is, I think we're past RTM is coming, right? It's like RTM's here, right? We're recording this at the end of twenty twenty five. Whether PTs like it or not, what's the opportunity here? What should clinics be doing now to prepare for twenty twenty six to twenty seven, twenty eight? Yeah, so it's definitely here.

16:27 It's not ubiquitous by any means. There's all kinds of places that have never heard of it. I talked to PTs that have never heard of RTM or remote therapeutic monitoring spelled out. But it's here and it's going to stay. Excuse me, CMS, not CSM, not the conference. We're really smart. We're in healthcare. We name our conference CSM. Well, a lot of us deal with CMS, but yeah, I guess. Yes. So CMS has made changes to the codes coming in twenty twenty six that essentially fill some gaps that used to were some areas where you couldn't build someone because they didn't use the app enough or you didn't interact with them enough. They filled some of those gaps next year. And from what I understand, any time CMS is making positive changes to our reimbursement codes like that means they stay.

17:11 Yeah, exactly. Yeah, it's it's rare, right? We're used to going in the other direction. Yes. But yeah, what what you should do now is, you know, you can reach out to me. I have a buddy named Matt Jurek who deals a lot. Yeah. So he's a good resource. And there's there's tons of vendors like I have some that I prefer. We can talk about that off. off mic if you or you can give him a shout out if you want like yeah yeah so uh orva is a great one orthopedic virtual assistant i really like them um i've dealt a little with um they just changed names i think it's prompt solutions uh they're integrated into prompt so if you use prompt those are the two i'm most familiar with but i've i've met with several different companies um vendors, you know, so there's, there's a lot.

17:57 And, and some of them are just, I don't like them because they don't fit the clinic that I'm helping implement. Some are going to be better for some things and different for other settings. Uh, Steve Cohen, show, uh, is there a health? Is that him? Yeah. Yeah. yep yep that's a that's a pretty popular one you see him everywhere in the pt world like that guy's if you go to a conference you do spot steve have you seen him in person at a conference yeah i saw him last year and he's like he wears like the uncomfortably colored uh track suits and i think it's like at first glance you're like that's ridiculous and that's it is why he's doing it i remember seeing him so it worked you know yes yeah but that that one is more of a text messaging platform so you don't have to have the smartphone use you can you know which some a lot of these rely on apps so that one you know takes that out of the equation if you have older patients so you think can't do apps but um yeah so you know reach out to somebody find a podcast there's a lot that's that's how i started learning about it just a little bit as i'm sure i listen to Matt Jurek was one of our most listened to episodes in twenty twenty might have been the end of twenty three.

19:03 And we might have been talking about that long. But he came in. Yeah, that's how I found him. Yeah. He came in and was like, I understand this. And that's what he does. Like not to get too much into Jurek. he drives around the country in an RV with his family and just like does cool stuff. And then he jumps on my laptop and he does this for clinics and he goes, they pay me and they're still making enough money to make the F the juice worth the squeeze. And I'm like, Oh, this is intersection of opportunity meets elbow grease. And I love those. Me and Matt met, he was in Arkansas when I reached out to him on LinkedIn and we just kind of met halfway, uh, over beers and talked through the whole rtm thing learned a lot so he's he's a great resource he gets it from two uh number one he understands the tech technology enough and he also meets you on the other side because he's a pt he's like i've been there i've been on the other side i know that this seems like it's going to be a pain in the ass but watch watch me remove every one of your um barriers or every one of your objections and if we can do it this smooth would you do it and when people you have to commit There is some work.

20:02 There's going to be a lot of work in the beginning. And then the amount of work is going to fade out and you're going to get no return in the beginning. But then the return is only going to compound. And, you know, luck favors the bold. Yeah. And in a, you know, it's twenty twenty five, almost twenty twenty six. Everyone has gone digital in the world. I mean, airplanes, finance, you know, those are big things. It makes sense. But like food delivery, the fitness world, like your smartphone knows more about your activity than your PT does. So why don't we utilize that to let your PT know these same things, right? Like the person who's guiding your movement and care should know what, you know, just your app within your smartphone knows or your Garmin watch knows this. That's what RTM is trying to come from.

20:43 It's trying to catch us up with the rest of the world. Yep. Um, How can people reach you? You said reach out to me. What's the, I want you to say it. Sure. Easiest way to find me would be, I'll give you three ways. So my email is just philmckelvey at gmail.com. I'm on LinkedIn, Philip McKelvey. And then my Instagram is philmckelvey.dpt. So you can reach, reach out on any of those. I'd be happy to talk to you. Let's talk about you for a second. You juggle a lot. In your intro, I mentioned clinician life, education, entrepreneurship, advocacy, son-in-law to another PT, so I'm sure he's always watching. I'm sure he's always eyeballing you. Your better half is also a physical therapist, too.

21:25 How do those roles feed each other, and what keeps someone like you curious? Yeah, so I'm the kind of person that comes up with lots of ideas and then I drop a lot of those ideas. But if something continues to excite me for, you know, while I'm learning about it week after week, month after month, I kind of run it past my wife, of course. She's the discerner. I think you and I have talked about that before. But if, yeah, if, if, if that, if it clears that path and I get some excitement from it or enjoyment from it, I just keep running with it until, until it stops. So it, you would think like, oh, he's, he does, there's an adjunct professor, been doing that for a few semesters.

22:08 I do the public relations. It's Arkansas College of Health Educations. What's your logo? What's the mascot? I judge schools by mascots and logos. Oh, I don't know that they really, I don't know if they really have a mascot. So it's just, it's like, yeah, they should get one. They have no sports teams. It's just like, it's like, yeah, but no, to my knowledge, there's no mascot. We'll work on it. Okay. Keep going. We'll work on it. Yeah. So all of these things like add to what I, they fill my cup. Like sometimes, you know, in PT, the word burnout is everywhere because it's, it's so easy to hit that. And dealing with patients with real problems and real sad things and, and, and, that can empty your cup so if you're not filling into it now i do that with disc golf and with hiking and camping and stuff like that but professionally it keeps me excited about being a pt by working on outside projects outside of my you know clinic job nine to five job and within that job i do some extra stuff there too so it the key to me is just finding things that you enjoy and and going down that and then if you stop and you know if it doesn't work then you just stop it you're not a failure you just you know you know, kind of that fail forward mentality.

23:21 Yeah. This is bear grills. This is myth busters. You try stuff, you put it out there. You know, you've seen that chart before where it's like success, how we think it goes. And it's like up into the right. And then like how actual success is. And it's like, it's all over the place. Yeah. And for me, like connecting with people is a, is a real like a fire, you know, lots of fire me. So I reach out to people on, on projects. Yeah. It helps, you know, make me feel engaged and excited in the, in whether it's APTA or outside of APTA or like within clinics, like. That's what the real superpower of APTA membership is. We've talked about this before. I've raged on it on LinkedIn. I'm not going to stop. You're not selling CEUs.

24:01 You're not selling a newsletter. You're not selling journal access. You are selling what Phil was talking about right now. companies and it's powerful yeah like the pts are great people and for the most part they want to like you can reach out to people on instagram on a post where you learn to learn something and these people can have eight hundred thousand followers and almost all of them message you back I figured that out a decade ago when Instagram PT was starting to become a thing. And I was reaching out to these people with specific questions I couldn't answer. And they were just mentoring me via DMs on Instagram. Miles, right? Yeah. And now some of those people are my friends. So it's just really cool. And so you can do that in lots of different ways.

24:43 I know some people don't feel comfortable with that, but I encourage it. That's one way. Yeah, if they don't respond, it's because they were too busy, not because they didn't like you. It's no big deal. You're right where you are today. Yeah, we're going to play a quick game. Are you ready to play a quick game? Ready. Neuro Factor Fiction. Phil, since you're deep in the Parkinson's world, I'm going to hit you with a few statements. You tell us... If it's neuro, fact, or fiction, and then you set the record straight. Coming in hot with three. Okay. Only PTs with LSVT big certification should be treating persons with Parkinson's disease.

25:25 Fact or fiction. Fiction LSVT big is great. And it really advanced how we see and treat people with Parkinson's in relation to amplitude based training, but that would severely limit access to people in, in bigger, bigger cities or certain areas where neuro specialists are, are present. Like it's, it's great. And those people get great care, but that's not where everyone with Parkinson's lives. So I want anyone who has Parkinson's or other movement disorders to get quality care, whether it makes sense for a PT and their vicinity to get certified or not. Number two, exercise can actually slow down the progression of Parkinson's disease. Fact or fiction?

26:06 Fact. There's a ton amount of animal research that shows this. Human research is a lot harder to do. They're working on the studies. But I mean, functionally, mood wise, et cetera, it's going to improve everything. And all of the research I've seen and all the data is pointing in the direction that it absolutely slows down progression of disease. Now we're going to twist it. We'll do factor fiction, but this is about RTM. I'll slide in an RTM question in there. RTM is just a billing trick. Is it a billing trick fact or is it a bill? It's not a billing trick fiction. What do you think? I'd go with fiction. It can be. It shouldn't be. I don't think people that are implementing it are using it that way because it's too much work to get going on to just make a few extra bucks.

26:50 And it can really offset some Medicare cuts and make you some money. But what it is, it's a way to better engage your patients and a way to better understand their recovery. There it is. All right. You're off the hot seat. That's fact or fiction. The last thing we do on most episodes. Where's my button? I got a button. I got a button. Here we go. This is the parting shot. Parting shot. Your last chance for a mic drop moment. I want to say thanks to AOMT. If you know, you know, AOMT is where orthopedic manual physical therapists go to connect, grow and sharpen their craft. Join the movement. at a-ompt.org that's a-a-o-m-p-t.org thanks for supporting the show parting shot your last chance for a mic drop moment what are you leaving with the audience today I'm going to get off both topics and just say, you know, work hard, be kind.

27:34 So my dad was one of the biggest influences on my life. And if I could boil down everything I learned from that guy for to be a successful human and have a happy life, work hard, be kind. It doesn't even have to be in that order. You know, be kind, work hard and you're going to go somewhere. Love it. You want to give a shout out to your state chapter as well. That's how we connected was through your state. That is. Yeah. So I'm from Arkansas. So if you're a PT in Arkansas, reach out to me or someone about being a member of what that means. We're trying to figure out what people want and don't want and make it better. So, you know, reach out to myself or one of the other. Yeah, we're trying to grow it. So reach out. We can talk. Love it. Phil, appreciate the time.

28:15 Thanks so much for for for espousing some wisdom here on the podcast. Appreciate that. I hope I had a little bit. Thanks for having me, Jimmy.