Business Listings Online & Website Management

The clinic I work at keeps getting pestered by other companies that want to manage our website or fix our listings online.  I currently do that for this clinic and it is not as hard as you think it would be.

I start with checking our online presence with this website to make sure there are no inconsistencies.  I then verified our business on Google.  You verify your business information and they will send you a post card with a code to make sure you are truly the owner.  It is very worthwhile having your business on FaceBook as there are billions of people all over the world that utilize the site.  Not too many of our patients utilize Twitter so we don't bother with it.  I also verified our listings on Bing, Yelp, and Foursquare which involves just a simple phone call with a code to verify.  I don't bother too much with the lesser known websites that are shown with the online presence site.  Being able to verify your business allows you to modify your business information easily, see what customers are saying about your business and able to reply to ratings, and see stats on how many times you were looked up.  This does not take much effort to set up and it helps you avoid paying for other companies like Townsquare that can do it for you.

I do not have much training in website coding, but I made our clinic's website pretty easily using Weebly.  You do not need any coding experience to make websites and involves mostly dragging and dropping tools onto a blank page such as text boxes or pictures.  They also have wonderful tutorials on how to add other content (I added my clinic's FaceBook feed).  You can also buy your own domain and manage it quite easily without using other hosting sites.  We were hosting with GoDaddy and having another company handle our website, but migrating to Weebly was super easy so we could retain our domain name.  I followed these simple steps and instantly had the new page I created live.  I really enjoy having access to editing our site and making them live instantly as it can take a very long time for other web masters to edit it for you.  Weebly has great iPhone/iPad apps to manage your site and offer great statistics on page views.  Other sites like Wix and SquareSpace are alternatives to website design.

Next post I will discuss smart watches and all the clinical uses I use my Apple Watch for since they are becoming more popular.

Absence

Being an adult is a whole lot more busier than I anticipated but now that I am on my own and have many financial things figured out.  I will try to post 1-2x/month and have still been keeping up with new ideas for use of technology and have a large list of things I want to talk about.

In the mean time, I found this app Angle Reader to be an interesting tool to help you learn you to eye angles better as I am very impressed to see OCS therapists eye angles with high accuracy.  It can be easy to very challenging depending on the window of error they give you!

Instant Video Feedback

I have been compiling a massive list of technological ideas I have been wanting to discuss on here between graduating and job searching and would like to start posting 2-3 times a month.  In fact I did my 4th site inservice on all these ideas, but kept it more brief during the presentation and will certainly elaborate more on here.

I recently just accepted a job in Wyoming, where I completed my 2nd clinical site, and I am very excited as it is in the setting I want to practice.  I have also been reviewing my orthopedic notes like crazy so I feel more confident going in day 1 while I am waiting on my license to come in the mail.

Anyways, in this post I want to discuss the use of video feedback.  In an earlier post I talked about the use of Coache's Eye to analyze client's movement and having the ability to time certain parts of the recording, use tools to measure angles, and playback in slow motion or even in reverse.

In my last Rehab setting for clinicals, I had a very large man for a patient who had thoracic surgery, that consequently decreased proprioception in his knee, and due to his large abdominal region or use of a stand aid he could not see his knee and ankle move during transfers or bed mobility.  We tried a mirror but still his view was obstructed by the stand aid.

I resorted to finding the app WiFi Camera which displays your iPhone's camera to your iPad's display when the app is open on both devices.  It works through bluetooth or WiFi and connects seamlessly.  I was able record the patient's knees while he was in the stand aid to work on knee extension while another therapist held the iPad in his view.  Another example was providing visual feedback while he moved his ankles to make transfers more effective with less physical assist needed from a therapist.  This method seemed to work fantastic for him and aided very well in improving his motor learning.  (I have also used this app to look for objects I accidently drop behind the washing machine without having to move it)

Recently the 3rd Generation Apple TV received a software update that allows iPhone/Mac to communicate directly rather than through a WiFi router, which has drastically reduced latency, when Air Displaying your TV.  This could be another great option is to get a 30"+ TV and display the iPhone's camera to it so you can show your patient parts of their body that are hard to see, even with the use of mirror.  I can't attest to how well using Chrome Cast is to display an Android phone to a TV in terms of latency.

Amazon has an incredibly cheap tripod I recently purchased (works on many phones) which could be a good stand to provide instant visual feedback with the methods I have described.  It's also great to take pictures to analyze posture or record movement which I will discuss further in a future post.  Apple Watch has a nifty tool to show you your camera's view and has a 3 second countdown timer for that perfect photo opportunity (such as your clinics Christmas Card).

I have tried the use of video calling each device through either Google Hangout's or FaceTime but there's too much latency for instantaneous visual feedback.  I foresee using this method with other patient populations to give them different perspectives of them moving out of certain planes during exercise.

Graduation

I haven't had much time to blog due to being in clinicals and preparing for the NPTE (still have a few days to wait for the results) I took last week.  UND graduation is on 5/16/15 and I'm really excited to start working.  My Apple Watch came in today and can't wait to share some good clinical uses for it and other interesting wearables.  I also plan to elaborate on past posts incorporating more evidence and possible ways of standardizing apps for assessment.  I'll try to redo some videos in order to make them higher quality as Blogger does not offer the highest resolution videos.

Goniometer

There are 2 goniometer apps I have been played around with that I feel I might use from time to time in the clinic or out and about.

1) Goniometer Pro

This app utilizes the accelerometers in the phone to measure angles and acts essentially as an inclinometer.  The downside to this is that some phones are long and do not have a nice small base you can put against a patient.  I have seen somewhere, but currently cannot find it, some sort of phone case that has a base like a bubble inclinometer.  I am curious if just simply creating a makeshift base to attach to your phone case would be effective and should not matter when you zero out the application to measure.  The phone can either be used to measure on its side or on its back to help get better measurements for certain joints.  It's also great for leveling pictures or making sure a surface is precisely parallel to the ground.

This application gives you an arc of motion when measuring and may be difficult to get the correct measurement if you cannot start at the appropriate beginning point for measuring a motion such as hip flexion (i.e. the patient can be in slight hip flexion/extension and give you more/less than what is considered normal values).

This article by Tousignant-Laflamme et al. (2013) looks at the reliability and criteriorn validity of an accelerometer application and the use of the iPhone's magnetometer to measure cervical ROM in healthy patients and compared it to the use of a CROM.  The accelerometer app was used to measure cervical flexion, extension, and lateral flexion whereas the magnetometer was used to measure rotation.  All positions were seated.
Results

• Moderate intra-rater reliability for each movement (ICC = 0.65-0.85)
• Poor inter-rater reliability (ICC < 0.60)
• Criterion Validity moderate (ICC > 0.50) to good (ICC > 0.65) for movements of flexion, extension, lateral flexion and right rotation but poor (ICC < 0.50) for left rotation.

I am curious to why this study chose to use the magnetometer.  I imagine they would have had better results if the measured the subjects cervical rotation in supine using the accelerometer as currently phones do not measure rotation well when the phone's z axis is in line with gravity (hence why the magnetometer was used).  I would love to be apart of a team to standardize test positions for the use of phones to collect objective data.  Even though there is poor inter-rater reliability, the good intra-rater reliability should be acceptable as long as you keep your measurements consistent and are the only one who sees your patient.

Another article by Ockendon et al. (2012) looked at measuring slight knee flexion in healthy subjects with the use of an accelerometer compared to a telescoping goniometer.
Results

• Telescoping goniometer
• Intraobserver reliability ±9.6° (r=0.927)
• Interobserver reliability ±8.4° (r=0.952)
• iPhone
• Intraobserver reliability ±4.6° (r=0.982)
• Interobserver reliability ±2.7° (r=0.994)
• Both Instruments Correlation r=0.947 and have a mean difference of -0.4° (SD 3.86°)

This study shows using the iPhone's accelerometer as a goniometer can be reliable for measuring subtle knee flexion in patients with certain conditions such as an ACL repair.

2) DrGoniometer

This app you use your camera to snap a picture of your client and align the points to get a measurement (forgive me if my land marks are not spot on as I did this very quickly to get a screenshot of its use).  One thing I enjoy about this app is it shows the line of gravity while you are talking the photo to get your camera straight up and down.

This article by Ferriero et al. (2011) examines the reliability of this particular app in elbow ROM in healthy patients in comparison to a universal goniometer.
Results

• Intra-rater correlation (ICC = 0.998, 95% CI 0.998-0.999)
• Interrator correlation (ICC = 0.998, 95% CI 0.996-0.999)
• Width of 95% Limits of Agreement (LoA) between app and universal goniometer: 10.26° (LoA = +4.51°, -5.75°)

In this study they considered 10° to be an acceptable interval (width) within 95% difference between measurements expected to lie (LoA = ±5°).  I am very curious to how standardization of using photography to measure will play out in the future to decrease error as this is a very fast method of getting objective data without having to have that "third hand" to position the patient and place the goniometer.

Coach's Eye I discussed earlier has an angle tool you can utilize to measure dynamic motions.  Here is another video I took of examples on how to use it.

Older post videos have not had such high resolution sorry about that, I will be uploading videos to youtube and linking to them from now on to improve the quality of videos.