Impingement and Instability (Lima, Ohio)- Enjoyed my first trip to the historic city of Lima in Northwest Ohio and it was a fun interesting weekend. Thank you to Alex Maag, DPT, PRC for your generosity as our host site coordinator and to the entire Lima Memorial Hospital rehab team for making the visit such a nice one.

I learned some cool things about Lima Ohio, before even getting there. Several people who knew I was going to Lima had the same question for me, "while you are there, are you gonna go to Kewpee Burger?" I didn't know much about it, but enough people asked me about it and shared their enthusiasm for the place, I knew I had to visit the historic burger joint while in town (twice :). I learned the small burger chain began in Flint Michigan in 1923 and it was named after the Kewpee Doll, originally being called the "Kewpee Motel Hamburg". The burgers were square and tasted a lot like a Wendy's hamburger and they were offered with chocolate shakes that tasted a lot like a Wendy's Frosty. C'mon Dave Thomas (headquartered in nearby Columbus), come clean and acknowledge that your great idea for a burger chain may not have been that original. And to Kewpee Burger, thank you for all the great innovative ideas and for your tasty offerings.

 Impingement and Instability, ... speaking of innovative ideas and useful offerings. In this case the innovation and usefulness was designed for the world of rehabilitation and performance medicine. I have been grateful to Ron Hruska for putting this body of work together since i first had exposure to the material back in 2004 (the first formal I & I course was actually taught in 2007) and I appreciate the honor he has given me to teach it. It is the course that keeps on giving. I have attended and taught this course more than probably anybody else, except maybe Mike Cantrell, MPT, PRC and I learn something new each time I teach it. I can't believe how truly innovative this material was 14 years ago when I was first exposed to it and it continues to challenge and impress me to this day.

The course is all about neurological awareness and sense of three things: 1) breath, 2) body position and 3) upright frontal plane control of center of gravity in space. When you lose these senses and/or the neurological awareness of these senses, instability can emerge in several different areas. This course goes over the neurological reference centers needed to minimize instability at the calcaneus, femur, ilium and scapula. The course then goes on to provide treatment recommendations for stabilization of the foot and ankle, tibia, femur, ilium and scapula, designed to be superimposed on top of the good preliminary work of AF and TS repositioning and stabilization, learned in PRI's introductory courses. Thank you Ron for an awesome body of work that continues to challenge and inspire.

We are so excited to announce the agenda and speakers for our 2019 Interdisciplinary Integration Symposium, titled "Airway Oscillation: An Interdisciplinary Approach to the Production of Voice, Airflow, and Resonance". The 11th Annual Interdisciplinary Integration Symposium will be held in Lincoln, NE on April 11-12, 2019.

The speaker line up and two day agenda are outlined below. To learn more about the course (including description and objectives), and to register online, CLICK HERE. Don't wait to sign up, this one is sure to fill up!

Speakers:
Ron Hruska, MPA, PT
Dr. Rosalba Courtney, ND, DO, PhD
Dr. Brad Story, PhD
Ruth Hennessy, MM, Indiana University
Mandy Harvey, America's Got Talent Season 12 Finalist
Dr. Howard Hindin, DDS
Dr. Ingo Titze, PhD

Grateful to be able to teach Postural Respiration this last weekend in Lincoln at the Postural Restoration Institute. Especially grateful that Ron was not traveling this week and that he was able to join me for the presentation. It reminded me of the early years of PRI when Ron brought me along to co-teach with him as he mentored me. I remember him taking the lead in those early courses and letting me chime in as I became more knowledgeable and confident. It was truly an honor this time around for me this be able to take the lead and to have Ron there to chime in to support what I was saying. Truly humbling and also very fun.

Besides getting to teach with Ron again, it was a cool weekend blending old relationships with new ones. I got to see Tim Newman, a neuromuscularly minded LMT I have known since the early 2000’s. It was also fun to see Tricia Athans, PT, PRC from Sandhills Sports Performance in North Carolina and Michelle Spicka, DPT, of Husker Rehabilitation and Wellness Center in Lincoln. Thanks for your support Michelle and for bringing 4 of your co-workers. Also appreciate Nick and Travis at Athletes Performance Center in Omaha for sending 5 members of your physical therapy team. Great to have them all there with us.

And thank you to a new friend, Nick Monzu, who was very generous serving as the demo for non-manual and manual techniques to give people insights on how the treatments look and “feel”. Also fun to have Lori Thompson, MPT, PRC in the house to support the class as a lab assistant and to make things better just because she was there. I always learn a lot when I listen to, learn from and have the opportunity to share with Lori.

The content of this Postural Respiration course provides an opportunity to delve into fundamental PRI concepts and explore both non-manual and manual treatments for thoraco abdominal patterns and patho-mechanics. Concepts like the ability to sense a respiratory breath from both sides of the diaphragm, the ability to achieve posterior mediastinal expansion sense on the left side and properly sequenced apical expansion on the right side were explored on both days. The power of a properly postured diaphragmic breath, the respiratory pause and use of lateralized airflow training to minimize patterned airflow were also discussed. Having Ron in attendance allowed clarification on all the principles being discussed and connection to the many research articles referenced throughout this manual, with the prospective of the institute’s founder.

PRI Integration for Geriatrics (Minneapolis, MN)- An awesome weekend in the Twin Cities of Minnesota with the great team at IMPACT Physical Medicine and their course coordinator, Christie Amundson, PT, DPT, HFS, PRC. Their owner, Mr. Stan Babel is a long-time friend of mine and both a gentlemen and a scholar, simply stated. I have been fortunate enough to work with their clinic over the last 17-18 years teaching and consulting and Stan has always treated me with the upmost kindness and respect (and for the record, he takes me to the best restaurants in St. Paul). This weekend reminded me of all my friendships over the years within this organization and the many memories I've been able to make over the different generations of IMPACT employees during this time. A big thanks to all of you, past and present.

There were a lot of great people from the Midwest in attendance, and I want to thank my two lab assistants, Christie Amundson, PT, DPT, HFS, PRC and Tom Tardiff, PT, DPT, CSCS, PRC for helping make the experience great for the class. You two were very helpful. Beyond all the great Minnesota people in attendance, I was especially appreciative of Matt Rosenboom, OT, for traveling all the way from New York City. I appreciate Matt for a couple of reasons, first because he was willing to travel away from the large coastal cities to attend a course like this in the Midwest, secondly, because he is an Occupational Therapist, and lastly, I love that he has already created collaborative learning with a hand full of PRI experienced people, including an old Protege of mine, Minh Nguyen, OT, PRC.

I highlight the fact that Matt is an OT, because this course has Occupational Therapy written all over it. Besides Matt, there were 9 other Occupational Therapists in attendance and the Physical Therapists got to take time to explore the world of OT, not the other way around. This is meaningful for us because PRI has always been a big fan of interdisciplinary work and appreciating everybody's contribution to the "whole" team. The "Gerald" handout of patterned and preferred "Functional Routines" we discussed on the second day really sums up the functional objectives of this course and helps make the material very practical.

This course has been a gem to share over the last 5 years, especially since completing the updates to the techniques section 2 years ago. People continue to love the exercise appendix, organized into bed, recliner, chair, transfer and standing sections. A couple of you have seen both versions of this course and provided us some valuable feedback on the updates. Thank you in particular, Stephanie Boespfug, PTA, PRC for your valuable insights and the positive feedback on how these new updates have helped you with clinical application working with Geriatrics. It was fun to have you there with us again.

Another reason this course is so fun to present is that it serves as a great introduction to the science of PRI and helps connect people to our fundamental concepts in a simple and non-confusing way. One course attendee wrote, "as a more experienced PRI clinician, I appreciated the amount I still learned exploring basic PRI concepts in this course." Another attendee from last weekend reported, "I am excited to get back to using PRI. I feel like I had stopped, but this course pulled some pieces together for me that I was definitely missing. Thank you." Another course attendee wrote, "Overall, one of the best courses I've been to. Great clinical application for all clinicians working with Geriatrics, not just home health. Pleasantly surprised with my ability to apply this in an outpatient setting. Thank you."