Managing Strokes


"Strokes are the leading cause of disabilities in adults,” reports The American Stroke Association.  So,  stroke victims will require a large segment of therapy resources.  

The majority of strokes occur for two reasons:

1.  A stationary blood clot (thrombus) forms and interferes with the circulation to the brain.

2.  A traveling blood clot (embolus) gets lodged and stops the flow of blood to the brain.

The thrombus is a solid mass that forms in a vessel. The embolus is often a piece of thrombus that broke away and travelled through the bloodstream…until it reached a spot too narrow to pass through. Once it becomes stuck, it cuts off circulation to that area. These clots account for 80% of strokes.

Vascular ruptures account for the other 20% of strokes. An example would be an intracranial hemorrhage, or bleeding in the brain.

Any one of these events causes a blood flow interruption and damages the brain, resulting in a stroke.

The level of impairment depends on the area of the brain damaged, and the extent of that damage. If the damage is on the right side of the brain, the left side of the body will experience problems. If the damage is on the left side of the brain, the right side of the body suffers.

Hemiplegia is the total paralysis of half (hemi) the body. The person has NO control over it.

(When dealing with hemiplegia, you need to approach from the “good” side so the person can see you.) 

Hemiparesis is weakness of half of the body. The person has some control and movement, but it is awkward and unstable.  

The main impairments that will concern physical therapists will be:

Managing Streaks

·  Function

·  Communication

·  Memory

·  Emotional control

·  Vision

·  Swelling/edema 

Patients with strokes usually have difficulty communicating.

Dysarthria is when the speech becomes slurred, slow, or difficult to understand. However, the person CAN speak.

Aphasia often accompanies the stroke in the forms of expressive aphasia or receptive aphasia.

Expressive aphasia is when a person is not able to produce the words he wants to say. He cannot express himself. The person may answer “Yes” when he means to say “No”.

Receptive aphasia is when the message someone else transmits gets garbled inside the patient’s brain.

You might ask the person to close her eyes but she lifts her hand instead. She is having difficulty receiving the message. 

The National Institute of Health has a standardized measure that shows the relationship between the  damage and prognosis. It gives detailed instructions on testing and obtaining a score which will help determine what therapies the patient will need.


Level of consciousness  (LOC)   Alert   0

  Drowsy   1

  Stuporous   2

  Comatose   3

LOC questions  Answers both correctly   0

(Ask patients their age and the month)  Answers one correctly  1

  Answers both incorrectly   2

LOC commands   

( Ask patient to open and close eyes  Performs both correctly   0

  and to make a fist)  Performs one correctly  1

  Performs neither task correctly  2

Gaze   Only horizontal movements are tested. Partial gaze palsy means that gaze is abnormal but forced deviation or total gaze pareses is not present. Forced deviation, or total gaze paresis NOT overcome by the oculocephalic maneuver. That maneuver is done by turning the head quickly to the right and left and watching to see if the eyes move normally. NOTE: The  oculocephalic maneuver is done on comatose patients.

Normal  0

   Partial gaze palsy    1

    Forced deviation   2   

Visual field   (Hemianopia is the loss of vision on the left or right side)

  No visual loss   0

  Partial hemianopia   1

  Complete hemianopia    2

  Bilateral hemianopia/blind     3

Facial palsy  None     0

  Minor (assymetry on smiling)     1

  Partial  (paralysis on lower face)     2

  Complete (absence of facial movement)     3

Motor arm function   No drift  (holds limb at 45° or 90  ° for 10 sec)     0

(score for both left and right sides)  Drift  (drifts down before 10 sec.)     1

    Some effort against gravity

    (limb drifts but has some effort )     2

    No effort against gravity (Limb falls)     3

     No movement     4

Motor leg function  No drift (Holds 30 ° position for 5 sec.)    0

(score both left and right sides)  Drift (falls before 5 sec. but does not hit bed)    1

    Some effort against gravity ( leg falls by 5 sec.,

    but has some effort against gravity)     2 

    No effort against gravity  ( falls on bed immediately)  3 

    No movement    4

Limb ataxia  Ataxia is poor coordination, unsteadiness, or difficulty functioning.

(Finger to nose and heel to shin tests are done ) 

   Absent     0

    Present  in one limb    1

     Present in two limbs    2

     Untestable ( explain why)    __


(Test by pinprick on face, arm, leg)  Normal    0

   Mild to moderate loss (feels, but less so than usual)  1

   Severe loss (is not aware of being touched)   2

Best language function   No aphasia    0

   Mild to moderate aphasia    1

     Severe aphasia    2

     Mute, global aphasia    3

Dysarthria   Normal articulation    0

     Mild to moderate dysarthria   1

    Severe dysarthria  (unintelligible or worse)     2

   Untestable (explain why)     __

Neglect  For this test it means the lossof  ability to see, hear, use space correctly, or pay attention.

   No neglect    0

    Partial neglect     1

    Profound neglect    2

  (does not recognize own hands or orients to only one side of space)   

Total the score of each individual test. The higher the score…the worse the damage.

(You may download a copy of this by typing--nih stroke score—into your computer search engine.) 

Exercising effected areas is vital. Physical therapists can help determine the person’s progress.

When you explain what is going to happen and why therapy is the key to a better outcome…the person is more likely to do it. 

What you do and what you get the stroke victims to do, will make all the difference in their recovery. Therefore, YOU are essential to their progress!


From ABCs to CEUs...


Milestone Continuing Education - Back To School CEUs

It's that time of year again; the time of year where something changes in the atmosphere and it's clear that summer is coming to an end. Store aisles are filled up with decorations for autumn and the days, while still hot, don't seem quite as long. Fall is my favorite time of year, so forgive me for romanticizing it. If you are one of those people that loves the wonderful warmth that comes with the summer months, then you'll have to forgive my indulgence. I crave crisper days,  colorful leaves, and pumpkin spice lattes from Starbucks.

Unfortunately, my favorite time of year is also synonymous with all of the hustle and bustle (and that admitted touch of dread) that comes with "back to school" season. Admit it, you've woken up in a cold sweat dreaming you'd slept through a final exam, or that you forgot to register for the one class you needed this semester, long after graduation has passed. It can't just be me. When you finally figure out that those unique problems are long gone with your student days and settle back into sleep, it hits you: homework assignments and test days have only evolved into work deadlines, CE courses and exams. Drat! And you thought you had escaped all of that... 

While the young people in your life start preparing for school it's time for you to start preparing for your CE deadlines. You can skip the parent teacher conferences and orientations and go straight to the Course Catalog with Milestone. Browse through thousands of hours of online CE courses designed with your success in mind. No need to dread exam time either, one of the many perks of self-paced study. When you've completed your study guide, (included with all Milestone CEU Courses), log in to the exam center and take the multiple-choice test. It is graded immediately after you submit it so you don't have to wait to see your score, and your Certificate of Completion is unlocked and sent to your Milestone CE Account with a score of 70% or higher. It's that simple!

Get started today! Don't procrastinate like you did in school, you know you'll regret waiting until later... 


August LMT Deadlines: Montana & Delaware


It's that time of year again. The stores are filling up school supplies and fall decor, signaling an impending change of seasons. But before summer slips away until next year, there are a few things Delaware and Montana massage therapists have to do. This post will cover the basic CE requirements for massage therapists up for license renewal in these states, but always be sure to reference the state board's website for updates and changes to the requirement.

Let's start with Montana. Licensees here can choose their CEU credits from any provider as long as the continuing education program offers courses that pertain directly to the practice of massage therapy, business administration, or ethics aspects of the field. Continuing education activities from other professional groups or academic disciplines may also be accepted for CE credits by the board if the practitioner can prove that the activity is related to their as a massage therapist. 

The renewal period, established back in 2012, ends on August 31st. By that time practitioners are expected to have completed and submitted 12 hours of continuing ed. and submit an "attestation" confirming the completion of the full requirement. It is advised that the practitioner keep track of their records for up to 3 years before discarding them because the board periodically conducts random audits on 2-5% of licensees throughout that time. 

Delaware has similar requirements for LMTs, but there are a few key differences. Licensees in this state will need to have completed 24 hours of approved CE by August 31st (the renewal period is biennial - always ending on August 31st of even-numbered years). However unlike in Montana, the total requirement is broken down into specifications: 18 hours of the total 24 hours must come from "core" courses, whose content pertains directly to the practice of massage therapy. The remaining 6 hours are elective, which means the course content may discuss topics outside of the practice of massage therapy and bodywork. 

As for choosing a CE provider, practitioners in Delaware have to either select a board-approved company, choose a CE company approved through the NCBTMB, AMTA, or ABMP, then the courses offered do not have to be directly approved through the board. Be careful when selecting course formats, as the board specifies that only 15 hours may be taken from online course providers (all 6 hours from the elective group and up to 9 from the core group). 

Milestone CE is a NCBTMB Approved Provider (#491) and currently offers over 85 hours of online courses for LMTs in Delaware and Montana. Explore titles derived from the most recent content available, make your selections, download them to your computer or tablet and you're ready to get started. It's that simple... Click on the course titles below for detailed descriptions, module information, professional objectives and more! 

Milestone CEUs for Massage Therapists

Reference Links:

Want to learn more about Milestone CE? Visit our FAQ Section or give us a call at 1-800-709-8820. 


A Day in the Life of a CPT


Working as an ACE certified personal trainer has brought me into contact with people from all walks of life.  Every workday is different and every client is an individual with specific needs and concerns.  I’ve trained men, women, teenagers, post-rehabilitation adults and the elderly.   

I’ve worked in the fitness industry for ten years and I’ve noticed many trainers have the education and knowledge but lack the “personal” part of personal training.  A client’s experience is highly dependent on their relationship with their trainer.  While it is a business relationship, it’s definitely a personal relationship too.  To that end, I learn about my clients and their interests.  I ask about their careers, families and hobbies.  From session to session, I ask follow-up questions about things discussed in our previous meeting. The fact that I remember these things and ask about them lets my clients know that I am truly interested in who they are.   

A day in the life of a certified personal trainerWhen I first meet with a client, I ask many questions about what they want to get out of their sessions.  Does she want to learn about exercise physiology and biomechanics?  Does he prefer to chat about topics other than exercise to make working out more enjoyable?  Does she want to know how many repetitions are left or does she prefer to work until I tell her to stop?  We also set goals and determine a course of action together. 

In the beginning of my career, I worked in a gym facility catering to women.  Being onsite enabled me to see up to eight clients in a day.  I often had breaks between clients and used those periods to eat or work out.  Our sessions were 55 minutes long and I used the last five minutes for stretching unless the client requested otherwise. I completed any paperwork or notes immediately afterward so as not to forget anything.   

For the past seven years, I’ve worked with private clients in their homes or occasionally mine.  Because of travel time, I can’t see nearly as many clients as I previously did but the pay is better and it’s easier to develop rapport with new clients because we’re on their “turf.”  Clients also tend to be more forthright about difficult topics in private environments.  I also enjoy being able to set my own hours and work with clients who are a good fit. 

Although the intent of every session is to give the client a good workout, sometimes things take a more serious turn and they disclose things that factor into a dislike of exercise or issues affecting self-esteem.  I’ve learned that I need to prepare for just about anything.

I don’t schedule more than three to four sessions per day and I limit myself to specific geographical boundaries because I could easily spend an entire day driving if I didn’t.   

How much pre-session prep I do is dependent upon what equipment we’re using.  I have a standard bag of tricks that accompanies me to every session but I also have a wide selection of equipment I can bring.  I’ve stocked my home gym with transportable items such as a Step 360, BOSU ball and an adjustable kettlebell.  I do need to schedule my departure time, make sure there’s gas in my car and keep it in good working order since it serves as a mobile gym/office.

Working as an independent personal trainer gives me the freedom and flexibility to cater to client needs and preferences as well as my own.  Personal training is an incredibly rewarding career and the best part about it is that I’m always learning something new! 

I Spy... a Puzzle Post!


It's been a while since we've published a puzzle post (wow, say that three times fast!) so we thought we'd send you into the weekend with a little bit of fun! You know what to do: search the puzzle for the continuing education keywords listed below. Good luck! 

And by the way, we solve all the puzzles we post just to make sure all of the keywords are in there.


MCE Fitness Challenge


A competition is heating up at Milestone HQ...

We love serving the continuing education needs of our practitioners, but that means spending a lot of time sitting down at a computer. Coinciding with our Facebook post from Monday, we're initiating an office-wide fitness challenge, complete with a worthy prize at the end! It all started with a fitness "bucket list" conversation.  

Kellene, an avid runner who's already conquered three half marathons (that's 13.1 miles in case you didn't know!), wants to enter her first full marathon in the fall or winter. Angie wants to work up to walking every evening (she asked me to mention that if the Indiana weather does not cooperate with her, she'll find a treadmill somewhere). For myself, I want to advance in my passion for rock climbing by becoming lead rope certified. What's that? You can learn more about lead roping here. (Yes, I just linked you to a Wikipedia article...). Other office fitness bucket list goals include: running a full mile without stopping, trying a new class at the gym every week (i.e.- yoga, boot camp, step, etc.), and speaking of classes, being able to get through an entire spin class - seriously, if you've never tried one, you should at least once. They're intense!   

While having a big outlying goal like a marathon is great motivation, it's not a requirement to participate in this with us. However big or small your motivating factors may seem, the most important thing is to develop the healthy habit of consistently exercising every week! Here's how we plan to accomplish that as a team. And by the way, if you want to participate along with us, be sure to use the hashtag #MCEfitnessChallenge so we can see how you're doing! 

The Challenge: 

Milestone Continuing EducationAt least four days a week, all participants must exercise for at least 20 minutes. The chosen activity must be one that elevates your heart rate, but the choice is completely up to you. If you miss a day of exercise during the week, you owe the collection jar $3, so the maximum amount you can owe the jar for a full week of missed opportunities is $12. And just like with many of your CEU courses, there is no carryover into the following week (so you can't work out every day one week, then only 1 day the following week. That does not count!). At the end of 12 weeks, the amount that's in the jar gets raffled off to someone in the office, and they will donate the amount to a charity of their choice. Sounds pretty simple, right? You may be thinking that twenty minutes isn't that bad... But just wait until you try to keep it up week after week. There's a reason we named it the MCE Fitness "Challenge!"  

We'll report in on our progress every week on our Facebook Page, so be sure to follow us there. Good luck! 


Chiropractic CE Requirements in Montana


License Renewal Requirements

Montana Chiropractor Continuing Education Courses OnlineMontana D.C.s are required to complete the renewal form and submit the fee to the board every two years on penalty of license termination. The deadline for submitting all of the required documents and payment is September 1st, annually. You can receive a new license by following the instructions listed here, as long as you are within 3 years of the date of termination. If you have been inactive in your practice for over three years, then you must reapply using these instructions. 

Continuing Education

In addition to submitting the payment and renewal form, chiropractors licensed in Montana must also include proof of completion of thirteen (13) hours of continuing education. Per board requirements,  only two (2) hours may come from course content that focuses on practice management or philosophy. One (1) hour of the total must be from course content focused on ethics or professional boundaries. Outside of the previously mentioned requirements, the remaining hours of the total must come from courses focused on the practice of chiropractics. The board notes that no credits can transfer over to the following renewal period. Random audits (on 10% of licensees) are conducted each renewal period and three (3) month extensions are allowed for practitioners who fail to meet requirements because of an audit. 

Approved Forms of CE

According to the board, D.C.s can obtain their credits from seminars, conferences, board meetings, and online sources like Milestone Continuing Education as long as the provider is approved through a state, regional, or national organization/association, or a state college or university (check the necessary continuing ed. credentials here). Milestone is a PACE recognized provider of online continuing ed. for chiropractors and currently offers over 400 hours of course content focused on the practice of chiropractic medicine. Explore titles like "Musculoskeletal MRI," "Movement System Impairment Syndromes," and "Whiplash" in the Course Catalog and get started today! 

If you have questions about our chiropractic continuing education program, please visit our FAQ Section, e-mail ( or call and talk with a friendly representative at 1-800-709-8820 who will help you get on the road to license renewal the easy, convenient and affordable way. But don't wait, your deadline is only 46 days away!


Mississippi CE (and a Recipe for OTs)!


Mississippi occupational therapists are responsible for completing 20 hours (or 2 continuing education units "CEUs") within the biennial renewal period ending on April 30, 2016. As part of the total 20 hour requirement, the board instructs that at least 6 hours (or ".6" CEUs) must come from courses directly related to the practice of occupational therapy. Additionally, these 6 hours must come from live occupational therapy seminars, or "face to face" classroom learning experiences. OTs are allowed to take up to 7 hours of the total requirement online. For more details about the OT continuing education rules and regulations, visit the Mississippi Occupational Therapy Board (specifics about CE are on Page 10 of the linked document)

Turn to Milestone CE, an AOTA Approved Provider (#7487), for your online courses. Start with the Course Catalog and browse through hundreds of hours of online CE courses with detailed course overviews, professional objectives and more just a click away! Select the courses that apply to your area of practice and download them to your computer or tablet device so you can study when it fits your schedule. Completing your CE courses with Milestone is as simple as this: read the material; take the exam; print your certificate! Get started today! 

mississippi, mud brownies, and continuing education for occupational therapists

While researching potential themes that would be fitting for a state awesome enough to have two official nicknames (the 'Magnolia State' and the 'Hospitality State') I stumbled upon this decadent recipe that I just couldn't resist sharing with you! I mean, it has Mississippi in the title, that's a close enough connection, right? You be the judge!  



  • ¾ cup (90 g) all-purpose flour
  • 2 tablespoons unsweetened cocoa powder
  • ½ teaspoon salt
  • ½ cup (113 g) unsalted butter, at room temperature
  • ½ cup (110 g) white sugar
  • ¾ teaspoon vanilla extract
  • 2 large eggs, at room temperature
  • ¾ cup (130 g) semi-sweet chocolate chips
  • ½ cup (125 g) crunchy peanut butter
  • 1 teaspoon vegetable oil
  • 2 cups (100 g) miniature marshmallows
  • ½ cup (65 g) chopped and toasted pecans

For the Chocolate Frosting:

  • 1½ cup (180 g) powdered sugar
  • ½ teaspoon salt
  • 4 tablespoons (60g) unsalted butter
  • 2 tablespoons unsweetened cocoa powder
  • ¼ cup (60 ml) milk
  • ¼ teaspoon vanilla extract


  1. Preheat oven to 350 degrees. Line an 8-inch square baking pan with parchment paper, and lightly spray with nonstick spray. Set aside.
  2. In a small bowl, combine flour, cocoa powder and salt. Set aside.
  3. In a large mixing bowl, beat together butter, sugar and vanilla extract, until light and fluffy.
  4. Add eggs, one at a time, beating well after each addition.
  5. Stir dry ingredients into batter.
  6. Pour batter into prepared pan and spread evenly. Sprinkle with chocolate chips and bake for about 20-25 minutes.
  7. In a microwave safe bowl, combine peanut butter and oil. Heat for 20 seconds to soften. Pour this mixture all over the warm brownies and spread.
  8. Spread miniature marshmallows over the peanut butter, return to the oven and bake until the marshmallows puff up, about 3 minutes.
  9. Remove from oven, top with the toasted chopped pecans and set aside to cool.
  10. Frosting: In a medium bowl, combine powdered sugar and salt.
  11. In a small pan, melt 4 tablespoons of unsalted butter. Stir in cocoa powder, milk and heat until the mixture begins to boil. Remove from heat and immediately whisk with powdered sugar/salt mixture. Beat in vanilla extract.
  12. Spread frosting evenly over puffed marshmallows and pecans.
  13. Let cool completely (for 1-2 hours) before cutting and serving.

Recipe found on the Yummy Addiction Blog


Late Summer CE Deadline Overview


It's time again to share the upcoming deadlines for late summer. As in our previous CE Deadline Overview, this is something we will be doing semi-monthly to keep everyone informed of their upcoming deadlines. 

Milestone Continuing Education OverviewOf course, as board rules are apt to change, be sure to always check the board rules in your state of licensure for more information on your deadline and continuing education requirements. Additionally, this review, as with all future posts on this subject, will only cover the requirements for states where Milestone CEUs are approved. Now that the disclaimers are out of the way, let's get started! 

Chiropractors - On August 1st chiropractors licensed in Nebraska will need to submit their 36 hours of continuing education (keeping in mind that only 6 hours may come from online sources). September 1st is a popular date for continuing ed. deadlines for D.C.s licensed in Montana and North Dakota. Montana chiropractors need to turn in their certificates of completion for their 13 hour requirement and North Dakota chiropractors must complete 20 hours of CEU courses by that date. Then on September 30th, South Carolina chiropractors are up for renewal and must have completed 36 hours, however only 18 of those may come from an online source.     

Occupational Therapists & Assistants - Delaware OT practitioners have to submit their renewal materials, including proof of completion of 20 hours of CE courses - careful, there's a 10 hour limit for online courses! - by July 31st. Wyoming occupational therapist and assistants have to complete their 16 hour requirement by July 31st as well. OT practitioners in Nebraska have a deadline the following day (August 1st) to complete their renewal requirements, including a 20 hour CE requirement for OTs and a 15 hour CE requirement for OTAs. 

Don't forget that when you purchase 20 hours from Milestone (that's two 10 hour CEU courses, or one 20 hour bundle pack), you receive a FREE 4 hour ethics course! This isn't a sale, this is a perpetual offer when you choose Milestone. Contact a CE Specialist toll-free at 1-800-709-8220 for details. 

Physical Therapists & Assistants - Time is up on September 1st for Arizona physical therapists to submit proof of the completed 20 hour requirement. Arizona PTAs do not have a CE requirement. Illinois physical therapists have until September 30th to submit their renewal documentation, including proof of completion of their 40 hour continuing ed. requirement. PTs in Illinois are only allowed to complete half of that amount (20 hours) via online resources. PTAs in Illinois are up for renewal next year. 

At Milestone CE, our mission is to provide the best online CE experience for our practitioners. Part of achieving this is maintaining our standing with national professional regulatory organizations like the Better Business Bureau, the PACE program within the Federation of Chiropractic Licensing Boards, the American Occupational Therapy Association (Approved Provider 7487), the Board of Certification, Inc. (Approved Provider #P8382), the National Strength and Conditioning Association (Approved Provider L1272), the National Certification Board for Therapeutic Massage and Bodywork (Approved Provider 491), as well as individual state boards for physical therapy  (click here to find out your state’s approval status). 

If you have any questions about our courses or company that are not answered here or in our FAQ Section, please do not hesitate to contact us! You can call toll-free at 1-800-709-8820 or e-mail us at We look forward to hearing from you! 


Universal Promo Code Expires Tonight!


Fourth of July Continuing Education CEU Sale

Before the lights go out on these special savings, go to the Course Catalog tailored to your profession, select the continuing education courses you need to complete your CE requirements, and enter Promo Code: INDEPENDENCE in the box provided at checkout to save 20% on your total purchase. No minimum amount required. Sales ends at Midnight.