We'll do the big fancy logo thing.
And they're back.
The note ninjas are here.
I figured more masks, not enough weapons.
Like where are the, no, no weapons.
All right.
Well, if you had, oh, first question.
If you had weapons as note ninjas,
as healthcare providers,
what would they be?
Oh man.
I would say like a,
like a recording pen type
of thing that I could just like,
and then it like goes to my
computer and it's done.
I have that.
Well, I want that.
Like a goniometer.
Like a goniometer would be
like what a note ninja might carry.
You know what I mean?
Threaten people with ranging
their shoulder or something.
Yeah.
All right.
Introduce yourselves to the
people who don't know who you are.
All right.
Hi, everyone.
I'm Nicole.
And I'm Stephanie.
We're the Note Ninjas,
an OT and PT duo teaching
other therapists treatment
ideas and documentation.
That is not the first time
you guys have done that.
You guys are pros.
We've been practicing, yeah.
All right,
so let's go backwards before we
go forwards,
because we're talking about
an event that you've put together.
You want people to come.
They should,
because you solved the problem
you wish was solved for you.
You did that.
Let's go back.
What was your personal, each of you,
your breaking point with documentation?
Was there a specific, like,
I'm going to pull my hair out,
I can't do this anymore
moment that led to the
creation of you putting on
the, the ninja, you know,
garb and becoming the note ninjas.
What was it?
I used to always say,
I used to bring my computer
home at night and I would
just be sitting on my couch
and usually go to bed early.
I'd be up to like,
I remember being up to
eleven thirty at night and it's like,
all right, we need to go to bed.
Like this needs to be over.
And it was just so stressful.
And I just dreaded and I
wanted to see almost less
patients sometimes to do
like less paperwork at the
end of the day.
And I just really couldn't
take it anymore.
It was burning me out.
Yeah, and I would say, I mean,
my very first evaluation,
it took me four hours.
And then I had very poor
internet connection at home.
And I like brought all my notes home.
And like,
I would literally spend like six
hours doing documentation
at night because I had no
idea what I was doing
because nobody taught me.
Yeah.
It's like, well,
your CI will teach you and
then figure it out.
And meanwhile, the CI was taught by a CI.
So it's a photocopy of a
photocopy of a photocopy.
And then we wind up just
doing what we think we should be doing,
but not what we should be doing.
Right.
We're told all the time.
I remember I was told in PT school anyway,
which was document every
single thing this way, you know,
you're safe.
And I'm like,
am I though like am I really
safe just because I did a
lot so you you you two
teach therapists how to
document more defensively
and creatively what does
that actually look like in
practice walk us through a
common example of how a
boring note becomes more of
a badass note so we just like to
say that you don't have to write a lot.
You just have to write
exactly what you did.
We just have to focus on the
skill of the clinician,
not necessarily the steps
of any activity.
So that's what we focus a
lot in our trainings,
showing an activity and
then exactly how to
document and living out the
stuff that's really not important.
It might be important why
the patient was doing it to reach a goal,
but not necessarily the
steps of all the activities
that you're doing.
Yeah, it's like,
Yeah.
And to incorporate like the
skilled phrases,
I think is like the big thing.
So, you know,
we keep the list of skilled
phrases like facilitated,
engaged instead of
tolerated and like things like that.
Can we retire tolerated?
It's about time.
Have you ever like imagine
someone was like, oh,
I went to have drinks with
my friend Jimmy.
Oh, yeah.
What's he like?
Well, I tolerated it.
Well, that sound positive at all.
No, it sounds awful.
You should not be reimbursed for that.
Yeah.
So you've mentioned cutting the fluff.
What are the top two or
three things besides
tolerated that therapists
should stop doing in their
notes outside of what you just mentioned,
which is like writing down
just a list of steps?
Good question.
Let's see.
Stop being vague with your notes.
So we always say cut the fluff,
but that doesn't mean being vague.
You need to be specific.
So we need to be incorporating,
incorporating the right
things into your notes.
So the skill that you use,
the strategy that you use,
what cues you're providing, you know,
you don't want to be vague in that, like,
oh, just facilitated a balance activity.
You know, why did you do that?
And what did you bring to
that treatment that a lay
person could not have done?
And even just how they're progressing or,
you have to modify so they
can do that that day if
they could do something the
other day and today they
can't that's fine people
are going to go up and down
but they present what did
you do and then how did the
patient present it's all
much more important than
those little steps in
between all right so
typically things like
compliance and
defensibility and
documentation and
creativity are like two
ends of the spectrum right
we're taught in school pt
school ot school slp school
the creativity is not on the syllabus,
right?
But we work with humans,
so we want to be creative.
So how do you guys teach
people to balance creative
patient-specific treatment
planning with the need for
those things that have to be there,
like compliance and
defensibility and documentation?
Well,
I think it's just like important that
like a lot of people think that we need,
like you, especially with social media,
you see all these crazy
equipment that you use.
And like, it's so like, oh wow,
I want that, you know?
But when it comes down to it, like,
you have to like think about
you and your patients.
Like, what do you have the means to,
you know,
you have to work within your
means of the equipment.
So we like to bring like these simple,
basic treatments and then
just kind of elevate them.
And that's going to show progress.
It's going to challenge them.
Plus it's going to be more fun.
And then we want to keep it
patient centered for the patient.
So instead of, you know,
just doing a ball toss,
maybe you're doing a ball
toss with a cognitive task
and having them, you know, name a certain,
some categories or walk and
do the ball toss.
Like it's just like that
little thing that sets us
apart because we're giving
like that little creativity
aspect with that simple
activity that anyone can
use in any setting.
Plus a lot of our job too is
to get them to want to come back.
A lot of times, you know,
people stop coming to
therapy and the buy-in and engagement and
So a lot of times they don't
want to just do like two
sets of fifteen like leg raises,
you know.
But if you add in some kind
of activity that they enjoy.
Like I was even thinking
that this morning.
I was at the gym and I go to
a lady that's very creative.
And I'm like, I know I don't need this,
but this keeps me coming back.
And this is what keeps our
patients coming back too.
Maybe they are.
A patient might like that, but.
a lot of them like to change
it up a little bit and have
a little bit of fun while
still getting all the benefits out.
Yeah.
This Justin,
no one wants to do two sets of
fifteen leg raises that we
can retire that along with tolerated.
Yeah.
But I feel like you guys
from the first time I sort
of came across your content,
was you weren't doing
anything necessarily revolutionary,
and that's not a knock,
it's a compliment.
What you were doing was
showing people like, hey,
what if we twist this?
What if we made this a little bit harder?
So I think people could copy
exactly what you're doing,
but really it felt like you
guys were putting things
out there to just spark...
Whoever the viewer or the watcher was...
take this and run with it.
Like we are not the end all be all.
We are the catalyst to let
you know you are allowed to be creative.
In fact,
you're supposed to be creative here.
Exactly.
Yeah.
We kind of like to set the
foundation and then, yeah.
And we get a lot of people that ask like,
oh, I have a lower level patient.
Like, how can I use this?
I'm like,
you just have to use your
clinical reasoning skills.
You know,
you need to use your own personal
judgment and trust yourself
as a clinician and to
modify the activity.
You know,
we're showing this activity
that's balanced and
sit down or have some support, you know,
add some,
add a gate bell and support them.
So it's really, yeah, like you said,
it's not revolutionary.
It's just, you have to kind of, you know,
use your own creativity.
It's the basics done repetitively, right?
Isn't that what we're taught?
Like understand the basics.
Sometimes people are on islands, right?
You have solopreneurs who
are out there sort of on their own.
And next thing you know, I've,
I've been there.
You're repeating the same
thing because you're like, man, I'm,
I'm not looking at anybody
else in clinic.
I'm not talking to people
enough because I'm busy.
Right.
I feel like how we consume
content on devices,
let's use that device for good,
which is expose people to
things and ideas that they
might not have been exposed
to in a different way.
And then they can bring that with them.
It's just, everything feels like yes and,
like the rules of improv.
Yes.
Yeah, no, totally.
I mean,
I wasn't even getting burnt out
because I was getting bored too.
I stole exercises from Nicole,
probably like one way it started.
She was always the creative one.
And I was always like, hmm.
She doesn't have this patient with me.
I'm totally taking that activity.
Yeah.
It made it more fun for me too.
And for our patients.
Yeah.
And she put her PT spin on it.
I guess I didn't really find
the beginning either,
especially being a PT.
I didn't think about the
creativity as much,
but it definitely did help
with me and with my
patients when I started.
Now,
you did mention people seeing devices
and saying, I want that.
And sometimes, I mean,
a lot of times we wind up
buying something, myself included,
off of Amazon.
And then I get it.
And three months later, I'm not using it.
Is there something that you
guys would recommend that
doesn't have to be expensive,
but that actually was helpful?
A lot of times it's usually cheap,
simple things that cover the basic.
Anything that comes to mind?
Oh yeah.
I would say there's,
there's three things that come to mind.
One is a resistance,
some type of resistance band.
You can use it as a visual cue.
Not even,
I know a lot of people like hate
on resistance bands for strengthening,
but once again,
as long as you're
facilitating it the right way,
we can get into that another time.
But yeah, they're,
they're great to use that.
We love them for visual cues
for just props.
And then a deck of playing cards,
simple as that.
There's tons of activities you could do.
And then a ball,
a simple handheld ball that you could,
work, you could do grip strength,
you can do balance, um,
working on ankle stability.
There's like tons of ideas.
Yeah.
It's being creative.
I was at a conference just
last week and I'm, this is not a paid ad.
I'm not trying to slide in an ad,
but I was,
I wound up playing with it
during the conference.
Cause their booth was next to ours.
Have you guys toyed around
with blaze pods at all?
That feels like a deck of cards.
Yes.
sort of a visual light sensor.
One of you guys, I mean,
you're both nodding on a podcast,
so I'm going to say that you want to.
Yeah.
We,
we always say we want to work with them.
Cause like they're so, they're so cool.
So yeah.
But like, that's the cool part.
Once you see videos like yours,
content like yours,
the idea was there like
that's those are those the
aha moments was like well
yeah of course of course
it's so simple it's like
well why don't you think of
it it's because sometimes
being creative is hard like
that's why it's a whole you
know that's why it's a
whole you can learn how to
be creative it's hard but
it's valuable the juice is
worth a squeeze on
creativity yeah and I think
the treatment was just like
the one side of it um and
like because we wanted to
do the we started with the
documentation idea but
we're like teaching
documentation is so boring
so boring so like why don't
we tie the documentation
with the treatment because
what's treatment without
documentation what's
documentation about
treatment like so we had to
put that together and I
mean I don't know anyone
who did that prior to us I
think there's some people
that do it now but um I
would say that we are
probably one of the first
people like groups of people that
really apply the
documentation to the treatment idea.
And I just like, it's so easy to do that,
but you know,
that's what people struggle with.
I'm going to push back.
It wasn't easy.
It was simple, right?
It was clear.
It was linear,
but it wasn't easy because if it was,
somebody else would have done it.
But of course now, you know,
imitation is the sincerest
form of flattery.
You know, people are on the bandwagon.
Like I'm sure you're
probably flattered and also like, great.
Like there's a lot of people
that need help, but
more graduating every single
year that are going to need this.
So you're not going to run
out of people that can
value this information.
Yeah.
We just need the people need it.
So more people that can get it out there.
Why not?
All right.
So you've got the note
ninjas summit coming up.
What's this look like?
What do attendees expect to
walk away with?
Why should a busy clinician
make time for this in person virtual?
Like this is your chance to
have at it and tee off.
All right.
Well,
it's definitely turning out way
better than we even imagined it could be.
So I learned about summits last year.
I came back to Nicole and said,
we absolutely have to do
this because we have, you know,
we have our treatments.
We worked with the older adult,
but there's definitely
other therapists too that
are more specialized in different areas.
We could ask all the time
for neuro or for this or whatever it is.
And that's, we're not specialized in that.
So we thought there was a
way to bring all those people together,
but we also told them they
had to tie in our documentation.
So we said they have to come
up with a presentation for PTs and OTs,
really leaving out the fluff,
giving them activity ideas
and ways to document it,
not why they have to, all that stuff,
like just straight down to
the facts that the
therapist can use the next day.
And we tried to find a good
variety of people so we
could cover a lot of
different topics for the
older adult as well.
Yeah, we have an insane lineup.
We got, I mean, we were really nervous,
like reaching out to people,
but we've built like this network.
I would say past year, year, well,
we've been doing this for six years,
but we really came out of
our shells like the past two years.
So we really have been like
building this network and
relationships with other
people that are online.
So we have an awesome lineup
of twenty plus PTs and OTs.
We have neuro home health professionals.
I can't even think of all
the new hand therapy, um, acute stroke,
cardiopulm.
It's like, it's insane.
It's a good variety.
Yeah.
And we decided to also,
we kind of been avoiding
like the CU things because
whoever does CUs knows it's
not easy to get them and
they like torture you.
So this is going to be our
first real like event that
we're pre-approved for PT and OT.
We got approved for IOTI and
I went through the torture
of getting it for most states for PT.
It was torture,
but so we have twenty CUs or
Contact hours.
Contact hours for OT.
And yeah,
so this time we really went all
in with that.
So they also get that.
And by the way,
it's called Innovative
Treatments Effortless
Documentation for PTs and
OTs working with older adults.
Make sure you,
that sounds like someone
who's an expert in
documenting something who
would rename that that way.
I would say.
All right.
Advice.
If you had one sticky notes
worth of advice,
because that's how we used
to keep track of things before apps,
one sticky notes worth of
advice to slap on every
therapist's laptop or clipboard,
whatever they're carrying around,
what would it say about
documentation or treatment planning?
What's the, like,
what's sort of the one
thing you'd want to hit people with?
Mine would say like, what did you do?
So like as you're the OT or
PT reading that, like what would you do?
Don't worry about, you know,
of course patient
presentation is important,
but you don't have to list
all the steps of the activity.
Just focus on the strategies
and that's going to be,
that's your skill right there.
That's what's going to be
reimbursed because that's
what insurance cares about
is what you did with the
patient and why your brain was used.
And then that's a good one.
And then the next one would be
is everything focusing on
one of the patient's goals?
Because I think another
thing we do too is what's
within normal limits.
What do we think it should be?
Adults do this.
Like, does the patient need this?
Is all the activities you're doing,
no matter how creative or how boring,
whatever it is,
are they all related to the
goals that the patient
wants to get back to?
And does it show it in your note?
All right.
You ready to play a quick game?
Oh, sure, I guess.
We're going to call it,
because you guys are famous
for wanting to cut out the fluff, right?
We're going to call it fluff or fire.
Okay.
I'm going to give you a statement,
and then you two have to
each shout it out.
You can't team up.
You have to do it individually.
Is it fluff, like cut it, or fire,
you keep it?
Are you ready?
Okay.
Here's the phrase.
Skilled services provided to
address patient deficits.
What?
What was it?
Patient participated in
obstacle course for dynamic
balance retraining.
Fire.
Patient tolerated treatment well.
Oh, fluff.
There's that word.
Terrible.
Used bubbles to encourage
midline crossing.
Fire.
Warm.
All right, good.
Continue plan of care as established.
Fluff.
All right, perfect.
So when we put it out there in that way,
it's funny and we're being
goofy with a game like this,
but you start to see those
things that were repeated
and copy pasted all the time,
maybe when you were
students or maybe when you
were out in practice for a while,
you can cut that fluff.
Where should someone go to
find out more about getting
together and learning with
the event you put together?
So you can go to www.thenoteninjas.com.
We will be having a pop-up for our summit.
And then make sure you get
on our email list.
That's the most important
thing because that's when
you'll get all the
announcements about the summit.
And of course,
our Instagram at The Note Ninjas.
We will be promoting our
summit all month long.
It is OT month.
So we make sure that you follow us.
And what can people get
outside of information
about the summit from your email list?
You guys are constantly
putting out good information.
Just give us the high level.
What can people expect in their inbox?
We always like to send,
we usually send two emails a week.
One is always like a
treatment ID or documentation.
It's very simple to the point.
And then we always like to
give a wrap up of our blogs and YouTubes.
We put a lot of information
on all of that every week.
Yeah, fantastic.
Well, thanks again for doing what you do.
It's needed.
If it wasn't,
people wouldn't be following along.
That's just how this works.
We're an attention economy.
And the fact that there are
enough people clamoring and
asking for it is saying it's needed.
So you've met that
intersection of fluff and fire.
Yeah, thank you.
All right, ladies, as always,
thanks so much.
We appreciate your time.
All right, thank you.