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This book is a philosophy of treatment, a way of conducting evaluations and delivering treatment. It is based on all my education, continued course work, books and magazine articles. I've read, had discussions with co-workers, and implemented patient care I have given throughout my life as a PT. The book's concept began to form after I was asked to conduct a seminar at a University on the clinical approach to the treatment of a geriatric population. When I began to put together a program for the seminar, I found that along with the information regarding ways to apply theory to clinical treatment, I was writing the story of my entire experience as a therapist. I wanted to include my mistakes as well as my successes so that new therapists could benefit from my experiences. Stories of patients and examples of treatment programs always taught me a great deal when I began my career. When I lecture I emphasize patient care. I try to support that point with an example from my experience. I used this same method when I sat down to write this book. This text offers information on practical treatment and offers advice on maintaining a positive work environment.
On the practice of manual therapy, a physical therapist should have a strong background and foundation of clinical orthopedics, physics, biomechanics, anatomy, neurophysiology, physiology, medical diagnostics for physical therapists, histology, and all other related subjects.
Within my treatment plan, I have tried to give a "cookbook" recipe as a guideline while anticipating that you will take the ingredients offering purpose of this book and add your own individuality to spice up the recipe to your taste. Each patient is an individual, and there is not a single treatment plan that will accommodate patient's suffering from the same diagnosis. A professional therapist will read and follow the conventional research (published in textbooks and journals such as the APTA Journal) and will adopt the most appropriate application to the treatment plan.
All the research materials, books, articles, etc., to which I refer are listed in the reference section of this text. Because of the nature of the therapy, many of my sources overlap and complement each other. For this reason, I have not cited each reference within the context of the book. I have also included information and training I've gained during my original course work and my continued course work. Every instructor I've ever had as well as every co-worker who has shared knowledge with me is a part of this book.
I have many friends who have supported me during my professional carrier and have helped me solve work related problems. My family has offered me the greatest support during this process. My husband was always available to listen and guide me in a very direct line. During the years when my children were young, I sometimes felt guilty about leaving them and going out to work. In retrospect, I feel that working as a PT made me a better mother to them. I had limited time so I had to make it quality time. I shared my work with my family over dinner and solved many problems by following the advice of my family.
Each of my patients are filed in a little drawer in my heart. On days when I need encouragement, I open one of the drawers and let the memory of a patient pop out and warm my heart. I let the memory of the beautiful people and the fact that I helped someone with a successful treatment take over and put a smile back on my face.
I would like to thank all of my teachers, co-workers, friends and family for supporting me and guiding me throughout my life. I love you all.
During the interview, if you can speak only to the supervisor, ask if you may walk around a bit after the interview. Talk with the staff members to form an impression of the facility. Ask yourself if you would like to spend the next few years of your life, eight hours a day, with that group of people.
In the department, try to understand and gage the atmosphere. You can see how the therapist's approach the patients, how much time they devote to each treatment, if they use a variety of techniques or equipment. Is the care provided quality care or are the therapists lackadaisical? Always ask whether one therapist follows the patient from the evaluation process to the completion of treatment or whether a single patient has many different therapists. Although you need the experience, if you will not be comfortable and happy in the particular situation, interview at another work place.
The patient is entirely an individual who has lived his life in a certain way before he experienced an accident and consequently came to you for professional help. If the patient is escorted by his wife to the room for the PT/OT evaluation, and she is the one who takes the leading role in answering the questions, please listen. Do not interrupt the dynamics between the two. You will have enough opportunity to build up the relationship with your patient in the following therapeutic sessions. It is important to build trust between yourself and the patient's wife, mother, or close family member so they can support your treatment and help you to create a good program to stimulate the healing process of the patient.
The profession of the patient is a very important component in understanding the patient. I always try to establish a complete image of the patient during the evaluation. It helps me establish my target goals and treatment plan appropriately and use examples from the patient's profession and hobbies to clarify my points.
For example: A 75 year old civil engineer who built bridges suffered from Hemiplegia. He did not know how to shift his weight forward in a chair in order to stand up. A few physical approaches did not bring the help him understand. The one explanation I used which demonstrated shifting weight forward in order to stand up was the description of a plumbing line used as part of the building process.
Another way in which I have used personal information gained during the initial evaluation was to help this same patient with depression due to his disability. He had become very depressed and his supportive daughter was concerned. She did not know how to get him out of the deep hole he was sinking into. We had talked about his hobbies and I found that he loved to draw portraits. Since I always wished to have a hand-drafted picture of my face I asked the patient to use his past talent and to sketch my face. During the next few minutes that he drew, he put his pen down a few times reluctant to continue. He needed constant encouragement. However, the end result was great, and I hoped he would continue with his delightful hobby when he is discharged to his home.
"No pain, no gain" is an idea whose time has come and gone. Now, we believe that when we take away the pain, we gain more. Sometimes people do not complain about their pain during treatments, but if you watch carefully you will see the signs of pain. Sometimes people will tell the therapist that they cannot stand pain. Experience has taught me that the patients really have high expectations for themselves, and it is a pleasure to work with them. There are those who complain vocally about pain during treatments which may distort your judgment. Look at their facial expression and decide whether to encourage them to achieve more motion or to encourage them to stop and rest.
Documentation is an important part of the therapy process. It helps us gear our thoughts toward a functional goal starting with evaluation and continuing through the duration of the treatment. We have to lay out our treatment plan, clarify our goals, and document the patient's performance and achievement. It is a communication device that transfers the information to all the other disciplines which provide care for the patient. In order to make your treatment clear to others think, about the phrase "A picture is worth a thousand words." So please describe the patient pictorially.
If you did not document it, you did not do it. Insurance companies evaluate your professional treatment based on your own notes. Therefore, documentation/notes should be considered by you to be a legal document. Always document exactly what the patient performed, not what you had planned for him to do. Make sure the notes are written in a clear and concise manner addressing the important functional deficits and your action plan toward achieving the desired goals.
If you do not see progress in three treatments, change your techniques, change your repetitions. Your objective is to see progress throughout the treatment.
We learn from our mistakes and from patients who do not respond to the techniques we choose. It is not enough to evaluate and analyze the patient and his movements. You must understand the technique itself. Study the components of the technique and adapt it to the patient's ability. Progress within the component of the movement he can perform. Study the complete picture as a puzzle and move piece by piece to invite progress.
For example: unbalanced and deviated gait. A diagnosis must be made regarding the cause: joint, muscle, and/or limitation. Concentrate on the limited joint or weak muscle and relate it to the gait as a whole. Find out what the patient can do by studying his responses to being moved. (Children and adults learn first with slow movements because the body needs time to adjust. Make corrections as they learn.) Do not presume that what you do will always work, but attempt movements and change or discard the technique if it doesn't work. Understand that you may not be successful, and learn from the cases where you are not successful. There will be trials and errors, but learning comes from your successes as well as your failures.
As a new graduate or working professional please advise as to other areas you would like to learn more about. If you have any specific experience to share please write.
If you are interested in obtaining additional information about this book or other projects please write to us.
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