Inspiring Excellence
Monday November 23, 2009
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“Excellence in PT means loving what you do, recognizing that the opportunity to help someone is a gift, [and] keeping your skills and knowledge up-to-date in order to provide optimum care,” says Lourdes M. Mengelkoch, PT, a physical therapist at Shands Rehab Center for Kids at the University of Florida in Gainesville.
Soon after starting in pediatrics, Mengelkoch met a 16-year-old boy with osteosarcoma, recovering from a hemipelvectomy, and learning to use a hip-knee-ankle-foot orthosis.
“In my PT ways and with all my enthusiasm, I proceeded to help him get out of bed and progress with his functional mobility,” Mengelkoch says. “This young man was dealing with pain and grief that was incomprehensible to me, a 28-year-old therapist.
One day, he began to yell at me and tell me I was useless to him, that I did not have anything to offer him and that I could not possibly understand. That was a pivotal point in my career. I was brought to tears and agreed with him. I was speechless, and I did recognize my limitations.”
Once she gathered her thoughts, Mengelkoch told him he was right, but she felt it an honor to be present in his life and to do what she could to move him through from one moment to the next. During the ensuing six months, the teen learned to walk again.
“The experience with this patient made me much more aware of the fact that I was working with a human being,” Mengelkoch says. “I realized how important it is to look at the whole person and not just my little area of PT. I can indeed play a large role in the quality of a person’s life.”
Patient-Inspired PT
When an 11-year-old patient with cancer who was walking on his toes because of contractures and neuropathic pain arrived at the outpatient rehabilitation department at Joe DiMaggio Children’s Hospital in Hollywood, Fla., Pilar Gonzalez, PT, drew on her skills to develop a special home exercise program for him. Gonzalez taught the child’s parents, aunts, and grandparents how to assist him, and pulled together a team that included a psychologist and adult sports therapists from the hospital to come up with a plan to boost his self-esteem. This unusual approach was critical to the patient’s motivation, as his sense of self-worth had been seriously battered from chemotherapy side effects and his inability to participate in family activities.
That summer, Gonzalez prepared the child to participate in a summer camp for children with cancer, and collaborated with camp physicians and counselors to ensure a safe and therapeutic week.
“He had an amazing seven days, and it was only gains and gains after that,” she says. “Rehab [for patients with] cancer is such an important thing, and early intervention makes such a difference and can improve the quality of life of our patients.”
Twenty years ago, a 3-month-old patient who sustained a spinal cord injury after being shot by her mother, presented a challenge for Patricia (Pam) Estler, PT, a physical therapist at Joe DiMaggio Children’s.
“[This patient] helped me understand with children the sky is the limit,” Estler says. “Anything she wanted to try to do, we figured it out and we did it.”
The girl used a standing platform and long-leg braces, and eventually learned to walk and climb stairs. Estler encouraged a healthy lifestyle, and persuaded the girl’s father to become the child’s life coach, helping the girl take part in the Paralympic Games and do well in school.
“That made me want to keep trying to do what we could do and stay on top of my game,” Estler says. “I like knowing I can walk into any situation and offer something that will improve the situation.”
Mentoring Future Excellence
Brittany Cox, PT, a physical therapist at Children’s Healthcare of Atlanta, credits mentorship by Kathi Frankel, PT, a fellow therapist at the facility, with shaping her career and inspiring her to practice with excellence.
“[Frankel] solidified the fact I wanted to be a pediatric physical therapist,” Cox says. “It’s opened up a whole new world for me. There are so many areas to work in when you are working with kids; I’m so much more fulfilled.”
Cox and Frankel met weekly at first, but now, with Cox more confident and established in her pediatric career track, they still talk but less frequently. Nonetheless, Cox still counts on Frankel’s sage advice.
“She plays a huge role in my life,” Cox says. “She helped me to focus on why I went into PT and to stay compassionate to the patients and families and the situations they are in.”
For some therapists, providing quality care is a continuum. “Excellence is taking the history of the past, what you know in the present, and your anticipation of the future, and you make clinical decisions based on evidence to help children and families with their treatments,” says Colleen Coulter-O’Berry, PT, DPT, MS, PCS, a physical therapist and limb deficiency program team leader at Children’s Healthcare of Atlanta.
Children’s Healthcare has made lower extremity prosthetics with the philosphy that if children are fitted right after amputation, they will learn how to use it. For her doctoral dissertation, Coulter-O’Berry set out to disprove a long-held belief that infants and toddlers could not control an articulating knee prosthesis.
“People were saying we were crazy, that it was a waste of our time,” Coulter-O’Berry says. “I did the study to validate what we were seeing.”
In her study, Coulter-O’Berry and her colleagues measured crawling in five babies and toddlers with congenital limb deficiencies who were fitted with prosthetic knees. “They had increased speed of crawling and less compensations,” she says. Overall, the articulating prosthetic knees allowed the children to crawl with less energy expenditure, a finding that surprised some experts.
“Never say never,” Coulter-O’Berry says. “There’s always a way to help a child.” •
Debra Wood, RN, is a contributing writer for Today in PT.
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